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Biomedical subjects

C Combe

Publications and source records attributed to C Combe.

At least 109 records · Page 6Linked to original sources
PubMed1991

Improvement of leucocytic Na+ K+ pump activity in uremic patients on low protein diet.

Leucocytic Na+ K+ pump activity was assessed in 20 patients with advanced renal failure. Na+ K(+)-ATPase activity was reduced when compared with the values obtained from normal subjects (101.8 +/- 48.6 versus 165.13 +/- 8.9 microM of Pi hr-1.g-1; P less than 0.001) and the mean 86Rb uptake by U 937 cells was depressed by 38% after the addition of patients' sera. Subsequently, patients were put on a diet providing 0.3 g protein/kg body weight daily and supplemented with ketoacids. After three months of dietary treatment Na+ K(+)-ATPase activity increased to 142 +/- 48.3 (P less than 0.01) and reached normal values at the sixth month (162.8 +/- 54.70 microM of Pi hr-1.g-1; P less than 0.001) whereas 86Rb uptake increased by 23 percent when compared to initial values. These data suggest that among the different mechanisms which have been advanced to explain the defects in the Na+ pump observed in uremic patients, circulating inhibitors deriving from alimentary protein intake may affect cation transport.

Adult↗
PubMed1991

Low-protein, low-phosphorus diet and tissue insulin sensitivity in insulin-dependent diabetic patients with chronic renal failure.

Tissue insulin sensitivity was measured by the glucose clamp technique in 8 uremic insulin-dependent diabetic patients before and after 3 months on a low-protein diet (LPD) providing daily 35 kcal/kg body weight, 60% of the caloric supply being obtained from carbohydrates. An improvement in tissue insulin sensitivity was observed for each steady state of the clamp and daily insulin requirements decreased significantly from 38.3 +/- 3.2 to 28.2 +/- 2.5 units (p less than 0.01) in spite of an increased carbohydrate intake. It is suggested that LPD lowers the production and accumulation of uremic toxins interfering with insulin sensitivity.

Adult↗
PubMed1990

Cardioprotective effect of trimetazidine in severe ischemic cardiomyopathy.

The aim of this study was to assess the value of long-term treatment with 60 mg per day of trimetazidine, a cellular antiischemic agent, in comparison with placebo, in patients with ischemic cardiomyopathy controlled by conventional treatments. Twenty patients, with a mean age of 59.5 +/- 1.6 years, suffering from severe ischemic cardiomyopathy (NYHA IV, 6 patients; NYHA III, 14 patients) confirmed by coronary angiography, were included in the study; four of them suffered from residual angina. All of these patients were receiving long-term treatment with long-acting nitrates associated with digitalis (9 patients), diuretics (15 patients), anticoagulants (13 patients), and antiarrhythmics (11 patients), and were considered to be stabilized at the time of inclusion in the study. The examinations consisted of clinical and laboratory assessment, resting ECG, 24-hour ECG monitoring, X-ray evaluation of cardiac volume (CV), and evaluation of echocardiographic left ventricular shortening (ELVS) and of isotopic ejection fraction (EF). These three parameters were expressed as a percentage variation with respect to the initial value, and their variation between the two groups was compared by means of two-way analysis of variance. Clinically, the therapeutic benefit provided by trimetazidine resulted in: a) an improvement of dyspnea in all patients treated with trimetazicine compared with only one patient with placebo (p less than 0.001), b) resolution of residual angina, which was unchanged with placebo, c) reduced requirements for complementary treatments (a single case versus eight cases in the placebo group; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomyopathy, Dilated↗
PubMed1990

Effect of prostaglandin E2 on proline uptake and protein synthesis by cultured human mesangial cells.

