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BACKGROUND/AIMS: recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) proposed a new equation for estimating glomerular filtration rate (eGFR), which could potentially replace the Modified Diet for Renal Disease Study (MDRD) equation in routine clinical use. Our aim was to evaluate the correlation between them and to compare the prevalence of each CKD stage using these two equations. METHODS: we measured serum creatinine in 38,188 consecutive patients and calculated eGFR using the CKD-EPI and MDRD equations. We also compared the distribution of CKD stages for both equations. RESULTS: there was very good correlation between eGFR estimated by CKD-EPI and MDRD at values < 60 ml/min × 1.73 m2, but not at higher values. Estimated prevalence of CKD (eGFR < 60 ml/min × 1.73 m2) was 5.9% with CKD-EPI and 7.5% with MDRD. Furthermore, the prevalence of CKD Stage 2 was lower with CKD-EPI (33.8% vs. 49.1%. with MDRD). CONCLUSION: the use of the CKD-EPI equation results in a lower estimated prevalence of CKD, compared to the MDRD equation. This may have important implications for public health and clinical practice, as well as for future modification of guidelines for laboratories.
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Tasa de Filtración Glomerular , Indicadores de Salud , Enfermedades Renales/diagnóstico , Riñón/fisiopatología , Tamizaje Masivo/métodos , Modelos Biológicos , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Enfermedad Crónica , Creatinina/sangre , Femenino , Humanos , Italia/epidemiología , Enfermedades Renales/epidemiología , Enfermedades Renales/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
High-pressure liquid chromatography instruments specifically devised for separating haemoglobin (Hb) fractions have been increasingly employed by the hospital laboratories over the recent years since they allow easy and fast screening for several Hb variants. Although such instruments may be proposed as sensitive, specific and reliable alternatives to the classic electrophoretic techniques, a major drawback of this screening strategy is the almost identical retention time of several Hb variants. In particular, at least 18 Hb variants have been reported in the same retention window as HbA(2), including HbE, the second most common beta-chain variant in humans after sickle cell trait. Recently, we evaluated the performance characteristics of an improved buffer formulation originally conceived for Hb variants separation procedures on the fully automated high-pressure liquid chromatography instrument Tosoh G7. At variance with other fully automated high-pressure liquid chromatography analyzers, the elution pattern on the G7 in subjects heterozygous for HbE is characterized by the presence of four suggestive peaks (HbF, HbA, HbA(2) and HbE), confirming the effective separation of HbE from HbA(2). Because of its potential value in the diagnosis of the thalassaemia syndromes, the effective separation of HbA(2) from HbE can provide clinical laboratories with a valuable information for the diagnostic reasoning.
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Cromatografía Líquida de Alta Presión/instrumentación , Hemoglobina A2/aislamiento & purificación , Hemoglobina E/aislamiento & purificación , Hemoglobinopatías/sangre , Hemoglobinopatías/diagnóstico , HumanosRESUMEN
The variation between different PSA assays seems to influence the interpretation of individual PSA values and the clinical decisions about prostate cancer. One reason for this variability could be the different reactivity of antibodies for the various molecular forms of serum PSA; as a result, samples containing the same amount of tPSA but different proportions of fPSA can produce very different values. In this study, serum samples were collected prospectively from 152 consecutive patients referred to 2 institutions (Regional Hospital, Venice, 90 subjects; San Bortolo Hospital, Vicenza, 62 subjects) for PSA elevation and/or symptoms. Serum samples were assessed according to the manufacturers' instructions on the following 2 analyzers: the Immulite 2000 assay (Diagnostic Products Corporation, Los Angeles, USA), which measures tPSA and fPSA, and the ADVIA Centaur (Bayer Diagnostics, Tarrytown, USA), which assays tPSA and cPSA. cPSA values were transformed into fPSA by the equation fPSA=tPSA-cPSA. When taking Immulite tPSA and f/tPSA values as 100%, ADVIA Centaur values were 92.6% and 122%, respectively, which means that 20% of patients would be classified differently according to the traditional biopsy cutoff. In conclusion, there are considerable differences between the 2 methods, which could affect clinical decisions.
