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Biomedical subjects

C Combe

Publications and source records attributed to C Combe.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Comparison of different monitoring techniques for vascular access in chronic hemodialysis].

Aim of the study was to compare different techniques of monitoring for vascular accesses in our chronic hemodialysis patients. Twenty seven patients (14 men, 13 women) were investigated. The accesses studied consisted of 19 arteriovenous fistulas and 8 vascular protheses. Twenty-four were trouble free, venous pressure was high in two, one was difficult to puncture. Three measurements of recirculation percentage were made for each patient, as well as a color Doppler flow imaging, and a digital angiography of the access. Recirculation measurements were normal for all patients including those with functional abnormalities. A stenosis was found 9 times with the Doppler and 10 times by angiography, there being disagreement between the two techniques in one case. The location of the stenosis was the same in the 9 concordant cases. There was a very strong correlation between the degree of stenosis found using the two techniques (p < 0.0001). In conclusion, measurement of recirculation appears to us to be of no interest for verifying a vascular access. On the other hand, the color Doppler seems to be an excellent choice for detecting an abnormality. An arteriographic confirmation seems necessary before correction.

Adolescent↗
PubMed1993

GM-CSF and G-CSF in Felty's syndrome.

The risk of infection is increased in patients with Felty's syndrome, neutropenia being one of the main reasons for the susceptibility to infection. We report the case of a 56-year-old patient with Felty's syndrome in whom successive therapy with GM-CSF, splenectomy, and G-CSF was tried because of recurrent severe infections. Therapy with GM-CSF and G-CSF resulted in improvement of neutropenia and in successful treatment of cutaneous and pulmonary infections.

Combined Modality Therapy↗
PubMed1993

Pontine myelinolysis following liver transplantation: a report of two cases.

Two cases of central pontine myelinolysis (CPM) following orthotopic liver transplantation (OLT) are reported. Several months after the onset of this neurological syndrome, the two patients are still alive but with severe neurological sequelae. Some patients undergoing emergency OLT present a high risk of CPM because of pre-existing malnutrition, encephalopathy, and hepatic insufficiency. All of these are associated with an inevitable abrupt rise in sodium serum concentration due to intraoperative compensation of blood losses with high-sodium content blood products. Whenever the renal capacity to excrete sodium is impaired by the surgical procedure, continuous intraoperative venovenous hemofiltration is recommended.

Adult↗
PubMed1993

[Cardiac involvements in scleroderma: study with echocardiography and cardiac Doppler in 38 patients].

A study of heart lesions has been conducted in 38 patients with systemic sclerosis using echocardiography, doppler and colour doppler. Abnormalities were found in 66% patients. Valvulopathies (mainly mitral regurgitation) were the most frequent lesions (45%). The presence of anti-SCL70 antibody was correlated to right cavities dilatation. Pulmonary hypertension was found in 6 patients.

Adult↗
PubMed1993

[Rheumatoid purpura in adults. Retrospective study of 38 patients].

The authors report retrospectively 38 cases of Schönlein-Henoch purpura (20 males, 18 females; median age, 26 years). Skin (37/38) and joint (21/38) manifestations are similar to those seen in children. Gastro intestinal (22/38) manifestations are less complicated. Long term outcome of the disease depends on kidney's involvement (32/38) and is severe: chronic renal failure in 31%.

Adult↗
PubMed1993

[Protein metabolism during nephrotic syndrome. Experimental and clinical influence of dietary protein intake].

In adults, 12 to 14 g of albumin are synthesized daily. The same quantity is catabolized, essentially by the vascular endothelium and to a lesser degree in renal tubules. During nephrotic syndrome, contrary to what is observed in malnutrition conditions accompanied by hypoalbuminemia, hepatic synthesis is only moderately increased, whereas fractional catabolism is greater than normal. The increase in alimentary protein-intake, which has been proposed to restore the pool of albumin, raises hepatic albumin synthesis, but also its urinary losses, most likely by stimulation of the renin-angiotensin system. A reduction in protein rations lowers proteinuria and improves the hepatic abnormalities of nephrotic syndrome but its longterm nutritional consequences are poorly understood. The association of a converting enzyme inhibitor with a diet moderately restricted in protein content (1 g/kg/day) might constitute a therapeutic satisfactory solution.

