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61.
Laura De La Higuera Emma Riva Codjo Djignefa Djade Sara Mandelli Carlotta Franchi Alessandra Marengoni Francesco Salerno Salvatore Corrao Luca Pasina Mauro Tettamanti Maura Marcucci Pier Mannuccio Mannucci Alessandro Nobili 《Internal and emergency medicine》2014,9(7):735-747
A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m2, reference group), group 2 with moderately reduced eGFR (30–59 ml/min/1.73 m2) and group 3 with severely reduced eGFR (<30 ml/min/1.73 m2). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 % CI 1.20–7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 % CI 0.54–1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 % CI 0.92–4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 % CI 1.13–5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization. 相似文献
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Membranous glomerulonephritis secondary to allogeneic stem cell transplant: review of the literature
Vischini G Niscola P Ferrannini M Cupelli L Tendas A Scaramucci L Giovannini M Dentamaro T de Fabritiis P Palumbo R 《Giornale italiano di nefrologia》2012,29(4):394-403
Renal injury associated with hematopoietic stem cell transplant (HSCT) may be related to a combination of factors. Chronic graft-versus-host disease (cGVHD) is the most common complication of allogeneic HSCT. Although the kidneys are not considered the primary target organs for GVHD, chronic impairment of renal function may occur in 20% to 60% of HSCT patients. Membranous glomerulonephritis (MG) is the most frequent renal complication observed in patients who develop nephrotic syndrome after allogeneic HSCT. In this setting, the pathogenesis of MG is not clearly understood and the most appropriate treatment approach has not been established. In order to summarize the current knowledge on this issue, a review of the pertinent literature has been performed. The available data on MG diagnosed in patients submitted to allogeneic HSCT were identified using the MEDLINE database (last accessed: Jan 30, 2012). Fifty-nine patients with allogeneic HSCT-related MG with a median age of 43 years were identified. MG occurred at a median time of 17 months after allogeneic HSCT. A history of acute or concomitant clinically apparent cGVHD was present in 69% and 31% of cases, respectively. cGVHD, nonmyeloablative conditioning regimens, immunosuppression withdrawal, and the use of peripheral blood stem cell grafts were identified as risk factors. Among the 53 patients with available outcome data, complete remission, partial response, and inefficacy of treatment were recorded in 65%, 22% and 13% of cases, respectively. MG after allogeneic HSCT seems to be etiologically related to subclinical or overt cGVHD, which flares up after discontinuation of immunosuppression. The available measures can induce sustained long-term remission in about two-thirds of affected patients. 相似文献
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Marco Sagripanti Carlotta Viti 《Cranio : the journal of craniomandibular practice》2013,31(6):381-389
Objectives: Central sensitization (CS) has been found in patients with temporomandibular disorders (TMD), craniofacial pain (CP) and primary headaches, but its clinical implications remain uncertain. The first aim was to provide a synthesis of the current state of knowledge about the link between CS and TMD associated with primary headaches; the second goal was to find methodologies to assess and treat CS in this subgroup of patients. Methods: A narrative review of the literature was conducted. Results: CS is described in literature as an aggravating factor in patients with TMD-related primary headaches. Further studies are required to support this assertion. Conclusions: The importance of excluding chronic neuropathic pain and recognizing CS as the main component using a top-down approach to target the best pharmacological and non-pharmacological treatments is evident. Some useful tools to discriminate patients with CS from others have become available, but more research is required to enable an appropriate diagnosis. 相似文献
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Alessandro Buda Cuzzocrea Marco Carlotta Dolci Federica Elisei Romina Baldo Luca Locatelli Rodolfo Milani Cristina Messa 《International journal of surgery case reports》2013,4(10):809-812
INTRODUCTIONOccult endometrial cancer after supracervical hysterectomy is very uncommon. Even if optimal management of those rare cases is still unproven, to guide the need for further therapies, restaging should be recommended in this situation.PRESENTATION OF CASEWe report of a 60-year old woman with occult high risk endometrial cancer after supracervical hysterectomy with morcellation. We describe the feasibility of laparoscopic intraoperative sentinel node identification with cervical stump removing to restage the suspicious early stage high risk endometrial cancer.DISCUSSIONIn high risk endometrial cancer surgical restaging is important, considering that 10–35% of cases can present pelvic nodal metastasis. To reduce the treatment related morbidity maintaining the benefit of surgical staging, with a negative preoperative PET/CT, we performed a laparoscopic SN mapping with cervical stump removing.CONCLUSIONThis report highlight the fact that SN mapping with cervical injection is a feasible and safe technique also without the uterine corpus after supracervical hysterectomy with morcellation. 相似文献
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Damiano Pasqualini Loredana Bergandi Luigi Palumbo Alberto Borraccino Valentina Dambra Mario Alovisi Giuseppe Migliaretti Gaetana Ferraro Dario Ghigo Serena Bergerone Nicola Scotti Mario Aimetti Elio Berutti 《Journal of endodontics》2012