PGE2 production by glomeruli is increased in a variety of glomerular diseases. Potentially, this process may affect mesangial cell protein synthesis and mesangial cell growth. Thus studies have been undertaken, using cultured human mesangial cells, to assess the effects of PGE2 on proline uptake, protein synthesis and cell proliferation. In the presence of 140 mM NaCl, incubation of mesangial cells with 0.01 to 1 microM PGE2 for 72 hours resulted in a marked decrease of 14C proline uptake, but did not modify 14C leucine uptake. Substitution of choline to sodium inhibited 14C proline uptake by 85% which became independent of PGE2, indicating that this PG specifically altered sodium-dependent proline uptake. Inhibition of this component reached 35 to 50% with 1 microM PGE2. The inhibitory effect of PGE2 on sodium-dependent proline uptake required a lag time of 48 hours, and was suppressed by ouabain, an inhibitor of Na+, K+ ATPase activity. PGE2 did not modify the Vmax of the transport system (1.007 vs. 1.023 nmol/mg/min) but increased (P less than 0.01) its Km (1.179 vs. 0.823 mM). 8-bromo-cyclic AMP also inhibited sodium-independent proline uptake, and PGE2 markedly increased cyclic AMP production. Taken together, these results suggested that PGE2 acted via cyclic AMP stimulation. PGE2 under identical conditions (1 microM, 72 hr incubation) produced a decrease in collagen synthesis estimated by the relative rate of collagen production after incubation of mesangial cells with 14C proline (percentage of 14C radioactivity in collagenase-sensitive proteins over total proteins). PGE2 also diminished the intracellular free proline pool. More generally, PGE2 inhibited cell proliferation and cell total proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Division↗
PubMed1990

Therapeutic value of a cardioprotective agent in patients with severe ischaemic cardiomyopathy.

Trimetazidine (TMZ) has been shown to have anti-ischaemic properties improving exercise tolerance without haemodynamic effects. A 6-month double-blind placebo-controlled study was carried out in 20 patients, mean age 59 +/- 6 years, to examine the benefit of adding 60 mg of TMZ vs placebo to the classical therapy, excluding those previously treated with calcium-antagonists, conversion enzyme inhibitors, vasodilators and antiplatelet agents. All patients had severe ischaemic cardiomyopathy, confirmed by coronary angiography; six were in NYHA class IV; 14 in NYHA class III; four had mild recurrent angina pectoris. assessment included clinical and biological evaluation, electrocardiography (ECG), 24-h ECG monitoring, cardiac volume evaluation with chest X-ray, left ventricular fractional shortening by echocardiography, left ventricular ejection fraction by radionuclide angiography. Baseline characteristics were similar in placebo (11 patients) and TMZ (nine patients) groups. Eighteen patients (nine in each group) were followed up for 6 months. In eight patients of the placebo group, treatment had to be modified (addition of calcium antagonists: four patients, conversion enzyme inhibitors: two patients; digitalics: one patient; diuretics: one patient). In the TMZ group, digitalic therapy was withdrawn in one patient and added in one patient (P less than 0.01). At 6 months, all TMZ group patients were free from angina; dyspnoea was improved in all TMZ patients and in only one placebo patient (P less than 0.001). Ejection fraction, increased by 9.3% in the TMZ group and decreased by 15.6% in the placebo group (P less than 0.018), CV decreased by 7% with TMZ, increased by 4% with placebo. (P = 0.034).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

[Conservative treatment of chronic renal insufficiency in the aged patient].

Patients over 70 years old constitute a large percentage of those with chronic renal insufficiency (CRI) (27% in our series). Vascular renal lesions appear to represent a predominant etiology in this age range that is equally remarkable for this multiplicity of potential etiologies and associated pathologies. The prognostic severity of CRI aggravated by hypovolemia or by the toxicity of prescribed drugs calls for great carefulness in prescribing diets and drugs for the elderly. It is hard to say whether an effective nephro-protection can be obtained through a hypoprotein diet supplemented with ketoanalogs, a diet very acceptable from a nutritional standpoint. On the other hand, the corrective effect of this diet upon certain metabolic abnormalities that occur during CRI seems to be undeniable.

Aged↗
PubMed1989

[Castleman's disease and glomerular nephropathy (apropos of 1 case].

