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B Hurault de Ligny

Publications and source records attributed to B Hurault de Ligny.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Synchronous bilateral renal cell carcinoma. Renal transplantation after nephrectomy].

INTRODUCTION: Treatment of bilateral and synchronous renal cell cancer may require bilateral nephrectomy and chronic dialysis. After an arbitrarily determined waiting period (2 years) on dialysis, kidney transplantation may be proposed. CASE REPORTS: Two patients underwent kidney transplantation after bilateral nephrectomy for early-stage low-grade renal cell cancer. Eight years after nephrectomy and 6 years after transplantation, there is no evidence of cancer recurrence and renal function is satisfactory. DISCUSSION: Certain patients treated for cancer may be candidates for kidney transplantation, even if the risk for cancer is higher in transplant recipients. Moreover, kidney transplantation without a required period on chronic dialysis could be proposed in early-stage lowgrade renal cell cancer.

Adult↗
PubMed1997

Enhanced expression of CD31 and CD54 on tonsillar high endothelial venules in IgA nephropathy.

Abnormalities in the partition of IgA- and IgG-producing cells in the tonsils of patients with IgA nephropathy have been suggested to result from a dysregulation of cell trafficking and homing through high endothelial venules in this lymphoid tissue. In order to document such adhesion anomalies, we used the 36 monoclonal antibodies of the cell adhesion molecules subpanel of the Fifth International Workshop on Leukocyte Differentiation Antigens on frozen sections of tonsils from 10 patients and 15 controls. This allowed us to describe the partition of cell adhesion molecules in human tonsils and to demonstrate a significant enhancement of CD31 and CD54 expression on high endothelial venules of tonsils from patients with IgA nephropathy. These observations are in keeping with the hypothesis of an increased lymphocyte recruitment in tonsils in this disease.

Adolescent↗
PubMed1997

Maintenance cyclosporin monotherapy after renal transplantation--clinical predictors of long-term outcome.

BACKGROUND: There is considerable debate about whether maintenance cyclosporin (CsA) monotherapy is advisable or not in renal transplantation. METHODS: Between August 1984 and December 1989, 463 adult patients received a first cadaver graft. Initial immunosuppression was sequential: antilymphocyte or antithymocyte globulins (10-14 days), prednisone and azathioprine were combined and CsA was introduced (6-8 mg/kg/day) when the antilymphocyte or antithymocyte globulins were discontinued. When the graft function was stable and the peak of preformed lymphocytotoxic antibodies was < or = 25% and/or the number of rejection episodes was < or = 1, the steroid therapy was stopped within 1.5-3 months after transplantation, and azathioprine within 3-12 months. Patients with both anti HLA antibodies > 25% and more than one rejection episode were excluded. Cyclosporin doses were adapted for whole-blood trough levels between 100 and 200 ng/ml (monoclonal antibody radioimmunoassay or high-performance liquid chromatography). Cyclosporin monotherapy was attempted in 234 of the 463 patients. RESULTS: At the end of the investigation in January 1993 (follow-up time > 36 months, mean 60.5 +/- 4.5 months), 135 patients were receiving CsA without steroids or azathioprine. The 99 CsA monotherapy failures were due to rejection episodes in 48 cases, CsA A nephrotoxicity in 26 cases, and other causes in 25 cases, including five deaths and four with poor compliance. Renal function was stable in patients with successful CsA monotherapy: mean creatininaemia was 124 +/- 10 mumol/l at the time of CsA monotherapy inclusion and 129 +/- 10 mumol/l at the end of follow-up (mean time of CsA monotherapy 52 +/- 6 months). The parameters for predicting monotherapy success were age (43.2 versus 37.8. P = 0.0014), timing of trial inclusion > or = 6 months post-transplant (7.9 +/- 3 versus 5.3 +/- 3.1 months, P = 0.04), and excellent and stable renal function at the time of inclusion (124 +/- 10 versus 145 +/- 32 mumol/l, P < 0.001). CONCLUSIONS: Maintenance CsA monotherapy was effective in 58% of low-immunological-risk first-graft patients and probably did not jeopardize overall results of our first grafts: patient and graft survival were respectively 90 and 73% at 6 years. We propose this policy to avoid long-term complications of glucocorticoid and azathioprine in selected compliant recipients with low immunological risk, follow-up time post-transplantation > 6 months, and stable creatininaemia levels.

