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Biomedical subjects

J Luciani

Publications and source records attributed to J Luciani.

At least 19 recordsLinked to original sources
PubMed1992

Chronic administration of cyclosporin A induces a decrease in hepatic excretory function in man.

Chronic administration of cyclosporin A may induce cholestasis in a few patients. The purpose of this study was to examine the effect of chronic administration of cyclosporin A on serum bile acid levels, serum bilirubin concentration, and bromosulfophthalein plasmatic fractional clearance. Twenty heart-transplanted patients with normal serum alanine aminotransferase activity receiving cyclosporine A during a mean duration of 33 months (range 7-54) were compared to 20 matched kidney-transplanted patients with normal serum alanine aminotransferase receiving azathioprine for a mean duration of 34 months (range 6-72). As compared to azathioprine-treated patients, patients treated with cyclosporin A had an increase in serum bile acid levels of 32% (P < 0.01), an increase in serum bilirubin concentration of 100% (P < 0.001), and a decrease in bromosulfophthalein plasmatic fractional clearance of 60% (P < 0.001). These results suggest that cyclosporin A induces a decrease in hepatic excretory function in man.

Adolescent↗
PubMed1992

Reappraisal of long-term renal replacement therapy. Renal transplantation: medical versus statistical approach.

The validity of the numerous statistical methods used for the assessment of the results achieved with renal transplantation performed for terminally uremic patients may be challenged by a medicalized approach of the patient's post transplantation course and outcome. This assumption has been applied to a population of 700 patients who received a grafted kidney in our unit between November 1972 and December 1990. Among 77 patients who had been followed up for 10-15 years after grafting, 75% had not suffered any serious related complication during the first decade after transplantation. In contrast, among the whole transplant population, transplantation entailed either a rapidly fatal issue due to an unpredictable and irreversible complication in 45 patients (6.4%), or a state of chronic illness with severely disabling complications in 150 others (21.5%). At present, the main cause of concern remains, however, the persistent long-term graft loss due to chronic rejection. Nevertheless, the advances and results achieved in the field of organ transplantation in recent years justifies the policy which privileges renal transplantation as the first-choice method of renal replacement therapy for every terminally uremic patient aged less than 60-65 years in whom careful workup does not reveal any clinical/psychological contraindication.

Actuarial Analysis↗
PubMed1992

[Value of tomodensitometry with injection and late images for the diagnosis of urinary leaks in kidney transplants].

Between May 1985 and May 1990, 263 renal transplantations were performed in 254 patients, with 4 kidney-pancreas double grafts. 12 urinomas were observed, i.e. 4.56%. In one half of cases, clinical examination alone was able to establish the diagnosis of urinoma, but in the other 6 cases, complementary investigations were required. Post-contrast computed tomography with late images (between 6 and 24 hours after the injection) would appear to be the most useful investigation. Performed in 6 cases, this examination established the diagnosis of urinoma in 5 cases and also suggested the mechanism of the leak, which was always confirmed at operation. The positive diagnosis is based on extravasation of contrast agent which is clearly visible, even in the presence of low concentrations due to impaired renal function. This extravasation occurred early in 3 cases, but was delayed in 2 cases, emphasising the importance of late images. Other investigations appear to be less useful either because of a lack of sensitivity or because of imprecise anatomical information. The severity of urine leaks and the need for rapid treatment justify post-contrast computed tomography with late images in any case of suspected urinoma.

Adult↗
PubMed1992

[Primary bladder lymphoma in kidney transplant recipients: report of a case].

The authors report the case of a type B EBC (+) primary lymphoma of the bladder occurring in a renal transplant patient 14 months after the graft. The postoperative course had been marked by three episodes of early rejection, the last of which required the use of anti-CD3 antibody, then the later addition of cyclosporin. After immune labelling showing oligoclonal proliferation, the lesion was treated with CD24 and CD21 monoclonal antibodies. Ten months after treatment, the patient is in remission with renal function at 200 mumol plasma creatinine. Azathioprine and cyclosporin have been stopped. This apparently unique case provides the authors with an opportunity to review the usual characteristics of lymphocyte tumours in transplant patients and to stress the rarity of primary lesions of the urinary tract. They conclude that the new therapeutic approach based upon monoclonal antibodies is of value in comparison with the attempts at surgery, radiotherapy and/or chemotherapy used in the past.

Adult↗
PubMed1991

[Combined kidney-pancreas transplantation. Experience at the Urologic Clinic of the La Pitié Hospital].

