Antibodies to hepatitis C virus (HCV) and transaminase concentration in chronic haemodialysis patients: a study with second-generation assays

We used first- and second-generation assays such as Ortho 1, Ortho 2 and 4-RIBA to define prevalence and risk factors for anti-HCV antibodies in haemodialysed patients. Forty-nine (24%) subjects were found to be anti-HCV positive. Anti-HCV positivity was related to duration of dialysis and past or current elevations of GOT and GPT; the frequency of transfused patients was greater in HCV-positive than in HCV-negative subjects; there were 31 patients (prevalence of 20%) with anti-HCV antibodies among non-transfused patients. These findings show that, tested by second-generation assays, HCV infection is detected more than twice as commonly in haemodialysis patients and may be responsible for a significant proportion of liver disease in this clinical setting. Acquisition of hepatitis C virus by dialysis patients is not only through blood transfusions but also secondary to hepatitis C virus presence within the unit itself.

Parathyroidectomy and blood pressure in hemodialysis patients

To assess whether parathyroidectomy (PTx) affects blood pressure (BP) in hemodialysis (HD) patients, we studied 11 uremics on HD treatment for 8.2 +/- 0.9 years who underwent successful PTx. As the control group, we selected 11 HD patients not submitted to PTx, matched with the study group for sex, age, years on HD, dialysis procedure and BP values. In the controls, BP and body weight did not change during the 2 years of observation. In the patients, BP remained stable in the year before PTx. PTx caused a progressive reduction in BP in 7 of the 11 patients. The fall was significant from the 3rd quarter onward (mean BP values before PTx: 139/82 mm Hg, 1 year after PTx: 122/75 mm Hg). The magnitude of the hypotensive effect of PTx was related to the pre-PTx systolic BP value (r = -0.70, p = 0.016). PTx also caused a significant progressive increase in body weight (1.56 +/- 0.57 kg 1 year after PTx). In conclusion, PTx causes BP fall in HD patients regardless of whether their preintervention values are normal or increased. The BP reduction occurs in concomitance with a consistent increase in body weight. BP variations are clinically relevant and may be related to the post-PTx calcium efflux from the vessel wall.

[Prevalence of insulin-dependent and non-insulin-dependent diabetes among Italian patients on replacement therapy. Preliminary survey at 3 dialysis centers]

We carried out a retrospective survey to assess prevalence and type of diabetes in three Italian Renal Units located respectively in the North (Tradate, Varese), in the Middle (Latina) and in the South (Reggio Calabria) of Italy. The prevalence of diabetes among patients accepted for RRT was 10.5% (60/659). 40 patients (66.7%) were non-insulin dependent and only 6 patients were insulin-dependent. A similar pattern was observed among the 289 patients referred to the Renal Unit of Reggio Calabria during 1972-1987 for evaluation of Chronic Renal Failure. Our data suggest that among the Italian diabetic patients treated by dialysis and transplantation insulin-dependent diabetes is uncommon. This finding could be explained by the low incidence of insulin-dependent diabetes in Italy.

Diabetes mellitus and renal replacement therapy in Italy: prevalence, main characteristics and complications

A number of reports on dialysis and transplantation for diabetic patients in the UK and USA are available. The aim of the present survey was to assess the prevalence, main characteristics and complications of diabetic patients treated by dialysis and transplantation in Italy. On 31 December 1987 in Italy, 1605 diabetic patients were being treated by dialysis or transplantation. The prevalence was 28 per million compared with the UK and the USA where the corresponding figures were 17 and 78 per million respectively. The annual incidence in 1987 was 9 per million (UK: 4 per million; USA: 33 per million). The mean age of the Italian diabetic patients was 59 years whereas that for British diabetic patients similarly evaluated was 48 years. Of the Italian diabetic patients 67% had NIDDM (UK: 22%; USA: 50%). Haemodialysis was used in 81% of the Italian patients, peritoneal dialysis in 14%, and only 5% were transplanted. This is in contrast to the UK where only 18% of the patients were treated by haemodialysis and 39% were transplanted. Amongst Italian patients who started RRT in 1987, 9% died within the year, and of the remainder 38% had severe bilateral visual impairment (UK 35%), 3% had had amputations (UK 6%), 7% had suffered from disabling strokes (UK 6%) and 7% had had a myocardial infarction (UK 17%). Before 31 December 1987 another 2.2% developed severe bilateral visual impairment, 0.6% underwent amputations, 1.0% had a disabling stroke and 0.6% suffered from a myocardial infarction. The proportion of diabetic patients treated by RRT in Italy is twice that of the UK but only half that of the USA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intestinal polyposis in children. Description and differential diagnosis of 2 cases]

The case of a 21-month-old girl with lymphoid nodular hyperplasia and the case of a 9-year-old girl with familial adenomatous polyposis are described. Both patients presented rectal bleeding. A defect of secretory IgA was found in the first patient. In both cases diagnosis was based on medical history, barium enema with aircontrast technique, colonscopy, and endoscopic biopsy. Differential diagnosis and diagnostic procedures in these two diseases are discussed.

Cholinergic nerves in the parietal pleura

Using the cholinesterase histochemical technique we investigated the innervation pattern of parietal pleura both in normal and chemically sympathectomized rats. AChE containing nerve fiber-like structures were observed within the parietal pleura. The apex, costal, and mediastinal surfaces of the pleura are poorly innervated, while the diaphragmatic pleura shows the richest innervation. In relation with thicker nerve fiber-like structures the existence of some elbow shaped AChE positive formation was observed. The chemical sympathectomy does not causes alterations in the distribution of AChE containing nerves in the pleura. The meaning of cholinergic innervation of parietal pleura is discussed.