Publications by authors named "Ramunni A"

In most patients only a few sessions of apheresis treatment are necessary to see the benefit. This is the case of immunological diseases when the production of a pathologic component is limited in time or in microcirculation disturbances when changes of vascular function may occur. In the first instance the acute effect is likely due to the removal of the corresponding antibody, while in the second case the improvement of the endothelium-dependent vasodilation and the reduction of blood viscosity play a major role.

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In microcirculation disorders, the therapeutic apheresis seems to have two different effects. The first, achieved after only a few sessions, is acute, consisting of drastic reduction of blood viscosity and obtained with the use of low-density lipoprotein (LDL) apheresis, rheopheresis, or fibrinogen apheresis. The second effect is long term, or chronic, and needs to be evaluated after a long course of treatment.

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Coupled plasma filtration absorption (CPFA) can increase blood pressure in septic shock and reduce fever during and after treatment. It is not able to stop the activation of intravascular coagulation and does not reduce the need for dialysis or the overall mortality.

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In 40% of patients with chronic hepatitis C, standard therapy is unable to eradicate the virus. Since the response to pharmacological treatment depends on the initial viral load, there is a rationale for reducing this load by means of apheretic depletion of the C virus. The aim of this work was to administer cascade filtration (CF) to non responder patients affected by hepatitis C (pts) before resuming the pharmacological treatment.

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Conclusions: Endothelial progenitor cells (EPCs) are a unique subtype of circulating cells with properties similar to those of embryonal angioblasts. They have the potential to proliferate and to differentiate into mature endothelial cells. EPCs are reduced in patients with vascular risk factors due to a decreased mobilization, an increased consumption at the site of damage or a reduced half-life.

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Rheopheresis comprises various types of apheresis procedures, namely double filtration plasmapheresis, LDL apheresis, and fibrinogen apheresis. These techniques are used to remove high molecular weight proteins from the circulation and have been shown to exert a protective effect on the vessel walls. The vascular protection can be attributed to pleiotropic mechanisms, especially from LDL apheresis, that safeguard against endothelial dysfunction by reducing the concentrations of proinflammatory and procoagulation factors.

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Background: Long-term treatment with low-density lipoprotein (LDL) apheresis (LA) has been shown to reduce the incidence of cardiovascular events in patients affected by familial hypercholesterolemia (FH). Data from experimental studies suggest that circulating endothelial progenitor cells (EPCs) can repair the vascular lesions caused by atherosclerosis. Since a reduction of these cells has been demonstrated to predict atherosclerosis progression, the aim of this study was to verify whether LA can increase the percentage of EPCs.

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LDL apheresis (LA), a technique employed to remove atherogenic lipoproteins, has been shown to exert a protective function on the vessel walls. This effect can be attributed to pleiotropic mechanisms that safeguard against endothelial dysfunction by reducing the concentrations of pro-inflammatory and pro-coagulation markers. Besides these actions, LA improves whole blood viscosity and endothelium-mediated vasodilation, and has a positive effect on the hemorheological picture, improving perfusion in the microcirculation.

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Article Synopsis
  • The study investigates endothelial dysfunction and microvascular reactivity in early-stage autosomal dominant polycystic kidney disease (ADPKD) before hypertension and renal impairment occurs.
  • Fifteen normotensive ADPKD patients were tested for microcirculation and various plasma parameters, showing significant differences when compared to healthy controls and hypertensive patients.
  • Results highlighted lower microvascular reactivity in ADPKD patients and elevated levels of Lp(a), suggesting that these factors may play a role in increased cardiovascular risks associated with ADPKD.
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Purpose: Verify the recovery of visual capacity after the administration of a combination of LDL apheresis (LA) and conventional therapy (CT). Design, prospective and interventional case series.

Methods: 20 patients affected by NAION were randomly subdivided into two groups of 10 patients (Group 1 and Group 2).

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Plasma exchange has been proposed as support therapy in both acute and chronic forms of multiple sclerosis (MS). For the first time, we aimed to assess whether double filtration plasmapheresis (DFPP) could be clinically efficacious. We describe the case of a patient affected by MS who developed a severe crisis refractory to conventional steroids, and immunosuppressive and immunomodulating therapy.

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Hepatitis C virus (HCV) is the major cause of cryoglobulinemia. Skin lesions are frequent and can be cured from the removal of cryoglobulins by therapeutic apheresis. We describe a case of HCV-positive type I cryoglobulinemia with severe leg ulcers, not responsive to antiviral and immunosuppressive treatment.

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Hypothesis: The aim of the present study was to evaluate the concentration of soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule 1 in patients affected by sudden sensorineural hearing loss (SSHL).

Study Design: Prospective study.

Setting: Tertiary referral center.

