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This study analyses management and costs of dialysis in the Italian National Health Service (NHS). Information on efficacy and health-related quality of life (HRQOL) based on the existing literature also is presented. The clinical differences between the dialysis modalities seem to be related to their appropriateness to specific patient groups. Efficacy rates are similar and the only differences are in complications and HRQOL. Traditional haemodialysis (THD) can be done by Italian patients in dialysis centres or in hospital. High-flux haemodialysis (HFHD) is generally only done in hospital. Peritoneal dialysis (PD) is usually done at home. The cost analysis was performed on a sample of Italian dialysis centres and hospitals, according to the full cost method. As expected, HFHD was more expensive than THD and PD, but no marked differences emerged among the different HFHD modalities. THD modalities in dialysis centres were less costly than in hospitals. Automated PD (APD) was much more expensive (almost twice) than continuous ambulatory PD (CAPD), the cheapest method in absolute terms. This study confirms that dialysis is costly and that it is very difficult to assess the cost-effectiveness of the different approaches. Although this study has limits, it should provide sufficient analytical information to local healthcare managers for more rational allocation of financial resources to dialysis services.

Background. Dermatan sulphate (DS) is a selective thrombin inhibitor with antithrombotic properties and low bleeding potential. In preliminary studies it was reported to be effective for preventing clot formation in the haemodialysis circuit. Methods. Ten patients on maintenace haemodialysis for chronic renal failure underwent three consecutive investigation phases. In phase 1 (individual dose titration), repeated dialyses were performed with increasing doses of DS until successful dialysis was obtained in two sessions at the same dose. In phase 2, individualized DS doses were validated by a randomized crossover comparison with the individual heparin dose of each patient. In phase 3, each patient underwent 24 consecutive dialyses with DS over 8 weeks. Successful dialysis was defined as completion of the procedure without visible clot formation in the bubble traps and lines or a greater than 20% decrease in dialyser capacity. Dialysis efficiency (decrease in serum urea and creatinine, Kt/V), APTT prolongation, bleeding time, and DS plasma concentrations were also assessed. Results. Phase 1: successful dialysis was achieved in nine patients with 4 mg/kg DS as a predialysis intravenous bolus followed by continuous infusion of 0.65mg/kg/h. One patient required 5 mg/kg plus 1.3 mg/kg/h. Phase 2: no statistically significant differences were found between DS and heparin in any of the investigated variables. Residual dialyser capacity and dialysis efficiency indexes indicated equivalent efficacy. Phase 3: residual dialyser capacity and dialyisis efficiency did not change with time. There was no accumulation of DS in plasma. No bleeding or thrombocytopenia were observed. Conclusions. The dose of DS can be individually titrated to suppress clot formation during haemodialysis as efficiently as with individualized heparin. Such an individualized DS regimen maintains its anticoagulant efficacy and is safe in prolonged use.

The involvement of the peripheral motor and sensory nerve, at least on a subclinical level, is a nearly constant event with chronic renal failure. The study of the motor and sensory propagation velocity indicates that a widespread functional lesion of the axon with a peripheral point of attack and secondary demyelination, may be the basic pathogenetic event of uremic polyneuropathy. Prolonged hemodialytic treatment is substantially unable to influence the evolution of uremic polyneuropathy. The electrophysiological follow-up study of the peripheral nerve does not seem to be an index of adequate dialysis.

Plasma free carnitine in 6 chronic uremic patients fell 73% during hemodialysis. The recovery time was 6 h with placebo and only 2 h when dl carnitine (3 g oral) was taken at the end of dialysis.

1-Carnitine was assayed before and after dialysis in plasma, dialyzate and muscle of four patients undergoing hemodialysis. The findings suggest that plasma carnitine losses occurring during hemodialysis may be at the expense of the carnitine present in extracellular fluid. Carnitine concentrations in muscle of hemodialyzed patients and controls did not differ significantly. Chronic carnitine administration did prevent plasma carnitine from falling below base levels, but did not affect muscle concentration.