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Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Biopsia , Humanos , Masculino , Próstata/citología , Próstata/patología , Curva ROC , Análisis de Regresión , Reproducibilidad de los ResultadosRESUMEN
Sequential dialysis techniques (i.e pure ultrafiltration followed by dialysis) have been used in the past, due to their capability to remove large volumes of fluids without inducing hemodynamic instability. The disadvantages of inadequate efficiency and lack of technology lead to the decline of such methods. Hemofiltration (HF) and hemodiafiltration (HDF) are recently being utilized in a greater proportion thanks to on-line fluid preparation systems. Each process (HF and HDF) has its own benefits in the removal of small, medium and high-molecular weight substances and in hemodynamic stability. Sequential convective therapies (SCT) such as hemofiltration-hemodiafiltration in sequence (HF-HDF) may combine the benefits and eliminate the disadvantages of each method and should be studied in order to explore their potential application in modern dialysis. Furthermore they can be easily applied nowadays, due to the development of new sophisticated dialysis machines. In order to evaluate the feasibility, safety, efficiency and tolerance of different SCT methods we studied 3 schedules: SCT1: 1h pre-dilution HF followed by 3h of post-dilution HDF (in the HF mode we lost 25% of the total fluid that had to be removed). SCT2: 1h pre-dilution HF followed by 3h of post-dilution HDF (in the HF mode we lost 50% of the total fluid that had to be removed). SCT3: 2h pre-dilution HF followed by 2h of post-dilution HDF (in the HF mode we lost 50% of the total fluid that had to be removed). We studied 6 chronic hemodialysis patients using the same machine (AK200 ULTRA), with on-line fluid preparation system and the same type of dialyzer (Polyflux 210). SCT schedules were compared to on-line HF, on-line HDF and high flux dialysis performed with the same dialyzers. The treatments resulted safe, easy, feasible and well tolerated with an improved hemodynamic response to high volume convective therapies. Adequacy of treatment was satisfactory in all SCT schedules while middle molecular weight solute clearance and removal resulted higher in treatments with higher convective component. SCT might represent an interesting option for the future especially in patients with hemodynamic instability and requirements for interventions during treatment.
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Hemodiafiltración/métodos , Hemofiltración/métodos , Fallo Renal Crónico/terapia , Sistemas en Línea , Presión Sanguínea/fisiología , Volumen Sanguíneo/fisiología , Creatinina/metabolismo , Estudios Cruzados , Estudios de Factibilidad , Humanos , Persona de Mediana Edad , Fósforo/metabolismo , Estudios Prospectivos , Urea/metabolismo , Microglobulina beta-2/metabolismoRESUMEN
BACKGROUND: The relationship between serum parameters of gastric function and Helicobacter pylori infection in human immunodeficiency virus (HIV)-positive patients is almost unknown. AIMS: To investigate in HIV-infected patients: (i) the relationship between serum gastrin and serum pepsinogens over the progressive phases of HIV-related disease; (ii) the impact of H. pylori infection on gastrin and pepsinogen serum levels and its relation to antral histology; (iii) the prevalence of parietal cell autoantibodies. METHODS: Fifty-nine HIV-positive patients were studied by upper endoscopy plus gastric antral biopsy. Serum samples were tested for gastrin, pepsinogen A, pepsinogen C and parietal cell autoantibodies. RESULTS: In patients without overt acquired immunodeficiency syndrome (AIDS), or with a CD4+ count of > 100 x 10(6) cells/L, mean serum levels of gastrin and pepsinogen C were higher than in subjects with AIDS or with a CD4+ count of < 100 x 10(6) cells/L (P < 0.01). Only one patient was found to be positive for parietal cell autoantibodies. H. pylori infection was associated with increased values of gastrin and pepsinogen C only in HIV-positive patients without AIDS or with a CD4+ count of > 100 x 10(6) cells/L. Atrophy was more frequent in patients with overt AIDS than in those without overt AIDS (57% vs. 33%, P=N.S.), and/or in patients with a CD4+ count of < 100 x 10(6) cells/L than in those with a CD4+ count of > 100 x 10(6) cells/L (62% vs. 26%, P < 0.05). CONCLUSIONS: HIV-positive patients without overt AIDS have increased serum levels of gastrin and pepsinogen C compared with HIV-positive patients with overt AIDS.
