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Biomedical subjects

D Pierre

Publications and source records attributed to D Pierre.

14 recordsLinked to original sources
PubMed2000

Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology.

BACKGROUND: We studied the feasibility, technical problems, safety, and effectiveness of percutaneous declotting of thrombosed native arteriovenous fistulae for hemodialysis. METHODS: Between 1992 and 1998, 93 declotting procedures were performed in 73 consecutive upper limb native fistulae (forearm 56 and upper arm 17), and 162 procedures were performed in 78 prosthetic grafts using manual catheter-directed thrombo-aspiration, with or without previous urokinase infusion. Detection of restenosis by clinical surveillance led to redilation or stent placement. Rethrombosis in four forearm and six upper arm fistulae were treated by 20 further declottings by aspiration. RESULTS: The initial success was 93% in the forearm and 76% in the upper arm (99% in grafts). The complications included one pulmonary embolism, one acute pseudoaneurysm, and one blood depletion requiring transfusion. Primary patency rates at one year were 49% in the forearm and 9% in the upper arm (14% in grafts). Secondary patency rates were 81 and 50% at one year, respectively (83% in grafts). Reinterventions were necessary every 19.6 months in the forearm and every 5.7 months in the upper arm (every 6.4 months in grafts, P < 0.05). Stents were placed in 11% of forearm fistulae and in 41% of upper arm fistulae (45% of grafts) for treatment of acute rupture (5 out of 19), stenosis recoil (6 out of 19), and early (< 6 months) recurring stenosis (8 out of 19). CONCLUSIONS: The percutaneous declotting of forearm fistulae by manual catheter-directed thrombo-aspiration was effective in more than 90% of cases and yielded 50% primary and 80% secondary patency rates at one year. The results were poorer in upper arm fistulae. The need for maintenance reinterventions was three times smaller in forearm fistulae than in upper arm fistulae and grafts.

Aged↗
PubMed1992

The polyhomeotic gene of Drosophila encodes a chromatin protein that shares polytene chromosome-binding sites with Polycomb.

The Polycomb group (PcG) genes in Drosophila melanogaster are required for maintenance of correct spatial expression of homeotic genes, and their products are thought to form either a regulatory network or act as a multimeric complex. Recently, it has been suggested that because of homology between Polycomb (Pc) and Su(var)205, PcG genes encode chromatin proteins required for the maintenance of a determined state in chromatin. The polyhomeotic (ph) gene is a member of the PcG of genes. We present DNA sequence of a ph cDNA, which encodes a 169-kD protein with a single putative zinc finger, a serine/threonine-rich region, and has glutamine repeats, suggesting that ph is a DNA-binding protein. Polyclonal antisera directed against ph protein bind to approximately 80 sites on polytene chromosomes. Most of these sites appear to be the same as those recognized by antibodies to Pc protein. ph protein binds to insertion sites of constructs containing DNA from the bithoraxoid (bxd) region of the Bithorax complex, showing that ph binding to chromatin is DNA dependent. The same bxd constructs are recognized by Pc protein, strongly supporting the hypothesis that ph and Pc interact directly.

Amino Acid Sequence↗
PubMed1987

[Arthropathies of the limbs in dialyzed renal failure patients].

During the last few years, articular symptoms have been reported in chronic renal failure patients on maintenance haemodialysis. A prospective study of arthropathies of the limbs was conducted in 73 such patients: 20 had experienced periarthritis, 32 had tendinous calcifications (3 or more in 16 cases), 29 had destructive arthropathies (especially of the hands) and 10 had calcium pyrophosphate dihydrate deposition. The periarthritis attacks were associated with the presence of tendinous calcifications. The destructive arthropathies could be due to calcium apatite microcrystal deposition, but the study provided no direct evidence of this mechanism. However, the pattern of erosive lesions, their location and their possible association with tendinous calcifications in the same joint were suggestive of calcium apatite deposition. Calcium pyrophosphate deposition, which affected the oldest patients, did not seem to be due to chronic renal failure treated with dialysis. The most important arthropathies were found in patients who had been haemodialysed for a long time, although the correlation was not statistically significant. The dialysis pattern did not seem to influence the articular disorders. There were more cases of calcification and periarthritis among patients whose phosphocalcium product (in mg) exceeded 6000, but the difference with other patients was not statistically significant. Periarthritis and arthropathies are truly disabling for these patients.

Calcinosis↗
PubMed1987

Primary bone oxalosis: the roles of oxalate deposits and renal osteodystrophy.

Primary oxalosis is a rare congenital disorder. The excessive oxalate biosynthesis induces deposits in many organs, particularly in kidney and bone. The late onset of primary oxalosis is reported in a 50-year-old man. His chronic renal failure was treated by maintenance hemodialysis for 3 years. He then developed a diffuse bone disease with osteosclerosis and roentgenographic features of hyperparathyroidism. A parathyroidectomy was performed, with debatable improvement of bone lesions. Laboratory results and histologic and histomorphometric studies before and after parathyroidectomy suggest a double histopathogenetic mechanism for this bone disease: renal osteodystrophy and massive bone oxalate deposits. Such deposits may induce both a heterogeneous osteosclerosis with dense metaphyseal bands and histologic bone lesions similar to those of hyperparathyroidism. The crystalline deposits induce in the bone tissue a granulomatous macrophagic reaction. These macrophages are unable to phagocytize the crystals and may be involved in active bone resorption. Bone lesions of oxalosis occur in patients with chronic renal failure, and hyperparathyroidism has a worsening role.

Bone and Bones↗
PubMed1985

[Peritonitis in renal failure patients treated by continuous ambulatory peritoneal dialysis. Treatment by intraperitoneal administration of a group M penicillin].