We describe a case of acute hepatonephritis in a worker of a pharmaceutical factory, due to sporadic and short exposures to chloroform at levels even 70 times higher than its TLV.

The plasma lipid pattern was investigated in 103 dialysis patients and 66 renal transplant patients. Only 32 percent of dialysed patients and 30 percent of transplanted patients had a normal lipid pattern. In other patients the most frequent disorder with hypertriglyceridaemia, and less frequently combined or isolated hypercholesterolaemia. Since these lipid abnormalities are known to predispose to an accelerated atherosclerosis, a dietetic therapeutic approach was tried. Fifteen transplanted patients with severe hypertriglyceridaemia were submitted to a hypocaloric (1700 kcal) and low carbohydrate (130 g) diet. During dieting the plasma lipid pattern was normalised and maintained in a normal range for the period of observation (3-12 months).

Biofiltration: an effective and simple method to reduce dialysis time. Six stable anuric patients, on maintenance hemodialysis, were treated for 10 weeks with a parallel flow 1 m2 cuprophan filter, for 20 weeks with a parallel flow 1.2 m2 polyacrylonitrile filter using the biofiltration (BF) technique and again 10 weeks with the cuprophan filter. Usual monitors were used, without automatic control of ultrafiltration. Biochemical and hematological profile, urea kinetic parameters, incidence of hypotensive episodes, body weight and blood pressure did not change throughout the study. We conclude that three hours of BF, at least for 20 weeks, are as effective and well tolerated as four hours standard hemodialysis and could be of value in reducing dialysis time, to permit better utilization of dialysis beds.

We reviewed the medical records of 177 patients who at 31 December 1985 had been on dialysis treatment for at least one year. Fifty cases of non-A, non-B hepatitis were found: 33 in 70 patients dialysed at the centre and 17 in 107 outpatients (P less than 0.0001). The difference was not related to blood transfusions but to the high prevalence of non-A, non-B in hospital patients who had not been transfused. The time on dialysis before the onset of non-A, non-B hepatitis became gradually shorter, from an average of 82 months before 1980 to 5.7 months in the patients starting haemodialysis after 1983. At follow-up, 7% of patients had abnormal hepatic enzymes 5 years from the onset of acute illness. The epidemiology of non-A, non-B hepatitis in haemodialysis patients appears to be similar to that of hepatitis B. Apart from blood transfusions, contamination of hospital environmental surfaces seems to be the major route of transmission. Our results strongly support a preventive programme for non-A, non-B hepatitis similar to that for hepatitis B, and a separate section for any patient with suspected non-A, non-B hepatitis must be considered.

Congestive heart failure may frequently occur in patients with isolated coarctation of the aorta within the first six months of life. Renal failure is on the contrary a very rare pathologic sequela. This is caused by a low renal blood flow related either to a poorly developed collateral circulation or in those instances of preductal coartation to an early closure of ductus arteriosus. Peritoneal dyalisis is very effective in these critically ill infants both in correcting biochemical abnormalitics and in supporting cardiac performance. Surgical treatment is however the only way to restore normal renal blood flow and good cardiac output. This report describes two patients with isolated coarctation of the aorta in whom renal failure developed within the first two months of life. Both patients were successfully treated by peritoneal dyalisis and subsequent surgical intervention.

