[Chronic Inflammatory Polyradiculopathy Post-Covid-19 and the Role of Therapeutic Apheresis: A Clinical Case].

There is a strong correlation between SARS-CoV-2 and the onset of autoimmune neurological disease with atypical clinical presentation, characterized by limited response to medical therapy, likely caused by the underlying mechanism of the virus itself. In situations like these, after the failure of pharmacological therapy, therapeutic apheresis, including immunoadsorption, can be pursued. Treatments with IMMUSORBA TR-350 columns have proven to be particularly effective in managing refractory forms of post-Covid-19 nephropathies, leading to complete recovery of disability and elimination of neurological signs and symptoms. We discuss the case of a patient with chronic inflammatory polyradiculopathy post-Covid-19, resistant to medical therapy, effectively treated with immunoadsorption.

[Health-related quality of life in patients with chronic kidney disease]. / Qualita' della vita nei nefropatici.

Assessment of quality of life in patients with different degrees of chronic kidney disease is an important issue because of its impact on clinical decisions and financial resource management in the health-care system. The aim of this study was to assess whether a generic instrument like the SF-36 questionnaire is able to discriminate three different populations of patients with different degrees of renal disease (pre-ESRD, ESRD, TxR). Five hundred sixty-three patients from 12 Italian nephrology units completed the SF-36 scales by themselves. The results from these samples were compared with those from the general population. Univariate analysis and multivariate regression were used. The generic SF-36 questionnaire proved to be a powerful instrument to discriminate populations with different degrees of chronic renal failure. The quality of life of patients on dialysis is significantly worse than that of the normal population and other patients with less severe renal function impairment.

[Hypertension and fluid volume increase in uremic patients treated with convective hemodialysis: electric bioimpedence analysis]. / Ipertensione arteriosa ed iperidratazione in uremici in emodialisi alternative: uso della bioimpedenza.

PURPOSE: Hypertension is considered an important cardiovascular (CV) risk for uremic patients on hemodialysis (HD). Its main pathogenetic factor is the extracellular fluid volume increase. METHODS: This study aimed to evaluate the water distribution by electric bioimpedence (BIA) in hypertensive uremic patients treated with convective hemodialysis (HD) (group A) and with diffusive HD (group B). The patients were on antihypertensive therapy: angiotensin-converting enzyme (ACE)-inhibitors, beta blockers, calcium antagonists and angiotensin II (ATII) antagonists. RESULTS: The BIA analysis demonstrated that the total and extracellular body water had the same distribution in the two groups with no statistical differences (Student's t-test); although the interdialytic weight gain was higher in group B than in group A. CONCLUSIONS: Blood pressure (BP) was treated by less drug use in patients on convective HD than in patients on diffusive HD.

[Herpetic viruses and renal transplantation]. / Virus erpetici e trapianto renale.

Over the last few years emerging evidence indicate the involvement of herpes viruses in the pathogenesis of several medical complications in transplanted patients. Herpes viruses are transmitted via inter-human contact and cause a primary infection, which commonly fails to give clinical signs and may persist even for years in a latent state in healthy subjects. In transplanted patients, herpes viruses may be transmitted through the transplanted organ or may be reactivated because of the use of powerful immunosuppressive drugs. Moreover, the persistence of immunosuppression greatly favours the clinical expression and severity of virus infection. Thus, herpes viruses seem to be involved in both acute and chronic deterioration of graft function, in the pathogenesis of post-transplant lymphoproliferative disorders and Kaposi sarcoma, and even in vessel atherosclerosis. This review will focus on relevant clinical aspects of herpes-virus infection, namely cytomegalovirus, EBV, herpes simplex 1 and 2, varicella zoster virus, HHV-6, HHV-7 and HHV-8, in kidney transplanted patients.

[Acquired cystic kidney disease (ACKD): experience of a dialysis center]. / Patologia cistica renale acquisita (ACKD): esperienza di un centro dialisi.

Acquired cystic kidney disease (ACKD) is characterized by the substitution of renal parenchyma with multiple cysts in patients either with end stage renal disease who are treated for uremia with dialysis (as on haemodialysis--HD--as on peritoneal dialysis--PD) due to non cystic kidney diseases. The aim of our study was to value the prevalence of ACKD in our haemodialysed patients (with exclusion of polycystic disease and obstructive nephropathy), its relationship between clinical and bioumoral parameters, and its complications in the follow-up. We have studied 56 uremic patients (32f and 24m) on bicarbonate HD three in a week. All our patients underwent renal echography using ECO B mode ALOKA SSD500 with electronic convex sector probe 3.5 MHz for to diagnose ACKD. We divided the population of the study in two groups: the group A includes 23 patients with ACKD; the group B includes 33 patients without ACKD. We analyzed in all patients body mass index (BMI), protein catabolic rate normalized (nPCR), dialitic adequacy index (KT/V), Hb, the serum levels of EPO by ELISA test (MEDAL GmbH, GE, Diagnostika, Hamburg; normal values 5 divided by 30 mUI/ml). We have found a prevalence of 42% for ACKD and statistical significance between the two groups for the duration of HD and BMI (Anova p < 0.01). The EPO serum concentration was higher in the group A (p < 0.05), while their rhuEPO requirement was lower. In two patients of group with ACKD we have found renal carcinoma. In conclusion, by our experience should be opportune to carry out a renal echography at the start of dialysis treatment and every six months for patients with ACKD and every year for those without ACKD. It is necessary to perform the echography of the kidney in all uremic patients before the start of haemo or peritoneal dialysis and report this examination in those patients with ACKD every six months and every year in those without ACKD.