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Infecciones Oportunistas Relacionadas con el SIDA/sangre , Síndrome de Inmunodeficiencia Adquirida/sangre , Gastrinas/sangre , Infecciones por Helicobacter/sangre , Helicobacter pylori , Pepsinógeno C/sangre , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Autoanticuerpos/análisis , Recuento de Linfocito CD4 , Femenino , Gastritis/sangre , Gastritis/etiología , Gastritis/inmunología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/inmunología , Humanos , Masculino , Persona de Mediana Edad , Células Parietales Gástricas/inmunologíaRESUMEN
COBAS INTEGRA 400 is a random-access analytical system consolidating assays for clinical chemistry analytes, electrolytes, serum proteins, drugs of abuse and therapeutic drugs. Analytical performance and practicability of the instrument were evaluated in seven laboratories over a 2-year period in parallel with system development. Good within-run and total imprecision for all assays was observed with a few exceptions for specimen pools with low concentration or activity. The coefficients of variation for total imprecision were well below 3.0% for clinical chemistry analytes and electrolytes, and below 5.0% for serum proteins and therapeutic drugs. Method comparisons demonstrated a good agreement with the various systems used for comparison, with slopes varying typically from 0.94 to 1.05, and Spearman correlation coefficient generally > 0.975. Accuracy was verified by recovery of controls and certified reference materials within 90 to 110% of target values. Assay ranges were linear within +/- 5%. No carry-over on reagent or sample pipetting systems was observed. Manufacturer-specified interference limits and onboard stabilities of reagents were confirmed. A time study for calculating direct personnel times and total processing time was carried out in three laboratories under different conditions including consolidated, STAT and dedicated use. On a scenario-independent basis, the total working time was shorter on the COBAS INTEGRA 400 than on routine systems in all three laboratories. Personnel time, in particular, was significantly reduced when compared to routine instruments. In general, system practicability was judged very positively in all laboratories. Owing to its versatility, the instrument is best placed as a consolidated workstation in small- to medium-sized laboratories or as an instrument for special determinations such as serum proteins, drugs, urinalysis or emergency analyses in large laboratories.
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Química Clínica/instrumentación , Proteínas Sanguíneas/análisis , Química Clínica/normas , Química Clínica/estadística & datos numéricos , Electrólitos/análisis , Enzimas/análisis , Europa (Continente) , Humanos , Drogas Ilícitas/análisis , Indicadores y Reactivos , Laboratorios , Preparaciones Farmacéuticas/análisis , Reproducibilidad de los Resultados , Programas InformáticosAsunto(s)
Química Clínica/métodos , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Valores de Referencia , Adolescente , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/química , Edad Gestacional , Humanos , Embarazo , Factores de TiempoRESUMEN
BACKGROUND: Advancing age may influence clarithromycin's pharmacokinetics. No studies have yet compared the effects of different dosages of clarithromycin in combination with a proton pump inhibitor and amoxicillin in elderly patients. AIM: To compare the efficacy and tolerability of clarithromycin 250 mg vs. clarithromycin 500 mg twice daily (b.d.) in combination with pantoprazole and amoxicillin in elderly patients. METHODS: One hundred and fifty-four elderly patients with H. pylori-associated ulcer disease or chronic gastritis were consecutively randomized to receive pantoprazole 40 mg daily plus amoxicillin 1 g, and either clarithromycin 250 mg b.d. (PAC 250) or clarithromycin 500 mg b.d. (PAC 500). Two months after therapy, endoscopy and gastric biopsies were repeated. RESULTS: The cure rates of H. pylori infection in the PAC 250 and PAC 500 groups were, respectively, 83% and 79% (ITT analysis) and 94% and 88% (PP analysis) (P=N.S.). Significant decreases in chronic gastritis activity both in the body (P < 0.00001) and the antrum (P < 0.0001) of the stomach were found in H. pylori-cured patients, independently of clarithromycin dosage. Four patients in PAC 250 (5%) and seven in PAC 500 (9%) reported adverse events (P=N.S.). One patient in PAC 250 (25%) and three in PAC 500 (43%) discontinued the study because of these drug-related side-effects (P=N.S.). CONCLUSIONS: In elderly patients, 1-week triple therapy with a proton pump inhibitor, amoxicillin and clarithromycin is a highly effective and well tolerated anti-H. pylori treatment. With this combination, clarithromycin at the lower dose of 250 mg b.d. achieved excel- lent cure rates and minimized adverse events and costs.
