Pheochromocytoma in a renal failure patient treated by hemodialysis.
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Biomedical subjects
Publications and source records attributed to I Etienne.
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The pharmacokinetics of meropenem (ICI 194,660) and its open-ring metabolite (ICI 213,689) were studied in 6 healthy volunteers and 16 patients with moderate to severe renal impairment after a single intravenous dose of 500 mg given as a 30-min infusion. Concentrations of unchanged meropenem in plasma and urine were measured by both microbiological and high-pressure liquid chromatographic (HPLC) assays. A good correlation was found between the two techniques. Pharmacokinetic parameters of unchanged meropenem were determined by using the HPLC data. The terminal half-life of unchanged meropenem increased in relation to the degree of renal impairment, being 1.2 h in subjects with normal renal function and 10 h in patients with end-stage renal failure. Total body clearance and renal clearance of unchanged meropenem are linearly related to creatinine clearance. The concentrations of the metabolite in plasma, which are very low in healthy subjects, significantly increased in uremic patients. The apparent half-life of ICI 213,689 increased in uremic patients and was about 35 h in patients with severe renal insufficiency. Meropenem and its metabolite are effectively removed by hemodialysis. The dialysis clearance of the unchanged drug was 81 +/- 22 ml/min. Dosage adjustments of meropenem will be necessary in patients with severe renal impairment.
The influence of ketoprofen (K), a non steroidal antiinflammatory drug (NSAID) on the pharmacokinetics of two fluoroquinolone derivatives: ofloxacin (O) and pefloxacin (P) was studied in ten healthy adult male volunteers. All subjects orally received every 12 h the fluoroquinolone derivative (either O or P) for three days and the combination of the quinolone and ketoprofen (once a day) during the three following days. Two pharmacokinetic studies were performed for each quinolone, on days four and eight of the treatment. Blood samples were taken at times 0, 1, 2, 3, 4, 6, 8, 10, 12 and 24 h after dosing. Urine was collected during 4 time-periods: 0-4 h, 4-8 h, 8-12 h and 12-24 h. Plasma and urine concentrations of the active drug of O and P were measured by microbiological assay. Ketoprofen did not significantly modify the pharmacokinetic parameters of the two fluoroquinolones studied in terms of peak plasma levels, time to peak, area under the curve, elimination half-life, volume of distribution and total and renal clearances.
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Treatment of nephrotic syndrome (without renal insufficiency) due to idiopathic membranous glomerulonephritis in adults is not clearly defined. A decisional analysis was done from data published in literature in order to define the best therapeutic choice. Three therapeutic strategies were studied: corticosteroids (either 125 mg/48 h or 30 to 60 mg/24 h), alternate therapy according to Ponticelli protocol (corticosteroids and chlorambucil), abstention of therapy. The data were divided in two groups according to the time of follow-up. The first group allows a decisional analysis for a short period of time (16 to 37 months), the second group allows this analysis for a longer period of time (54 to 65 months). The results differed according to the length of post treatment follow-up. For the shorter follow-up, corticosteroids or the association corticosteroids and chlorambucil appeared to be better than no treatment. For longer follow-up, any treatment shows an advantage in comparison to abstention of therapy. Our tentative conclusion is to propose only symptomatic treatment for this disease.
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Blood pressure levels increase with age. So, the prevalence of both isolated systolic (systolic pressure greater than 160 mmHg and diastolic less than 90 mmHg) and diastolic hypertension (diastolic pressure greater than 95 mmHg) in the elderly is high. Due to high variability of blood pressure and to overestimation of real blood pressure when arterial walls are sclerosed, the true prevalence of hypertension is probably overestimated. Nevertheless, like in younger persons, hypertension in elderly is a major risk factor of cardiovascular morbidity and mortality. Results of clinical trials designed in the last 30 years have clearly proved benefit of antihypertensive therapy. However, a lot of questions remain: Is treating hypertension justified in the very old? Has isolated systolic hypertension to be treated? Which antihypertensive drugs may be used? Is screening for atherosclerotic renovascular disease useful? Which investigations have to be performed for diagnosing atheromatous renal failure?
The authors report a case of transperitoneal laparoscopic drainage of a recurrent, compressive lymphocele occurring 3 months after cadaver renal transplantation. The technique consists of creating a transperitoneal breach and resecting the walls of the lymphocele to ensure internal drainage followed by suture of a slip of greater omentum over the opened lymphatic cavity. Preoperative aspiration and computed tomography precisely defined the site of the lymphocele in relation to urinary and vascular structures, confirmed the lymphatic nature of the collection and excluded the presence of infection. This technique has the same indications as classical surgical internal drainage and can be used to easily perform the same procedures. Because of its simplicity and low morbidity, laparoscopic drainage can be proposed as first-line treatment for large, symptomatic and recurrent posttransplantation lymphoceles, in the absence of infection and provided the lymphocele is in an accessible site and the operator has a sufficient experience of laparoscopic techniques.