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Iuliano S, Greco F, Seminara G, Zagari MC, Sgrò P, DI Gennaro G, Greco EA, Aversa A. Positive effects of dietary supplementation with nutraceuticals on male subclinical hypogonadism: a pilot study. Minerva Endocrinol (Torino) 2023; 48:274-281. [PMID: 37158812 DOI: 10.23736/s2724-6507.23.04024-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Lifestyle modifications (i.e., physical activity [PA] and lower dietary intake) often are not sufficient to improve testosterone (TE) levels and promote weight loss in men with metabolic hypogonadism. The aim of the study was to investigate the effects of a nutraceutical formulation containing myoinositol, alpha lipoic acid, folic acid and SelectSIEVE® as add-on treatment to lifestyle modifications in improving obesity-related subclinical hypogonadism. METHODS Body composition, insulin resistance, testicular and erectile function were investigated in 15 males (age=39.5±14.5 years; Body Mass Index [BMI]=30.2±3.8 kg/m2, with subclinical hypogonadism (TE levels <14 and normal luteinizing hormone [LH]). After a run-in three months unsupervised PA period (T1), the nutraceutical supplement was administered two-times per day for three additional months (T2). RESULTS BMI, the percentage fat mass, insulinemia and Homeostasis Model Assessment Index (P<0.01) along with glycemia (P<0.05) were significantly reduced at T2 compared to T1, respectively; fat free mass (FFM) was significantly higher at T2 compared to T1 (P<0.01). Also, TE, LH and 5-item international index of erectile function score were significantly increased at T2 compared to T1 (P<0.01), respectively. CONCLUSIONS The combination of unsupervised PA and nutraceutical supplement improves body composition, insulin sensitivity and TE production in overweight-obese men with metabolic hypogonadism. Further controlled studies in the long-term are warranted to elucidate potential changes in fertility.
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Affiliation(s)
- Stefano Iuliano
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Francesca Greco
- Department of Movement, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
| | - Giuseppe Seminara
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Maria C Zagari
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Paolo Sgrò
- Department of Movement, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
| | - Gianfranco DI Gennaro
- Department of Health Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | - Antonio Aversa
- Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy -
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2
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Tartaglione L, Rotondi S, Aucella F, Bonomini M, Caruso MR, Casino F, Cuzziol C, Farcomeni A, Filippini A, Lomonte C, Marinelli R, Rolla D, Rubino F, Seminara G, Pasquali M, Mazzaferro S. Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study. J Nephrol 2023; 36:1947-1955. [PMID: 37351832 PMCID: PMC10543527 DOI: 10.1007/s40620-023-01658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/28/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Severe secondary hyperparathyroidism (SHPT) is associated with mortality in end stage kidney disease (ESKD). Parathyroidectomy (PTX) becomes necessary when medical therapy fails, thus highlighting the interest to compare biochemical and clinical outcomes of patients receiving either medical treatment or surgery. METHODS We aimed to compare overall survival and biochemical control of hemodialysis patients with severe hyperparathyroidism, treated by surgery or medical therapy followed-up for 36 months. Inclusion criteria were age older than 18 years, renal failure requiring dialysis treatment (hemodialysis or peritoneal dialysis) and ability to sign the consent form. A control group of 418 patients treated in the same centers, who did not undergo parathyroidectomy was selected after matching for age, sex, and dialysis vintage. RESULTS From 82 Dialysis units in Italy, we prospectively collected data of 257 prevalent patients who underwent parathyroidectomy (age 58.2 ± 12.8 years; M/F: 44%/56%, dialysis vintage: 15.5 ± 8.4 years) and of 418 control patients who did not undergo parathyroidectomy (age 60.3 ± 14.4 years; M/F 44%/56%; dialysis vintage 11.2 ± 7.6 y). The survival rate was higher in the group that underwent parathyroidectomy (Kaplan-Meier log rank test = 0.002). Univariable analysis (HR 0.556, CI: 0.387-0.800, p = 0.002) and multivariable analysis (HR 0.671, CI:0.465-0.970, p = 0.034), identified parathyroidectomy as a protective factor of overall survival. The prevalence of patients at KDOQI targets for PTH was lower in patients who underwent parathyroidectomy compared to controls (PTX vs non-PTX: PTH < 150 pg/ml: 59% vs 21%, p = 0.001; PTH at target: 18% vs 37% p = 0.001; PTH > 300 pg/ml 23% vs 42% p = 0.001). The control group received more intensive medical treatment with higher prevalence of vitamin D (65% vs 41%, p = 0.0001), calcimimetics (34% vs 14%, p = 0.0001) and phosphate binders (77% vs 66%, p = 0.002). CONCLUSIONS Our data suggest that parathyroidectomy is associated with survival rate at 36 months, independently of biochemical control. Lower exposure to high PTH levels could represent an advantage in the long term.
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Affiliation(s)
| | - Silverio Rotondi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Filippo Aucella
- Nephrology Unit, Casa Sollievo della Sofferenza, Monte Rotondo, Italy
| | - Mario Bonomini
- Department of Medicine and Aging Sciences, G. D'annunzio University, Chieti, Italy
| | | | | | | | - Alessio Farcomeni
- Department of Economics and Finance, Tor Vergata University Rome, Rome, Italy
| | | | - Carlo Lomonte
- Nephrology Department, Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Italy
| | | | - Davide Rolla
- Sant'Andrea Hospital La Spezia, La Spezia, Italy
| | | | | | | | - Sandro Mazzaferro
- Nephrology Unit, Azienda Policlinico Umberto I, Rome, Italy.
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Mauceri R, Seminara G, Rodolico V, Campisi G. Neoformazione esofitica mandibolare in una giovane paziente. Dental Cadmos 2022. [DOI: 10.19256/d.cadmos.10.2022.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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4
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Menduni M, D'Amato C, Leoni M, Izzo V, Staltari M, Greco C, Abbatepassero A, Seminara G, D'Ippolito I, Lauro D, Spallone V. Clinical scoring systems for the risk of cardiovascular autonomic neuropathy in type 1 and type 2 diabetes: a simple tool. J Peripher Nerv Syst 2022; 27:259-270. [PMID: 36029134 DOI: 10.1111/jns.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS This study was aimed at developing a clinical risk score for cardiovascular autonomic neuropathy (CAN) for type 1 and type 2 diabetes. METHODS In a retrospective cross-sectional one-centre study in an unselected population, 115 participants with type 1 diabetes (age 41.1±12.2 years), and 161 with type 2 diabetes (age 63.1±8.9 years), well-characterised for clinical variables, underwent standard cardiovascular reflex tests (CARTs). Strength of associations of confirmed CAN (based on 2 abnormal CARTs) with clinical variables was used to build a CAN risk score. RESULTS CAN risk score was based on resting heart rate, HbA1c, retinopathy, nephropathy, cardiovascular disease in both type 1 and type 2 diabetes, and on HDL cholesterol, systolic blood pressure, and smoking in type 1 diabetes or insulin treatment and physical activity in type 2 diabetes (range 0-10). In type 1 diabetes, CAN risk score showed an area under the ROC curve (AUC) of 0.890±0.034, and at cut-off of 4 sensitivity of 88%, specificity of 74.4%, and negative predictive value (NPV) of 95.7% for confirmed CAN. In type 2 diabetes, CAN risk score showed an AUC of 0.830±0.051 and at the cut-off of 4 sensitivity and specificity of 78.6% and 73.5%, respectively, and NPV of 97.3% for confirmed CAN. INTERPRETATION These newly developed CAN risk scores are accessible in clinical practice and, if confirmed in a validation study, they might identify asymptomatic individuals with diabetes at greater risk of CAN to be referred to CARTs, thus limiting the burden of a universal screening. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marika Menduni
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia D'Amato
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Martina Leoni
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Izzo
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Mariateresa Staltari
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Abbatepassero
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Seminara
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Ilenia D'Ippolito
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Department of Systems Medicine, Endocrinology Section, University of Rome Tor Vergata, Rome, Italy
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Andrulli S, Rossini M, Gigliotti G, La Manna G, Feriozzi S, Aucella F, Granata A, Moggia E, Santoro D, Manenti L, Infante B, Ferrantelli A, Cianci R, Giordano M, Giannese D, Seminara G, Di Luca M, Bonomini M, Spatola L, Bruno F, Baraldi O, Micarelli D, Piemontese M, Distefano G, Mattozzi F, De Giovanni P, Penna D, Garozzo M, Vernaglione L, Abaterusso C, Zanchelli F, Brugnano R, Gintoli E, Sottini L, Quaglia M, Cavoli GL, De Fabritiis M, Conte MM, Manes M, Battaglia Y, Fontana F, Gesualdo L. The risks associated with percutaneous native kidney biopsies: a prospective study. Nephrol Dial Transplant 2022; 38:655-663. [PMID: 35587882 PMCID: PMC9976765 DOI: 10.1093/ndt/gfac177] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The known risks and benefits of native kidney biopsies are mainly based on the findings of retrospective studies. The aim of this multicentre prospective study was to evaluate the safety of percutaneous renal biopsies and quantify biopsy-related complication rates in Italy. METHODS The study examined the results of native kidney biopsies performed in 54 Italian nephrology centres between 2012 and 2020. The primary outcome was the rate of major complications 1 day after the procedure, or for longer if it was necessary to evaluate the evolution of a complication. Centre and patient risk predictors were analysed using multivariate logistic regression. RESULTS Analysis of 5304 biopsies of patients with a median age of 53.2 years revealed 400 major complication events in 273 patients (5.1%): the most frequent was a ≥2 g/dL decrease in haemoglobin levels (2.2%), followed by macrohaematuria (1.2%), blood transfusion (1.1%), gross haematoma (0.9%), artero-venous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), a rapid increase in serum creatinine levels (0.1%) and death (0.02%). The risk factors for major complications were higher plasma creatinine levels [odds ratio (OR) 1.12 for each mg/dL increase, 95% confidence interval (95% CI) 1.08-1.17], liver disease (OR 2.27, 95% CI 1.21-4.25) and a higher number of needle passes (OR for each pass 1.22, 95% CI 1.07-1.39), whereas higher proteinuria levels (OR for each g/day increase 0.95, 95% CI 0.92-0.99) were protective. CONCLUSIONS This is the first multicentre prospective study showing that percutaneous native kidney biopsies are associated with a 5% risk of a major post-biopsy complication. Predictors of increased risk include higher plasma creatinine levels, liver disease and a higher number of needle passes.