Merkel cell carcinoma in a renal transplant patient.

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer which seems to be common in transplant recipients. We describe the case of a renal transplant patient who developed a MCC on the right glutaeus eight years after transplantation.

Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases.

The aim of this study was to evaluate the accuracy of dynamic CT in the preoperative staging of gastric cancer. One hundred seven patients affected by gastric cancer diagnosed by endoscopic biopsy were prospectively staged by dynamic CT prior to tumor resection. After an oral intake of 400-600 ml of tap water and an intravenous infusion of a hypotonic agent, 200 ml of non-ionic contrast agent were administered by power injector using a biphasic technique. The CT findings were prospectively analyzed and correlated with the pathological findings at surgery. The accuracy of dynamic CT for tumor detection was 80 and 99% in early and advanced gastric cancer, respectively, with overall detection rate of 96% (103 of 107). Three early (pT1) and one advanced (pT2) cancers were undetected. Tumor stage as determined by dynamic CT agreed with pathological findings in 83 of 107 patients with an overall accuracy of 78%. The accuracy of CT in detecting increasing degrees of depth of tumor invasion when compared with pathological TNM staging was 20% (3 of 15) and 87% (80 of 92) in early and advanced cancer, respectively. The sensitivity, specificity, and accuracy of CT in the preoperative staging (pT3-pT4 vs pT1-pT2) was 93, 90, and 91.6%, respectively. The sensitivity, specificity, and accuracy of CT in assessing metastasis to regional lymph nodes was 97.2, 65.7, and 87%, respectively. Computed tomography correctly staged liver metastases in 105 of 107 patients with an overall sensitivity of 87.5% and specificity of 99 %. The sensitivity of peritoneal involvement was 30% when ascites or peritoneal nodules were absent. Our findings show that dynamic CTcan play a role in the preoperative definition of gastric cancer stage. The results can be used to optimize the therapeutic strategy for each individual patient prior to surgery, thus avoiding unnecessary intervention and allowing careful planning of extended surgery in eligible patients.

Different expressivity of two adjacent mutations of the APC gene.

AIMS AND BACKGROUND: The phenotypic expression of different APC mutations in familial adenomatous polyposis (FAP) is variable: two to three variants of the disease have been defined based on the severity of colonic manifestations. Age of onset and number of polypectomies per person-year of post-surgical follow-up were compared in two FAP families with very close mutation sites in the APC gene, in order to ascertain mutation-specific variation of expressivity. FAMILIES AND APC MUTATIONS: Family A (5 patients) carried a newly characterized mutation, a four bp deletion at codon 843. Family B (5 patients) carried a previously identified mutation at codon 835. RESULTS: Mean age of onset was 49.7 years in family A and 30.5 years in family B; number of polypectomies per person-year of follow-up was 1.05 for family A and 10.1 for family B (P < 0.001). CONCLUSIONS: There is significant variation of expressivity (allelic heterogeneity) in FAP between two mutations separated by only eight codons, located at the 5' extremity of APC gene exon 15.

[Indices of disease activity in systemic lupus erythematosus. Review of the literature]. / Indici di attività di malattia nel Lupus Eritematoso Sistemico. Revisione critica della letteratura.

Systemic lupus erythematosus is a multisystem autoimmune disease characterized by the production of autoantibodies reacting with many different self antigens. The analysis of clinical expression and evolution of this disease is a milestone in the definition of therapeutic strategies. A parameter universally accepted as gold standard is lacking so far. About 60 indices for defining and measuring the activity of this disease have been proposed in the last 20 years. The most important of these are discussed in this review, focusing both on their role in the evaluation and outcome of patients and on the main studies assessing their validity and reliability.

Prostate cancer update 1995.

There are many current opinions of how to diagnose and treat carcinoma of the prostate. The authors' believe that it is imperative to remember that physicians are treating people with disease and not the disease itself. Especially in the geriatric population with concurrent medical diseases, physicians must be sure that the treatment benefits the individual patient.

Isolation perfusion in extracorporeal circulation with interleukin-2 and lymphokine-activated killer cells in the treatment of in-transit metastases from limb cutaneous melanoma.

