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Biomedical subjects

J Rottembourg

Publications and source records attributed to J Rottembourg.

At least 19 recordsLinked to original sources
PubMed1995

[Treatment by continuous ambulatory peritoneal dialysis for chronic renal insufficiency in the diabetic].

The number of diabetics with end stage renal failure is growing. The best treatment at the lowest cost possible should be offered to all diabetics if therapeutics facilities are available. Such a policy requires that all dialysis methods and transplantation should be available and that transfer from one method to another should always be allowable. Results observed among diabetics are improving steadily, even in the older age group. However they are inferior to those observed in non diabetic people of the same age. In diabetic patients under fifty years of age, renal transplantation using a kidney from a cadaver or a related donor should be the first choice. In some cases kidney and pancreas transplantation is possible. However, for most patients dialysis methods are required as the only treatment or while waiting for a transplant. If home dialysis is considered, continuous ambulatory peritoneal dialysis offers the opportunity to treat many insulin or non insulin-dependent diabetics at home even those in the high risk population because of age and/or cardio-vascular instability with excellent control of blood glucose levels, hypertension, vision, residual renal function, despite the peritoneal infections. These results are obtained from data in the literature and the survey of patients treated at the Hospital de la Pitié.

Blood Glucose↗
PubMed1994

Is overhydration in CAPD patients a contraindication to renal transplantation?

Over a 14 year period, 56 of 415 CAPD patients (34 male, 22 female), aged 42.7 +/- 11 years, underwent renal transplantation (TR). A cadaver kidney was used in 53 patients (kidney-pancreas in 2), and a human leucocyte antibody (HLA) identical related donor organ was used in 3. Underlying renal diseases were chronic glomerulonephritis in 30 patients, diabetic nephropathy in 10, interstitial nephropathy in 5, vascular in 4, polycystic kidney in 3, and undetermined in 4. Mean duration of CAPD prior to TR was 13 months (2-56 months). A three-week peritonitis episode-free interval was requested prior to TR. At year 1, actuarial patient and graft survival (96% and 86%, respectively), plasma creatinine, and number of rejection episodes were not different from those recorded in patients treated with hemodialysis (HD) prior to TR. At TR, pulmonary artery pressure (PAP) was elevated (average 21.1 +/- 7.4 mm Hg), > or = 25 mm Hg and > or = 30 mm Hg in 36% and 14.6% of CAPD patients, respectively. Post-TR, HD was performed in 4 patients; no peritoneal infection occurred. Postoperative sonography disclosed ascitis in 12.7% of CAPD patients. The PD catheter was removed two months post-TR. Hemodynamic findings at TR suggest a frequently underestimated overhydration in CAPD patients, which should be detected and treated in order to reduce acute cardiovascular complications at TR.

Adult↗
PubMed1993

[Definitive end-stage chronic kidney failure after cisplatin treatment].

Renal failure secondary to CDDP is due to acute tubular necrosis and is usually reversible. We report 4 cases of definitive renal failure secondary to administration of cisplatin (CDDP). Three women and one man, mean age 40 +/- 8 years (24 to 64 years), at onset of dialysis are reported. They had received 1 to 4 courses of CDDP for an endometrial carcinoma (n = 2), a breast carcinoma or a thymoma. The mean total dose of CDDP was 447 +/- 169 mg (160 to 900 mg). There was no additional nephrotoxic drug. Before treatment serum creatinine concentration was normal (77 +/- 7 mumol per liter) in all patients. In 2 cases dehydration (due to vomiting and use of mannitol) occurred during CDDP treatment. One patient was treated 30 days after a nephrectomy. At the onset of dialysis, renal ultrasound was normal. In 3 cases dialysis was necessary within 15 days following chemotherapy. In one case renal function deteriorated progressively to end stage renal failure 12 months after CDDP treatment. Dialysis was performed in 3 cases by hemodialysis and in one patient by peritoneal dialysis. All patients remained more than 6 months on dialysis. Three patients died from their cancer. One patient, being considered cured from his thymoma, is currently being evaluated for a kidney transplantation. Our observations outline the potential severity of CDDP nephrotoxicity. Systemic hydration with serial serum creatinine measurements are mandatory during and after CDDP administration these patients.