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Affiliation(s)
| | - Michele Rossini
- Nephrology, Dialysis and Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Gigliotti
- Nephrology and Dialysis Unit, Maria Santissima Addolorata Hospital, Eboli, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, University of Bologna, Bologna, Italy
| | - Sandro Feriozzi
- Nephrology and Dialysis Unit, Belcolle Hospital, Viterbo, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Granata
- Nephrology and Dialysis Unit, ‘San Giovanni di Dio’ Hospital, Agrigento, Italy
- Nephrology and Dialysis Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Domenico Santoro
- Nephrology and Dialysis Unit, Università degli Studi di Messina Facoltà di Medicina e Chirurgia, Messina, Italy
| | - Lucio Manenti
- Dipartimento di Medicina e Chirurgia, UO di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Barbara Infante
- Nephrology, Dialysis and Transplantation Unit, Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Angelo Ferrantelli
- Nephrology and Dialysis Unit, Villa Sofia Cervello United Hospitals, Palermo, Italy
| | - Rosario Cianci
- Nephrology Unit, Umberto I Policlinico di Roma, Roma, Italy
| | - Mario Giordano
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Domenico Giannese
- Nephrology, Dialysis, Transplantation, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Marina Di Luca
- Unit of Nephrology and Dialysis, San Salvatore Hospital, Pesaro, Italy
| | - Mario Bonomini
- Department of Medicine, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Leonardo Spatola
- Renal and Hemodialysis Unit, Istituto Clinico Humanitas, Rozzano, Italy
| | - Francesca Bruno
- Nephrology and Dialysis Unit, Maria Santissima Addolorata Hospital, Eboli, Italy
| | - Olga Baraldi
- Nephrology Dialysis and Renal Transplantation Unit, University of Bologna, Bologna, Italy
| | - David Micarelli
- Nephrology and Dialysis Unit, Belcolle Hospital, Viterbo, Italy
| | - Matteo Piemontese
- Nephrology and Dialysis Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulio Distefano
- Nephrology and Dialysis Unit, ‘San Giovanni di Dio’ Hospital, Agrigento, Italy
| | - Francesca Mattozzi
- Paediatric Nephrology Unit, Regina Margherita Children's Hospital, Torino, Italy
| | - Paola De Giovanni
- Nephrology and Dialysis Unit, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Davide Penna
- Nephrology and Dialysis Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maurizio Garozzo
- Nephrology and Dialysis Unit, Santa Marta and Santa Venera Hospital District, Acireale, Italy
| | - Luigi Vernaglione
- Nephrology and Dialysis, ‘M. Giannuzzi’ Hospital of Manduria, Brindisi, Italy
| | - Cataldo Abaterusso
- Nephrology and Dialysis Unit, Civil Hospital of Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Fulvia Zanchelli
- Nephrology and Dialysis Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | - Enrica Gintoli
- Nephrology and Dialysis Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Sottini
- Nephrology and Dialysis Unit, Presidio Ospedaliero Santa Chiara, Trento, Italy
| | - Marco Quaglia
- AOU Maggiore Della Carità, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | | | - Marco De Fabritiis
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Maria Maddalena Conte
- Nephrology and Dialysis Unit, University Hospital Maggiore della Carità, Novara, Italy
| | - Massimo Manes
- Nephrology and Dialysis Unit, Umberto Parini Hospital, Aosta, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, Hospital-University St Anna, Ferrara, Italy
| | - Francesco Fontana
- Nephrology and Dialysis Unit, Azienda Ospedaliero Universitaria, Modena, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Mauceri R, Seminara G, Rodolico V, Campisi G. Tumefazione della mucosa alveolare mandibolare. Dental Cadmos 2022. [DOI: 10.19256/d.cadmos.04.2022.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Costanza G, Maccarrone R, La Rosa S, Seminara G, Di Natale E, Granata A. [Urinary tract infections in nephrology: antibiotic therapy in the era of antibiotic resistance]. G Ital Nefrol 2022; 39:2022-vol1. [PMID: 35191623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urinary tract infections (UTIs) are an emerging health problem. Kidney patients with UTI are at increased risk of antimicrobials resistance (AMR) and bad prognosis. In the nephrological setting, optimizing the management of UTIs is certainly a challenge, but it is indispensable for a favorable clinical outcome and in fighting AMR. When UTIs caused by multidrug-resistant germs are suspected, it is necessary to initiate empirical antibiotic therapy timely, pending microbiological study and bacterial sensitivity. The empirical choice of antibiotic must be based on: guidelines, resistance rates recorded in the region, and knowledge of pharmacokinetic and pharmacodynamic characteristics of the drug, in order to maximize efficacy, reduce adverse effects and minimize AMR development. Recently, the clinical use of old drugs such as colistin has increased, due to the limited circulation of resistant bacterial strains. On the other hand, ceftolozane/tazobactam, ceftazidime/avibactam, cefiderocol, imipenem/cilastatin/relebactam and meropenem-vaborbactam are very promising new antibiotics. Ongoing clinical studies will be able to determine the place for these interesting molecules in the treatment of infections and in fighting AMR.
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Affiliation(s)
- Giuseppa Costanza
- UOC Nefrologia e Dialisi, P.O. "Vittorio Emanuele" - Gela (CL), Italy
| | | | - Sandra La Rosa
- UOC Nefrologia e Dialisi, P.O. "Giovanni Paolo II" - Sciacca (AG), Italy
| | - Giuseppe Seminara
- UOC Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro" - Catania, Italy
| | | | - Antonio Granata
- UOC Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro" - Catania, Italy
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8
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Sessa C, Morale W, Zanoli L, Biancone L, Barreca A, Seminara G, Londrino F, Granata A. [Atheroembolic renal disease: risk factors, diagnostics, histology, and therapeutic approaches]. G Ital Nefrol 2021; 38:38-05-2021-07. [PMID: 34713643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The increase in patients' average age, the enhancement of anticoagulation therapy and the growth of vascular interventions represent the perfect conditions for the onset of atheroembolic renal disease. AERD is observed in patients with diffuse atherosclerosis, generally after a triggering event such as surgery on the aorta, invasive procedures (angiography, catheterization of the left ventricle, coronary angioplasty) and anticoagulant or fibrinolytic therapy. The clinical signs are heterogeneous, a consequence of the occlusion of downstream small arterial vessels by cholesterol emboli coming from atheromatous plaques of the aorta, or one of its main branches. The proximity of the kidneys to the abdominal aorta, and the high flow of blood they receive, make them a major target organ. For this reason, AERD represents a pathological condition that always needs to be taken into account in the nephropathic patient, although its systemic nature makes the diagnosis difficult. This manuscript presents a review of the existing literature on this pathology, to provide an updated summary of the state of the art: risk factors, diagnostics, histology and therapeutic approaches.
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Affiliation(s)
| | - Walter Morale
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Italy
| | - Luca Zanoli
- Nefrologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy
| | - Luigi Biancone
- Nefrologia Dialisi e Trapianto, AOU città della salute e della Scienza, Torino, Italy
| | - Antonella Barreca
- Anatomia Patologica, AOU città della salute e della Scienza, Torino, Italy
| | - Giuseppe Seminara
- U.O.C di Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro", Catania, Italy
| | - Francesco Londrino
- U.O.C. Nefrologia e Dialisi, ASL Roma 2, A.O. "Sant'Eugenio", Roma, Italy
| | - Antonio Granata
- U.O.C di Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro", Catania, Italy
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Costanza G, Pesce F, Forcella M, Leonardi G, Seminara G, Di Natale E, Granata A. [SGLT2 inhibitors, beyond glucose-lowering effect: impact on nephrology clinical practice]. G Ital Nefrol 2020; 37:37-4-2020-2. [PMID: 32809279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Epidemiological data show an increasing diffusion of diabetes mellitus worldwide. In the diabetic subject, the risk of onset of chronic kidney disease (CKD) and its progression to the terminal stage remain high, despite current prevention and treatment measures. Although SGLT2 inhibitors have been approved as blood glucose lowering drugs, they have shown unexpected and surprising cardioprotective and nephroprotective efficacy. The multiple underlying mechanisms of action are independent and go beyond glycemic lowering. Hence, it has been speculated to extend the use of these drugs also to subjects with advanced stages of CKD, who were initially excluded because of the expected limited glucose-lowering effect. Non-diabetic patients could also benefit from the favorable effects of SGLT2 inhibitors: subjects with renal diseases with different etiologies, heart failure, high risk or full-blown cardiovascular disease. In addition, these drugs have a good safety profile, but several post-marketing adverse event have been reported. The ongoing clinical trials will provide clearer information on efficacy, strength and safety of these molecules. The purpose of this review is to analyze the available evidence and future prospects of SGLT2 inhibitors, which could be widely used in nephrology clinical practice.
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Affiliation(s)
- Giuseppa Costanza
- UOC Nefrologia e Dialisi, P.O. "Vittorio Emanuele" - Gela, Caltanissetta, Italia
| | - Francesco Pesce
- UOC Nefrologia, Dialisi e Trapianto, Università "A. Moro" - Bari, Italia
| | - Mauro Forcella
- UOC Nefrologia, Dialisi e Trapianto, Università di Foggia - Foggia, Italia
| | - Giuseppe Leonardi
- UOC Cardiologia, AOU "Vittorio Emanuele-Policlinico" - Catania, Italia
| | - Giuseppe Seminara
- UOC Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro" - Catania, Italia
| | | | - Antonio Granata
- UOC Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro" - Catania, Italia
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Patanè D, Failla G, Coniglio G, Russo G, Morale W, Seminara G, Calcara G, Bisceglie P, Malfa P. Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: Drug-coated balloons versus angioplasty. J Vasc Access 2018; 20:209-216. [DOI: 10.1177/1129729818793102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of our study is to report the results of two types (type A, type B) paclitaxel drug-coated balloon compared with standard percutaneous transluminal angioplasty in the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic hemodialysis arteriovenous fistulas. Two groups of 26 and 44 patients treated with two different drug-coated balloon are compared with a control group of 86 treated with standard percutaneous transluminal angioplasty. A color Doppler ultrasound was performed to evaluate stenosis and for treatment planning. We assess primary patency, defined as the absence of dysfunction of the arteriovenous fistulas, patent lesion or residual stenosis < 30% and no need for further reintervention of target lesion. Primary patency and secondary patency are evaluated after 12 months with color Doppler ultrasound for the whole arteriovenous fistulas, defined as absolute (absolute primary patency, absolute secondary patency) and target lesion. Postprocedural technical and clinical success was 100%. After 12 months, absolute primary patency is 81.8% for type A, 84.1% type B, and 54.7% for standard percutaneous transluminal angioplasty; target lesion primary patency is 92% type A, 86.4% type B, and 62.8% standard percutaneous transluminal angioplasty; absolute secondary patency is 95.4% type A, 95.5% type B, and 80.7% standard percutaneous transluminal angioplasty; target lesion secondary patency is 100% type A, 97.7% type B, and 80.7% standard percutaneous transluminal angioplasty. All the patients treated with drug-coated balloon (type A + type B) have an absolute primary patency of 83.3%, a target lesion primary patency of 87.9%, an absolute secondary patency of 95.5%, and a target lesion secondary patency of 98.4%. Our study confirms that the use of drug-coated balloon, indiscriminately among different brands, improves primary patency with statistically significant difference in comparison with standard percutaneous transluminal angioplasty and decreases reintervention of target lesion in juxta-anastomotic stenoses of failing distal arteriovenous fistulas maintaining the radiocephalic fistula as long as possible.