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Envejecimiento , Antibacterianos/farmacología , Antibacterianos/farmacocinética , Claritromicina/farmacología , Claritromicina/farmacocinética , Infecciones por Helicobacter/tratamiento farmacológico , Inhibidores de la Bomba de Protones , 2-Piridinilmetilsulfinilbencimidazoles , Administración Oral , Anciano , Anciano de 80 o más Años , Amoxicilina/administración & dosificación , Amoxicilina/farmacología , Antiulcerosos/administración & dosificación , Antiulcerosos/farmacología , Bencimidazoles/administración & dosificación , Bencimidazoles/farmacología , Biopsia , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Endoscopía , Femenino , Helicobacter pylori/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/análogos & derivados , Pantoprazol , Penicilinas/administración & dosificación , Penicilinas/farmacología , Sulfóxidos/administración & dosificación , Sulfóxidos/farmacología , Resultado del TratamientoRESUMEN
Cardiopulmonary bypass (CPB) induces a whole body inflammatory response leading to postoperative lung dysfunction. Activated leukocytes may play a role in the pathogenesis of pulmonary dysfunction. We evaluated postoperative lung function after the use of leukocyte-depleting filters incorporated in the extracorporeal circuit during CPB. From November 1997 to March 2000, 40 patients underwent isolated coronary artery bypass grafting. Patients were randomly allocated to the leukocyte-depletion group (group F, 20 patients) or to the control group (group C, 20 patients). There was no significant difference between the two groups with respect to age, sex, weight, height, body surface area, haemoglobin and haematocrit levels, preoperative left ventricular ejection fraction, cooling temperature, aortic crossclamping and CBP duration. Blood samples were drawn preoperatively, at aortic declamping, 60 min after CPB, after arriving at the intensive care unit (ICU) and 24 h after the operation. We analysed blood cell count, elastase, interleukin-8 (IL-8) and tumour necrosis factor (TNF-alpha) levels and continuous monitoring of arterial blood gases in the intensive care unit (ICU). The analysis of total circulating white blood cells (WBCs) showed a significant reduction of WBCs in both groups soon after aortic declamping [from the right atrium: 6.4 x 10(9)/l +/- 1.4 x 10(9)/l in group F vs 10.3 +/- 1.8 x 10(9)/l in group C (p<0.05); from the left atrium: 5.8 +/- 1.3 x 10(9)/l in group F vs 8.4 +/- 1.9 x 10(9)/l in group C (p<0.05)] and after 60 min of CPB [7.1 +/- 2.2 x 10(9)/l in group F vs 10.4 +/- 1.8 x 10(9)/l in group C (p<0.05)]. The analysis of circulating neutrophils showed similar findings in both groups. Elastase levels increased during CPB in both groups with a peak at the end of CPB without significant difference between the two groups (group C: 260 +/- 148 microg/l vs group F: 371 +/- 68 microg/l). The decrease of plasmatic elestase levels was observed, for both groups, in the 24 h after CPB. There was no difference in intubation time between the two groups (16.4 h for group C vs 11.2 h for group F). Pulmonary function tested by pulmonary respiratory index [RI = partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2 x 100)] did not show significant difference between the two groups, either arriving in the ICU (group C RI 265 vs group F RI 322), or after 3 h (group RI 304 vs group F RI 305) or after 6 h (group C RI 292 vs group F RI 319). Leukocyte-depleting filters reduce with blood cells count during CPB, but, in this study, WBC depletion did not significantly improve clinical conditions or laboratory finding.
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Puente Cardiopulmonar/métodos , Leucaféresis , Leucocitos , Anciano , Puente Cardiopulmonar/efectos adversos , Femenino , Filtración , Humanos , Inflamación/etiología , Inflamación/prevención & control , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Elastasa Pancreática/sangre , Pruebas de Función Respiratoria , Factores de TiempoRESUMEN
BACKGROUND: There are conflicting data on the association between Helicobacter pylori (HP) infection and cardiovascular diseases. AIM: To determine if there is an association between gastric HP infection and atherosclerosis of cerebral or peripheral arteries in elderly subjects. METHODS: 90 dyspeptic elderly subjects had upper gastro-intestinal endoscopy and the gastroduodenal pathology was identified. HP infection was confirmed by gastric histology and the rapid urease test. Vascular ultrasonography of extracranial cerebral arteries and leg arteries was performed to evaluate (i) the presence of an atherosclerotic lesion, (ii) the total length of all plaques documented and (iii) the number of arteries with atherosclerotic lesions. Statistical analysis was by the chi2 test, Yates's corrected chi2 test, the Mann-Whitney test and logistic regression. RESULTS: 59 subjects were HP-positive. These had a higher prevalence of peptic ulcer disease (P = 0.01) and higher serum levels of IgG anti-HP antibodies (P = 0.0001), but no significant differences in the number of atherosclerotic lesions, the total length of the plaques or the number of arteries with lesions. No significant association of HP positivity was found with diabetes mellitus, hypertension, cigarette smoking or coronary heart disease, nor with serum concentrations of HDL-cholesterol, fibrinogen, triglycerides or glucose. CONCLUSIONS: Elderly dyspeptic subjects with gastric HP infection had significantly more peptic ulcer disease but no more atherosclerotic lesions than those who were HP-negative. Atherosclerosis was not associated with HP infection. In this cross-sectional study of elderly patients with dyspepsia, no association between HP infection and extracardiac atherosclerosis was found.
