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Patients in end-stage renal disease undergoing renal replacement treatment (ESRD-RRT) are considered immunocompromised. The hemodialysis (HD) or peritoneal dialysis (PD) procedures seem to produce alterations of the immune status. Interest in immunosuppression has increased due to the poliomavirus BK (BKV) infection. Our study evaluated the prevalence of BKV infection in ESRD-RRT patients and viral replication on HD or PD. From 2006 to 2011 we selected 58 patients (34 males) in ESRD-RRT for inclusion in our study. BKV replication was evaluated by qualitative real-time polymerase chain reaction. In ESRD-RRT patients, the prevalence of BKV replication on plasma was 21%. We identified two groups of patients according to the dialysis procedure: 36 patients on HD (HD group) and 22 on PD (PD group). BKV replication in the HD group was 33% (12 of 36) versus 0% (0 of 22) in the PD group. Different age, number of months on RRT, and preserved diuresis was observed in the HD versus PD groups. With our results we can speculate that BKV infection in ESRD-RRT patients is linked to factors involved in the uremia-related immune dysfunction but also to specific mechanisms related to the different RRTs. PD is an option that could be associated with a better transplant outcome for patients undergoing kidney transplantation.

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In glomerulonephritis we find various anatomical and pathological aspects of the kidneys, despite the clinical manifestations are almost identical (haematuria, proteinuria, nephrotic or nephritic syndrome). The anatomical damage and the clinical manifestations is produced by a known or unknown antigenic insult, in relation to the predisposing genetic factors and to the defences predisposed by the immunological system. From the '80, some publications showed an immunological pathogenesis of the glomerulonephritis, with the participation of haematological elements such as lymphoid cells. Therefore, the pathogenesis of the primitive glomerulonephritis are in great part unknown, although we know that the increased permeability of the glomerular capillary is correlated to the production of proinflammatory lymphokines from T cells, which are overexpressed (RANTES). Not to succeed to adequately eliminate these cells can be, thus, a cause of relapse with the final result of renal infiltration and amplification of the immune response.

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Systemic Lupus Erythematosus (SLE) is a pathology of unknown cause, characterized by tissue and cellular damage, secondary to production of autoantibodies and to deposition of immunocomplexes. Lupus nephritis is one of the most common complications of SLE. Our purpose is to propose a therapeutic protocol for patients suffering from Lupus nephritis. This consists of Plasmapheresis associated with pharmacological therapy so that dosage of immunosuppressors can be reduced and consequently also the side effects of the pharmacological therapy.

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We studied 15 patients suffering from nephrotic syndrome (NS) in bioptically-accertained primary and secondary glomerulopathies responding poorly to the common pharmacological treatment. They were monitored for one year by assessing their immunological and kidney functionality parameters, especially proteinuria. The patients underwent 3 apheretic sittings using the cascade double-filtration technique. After the third apheretic sitting the patients received metilprednisolone 300 mg/m2. This therapy was repeated every month for 6 months. At the end of the apheretic cycle it was shown that all patients had responded well to the therapy with a dramatic decrease in proteinuria, maintenance and/or recuperation of kidney functionality and improvement of lipidic asset; these data remained unchanged over time. Considering our preliminary results, we believe that therapeutic apheresis has a precise function in refractory nephrotic syndrome and, in particular, we propose the use of the cascade double-filtration technique.

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A case of amanita phalloides which presented a typical picture of phalloides intossication has been treated at our Centre. The patient was submitted to four treatments of plasmaexchange (Plasmafiltration), exchanging from 70 to 80% of the plasmatic volume and using substitutive liquids 4% albumine and frozen plasma, using as filter Plasmaflo Asahi OP-O5 (1) and Plasmapheresis equipment SIFRA mod. 914. Already after the first treatment there was an improvement of the general condition with a stabilization of the renal and hepatic parameters at the end of the cycle.

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Haemodynamics modifications in 49 patients divided in two groups consisting of 21 young people (average age 43 +/- 12 yrs.) and 28 elderly people (average age 72 +/- 7 yrs.) who have undergone at least three treatments with haemofiltration for congestive cardiac decompensation and chronic renal failure have been evaluated. Systolic and diastolic blood pressure and heart rate have been monitored for each patient in a length of time of iT, T30 min., T60 min., fT. The results show a statistically significant reduction of the systolic pressure during the time interval iT-T30 min. in subjects over 65, contrary to the control group. Such preliminary results can be justified by the haemodynamic modifications correlated to the elderly process. In any case the hypothesis cited by the authors need further testing even if confirming the indication of the dialytic treatment on patients over 65 through haemofiltration techniques.