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Affiliation(s)
- Domenico Patanè
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giovanni Failla
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giovanni Coniglio
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera Papardo, Messina, Italy
| | - Giorgio Russo
- IBFM CNR, Cefalù 90015(PA) and UOS Fisica Sanitaria, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Walter Morale
- Department of Nefrology e Dialisys, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giuseppe Seminara
- Department of Nefrology e Dialisys, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Giacomo Calcara
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Paola Bisceglie
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
| | - Pierantonio Malfa
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy
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Santoro D, Marcantoni C, Visconti L, Pellicano' V, Seminara G, Ferrantelli G, Cernaro V, Buemi M, Ferrantelli A. MP185CLINICAL-PATHOLOGICAL CORRELATIONS AND PROGNOSTIC FACTORS IN A SICILIAN COHORT OF IGAN PATIENTS: A MULTICENTER RETROSPECTIVE ANALYSIS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx165.mp185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morale W, Patanè D, Incardona C, Seminara G, Malfa P, L'Anfusa G, Calcara G, Bisceglie P, Puliatti D, Di Landro D. [Project work: formation of health-care personnel for self-care of tunnelled central venous catheters in hemodialysis patients of the territory]. G Ital Nefrol 2013; 30:gin/00088.12. [PMID: 24403202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Scientific data from current literature demonstrate an incidence of bacteraemia due to tunnelled central venous catheter (tCVC) use accounting for 1.6 / 1000 days per tCVC, with a range of 1.5 to 1.8. In Sicily no data on the incidence of tCVC- related bacteraemia are available. In our hospital, tCVC infection occurs 2.4 times in 1000 days during CVC use. A retrospective analysis carried out from 2006 to 2012 was performed on 650 patients with tunnelled catheters. Of the subjects who received tCVC in our hospital, 90% were destined to undergo haemodialysis in a private health care environment outside our hospital. MATERIALS AND METHODS In order to improve the aforementioned infection outcome, we planned and implemented a specific work project. The work project (WP) was subdivided into two steps: 1) The first step was further subdivided into two sub-phases. The first was principally concerned with the implementation of educational courses, conducted directly on the ward and aimed at the implementation of meticulous nursing regimes for the care of tCVC by our health care nurse. The courses were entitled Management of Vascular Access: from doing - to teaching to do!. These educational courses were organized by the Nephrology Department, which takes care of the management and handling of the major complications of tCVCs for the maintenance of haemodialysis. After this first step, the nurses who had participated became the promoters of the second part of the course, which concerned the development of know-how within an outpatient clinic, which deals exclusively with the nursing management of tCVCs. 2) The title of the second phase was Therapeutic Education: self-Care and understanding and managing your venous access at home. The aim of this step was the integration of correct in-hospital care with that available in outsourced private institutions, via the involvement of the patient in the management of their own central venous access. During our training project, a more detailed analysis of the stakeholder as well as a swot analysis on the feasibility of the project were used to determine ad interim and final targets of the study. A summary of operative planning is included to explain in greater detail the study design, timing and costs of the various phases. Risk management and corrective measures adopted during the project are also mentioned and monitoring of the phases is described in relation to the fulfilling of intermediate goals. The prompt correction of mistakes allows for safer realisation of outcomes. CONCLUSION From our experience with this work project, we can conclude that a more accurate management of tCVCs can significantly reduce the morbidity and mortality of patients. The project offers a positive cost-benefit balance through a decrease in costs of hospitalisation for tCVC-related infections and other life.threatening conditions related to the use of tCVCs an important goal for any spending review.
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Tambroni N, Seminara G. A one-dimensional eco-geomorphic model of marsh response to sea level rise: Wind effects, dynamics of the marsh border and equilibrium. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2012jf002363] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Patanè D, Morale W, Malfa P, Seminara G, L'Anfusa G, Spanti D, Incardona C, Mandalà ML, Di Landro D. [Multislice computed tomographic angiography in the assessment of central veins for endovascular treatment planning: comparison with phlebography]. G Ital Nefrol 2010; 27:69-77. [PMID: 20191462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The dysfunction of a vascular access for hemodialysis and its loss may depend on drainage difficulties of the superficial or deep venation due to hemodynamically significant stenosis or obstruction of a central vein, which generally involve the innominate-subclavian veins or superior vena cava. These alterations are often neglected due to their central and deep location; when there is hemodynamic compensation, they may remain asymptomatic. For these reasons every suspect clinical sign for central vein stenosis (gross arm syndrome or venous hypertension in an arteriovenous fistula) must not be ignored, as timely intervention is essential for functional recovery of the vessel and for the protection of the arteriovenous fistula. The modern imaging techniques ensure thorough diagnostic assessment, while the possibilities of endovascular treatment with interventional radiology allow, in a large proportion of cases, optimal minimally invasive treatment, but above all the recovery of venation in a hemodialyzed patient. We report our experience with multislice computed tomographic angiography (MS-CTA) and reconstruction software for treatment planning of central vein stenosis or obstruction. Forty-nine patients were studied with MS-CTA (GE 16). Images were acquired in the venous phase (120-180 seconds after contrast medium injection) followed by digital vascular reconstruction (AutoBone for bone removal, vessel analysis for caliber and length measurements, thin and curved MIP, MPR). Within a week control phlebography was performed. The venous tree was divided into seven segments and analyzed in a double-blind fashion with a distinction between patent segments, 50-70% stenosis, >70% stenosis, occlusion, and collateral vascular beds. There was excellent correspondence in all the examined segments for patency, >70% stenosis, and occlusion, with high sensitivity (98%), specificity (99.3%), and diagnostic accuracy (99.1%). The binomial test demonstrated a highly significant concordance (alpha=0.99) for all patients and in all vascular segments with the exception of 70% stenoses, in which MS-CTA gave a slight overestimate. In the central venous district, color Doppler ultrasonography may not be as effective as for the peripheral study of arteriovenous fistulae, and second-level imaging techniques such as MS-CTA are more useful. We suggest that endovascular treatment must be preceded by MS-CTA. This examination shows the lesions that may benefit from endovascular treatment and recognizes ''uncrossable'' lesions, ie, the ones that will not benefit from treatment. Moreover, it allows accurate planning of endovascular treatment by showing the lesion type (stenosis or obstruction), the position and extension of the involved vessels, the vessel caliber above and below the lesion, and the possible presence of a collateral vascular bed. MS-CTA with dedicated reconstruction software, if correctly performed and accurately reconstructed, is a precious tool for diagnosis and treatment planning.
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Affiliation(s)
- Domenico Patanè
- U.O.S. Angiografia e Radiologia Interventistica, U.O.C. Diagnostica per Immagini, Azienda Ospedaliera Cannizzaro, Catania.
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Patanè D, Morale W, Malfa P, Seminara G, Caudullo E, L'Anfusa G, Spanti D, Incardona C, Mandalà ML, Infantone L, Di Landro D. [Steno-obstructions of haemodialytic FAV: new aspects of endovascular treatments]. G Ital Nefrol 2009; 26:236-245. [PMID: 19382080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Angioplasty is the usual method for the treatment of stenosis of arteriovenous fistulas for hemodialysis, along with fibrinolysis and thrombus aspiration. We evaluated the efficacy and safety of interventional radiology procedures in the treatment of stenosis or occlusion of arteriovenous fistulas. One hundred thirteen patients suffering from malfunction of arteriovenous fistulas underwent interventional radiological procedures (140 treatments). In all patients color-Doppler was performed beforehand. Stenosis at the site of the fistula was found in all patients and was treated with percutaneous transluminal angioplasty (PTA); stenosis at the anastomosis site was found in 63 cases and was treated by angioplasty with a microcatheter. In 40 patients suffering from recent thrombotic occlusion, locoregional thrombolysis and PTA were necessary. Technical and clinical success was achieved in 107 patients (94.6%); in 1 of 6 unsuccessful treatments the procedure had to be interrupted due to the rupture of a vein. Follow-up exams demonstrated primary patency in 92.5%, 71.9% and 49.5% of patients at 6 months, 1 year and 2 years, respectively. In 19 patients (17.7%) hemodynamically significant restenosis was observed, which was treated with multiple PTAs (27 treatments, only 1 of which with a negative outcome), resulting in a 94.2% success rate; only 1 patient had to undergo a fourth PTA. The overall patency rate was 95%, 87.2%, 62.3% at 6 months, 1 year and 2 years, respectively. In our experience immediate success and excellent patency rates were observed, which persisted in the medium and long term. PTA, with thrombolysis and thromboaspiration, is the treatment of choice in cases of malfunctioning arteriovenous fistulas. PTA should always be attempted before making a new surgical access in order to preserve the vascular tree.
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Affiliation(s)
- D Patanè
- U.O.C. Diagnostica per Immagini, S.S. Angiografia e Radiologia Interventistica, A.O. Cannizzaro, Catania.
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16
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Morale W, Patane' D, Seminara G, Incardona C, Malfa P, L'anfusa G, Caudullo E, Spanti D, Mandala' ML, Di Landro D. [Use of venae comitantes in the creation of arteriovenous fistulas: retrospective evaluation of our experience]. G Ital Nefrol 2008; 25:729-734. [PMID: 19048576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In order to estimate the outcome of arteriovenous fistula (AVF) for hemodialysis, we reviewed our experience in the construction of AVFs using the venae comitantes in patients without an adequate superficial venous vascular territory. The study included 34 patients affected by end-stage renal disease in whom an AVF was created using the deep venous system. In 26 of them we performed an anastomosis between the brachial artery and its vena comitans. Immediate success, defined by the presence of a thrill at the end of the anastomosis, was obtained in 84%, while primary failure of the AVF (immediate postoperative failure) occurred in 3 patients (12%). Early failure, defined as failure within 6 weeks of AVF placement, occurred in 4% of patients. Of the 22 patients with a functioning AVF, 8 (36%) subsequently requested a second operation to bring the fistula to the surface. Some of these involved the placement of synthetic grafts for better accessibility. The primary patency of the AVFs was equal to 64%, while the patency after a second intervention was 91%. Among the 26 AVFs created with venae comitantes, total patency at 50 weeks was 62%. Our experience with the placement of prosthetic grafts draining into the venae comitantes has not provided encouraging results. We believe that for adequate exploitation of venae comitantes it is important to use native veins that have to meet specific anatomical and functional requirements. The creation of an AVF with a native vein, taking advantage of the deep venous system, is feasible under the right circumstances.
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Affiliation(s)
- W Morale
- U.O.C. Divisione di Nefrologia e Dialisi, Azienda Ospedale Cannizzaro, Via Messina 829, Catania, Italy.