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Arteriosclerosis/etiología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Gastropatías/microbiología , Anciano , Anciano de 80 o más Años , Arteriosclerosis/sangre , Arteriosclerosis/complicaciones , Arteriosclerosis/diagnóstico por imagen , Arterias Cerebrales/diagnóstico por imagen , Estudios Transversales , Dispepsia/complicaciones , Dispepsia/microbiología , Femenino , Infecciones por Helicobacter/sangre , Infecciones por Helicobacter/diagnóstico , Humanos , Modelos Logísticos , Masculino , Estudios Prospectivos , Factores de Riesgo , Gastropatías/complicaciones , Arterias Tibiales/diagnóstico por imagen , UltrasonografíaRESUMEN
BACKGROUND: The prevalence of Helicobacter pylori increases with age. However, data regarding the effects of anti-H. pylori treatments in the elderly are very scarce. METHODS: To evaluate the effect of three lansoprazole-based, 7 day, triple-therapy regimens on H. pylori eradication rates, symptomatology, chronic gastritis activity and serological markers of H. pylori infection in elderly subjects, we studied 150 symptomatic patients over 60 years of age with H. pylori-positive duodenal ulcer (DU, n = 34), gastric ulcer (GU, n= 19) or chronic gastritis (CG, n = 97). Patients were consecutively treated with one of the following regimens: (A) lansoprazole (LNS) 30 mg b.i.d. + clarithromycin (CLR) 250 mg b.i.d. + metronidazole (MTR) 250 mg q.i.d.; (B) LNS 30mg b.i.d. + amoxycillin (AMOX) 1 g b.i.d. + MTR 250 mg q.i.d.; and (C) LNS 30 mg b.i.d. + CLR 250 mg b.i.d. + AMOX 1 g b.i.d. RESULTS: Two months after therapy, the eradication rates of the three treatments, expressed using both intention-to-treat and per-protocol analyses were, respectively; group A, 86 and 91.5%; group B, 80 and 87%; group C, 82 and 89.1%. After therapy, a significant reduction in epigastric pain (P<0.001), heartburn (P=0.02), dyspepsia (P<0.001) and vomiting (P< 0.005) was observed independently of the success of H. pylori eradication. A significantly higher percentage of asymptomatic patients were in the GU-DU group than in CG group (87.7 vs 70.0%, P= 0.032). After therapy, 33 subjects still suffered from symptoms. Persistence of symptoms was significantly associated with an endoscopic diagnosis of oesophagitis and not with H. pylori infection. Patients cured of H. pylori infection showed a significant decrease in the histological activity of both antral and body gastritis (P< 0.0001), a significant drop in immunoglobulin (Ig) G anti-H. pylori antibodies (P< 0.0001) and pepsinogen (PG) C (P<0.0001) and an increase in the PGA/PGC ratio (P<0.0001). CONCLUSIONS: The 7 day, lansoprazole-based triple therapy was well tolerated and highly effective in the cure of H. pylori infection, the reduction of symptoms, chronic gastritis activity and serum levels of IgG anti-H. pylori antibodies and PGC. Persistence of symptoms after therapy was significantly higher in CG than GU and DU patients and was significantly associated with oesophagitis.
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Quimioterapia Combinada/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Omeprazol/análogos & derivados , Inhibidores de la Bomba de Protones , 2-Piridinilmetilsulfinilbencimidazoles , Anciano , Anciano de 80 o más Años , Amoxicilina/uso terapéutico , Anticuerpos Antibacterianos/sangre , Claritromicina/uso terapéutico , Femenino , Gastritis/sangre , Gastritis/tratamiento farmacológico , Gastritis/microbiología , Helicobacter pylori/inmunología , Helicobacter pylori/aislamiento & purificación , Humanos , Lansoprazol , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Omeprazol/uso terapéutico , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/microbiología , Resultado del TratamientoRESUMEN
Cardiac troponin I, a specific and sensitive marker of myocardial damage, was detected in the blood of 6 of 26 patients studied in our Heart Failure Clinic. In these patients functional class, ventricular function, and prognosis were significantly worse than in those without detectable troponin I. This study suggests that troponin I may represent the biochemical marker of myocardial damage occurring in severe heart failure.