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We followed for a period of six months, 54 patients of over 60 years old, submitted to hemodialitic treatment. We gave human recombinant erythropoietin, average dosage 50 UI/Kg subcutaneously on alternative days, folic acid and iron supplements together with a proteic supply of 1.2 g/Kg/die (35 Kcal/Kg). The medullary response has been monitored with hematochemical tests; blood pressure and nutritional conditions have been evaluated. Furthermore, the patients were given a questionnaire to evaluate their quality of life. At the end of the follow up, 50 patients responded positively to therapy. These patients showed an increase of RBC (from 2,789,780 +/- 259,310 to 3,313,110 +/- 472,780 p < 0.001) of HCT (from 21.86% +/- 2.16% to 27.18 +/- 2.74% p < 0.0001) and of Hb (from 7.72 +/- 1.12 g/dl to 9.28 +/- 0.98 g/dl p < 0.006). Total protein and albumin increased too. Furthermore they showed a progressive increase of "performance status". Our results confirm efficacy of erythropoietin in the treatment of anemia in elderly hemodialized patients.

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The primary or secondary forms of colorectal cancers involving local structures or spreading in the abdomen or pelvic area without extra-regional metastases are identified as regionally advanced colorectal cancers (RACRC). They are unresectable and thus radiotherapy and chemotherapy are the fundamental treatment methods. However, these regimens have failed to check the diffusion of tumor satisfactorily in most forms of RACRC. The abdominal and pelvic regions can be isolated from corporal circulation by temporary occlusion of the aorta and cava and perfused with high doses of chemotherapeutic drugs. The hypoxic abdominal or pelvic stop-flow method for delivering high-dose antiblastic agents to these body districts to avoid toxicity by chemofiltration has been suggested. This study examines the possibility of using this method to treat various forms of RACRC.

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Thirty-four patients affected by mixed cryoglobulinaemia have been submitted to treatment by apheresis (plasma exchange or double cascade filtration). The authors have monitored clinical, laboratory and, above all, haemorheological changes following therapy. The final results have shown mainly a reduction of plasma viscosity and consequently an improvement of the haemorheology of the affected organs. In conclusion, apheresis may be considered a successful therapy in patients with severe renal or neurological diseases due to mixed cryoglobulinaemia.

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Ascites often appears as a complication of several illnesses. The therapy is essentially based on the use of low-sodium diet, plasma or albumin infusion, diuretics and low-dosed ACE-inhibitors. To use the simple paracentesis or special techniques as Rhodiascit or Lee Veen Shunt means not to resolve definitively the problem and sometimes to cause undesirable complications. The authors present a new therapeutic tactics that joins the use of technique of double filtration of ascitic fluid and reinfusion of concentrated proteins (DFAF) with the injection in the peritoneal cavity of beta-interferon and the venous infusion of ATIII. Twenty patients affected by hepatic cirrhosis with the presence of ascitic fluid not treatable with the usual therapy have been subjected to this treatment. All the patients showed an immediate improvement of the clinical situation. After one year of observation, we describe our results. Twelve patients needed a further treatment with the DFAF technique, two patients died for the original pathology and six patients just needed an adjustment of pharmacologic therapy.

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The development of new technologies implying the use of semidialytic synthetic membranes in therapeutic apheresis, lays stress also on the problem of biocompatibility. The first alterations of plasma proteins and of the immune system are observable 15 minutes after the beginning of the apheretic session. This may suggest that the acute clinical reactions observed during apheresis are related to biocompatibility. However, the first chronic side effects, comparable to those observed in hemodialysis, do not occur before 10-20 sessions. It is known, in fact, that even when inactive materials, such as the last generation membrane, are used, plasma exchange affects the immune system and may determine plasma protein alterations (protein film, erythrocytic damage, ADP release, beginning of the coagulation process, complement consumption). The whole system or the type of membrane, the involucre, the potting glue and the lines affect the interactions. The contact of blood with a foreign surface initiates a number of local reaction, with subsequent reactivity of the organism. The activation of the complement system, coagulative system, fibrinolytic system and callicrein-kinin system is therefore responsible for the cell functional modifications. It is necessary to underline the role of the membrane surface used, in that the activation of the complement system, of the gathering of platelets and of the cell activity modification all increase with the increase in surface. Biocompatibility may be affected not only by the membranes, but also by the substitution fluids and by the anticoagulant used.

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The approach to the hypertensive patient is still a subject of debate. The use of new measurement methods permits us to obtain more exact blood pressure values which represent an index of cardiovascular condition. We also demonstrated that non-invasive monitoring and self-measurement at home consent better management of hypertension.

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We present high resolution tracings of atrial flutter which, to our knowledge, have not been previously described. Two patients have been studied; in both cases atrial activity was made by waves similar to each other, differing only in voltage. We discuss the nature of these waves, which are probably related to continuous atrial activity, with a segregation into small and large waveform activity. It is concluded that high resolution recordings may be valid support for the interpretation of atrial flutter activity.

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Recording of His bundle potentials by means of non invasive technique was first obtained in 1973. The Authors used a computerized, high resolution cardiograph to study 26 patients, 17 males and 9 females, mean age 57.15 +/- 21.79 years. H wave could be identified and therefore H-V interval could be calculated in 19 patients (73%). H wave identification is based on its morphological differentiation from other bioelectrical signals present in P-Q interval and on its repeated presence in all, or at least in the largest number of the six available leads. This technique, based on averaging process, is very useful in depistage of acute and chronic A-V conduction troubles.

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