We report a case of Castleman's disease of multifocal plasma-cell type revealed by a severe general weakness, associated to a nephrotic syndrome with renal failure. The characteristic aspects of lymphoid hyperplasia with hyalinization of follicles and interfollicular vascular proliferation were observed in mesenteric lymph nodes, the spleen was involved by an infarcted localisation of Castleman's disease. The glomerular lesions were consistent with a proliferative mesangial glomerulonephritis. The removal of the spleen and of the mesenteric nodes involved by the disease, associated with a steroid course was curative. The nephrotic syndrome appears to be etiologically related to the presence of the Castleman's tumor. The removal of the tumor relieves the proteinuria and the renal failure as in other cases reported in the literature.

Acute Kidney Injury↗
PubMed1989

[Value of trimetazidine in the long-term treatment of cardiomyopathies of ischemic origin].

The effect of a cellular anti-ischemic, trimetazidine (TMZ) in ischemic cardiomyopathies, was evaluated in a double-blind versus-placebo (P) trial, over a period of six months. 20 patients, mean age: 59.5 years, with advanced ischemic cardiomyopathy, demonstrated by left catheterization and coronary angiography, with a past history of myocardial infarction, received either 60 mg per day of TMZ (nine patients) or the placebo (eleven patients) in addition to a basic treatment of digitalis, diuretics and nitrated medications. A complete, clinical, biological and paraclinical evaluation, including chest X-ray, ultrasonography, isotopic ventriculography and 24 h-ECG, was performed upon inclusion in the study; and after three and six months of treatment. Two patients from the placebo group were not reevaluated at six months. The clinical condition, according to the NYHA classification, improved in all patients from the TMZ group, deteriorated in eight on nine patients from the placebo group (p less than 0.001). The isotopic stroke volume is preserved with TMZ, deteriorated with P. The cardiac volume decreases with TMZ, increasing with P. TMZ is beneficial clinically and functionally in advanced ischemic cardiomyopathies.

Analysis of Variance↗
PubMed1987

[Cardiac complications of dermatopolymyositis. Apropos of 56 cases].

A retrospective study was conducted on 58 patients hospitalized for dermato- or polymyositis between 1967 and 1986, with the view of determining the cardiovascular complications specific to these diseases. The patients' mean age was 51 years, less than 6 months had elapsed between first symptoms and diagnosis, and 31 p. 100 of the patients had died. The electrocardiogram was considered normal in 46 patients, none of whom presented with the slighted clinical evidence of cardiovascular involvement. ECG abnormalities were present in 10 cases, including 5 with disorders of conduction. Five cases of cardiovascular pathology with clinical manifestations were discovered. A 36-year old woman had severe myocardial pathology with marked rhabdomyolysis (CPK greater than 100,000) and complete atrio-ventricular block requiring emergency pacemaker implantation. Three years after the onset of the disease, and whilst the clinical signs of polymyositis had regressed, this patient still had complete AVB and moderately dilated congestive cardiomyopathy. This study shows that cardiac complications of dermato-polymyositis are rare and predominantly consist of disorders of conduction which may become permanent and associated with alterations of left ventricular kinetics. The authors suggest that a high-risk category for patients with disorders of conduction and cardiomyopathy can be identified by echocardiography, but this examination needs mainly be performed in cases when ECG abnormalities are present, since no clinical cardiac pathology was observed in patients of this series with normal electrocardiogram.

Adult↗
PubMed1987

[Fate of angina in women with healthy coronary vessels. Retrospective study of 68 patients with a 42-month follow-up].

The discovery of normal coronaries on angiography in patients known and treated for many years for true angina, if reassuring for the physician, raises other problems about the evolution of the patient. Among the 235 patients seen with this diagnosis between january 1980 and may 1986, 68 had healthy coronaries without any associated disease (mean age = 57.4 years). The objective is to determine the evolution of this group with a mean follow-up of 42 months and the advantages of coronary angiography. No infarction or sudden death occurred. 91 p. cent have an unlimited housekeeping activity, 10 p. cent have stopped working for a cardiac reason, 55 p. cent continue to work, 13 p. cent were rehospitalized for the same reason and 25 p. cent developed extra cardiac symptoms (2 neoplasms). But only 35 p. cent do not experience chest pain. On the contrary, failure is obvious concerning the anti-angina treatment since only 10 p. cent are not any longer on medication and the total consumption did not vary. The fact that 84 p. cent of the patients have little or no pain under calcium-blockers, taken alone or in association with other drugs, raises the question of their true efficacy, without any placebo effect, since the beta-blockers consumption decreases slightly.