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Insuficiencia Cardíaca/sangre , Troponina I/sangre , Anciano , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
The development of methods for the detection of circulating CK-MB mass, cardiac troponin T (cTn-T) and troponin I (cTn-I) has increased the diagnostic potential in the identification of myocardial damage. Coronary angioplasty (PTCA) represents a widely accepted revascularization procedure and a clinical model of induced ischemia. Using these new biochemical markers, we evaluated the incidence and the clinico-procedural correlates of minor myocardial damage (MMD) in a series of patients treated with PTCA in our Department. In 57 consecutive patients (75% males; mean age 58 years; range 35-80) undergoing elective PTCA from March 1 to June 30, 1995, serum levels of CK-MB mass, cTn-T and cTn-I were measured at baseline and at 6, 12 and 24 hours after the procedure. Seventy-eight coronary stenoses were dilated (mean 1.4 lesion/patient), 17 of these were in infarct-related vessels; 8 were total occlusions and 2 were located in saphenous vein grafts. Twenty-two procedures were completed by coronary stenting (17 elective). cTn-T and cTn-I were considered abnormal when serum levels were > 0.2 ng/ml and > 0.6 ng/ml, respectively. CK-MB mass was also determined in all patients (abnormal > 5 ng/ml). No patients had clinical or electrocardiographic evidence of myocardial infarction after the procedure. Overall, 16 patients (28%) developed biochemical evidence of post-procedural MMD (defined as the presence of at least one abnormal sample of any among the three markers tested). Four (7%) had abnormal CK-MB mass (at least one sample), 9 (16%) abnormal cTn-T, and 15 (26%) abnormal cTn-I. When CK-MB mass was elevated, both cardiac troponins were also elevated. In patients positive for MMD and abnormal CK-MB mass, peak cTn-I was significantly higher than in patients with normal CK-MB (3.02 +/- 1.07 vs 1.02 +/- 0.11 ng/ml; p = 0.009). The difference was not evident when comparing the same groups of patients for cTn-T (0.26 +/- 0.04 vs 0.18 +/- 0.10 ng/ml; p = 0.16). Also, peak cTn-I but not peak cTn-T had a positive correlation with peak CK-MB mass (r = 0.89; p < 0.0001 and r = 0.23; p = 0.40). The elevation of either marker of MMD was not related to clinical, angiographic or procedural variables. A possible interpretation for MMD was found in 2/3 of cases: bail-out (2); late occlusion (1); minor side branch occlusion (3); distal embolization from saphenous vein grafts (2) or total occlusions (2). In our series, MMD after PTCA occurs in 28% of cases and is unrelated to clinical, angiographic and procedural variables. Both cTn-T and cTn-I increase the sensitivity of CK-MB mass in the detection of MMD after PTCA, cTn-I being the most sensitive marker. In about 1/3 of cases, the presence of MMD remains unexplained. The prognostic implications of MMD are as yet undefined.
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Angioplastia Coronaria con Balón/efectos adversos , Creatina Quinasa/sangre , Lesiones Cardíacas/diagnóstico , Troponina I/metabolismo , Troponina/metabolismo , Adulto , Anciano , Biomarcadores , Electrocardiografía , Femenino , Lesiones Cardíacas/enzimología , Lesiones Cardíacas/metabolismo , Humanos , Isoenzimas , Masculino , Persona de Mediana Edad , Troponina TRESUMEN
The presence of Hb variants may cause analytical interference in HbA1c values measured with the HPLC techniques currently used in Italian laboratories. In this study performance of a new HPLC system, (HA-8140, Menarini) was compared with two other traditional HPLC systems (HA-8121, Menarini and Diamat, Bio-Rad). The HA-8140 system detects the Hb variant possibly present in an independent peak. The integration area of such a peak is not computed in the calculation of the percentage value of HbA1c. In this manner the underestimation of values obtained with traditional HPLC systems is avoided.
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Hemoglobina Glucada/análisis , Hemoglobinopatías/fisiopatología , Glucemia/metabolismo , Cromatografía Líquida de Alta Presión/métodos , Diabetes Mellitus/fisiopatología , Hemoglobinas/análisis , Heterocigoto , Homocigoto , Humanos , ItaliaRESUMEN
BACKGROUND: Specific data on anti-H. pylori treatments in elderly people are very scarce. The aim of the study was to evaluate in the elderly the efficacy of different anti-H. pylori therapies and the behaviour of serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio induced by the anti-H. pylori treatment. METHODS: One hundred and twenty-one dyspeptic patients aged > 60 years (mean age, 73 years; range, 61-89 years) with H. pylori-positive gastric ulcers (17 patients), duodenal ulcers (33 patients) or chronic gastritis (71 patients) were treated with one of the following anti-H. pylori treatments: (A) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days; (B) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 mg q.d.s. for 7 days; (C) omeprazole 40 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 q.d.s. for 7 days; (D) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days; (E) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days plus metronidazole 250 q.d.s. for 7 days; and (F) omeprazole 40 mg/day plus clarithromycin 250 mg b.d. for 7 days plus metronidazole 250 mg q.d.s. for 7 days. At the baseline and 2 months after therapy, endoscopy and serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio were measured. RESULTS: Ten patients (8.2%) dropped out of the study. Six patients (4.9%) reported side-effects. The eradication rates of the six regimens, expressed using intention-to-treat and per protocol analysis, were, respectively: (A) 39% and 44%; (B) 50% and 56%; (C) 65% and 77%; (D) 47% and 50%; (E) 85% and 90%; and (F) 83% and 87%. The triple therapy for regimens E and F was significantly more effective than dual therapies (regimens A and D; intention-to-treat = P < 0.007, per protocol = P < 0.001) or the triple therapy for regimens B and C (intention-to-treat = P < 0.009, per protocol = P < 0.03). Patients cured of H. pylori infection showed a significant decrease in the activity of gastritis (P < 0.0001), a significant drop in IgG anti-H. pylori (P = 0.0004) and pepsinogen C (P < 0.0001), and an increase in PGA/PGC ratio (P < 0.001), while patients remaining H. pylori-positive showed no changes in the serum parameters. CONCLUSIONS: In the elderly, triple therapy with omeprazole+metronidazole+clarithromycin for 1 week is well tolerated and highly effective; anti-H. pylori antibody and PGC serum levels decrease soon after anti-H. pylori therapy only in patients cured of H. pylori infection.
