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Abstract

A. Schwarting, F. Dehout, S. Feriozzi, M. Beck, A. Mehta and G. Sunder-Plassmann on behalf of the European FOS Investigators

¹Department of Nephrology, University of Mainz, Mainz, Germany, ²Department of Nephrology, CHU de Charleroi, Charleroi, Belgium, ³Division of Nephrology and Dialysis, Department of Medicine, Belcolle Hospital, Viterbo, Italy, ⁴Children’s Hospital, University of Mainz, Mainz, Germany, ⁵Department of Haematology, Royal Free Hospital, University College London, London, UK, and ⁶Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
Aim: Fabry disease is a rare lysosomal storage disorder caused by deficient activity of a-galactosidase A, resulting in progressive cellular accumulation of glycolipids, which may ultimately result in end-stage renal disease. We examined the effects of enzyme replacement therapy (ERT) with Agalsidase-a on renal function using data from a large international database, the Fabry Outcome Survey (FOS). Methods: This analysis was based on 1,040 serum creatinine measurements in 201 patients with Fabry disease, aged 20 – 60 years, with serum creatinine concentrations of less than 2 mg/dl and duration of ERT of up to 4.7 years. Both pretreatment and treatment data were used to examine independent predictors of changes in serum creatinine. In a second approach longitudinal serum creatinine measurements from 1 year before treatment, at baseline and 1 and 2 years after the start of treatment were analyzed in 20 patients with chronic kidney disease (CKD) Stage 2 and 3. Results: We found an independent negative association between serum creatinine and time on Agalsidase-a treatment (p < 0.05). Renal function declined significantly (p < 0.05) in the year before treatment. After 1 year of treatment, however, the decline in estimated glomerular filtration rate had been halted, and renal function was preserved for up to 2 years. Conclusions: In conclusion, ERT with Agalsidase-a is associated with decrease of serum creatinine and may prevent the deterioration of renal function in patients with Fabry disease.Correspondence to:
Prof. G. Sunder-Plassmann

Division of Nephrology and Dialysis

Department of Medicine III

Medical University Vienna

Währinger Gürtel 18 - 20

1090 Vienna, Austria
Email: gere.sunder-plassmann@meduniwien.ac.at

Abstract

Z. Xia, G. Liu, Y. Gao, Z. Fan, Y. Fu, L.F. Zhang, X. Ren and C. Gao

Department of Pediatrics, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Objective: To evaluate the efficacy of FK506 in the treatment of children with nephrotic syndrome of different underlying pathology. Methods: 12 patients were treated with FK506 with a dosage of 0.1 – 0.15 mg/kg/d while corticosteroid dose was tapered stepwise. This therapeutic course lasted 3 – 6 months during which the plasma concentration of FK506 was monitored. Results: 12 children with different pathological types nephrotic syndrome were treated with FK506, including 4 cases of MCN, 6 cases of MsPGN, and 1 case of MPGN and 1 case of FSGS. After 2-month duration, 8 patients got complete remission including 4 cases of MCN and 4 cases of MsPGN and 3 children including 1 case of MsPGN, 1 case of MPGN, and 1 case of FSGS got partial remission. Only 1 child with MsPGN was considered to be a treatment failure. The overall response rate was 91.67% with the plasma concentration of FK506 maintained at 5 ~ 12 ng/ml, and the response time was 10 – 38 days. After 1-month duration, all patients except one experienced a reduction in proteinuria to normal levels or a partial response (50% reduction in protein excretion), significant increase in serum albumin, decrease in serum cholesterol and triglyceride and disappearance of edema. 2 months later, in 11 patients, blood biochemical values had returned to normal levels. The drug was generally well-tolerated. 3 patients had anorexia, nausea, vomiting. 2 patients experienced transient elevated serum creatinine which was reversible after the adjustment of dosage. 3 patients had minor changes in urine NAG. Only 2 of all patients relapsed. Conclusion: FK506 is one of the effective immunosuppressants. In this study, FK506 in combination with a small doses of steroid while decreasing FK506 dosage plays a role in consolidating the curative effect and preventing relapse. In conclusion, FK506 may be effective in the treatment of nephrotic syndrome.Correspondence to:
Z. Xia, MD
Department of Pediatrics
Nanjing Jinling Hospital
305 East Road
ZhongShan, Nanjing 210002, P.R. China
Email: xzk@nzkidney.com,njxzk@126.com