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17
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Patanè D, Morale W, Malfa P, Seminara G, Caudullo E, L'Anfusa G, Spanti D, Mandalà ML, Di Landro D. [Central venous stenting in patients on hemodialysis: review of our case series and long-term follow-up]. G Ital Nefrol 2008; 25:475-483. [PMID: 18663694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Aims of the study was validate the venous stenting technique as the treatment of choice in patients affected by stenosis or occlusion of the central venous area. To evaluate the long-term patency of placed stents in our series and to detect factors predisposing to restenosis. Twenty-three hemodialyzed patients were treated by PTA or placement of a metallic self-expandable stent in the central venous area because of occlusion or severe stenosis caused by repeated central venous access puncture for Port-A-Cath or pacemaker placement. All patients were examined every 3 months after treatment by clinical examination and color-Doppler ultrasound. Stents were placed with success in all cases but one, where it was impossible to get past the occlusion. Restenosis was observed in 12 cases at 4 to 12 months (average 8 months). Intrastent restenoses were treated with success by PTA alone and stent placement in 4 cases. A new restenosis was observed in 4 retreated patients in whom the stent was short or angled. In the other patients restenosis was attributable to disregard of anticoagulant therapy. In conclusions, the availability of new devices and dedicated stents is still necessary. There is a limited relationship between patency and wrong stent placement. Patients undergoing stenting should be controlled by clinical examination and color-Doppler ultrasound in hospitals where skilled interventional radiologists are available.
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Affiliation(s)
- D Patanè
- UOC Diagnostica per Immagini, SS Angiografia e Radiologia Interventistica, Azianda Ospedaliera Cannizzaro, Catania, Italy.
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Gareri P, Fazio PD, Gallelli L, Fazio SD, Davoli A, Seminara G, Cotroneo A, Sarro GD. Venlafaxine–Propafenone Interaction Resulting in Hallucinations and Psychomotor Agitation. Ann Pharmacother 2008; 42:434-8. [PMID: 18303146 DOI: 10.1345/aph.1k405] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To report a case of visual hallucinations and psychomotor agitation probably induced by an interaction between venlafaxine and propafenone. Case Summary: An 85-year-old woman was admitted for evaluation of a mood disorder on March 20, 2006. Her general practitioner had prescribed sertraline for treatment, which had started about 6 months earlier. The patient's medical history included hypertension, supraventricular tachycardia, chronic bronchitis, and arthritis, for which she received ramipril, ticlopidine, torsemide, theophylline, acetaminophen, and triazolam. The patient had also received propafenone 150 mg every 12 hours for 3 years. Results of biochemical tests were normal; however, a computed tomography (CT) scan of the brain showed signs of cortical atrophy. Sertraline was discontinued after a few days because of its reduced effectiveness and was replaced with extended-re lease venlafaxine 75 mg/day. No other changes to the patient's drug therapy were made. Four weeks later, because of the persistence of psychiatric disturbance, the venlafaxine dosage was increased to 150 mg/day. Ten days later the patient returned to our observation due to the onset of visual hallucinations lasting about 2 hours, especially at night, and psychomotor agitation. Venlafaxine was discontinued, with a complete remission of hallucinations and psychomotor agitation in about 4 days. The Naranjo probability scale indicated a probable relationship between venlafaxine and the patient's symptoms. Citalopram was started one month later for the persistence of mood disorders, with no adverse effects. Discussion: A CT scan documented signs of cortical atrophy in our patient's brain but excluded vascular brain injury, while clinical evaluation and anamnesis excluded a relationship between hallucinations and cortical atrophy. Genetic and pharmacologic factors may be involved in venlafaxine-induced adverse effects. Venlafaxine is metabolized primarily by CYP2D6 and is a substrate of P-glycoprotein. Propafenone, a known substrate and inhibitor of both CYP2D6 and P-glycoprotein, could therefore be involved in venlafaxine-induced hallucinations through the increase of venlafaxine plasma concentrations. Conclusions: To prevent the onset of clinical disturbances during venlafaxine treatment, we suggest careful evaluation of concomitant treatment with CYP2D6 or P-glycoprotein inhibitors (eg, propafenone) and, when possible, venlafaxine serum concentration monitoring.
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Affiliation(s)
- Pietro Gareri
- Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University Magna Graecia of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Operative Unit Elderly Health Care, Catanzaro, Italy
| | - Pasquale De Fazio
- Clinical Psychiatric Unit, Chair of Psychiatry, Department of Experimental and Clinical Medicine, School of Medicine, University Magna Graecia of Catanzaro, Mater Domini University Hospital
| | - Luca Gallelli
- Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University Magna Graecia of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital
| | | | | | - Giuseppe Seminara
- Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University Magna Graecia of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital
| | | | - Giovambattista De Sarro
- Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University Magna Graecia of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital
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Zoccali C, Benedetto F, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P, Malatino LS, Bonanno G, Seminara G. Low triiodothyronine and cardiomyopathy in patients with end-stage renal disease. J Hypertens 2007; 24:2039-46. [PMID: 16957565 DOI: 10.1097/01.hjh.0000244954.62362.8f] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES AND METHODS Low free plasma triiodothyronine (fT3) is associated with inflammation and cardiovascular damage in patients with end-stage renal disease (ESRD). We investigated the relationship between fT3, left ventricular systolic function and left ventricular mass in a group of 234 dialysis patients, and modelled the association between fT3 and cardiomyopathy in statistical analyses including both direct (interleukin-6 and C-reactive protein) and inverse (serum albumin) acute phase inflammation markers. RESULTS Plasma fT3 concentration in dialysis patients was significantly (P < 0.001) reduced in comparison with healthy participants and clinically euthyroid patients with normal renal function. Left ventricular systolic function was depressed (P <or= 0.003) and left ventricular mass increased (P < 0.001) in patients in the first fT3 quartile as compared with patients in other quartiles. In multiple regression analyses these associations remained significant also after adjustment for Framingham risk factors and antihypertensive therapy (P </= 0.01), and for risk factors peculiar to ESRD (P = 0.03). Adjustments for interleukin-6 or for albumin, however, abrogated these relationships. CONCLUSIONS Low triiodothyronine is associated with left ventricular dysfunction and left ventricular hypertrophy in ESRD patients. These associations appear largely mediated by inflammation. Low fT3 may be an intermediate mechanism implicated in the adverse cardiac effects of inflammation in patients with ESRD.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- C-Reactive Protein/metabolism
- Case-Control Studies
- Female
- Humans
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Interleukin-6/blood
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Renal Dialysis
- Risk Factors
- Serum Albumin/metabolism
- Triiodothyronine/blood
- Ultrasonography
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
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Affiliation(s)
- Carmine Zoccali
- CNR-IBIM, Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension & Division of Nephrology, Reggio Calabria, Italy.
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Affiliation(s)
- N. Tambroni
- Department of Environmental Engineering; University of Genova; Genoa Italy
| | - G. Seminara
- Department of Environmental Engineering; University of Genova; Genoa Italy
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Zoccali C, Benedetto FA, Tripepi G, Mallamaci F, Rapisarda F, Seminara G, Bonanno G, Malatino LS. Left ventricular systolic function monitoring in asymptomatic dialysis patients: a prospective cohort study. J Am Soc Nephrol 2006; 17:1460-5. [PMID: 16597683 DOI: 10.1681/asn.2005111240] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although it is well established that compromised systolic function predicts cardiovascular (CV) complications in symptomatic and asymptomatic patients with ESRD, it still is unknown whether repeated echocardiographic measurements of systolic function in asymptomatic patients with ESRD is useful for monitoring the evolution of cardiomyopathy in these patients. The prognostic value for CV events of changes in systolic function, as measured by midwall fractional shortening (mwFS) in a cohort of 191 dialysis patients, was tested. Echocardiography was performed twice, 17 +/- 2 mo apart. Changes in mwFS (ch-mwFS) that occurred between the second and the first echocardiographic studies then were used to predict CV events during the ensuing 27 +/- 13 mo. After the second echocardiographic study, 85 patients had incident CV events. In a Kaplan-Meier analysis, there was a graded increase in the risk for fatal and nonfatal CV events across ch-mwFS quartiles (P = 0.005). On multivariate Cox regression analysis, ch-mwFS maintained an independent association with CV outcomes. In this analysis, the risk for CV events was 51% lower in patients who manifested an increase in mwFS (hazard ratio 0.49; 95% confidence interval 0.27 to 0.88; P = 0.02) than in those who had a decrease in mwFS. Changes in mwFS have an independent prognostic value for CV events, and periodic echocardiographic studies of systolic function are useful for monitoring asymptomatic dialysis patients.
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Affiliation(s)
- Carmine Zoccali
- National Research Council-Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy.
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Tambroni N, Bolla Pittaluga M, Seminara G. Laboratory observations of the morphodynamic evolution of tidal channels and tidal inlets. ACTA ACUST UNITED AC 2005. [DOI: 10.1029/2004jf000243] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- N. Tambroni
- Department of Environmental Engineering; University of Genova; Genova Italy
| | - M. Bolla Pittaluga
- Department of Environmental Engineering; University of Genova; Genova Italy
| | - G. Seminara
- Department of Environmental Engineering; University of Genova; Genova Italy
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Mallamaci F, Bonanno G, Seminara G, Rapisarda F, Fatuzzo P, Candela V, Scudo P, Spoto B, Testa A, Tripepi G, Tech S, Zoccali C. Hyperhomocysteinemia and arteriovenous fistula thrombosis in hemodialysis patients. Am J Kidney Dis 2005; 45:702-7. [PMID: 15806473 DOI: 10.1053/j.ajkd.2005.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To date, the relationship between vascular access (VA) failure and plasma total homocysteine level has been investigated only in mixed dialysis populations (ie, patients with a native arteriovenous [AV] fistula or arterial graft), whereas almost no data exist for hemodialysis patients with a native AV fistula. METHODS In this prospective cohort study, we examined the relationship between plasma total homocysteine level and the methylenetetrahydrofolate reductase (MTHFR) gene and VA-related incident morbidity in a cohort of 205 hemodialysis patients, all with a native AV fistula. RESULTS During follow-up, 78 patients experienced 1 or more VA thrombotic episodes. Patients with incident VA thrombosis had a significantly greater plasma total homocysteine level compared with patients without this event (P = 0.046). In Kaplan-Meier survival analysis, the hazard ratio for VA thrombosis increased in parallel with homocysteine level, such that patients in the third homocysteine level tertile had a relative risk for this outcome 1.72 times (95% CI, 1.21 to 2.24) greater than in those in the first tertile (log-rank test, 6.81; P = 0.009). In a multiple Cox regression model, plasma total homocysteine level was confirmed to be an independent predictor of AV fistula outcome. Plasma total homocysteine level was significantly greater (P < 0.001) in patients with the TT genotype of the MTHFR gene than in those with the CT or CC genotype. CONCLUSION VA thrombosis in dialysis patients is associated with hyperhomocysteinemia. Intervention studies are needed to clarify whether decreasing plasma homocysteine concentrations may prevent VA failure in hemodialysis patients.