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Gastritis/sangre , Gastritis/tratamiento farmacológico , Infecciones por Helicobacter , Helicobacter pylori , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Antiulcerosos/uso terapéutico , Anticuerpos Antibacterianos/sangre , Azitromicina/uso terapéutico , Biomarcadores/sangre , Claritromicina/uso terapéutico , Quimioterapia Combinada , Inhibidores Enzimáticos/uso terapéutico , Femenino , Humanos , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Omeprazol/uso terapéutico , Pepsinógenos/sangreRESUMEN
OBJECTIVE: To assess whether and to what extent elective coronary stenting is associated with biochemical evidence of minor myocardial damage (MMD), as defined by the detection of abnormal post-procedural serum levels of one more among the following markers of ischaemic injury: creatine kinase (CK)-MB mass, troponin T (Tn-T) and troponin I (Tn-I). METHODS: Nineteen elective procedure of coronary stenting were compared with a matched group of 25 conventional percutaneous transluminal coronary angioplasty (PTCA) procedures performed in our laboratory from March to June 1995. Cases with evolving or recent (< 2 weeks) myocardial infarction, chronic total occlusions and dilation of saphenous vein grafts were excluded. By definition, all of the patients had undergone uneventful deployment of a single palmaz-Schatz stent, with no chest pain and no persistent ECG changes after the procedure. Serum levels of CK-MB mass, Tn-T and Tn-I were determined at baseline and 6, 12 and 24 h after the procedure. The frequency of abnormal results was determined for each marker. Baseline and peak post-procedural levels in the two groups were compared and related to procedural variables. RESULTS: Baseline values were normal in all cases. The quantitative analysis showed that post-procedural levels of each marker (including total CK) were significantly higher with respect to baseline in both groups. In the stent group, two patients had positive CK-MB mass, four positive Tn-T and seven positive Tn-I. Absolute changes in Tn-T and Tn-I were closely related to changes in CK-MB mass (r = 0.76, P < 0.0001; r = 0.90, P < 0.0001), respectively). Three of these patients developed clinically silent side-branch occlusion. All of them were positive for troponins and two were positive for CK-MB. No correlation was found between procedural variables and the results of biochemical assays. In the PTCA group, three patients were positive for Tn-I, whereas the CK-MB mass and Tn-T remained constantly normal. No side-branch occlusion was observed. The peak CK-MB mass and Tn-I were significantly higher in the stent group than they were in the PTCA group (3.04 +/- 4.1 versus 1.27 +/- 1.3 ng/ml, P = 0.046; 0.78 +/- 1.17 versus 0.28 +/- 0.3 ng/ml, P = 0.046, respectively). This difference was no longer apparent when patients with side-branch occlusion were excluded. CONCLUSIONS: In our series, Tn-I measurement shows the highest ability to detect MMD, being positive in 37% of stent and 14% of PTCA cases. Elective coronary stenting associated with greater release of CK-MB mass and Tn-I than is conventional PTCA. This finding is mainly determined by cases of side branch occlusion, which account for most, but not all, periprocedural MMD in the stent group.