Abstract

A. Shoker, M.A. Hossain, T. Koru-Sengul, D.L. Raju and D. Cockcroft

¹Department of Medicine, ²Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
Background: Prediction of endogenous creatinine clearance by mathematical equations such as the Cockcroft-Gault formula is used in clinical practice in spite of the reported concern for their limited predictability. The aim of this study is to determine whether the measured creatinine clearance can be predicted accurately by a number of published equations including the recently modified Cockcroft-Gault formula = Cockcroft-Gault formula × 1.73 m2/body surface area from the original Cockcroft-Gault population. Methods: The performance of the mathematical equations in patients with different creatinine clearance and body mass indices was assessed by computing accuracy at different percentiles, bias and precision from the original Cockcroft-Gault data. Results: Refitting the modified formula to the Cockcroft-Gault data gave superior results compared to the original Cockcroft-Gault formula with an overall accuracy in the general and subgroup analysis above 70% agreement within 30% estimate of the measured creatinine clearance. On the other hand, analysis of the other equations, including the original Cockcroft-Gault, demonstrated a limited accuracy to predict creatinine clearance particularly in patients with creatinine clearance below 50 ml/min with an overall accuracy in less than 1/3 of the calculated creatinine clearance within 30% range from the measured creatinine clearance. Conclusion: The current creatinine clearance equations and even the original Cockcroft-Gault formula did not accurately predict the measured creatinine clearance. Normalization for body surface area in the original Cockcroft-Gault formula demonstrated more accuracy to estimate creatinine clearance, particularly in patients with diminished renal function and is recommended to physicians who wish to use the Cockcroft-Gault formula in their practice until more credible formulas are developed. Correspondence to:
Dr. A. Shoker
Division of Nephrology
St. Paul’s Hospital
1702 – 20th St. West
Saskatoon, SK S7M 0Z9, Canada
Email: shoker@sask.usask.ca

Abstract

R.L. Benz

The Lankenau Hospital and Institute for Medical Research, Wynnewood, PA, USA
Background: For many ESRD patients who are prescribed a certain level of hemodialysis (HD), delivered dose often does not achieve prescription. While various causes have been well-documented in the literature, there are no available data that may be used in predicting the likelihood of achieving a particular urea reduction ratios (URR) goal based on the number of these factors present. This study evaluated URRs of all patients in an outpatient HD unit for a 6-month period to identify factors significant in attaining goal in order to predict likelihood of goal attainment based on number of factors present. Methods: The inclusion criterion in this study was any HD patient during the study period with ³ 3 monthly URR measurements. Of 203 patients, 169 qualified for 900 treatments. A database was created for each patient that included demographics, factors affecting Kurea, time and access. After grouping percentages of patients with URR ³ 70%, 65 – < 70%, and < 65%, we studied a subset of 107 patients (568 treatments) that had at least 1 URR < 70% to identify factors associated with a URR of ³ 65% vs. < 65%. To determine factors predictive of URR ³ 65%, a sum percentage across all treatments was created for each patient. Mean percentages were compared between groups created by constant characteristics (e.g. gender, DM). Variables, e.g. catheters, were summarized as a percentage for each patient, and these percentages were correlated with rate of URR ³ 65%. Time was assigned a value of 0 (prescribed), positive (longer), negative (shorter), summarized as per-patient mean. After these factors were identified, each treatment was reviewed to determine the percentage of treatments ³ 65% with the number of statistically significant factors present. Results: The average, across all patients, of percentage of treatments meeting URR ³ 65% was 87.95% while a mean of 66.65% met URR ³ 70%. Factors associated with percentage of treatments per patient not meeting K/DOQI goal included catheter use (Spearman's correlation = –0.31, p = 0.001), blood flow < 90% of prescription (Spearman's correlation = –0.17, p = 0.041), younger age (³ 61 years vs. < 61 years, p = 0.001: patients ³ 61 years had a higher percentage of URR ³ 65%), inadequate access for prescribed blood flow (Spearman's correlation = –0.32, p = 0.001), actual time vs. prescribed time (Spearman's correlation = 0.25, p = 0.009), and HD w/o heparin (Spearman's correlation = –0.21, p = 0.031). In 178 treatments, all having “good” values (no catheter, blood flow ³ 90% prescribed, age ³ 61 years, etc.), the percentage of treatments meeting URR of ³ 65 was 96.1%. With 1 bad value factor: 83.8% of 216 treatments met goal, 2 bad value factors: 71.7% of 106 met goal, 3 bad value factors: 60.5% of 43 met goal. With 4 or 5 bad value factors: only 36.1% of 25 treatments met goal. Conclusions: Significant factors in meeting adequacy defined by K/DOQI in rank order (excluding age) include inadequate access for prescribed blood flow, catheter use, time, lack of heparin and inability to achieve blood flow ³ 90% prescribed. A direct correlation exists between number of these factors present and K/DOQI goal attainment in a given treatment.Correspondence to:
R.L. Benz, MD

