176 research outputs found
Nutrition of the kidney transplant recipients
No full textThe outcome of kidney transplantation can be influenced by the nutritional status of the patient. Malnutrition, obesity and other metabolic complications can be prevented or corrected with correct nutritional interventions. There are currently few randomized clinical trials of nutrition interventions after kidney transplantation. However nutritional guidelines have been developed in order to optimize the nutritional status of patients with chronic kidney disease at all stages and for the nutritional management of kidney transplant recipients. The present chapter summarizes the key recommendations of the available evidence-based guidelines. The recommended nutritional intakes in adult and pediatric transplanted patients are reported in tables 1 and 3. The nutritional suggestions to prevent or to manage metabolic-related complications are summarized in table 2. Large multicenter trials are underway to assess the effect of nutritional interventions in kidney transplant recipients and to provide data for a structured dietetic and multidisciplinary approach to nutritional post-transplant care
Mycophenolic acid in combination with FK506: a pharmacokinetic study in piglets after small bowel transplantation
No full textAssessment of an lc-ms method for plasma quantification of the new immunosuppressant fk778 through comparison with hplc-uv
No full textFK778 is a new immunosuppressive agent, derived from the leflunomide-active metabolite A77 1726. It inhibits de novo pyrimidine nucleotide synthesis showing efficacy in the prevention and treatment of rejection in experimental transplant models. The aim of this work was to develop an HPLC-MS method to measure FK778 in plasma for pharmacokinetic studies.
The equipment used for mass evaluation was an HLPC coupled to an ion trap analyzer through an electrospray source. After precipitation of plasma proteins with acetonitrile, the supernatant was injected onto an analytical RP-C18 column. Chromatographic separation was performed under isocratic conditions, using a mobile phase consisting of ammonium acetate buffer and acetonitrile (55:45. vol/vol). MS detection was performed in the negative ionization mode by monitoring the molecular ion of FK778 (m/z 307) and IS (m/z 269), using selected ion monitoring for both. However, we observed peaks corresponding to dimers, trimers, and tetramers of FK778 (m/z 637, m/z 945, m/z 1274).
The HPLC-MS method was applied to pharmacokinetics in animal models showing comparable results to those obtained by an HPLC-UV assay at 290 nm. Good agreement was observed in the plasma FK778 concentration versus time curves. The rapid preparation of samples and the short run-time make this method attractive for use in clinical practic
DIAGNOSIS OF COELIC DISEASE AFTER INCIDENTAL FINDING OF PNEUMATOSIS CYSTOIDES INTESTINALIS
No full textPAIR vs conservative surgery for uncomplicated echinococcal cysts: evaluation of costs in Italy
No full textThere is no consensus about the best treatment (surgery, chemotherapy and percutaneous treatments) for hepatic cystic echinococcosis (CE). Retrospective studies have addressed the pros and cons of each option, but costs of treatments have never been studied extensively. Aim of this paper is to compare the cost of PAIR and conservative surgery for non-complicated echinococcal cysts of the liver in Italy.
Materials and Methods. Costs of hospital stay, operating theatre, disposable items, salaries for health personnel and sonograms, were obtained from the S.Matteo Hospital Administration and pharmacy. The institution is a large tertiary care teaching hospital in Lombardy, a region in Northern Italy. Costs of 1-year follow-up were included. The costs were calculated for a 3-day hospital stay for PAIR procedure and 4-day hospital stay for surgery, both without complications.
Results and Discussion. The 2006 mean specific cost of a PAIR treatment for a 3-day hospital stay and 1 year follow-up was 2,072 EUR (average exchange rate: 1 EUR = 1.26 USD). Main cost entries were the following:
a) hospital stay (net cost): € 1,500 (72.4% of the total cost);
b) disposable items (needles, catheters) € 239 (11.5%);
c) personnel: € 156 (7.5%);
d) drugs (30-days albendazole administration as prophylaxis of secondary echinococcosis): € 72 (3.5%);
e) ultrasound scans (paid by patient): € 105 (5.1%).
In the same year and same hospital, the specific cost of a surgical conservative intervention and 1-year follow-up was 3,267 EUR. Main cost entries were the following:
a) hospital stay (net cost): € 2,000 (61,2% of the total cost);
b) operating theatre (2 hours): € 140 (4,3%);
c) disposable items: e.g. :Fibrin Glue € 500 (15,3%);
d) personnel: € 300 (9,2%);
e) pre-operative tests (Labs, ECG, Chest X-ray, anesthesiological evaluation): € 150 (4,6%);
f) drugs (30-days albendazole administration as prophylaxis of secondary echinococcosis): € 72 (2,2%);
g) ultrasound scans (paid by patient): € 105 (3,2%).
Conclusion
PAIR is significantly less expensive than conservative surgery for uncomplicated echinococcal cysts of the liver.
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La chirurgia barbarica quale possibile scelta per la terapia e la prevenzione delle patologie del piano pelvico
No full textIn our country, 10% of the population is obese; probably 20% of these subjects are affected by severe obesity (BMI >40) or by obesity complicated by diseases able to reduce life expectancy and to worsen quality of daily living. So these patients will be considered chronically ill. The rapid increase of obesity in the incoming years foresees a percentage of obese people suffering from other chronic diseases much higher than nowadays. Bariatric surgery is an effective remedy to treat those obese who have had no benefit from previous medical and nutritional treatments. Such complex surgery involves doctors of different disciplines, and requires dedicated resources. In particular, for patients (women and men) with pelvic floor diseases, there can be a significant improvement after bariatric surgery in terms of bladder and rectal function, with reduction of problems connected with continence. It is known that urinary and fecal incontinence is more prevalent in obese subjects than in
non-obese population. Patients with severe obesity have an increased incidence of pelvic organ prolapsed, stress incontinence, pelvic floor disorders, difficulty with complete bladder emptying, excessive filling incontinence, and bladder irritation symptoms. On the other hand, pathological obesity can be considered an independent risk factor for urinary incontinence and bladder symptoms, but it is really a modifiable factor in case a proper weight loss can be obtained
Pharmacokinetics of FK506 and mycophenolic acid in experimental and clinical intestinal transplantation
No full textIntrahepatic fluorodeoxyuridine to treat unresectable hepatocellular carcinoma patients
No full textOf 16 HCC patients who received intrahepatic FdUrd at a dose of 0.3 mg/kg/day for 14 consecutive days by continuous infusion, every 28 days, no one achieved a complete response, while 3 patients achieved partial response (18.75%), lasting 6, 9 and 18 months, respectively. Seven patients (43.75%) exhibited stable disease and their mean time to progression was 4.28 months; in the extant 6 patients (37.5%) the disease progressed. Major biliary toxicity was observed. On the basis of these data, intra-arterial chemotherapy should not yet be considered the standard treatment of unresectable HCCs
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