[Report of the National Renal Ultrasound Study Group on the ultrasound activity of nephrology care units in Italy]. / Report del gruppo di studio nazionale di ecografia renale sull'attivita' ecografica delle U.O. di Nefrologia in Italia.

The presence of operational and organizational differences in the use of ultrasonography in Italian nephrology units has prompted this survey on a nationwide scale. The survey was carried out by questionnaire and included questions about the activity and equipment of each nephrology unit, dedicated personnel and relevant training, and the fields of ultrasonography application. Seventy-five percent of the contacted care units replied to the questionnaire. Twenty-six percent of these performed their ultrasound examinations outside the care unit, sharing equipment with other units. The mean lifetime of ultrasound devices was longer (5.8 years) than allowed by the electro-medical equipment regulations. In spite of an increasing number of nephrologists with ultrasonographic expertise, in each care unit the percentage of physicians performing ultrasound examinations was very low. The number of operators who learned this methodology directly at surgeries using ultrasound devices was higher than that of operators who attended training courses and obtained the relevant certificates. In addition to the kidneys and urinary tract, other body districts investigated included abdominal organs, parathyroids, vascular access for hemodialysis treatment, and the bone-joint system. Moreover, ultrasonography was widely used for surgical procedures in nephrology. However, in spite of the widespread application of ultrasound imaging, the use of radiology was unexpectedly high (80%). Finally, the questionnaire results evidenced the particular care of nephrologists towards follow-up for situations of nephrological interest, such as acquired renal cysts, vascular access visualization, and monitoring of parathyroids.

Extracorporeal blood oxygenation and ozonation (EBOO) in man. preliminary report.

Autohemotherapy with ozone has been used for four decades with encouraging results but, owing to the lack of clinical studies, it has never been adopted by orthodox medicine. Confident of the valid principles of ozone therapy, we have endeavoured to increase its therapeutic efficacy. Over a ten-year period we have developed an apparatus that makes it possible to treat large quantities of blood with ozone in extracorporeal circulation (extracorporeal blood oxygenation and ozonation EBOO). One of us volunteered to test the system and after six treatments noted the disappearance of two lipomas. This prompted us to treat a patient with Madelung disease and several patients with atherosclerotic vasculopathy. Besides showing therapeutic effects, the preliminary results indicate that EBOO is clinically valid, without side-effects and worthy of testing in various diseases.

A new method of evaluating urinary erythrocyte dysmorphisms (UED) in glomerulonephritis.

A new method of evaluating urinary sediment, based on electronic processing of the images obtained by traditional microscopy, has been developed. Preliminary data suggests that the method can clarify many doubts on the real diagnostic value of UED.

Bleeding tendency of chronic uremia improved by vascular factor.

Complex hemostatic changes in uremic patients are characterized by platelet distress and prolonged bleeding time. Dialysis corrects platelet function and improves the bleeding time but introduces a tendency to thrombophilia. The uremic patient is thus an excellent model for the evaluation of hemostatic drugs. VUEFFE (VF) is a new hemostatic agent which reduces bleeding time without modifying clotting parameters. Changes in hemostasis and coagulation were studied in 42 hemorrhagic uremic subjects in dialysis or on conservative management. The patients were divided into two groups, one of which was given oral VF and the other oral placebo. 84% of those receiving VF ceased bleeding within 15 days (compared to 25% for placebo) and there was a significant reduction in bleeding time. The drug can be given orally or parenterally, is well tolerated and without side effects, making it suitable for administration to hemorrhagic uremic patients.

Morphology of the peritoneal membrane during continuous ambulatory peritoneal dialysis.

In the last 3 years we performed 52 peritoneal biopsies (PB) in 31 patients on continuous ambulatory peritoneal dialysis (CAPD). Samples of the parietal peritoneum were obtained either during insertion of the catheter or while it was being repositioned or removed. PB was performed in 13 patients before initiating CAPD and in 27 after 7-49 months of CAPD while 7 had PB during peritonitis, and, again, in 5 of these cases, PB was repeated after 1-4 months for light, electron transmission, and scanning electron microscopy. BP after CAPD showed that mesothelial cells were irregularly spaced, and at times we observed alterations in the cellular structure. Rarely were these cells degenerating, while rarefaction and in many cases complete absence of microvilli were observed. In some cases the submesothelial layers showed rarefaction of the connective tissue and sclerosis. During peritonitis, PB showed more alterations with marked degeneration and in some cases necrosis of the mesothelium and alterations of connective tissue. PB performed some months after peritonitis showed only a partial regression of these alterations and sclerotic patches, and no microvilli were noted in the mesothelium.

Phosphatidylcholine and peritoneal transport during peritoneal dialysis.

Peritoneal effluent of patients on chronic ambulatory peritoneal dialysis (CAPD) contains a surface-active material (SAM) made up of phospholipids and showing phosphatidylcholine on thin-layer chromatography. This substance drastically lowers surface tension, helps to repel water and has a lubricating effect. The presence of stratified phosphatidylcholine on the peritoneum might narrow the stagnant dialysate fluid layer and situations which can alter the quantity or composition of SAM may affect peritoneal transport and also, perhaps, the formation of adherences. This led us to verify, experimentally, the presence of phospholipids in basal conditions, after CAPD and during peritonitis and to check if addition of phosphatidylcholine to dialysis liquid is able to modify water transport in patients with low ultrafiltration and peritonitis. Phospholipids in the dialysis effluent of patients who have been on CAPD for a long time are lower than observed in the first days of peritoneal dialysis. A more drastic, significant decrease in phospholipids was observed in patients with low ultrafiltration and in patients with peritonitis. Mean ultrafiltration significantly increases in patients with low ultrafiltration and in those with peritonitis during dialysis exchanges containing phosphatidylcholine (50 mg/l) indicating that the latter is able to restore normal physiological conditions.