Bleeding is a major complication of uremia. Both cryoprecipitate and desmopressin favourably infuence clinical bleeding, but the former carries the risk of transmitting blood-borne infectious diseases and both have a short duration of action. We recently demonstrated in a controlled study that CE effectively shortened bleeding time (BT) (the best available marker of clinical bleeding) in uremics. The effect of CE on BT is long lasting. Thus CE might represent an alternative to cryoprecipitate or desmopressin when long-lasting hemostatic” competence is required. In the present study we followed for two years 6 uremic patients on chronic hemodialysis with severe bleeding tendence, often requiring blood transfusion. In the first year each hemorrhagic episode was treated only with a replacement therapy, while the subsequent year CE infusions (Emopremarin, 0.6 mg/Kg/die for 5 consecutive days) were given after each bleeding episode. The incidence of hemorrhagic episodes/year and the number of blood transfusions/year decreased from 39 to 8 and from 26 to 9 respectively. No side effects of CE have been noted. Results of this study indicate that CE are effective and safe in treating hemorrhages of uremics.

In the context of exploratory OLAP, coupling the information wealth of linked data with the precision and detail of corporate data can greatly improve the effectiveness of the decision-making process. In this paper we outline an approach that enables users to extend the hierarchies in their corporate cubes through a user-guided process that explores selected linked data and derives hierarchies from them. This is done by identifying in the linked data the recurring modeling patterns that express roll-up relationships between RDF concepts and translating them into multidimensional knowledge.

Extending database-like techniques to semi-structured and Web data sources is becoming a prominent research field. These data sources are essentially collections of textual documents. Hence, in this context, one of the key tasks consists in wrapping documents to build database abstractions of their content that can be manipulated using high-level tools. However, the degree of heterogeneity and the lack of structure make standard grammar parsers excessively rigid, and often unable to capture the richness of constructs in these documents. This paper presents Minerva , a formalism for writing wrappers around Web sites and other textual data sources. The key feature of Minerva is the attempt to couple the benefits of a declarative, grammar-based approach, with the flexibility of procedural programming. This is done by enriching regular grammars with an explicit exception-handling mechanism. Contributions of the paper stand in the definition of the formalism, and in the description of its implementation, which relies on a number of ad-hoc techniques for parsing documents, among which an extension of the traditional LL(1) policy based on dynamic tokenization.

We demonstrate a system to automatically grab data from data intensive web sites. The system first infers a model that describes at the intensional level the web site as a collection of classes; each class represents a set of structurally homogeneous pages, and it is associated with a small set of representative pages. Based on the model a library of wrappers, one per class, is then inferred, with the help an external wrapper generator. The model, together with the library of wrappers, can thus be used to navigate the site and extract the data.

Information extraction from websites is nowadays a relevant problem, usually performed by software modules called wrappers. A key requirement is that the wrapper generation process should be automated to the largest extent, in order to allow for large-scale extraction tasks even in presence of changes in the underlying sites. So far, however, only semi-automatic proposals have appeared in the literature.We present a novel approach to information extraction from websites, which reconciles recent proposals for supervised wrapper induction with the more traditional field of grammar inference. Grammar inference provides a promising theoretical framework for the study of unsupervised---that is, fully automatic---wrapper generation algorithms. However, due to some unrealistic assumptions on the input, these algorithms are not practically applicable to Web information extraction tasks.The main contributions of the article stand in the definition of a class of regular languages, called the prefix mark-up languages, that abstract the structures usually found in HTML pages, and in the definition of a polynomial-time unsupervised learning algorithm for this class. The article shows that, differently from other known classes, prefix mark-up languages and the associated algorithm can be practically used for information extraction purposes.A system based on the techniques described in the article has been implemented in a working prototype. We present some experimental results on known Websites, and discuss opportunities and limitations of the proposed approach.

The Web is creating exciting new possibilities for direct and instantaneous publishing of information. However, the apparent ease with which one can publish documents on the Web hides more complex issues such updating and maintaining Web pages. We believe one of the crucial requirements to document delivery is the ability to extract and reuse information from other documents or sources. In this paper we present a descriptive language that allows users to write virtual documents, where dynamic information can be retrieved from various sources, transformed, and included along with static information in HTML documents. The language uses a tree-like structure for the representation of information, and defines a database-like query language for extracting and combining information without a complete knowledge of the structure or the types of information. The data structures and the syntax of the language are presented along with examples.