[Switching to Neoral in patients with a stable kidney transplant. Retrospective study]. / Conversione a Neoral in pazienti con trapianto renale stable. Studio retrospettivo.

BACKGROUND: The aim of this retrospective study of patients with stable kidney transplantation was to evaluate "in the field" whether conversion from Sandimmune to Neoral led to a reduced variability of cyclosporinemia. METHODS: 153 patients were included in the study, from 16 centres in Piedmont, and were observed for a period of 13 months each. Data from the statutory controls specified in Piedmont for the follow-up of kidney transplantation patients were used in the evaluation. RESULTS: The mean coefficient of variation for cyclosporinemia (CV%) after conversion was slightly lower than pre-conversion CV% (22% vs 24%; p = 0.054). If the patients were divided into subgroups however, it was observed that only subjects who had presented a high CV% in Sandimmune (30%), equivalent to 23% of the population, showed greater stability in Neoral, whereas those who already presented satisfactory stability (CV% 20%), 45% of the population, underwent a deterioration of CV% in 42% of cases. The remaining 32% of patients revealed an intermediate level. CONCLUSIONS: In conclusion, this study showed that conversion to neoral is certainly indicated in those patients with a high variability of cyclosporinemia levels in sandimmun. It is not regarded as beneficial in patients with low levels of variability, also owing to the added cost. In patients with intermediate levels, ongoing studies on survival following transplantation using these two formulations will indicate the advantages or otherwise of conversion.

[Transluminal percutaneous angioplasty of stenosis of arteriovenous fistulas; 24-month follow-up]. / Angioplastica percutanea transluminare delle stenosi di fistole artero-venose. Follow-up di 24 mesi.

Stenosis is a common cause of the functional loss of vascular shunts used in chronic hemodialysis and percutaneous transluminal angioplasty represents the elective method to correct these anomalies. A total of 42 percutaneous transluminal angioplasties were performed, with a prospective study and follow-up lasting an average of 18 months, in 32 patients with insufficient blood flow of arteriovenous fistula. In over 90% of cases the procedure restored adequate hemodynamic conditions that remained unchanged during follow-up. The authors therefore conclude that percutaneous transluminal angioplasty is an efficacious, easily performed and low-cost method that does not present major complications.

[Hepatitis B vaccine in dialyzed patients: persistence of antibody titres after a 48-month follow-up]. / Vaccinazione antiepatite B nei dializzati: persistenza del titolo anticorporale dopo follow-up di 48 mesi.

The persistence of a protective level of HBV antibodies 48 months after vaccination has been evaluated in 52 dialysis patients (32 vaccinated with Pasteur vaccine--group A--and 20 with recombinant vaccine--group B). A protective titer was present after 48 months in 32 group A patients (100%) and in 18 group patients (90%). After the standard vaccination program (5 micrograms at 0, 1, 2, 6, 18 months for group A and 40 micrograms at 0, 1, 2, 6, 12 months for group B) 20 group A and 6 group B patients maintained during the whole observation period of 48 months a protective titer. In 24 patients, 12 for each group, classified as non responders after the standard vaccination programme or which presented in the control during the observation time a titer lower than 50 mIU/ml, additional doses were necessary. Patients not treated with additional doses showed in both groups, after 4 and 7 months, significantly higher antibody titers in comparison with patients for which additional doses had been necessary. These patients were significantly younger in Group A. The monitoring of the antibody titers and the administration of additional doses has allowed to maintain after 48 months a protective HBV antibody level in 96.15% of the patients (50/52).

Protein C and protein S levels in uremic patients before and after dialysis.

The inhibitory capacity of the natural protein C (PC)/protein S (PS) system was evaluated measuring both the functional activity and the antigen level of both these inhibitors in 30 uremic patients before and after a dialytic treatment and in 30 healthy normal volunteers. PC functional activity was determined by two methods, one clotting and one chromogenic. PS antigen level was measured both as free protein and as total content. Unlike previous authors, we found that PC functional activity and the antigen level were normal in patients before dialysis, with a significant increase after. PS functional activity and free and total antigen levels were all normal before dialysis, and all except free antigen showed a significant post-treatment rise.

[Use of urokinase in the occlusion of the vascular access routes in chronic hemodialysis. 7 years' experience]. / Uso dell'urochinasi nell'occlusione di accessi vascolari per emodialisi cronica. Sette anni di esperienza.

Pharmacological treatment with urokinase in obstructions of vascular accesses due to chronic dialysis is a tried and tested technique. Retrospective investigation of a group of 111 cases treated with urokinase makes it possible to calculate the actuarial survival curve of vascular access in the period subsequent to fibrinolytic treatment. Mathematical analysis provides a precise indication to the use of the drug in thromboses of a-v fistulas and anatomically unimpaired vascular prothesies. In the presence of stenosis of a-v anastomosis, pharmacological thrombolysis permits restoration of a blood flow suitable to the conduction of haemodialytic treatment for a period useful to surgical correction. Infusion of urokinase is useless in cases of vascular prosthesis thrombosis complicated by the presence of stenosis of the lumen.

Acute renal failure in preeclampsia-eclampsia.

Acute renal failure (ARF) is regarded as relatively uncommon in preeclampsia-eclampsia (PE-E) and, in any event, of moderate degree or reversible. Cortical necrosis is reported as rare, even in fatal cases. Little light has as yet been shed on the mechanisms responsible for ARF in PE-E. This paper describes 17 cases observed over the last 15 years, in which cortical necrosis (3 histological and 2 clinical diagnoses) was relatively frequent (29.4%). The severity of renal impairment did not appear to be related to chronological age, parity, period of pregnancy in which PE-E commenced and its duration prior to delivery, presence of frank eclamptic crises or the concomitance of earlier vascular or renal disease (p greater than 0.05). The superimposition of abruptio placentae (AP) was the only clinical factor significantly correlated with cortical necrosis (p greater than 0.05). The association PE-E + AP seems to be a particularly unfavorable prognostic sign for the kidney owing to the contribution of additional damage mechanisms (vasospasm, disseminated intravascular coagulation, hemorrhagic shock) furnished by AP, while PE-E itself prepares the ground for AP. The fact that PE-E is difficult to diagnose when AP is the onset symptom may be responsible for the underestimation of its contribution towards the induction of severe renal damage.

[Possibilities and current technics of dialysis in leptospirosis with severe renal damage]. / Possibilità e tecniche attuali di dialisi nella leptospirosi con grave danno renale.

Three patients with severe liver and renal failure admitted to the Infectious Diseases Department of the Alessandria for suspected leptospirosis in the second half of 1979 are presented. In one case, the agent responsible was Leptospira icterohaemorrhagiae AB Wjnberg strain, in another Gram-negative sepsis, and in the third acute pancreatitis associated with serious Escherichia coli infection. An account is given of the peritoneal dialysis technique that led to successful resolution of the serious liver and renal failure.