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Affiliation(s)
- Francesca Mallamaci
- Division of Nephrology, Consiglio Nazionale della Ricerche-Istituto di Bio-Medicina, Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
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Gareri P, Cotroneo A, Lacava R, Seminara G, Marigliano N, Loiacono A, De Sarro G. Comparison of the efficacy of new and conventional antipsychotic drugs in the treatment of behavioral and psychological symptoms of dementia (BPSD). Arch Gerontol Geriatr 2004:207-15. [PMID: 15207416 DOI: 10.1016/j.archger.2004.04.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This double-blind study evaluated the efficacy and safety of risperidone or olanzapine vs. promazine in the treatment of behavioral and psychological symptoms in dementia(BPSD). Patients were required to be 65 years or older, to have DSM-IV diagnoses of Alzheimer's disease (AD), vascular dementia (VD) or a combination of both. A brain computerized tomography (CT) was performed for all the patients; 60 demented patients,27 men (45 %) and 33 women (55 %) were selected for this study. The University of California Los Angeles neuropsychiatric inventory (NPI) was administered at baseline, then after 4 and 8 weeks. Patients had at least a score of 24 or more. The Hoehn and Yahr scale was used for evaluating parkinsonism. The scales were administered by an examinator who was not aware of the kind of treatment of the patients. After a wash-out period of 10 days,20 patients, 9 men and 11 women, mean age 76.6 +/- 6.0 years, were randomly assigned torisperidone 1 mg daily in divided doses (morning and bedtime) (Group A); 20 patients, 9 men and 11 women, mean age 82.5 +/- 9.3 years were randomly assigned to olanzapine 5mg at bedtime (Group B), and 20 patients, 9 men and 11 women, mean age 77.6 +/- 4.6 years, were randomly assigned to promazine 50 mg daily (morning and bedtime) (Group C). In case of lack of clinical response, after 4 weeks, the dose could be increased to 2 mg/day of risperidone, 10 mg/day of olanzapine, and to 100 mg/day of promazine in the respective groups. Repeated measures ANOVA was used for the statistical analysis of rating scales over time (baseline, 4 and 8 weeks). At the end of the 8th week, a global improvement was obtained in 80% of patients treated with risperidone and olanzapine, vs. 65 % of patients treated with promazine (p < 0.01). The results show that risperidone in doses of 1-2 mg/day and olanzapine in doses of 5-10 mg/day are effective and safe in the treatment of BPSD. Risperidone presents a major and dose-dependent antidopaminergic action and seems to be preferable when hallucinations and delusions are prevailing symptoms, even if it gives good results on aggression and wandering. Olanzapine seems to be faster in its sedative effect, probably for H1 receptor blockade. Moreover, 5-HT6 antagonism may favor acetylcholine release and this explains why these patients have not presented a cognitive worsening. However, both drugs are comparable or even superior to promazine, with significantly fewer side effects of both anticholinergic and extrapyramidal character.
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Affiliation(s)
- P Gareri
- Department of Experimental and Clinical Medicine, Mater Domini University Hospital of Catanzaro, I-88100 Cantanzaro, Italy
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Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Cataliotti A, Seminara G, Stancanelli B, Malatino LS. Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients. J Am Soc Nephrol 2004; 15:1029-37. [PMID: 15034106 DOI: 10.1097/01.asn.0000117977.14912.91] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with end-stage renal disease (ESRD) are at high risk for heart failure, but the prevalence and the prognostic value of asymptomatic systolic dysfunction in these patients are unknown. In this prospective cohort study, the authors have therefore assessed by echocardiography the prevalence and the prognostic value of systolic function as estimated by ejection fraction (EF), fractional shortening at endocardial level (endoFS), and at midwall (mwFS), in a cohort of 254 asymptomatic dialysis patients. Systolic dysfunction had a prevalence rate of 26% by endoFS and of 48% by mwFS. During the follow-up period, 125 patients had one or more fatal and nonfatal CV events. On multivariate COX regression analysis, the three LV systolic function indicators were independently associated with incident fatal and nonfatal CV events, and there were no differences in the predictive power of these indicators (P > 0.30). The prediction power of LV function indicators was largely independent of traditional and novel risk factors in ESRD such as C-reactive protein and asymmetric dimethyl arginine (ADMA). ADMA was significantly related with LV function indicators as well as with mortality and incident CV events, but these links were much reduced (P = NS) in models including LV function indicators. Of note, the risk of CV events was minimal in patients with normal LV mass and function, intermediate in patients with either LVH or systolic dysfunction, and maximal in patients displaying both alterations. The study of myocardial contractility by echocardiography provides prognostic information independently of LV mass and other risk factors in ESRD. Risk stratification by simple systolic function parameters may prove useful in secondary prevention strategies in these patients.
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Affiliation(s)
- Carmine Zoccali
- CNR-IBIM National Research Council, Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Ospedali Riuniti via Vallone Petrara, 89124 Reggio Calabria, Italy.
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26
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Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Parlongo S, Cutrupi S, Iellamo D, Bonanno G, Rapisarda F, Fatuzzo P, Seminara G, Cataliotti A, Malatino LS. Prospective Study of Neuropeptide Y as an Adverse Cardiovascular Risk Factor in End-Stage Renal Disease. J Am Soc Nephrol 2003; 14:2611-7. [PMID: 14514739 DOI: 10.1097/01.asn.0000089026.28617.33] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT. Chronic renal insufficiency is a situation characterized by high plasma concentration of neuropeptide Y (NPY). Because this neuropeptide interferes with cardiovascular (CV) function, it is possible that it is involved in the high CV-related morbidity and mortality of these patients. To test this hypothesis, a follow-up study was performed (average duration, 34 mo; range 0.2 to 52.0 mo) in a cohort of 277 patients with end-stage renal disease receiving chronic dialysis. Univariate analysis revealed that plasma NPY was directly related to plasma norepinephrine (r = 0.37, P < 0.001) and epinephrine (r = 0.17, P = 0.005), exceeding the upper limit of the normal range in the majority of patients with end-stage renal disease (170 of 277, 61%). One hundred thirteen patients had one or more fatal and nonfatal CV events; 112 patients died, 66 of them (59%) of CV causes. Plasma NPY failed to predict all-cause mortality but was an independent predictor of adverse CV outcomes (hazard ratio [10 pmol/L increase in plasma NPY], 1.32; 95% confidence interval, 1.09 to 1.60; P = 0.004) in a Cox proportional-hazard model that included a series of traditional and nontraditional CV risk factors. Plasma NPY maintained its predictive power for CV events in statistical model including plasma norepinephrine. Plasma NPY predicts incident CV complications in end-stage renal disease. Controlled trials are needed to establish whether interference with the sympathetic system, NPY, or both may reduce the high CV morbidity and mortality of dialysis patients. E-mail: carmine.zoccali@tin.it
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Affiliation(s)
- Carmine Zoccali
- CNR-IBIM, Institute of Biomedicine, Epidemiology, and Pathophysiology of Renal Diseases and Hypertension, and Division of Nephrology, Morelli Hospital, Reggio Calabria, Italy.
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27
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Zoccali C, Mallamaci F, Tripepi G, Parlongo S, Cutrupi S, Benedetto FA, Bonanno G, Seminara G, Fatuzzo P, Rapisarda F, Malatino LS. Chlamydia pneumoniae, overall and cardiovascular mortality in end-stage renal disease (ESRD). Kidney Int 2003; 64:579-84. [PMID: 12846753 DOI: 10.1046/j.1523-1755.2003.00095.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cross-sectional and retrospective studies suggest that Chlamydia pneumoniae infection may contribute importantly to the high cardiovascular risk of patients with end-stage renal disease (ESRD). METHODS We investigated the relationship between C. pneumoniae serology and survival and incident fatal cardiovascular events in a cohort of 227 ESRD patients (follow-up of 39 +/- 20 months). RESULTS On univariate Cox regression analysis patients with anti-C. pneumoniae immunogloblulin A (IgA) titer > or = 1:16 had a significantly higher risk of all-cause and cardiovascular mortality when compared to patients without IgA antibodies. However, after data adjustment for age and smoking, the hazard ratio (HR) decreased substantially and became largely nonsignificant. Adjustments for traditional and nontraditional risk factors further decreased the independent association of IgA anti-C. pneumoniae and these outcomes (all-cause mortality HR, 1.08; 95% CI, 0.68 to 1.72; P = 0.74; cardiovascular mortality HR, 1.07; 95% CI, 0.60 to 1.89; P = 0.83). A similar loss of prognostic power was observed for IgG anti-C. pneumoniae so that in fully adjusted models the HRs were very close to those observed for IgA anti-C. pneumoniae (all-cause mortality HR, 1.13; 95% CI, 0.68 to 1.86, P = 0.64; cardiovascular mortality HR, 1.10; 95% CI, 0.60 to 2.00; P = 0.77). CONCLUSION C. pneumoniae seropositivity is associated to shorter survival and incident fatal cardiovascular events in patients with ESRD but these associations are in large part attributable to the link between C. pneumoniae and well-established, traditional risk factors. It is highly unlikely that C. pneumoniae infection is a major risk factor in patients with ESRD.
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Affiliation(s)
- Carmine Zoccali
- National Research Council (CNR), Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
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Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Parlongo S, Malatino LS, Bonanno G, Rapisarda F, Fatuzzo P, Seminara G, Stancanelli B, Nicocia G, Buemi M. Fibrinogen, mortality and incident cardiovascular complications in end-stage renal failure. J Intern Med 2003; 254:132-9. [PMID: 12859694 DOI: 10.1046/j.1365-2796.2003.01180.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Fibrinogen is an established predictor of cardiovascular events in the general population but the relationship between fibrinogen, mortality and incident cardiovascular complications has been very little investigated in patients with end-stage renal disease (ESRD). DESIGN AND SUBJECTS We investigated the relationship between fibrinogen and all cause mortality and cardiovascular outcomes in a prospective cohort study in 192 patients on chronic haemodialysis treatment (follow-up: 34 +/- 16 months). RESULTS Fibrinogen was significantly higher in patients who died during the follow-up than in those who survived. Similarly, fibrinogen was higher in patients who had fatal or nonfatal cardiovascular events than in event free patients. On multivariate Cox regression analysis fibrinogen was an independent predictor of survival [hazard ratio (1 g x L(-1) increase in plasma fibrinogen): 1.19, 95% confidence interval (CI): 1.05-1.35, P = 0.006] and a highly significant (P = 0.0008), independent predictor of fatal and nonfatal cardiovascular events [hazard ratio (1 g x L(-1) increase in plasma fibrinogen): 1.25, 95% CI: 1.10-1.43] in a model including traditional risk factors and serum C-reactive protein (CRP) and plasma homocysteine. CONCLUSIONS Fibrinogen is as an independent risk factor for overall and cardiovascular mortality in patients with ESRD. Intervention studies are required to see whether reducing plasma fibrinogen may help to curb the exceedingly high cardiovascular risk of the uremic population.