Adult↗
PubMed1993

Compliance and effects of nutritional treatment on progression and metabolic disorders of chronic renal failure.

Low-protein, low-phosphorus diets (LPD) are prescribed to patients with chronic renal failure (CRF) to slow down the rate of progression of CRF and to control uraemic symptoms. A satisfactory adherence of patients to the prescribed diet is needed to meet these two goals. We studied the compliance of CRF patients to a LPD providing daily (per kg body weight) 0.3 g protein, 3-5 mg phosphorus, 35 kcal, and supplemented with essential amino-acids and keto-analogues. Forty CRF patients were studied for 23.3 +/- 10.8 months (range 12-45). Compliance to LPD was evaluated by dietary inquiry and protein intake estimated from urinary urea excretion. According to compliance to LPD, patients were retrospectively assigned to the compliant (n = 27) or the non-compliant (n = 13) group. GFR measured by the urinary clearance of [51Cr]-EDTA was identical in the two groups at the start of the study: compliant patients 15.7 +/- 5.3 ml/mn, non-compliant patients 15.4 +/- 5.9 ml/mn. The decrease of GFR was -0.08 +/- 0.22 ml/min per month in compliant patients versus -0.31 +/- 0.37 ml/min per month in non-compliant patients (P < 0.02). These results were not demonstrated if the progression of CRF was assessed by the linear regressions over time of creatinine clearance or the reciprocal of creatinine. Serum bicarbonate, serum phosphorus and PTH levels were corrected by LPD in compliant patients (P < 0.005 for all parameters) but not in non-compliant patients. These results suggest that evaluation of compliance is necessary to assess the response of CRF patients to LPD, whether the aim is to slow the progression of CRF or to control its metabolic consequences. A beneficial effect of compliance to LPD was demonstrated upon these two goals.

Adult↗
PubMed1993

[Cystine lithiasis and its treatment with d-penicillamine. The experience in a nephrology service in a 23-year period. Apropos of 26 patients].

From 1968 through 1990, 26 patients with cystine lithiasis were followed-up for a mean of 10.6 +/- 6.7 years in the department of Nephrology of the Pellegrin Hospital in Bordeaux, France. Clinical and surgical features in these patients are reported as well as the experience acquired with the use of D-penicillamine over the 23-year study period. Long-term D-penicillamine treatment can be used in patients with cystinuria and is both effective and safe. Use of other thiol compounds for preventing cystine stone formation was not necessary in our patients.

Adolescent↗
PubMed1992

Ketodiet, physiological calcium intake and native vitamin D improve renal osteodystrophy.

The effects of a very low-protein diet (VLPD) supplemented with amino acids and ketoanalogues (KA) and with 1 g of calcium carbonate and 1000 IU of vitamin D2, were studied in 17 patients with advanced renal failure (GFR < or = 20 ml/min) over a period of one year. The protein intake was 0.3 g protein/kg body wt/day. Daily phosphorus and calcium intake were respectively 1,500 mg and 300 mg. Sequential bone densitometry was performed and bone histomorphometry after double tetracycline labeling was evaluated, before and after one year of diet. Calcium and phosphate metabolism parameters were monitored every two months. In spite of a significant decrease of GFR, phosphorus, parathyroid hormone (1-84) and osteocalcin plasma levels decreased significantly, while low plasma bicarbonate normalized, and calcitriol and calcium levels remained respectively low and normal. Before the diet, histological study disclosed four cases of mixed osteopathy: osteomalacia associated with osteitis fibrosa (OM/OF), nine pure osteitis fibrosa (OF) and four with normal bone remodeling (NB). After one year of diet, the OM component of OM/OF disappeared, as evidenced by a normalization of the mineral apposition rate and osteoid thickness. In the patients presenting pure OF, a significant decrease in osteoblastic and osteoclastic surfaces, in the number of osteoclasts, and in the bone formation rate (BFR) were found. Vertebral mineral density measured by quantitative computerized tomodensitometry did not change significantly. In conclusion, this study not only confirms the beneficial effects of VLPD + KA + calcium on uremic hyperparathyroid bone disease in advanced renal failure assessed using static bone histomorphometry, but also shows a correction of histodynamic bone parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