Suite 130, Lankenau MOB West

100 Lancaster Avenue

Wynnewood, PA 19096, USA
Email: benz@op.net

Abstract

K. Budde¹, G. Knoll², J. Curtis³, L. Chan⁴, E. Pohanka⁵, M. Gentil⁶, Y. Seifu⁷, A.-C. Marrast⁸ and H.-H. Neumayer¹ on behalf of the ERL B³⁰² Study Group⁹

¹Department of Nephrology, Campus Charité Mitte Charité, Humboldt University, Berlin, Germany, ²Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, ³Division of Nephrology, University of Alabama, Birmingham, AL, ⁴University of Colorado Health Sciences Center, Denver, CO, USA, ⁵Division of Nephrology and Dialysis, Internal Medicine III, Medizinische Universität Wien, Vienna, Austria, ⁶Nephrology Service, Virgen del Rocio Hospital, Sevilla, Spain, ⁷Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, ⁸Novartis Pharma AG, Basel, Switzerland, and ⁹see Acknowledgments
Aim: A 12-month multicenter, double-blind trial in which maintenance renal transplant patients were randomized to remain on mycophenolate mofetil (MMF) or convert to enteric-coated mycophenolate sodium (EC-MPS, myfortic®) has demonstrated that conversion from MMF to EC-MPS is safe. Patients completing the study were invited to enter an open-label extension. Upon entry to the extension, patients who had received MMF during the randomized phase were converted to EC-MPS (“newly-exposed EC-MPS” group) and were monitored separately from those who had been randomized to EC-MPS (“long-term EC-MPS” group). The aim of the extension study was to collect long-term safety and efficacy data on EC-MPS, and to confirm the safety of conversion from MMF to EC-MPS in a larger patient population. Methods: All patients received EC-MPS 720 mg b.i.d. with cyclosporine microemulsion and corticosteroids per local practice. Data derived from the analysis of the first 24 months of the extension phase are presented. Results: Of the 297 patients who completed the core study, 260 (88%) entered the extension; 195 (75%) completed the 24-month extension visit. For on-treatment patients > 95% of the planned daily dose of EC-MPS was administered, and < 13% of patients in both groups had discontinued EC-MPS due to adverse events by 24 months. The overall incidence of adverse events during the extension phase, including infections and hematological abnormalities, was comparable to that seen in the core study, with a similar safety profile in the newly-exposed and long-term EC-MPS groups. There were 3 deaths during the first 24 months of the extension, and 2 graft failures in both the “newly-exposed” and “long-term” EC-MPS groups. Conclusions: These data demonstrate that long-term use of EC-MPS is effective and has an acceptable tolerability profile in renal transplant patients, and confirm that conversion of maintenance renal transplant patients from MMF to EC-MPS is a safe therapeutic option.Correspondence to:
Dr. K. Budde
Department of Nephrology
Campus Charité Mitte Charité
Humboldt University
Schumannstrasse 20/21
10117 Berlin, Germany
Email: klemens.budde@charite.de

Abstract

M. Salvadori, H. Holzer, G. Civati, H. Sollinger, B. Lien, S. Tomlanovich, E. Bertoni, Y. Seifu and A.-C. Marrast on behalf of the ERL B³⁰¹ Study Group