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Affiliation(s)
- C Zoccali
- National Research Council, Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Cal, Italy.
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Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Cutrupi S, Parlongo S, Malatino LS, Bonanno G, Rapisarda F, Fatuzzo P, Seminara G, Nicocia G, Buemi M. Fibrinogen, inflammation and concentric left ventricular hypertrophy in chronic renal failure. Eur J Clin Invest 2003; 33:561-6. [PMID: 12814392 DOI: 10.1046/j.1365-2362.2003.01169.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We investigated the relationship between fibrinogen and echocardiographic measurements of left ventricular (LV) geometry and LV function in a group of 192 patients with end stage renal disease (ESRD). RESULTS Patients in the third fibrinogen tertile had higher mean wall thickness (MWT), relative wall thickness (RWT) and left ventricular mass index (LVMI) and lower LV end diastolic diameter and LV ejection fraction than those in the other tertiles. On multivariate analysis fibrinogen resulted to be an independent correlate of MWT (P = 0.001) and RWT (P = 0.0001) and the first factor in rank explaining the variance in LV ejection fraction (P = 0.0001). Left ventricular concentric hypertrophy was more prevalent (P = 0.001) in patients in the third fibrinogen tertile (n = 35, 54%) than in those in the second (n = 24, 37%) and first (n = 13, 21%) tertiles. In a multiple logistic regression model patients in the third tertile of fibrinogen had a risk for left ventricular concentric hypertrophy that was 3.56 (95% CI: 1.56-8.14) fold higher than in those in the first tertile (P = 0.003). CONCLUSIONS Elevated fibrinogen is independently associated with LV concentric hypertrophy and systolic dysfunction in ESRD patients. These relationships may contribute to the negative prognostic impact of elevated fibrinogen levels in ESRD.
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Affiliation(s)
- C Zoccali
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, c/o Ospedali Riuniti Bianchi-Melacrino-Morelli Via Vallone Petrara, 89124 Reggio Calabria, Italy.
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Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Parlongo S, Cutrupi S, Bonanno G, Rapisarda F, Fatuzzo P, Seminara G, Cataliotti A, Malatino LS. Neuropeptide Y, left ventricular mass and function in patients with end stage renal disease. J Hypertens 2003; 21:1355-62. [PMID: 12817184 DOI: 10.1097/00004872-200307000-00025] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neuropeptide Y (NPY) is released during sympathetic stimulation and mediates the central effects of the adipostatic hormone leptin. The plasma concentration of NPY and leptin is increased in patients with end stage renal disease (ESRD), but it is unknown whether these substances are related to biochemical markers of sympathetic activity and to alterations in left ventricular (LV) mass and function in these patients. DESIGN We investigated the relationship between NPY, norepinephrine (NE), leptin and echocardiographic measurements in a cross-sectional study in 198 patients with ESRD. RESULTS NPY was directly related to plasma NE and heart rate but it was largely independent of arterial pressure and of retention of metabolic waste products. NPY was significantly higher in patients with LV hypertrophy and in those with LV systolic dysfunction than in those without these alterations. Of note, NPY emerged as an independent correlate of LV mass index and of LV ejection fraction (LVEF) (both P <or= 0.002) in multiple linear regression analyses including a series of cardiovascular risk factors. Furthermore in a multiple logistic regression model patients in the top NPY tertile had a risk for LV concentric hypertrophy that was 18.10 (95% confidence interval: 5.87-55.83) times higher than in those in the first tertile (P < 0.001). Leptin was unrelated to NPY as well as to LV mass and to systolic function. CONCLUSIONS Elevated NPY is independently associated with LV concentric hypertrophy and systolic dysfunction in ESRD. It remains to be seen whether these links contribute to the high cardiovascular mortality in these patients.
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MESH Headings
- Adult
- Aged
- Biomarkers
- Cohort Studies
- Cross-Sectional Studies
- Echocardiography
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/metabolism
- Hypertrophy, Left Ventricular/pathology
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/metabolism
- Leptin/blood
- Male
- Middle Aged
- Myocardium/pathology
- Neuropeptide Y/blood
- Norepinephrine/blood
- Risk Factors
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/pathology
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Affiliation(s)
- Carmine Zoccali
- CNR, Institute of Biomedicine, Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Morelli Hospital, Reggio Calabria, Italy.
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Mallamaci F, Zoccali C, Parlongo S, Tripepi G, Benedetto FA, Cutrupi S, Bonanno G, Fatuzzo P, Rapisarda F, Seminara G, Stancanelli B, Bellanuova I, Cataliotti A, Malatino LS. Diagnostic value of troponin T for alterations in left ventricular mass and function in dialysis patients. Kidney Int 2002; 62:1884-90. [PMID: 12371993 DOI: 10.1046/j.1523-1755.2002.00641.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) is related to left ventricular (LV) mass in patients with end-stage renal disease (ESRD). Furthermore, cTnT reflects the severity of systolic dysfunction in patients with heart diseases. We tested the diagnostic value of cTnT for left ventricular hypertrophy (LVH) and LV systolic dysfunction in a large group of clinically stable hemodialysis patients without heart failure. RESULTS CTnT was significantly (P < 0.001) higher in patients with LVH than in those with normal LV mass. In a multiple logistic regression model, adjusting for potential confounders (including cardiac ischemia), systolic pressure and cTnT (both P = 0.003) were the strongest correlates of LVH. Similarly, cTnT was significantly higher (P = 0.005) in patients with systolic dysfunction than in those with normal LV function and in a multiple logistic regression model cTnT ranked as the second independent correlate of this alteration after male sex. Serum cTnT had a high positive prediction value for the diagnosis of LVH (87%) but its negative prediction value was relatively low (44%). The positive predictive value of cTnT for LV dysfunction was low (25%) while its negative predictive value was high (93%). A combined analysis including systolic pressure (for the diagnosis of LVH) and sex (for the diagnosis of LV systolic dysfunction) augmented the diagnostic estimates to an important extent (95% positive prediction value for LVH and 98% negative prediction value for LV systolic dysfunction). CONCLUSIONS CTnT has a fairly good diagnostic potential for the identification of LVH and for the exclusion of LV systolic dysfunction in patients with ESRD without heart failure. This marker may be useful for the screening of alterations in LV mass and function in clinically stable hemodialysis patients.
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Affiliation(s)
- Francesca Mallamaci
- CNR Centre of Clinical Physiology and Division of Nephrology, Reggio Calabria, Italy
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Mallamaci F, Zoccali C, Parlongo S, Tripepi G, Benedetto FA, Cutrupi S, Bonanno G, Fatuzzo P, Rapisarda F, Seminara G, Stancanelli B, Bellanuova I, Cataliotti A, Malatino LS. Troponin is related to left ventricular mass and predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2002; 40:68-75. [PMID: 12087563 DOI: 10.1053/ajkd.2002.33914] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac troponin T (cTnT) predicts death and cardiovascular outcomes in clinically stable patients with end-stage renal disease. Because this protein is synthesized exclusively in myocardial cells, its predictive power for these outcomes may be because it reflects, besides cardiac ischemia, left ventricular (LV) mass, which is a strong predictor of cardiovascular death in this population per se. We tested the relationship between cTnT level and LV mass and the predictive power of this cardiac protein for all-cause and cardiovascular mortality in a cohort of hemodialysis patients (n = 199) without acute coronary syndrome and heart failure followed up for an average of 35 months (range, 0.8 to 52 months). cTnT was measured by means of a third-generation electrochemiluminescence immunoassay. cTnT level was related directly to interventricular septum (r = 0.36; P < 0.001) and posterior wall thickness (r = 0.40; P < 0.001), as well as LV mass (r = 0.45; P < 0.001). On multivariate analysis, after age, LV mass was the strongest independent predictor of cTnT level (beta = 0.28; P < 0.001). Serum cTnT level was significantly related to all-cause and cardiovascular mortality on univariate analysis (P < 0.001). On multivariate Cox regression analysis, the adjusted risk for all-cause death was 2.39 times (95% confidence interval [CI], 1.13 to 5.06; P = 0.02) greater in patients in the third cTnT tertile than the first tertile, and a similar pattern emerged for cardiovascular mortality (hazard ratio, 2.35; 95% CI, 1.01 to 5.49; P = 0.048). In hemodialysis patients, plasma cTnT level is independently related to LV mass and predicts all-cause and cardiovascular mortality. These data support the hypothesis that this marker can be usefully applied for risk stratification in clinically stable dialysis patients.
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Affiliation(s)
- Francesca Mallamaci
- Divisione di Nefrologia e CNR, Centro di Fisiologia Clinica, Reggio Calabria, Italy
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Zoccali C, Mallamaci F, Parlongo S, Cutrupi S, Benedetto FA, Tripepi G, Bonanno G, Rapisarda F, Fatuzzo P, Seminara G, Cataliotti A, Stancanelli B, Malatino LS, Cateliotti A. Plasma norepinephrine predicts survival and incident cardiovascular events in patients with end-stage renal disease. Circulation 2002; 105:1354-9. [PMID: 11901048 DOI: 10.1161/hc1102.105261] [Citation(s) in RCA: 357] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sympathetic tone is consistently raised in patients with end-stage renal disease (ESRD). We therefore tested the hypothesis that sympathetic activation is associated with mortality and cardiovascular events in a cohort of 228 patients undergoing chronic hemodialysis who did not have congestive heart failure at baseline and who had left ventricular ejection fraction >35%. METHODS AND RESULTS The plasma concentration of norepinephrine (NE) was used as a measure of sympathetic activity. Plasma NE exceeded the upper limit of the normal range (cutoff 3.54 nmol/L) in 102 dialysis patients (45%). In a multivariate Cox regression model that included all univariate predictors of death as well as the use of sympathicoplegic agents and beta-blockers, plasma NE proved to be an independent predictor of this outcome (hazard ratio [1-nmol/L increase in plasma NE]: 1.07, 95% CI 1.01 to 1.14, P=0.03). Similarly, plasma NE emerged as an independent predictor of fatal and nonfatal cardiovascular events (hazard ratio [1-nmol/L increase in plasma NE] 1.08, 95% CI 1.02 to 1.15, P=0.01) in a model that included previous cardiovascular events, pulse pressure, age, diabetes, smoking, and use of sympathicoplegic agents and beta-blockers. The adjusted relative risk for cardiovascular complications in patients with plasma NE >75th percentile was 1.92 (95% CI 1.20 to 3.07) times higher than in those below this threshold (P=0.006). CONCLUSIONS Sympathetic nerve overactivity is associated with mortality and cardiovascular outcomes in ESRD. Controlled trials with antiadrenergic drugs are needed to determine whether interference with the sympathetic system could reduce the high cardiovascular morbidity and mortality in dialysis patients.