The first attempts of pancreas transplantation were made in the middle of the 1960s and were further developed in the early 1980s with the coming of Cyclosporine. Various surgical techniques were used to carry out pancreas grafts; a total pancreatic transplantation with duodenovesical anastomosis was selected for 7 combined kidney-pancreas transplantations carried out during the past 18 months in our group. After a time lapse ranging from 18 months to 30 days, all patients were alive with functional kidney grafts. One patient only, who had lost his pancreatic graft, showed biological and histological signe of chronic rejection of his kidney graft. Five pancreas grafts are functioning, as is proved by the normal blood glucose and the normality of the markers. An immunosuppressant treatment was used in all similar cases, comprising, after an initial bolus of one gram of Methyl-Prednisolone, an initial four-drug treatment on 1/3 mg/kg/day of Prednisone, 7 mg/kg/day of Cyclosporine, 1 mg/kg/day of Imurel and, during the first fifteen days, the use of rabbit antithymocytic globulins. Ana analysis of the postoperative period revealed frequent local infectious complications, probably due to pancreatitis of the graft; however, in our experience so far, no pancreas graft was lost. The credit for this specific feature of our short series may be due to an exclusively subperitoneal approach for both the pancreas and the kidney transplantation, thus limiting the seriousness of postoperative infectious complications to a large extent.

Anastomosis, Surgical↗
PubMed1990

[The value of pulsed Doppler for the follow-up of the transplanted kidney in the first 3 months of transplantation].

This prospective study was conducted in 34 consecutive renal transplant patients. Pulsed doppler was used to evaluate the peripheral resistance (PR) in the transplant vessels. Under normal conditions, the PR of the graft is low, resulting in a continuous diastolic blood flow. The intensity of this blood flow was evaluated by means of a resistance index (RI), Pourcelot's index, calculated as follows: RI = systolic peak - end-diastolic peak/systolic peak This study demonstrated values for RI of 0.71 +/- 0.087 in 14 totally asymptomatic patients. In 10 cases of acute rejection, the RI increased to 0.91 +/- 0.12. The 7 patients with acute tubular necrosis had an RI equal to 1. In patients with cytomegalovirus infection of suffering from cyclosporin overdose, the RI was not modified in relation to asymptomatic subjects. This study demonstrates the existence of a rise in the PR in cases of acute rejection and acute tubular necrosis with a sensitivity of 90% and 100% respectively for these two diagnoses. However, this method cannot be used to distinguish between acute rejection and acute tubular necrosis.

Cyclosporins↗
PubMed1990

[Analysis of 10 cases of pregnancy after renal transplantation].

Renal transplantation has changed completely the fertility of women who had been dialysed. Our study is on 10 pregnancies which we followed up in 7 women who had had renal transplants in the University Hospital of Pitié Salpêtrière (Professor Y. Darbois) between 1979 and 1985. All patients were treated by the same technique and the same methods of prevention of rejection of the transplant. The mean interval between the transplant and pregnancy was 53 months. In 3 cases there was hypertension and raised creatinine levels (more than 150 in 3 cases). In 2 cases the two conditions were associated. The prognosis is bad when a raised blood pressure or a change in renal function occurs before pregnancy starts, leading to a real deterioration in renal function during the pregnancy when such function was abnormal before the pregnancy started. As far as the infants were concerned, the most common complication was IUGR (intrauterine growth retardation) which was found in half of all cases. Blood flow studies in these fetuses are particularity interesting. There were two cases of intra-uterine fetal death. The reasons for these were not necessarily connected with the deterioration in renal function. All the deliveries were by caesarean section, for medical reasons in 7 out of 10 cases. The average duration of the pregnancy was 35 weeks of amenorrhoea. As far as the mothers were concerned, they did not have more infections than other women in spite of being immuno-suppressed (this was excluding urinary tract infections).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Bopindolol in the treatment of moderate hypertension: a dose-response study.

To determine the optimal antihypertensive dose of bopindolol, we performed a randomized double-blind study in parallel groups. After 15 days of placebo single-blind, 115 hypertensive patients received daily for 28 days one of 4 doses: 0 mg (placebo), 0.5 mg, 1.0 mg, 2.0 mg. The reduction of supine diastolic blood pressure (BP) did not exhibit the pattern of a dose-effect relationship. The effect of 0.5 mg belonged to the plateau of the dose-effect curve (P = 0.1, analysis of variance). The reduction of heart rate (HR) followed a typical dose-effect curve, with a plateau beginning with 1 mg (P = 0.02). A trend toward an increase in the incidence of side-effects with dosage was observed (P = 0.3). Thus, the optimal antihypertensive dose may be 0.5 mg or less. Previous studies not using parallel randomized groups suggested an antihypertensive dose ranging from 2 to 4 mg. This study confirms that the dose-effect curves of beta blockers on HR and BP are dissociated. The dose-effect curve of HR seems unsuitable for assessing the optimal antihypertensive dose of a beta blocker.