¹Renal Unit Careggi University Hospital, Florence, Italy, ²Division of Nephrology and Hemodialysis, Medical University Graz, Graz, Austria, ³Az. Osp Niguarda Ca Granda, Milan, Italy, ⁴University of Wisconsin-Madison, Madison, USA, ⁵Rikshospitalet, Oslo, N
Background: To date, there are no data on long-term use of enteric-coated mycophenolate sodium (EC-MPS; myfortic®) from time of renal transplantation. We report the first long-term safety and efficacy data on EC-MPS when administered for up to 3 years post transplant. Methods: De novo renal transplant recipients completing 1 year of treatment in a multicenter, randomized, double-blind trial of EC-MPS versus mycophenolate mofetil (MMF) were invited to take part in an open-label extension during which all patients received EC-MPS 720 mg b.i.d. Results from the period 12 – 36 months post transplant were compared to comparable data from MMF-treated patients taking part in two studies of everolimus versus MMF (RAD 201 and RAD 251). Results: Of 367 patients completing the blinded core study, 247(62%) entered the open-label extension phase. During the first 24 months of the extension, the incidence, type and severity of adverse events were comparable between the newly-exposed and long-term EC-MPS patients. There were 2 deaths in the newly-exposed group and 4 among long-term EC-MPS patients, with 1 and 2 graft losses, respectively. Six patients (5%) in the newly-exposed group and 4 (3%) in the long-term EC-MPS group experienced biopsy-proven acute rejection. Cross-study comparisons indicated that the tolerability profile of EC-MPS was similar to MMF, including the incidence of adverse events, infections and malignancies, as was the incidence of efficacy events. Conclusion: These results demonstrate that EC-MPS with cyclosporine and steroids provides good long-term efficacy and tolerability, and confirm the safety of converting renal transplant patients from MMF to EC-MPS.Correspondence to:
Prof. M. Salvadori

Renal Unit Careggi University Hospital

Viale Pieraccini 18

50139 Florence, Italy
Email: salvadorim@ao-careggi.toscana.it

Abstract

M.L. Troxell, A. Bhatt Saxena and N. Kambham

¹Department of Pathology, Stanford University Medical Center, Stanford, CA, ²Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA, USA
Background: Anti-glomerular basement membrane disease (anti-GBM) is a relatively rare entity characterized by antibodies to collagen type IV of glomerular and alveolar basement membranes. The sequential or simultaneous presentation of anti-glomerular basement membrane disease with membranous glomerulonephritis has been infrequently described. Case: We present the case of a 49-year-old man who had fatigue, flank pain, hematuria and renal failure. Serology was positive for anti-GBM antibodies; crescentic glomerulonephritis was seen on renal biopsy. Immunofluorescence and electron microscopy demonstrated evidence of both anti-GBM glomerulonephritis and membranous deposits. Discussion: Simultaneous anti-GBM disease and membranous glomerulonephritis is the most common temporal presentation of this rare entity. However, cases of membranous glomerulonephritis preceding or following recovery from anti-GBM disease have been described. Study of such cases provides insight into pathophysiologic mechanisms, including the possibility of increased antigen synthesis, exposure of cryptic epitopes, and/or capping and shedding of antigen-antibody complexes, in analogy to Heymann nephritis.Correspondence to:
M.L. Troxell, MD, PhD Oregon Health & Science University Department of Pathology, L471 3181 SW Sam Jackson Park Road Portland, OR 97239-3098, USA
Email: troxellm@ohsu.edu