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Affiliation(s)
- Carmine Zoccali
- CNR, Centre of Clinical Physiology and Division of Nephrology, Reggio Calabria, Italy.
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Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Cutrupi S, Parlongo S, Malatino LS, Bonanno G, Seminara G, Rapisarda F, Fatuzzo P, Buemi M, Nicocia G, Tanaka S, Ouchi N, Kihara S, Funahashi T, Matsuzawa Y. Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease. J Am Soc Nephrol 2002; 13:134-141. [PMID: 11752030 DOI: 10.1681/asn.v131134] [Citation(s) in RCA: 455] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Adiponectin (ADPN), which is a secretory protein of adipose tissue, attenuates endothelial inflammatory responses in vitro. Among human subjects, plasma ADPN concentrations are reduced among patients with atherosclerotic complications but are substantially increased among patients with advanced renal failure. The clinical and biochemical correlates of plasma ADPN levels were investigated and the predictive power of ADPN levels with respect to survival rates and cardiovascular events was prospectively tested in a cohort of 227 hemodialysis patients, who were monitored for 31 +/- 13 mo. Plasma ADPN levels were 2.5 times higher (P < 0.0001) among dialysis patients (15.0 +/- 7.7 microg/ml) than among healthy subjects (6.3 +/- 2.0 microg/ml), were independent of age, and were higher (P = 0.03) among women (15.2 +/- 7.9 microg/ml) than among men (14.0 +/- 7.4 microg/ml). For both genders, plasma ADPN levels were inversely related to body mass index values, plasma leptin levels, insulin levels, serum triglyceride levels, and homeostatic model assessment index values. Furthermore, plasma ADPN levels were directly related to HDL cholesterol levels and inversely related to von Willebrand factor levels. Plasma ADPN levels were lower (P < 0.05) among patients who experienced new cardiovascular events (13.7 +/- 7.3 microg/ml) than among event-free patients (15.8 +/- 7.8 microg/ml). There was a 3% risk reduction for each 1 microg/ml increase in plasma ADPN levels, and the relative risk of adverse cardiovascular events was 1.56 times (95% confidence interval, 1.12 to 1.99 times) higher among patients in the first ADPN tertile, compared with those in the third tertile. Plasma ADPN levels are an inverse predictor of cardiovascular outcomes among patients with end-stage renal disease. Furthermore, ADPN is related to several metabolic risk factors in a manner consistent with the hypothesis that this protein acts as a protective factor for the cardiovascular system.
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Affiliation(s)
- Carmine Zoccali
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Francesca Mallamaci
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Giovanni Tripepi
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Francesco A Benedetto
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sebastiano Cutrupi
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Saverio Parlongo
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Lorenzo S Malatino
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Graziella Bonanno
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Giuseppe Seminara
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Francesco Rapisarda
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Pasquale Fatuzzo
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Michele Buemi
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Giacomo Nicocia
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sachiyo Tanaka
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriyuki Ouchi
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinji Kihara
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tohru Funahashi
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuji Matsuzawa
- *National Research Council Center of Clinical Physiology, Reggio Calabria, Italy; Cardiology Division, Ospedale Morelli, Reggio Calabria, Italy; Departments of Internal Medicine and Nephrosurgery and Institute of Internal Medicine and Geriatry, Catania University, Catania, Italy; Clinical Pathology and Nephrology Units, University of Messina, Messina, Italy; and Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Cataliotti A, Seminara G, Stancanelli B, Malatino LS. Prognostic impact of the indexation of left ventricular mass in patients undergoing dialysis. J Am Soc Nephrol 2001; 12:2768-2774. [PMID: 11729247 DOI: 10.1681/asn.v12122768] [Citation(s) in RCA: 215] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is exceedingly frequent in patients undergoing dialysis. Cardiac mass is proportional to body size, but the influence of various indexing methods has not been studied in patients with end-stage renal disease. The issue is important because malnutrition and volume expansion would both tend to distort the estimate of LV mass (LVM) in these patients. In a cohort of 254 patients, the prognostic impact on all-cause mortality and cardiovascular outcomes of LVH values, calculated according to two established methods of indexing, either body surface area (BSA) or height(2.7), was assessed prospectively. When LVM was analyzed as a categorical variable, the height(2.7)-based method identified a larger number of patients with LVH than the corresponding BSA-based method. One hundred and thirty-seven fatal and nonfatal cardiovascular events occurred during the follow-up period. Overall, 90 patients died, 51 of cardiovascular causes. In separate Cox models, both the LVM/height(2.7) and the LVM/BSA index independently predicted total and cardiovascular mortality (P < 0.001). However, the height(2.7)-based method coherently produced a closer-fitting model (P < or = 0.02) than did the BSA-based method. The height(2.7) index was also important for the subcategorization of patients according to the presence of concentric or eccentric LVH because the prognostic value of such subcategorization was apparent only when the height(2.7)-based criterion was applied. In conclusion, LVM is a strong and independent predictor of survival and cardiovascular events in patients undergoing dialysis. The indexing of LVM by height(2.7) provides more powerful prediction of mortality and cardiovascular outcomes than the BSA-based method, and the use of this index appears to be appropriate in patients undergoing dialysis.
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Affiliation(s)
- Carmine Zoccali
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Francesco Antonio Benedetto
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Francesca Mallamaci
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Giovanni Tripepi
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Giuseppe Giacone
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Alessandro Cataliotti
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Giuseppe Seminara
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Benedetta Stancanelli
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
| | - Lorenzo Salvatore Malatino
- *Centre of Clinical Physiology and Division of Nephrology and Cardiology Unit, Morelli Hospital, Reggio Cal, Italy; and Institute of Internal Medicine "L. Condorelli" and Institute of Internal Medicine and Geriatrics, Catania University, Italy
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36
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Cataliotti A, Malatino LS, Jougasaki M, Zoccali C, Castellino P, Giacone G, Bellanuova I, Tripepi R, Seminara G, Parlongo S, Stancanelli B, Bonanno G, Fatuzzo P, Rapisarda F, Belluardo P, Signorelli SS, Heublein DM, Lainchbury JG, Leskinen HK, Bailey KR, Redfield MM, Burnett JC. Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling. Mayo Clin Proc 2001; 76:1111-9. [PMID: 11702899 DOI: 10.4065/76.11.1111] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine levels of natriuretic peptides (NPs) in patients with end-stage renal disease (ESRD) and to examine the relationship of these cardiovascular peptides to left ventricular hypertrophy (LVH) and to cardiac mortality. PATIENTS AND METHODS One hundred twelve dialysis patients without clinical evidence of congestive heart failure underwent plasma measurement of NP concentrations and echocardiographic investigation for left ventricular mass index (LVMI). RESULTS Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations correlated positively with LVMI and inversely with left ventricular ejection fraction, whereas C-type NP and Dendroaspis NP levels did not correlate with LVMI. In dialysis patients with LVH (LVMI >125 g/m2), plasma ANP and BNP concentrations were increased compared with those in dialysis patients without LVH (both P<001). In a subset of 15 dialysis patients without LVH or other concomitant diseases, plasma BNP concentrations were not significantly increased compared with those in 35 controls (mean +/- SD, 20.1+/-13.4 vs 13.5+/-9.6 pg/mL; P=.06), demonstrating that the BNP concentration was not increased by renal dysfunction alone. Furthermore, the BNP level was significantly higher in the 16 patients who died from cardiovascular causes compared with survivors (mean +/- SD, 129+/-13 vs 57+/-7 pg/mL; P<.003) and was significantly associated with greater risk of cardiovascular death in Cox regression analysis (P<.001), as was the ANP level (P=.002). CONCLUSIONS Elevation of the plasma BNP concentration is more specifically related to LVH compared with the other NP levels in patients with ESRD independent of congestive heart failure. Thus, BNP serves as an important plasma biomarker for ventricular hypertrophy in dialysis patients with ESRD.
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Affiliation(s)
- A Cataliotti
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
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37
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Catania MV, Bellomo M, Di Giorgi-Gerevini V, Seminara G, Giuffrida R, Romeo R, De Blasi A, Nicoletti F. Endogenous activation of group-I metabotropic glutamate receptors is required for differentiation and survival of cerebellar Purkinje cells. J Neurosci 2001; 21:7664-73. [PMID: 11567056 PMCID: PMC6762889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
We have applied subtype-selective antagonists of metabotropic glutamate (mGlu) receptors mGlu1 or mGlu5 [7-(hydroxy-imino) cyclopropa[b]chromen-1a-carboxylate ethyl ester (CPCCOEt) or 2-methyl-6-(phenylethynyl)pyridine (MPEP)] to mixed rat cerebellar cultures containing both Purkinje and granule cells. The action of these two drugs on neuronal survival was cell specific. Although CPCCOEt (1, 10, 30 microm) reduced the survival of Purkinje cells, MPEP (3 or 30 microm) selectively reduced the survival of granule cells. Both effects required an early exposure of cultures to antagonists [from 3 to 6 d in vitro (DIV) for CPCCOEt, and from 3 to 6 or 6 to 9 DIV for MPEP]. Addition of MPEP from 6 to 9, 9 to 13, or 13 to 17 DIV also induced profound morphological changes in the dendritic tree and dendritic spines of Purkinje cells, suggesting that endogenous activation of mGlu5 receptors is required for the age-dependent refinement of Purkinje cell phenotype. In in vivo studies, an early blockade of mGlu1 receptors induced in rats by local injections of LY367385 (20 nmol/2 microl), local injections of mGlu1 antisense oligonucleotides (12 nmol/2 microl), or systemic administration of CPCCOEt (5 mg/kg, s.c.) from postnatal day (P) 3 to P9 reduced the number and dramatically altered the morphology of cerebellar Purkinje cells. In contrast, mGlu5 receptor blockade induced by local injections of antisense oligonucleotides reduced the number of granule cells but also produced substantial morphological changes in the dendritic tree of Purkinje cells. These results provide the first evidence that the development of cerebellar neurons is under the control of mGlu1 and mGlu5 receptors, i.e., the two mGlu receptor subtypes coupled to polyphosphoinositide hydrolysis.
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Affiliation(s)
- M V Catania
- Institute for Bioimaging and Pathophysiology of the Central Nervous System (IBFSNC), National Research Council (IBFSNC-CNR), 95123 Catania, Italy.
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Giordano M, Seminara G, Infantone L, de Pascale E, Giordano C. A case of transient blindness in a postoperative hyponatremic child. Clin Nephrol 2000; 53:222-5. [PMID: 10749303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Hyponatremia represents a common electrolyte disorder in postoperative patients. Headache, nausea, emesis, weakness and lethargy are all consistent symptoms of hyponatremia in children. Among the neurologic symptoms that are infrequently seen in severe hyponatremic pediatric patients seizure is included while visual disorders are not. We report a case of an 8-year-old boy who underwent abdominal surgery and developed severe hyponatremia. Five days after surgery the child suffered a seizure and successively experienced bilateral visual loss. However, after prompt correction of serum sodium concentration, a complete resolution of the blindness was obtained. Thus, we discuss the present case speculating on the pathogenesis of hyponatremic blindness and on its possible therapeutic approach. In conclusion, we suggest that blindness is to be considered a rare symptom that can occur in the clinical scenario of hyponatremia and we report its complete reversibility after timely treatment of hyponatremia.
