[Prevention of viral hepatitis B with specific gamma globulin. Results of 2 years' experience in a hemodialysis center]. / Profilassi dell'epatite virale B con gamma globuline specifiche. Risultati di due aunni di esperienza in un Centro di Emodialisi.

Prophylaxis with gamma globulins specific for virus hepatitis B was carried out at the Trieste Haemodialysis Centre from December 1979 to December 1981. Since no clear distinction could be drawn between HBsAg-positive dialysed subjects, all staff and patients at the Centre were regarded as constantly at risk for contagion, and hence in the post-exposure state. Those who refused prophylaxis were excluded, together with surface antigen carriers and subjects with antibodies. Specific gamma globulins (Uman-Big) were given at a dose of 0.06 cc/kg at intervals of 90-105 days, together with 0.02 cc/kg standard gamma globulins for conjectured protection against non-A and non-B hepatitis. No allergic reactions worthy of not were observed. Only one patient positivised of all those who underwent continuous prophylaxis. New carriers of HBsAg gradually decreased in number from 1976 to 1981, initially due to the adoption of disposable filters, subsequently owing to partial separation of Au-positives, and finally, in a significant manner, with the introduction of prophylaxis with specific gamma globulins.

Simple methods for nutritional assessment in hemodialyzed patients.

Uremic patients undergoing hemodialysis are often catabolic and malnourished. To treat malnutrition effectively, a preliminary nutritional assessment is needed. Available techniques should enable the clinician to readily detect the presence of malnutrition and to follow the response to nutritional therapy. In a group of chronic uremic patients undergoing maintenance hemodialysis, the authors evaluated the nutritional status with the following indices: 1) assessment of the somatic fat and protein compartments by means of anthropometric measurements (weight/height ratio, triceps and subscapular skinfold thickness, and arm muscle circumference); 2) assessment of the visceral protein compartment (serum total protein, albumin, transferrin, pseudocholinesterase, C3, and immunoglobulin content); 3) assessment of cell-mediated immunity by means of skin tests ("skin window," PPD and phytohemagglutinin) and blood lymphocyte content; and 4) assessment of the dietary intake of nutrients with dietary diaries. Anthropometric indices, serum protein content (except immunoglobulins), and the immune response was generally lower than in normal subjects, suggesting a mixed marasmus-like and kwashiorkor-like pattern of protein-calorie malnutrition. The protein intake was normal, whereas the energy intake tended to be low. Protein intake was significantly correlated with the predialysis serum urea nitrogen. Due to the difficulties in improving oral energy intake and the negative nitrogen balance reported during the days of dialysis therapy, patients were given intravenous supplements of essential or essential and nonessential amino acids for 2 months. The effects of this short-term supplementation were limited.