Adrenergic beta-Antagonists↗
PubMed1987

[Specific IgM of cytomegaloviruses and primary infection in kidney transplant patients].

In 20 renal transplant recipients suffering from symptomatic CMV infection we looked if a specific IgM response was indicative of a primary infection. By an ELISA technique we investigated the specific IgG and IgM in a pair of sera taken at the time of the transplantation and later at the time of the CMV isolation. For 7 out of 8 patients exhibiting an IgM response in the late serum, the pretransplant serum did not contain either IgG or IgM specific antibodies. Therefore the specific IgM response was associated in 7 out of 8 patients with a primary CMV infection. Nevertheless in 6 other primary infected patients no specific IgM response was detected. Otherwise rheumatoid factors appeared in each primary infected patient developing a specific IgG response, with or without specific IgM response.

Antibodies, Viral↗
PubMed1987

[Restoration of urinary tract continuity in a non-functioning bladder after renal transplantation].

The restoration of the continuity of the urinary tract after renal transplantation in anuric patients, an increasingly frequent situation, raises a number of theoretical problems: is it possible to use a bladder which has been non-functioning, sometimes for many years (20 years)? What should be performed during pre-operative assessment? Which surgical technique should be used? The authors try to answer these questions on the basis of their experience of 116 transplanted anuric patients. Anuria, even of long duration, does not prevent the use of the bladder, provided that the bladder was originally normal and is not infected. The pre-operative assessment is the same as for other patients and urodynamic investigations are not required. The optimal reimplantation technique is the Leadbetter-Politano open bladder technique and every effort should be made to obtain abundant diuresis immediately. Under these conditions, reimplantation into these non-functioning bladders is not associated with more complications than in the case of normal bladders.

Adult↗
PubMed1985

Early monitoring of human renal transplantations by N-acetyl-beta-D-glucosaminidase isoenzyme activities in urines.

Monitoring of variations in N-acetyl-beta-D-glucosaminidase (NAG) urinary activity, following renal transplantation, has been proposed for the early diagnosis of rejection episodes. In this study, the measurement of urinary NAG-B activity was conducted as a complement to total NAG (A + B) measurement, which is normally used alone. Selective measurement of NAG-B activity is carried out after fixation of NAG-A on ion exchanger in test tubes. Results of NAG (A + B) activity confirm that the assay of urinary NAG is a useful indicator of rejection, but a positive correlation between NAG-B and NAG (A + B) activities was observed during the various complications which can occur after transplantation. The specific measurement of this isoenzyme does not, therefore, seem to provide additional information in the early monitoring of human renal transplantations. Apart from rejection episodes, other factors are likely to produce marked NAG-B excretion, e.g. gentamicin therapy.

Acetylglucosaminidase↗
PubMed1979

Early anuria prevention in human kidney transplantation. Advantage of fluid load under pulmonary arterial pressure monitoring during surgical period.

In human kidney transplantation, a high blood flow established through the graft immediately upon clamp release is usually associated with immediate satisfactory renal function. One hundred consecutive kidney transplant patients were thus provided with a large volume of fluid during surgery. To avoid pulmonary edema, fluid load was given under mean pulmonary arterial pressure (PAP) monitoring, and controlled ventilation was maintained during the early postoperative period. Whether initial PAP value was within normal range or elevated, all patients required an equivalent fluid load to reach the best hemodynamic condition upon clamp removal. The mean intraoperative fluid load consisted of 2406 +/- 968 ml of water with 22.8 +/- 9.4 g of sodium chloride, 5.9 +/- 1.8 units of albumin, and 2.6 +/- 1.8 units of packed red blood cells. Immediately before clamp release patients were given furosemide and mannitol. During the postoperative period, i.v. infusions consisted of water and sodium chloride (6 g/liter) to match urine output, provided that diuresis was equal to or above 400 ml/hr. If diuresis remained or decreased below this level, diuresis replacement was associated with PAP-controlled infusion of saline, albumin, and red blood cells if needed. Furosemide was eventually given if diuresis did not increase above 400 ml/hr with fluid loading. With this protocol a good early diuresis was established in 95% of the cases. Ten patients required dialysis before the 5th postoperative day, one of them because of fluid overload and anuria. Concurrently, a decreased mortality rate and an increased graft survival rate were observed.

Adolescent↗