BACKGROUND: Therapies of advanced melanoma patients with interleukin-2 (IL-2) and cytotoxic lymphocytes have produced interesting results, but a larger diffusion of these treatments is limited by the severe side effects due to IL-2 systemic infusion. A strictly regional administration of IL-2 and cells by an isolation perfusion (IP) in extracorporeal circulation (ECC) for the treatment of regional melanoma metastases could improve tolerability and efficacy of this specific modality of immunotherapy. METHODS: Ten patients were submitted to adoptive immunotherapy with IL-2 and lymphokine-activated killer (LAK) cells by IP in ECC. The schedule of treatment included the first course of a 5-day systemic administration of IL-2 (Proleukin, EuroCetus 9-12 x 10(6) IU/m2/day continuous infusion); autologous LAK cells were obtained via leukapheresis and after in vitro activation were given (range 8-28 x 10(9)) along with IL-2 (120-2,400 IU/ml of perfusion priming) to the affected limb by IP; IL-2 (9-12 x 10(6) IU/m2/day) was also administered by systemic continuous infusion for 5 days starting on the day after IP. RESULTS: All patients concluded the treatment without any major local or systemic toxicities. Clinical responses included one complete and six partial remissions; three patients had stable disease. All patients are alive. Follow-up after IP ranged from 12 to 35 months (median: 22). The analysis of circulating lymphocytes revealed the rapid disappearance of LAK cells, suggesting their extravasation and/or endothelial adhesion in perfused tissues. CONCLUSIONS: IP with IL-2 and LAK cells is a new approach for the treatment of in-transit metastases due to cutaneous melanoma. The treatment appears to be feasible and reliable. Further biological and immunological studies should permit amelioration of the present modality of treatment.

[Use of buprenorphine after right hepatectomy]. / Impiego della buprenorfina dopo intervento di epatectomia destra.

Ten patients who underwent surgery (5 right hepatectomy and 5 colectomy) for cancer participated in a clinical controlled study. They were treated with buprenorphine (i.v. slow infusion) to relieve postsurgical pain. We found an increased urinary excretion of this drug in patients who underwent hepatectomy as compared with patients who underwent colectomy. However no differences in the occurrence of side-effects and/or in the therapeutic effect were observed between the two groups. We conclude that buprenorphine can be effectively and safely used also in patients with a resection of liver parenchyma.

Effects of an acute protein load on urinary albumin excretion in kidney donors.

In six kidney donors with normal baseline urinary albumin excretion (UAE) we studied the behavior of the UAE after 150 g of a meat protein meal and after a carbohydrate meal of equal caloric (1,370 kcal), water (1 liter) and sodium content (51 mEq). The mean creatinine clearance (Ccr) increased significantly after a protein load at the first (p less than 0.01) and second hour (p less than 0.05), while it did not change after the carbohydrate meal. The mean UAE increased significantly after the protein meal at the first (p less than 0.05) and second hour (p less than 0.05), while after the carbohydrate meal the mean values were increased at the first (p less than 0.05), second (p less than 0.05) and third hour (p less than 0.05). Furthermore, the mean values of UAE after the protein meal were significantly higher (p less than 0.05) than those found at the same time after the carbohydrate meal. Diuresis and natriuresis increased significantly after both meals. These findings show that the increased UAE after the protein meal may be due to a further increase in Ccr in the hyperfiltering remaining kidney, while the smaller increase in the UAE observed after the carbohydrate meal may be due to water load and increased urine flow, which impairs albumin tubular reabsorption. The prognostic importance of microalbuminuria after either meal is therefore uncertain.

Acute effects of peritoneovenous shunt (Le Veen) on the hemodynamics and gas exchange in patients with hepatic intractable ascites.

The acute effects of the peritoneovenous shunt (LeVeen) on hemodynamics and pulmonary gas exchange in 6 consecutive patients with intractable ascites and cirrhosis were evaluated. After opening the peritoneovenous shunt, there was a marked increase in cardiac index, (from 3.78 +/- 0.4 to 5.86 +/- 0.4 1/min. m2, p less than 0.01), and mean pulmonary artery pressure (from 17.3 +/- 1.9 to 23.3 +/- 1.5 mmHg, p less than 0.05), while a significant decrease in systemic vascular resistances (from 1086 +/- 116 to 694 +/- 52 dynes.sec.cm-5, p less than 0.05) was observed. In all patients there was a drop in arterial oxygen tension (PaO2) (from 76 +/- 3 to 67 +/- 3 torr, p less than 0.01) and an increase in venous admixture (Qsp/Qt) from 13.1 +/- 2 to 18.9 +/- 2%, p less than 0.01). The comparable increase in cardiac output and in venous admixture produced by opening the peritoneovenous shunt, might be related to the massive transfusion of ascitic fluid into the intravascular compartment. It is therefore concluded that this impairment of tas exchange further support discarding an appropriate amount of ascitic fluid at the time of shunt insertion.

Dysgerminoma of the ovary: a report on 29 patients.

Twenty nine patients with pure dysgerminoma of the ovary were referred to the Institute of Radiology of the University of Florence between 1960 and 1983. Twenty six patients received radiation therapy after surgery; three cases, classified as Stage IA, were not submitted to postoperative radiation therapy. Five patients relapsed 2 to 16 months after initial surgery, and three of them died because of their tumours. Sites of relapse were found to be outside the treated volume in four out of these five patients. The overall survival rate for this series is 90%. The survival rate seems to depend not only on the stage of the disease, but also on initial accurate staging and appropriate therapy. Criteria for selecting patients from whom post-operative radiotherapy may be withheld are discussed.