Abstract

T. Révai¹,⁴, I. Kaszás², C. Márton⁴, G. Árpási³ and G. Winkler⁴

¹Outpatient Department of Nephrology St. John's Hospital, ²Department of Pathology, St. Margit Hospital, ³Department of Urology, St. John's Hospital and ⁴²nd Department of Internal Medicine, St. John’s Hospital, Budapest, Hungary
Aims and methods: Focal segmental glomerulosclerosis (FSGS) is a glomerular disease defined by a characteristic histologic pattern that occurs either as a primary kidney disease (primary FSGS) or as a result of a systemic illness (secondary FSGS). Proteinuria, often in the nephrotic range, is the hallmark of FSGS. The occurrence of nephrotic syndrome after an insect sting is rarely reported in the literature. We present a case of nephrotic syndrome with focal segmental glomerulosclerosis with a glomerular tip lesion developing after an insect bite. Results: A 51-year-old Caucasian female was bitten by an insect on her left leg, which immediately became swollen. Generalized edema developed and she was admitted for further investigations. Urinary 24-h protein excretion was 7 g. Percutaneous renal biopsy was performed and showed focal segmental glomerulosclerosis of the tip variant. Nephrotic syndrome was steroid-resistant, and when we added cyclophosphamide for 8 weeks complete remission was achieved. There was no relapse of the disease during the 2-month follow-up. Conclusions: This report demonstrates the useful role of cyclophosphamide in the treatment of steroid-resistant nephrotic syndrome due to FSGS with glomerular tip lesion. A causal relationship between the insect bite and the nephrotic syndrome is suggested and an immune response could be responsible for the nephrotic syndrome.Correspondence to:
T. Revai, MD
2nd Dept. Internal Medicine
Outpatient Nephrologic Unit St. John’s Hospital
XII Diosarok u. 1
Budapest, Hungary
Email: drrt@t-online.hu

Abstract

D. Santoro, M. Stella and S. Castellino

¹Unit of Nephrology and Dialysis, San Vincenzo Hospital, Taormina ASL ⁵, ²Unit of Pathology Cervello Hospital, Palermo, Italy
We report a case of a relapse of Henoch-Schönlein Purpura (HSP) associated with intake of paracetamol (also known as acetaminophene) and codeine. A 69-year-old man presented with fever, gross hematuria, acute renal failure, palpable purpuric skin rash over the legs, feet and arms, arthralgias and abdominal discomfort. 1 week before he had started therapy with co-efferalgan (association of paracetamol and codeine) for cervical arthrosis. Blood test revealed increase in serum creatinine levels (2.6 mg/dl), CRP (375 mg/dl), with no thrombocytopenia or hypocomplementemia. Co-efferalgan was discontinued. Gross hematuria resolved in 2 days, purpuric rash disappeared in 10 days, renal function returned to normal after 2 weeks and abdominal pain and arthralgias improved on the following 2 – 3 weeks. An objective causality assessment in accordance with the Naranjo algorithm, revealed that the adverse drug reaction was probable between paracetamol/codeine and Henoch-Schönlein purpura. To our knowledge, and based on a medline search (up to 2005), we believe that this could be considered the first case of Henoch-Schönlein purpura, associated with intake of paracetamol and codein. Although this event could be considered rare, clinicians should to be aware of possible associations between HUS and the intake of paracetamol and/or codeine to provide an early therapeutic intervention and a close monitoring.Correspondence to:
D. Santoro, MD
Unit of Nephrology and Dialysis
San Vincenzo Hospital
Taormina ASL 5, Italy
Email: santisi@hotmail.com

Abstract

M. Prelog, H. Fischer, I. Gassner, A. Tzankov, K. Glatz-Krieger, M. Mihatsch and L.B. Zimmerhackl

¹Department of Pediatrics, ²Institute of Pathology, Medical University Innsbruck, Austria, ³Institute of Pathology, University of Basle, Switzerland
Neonatal renal vein thrombosis (RVT) is associated with neonatal stress, catheters and genetic prothrombotic risk factors. In an unusual case of bilateral RVT a twin newborn showed initial good adaptation at birth (weight 2,720 g). The placenta was monochorionic, diamnionic. The infant (gestational week 37) exhibited a severe macrohematuria within 24 hours after birth. Sonography of the kidneys showed a dense cortical parenchyma, loss of cortico-medullary differentiation and negative diastolic flow in both renal arteries and veins, while no thrombus in the main renal veins could be detected. No prothrombotic blood parameters and positive infection serology were detected. Because of acute renal failure peritoneal dialysis was necessary for 6 weeks. The patient was treated by heparinization for 5 days. Interestingly, it was kidney biopsy which confirmed the diagnosis of RVT in addition to the clinical presentation, whereas sonography was unspecific. Histology exhibited the picture of an ischemic contracted kidney with numerous siderophages. At present (age 19 months), the patient suffers from chronic renal failure (calculated glomerular filtration rate according to Schwartz 12 ml/min/1.73 m2). In conclusion, our case teaches that, despite the lack of a clinically obvious shock event, absence of known risk factors and indirect ultrasound findings, renal vein thrombosis should be considered in a macrohematuric newborn with renal failure. For clinical suspicion of RVT correct therapy was initiated, however, the diagnosis remained unclear until a renal biopsy was performed.Correspondence to:
L.B. Zimmerhackl, MD Department of Pediatrics Medical University Innsbruck Anichstrasse 35 6020 Innsbruck, Austria
Email: Lothar-Bernd.Zimmerhackl@uklibk.ac.at

