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Unexpected hypercalcemia in a diabetic patient with kidney disease

World Journal of Nephrology 2015年第3期4卷 438-443页

作者： Rosaria Lupica Michele Buemi Alfredo Campennì domenico Trimboli Valeria Canale Valeria Cernaro domenico santoro Department of Clinical and Experimental Medicine Division of Nephrology and DialysisUniversity of Messina Nuclear Medicine Unit Department of Biomedical Science and of Morphological and Functional ImagesUniversity of Messina

We report a case of a diabetic patient with progressive chronic kidney disease and unexplained hypercalcemia. This unusual presentation and the investigation of all possible causes led us to perform a renal biopsy. The systemic sarcoidosis diagnosis was confirmed by the presence of interstitial multiple granulomas composed of epithelioid and multinucleated giant cells delimited by a thin fbrous reaction, and by pulmonary computed tomography finding of numerous lumps with ground-glass appearance. Sarcoidosis most commonly involves lungs, lymph nodes, skin and eyes, whilst kidney is less frequently involved. When it affects males it is characterized by hypercalcemia, hypercalciuria, and progressive loss of renal function. Early treatment with steroids allows for a gradual improvement in renal function and normalization of calcium serum values. Otherwise, the patient would quickly progress to end stage renal disease. Finding of hypercalcemia in a patient with renal failure must alert physicians because it may be a sign of several pathological entities.

关键词： Biopsy Granulomatous Hypercalcemia Kidney Sarcoidosis

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Ego strength and health: An empiric study in hemodialysis patients

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Health 2012年第12期4卷 1328-1333页

作者： Salvatore Settineri Carmela Mento domenico santoro Agostino Mallamace Guido Bellinghieri Vincenzo Savica Biagio Ricciardi Santina Castellino domenico Mallamace Department Department of Clinical and Experimental Medicine and Pharmacology University of Messina Messina Italy Department of Human and Social Sciences University of Messina Messina Italy Department of Nephrology University of Messina Messina Italy Department of Neurosciences Psychiatric and Anaesthesiological Sciences Division of Psychiatry University of Messina Messina Italy Nephrology and Dialysis Units Papardo Hospital Messina Italy Researcher in Nephrology Department of Internal Medicine University of Messina Messina Italy Unit of Nephrology ASP5 Milazzo Hospital Milazzo Italy Unit of Nephrology ASP5 Taormina Hospital Taormina Italy

Introduction: Ego strength represents an important variable that could be predictable about health and compliance in chronic diseases. In this study we propose a new questionnaire, E.F.E. “Ego Functioning Experience”, able to reveal the psychological functioning profile in Hemodialysis patients. The aim of this work, is to underline the existing relations between emotional profile and compliance, whit E.F.E., that may be predictive of a state of psychologycal health in hemodialysis patients. Methods: Study population included 90 hemodialysis patients. The study protocol was made by three psychological tests: the E.F.E. Questionnaire, the DMI, the Self-Liking and Self-Competence Scale. Results: Factor analysis extracts three factors: 1) “Need of Ego support”;2) “Ego activity oriented to treatment”;3) “Ego strength”. The correlation coefficients between the E.F.E. Questionnaire factors (three factors) and other measures, showed a direct correlation with the first factor and “turning against object” TAO of the DMI test (correlation is significant at the 0.001 level) and an inverse relation with set mechanisms of “Principalization”, PRN of the DMI (correlation is significant at the 0.005 level). The correlations of the second and the third factors with other measures, were not statistically significant. No relations were found about other variables. Conclusions: The E.F.E. questionnaire is a simple evaluation to detect hemo-dialysis patients who may need greater attention to the psychological health and therefore the need for treatment such as psychological support. In fact, lower presence of ego strength is indicative of poor compliance to clinical treatment in hemodialysis, but also of worsening of psychiatric symptoms such as demoralization and depressed mood. In conclusion, an increased social support is needed in hemodialysis patient in order to achieve better compliance and achieve a better state of psychological health in chronic hemodialysis patients.

关键词： Hemodialysis Compliance Ego Strenght Emotional States

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Renal biopsy:Still a landmark for the nephrologist

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World Journal of Nephrology 2016年第4期5卷 321-327页

作者： Luca Visconti Valeria Cernaro Carlo Alberto Ricciardi Viviana Lacava Vincenzo Pellicanò Antonio Lacquaniti Michele Buemi domenico santoro Unit of Nephrology and Dialysis University of Messina

Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefts must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.

关键词： Renal biopsy Acute kidney injury Bleeding Haematuria Hematoma Chronic renal failure

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Iatrogenic calcinosis cutis in a child affected by Acute Lymphoblastic Leukemia

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Case Reports in Clinical Medicine 2014年第1期3卷 13-17页

作者： Teresa Perillo Giampaolo Arcamone domenico Bonamonte Michele Pascone Nicola santoro Department of Dermatology Policlinico Hospital Bari Italy Department of Pediatric Oncology Policlinico Hospital University of Studies Bari Italy Department of Plastic Surgery Policlinico Hospital Bari Italy

Iatrogenic calcinosis cutis is a rare disorder that can be due to the intravenous administration of calcium or phosphate-containing infusions such as calcium gluconate or calcium chloride with extravasation. Fortunately, the course of calcinosis cutis is benign in immunocompetent children. The treatment remains supportive therapy. After about 6 months, there is no evidence of tissue calcification. We describe a 4-year-old girl with Acute Lymphoblastic Leukemia (ALL) who developed severe calcinosis cutis in the left humerus after extravasation of calcium gluconate during the treatment for the tumor-lysissyndrome-related hypocalcaemia. Surgical debridement and local wound care were not successful, and so a temporary suspension of chemotherapy was necessary to achieve complete healing of the lesion. Notwithstanding this complication, her ALL is in complete hematological remission after 8 months from the diagnosis. No functional or sensitive impairment due to the cutis has persisted.

关键词： Calcinosis Cutis Treatment Immunocompromised Leukemia

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