Adult↗
PubMed1997

[Rheumatoid purpura during pregnancy].

We report the case of a 26 year old woman who presented a Henoch Schönlein purpura at 13 weeks' gestation. IgA glomerulonephritis without pejoratif feature was confirmed by renal biopsy. Corticosteroid therapy was unsuccessful on nephrotic syndrome. At 25 weeks' gestation foetal death occurred followed by a rapid development of end stage renal failure.

Adrenal Cortex Hormones↗
PubMed1997

Peritoneal ultrafiltration and refractory congestive heart failure.

This prospective nonrandomized study enrolled 16 patients with congestive heart failure [NYHA (New York Heart Association) III and IV] refractory to a maximal well-tolerated drug therapy. The aims were to evaluate if peritoneal ultrafiltration (PUF) could improve clinical conditions and to determine morbidity secondary to resistant congestive heart failure (RCHF) and PUF. There were 16 patients (12 male, 4 female) with a mean age of 65.4 years (56-81 years) and follow-up of 15.6 months (4-33 months). Thirteen patients had RCHF without end-stage renal disease. Patients were classified as NYHA class IV (n = 11) or class III (n = 5). One anuric patient had been on previous hemodialysis and switched to APD. PUF was obtained with a 2-L hypertonic dialysis solution, once a day (n = 7) or every 2 days (n = 4). Clinical improvement was obtained for all the patients. Weight decreased from 72.2 to 66.7 kg with a weekly ultrafiltration of 3.74 L (2.2-6.5 L). Sodium removal was 79 mmol/day (urinary 43%, peritoneal transport 57%). During the follow-up period, 2 patients received a cardiac transplant since 7 died due to cardiac reasons. Mean hospitalization time was 4.4 and 1.20 per patient per day before and after PUF, respectively. Hospitalization was in keeping with either RCHF (36%), dialysis complications (16%), or miscellaneous causes (48%). Our experience showed that a functional improvement and a better quality of life were achieved for all these patients with a low rate of hospitalization.

Aged↗
PubMed1995

[Quantitative detection of pp65 intraleukocyte cytomegalic antigen in renal transplantation].

OBJECTIVE: To assess the clinical value of quantitative assay of leukocyte cytomegalovirus antigen (LCA) in the management of immunodepressed patients. METHODS: Thirty-three kidney transplant recipients followed a weekly follow-up protocol during the first 3 months after transplantation. LCA was compared with cytomegalovirus (CMV) detection in blood using fibroblast cell culture and with serology tests. LCA was expressed in number of positive cells per 2.10(5) leukocytes, detected by immunofluorescence with a specific monoclonal antibody directed against the pp65 antigen. The standard culture method and a rapid centrifuge method were used for blood samples. The serum level of anti CMV antibodies was determined by ELISA. RESULTS: CMV infection defined as positive viraemia and/or positive serology tests was diagnosed in 22 of the 33 patients. LCA was detected in 20 patients, including all those with clinical signs of infection. Serology was the only method giving a positive diagnosis in 2 patients and was negative in 3 infections positive for LCA. Viraemia was negative in 2 patients positive for LCA. LCA was detected in 60 of the 65 blood samples with a positive viraemia test and in 46 of the 165 negative samples (sensitivity 92% and specificity 72%). Quantitatively, LCA in samples taken from patients with clinical signs was higher than that in samples taken from asymptomatic patients (51 +/- 5 versus 20 +/- 2, p < 0.001). In addition, LCA was detected a mean 7.6 +/- 4 days before significant changes in serology tests, 2.2 +/- 1.6 days before the viraemia and 7.1 +/- 1 days before clinical manifestations. CONCLUSION: Leukocyte cytomegalovirus antigen gives a sensitive means of early positive diagnosis. The quantified level illustrates the patient's risk of infection. This new method is a very helpful tool in following renal transplantation recipients.