Abstract

K. Tokashiki, A. Ishida, M. Kouchi, S. Ishihara, N. Tomiyama, K. Kohagura, K. Iseki and S. Takishita

¹Department of Cardiovascular Medicine, Nephrology and Neurology, Faculty of Medicine, ²Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
Vascular calcification is common among hemodialysis (HD) patients and contributes to the development of peripheral arterial disease. A 57-year-old Japanese man who had been on HD for 30 years was referred to us for severe pain with multiple ulcers on his toes and fingers. He was an ex-smoker and had no diabetes mellitus. On admission, he had ulcers on his big toes bilaterally and right 2nd – 4th fingers. Peripheral pulses were strong and his ankle-brachial pressure index was above 1.3. Laboratory data were as follows: calcium 9.9 mg/dl, albumin 3.3 g/dl, phosphate 3.0 mg/dl, Ca × P product 30, and parathyroid hormone 98 pg/ml. He had a parathyroidectomy in 1998 and 1999. X-rays of his hands and legs showed diffuse subcutaneous arteriolar calcification. Angiography revealed no local stenotic lesions. Despite intensive therapies including hyperbaric oxygen therapy, painful gangrene developed on his right big toe and the pain was so intense that he could not go to sleep in a supine position. We infused intravenous sodium thiosulfate (20 g) 3 times weekly, based on previous reports. Within 4 – 5 days, he experienced rapid and dramatic symptom relief. The score of the visual analogue pain scale improved from 10/10 – 2/10. The signs of ischemia, measured by transcutaneous partial oxygen pressure and thermography, improved significantly. During the infusion of sodium thiosulfate, the patient complained of nausea, vomiting and hyperosmia. These adverse symptoms were resolved after discontinuation of the infusion. Pain relief was sustained and he could walk after 2 weeks of infusion. Our case supports the use of sodium thiosulfate as a novel therapeutic choice for critical limb ischemia with severe vascular calcification in chronic HD patients.Correspondence to:
Dr. K. Tokashiki
Department of Cardiovascular Medicine
Nephrology and Neurology
Faculty of Medicine
University Hospital of the Ryukyus
207 Uehara, Nishihara, Okinawa 903-0215, Japan
Email: chihokun@med.u-ryukyu.ac.jp

Abstract

R. Diwakar and P.A. Andrews

SW Thames Renal & Transplantation Unit, St. Helier Hospital, Carshalton, Surrey, Great Britain
We describe a patient with loin pain hematuria syndrome who required bilateral nephrectomy because of intractable pain and urological complications. After bilateral nephrectomy, his pain disappeared for the first time in 40 years. He subsequently received a cadaveric renal transplant which, at 4-year follow-up, is working well. Although he has developed intermittent microscopic hematuria, there has been no significant recurrence of pain over the kidney. This is the first reported case of transplantation after bilateral nephrectomy for loin pain hematuria syndrome. It provides insight tnto the possible pathogenic mechanisms underlying the condition.Correspondence to:
Dr. P.A. Andrews Consultant Nephrologist SW Thames Renal & Transplantation Unit St. Helier Hospital Wrythe Lane Carshalton, Surrey SM5 1AA, Great Britain
Email: peter.andrews@epsom-sthelier.nhs.uk

Abstract

P. Delanaye, E. Cavalier, J.M. Krzesinski and J.-P. Chapelle

Abstract

G. Kim, E.C. Jang, Y.S. Kim, S.A. Yoon, S.S. Kim, S.J. Yoo, Y.S. Chang and Y.O. Kim

Abstract

G. Bovio, V. Piazza, G. Montagna, E. Efficace, F. Galli, L. Picardi, L. Semeraro, G. Villa and S. Segagni

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Volume 66, No. 2/2006(August)