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Background: Fibrinogen is mainly responsible for determining the viscosity of whole blood. In peripheral arterial disease (PAD) the fibrinogen concentration seems to affect the microcirculation flow.

Aim: To study the effects of an abrupt reduction of fibrinogen on the hemodynamics of the lower extremities and the clinical picture of patients with PAD.

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During hemodialysis, ultrafiltration (UF) seems to affect the dialytic dose because of convective removal of urea and contraction of its distribution volume. We aimed to assess whether the adoption of a decreasing UF profile could yield a different dialytic dose from that obtained with a constant UF mode. Ten patients were randomly assigned to undergo 12 sessions with a constant UF mode (phase A) followed by 12 sessions with a decreasing UF rate (phase B), or the reverse.

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Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (LDLA). Three weekly sessions of LDLA were administered in 23 patients affected by nonarteritic ischemic optic neuropathy.

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Sudden hearing loss (SHL) is a highly disabling affliction that can severely affect the subject's social and relational life. Although the etiology of the complaint is still debated, it is thought that microcirculation disturbances conditioned by an endothelial dysfunction might be the main pathogenetic mechanism. Adhesion molecules favoring interaction between leukocytes and endothelial cells are early markers of endothelial damage.

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Background: The primary antiphospholipid syndrome (PAPS) is characterized by the presence of circulating antiphospholipid antibodies, clinically associated with blood hypercoagulability. Renal involvement in course of PAPS is very frequent, although the true prevalence of PAPS-correlated kidney disease is difficult to estimate.

Materials And Methods: We reviewed 270 consecutive renal biopsies examined in our Nephrology Division of Bari University Hospital between 1998 and 2004 to identify those performed in patients with PAPS.

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Nonarteritic acute anterior ischemic optic neuropathy (NAION) is a disabling disease which impairs visual function. It is presumed to result from disturbances of microcirculation in the anterior portion of the optic nerve head due to hemodynamic factors derived from excessive blood viscosity, or restriction of the vasal lumen in hypertensive, hypercholesterolemic, diabetic patients. We aimed to determine whether acute reduction of plasma fibrinogen and serum low-density lipoprotein (LDL) cholesterol is effective for treatment of NAION.

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Purpose: Hereditary hemorrhagic telangiectasia (HHT) is a genetic angiodysplasia affecting multiple organs. Clinical manifestations include spontaneous and recurrent epistaxis, mucocutaneous telangiectases that bleed easily and arteriovenous malformations in many organs. Despite the anecdotal recommendations of some groups, to our knowledge information regarding the prevalence of microscopic hematuria (MH) in patients with HHT has not been reported to date.

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Aim: The Cockcroft and Gault formula is a quick and reliable method for calculating creatinine clearance without a 24-hour urine collection (CG-cl). In obese subjects an excess of fat mass provokes a reduction in daily creatinine urine excretion per body kilo weight and is responsible for overestimated renal function when calculated by CG-cl. The aim of this study was to devise a simple correction method which could also make use of CG-cl in obese subjects.

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Acute anterior ischemic optic neuropathy (AION) is a disabling disease which impairs visual function. Standard treatment is unable to affect the outcome and the visual damage persists. We describe the case of a 64-year-old patient affected by AION, whose only known risk factor was hypercholesterolemia.

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Article Synopsis
  • Activation of the renin-angiotensin system (RAS) may increase renal vascular resistance (RVR) and contribute to hypertension in autosomal dominant polycystic kidney disease (ADPKD) patients.
  • A study involving 34 ADPKD patients, divided into hypertensive and normotensive groups, found that plasma renin activity (PRA) was normal in both groups, but RVR was significantly higher in hypertensive patients.
  • The results indicate a strong correlation between RVR and mean arterial pressure (MAP), suggesting that factors other than RAS are likely involved in early hypertension development in ADPKD patients without renal impairment.
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Central diabetes insipidus (CDI) arising in the puerperal period has been attributed mainly to Sheehan's syndrome or to lymphocytic infundibulo-neurohypophysitis. We report the case of a 24-year-old woman who came to our observation for the appearance, 3 weeks after a normal delivery, of a polyuric-polydipsic syndrome. Measurements of urinary volumes, plasma osmolality and urinary osmolality, in conditions of free water intake, water deprivation and a water deprivation-vasopressin administration test, demonstrated CDI.

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Antihypertensive drugs may have an important effect on glomerular haemodynamics. In chronic nephropathy patients, we compared the effect on glomerular haemodynamics of two second-generation dihydropyridinic agents, nitrendipine and amlodipine, with a first generation dihydropyridinic agent and an ACE-inhibitor, enalapril. In all, 32 patients (pts), divided into four groups, received the different drugs: ENA (enalapril, eight pts), NIF (nifedipine, eight pts), NIT (nitrendipine, eight pts) AML (amlodipine, eight pts).

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