1,721,147 research outputs found
Qualities of fatigue in patients on chronic hemodialysis
No full textWe aimed to assess the relationship among fatigue qualities (FQ) and the association of FQ with various characteristics of chronic hemodialysis (HD) patients. In 68 HD patients, we assessed the Charlson Comorbidity Index (CCI), the Geriatric Depression Scale score (GDS), the Mini Mental Status Examination (MMSE), and measured the laboratory parameters. In addition, patients answered to six questions about FQ (Tiredness: Do you feel tired much of the time? Emotional: Do you feel that life is empty? Cognitive: Do you have trouble concentrating? Sleepiness: Have you had difficulty sleeping in the past month? Weakness: Have you had muscle weakness in the past month? Lack of energy: Do you feel full of energy?). At least one FQ was reported by 62 patients. Muscle weakness (61.7%) was the most frequent and cognitive fatigue (22%) the least. Physical FQ were all more common than the mental ones. Correlation between the two mental FQ (emotional and cognitive) was 0.381 (p = 0.002). Six patients reported none of the FQ, 20 one FQ, 13 two FQ, and 29 three or more FQ. CCI and GDS were associated with all FQ and MMSE with all FQ but sleepiness. Patients reporting ≥3 FQ were older, had more comorbidities, more symptoms of depression, and a lower MMSE score. At multivariate linear regression analysis, the GDS was the only significant predictor of the number of FQ. HD patients report a variety of qualities of fatigue and the number of FQ is independently associated with symptoms of depression
Positive end-expiratory pressure during laparoscopy: cardiac and respiratory effects
No full textTo determine the effect of positive end-expiratory pressure (PEEP) on the respiratory system and on cardiac function
[Steroid and cyclosporine therapy in idiopathic membranous nephropathy: monocentric experience and literature review]
No full textAbstract
INTRODUCTION:
Immunosuppressive treatment of patients with idiopathic membranous nephropathy (IMN) is debated due to its possible side effects. The 2012 KDIGO guidelines suggest alkylating agents as first choice therapy. The aim of the study is to retrospectively evaluate the induction and maintenance of clinical remission in patients with histological diagnosis of IMN undergoing steroid and/or cyclosporine therapy at the Nephrology Unit of the Sant'Andrea Hospital in Rome.
MATERIALS AND METHODS:
Therapy A (conservative) was reserved to low-risk patients. 8 medium and high risk patients were induced by Therapy B (Prednisone 1 mg / kg ≤12-16 weeks plus 8 weeks withdrawal); 6 patients by Therapy C (Prednisone 1 mg /kg ≥20-24 weeks plus 8 week withdrawal) and, finally, 6 steroid-resistent patients by Therapy D (steroid withdrawal + cyclosporine 3-5 mg / kg for 2 years).
RESULTS:
Complete remission was observed in 37.5% of patients in Therapy B, in 83.3% of patients in Therapy C and in 66.6% of patients in Therapy D. Patients in group B relapsed more frequently than patients in the other groups. Side effects were irrelevant.
CONCLUSIONS:
In view of the potential cytotoxicity of alkylating agents, steroids are a valid alternative in inducing and maintaining clinical remission over time, when administered with a more aggressive induction scheme. In cases of steroid resistance or rapid relapse, cyclosporine is a valid alternative to alkylating agents
Dopamine infusion and fluid administration improve renal function during laparoscopic surgery
No full textBackground: Previous studies have documented the negative influence of pneumoperitoneum on cardiac and renal function during laparoscopy. In this respect, regard there is a lack of data regarding the use of an appropriate management of fluid therapy to decrease these side effects. The aim of this study was to investigate the cardiac and renal responses to the administration of different amounts of crystalloid solution, alone or in association with dopamine during laparoscopy. Methods: Sixty ASA I patients undergoing laparoscopic surgery for endometriosis were randomly assigned to three groups. Group A was given saline solution at 5 ml/kg/h; group B received saline solution at 5 ml/kg/h and dopamine 3 mg/kg/min, and group C received saline solution at 10 ml/kg/h. Patients received A, B or C peri-operatively. Renal function was evaluated by assessing total intraoperative diuresis and estimated glomerular filtration rate. Vasopressin plasmatic levels before and after surgery were measured. Trans-thoracic echocardiography was performed to estimate left ventricular filling pressure by using Tissue Doppler Imaging and registering the E/Ea ratio every hour after pneumoperitoneum. Results: Total intraoperative diuresis was impaired in group A and significantly increased in group C (p<0.001). In group A estimated glomerular filtration rate significantly decreased after the end of surgery (p<0.003) and vasopressin significantly increased (p<0.001). The E/Ea ratio was significantly increased in group C (p<0.001). The infusion of saline solutions with the addition of dopamine slightly affected this parameter. Conclusion: A low rate of saline infusion could lead to an impaired renal function during laparoscopic surgery. This could be prevented by increasing the amount of saline solutions infused per hour or by adding a dopamine infusion
