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Biomedical subjects

G Deschodt

Publications and source records attributed to G Deschodt.

At least 19 recordsLinked to original sources
PubMed1997

[Secondary hyperparathyroidism and multiple vertebral brown tumors: cure after parathyroidectomy].

A 46 year old man was referred for severe left cruralgia and multiple vertebral cystic defects on CT-scan. He was treated by hemodialysis since 1987 for chronic renal failure secondary to focal and segmental glomerulosclerosis, diagnosed in 1960 on renal biopsy. Dialysis schedule consisted of 3 x 4 h/week with a polysulfone dialyser and 1.75 mMol Ca containing bicarbonate dialysate. On early 1995, the patient complained of back pain and cruralgia, which gradually worsened. Vertebral column CT-scan and MRI showed multiple lytic lesions expanding into the medullary canal. Biological hyperparathyroidism was present. To differentiate between hyperparathyroidism with brown tumors, malignancy and amyloid deposition, an iliac biopsy and a biopsy of a corporeal vertebral cyst were done. They showed florid hyperparathyroidism and brown tumors. The patient was submitted to surgical parathyroidectomy. Six months after surgery, cruralgia resumed, CT-scan and MRI showed refilling of the cysts by calcic material.

Glomerulosclerosis, Focal Segmental↗
PubMed1994

[Tunneled jugular catheters in chronic hemodialysis: report from a Center apropos of 101 cases].

Since 1984, internal jugular vein cannulation (I.J.V.C.) was performed in our Center for ESRD patients. 202 catheters were implanted in 79 patients. Our population was divided in 2 groups: group I corresponding to a rescue procedure for the chronic vascular access failure, group II corresponding to chronic implantation. Outcome analysis indicate the follows results: in both groups, the first I.J.V.C. withdrawal cause was a functional AV fistula. Infections were observed only in group II. Thrombosis is not infrequent requiring fibrinolytic drugs with a 54 FF per patient year additive cost. A special nurse training protocol is also required to reduce the thrombosis incidence. Accidental withdrawal occurred in 11% cases of group II. This observation underlines the need of better fixation devices.

Adult↗
PubMed1990

Long-term effects of treatment with recombinant human erythropoietin on haemodynamics and tissue oxygenation in patients with renal anaemia.

Regional peripheral vascular resistance, transcutaneous oxygen pressure and blood pressure were studied in seven normotensive, chronically haemodialysed patients with renal anaemia before and after 3 and 12 months of rHuEpo therapy. Haematocrit increased from 21% to 33% within 3 months of commencing therapy, and remained stable throughout the following observation time. Though regional blood flow of the calf was markedly reduced after 3 and 12 months of rHuEpo compared to pretreatment values, transcutaneous oxygen pressure was significantly increased after 3 months and remained constantly elevated after 12 months. Mean arterial blood pressure increased significantly by 7.3 mmHg after 3 months of rHuEpo treatment but did not reach hypertensive values and was no longer different from pretreatment values 12 months after the start of rHuEpo. Results of peripheral haemodynamic studies were compared to those obtained by measurement of central haemodynamics in four further normotensive anaemic patients. In these patients cardiac output decreased, total peripheral vascular resistance increased and blood pressure increased slightly (by 5.5 mmHg) when a haematocrit of 37% was reached after 8 weeks of rHuEpo therapy. These effects were partly reversed when the maintenance haematocrit decreased to 32% (after 16 weeks of rHuEpo). In summary rHuEpo treatment induced a long-term increase of the total and regional peripheral resistance, an increase of blood pressure within the normal range, and a decrease in cardiac output. Despite these changes tissue oxygenation improved.

Adult↗
PubMed1990

Two years experience of daily self-administered subcutaneous erythropoietin.

Recombinant human erythropoietin (EPO) has been used for 4 years in end-stage renal disease patients, administered intravenously 3 times a week. A study was undertaken to determine the optimal way of administration comparing 3 times weekly intravenous EPO to self-administered daily subcutaneous EPO (SADSCEPO). In a first group of 4 patients, we demonstrated that the change from 3 times weekly intravenous EPO to SADSCEPO permitted a dose reduction of 70%. In a second group of 20 patients who started the EPO therapy with the daily subcutaneous route at a median dose of 12 U/kg/day, the hematocrit increased from 20 to 30% in 4 months and remained over 30% in spite of a median dose reduction to 9 U/kg/day. The patients' acceptance of SADSCEPO was good. The mechanism allowing such a dose reduction is unknown. However, the significant reduction in median dosage requirement with the subcutaneous route should allow a greater number of patients to be treated more cost-effectively.

Adult↗
PubMed1989

Is the rise in plasma beta-2-microglobulin seen during hemodialysis meaningful?

Beta 2-Microglobulin (beta 2M) plasma levels and levels of a second low-molecular-weight protein (myoglobin) were studied during a 2- to 4-hour sham dialysis period (no dialysate flow, no weight loss) and during a 4- to 5-hour hemodialysis (HD) with a Cuprophan capillary dialyzer. While no rise of the beta 2M or myoglobin levels occurred during sham dialysis, a rise of 22.1 +/- (SD) 8.5% (beta 2M) or 19.9 +/- 12.1% (myoglobin) was seen during regular HD. The increases of both molecules showed a significant correlation (r = 0.44; p less than 0.03). Both rises could not be completely abolished using correction factors for hemoconcentration. The rises occurred irrespectively of the dialysate buffer. The results suggest that neither the Cuprophan membrane nor the extracorporeal circuit were responsible for the rise of both molecules during HD. It seems more likely that changes of the extracellular volume and extra- to intracellular water shifts are involved and account for the majority of the rise. However, the possibility of minor increase in the extracellular mass of beta 2M or myoglobin cannot be excluded completely.