Adult↗
PubMed1991

[Absence of a direct effect of peritoneal dialysate on venous lower limb flow].

In order to verify if the presence of 21 of fluid in the peritoneum is likely to produce a slowing of the venous flow in the lower limbs, 34 patients suffering from end stage chronic renal failure and treated by continuous ambulatory peritoneal dialysis (CAPD) were followed up for two years by means of noninvasive methods. The maximum femoral venous flow velocity before and during CAPD was evaluated using Doppler effect, in 2 positions of the patients (recumbent or upright), and with or without dialysate (abdomen full or empty). The venous distensibility and the maximum venous outflow were evaluated using venous occlusion plethysmography in the recumbent position. Despite a decrease in mean arterial blood pressure (before the start of CAPD: 116.0 +/- 3.7 mm Hg; after 2 years of CAPD: 104.3 +/- 3.2 mm Hg, p less than 0.02), there was no significant slowing of the venous limb flow during the two years of treatment by CAPD, and in no case did the peritoneal fluid constitute a mechanical obstruction.

Blood Flow Velocity↗
PubMed1990

[Glycosylated plasma proteins in chronic renal failure].

In chronic renal failure HbA1c values and plasma fructosamine concentrations are difficult to interpret owing to anaemia (for HbA1c) and analytical interferences (for fructosamine test). Plasma proteins glycation was measured more specifically by affinity chromatography. Glycated albumin, glycated immunoglobulins G and glycated proteins were determined in 30 control patients, 30 diabetics and 28 patients with chronic renal failure divided into 17 non diabetics and 11 diabetics. Glycated albumin, glycated IgG and glycated total proteins were not modified by chronic renal failure in non diabetic patients on the contrary of HbA1c and fructosamine test.

Adolescent↗
PubMed1989

[Value of plasma fructosamine in non-diabetic and diabetic chronic renal failure].

Plasma fructosamine concentrations were measured in non-diabetic and diabetic patients with chronic renal failure divided into two three groups: patients without dialysis, under haemodialysis and under continuous ambulatory peritoneal dialysis. In non-diabetic patients plasma fructosamine values were consistently higher than in a control population (2.26 +/- 0.26 mmol/l), being 2.38 +/- 0.35 mmol/l in patients without dialysis, 2.57 +/- 0.33 mmol/l in patients under peritoneal dialysis and 2.67 +/- 0.31 mmol/l in patients under haemodialysis. In diabetic patients, plasma fructosamine values were increased, being equal to, or higher than 3 mmol/l; these values were almost identical with those obtained in populations of diabetics without renal pathology. Considering that Hb Alc values are difficult to interpret in chronic renal failure owing to anaemia and to the analytical problems raised by haemoglobin carbamylation, the fructosamine test may well be a reliable marker for the monitoring of diabetes in patients with chronically impaired renal function.

Diabetes Mellitus, Type 1↗
PubMed1989

[Continuous ambulatory peritoneal dialysis. Current concepts after 10 years' experience].

Designed, in contrast with hemodialysis (HD), as a permanent dialysis procedure, CAPD progressively established itself as an accepted mode of therapy of end stage renal disease. About 8 p 100 of the total population currently undergoing renal replacement therapy in France is being treated by CAPD. Important technical advances were made over the last decade. The recent disconnectable systems reduced the rate of peritonitis down to one episode every two to three years of treatment. Loss of ultrafiltration and sclerosing peritonitis can also be efficiently prevented. Maintenance of an adequate nutritional status in the patients remains however an often difficult problem. CAPD is now preferably recommended for young patients awaiting renal transplantation, diabetics, children and also elderly patients provided a satisfactory nutritional status can be maintained over time. Although a randomized study is not practically feasible, it can be stated that HD and CAPD yield similar overall results in comparable groups of patients with end stage renal disease. Long term studies do not show any substantial decrease over time of the permeability and clearance performances of the peritoneal membrane.