Adult↗
PubMed1995

[Quantitative cytomegaloviral leukocytic antigenemia. Clinical aspects].

Cytomegalovirus infection, commonly observed in immunodepressed patients, raises a number of problems both in clinical practice (early rapid diagnosis, therapeutic options) and biological research (resistant strains, mutations). The classical methods of diagnosis do not provide specific information for decision making in each particular clinical situation. We report a case of cytomegalovirus infection in a renal transplant recipient in which quantitative cytomegalovirus antigen level in leukocytes provided rapid early diagnosis of the primary infection and two episodes of recurrent infection. Increase antigen level always preceded clinical manifestations. Three anti-cytomegalovirus regimens were given and the antigen level fell proportionally to clinical improvement. Based on the data in the literature and this clinical observation, it appears that cytomegalovirus antigen level in leukocytes is a precise tool for early diagnosis of cytomegalovirus infection. The technique is rapid, has an excellent sensitivity and the quantitative results are correlated with clinical manifestations. Quantitative anti-cytomegalovirus antigen assay can be a very helpful tool in the management of infected immunodepressed patients.

Antigens, Viral↗
PubMed1995

[Nephropathies caused by interferon alpha: apropos of 2 cases].

Two cases reports of interferon alpha-associated nephropathy are reported. The first observation is a membranoproliferative glomerulonephritis and the second a renal microangiopathy. The different cases in the literature are reviewed and the pathophysiology is discussed.

Adult↗
PubMed1995

Serum anti-dextran antibodies in IgA nephropathy.

Abnormally high humoral responses have been described in IgA nephropathy (IgAN), towards antigens commonly involved in infectious events or food intolerance. Here we report a comparative analysis of humoral responses to a common environmental antigen, dextran B 512, present both in nonpathogenic microorganisms and normal diet. Dextran-specific IgG, IgA and IgM were assayed using an ELISA method in serum samples from 121 patients with IgAN, 40 controls and 32 patients with biopsy-proven renal diseases different from IgAN. Among the latter, 17 were transplant recipients. Anti-dextran IgG antibodies were found significantly (p < 0.05) more frequently and at higher levels in IgAN patients than in patients with other renal diseases. Anti-dextran IgA were at significantly (p < 0.05) higher levels in IgAN patients than in controls or untransplanted NIgAN patients. However, similarly elevated levels of anti-dextran IgA were found in IgAN patients and transplanted patients with other renal diseases. These data confirm that IgA and IgG responses towards common antigens are elevated in IgAN, possibly as a consequence of the pathogenesis of this disease rather than because of renal impairment. Moreover, since the same degree of dysregulation was noted in the control group of transplanted patients whose initial diagnosis was not IgAN, these data favour the hypothesis of a global dysregulation of the IgA system in IgAN, yielding enhanced humoral immune responses to possible pathogens and diet antigens.

Adult↗
PubMed1995

[Role of peritoneal dialysis in the treatment of terminal chronic renal insufficiency. Survival of patients and method].

Chronic peritoneal dialysis, especially continuous ambulatory peritoneal dialysis, is now a modality of treatment for patients with end stage renal failure. The proportion of patients varies considerably from country to country. Non medical considerations seem to be the main reason for the limited development of the treatment modality. Most of available reports point out no difference in patient or technique survivals on hemodialysis or peritoneal dialysis. Age, diabetes mellitus, cardiovascular diseases, infections complications (peritonitis and exit-site infections) impact on mortality and morbidity (number of hospital days per patient per year). The probability of death or dropout is much higher for patients with diabetes and patients in older age groups. Most patients with end stage renal failure, especially those waiting for a kidney transplant, are suitable for peritoneal dialysis.

Aged↗