[Treatment of HCV-associated cryoglobulinemic glomerulonephritis]. / Terapia della glomerulonefrite secondaria a crioglobulinemia HCV-correlata.

HCV-related membranoproliferative glomerulonephritis is the most common cause of hepatitis C-associated renal disease. Its treatment is still under debate and based on scant experimental evidence. The recommended therapeutic strategy depends on the severity of the kidney disease. The first-line treatment for patients with mild to moderate clinical and histological kidney damage is antiviral therapy with pegylated interferon alpha and ribavirin for 48 weeks combined with symptomatic treatment (diuretics, angiotensin converting enzyme inhibitors and angiotensin receptor blockers). In case of severe renal involvement (nephrotic syndrome, nephritic syndrome and/or progressive renal failure, high activity score of glomerulonephritis on light microscopy), the initial treatment may consist of sequential administration of immunosuppressive therapies (plasmapheresis, corticosteroids and cyclophosphamide) and antiviral agents, although no definitive data are yet available from the literature. B-cell depleting agents such as rituximab may be an alternative to conventional therapy in refractory or intolerant patients. Large randomized and controlled clinical trials are needed to establish guidelines for the treatment of HCV-related cryoglobulinemic glomerulonephritis.

Postural control in patients with total hip replacement.

AIM: The aim of this study was to investigate the balance of the standing position and the motor responses by means of dynamic posturography (DP) in patients affected by hip osteoarthritis and treated by total hip replacement (THR). METHODS: Data obtained from THR patients were compared with those of control adult groups ofage-matched subjects with normal hearing and no history of audio-vestibular symptoms. The statistical tests used were paired and unpaired Student's t-test. Significance was set for P<0.05. The study was carried out at the Department of Otorhinolaryngology and Department of Physiatrics and Rehabilitation of the A. Gemelli University Hospital of Rome (Italy). Twenty-three consecutive patients, without cochleo-vestibular or neurological pathologies (screened by accurate case-history), affected by hip osteoarthritis and treated by THR were enrolled. The main outcome measure were Sensory Organization Test (SOT), Motor control test (MCT) and Adaptation test (AT) obtained by means of Equi-Test Dynamic Posturography System by NeuroCom (Int. Inc., Clackamas, OR, USA). RESULTS: When analysing the SOT and MCT, no statistically significant differences were observed between patients and controls. In the AT, the sway energy score decreased in the course of the test in an up and down perturbation both in healthy and in THR patients. CONCLUSIONS: These data confirm a normal postural control and symmetrical responses in THR patients and confirm the absence of a detectable relationship between balance problems and fall risk. These results could be justified by an irrelevant role of intracapsular proprioceptors in maintaining balance. Moreover DP could be useful in osteo-articular diseases for understanding balance, evaluating surgical outcome and monitoring the rehabilitation program.

[Hypertension in patients on hemodialysis: the role of salt intake]. / L'ipertensione arteriosa nell'uremico in emodialisi: importanza dell'intake di sale.

In the 1960s, about 10% of hemodialysis (HD) patients had hypertension; the current percentage of hypertensive patients has risen to 70-75%. The scarce implementation of low-salt diets and the increment of dialysate sodium concentration aimed at ameliorating treatment tolerability are the main causes of the currently poor hypertension control. Considerable sodium intake activates a vicious circle: an increase in serum osmolarity, greater thirst and greater water intake, high inter-dialytic weight gains, need for large ultrafiltration rates, more frequent episodes of intradialytic hypotension, failure to achieve dry weight, progressive extra-cellular volume (ECV) expansion, and finally, blood pressure (BP) increase. Therefore, many studies have pointed out the importance of a low-salt diet in HD; it has been proven that the normalization of BP and ECV overload with a low-salt diet is associated with left ventricular hypertrophy regression and diastolic dysfunction improvement. Preparing meals with fresh foods, using spices, avoiding salt when cooking, and drastically limiting salty foods reduce dietary sodium down to about 6 g/day. Sodium intake during inter-dialytic periods can easily be assessed by measuring the changes in serum sodium concentration and in body weight.

Endovascular vs. open surgery of abdominal aortic aneurysm in high-risk patients: a single center experience.

BACKGROUND: We compared two groups of high-risk patients with abdominal aortic aneurysm to assess the safety and efficacy of endovascular repair vs. open surgery. METHODS: From January 1998 to July 2003, sixty-two high-risk patients were divided into two groups: group A consisted of 28 (46 %) open surgery patients and group B consisted of 34 (54 %) patients who underwent endovascular repair. RESULTS: Four patients (14.3 %) in the open surgery group died, while no deaths occurred in the endovascular group ( p < 0.05). There were 14 complications in 8 patients of the open surgery group versus 2 complications in 2 patients of the endovascular group ( p = 0.01). At follow-up there were 4 (16.6 %) deaths in group A and 3 (8.8 %) in the endovascular group ( p = n. s.). CONCLUSIONS: While the use of endovascular repair in patients who are physiologically fit for open surgical repair remains controversial, we believe that patients with multiple or advanced comorbidities, i.e. high-risk patients, can benefit from the endografting procedure.

[Anesthesia, awareness and wakefulness]. / Anestesia, coscienza e vigilanza.

Drugs used in anesthesia do not always produce the expected neurophysiological results. By studying those cases in which the reappearance of intraoperative awareness is most common, an attempt was made to estimate how many and which levels of cerebral function could be identified. Four levels were recognised: awareness with or without memory, and wakefulness with or without dreams. These conditions are related to greater or lesser cortical activity. They can be identified using Tunstall's technique and by carefully interviewing the patient immediately after the operation.