Ultrasound-guided percutaneous laser ablation (LA) in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients
No full textBackground: Laser ablation may be useful in debulking of benign thyroid nodules. Methods: To evaluate retrospectively the effectiveness and safety of LA, 45 patients with benign solid thyroid nodules, with a fluid component ≤20%, were included in our series between October 2009 and January 2011. All reported pressure and/or cosmetic complaints. Nd:YAG laser at 1064 nm was used, with a fix-power (3W), changing the application time. All patients were evaluated at baseline, 6 and 12 months. Complications were recorded. Results: mean nodule volume reduction decreased from 24.2 mL ±19.4 to 4.5 ± 5.2 at 12 months (p<0.001). Mean nodule volume reduction was 84% ± 13. Cosmetic signs were completely resolved in 87%, reduced in 9%, unchanged in 2%; pressure symptoms were resolved in 88%. One patient experienced transient dysphonia. Conclusions: US-guided LA is an effective tool for treatment of symptomatic benign thyroid nodules in patients not eligible for surgery. This article is protected by copyright. All rights reserved
Low plasma concentrations of albumin influence the affinity column-mediated immunoassay method for the measurement of tacrolimus in blood during the early period after liver transplantation
No full textMonitoring of tacrolimus (TAC) concentrations in transplanted patients is necessary to ensure effective immunosuppression and to avoid adverse side effects. The fully automated analysis of TAC by the affinity column-mediated immunoassay (ACMIA), which does not require a precipitation step, may represent an efficient alternative to liquid chromatography-tandem mass spectrometry (LC-MS/MS), including in the clinically urgent situation. The aim of this work was to compare the analytical performances of ACMIA with those of LC-MS/MS and to evaluate the influence of hematological parameters, time posttransplant, and type of transplant on the results obtained from routine blood samples
Post-dialysis fatigue and survival in patients on chronic hemodialysis
No full textPost-dialysis fatigue and survival in patients on chronic hemodyalis
Post-Dialysis Fatigue Is Not Associated with Serum Lactate Levels in Patients on Chronic Hemodialysis
Full text linkBackground/Objectives: To measure the peri-dialytic serum lactate, sodium, potassium, calcium, and pH and base excess in chronic hemodialysis patients with and without post-dialysis fatigue (PDF). Methods: Patients were asked “Do you feel fatigued after dialysis?” Each patient was invited to rate the intensity, duration, and frequency of PDF from one to five. The recovery time after the hemodialysis session (TIRD) was calculated, and inviting patients were to answer the following single open-ended question: “How long does it take you to recover from a dialysis session?” Pre- and post-dialysis arterial blood was sampled, and pH, bicarbonates, base excess, sodium, calcium, potassium, and lactate were measured. Results: One hundred fifty-eight patients were included in the study. One hundred seventeen patients declared to suffer from PDF and forty-one did not. Median [range] PDF frequency, intensity, duration, and TIRD were 5 (1–5), 4 (1–5), 3 (1–5), and 12 h (1–48), respectively. Seventy patients had a TIRD ≤ 12 h and forty-seven had a TIRD > 12 h. Median post-dialysis and post-dialysis/pre-dialysis difference serum lactate levels (mmol/L) did not differ between patients with and without PDF (p = 0.111 and p = 0.395, respectively). In addition, the distribution of patients according to post-dialysis serum lactate levels was similar in the presence or absence of PDF. The median post-dialysis and post-dialysis/pre-dialysis difference serum lactate concentrations did not differ significantly according to the score of the PDF intensity and PDF duration (p = 0.928 and 0.935, p = 0.610 and 0.548, respectively). Finally, we stratified patients into two groups according to the length of TIRD: ≤12 h and >12 h. The median post-dialysis serum lactate concentrations did not differ significantly between the two groups (p = 0.862) as well as the median post-dialysis/pre-dialysis difference (p = 0.583). Also, the distribution of patients according to post-dialysis serum lactate levels was similar in the two groups. Conclusions: PDF and TIRD are not associated with peri-dialytic changes in serum lactate in patients on chronic hemodialysis
Bilirubin and s-nitrosothiols interaction: evidence for a possible role of bilirubin as a scavenger of nitric oxide
No full text- …