From February 1980 to February 1983, 55 patients with chronic renal failure were put on continuous ambulatory peritoneal dialysis. Eighty-four episodes of peritonitis occurred., i.e one episode every 9.9 months of treatment. Since staphylococci accounted for 58% of the germs identified, intraperitoneal therapy with a penicillin M was instituted while dialysis was continued through chambers. Cure was obtained in 85.7% of all episodes, either with the penicillin M alone (57% of the cases) or after adjustment of the antibiotic therapy to bacteriological results (28.6% of the cases). Dialysis was discontinued in 10 patients (18%) on account of the peritonitis. The duration of hospital stay for peritonitis was 3.6 days per patient per year. These results were compared with those obtained by other groups. The advantages of penicillin M are its ease of administration, its narrow spectrum and high activity against the pathogens most commonly encountered, and its very low toxicity.

Adult↗
PubMed1985

[Plasma exchange and hyperthyroidism. Current indications].

Serious thyrotoxicosis must be treated quickly and efficiently. Plasma exchange (PE) takes place when ordinary treatment is not suitable in emergency cases. Several methods of plasma clearing have already been practiced successfully. PE is the best one. It quickly removes a great amount of thyroid hormones and occasionally pathological immunoglobulins. Risks have not to be underestimated. The most serious accidents are particularly linked with the substitution fluids. Hemoperfusion, peritoneal dialysis, transfusion exchanges can be used too. Thyrotoxicosis crisis, as far as life prognosis is concerned, is an appropriate indication of PE, either as a first line treatment or after the classical treatment has failed. Serious hyperthyroidism due to iodine overload is not improved with common treatment. In this case PE might be worthwhile. In malignant exophthalmia, unimproved with an usual treatment PE can be successfully used, every time ocular prognosis is concerned.

Graves Disease↗
PubMed1985

[5 years of continuous ambulatory peritoneal dialysis (CAPD) (multicenter study of 345 patients)].

A retrospective survey has been undertaken in 7 different centers: 345 patients trained to CAPD between 1978 and 1983 were studied: technic success and survival rate were analysed using actuarial methods. Drop-out has dramatically decreased after May 1981 due to a lower mortality whatever the age. For all patients the actuarial survival at two years after 1981 is 87.1%. Related to a lower mortality, better results are obtained in patients younger than 55. However peritonitis is the main complication since they are involved in 1/3 of drop-out causes. It is concluded that CAPD might be used in almost 30% of chronic renal failure patients and that patients waiting for a kidney transplantation represent the best indication. In aged patients, nutritional status and psychosocial background must be carefully analysed before starting CAPD.

Actuarial Analysis↗
PubMed1985

[Calcium oxalate microcrystalline arthropathy in primary oxalosis].

This paper dealt with the case of a 53 years old man, affected by a chronic renal failure as the initial symptom of a primary oxalosis and treated by hemodialysis three years ago. Two years after the onset of renal failure, the left knee was painful and swollen but no cartilage or bone joint lesion was observed. Presence of intra synovial calcium oxalate crystals suggests that this arthropathy may be related to the primary oxalosis. However the role of other calcium salts under identification evidenced by synovial electron microscopy (apatite ? pyrophosphate ?) is discussed.

Calcium Oxalate↗
PubMed1983

Hepatitis B vaccine: simultaneous passive and active immunization. Indications in pre- and post-exposure.

An alum bivalent hepatitis B vaccine (HB vaccine) containing 5 micrograms/dose of formalin-inactivated and purified HBsAg has been used for active immunization of dialysis patients since the fall of 1975. Elderly patients had a weak and delayed response to three injections of HB vaccine. They were thus at risk of being infected by HBV before the completion of immunization. To prevent these early infections a four-way passive-active immunization trial was undertaken. Patients received three or four injections of HB vaccine in combination with one or two injections of hyper-immune anti-HBs globulin (HBIG). Results show that passive anti-HBs did not impair the immune response to the vaccine. Moreover, immediate administration of HBIG upon entry in the dialysis centre significantly reduced early-acquired chronic HBs antigenaemia as compared to a group of patients receiving the HB vaccine alone. Passive-active immunization can also be used for post-exposure prophylaxis after accidental inoculation of HBsAg blood (needle-stick) or for the prevention of mother-infant transmission of HBV in children born to HBsAg/HBeAg positive mothers.

Adolescent↗
PubMedDate not supplied

[Unusual hemolytic-uremic syndrome in an adult].

A 44-year old woman presented with haemolytic-uraemic syndrome due to predominantly arteriolar microangiopathy, with anuria lasting 48 days. The semeiology in this case was unusual: there was no anaemia and only rare schizocytes on admission, blood pressure was normal and anuria was prolonged. The severity of arteriolar thrombosis observed at renal biopsy stood in sharp contrast with the lack of arterial hypertension and the almost total recovery of renal function within three months.

Adult↗
PubMedDate not supplied

[Psychotherapeutic approach to migrant patients of the 1st or 2nd generation: contribution of Tobie Nathan's ethnopsychoanalysis].

Based on our experience of the ethnopsychiatric consultation directed by Tobie Nathan in Paris, we try to define the adaptations of the therapeutic setting necessary, according to him, in a transcultural situation, and by whom we can be inspired (work-group, participation of a translator, mobilisation of the traditional etiological interpretations). Then, we study the clinical case of a young Algerian girl living in Belgium. We analyze her acute delirious psychosis following the conceptions of Tobie Nathan: the particular situation of migrant children would be a proneness for the splitting of the ego. At least we show how important is in the psychotherapy the restitution of the original cultural framework.

Adolescent↗