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Affiliation(s)
- M Giordano
- Institute of Internal Medicine, University of Catania, Italy
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Malatino LS, Benedetto FA, Mallamaci F, Tripepi G, Zoccali C, Parlongo S, Cutrupi S, Marino C, Panuccio V, Garozzo M, Candela V, Bellanuova I, Cataliotti A, Rapisarda F, Fatuzzo P, Bonanno G, Seminara G, Stancanelli B, Tassone F, Labate C. Smoking, blood pressure and serum albumin are major determinants of carotid atherosclerosis in dialysis patients. CREED Investigators. Cardiovascular Risk Extended Evaluation in Dialysis patients. J Nephrol 1999; 12:256-60. [PMID: 10493569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
AIM To investigate the relationship between carotid atherosclerosis and some major cardiovascular risk factors in uremic patients on chronic dialysis. METHODS A cross-sectional study was carried out in 119 unselected dialysis patients (89 on hemodialysis and 30 on chronic ambulatory peritoneal dialysis, CAPD). Fasting blood sampling for serum lipids, albumin, hemoglobin, and echo-colour-Doppler evaluation of common carotid arteries were performed in all patients (during the non-dialysis day in hemodialysis patients). In hemodialysis patients BP was measured before and after dialysis; in CAPD patients home BP values were recorded during the month before the study day. RESULTS Ninety-five patients had at least one plaque and 57 had at least four plaques. Thirty-eight had mild and eleven severe carotid stenosis. In multiple regression models, the mean internal diameter of carotid arteries was explained (R=0.52, P=0.0001) by systolic pressure (r=0.39), serum cholesterol (r=-0.28), age (r=0.27) and smoking (r=0.24) while the degree of carotid stenosis was predicted (R=0.39, P=0.0001) by age (r=0.36) and smoking (r=0.25). The number of atherosclerotic plaques was explained (R=0.51, P=0.0001) by age (r=0.36), smoking (r=0.25) and pulse pressure (r=0.20), serum albumin just failing to reach statistical significance (P = 0.06). However, serum albumin was a significant and independent predictor of the number of atherosclerotic plaques (r=-0.26) in hemodialysis patients (n=89). Sex, diabetes, Kt/V, duration of dialysis treatment, hemoglobin, serum calcium and phosphate did not add any predictive power to the models. CONCLUSIONS In dialysis patients arterial pressure and smoking are associated with carotid atherosclerosis. Serum albumin appears to serve as an independent predictor of carotid atherosclerosis.
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Affiliation(s)
- L S Malatino
- Istituto di Clinica Medica L. Condorelli, Reggio Calabria, Italy.
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Abstract
Eosinophilic gastroenteritis is a rare disease of unknown aetiology characterized by eosinophilic infiltration of the gastrointestinal wall and increased peripheral blood eosinophilia. The frequent finding of concomitant extradigestive involvement calls for differential diagnosis to distinguish some multisystemic pathologies, such as connective tissue disease. We recently treated a young woman affected by eosinophilic infiltration of the small and large intestine which spread to other organs. Tests ruled out allergic or parasitic aetiopathogenesis of the disease. The clinical, biological and evolutive findings suggest that eosinophilic gastroenteritis may evolve into idiopathic hypereosinophilic syndrome.
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Affiliation(s)
- M Malaguarnera
- Istituto di Medicina Interna e Geriatria, Università di Catania, Italia
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Siciliano R, Trovato BA, Seminara G, Giustolisi V, Malaguarnera M. Interferon or hepatitis C virus induced autoimmune aplastic anemia and severe thrombocytopenia? A case report. Ann Ital Med Int 1995; 10:193-4. [PMID: 7577317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe a case of aplastic anemia with severe thrombocytopenia in a patient affected by chronic active hepatitis C treated with interferon. The hematologic alterations did not disappear after suspension of interferon or after the ensuing steroid treatment. Administration of cyclosporin markedly improved the hematologic parameters and serum transaminase levels.
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Affiliation(s)
- R Siciliano
- Istituto di Medicina Interna e Geriatria, Università degli Studi di Catania
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43
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Seminara R, Seminara G. Cephalometrics and oral myofunctional impairment. N Y State Dent J 1994; 60:53-7. [PMID: 7970420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is essential that the practitioner determine the factors that are etiologically operative in oral myofunctional therapy in order to establish effective methods of intervention. Of these methods, cephalometrics and facial analysis are especially valuable in revealing and differentiating open bite syndrome. They are discussed here along with procedures for their use.
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44
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Malaguarnera M, Giugno I, Seminara G, Biondi G, Trovato BA. Liver Damage Induced by Danazol. Clin Drug Investig 1994. [DOI: 10.1007/bf03257436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Siciliano R, Trovato BA, Romano M, Pantò A, Seminara G, Malaguarnera M. [Long-term therapy in chronic hepatitis C with recombinant alpha interferon]. Riv Eur Sci Med Farmacol 1994; 16:73-8. [PMID: 7480963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The dosage and duration of Chronic Hepatitis (CH) C therapy with alpha (alpha-IFN) is still an unresolved problem. Considering mainly antiviral activity of alpha-IFN, the authors carried out research on 35 patients with CH-C to evaluate the efficacy and safety of long term therapy and to compare recombinant alpha-IFN-2a with recombinant alpha-IFN-2b. 21 patients (Group A: 20 males, 1 female, mean age 48.8 years, 14.2% CPH, 76% CAH, 9.5% AC) were treated with r-alpha-IFN-2a; 14 patients (Group B: 7 males, 7 females, mean age 45.2 years, 7.1% CPH, 78.5% CAH, 14.3% AC) were treated with r-alpha-IFN-2b, at a dosage of 3 MU thrice weekly (TIW) for 12 months; the follow-up was from 6 to over 24 months. Complete Response (CR) was achieved in 49.3% of the patients treated, Long Term Response (LTCR) in 19.3%, Partial Response (PR) in 29% and No Response (NR) in 22.6%), Delayed CR in 6.5%. The authors found a similar number of CR and LTRC in group A and group B; a greater percentage of PR in group A and a greater percentage of NR in group B. Early and serious side effects in 4 patients, late and serious side effects in 2 patients were observed. The date suggest that the long term therapy of CH with r-alpha IFN is effective in inducing clinical and biochemical remission in a large portion of patients and a greater number of sustained response, with respect to a therapy schedule of 6 months even at greater dosages.
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Affiliation(s)
- R Siciliano
- Istituto di Medicina Interna e Geriatria, Università degli Studi di Catania
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46
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Seminara G, Trassari V, Prestifilippo N, Chiavetta R, Calandra C. [Atypical tricyclic neuroleptics for treatment of schizophrenia. Clothiapine and clozapine]. Minerva Psichiatr 1993; 34:95-9. [PMID: 8105359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The main objective of the pharmacotherapy of schizophrenia has been, and still is, to obtain optimal therapeutic efficacy, which is seconded by the aim to restrict as far as possible the sometimes severe collateral effects which are acknowledged as being the major drawback to the regular use of neuroleptic agents. Tight from the start, some "atypical neuroleptics" were identified as being of interest for this reason; these included Clothiapine and Clozapine, a more recently discovered drug which is not yet commercially available in Italy. Both of these neuroleptics have been found to offer extremely interesting advantages. The authors now report data referring to the clinical use of these drugs during 1989-1990 in addition to those published in the literature on this subject.
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Affiliation(s)
- G Seminara
- Istituto di Clinica Psichiatrica, Università degli Studi di Catania
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47
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Calcara G, Rapisarda F, Rapisarda C, Brischetto R, Fatuzzo P, Seminara G, Vasta E, Motta M. [Evaluation of the risk of hepatitis delta virus (HDV) infection in a population of hemodialyzed patients: significance of the determination of anti-delta antibodies in the blood]. Arch Ital Urol Nefrol Androl 1989; 61:229-33. [PMID: 2529638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepatitis delta virus (HDV) is a defective virus which requires the helper function of hepatitis B virus (HBV) for replication. HDV infection occurs only during or after HDV infection. Viral infection spreads parenterally in both cases. However, it has been reported that the risk of HDV infection is limited to hemodialysed patients, unlike the risk of HBV infection. In order to verify these findings the Authors studied 108 patients undergoing periodical hemodialytic treatment in order to study the delta antibodies present in their blood. Sixty-one of these subjects had received previous blood transfusions, 15 were HBsAg positive and 7 positive for other serological markers of the hepatitis B virus. None of the subjects examined was positive for anti HDV. Our results agreed with the literature reporting an incidence of positive HDV serological markers limited to hemodialyzed patients. The Authors observed that the behaviour of the HDV serological markers can vary from patient to patient and that it is impossible to furnish diagnosis of HDV infection after HBV and HDV clearance. Since these factors can lead to underestimation of the real incidence of HDV infection in hemodialyzed patients, the Authors underline the need to perform long term epidemiological studies and to investigate all the HDV serological markers.
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Russo R, Rizzoli G, Stritoni P, Seminara G, Rubino M, Brumana T. T-wave changes in patients with hemodynamic evidence of systolic or diastolic overload of the left ventricle: a retrospective study on 168 patients with isolated chronic aortic valve disease. Int J Cardiol 1987; 14:137-43. [PMID: 2950064 DOI: 10.1016/0167-5273(87)90003-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of systolic and diastolic overload of the left ventricle on the T wave was studied in 86 patients with pure aortic stenosis and in 82 patients with pure aortic insufficiency documented by hemodynamic investigation. All patients had hemodynamically significant, chronic isolated aortic valve disease with electrocardiographic evidence of left ventricular hypertrophy (Sokolow index greater than or equal to 45 mm). All had undergone selective coronary angiography. Flattened or negative T waves were present in 44 patients with aortic stenosis (51%) and in 66 (80%) with aortic incompetence. Inversion of the T wave in left ventricular leads was unrelated to the presence of ventricular conduction disturbances or to coronary artery disease or to low cardiac index. It was significantly related to older age (P = 0.0001) and, in patients with aortic incompetence, to the end-diastolic volume (P = 0.04). Digitalis intake was a nonsignificant (P = 0.10) independent variable. These findings suggest that patients with aortic stenosis cannot be distinguished from patients with aortic incompetence by the electrocardiogram and that the theory of Cabrera and Monroy is not valid in this set of patients.
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Hall P, Seminara G. Proceedings: An instability mechanism relevant to flow in the aorta. J Physiol 1975; 252:9P-10P. [PMID: 1206567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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