[Prognosis evaluation in the critically ill with acute renal failure]. / Indici prognostici nel paziente critico con insufficienza renale acuta.

Acute renal failure (ARF) is highly incident among hospitalized patients, especially in intensive care units. ARF carries an independent and significant risk for increased mortality, morbidity, and health resources usage, both in the short- and the long-term perspective. Many controversies exist concerning the epidemiological and prognostic aspects of ARF. Key problems are the lack of a widely accepted ARF definition, the poor knowledge of the pathophysiological mechanisms of complications peculiar to ARF, and the unavailability of prognostic tools able to adequately express the medical complexity of the syndrome. These aspects are fundamental with regard to ARF prevention, a strategic goal in the approach to the syndrome; therefore, they will analyzed in depth in this review.

[Sustained low-efficiency dialysis in acute renal failure]. / Terapie sostitutive renali intermittenti prolungate (SLED/EED) nell'insufficienza renale acuta in terapia intensiva.

Renal replacement therapies (RRT) are a key component of the therapeutic approach to acute renal failure (ARF) in the intensive care unit (ICU), and they are usually performed as classic Intermittent (intermittent hemodialysis) or continuous RRT (such as for example continuous venovenous hemofiltration, CVVH). No clear evidence exists on what the first-choice RRT option should be for ICU patients with ARF. Alternative strategies have been developed, under the form of intermittent prolonged RRT, with the aim of providing easy to perform, highly efficient, and less expensive RRT in the ICU. In this review we put forward the hypothesis that hybrid RRT, such as sustained low-efficiency dialysis ( sLED), could offer a valuable alternative to the currently available strategies in the critically ill with ARF.

[Artificial nutrition in acute renal failure]. / Nutrizione artificiale nell'insufficienza renale acuta.

Artificial nutrition in course of acute renal failure (ARF) is reviewed, on the basis of recent concepts on epidemiology and prognosis of the syndrome in critically ill patients. The relationships between nutritional status and ARF are evaluated, analyzing the possible role of nutritional status alterations as comorbidities and complications; pathogenetic mechanisms and consequences of hypercatabolism are described, with special regard to the peculiar metabolic derangements which are the hallmark of ARF. The effects of artificial nutrition on mortality and morbility in ARF are illustrated, along with quantitative and qualitative aspects of nutritional support (energy and protein needs, trace elements, vitamins etc). A rational approach to nutritional management of ARF patients is proposed, stressing the potential role of enteral nutrition, as well as the need for a full integration between nutritional support and renal replacement therapies.

[Antihaemostatic strategies or renal replacement therapies in acute renal failure]. / Trattamento anticoagulante per le terapie sostitutive della funzione renale (RRT) nell'insufficienza renale acuta.

Critically ill patients with acute renal failure, and especially those with sepsis, may have increased coagulation changes as well as a high incidence of hemorrhagic complications. Thus, in this clinical condition, the use of renal replacement therapies (RRT) can be frequently complicated both by high rates of extracorporeal circuit coagulation, resulting in a reduced treatment efficacy, and by increased incidence of bleeding. Heparin is the most commonly used RRT anticoagulant, even if several alternative options have been proposed, aiming at obtaining regional anticoagulation (i.e., limited to the extracorporeal circuit). This review analyses modern strategies for RRT anticoagulation and evaluates safety and efficacy parameters of each method. In this regard, no definite recommendations can be made based on the available evidence further randomised controlled trials are needed in this field, with a clear endpoint definition.

Outbreaks of highly pathogenic avian influenza (H5N2) in Italy during October 1997 to January 1998.

Between the month of October 1997 and January 1998, eight outbreaks of highly pathogenic avian influenza were diagnosed in the Veneto and Friuli-Venezia Giulia regions in north-eastern Italy. For each of the eight outbreaks, influenza A virus of subtype H5N2 was isolated and the inoculation of susceptible chickens confirmed these viruses to be extremely virulent with intravenous pathogenicity indices in 6-week-old chickens of 2.98 to 3.00. Although it was not possible to trace the origin of infection, the epidemiological investigation revealed connections between several outbreaks and emphasized the well-known risk factors for avian influenza such as bird movement, rearing of mixed populations and contact with migratory waterfowl. Control measures listed in European Union directive 92/40/EEC were implemented promptly and spread of the infection to intensively-reared domestic poultry was avoided.

Familial outbreak of agricultural anthrax in an area of northern Italy.

Three cases of cutaneous anthrax are reported which occurred in a farming family in northern Italy. Epidemiological studies revealed contact with an infected cow (delivery of a stillborn fetus and slaughter). The cow was slaughtered soon after the delivery; cultures of carcass specimens yielded growth of Bacillus anthracis. The origin of the animal infection was not known. Serum samples were obtained from all 11 members of the family group and randomly from 10 of the 75 cows on the farm, which appeared to be in good health. Tests for antibodies against protective antigen and lethal factor using EIA and Western blot techniques were positive in three subjects (in paired sera) with cutaneous anthrax and in one subject who neither had had direct contact with the infected cow nor showed any sign of anthrax.

Spontaneous toxoplasmosis in canaries (Serinus canaria) and other small passerine cage birds.

An outbreak of spontaneous Toxoplasma gondii infection on an Italian bird-farm is described. Small passerine birds (Serinus canaria, Carduelis chloris, Carduelis carduelis, Carduelis spinus, Carduelis cannabina, Pyrrhula pyrrhula) showed clinical signs consisting of anorexia, prostration, weight loss, diarrhoea and dyspnoea accompanied by a high mortality rate. Clinical, pathological, biological and serological investigations were performed. Characteristic lesions and Toxoplasma gondii specimens were identified in several tissues by histopathological examinations. The detection of antibodies against Toxoplasma gondii was constant in dead and sacrificed animals with macroscopic lesions. A therapy based on the administration of sulphadimethoxine and diaveridine was successful in limiting the mortality rate. Four months later some surviving birds developed ocular atrophy. Toxoplasma gondii cysts were observed in the brain and cerebral and ocular lesions described. Sera obtained from these animals were positive (>1:64) for antibodies against Toxoplasma gondii. The authors conclude with some observations on the spread of toxoplasmosis among cage birds.