[Nutritional and Functional assessment of peritoneal dialysis patients in the clinical practice: Report from MITO-DP Group]. / Valutazione Nutrizionale e Funzionale dei pazienti in dialisi peritoneale nella pratica clinica: l'esperienza del Gruppo Medico-Infermieristico Toscano di Dialisi Peritoneale (M.I.TO.-DP).

Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice. The study includes all the 133 prevalent patients (80 m, 53 f, age 65 14 years), in peritoneal dialysis treatment (vintage 26 19 months) in 9 centers in Tuscany. We performed anthropometry, bioimpedance (BIA), clinical biochemistry, evaluation of habitual physical activity (RAPA tests) and performance (Sit-To-Stand test), appetite-evaluation questionnaire, and indices including the Malnutrition Inflammation Score (MIS), Geriatric Nutrition Risk Index (GNRI), Charlson comorbidity index, Barthel and Karnowsky index. The latter showed a condition of dependence in 7.2% and 19.7% of cases, respectively. Poor appetite was recorded in 48.2%. The majority of patients fell within the overweight / obesity range (51%) with waist circumference values associated with increased cardiovascular risk in 51% of males and 60% of females. At the BIA analysis, a BCMI <8 kg/m2 was detected in 39% of patients; an estimated protein intake <1.0 g / kg/d was found in 59% of cases; 34% of patients had serum albumin <3.5 g / dl; control of acidosis was good (bicarbonate 25.4 3.8 mM) but hyperphosphatemia was present in 64.6% of patients. A condition of sedentary or light physical activity was reported by 65.1% of patients, vigorous activity only by 11.9%. The 86.5% of patients able to perform the Sit-to-stand test reported a lower than the reference values for age and sex. A diagnosis of PEW was possible in 8% of our series, while a MIS score> 11, indicative of PEW, took place in 12.7% of cases. The values of the MIS correlated directly with age and the degree of comorbidity and inversely with the sit-to-stand test, RAPA tests and appetite level. The data in this study show that single tests indicative of malnutrition disorders are frequent to be found in our series of peritoneal dialysis patients. However, a diagnosis of PEW is quite infrequent. A large percentage of patients are overweight with increased abdominal adiposity, and reduced cell mass and protein intake below recommended levels; the level of habitual physical activity is low, and the level of physical capability is scarce. Therefore it is conceivable a nutritional counseling intervention to increase the intake of proteins, limiting the phosphorus and (when indicated) energy intake and to stimulating spontaneous physical activity or arranging assisted programs for functional rehabilitation. Close monitoring of the nutritional status and implementation of programs of adapted physical activity should have a prominent role in the clinical management of patients on peritoneal dialysis.

[Use of a new type of permanent caval filter in a case of recurrent pulmonary embolism]. / Utilizzazione di un nuovo tipo di filtro cavale definitivo in un caso di embolia polmonare recidivante.

We describe a case of postoperative recurrent pulmonary embolism, treated with a percutaneous caval filter ("Double hooks DF 06-Filcard"), that was useful for stemming the tide of venous thromboembolism starting from right leg deep venous thrombosis. We discuss diagnostic protocols, current indications to caval filtration, and the characteristic of an ideal caval filter.

Clinical experiences with Ro 15-1788 (anexate) in benzodiazepine and mixed-drug overdoses.

Benzodiazepine overdose is the most common of admission to the Toxicological Unit of the University of Florence. The aim of this study has been to evaluate the efficiency of Ro 15-1788 in benzodiazepine and mixed drug overdoses. The administration of Ro 15-1788 was followed by a quick reversal of central nervous system depression and was more effective in benzodiazepine overdoses than in mixed drug overdoses. The dose was titrated individually and the range 2-10 mg was effective according to the conditions of the patient. In some cases, the comatose state relapsed; further administration of Ro 15-1788 again promptly reversed the condition. On awakening, two patients displayed anxiety and restlessness.

The release of histamine by parasympathetic stimulation in guinea-pig auricle and rat ileum.

Two preparations, a segment of rat ileum and the vagally innerved guinea-pig auricles, have been used in an analysis of the responses to vagal or to electrical field stimulation. The responses to parasympathetic stimulation were depressed by atropine and by tetrodotoxin, and potentiated by eserine. Supramaximal stimulation (10-20 Hz) resulted in increased release of acetylcholine and histamine, both in rat ileum and guinea-pig auricles. The release of histamine after parasympathetic stimulation did not exhibit tachyphylaxis, and it was not reproduced by non-parasympathetic stimuli. In both preparations, atropine produced a significant, dose-related reduction of histamine measured in the bath fluid after stimulation, while eserine increased histamine output. A significant diminution of mast cell granules metachromasia was observed in guinea-pig auricles and in rat intestine after parasympathetic stimulation. The possibility is discussed that acetylcholine released by parasympathetic stimulation would in turn evoke the secretion of histamine from tissue mast cells.

Mediator release from isolated rat ileum in response to field stimulation.

The effect of electrical field stimulation on mediator release from the isolated rat ileum was evaluated by recording the muscle responses and by measuring acetylcholine and histamine appearing in the perfusion fluid. In the presence of cholinesterase inhibitors, supramaximal field stimulation (10 Hz) resulted in twitch responses accompanied by an increased release of acetylcholine. The resting output of histamine was measurable also in the absence of inhibition of cholinesterases, and neatly increased during electrical stimulation. Atropine produced a dose-related decrease in the release of histamine from electrically stimulated muscle, while eserine extends the time-course of the contractile response and of the histamine release as well. The results are discussed in the context of the role ascribed to acetylcholine as a physiological modulator of histamine release.

Histamine release by vagal stimulation.

The content of acetylcholine and histamine in the effluent of isolated, vagally innerved guinea-pig auricles was determined. Spontaneous or stimulation-induced overflow of acetylcholine was detected only in the presence of acetylcholinesterase inhibitors. The histamine overflow was measurable also in the absence of inhibition of cholinesterase, and neatly increased during vagal stimulation. The vagally evoked histamine overflow was blocked by atropine and potentiated by eserine. The stimulation-induced histamine overflow in the effluent is discussed, presumably assuming that acetylcholine may release histamine from cardiac histamine stores.