Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Pathology of Serratia marcescens mastitis in cattle

Microbiological, cytological, histopathological, and immunohistochemical investigations were carried out on four dairy cows affected by Serratia marcescens mastitis. The animals under study were from a herd of 120 lactating cows bred in the province of Rome. In the above herd, S. marcescens mastitis showed a prevalence of 20.8%. S. marcescens was the only bacterial agent isolated, prior to and after slaughter, from the teat milk, the mammary gland and the supramammary lymph nodes of the four cows under study. Cytologically, the four subjects exhibited high cell counts in their milk, with an average of up to 5,570,000 cells/ml in S.marcescens-infected quarters. Macroscopically, nodular lesions were apparent scattered throughout the mammary parenchyma, with enlargement of the regional lymph nodes. Histologically, a chronic, non-purulent mastitis, characterized by a marked fibrous tissue proliferation and the coexistence of corpora amylacea within the glandular alveoli, was observed in association with chronic hyperplastic lymphadenitis involving the supramammary lymph nodes of the four cows. Immunohistochemically, S. marcescens was demonstrated, by means of monoclonal antibodies, both in the mammary gland and in the supramammary lymph nodes from these four animals.[...

Circular hemorrhoidectomy in advanced hemorrhoidal disease

BACKGROUND/AIMS: Milligan-Morgan's hemorrhoidectomy has a high recurrence rate (> 10%) in patients with circular IV grade hemorrhoids. In such cases a circular hemorrhoidectomy with complete elimination of residual piles, and anoplasty might be more successful. The aim of this retrospective study was to compare the results of circular hemorrhoidectomy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrhoidal disease. METHODOLOGY: From January 87 to December 96, 100 consecutive patients with circular IV grade hemorrhoids underwent radical hemorrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients were strictly controlled in the postoperative period and in cases of early fibrosis anal dilators were used. RESULTS: Eighty one percent of patients had a complete recovery. The recurrence rate was 4%. The cumulative rate of early and late complications was 34%. Early and late hemorrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same. CONCLUSIONS: The HLB operation is the best choice for patients with advanced circular hemorrhoids because of its radicality and good results. The postoperative morbidity of HLB hemorrhoidectomy is higher than traditional hemorrhoidectomy; nevertheless, all complications are tractable without extension of hospital sta