Effect of different dialyzer membranes on serum angiotensin-converting enzyme during hemodialysis.

The effects of different dialyzer membranes on serum concentration of angiotension-converting enzyme (ACE) and white blood cells during hemodialysis were examined on a cross-over basis in 20 chronically uremic patients. Hemodialysis with cuprophane membranes was associated with a significant (p less than 0.001) fall in the mean leukocyte count during the 1st hour of treatment. The use of polymethylmethacrylate membranes resulted in a more attenuated form of leukopenia and with polyacrylonitrile membranes no change was observed during hemodialysis. Hemodialysis with each membrane caused a comparable, significant (p less than 0.005) increase in serum ACE, independent of the degree of leukopenia but significantly (p less than 0.001) correlated with the increases in serum proteins. We conclude that this increase in serum ACE concentration after hemodialysis does not reflect acute damage of the pulmonary vascular endothelium during treatment and most probably is a result of hemoconcentration. Therefore, serum ACE analysis is not an indicator of dialyzer membrane biocompatibility.

Red blood cell volume distribution width (RDW) in uraemic patients on chronic haemodialysis.

Red blood cell volume distribution width (RDW) was obtained with the Coulter counter in 60 haemodialysis patients and 55 normal individuals. RDW tended to be higher in the former and the degree of increase was to some extent correlated with the underlying nephropathy. Although RDW failed to correlate with conventional tests of iron status, it was observed that iron administration could produce a decrease toward normal in RDW and a parallel increase in haemoglobin when the initial RDW was increased. In contrast, the response to iron was negligible in the patients with normal RDW basally. It was concluded that high RDW is an acceptable indicator of iron deficiency in haemodialysis patients.

Ultrasound-guided percutaneous needle aspiration biopsy of peripheral pulmonary lesions.

Percutaneous needle aspiration (PCNA) biopsy of pulmonary lesions is usually performed under fluoroscopic or computed tomographic guidance. In subpleural lesions, PCNA may be performed under ultrasonographic guidance. In this study, the diagnostic results of ultrasound-guided PCNA in 45 patients with peripheral pulmonary lesions of unknown aetiology are evaluated. The overall diagnostic yield was 80% (36/45). The most important factor affecting the success rate was the nature of the lesion. The diagnostic yield was 92% (33/36) in malignant lesions, but only 33% (3/9) in benign lesions. The size of the lesions did not affect the success rate. None of the patients had complications. Ultrasound-guided PCNA is a quick cheap ionizing radiation-free procedure and may be a valid option in the diagnosis of peripheral lesions. The real-time monitoring, possibility of driving the needle into solid nonnecrotic areas and visualization of the vessels surrounding the lesions make the procedure effective and safe. The major limitation of the method is that the nodule from which a biopsy is to be taken must be close to the visceral pleura, and thus detectable by ultrasound.

[Iproniazid-induced acute hepatitis]. / Epatite acuta da iproniazide.

Many drugs can cause an acute liver damage. The patient history is the guideline for diagnosis. Iproniazid, a monoamine-oxidase inhibitor not for sale in Italy, can frequently cause severe acute hepatitis. A case of acute iproniazid-induced, hepatitis in which the course was favourable, is reported.

Lack of evidence for the role of secondary hyperparathyroidism in the pathogenesis of uremic thrombocytopathy.

The possible relationship between platelet dysfunction and secondary hyperparathyroidism (HPT) in chronic renal failure was examined in 23 uremic patients on conservative therapy (group I) and in 27 patients on maintenance hemodialysis (group II). Platelet function was assessed by measuring the degree of aggregation in response to various concentrations of adenosine diphosphate. Secondary HPT was evaluated by means of serum biochemistry (parathyroid hormone, calcium, phosphorus, and alkaline phosphatase) and radiographic examinations (x-ray films of the hand skeleton). This study showed impaired platelet aggregation in group I patients, compared to either group II patients or controls. There were no significant differences when group II patients were compared to controls. No significant correlations between platelet aggregation and the hematochemical changes associated with secondary HPT were found. No differences in platelet aggregation were found with regard to the activity (alkaline phosphatase) and the severity (x-ray findings) of secondary HPT. Effective treatment of secondary HPT with 1,25-dihydroxycholecalciferol in both group I and group II patients was not associated with consequent changes in platelet aggregation. It is concluded that secondary HPT is probably not a major factor in the pathogenesis of platelet dysfunction in chronic renal failure.

Primary non-Hodgkin's lymphoma of the esophagus.

Esophageal involvement of non-Hodgkin's lymphomas is extremely unusual; primary lymphoma of the esophagus is even less common. This report describes a case of malignant small lymphocytic-plasmacytoid lymphoma with primary esophageal localization. Endoscopic diagnosis was confirmed by histological examination of a large portion of tumoral tissue spontaneously expelled after esophagogastroscopy. Lymph nodes, bone marrow, and other gastrointestinal sites were not involved in the disease. We describe the clinical history of the patient, with the remissions induced by chemotherapy, over a 5-yr observation up to the patient's death, which was not directly related to the tumor.