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Enfermedad Coronaria/sangre , Enfermedad Coronaria/terapia , Creatina Quinasa/sangre , Stents , Troponina I/sangre , Troponina/sangre , Adulto , Anciano , Angioplastia Coronaria con Balón , Biomarcadores/sangre , Angiografía Coronaria , Enfermedad Coronaria/fisiopatología , Femenino , Humanos , Isoenzimas , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Troponina TRESUMEN
OBJECTIVE: To evaluate the clinical usefulness of Pepsinogen A (PGA) and C (PGC), PGA/PGC ratio, gastrin, and specific IgG anti-HP antibodies (anti-HP Ab) in monitoring the effect of cure for Helicobacter pylori (HP) infection in older people. DESIGN: We studied the changes in serum parameters (PGA, PGC, PGA/PGC ratio, gastrin and anti-HP Ab) in older patients before and 2 months after stopping therapy for the cure of HP infection. PATIENTS: Eighty-eight older patients (M = 43, F = 45, mean age = 73.3, range = 60-89) with chronic gastritis (42), gastric ulcer (14) or duodenal ulcer (32) were found HP-positive by histology of gastric antral and body biopsies and the rapid urease test. INTERVENTIONS: Two different associations of antibiotics and antiulcer drugs (omeprazole, metronidazole, azithromycin, or clarithromycin) for 2-4 weeks. MEASUREMENTS: At the beginning of the study and 2 months after treatment withdrawal, the subjects were studied by upper G.I. endoscopy with at least two antral and two body gastric biopsies (Giemsa stain and rapid urease test for HP); serum PGA (RIA method, microgram/mL), PGC (RIA method, microgram/mL), PGA/PGC ratio, gastrin (RIA method, picogr/mL), and anti-HP Ab (ELISA method, Biolife, MU/mL) were also determined. Statistical analysis was based on either the Wilcoxon test, for paired data, the chi-square test, the Kruskal Wallis test, or the Mann-Whitney test for unpaired data. The choice of the best cut-off value in the different parameters was performed by receiver operating characteristics curves (ROC) and by Youden index. The correlation between HP density in the gastric mucosa and gastritis activity was verified by Spearman rank correlation test. RESULTS: After therapy, 56/88 patients proved HP-negative (HP-eradicated: M = 30, F = 26, mean age = 73.0, range = 60-87 years), whereas 32/88 were not cured (HP-persistent: M = 13, F = 19, mean age = 73.0, range = 60-89 years). After therapy, in HP-eradicated cases, a statistically significant change was found in anti-HP Ab (75.23 +/- 8.94 vs 47.32 +/- 5.26, P < .001), PGC (21.58 +/- 1.97 vs 14.34 +/- 1.75, P < .001), and PGA/PGC ratio (8.46 +/- 0.68 vs 11.54 +/- 0.89, P < .001), but not in PGA and gastrin. On the other hand, in HP-persistent cases, anti-HP Ab, PGA, PGC, PGA/ PGC ratio and gastrin did not change after therapy. The sensitivity and specificity were, respectively, 0.62 and 0.56 for anti-HP Ab and 0.75 and 0.56 for the PGA/PGC ratio, which demonstrated the best diagnostic accuracy (68%). CONCLUSIONS: The eradication of HP from the stomach of older patients induces a rapid and significant decrease in serum levels of IgG anti-HP antibodies and PGC, with an increase in PGA/PGC ratio but not in gastrin. Unchanged serum levels of IgG anti-HP antibodies, PGC, and PGA/PGC ratio 2 months after completing HP eradication therapy are indicative of ongoing HP infection. The PGA/PGC ratio showed the best diagnostic accuracy among serum measures tested.
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Anticuerpos Antibacterianos/sangre , Monitoreo de Drogas/métodos , Gastrinas/sangre , Infecciones por Helicobacter/sangre , Helicobacter pylori , Inmunoglobulina G/sangre , Pepsinógenos/sangre , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Quimioterapia Combinada , Femenino , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/enzimología , Infecciones por Helicobacter/inmunología , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Arginine vasopressin (AVP), human atrial natriuretic peptide (hANP), and body fluid and electrolyte balance were examined during the first five days of life in eleven premature infants (birthweight 1610 +/- 240 g, gestation 30 +/- 1 weeks) receiving mechanical ventilation for respiratory distress syndrome (RDS). Plasma hANP and urine AVP concentrations were determined by radioimmunoassay on the first, third and fifth days. Arginine vasopressin urine levels remained constantly elevated during the study period (mean +/- SD 13.5 +/- 7.8 day 1, 12.0 +/- 9.9 day 3, 13.2 +/- 5.1 ng/l day 5, p = n.s.), while plasma hANP was significantly increased on the third day (626 +/- 495 vs. 298 +/- 240 pg/ml on day 1, p < .05). Urine sodium concentration, urine osmolality and osmolality and osmolar clearance were elevated significantly as well on day 3, p < .05, and correlated to hANP levels. Body weight decreased during the study by 8.2% on the third day and by 11.3% of birthweight on the fifth day. A significant increase in creatinine clearance occurred after the third day (p < .01), while free water clearance remained essentially the same during the first five days of life. We speculate that an increase in plasma hANP concentration on day 3 of life results in a natriuresis and osmolar diuresis without correlations or temporal relationships to hypervasopressinemia of the premature neonate with RDS.