Angina Pectoris↗
PubMed1985

Septicemia caused by Agrobacterium sp.

Agrobacterium radiobacter biovar 2 was repeatedly grown from the blood of an elderly patient receiving artificial ventilation and broad-spectrum antibiotics. No source of the organism was found, but the septicemia ceased when cefotaxime was given. Sera from the patient showed a fourfold rise in antibody against the organism and higher titers than sera from all but 1 of 50 healthy blood donors. The organism did not contain the plasmid associated with plant oncogenicity. This case may be only the second in which Agrobacterium sp. has been clearly linked with human infection.

Aged↗
PubMedDate not supplied

Gd-DOTA tubular transit asymmetry induced by angiotensin-converting enzyme inhibitor in experimental renovascular hypertension.

In stenosis of a renal artery, angiotensin-converting enzyme inhibitor (ACEI) can induce a decrease in ipsilateral glomerular filtration. Dynamic MR imaging with gadolinium chelate enhancement was tested to detect this glomerular filtration reduction in experimental renovascular hypertension in the rat. Thirteen rats, with surgically induced left renal artery stenosis, developed hypertension and were studied before and after intravenous injection of ACEI with sequential Gd-DOTA-enhanced MR imaging. The time to onset of the tubular phase, the time of the maximal drop of signal, and the medullary signal-time curves of both kidneys were compared. Before ACEI, tubular phases were symmetric in 11 rats and slightly asymmetric in 2. Twelve rats showed ACEI-induced changes (positive test): absence of tubular phase on the left side (n = 8) or delay (n = 4) with significant differences (P < .01). Tubular phases remained symmetric in one (negative test). Dynamic MR imaging can identify ACEI-induced Gd-DOTA tubular transit asymmetry, indicative of functionally significant renal artery stenoses, in rats.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

MR imaging of nephropathies.

Acute and chronic nephropathies are responsible for morphologic and functional renal changes. However, radiologic techniques currently play a minor role in imaging of parenchymal nephropathies in native or transplanted kidneys. From a morphologic point of view, three-dimensional magnetic resonance (MR) volumetric biomarkers of kidney function, such as renal and cortical volumes or cystic volume, in polycystic kidney diseases play a growing role in nephrologic practice. From a functional point of view, if scintigraphic techniques remain the major sources of renal performance assessment, new MR imaging systems and specific MR contrast agents may soon provide significant developments in the evaluation of renal performance (glomerular filtration rate measurement), in the search for prognostic factors (hypoxia, inflammation, cell viability, degree of tubular function, and interstitial fibrosis), and for monitoring new cell therapies. New developments that have provided higher signal-to-noise ratio and higher spatial and/or temporal resolutions have the potential to direct new opportunities for obtaining morphologic and functional information on tissue characteristics that are relevant for various renal diseases with respect to diagnosis, prognosis, and treatment follow-up.

Humans↗
PubMedDate not supplied

Resting energy expenditure in uremic, diabetic, and uremic diabetic subjects.

We compared Harris and Benedict [H & B; Harris, J. A., & Benedict, F. G. (1919). A biometric study of basal metabolism in man. Washington, DC: Carnegie Institution of Washington. p. 279.] predicted resting energy expenditure (REE) to values measured by indirect calorimetry in normal, uremic, diabetic, and uremic diabetic subjects. Predicted REE were overestimated (+9.2%, P<.005) in uremic subjects, and underestimated (-8.5%, P<.0001) in diabetic subjects. Uremic diabetic subjects were submitted to the opposite influences of diabetes and uremia on REE. Differences in body composition (lower fat-free mass in uremia and higher fat-free mass in diabetes) played a major role in these influences. In uremic diabetic subjects, predicted REE seemed well fitted to measured REE (biases <2%), but they were less correlated, and limits of agreement between predicted and measured REE were large. Although their mean REE seems normal, prediction by the H&B equation leads to important individual errors in uremic diabetic subjects: direct measurement of energy expenditure by indirect calorimetry may be helpful to precise the adequate energy content of a diet for these subjects.

Adult↗