Adolescent↗
PubMed1989

High-flux synthetic versus cellulosic membranes for beta 2-microglobulin removal during hemodialysis, hemodiafiltration and hemofiltration.

Efficient removal of beta 2 microglobulin (beta 2-M) in end-stage renal failure patients is a continuing preoccupation, as the incidence and severity of dialysis-associated amyloidosis are increasing. To evaluate comparative beta 2-M removal we studied six stable end-stage renal failure patients during high-flux 3-h haemodialysis, haemodia-filtration, and haemofiltration, using acrylonitrile, cellulose triacetate, polyamide and polysulphone capillary devices. The reduction of plasma beta 2-M, total removal in ultrafiltrate/dialysate, and beta 2-M sieving coefficients were measured by RIA. The results suggest that convection plays the major role in beta 2-M removal when high-flux synthetic membranes are used in combination with high blood flow rates. In contrast, using the cellulose triacetate membrane under investigation, beta 2-M removal is diminished when ultrafiltration rates are increased. Accordingly, in any future prospective study on the role of beta 2-M retention in the amyloidogenesis, it is recommended that high-flux synthetic membranes be employed rather than the type of high-flux cellulosic membranes used in this study. The modality with which these synthetic membranes are used is probably less important, as long as maximum convective transport rates are obtained. Under present conditions, this will imply haemofiltration or haemodiafiltration rather than haemodialysis.

Cellulose↗
PubMed1987

Beta 2-microglobulin kinetics during haemodialysis and haemofiltration.

Since the identification of beta 2-microglobulin as a major component of 'dialysis amyloid', concern about its removal by different dialysis methods has been raised. Haemodialysis with regenerated cellulose membranes increases serum beta 2-microglobulin by 10-15%. Serial measurements show a very early increase during cuprophan haemodialysis, the mechanism of which is as yet unknown. After cuprophan haemodialysis, serum values return to the initial pretreatment concentrations by the time of the next haemodialysis. In contrast to regenerated cellulose, dialysis with polycarbonate lowers serum beta 2-microglobulin by 8%, and dialysis with polysulphone by 53%. As opposed to cuprophan, after polysulphone haemodialysis the serum concentrations have not returned to the initial pretreatment levels within 48 h. Comparison of beta 2-microglobulin removal using the same polysulphone membrane for haemodialysis and haemofiltration shows that beta 2-microglobulin is more effectively removed by convection than by diffusion when both treatment modes are matched for blood flow and urea clearance. Therefore, in contrast to haemodialysis with regenerated cellulose membranes, where a transient, intradialytic release of beta 2-microglobulin is induced, significant removal is observed using higher permeable membranes. These findings may have implications for the generation of 'dialysis amyloid'.

Adult↗
PubMed1984

The anatomical value of technetium-thallium subtraction scanning in detection and location of parathyroid adenomas.

99mTechnetium-201Thallium subtraction scanning was performed in 24 patients with primary (N = 5) and secondary (N = 19) hyperparathyroidism. The preoperative scintigraphy (N = 12) detected 21 of 23 enlarged glands surgically removed and was helpful for detecting abnormal location especially in the mediastinum. Postoperative scanning in patients with recurrent hyperparathyroidism confirmed the excessive growth of the remaining half parathyroid after subtotal parathyroidectomy or a missing fifth parathyroid after total parathyroidectomy and autotransplantation. False negative results were due to tumor hyperplasia. The technique is recommended prior to repeated exploration in patients presenting persistent disease to predict the location of adenomas generally unsuccessfully detected by ultrasonography and computed tomography.

Adenoma↗
PubMed1983

The role of the renin-angiotensin system in the hormonal and renal responses to tilt in normal man.

Head-up tilt is associated with rapid increases in total peripheral and renal resistance and falls in the urinary excretion of water and sodium. The influence of the acute oral administration of the converting enzyme inhibitor captopril (50 mg) on the consequences 60 degrees head-up tilt were assessed in 6 normal subjects on unrestricted sodium intake. Captopril did not modify the responses of arterial pressure and heart rate to tilt, although a significant decrease in supine mean arterial pressure was induced by captopril. In addition, the agent blunted by 50-60% all the changes in renal hemodynamics and urinary excretion of water and electrolytes except for that of the fractional excretion of sodium. Urinary kallikrein activity which markedly fell and plasma aldosterone concentration which increased during tilt before captopril were not affected after administration of the drug. These studies indicate that angiotensin might mediate at least in part the renal hemodynamic and functional responses to tilt in normal man and is the primary determinant of the aldosterone stimulating effect of tilt.

Adolescent↗
PubMed1983

[Hypoxemia in hemodialysis: hemodynamic mechanism? Hemodynamic and spirometric study using acetate and bicarbonate buffers].

The background of this study is the occurrence during acetate hemodialysis (HDA) of arterial hypoxemia associated with well described vasodilatator hemodynamic changes. Our aim was to evaluate the relationship between these 2 phenomena. Eleven patients (7 males, 4 females, mean age 54 years) were compared in a protocol of HDA and bicarbonate hemodialysis (HDB) as regards their cardiac output measured by the dye dilution method, blood gases and respiratory gas measurements made at the bedside. The results show significant hypoxemia with hypocapnia as soon as the 30th minute of HDA and no significant variation of cardiac index. No significant variation of respiratory response was noted. Arterial prostaglandin levels rose significantly higher during HDA (+ 302%) than HDB (+ 163%; 2 alpha less than 0,05). The absence of a correlation between arterial hypoxemia and hemodynamic changes in HDA compared to HDB suggests that the phenomena are not interdependent. The importance of increased thromboxane activation in HDA will require further investigation.

Acetates↗