Adolescent↗
PubMed1989

Rheumatic syndromes and beta 2-microglobulin amyloidosis in patients receiving long-term peritoneal dialysis.

We studied 56 patients who had been receiving peritoneal dialysis for greater than 3 years, to investigate the prevalence of rheumatic diseases suggestive of beta 2-microglobulin (beta 2m) amyloid deposition. Eight patients were found to have carpal tunnel syndrome, 16 had chronic shoulder pain, 8 had subchondral bone cysts, and 13 had destructive arthropathies. Amyloid reacting with anti-beta 2m was demonstrated in the hip synovium of 1 patient. Serum beta 2m levels were elevated in all patients. These data suggest that peritoneal dialysis, like hemodialysis, may lead to the development of an arthropathy associated with beta 2m accumulation and beta 2m amyloid deposition.

Adult↗
PubMed1989

Anesthesia for creation of a forearm fistula in patients with endstage renal failure.

The effects of local infiltration anesthesia, brachial plexus blockade, isoflurane, or halothane anesthesia on blood flow through the brachial artery and through a newly created forearm arteriovenous fistula (AVF) were compared in 36 patients with endstage renal failure. Brachial artery blood flow was measured at two different times, before anesthesia and during anesthesia but before surgery, using a pulsed Doppler flowmeter. AVF flows were calculated from brachial, radial, and ulnar blood flows at the end of surgery, 2 h after surgery, and 3 and 10 days after the procedure. Mean arterial pressure was lower in patients receiving isoflurane or halothane than in those receiving local anesthesia or brachial plexus blockade (BPB). There was a significant increase in brachial artery blood flow following BPB (43.7 +/- 18.7 to 186.9 +/- 98.2 ml.min-1) during isoflurane anesthesia (46.2 +/- 15.9 to 153.1 +/- 80.5 ml.min-1) and during halothane anesthesia (49.9 +/- 24.1 to 97.6 +/- 62.1 ml.min-1). During anesthesia, the difference in brachial artery blood flow between patients in the BPB and halothane groups was significant. Local anesthesia failed to increase brachial artery blood flow (44.0 +/- 12.7 to 45.6 +/- 11.3 ml.min-1). In the immediate postoperative period, the AVF blood flow was lower in patients in the halothane group than in the other groups, but this difference was only significant when compared with BPB group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Clinical aspects of continuous ambulatory and continuous cyclic peritoneal dialysis in diabetic patients.

The treatment of end-stage renal diabetic nephropathy remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD). Eighty-one patients, mean age 51.3 years, were treated over the last 9 years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, were present in this high-risk group of patients. The technique was modified in order to inject intraperitoneally, 4 times per day, insulin to control blood glucose level in CAPD patients. Actuarial survival was 92% at 1 year, 50% at 4 years mainly influenced by age: 85% survival at 2 years in 35 patients aged less than 50 years old and 62% at 2 years in 46 patients aged more than 50 years old. The main causes of death were of cardiovascular origin: myocardial infarction, stroke, atherosclerotic vasculopathy. The main causes of transfer to hemodialysis were due to technical complications. Peritonitis rate was one episode every 14 patient-months. Control of blood pressure, blood glucose levels, main biological parameters, and visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD-CCPD is the technique of first choice in young diabetics and the preferential technique for home dialysis.

Actuarial Analysis↗
PubMed1989

Recovery of renal function in patients treated by CAPD.

Recovery of renal function was observed in 10 out of 300 patients (3.3%) treated by CAPD. These 10 patients presented the following primary renal diseases: 4 nephroangiosclerosis, 4 interstitial nephropathies, 1 diabetic nephropathy, 1 unknown nephropathy, and were treated by CAPD for a mean period of 10.2 +/- 5.5 months. CAPD was discontinued when residual renal function reached 12 ml/min. After recovery 8 patients were still alive, including 1 patient who returned to dialysis. 2 patients died. When risk factors such as uncontrolled hypertension, cardiac failure, severe nephrotic syndrome, rapidly progressive renal failure, analgesics or non steroidal anti-inflammatory drug treatments or abuses, chronic urinary obstruction, cholesterol emboli were associated with end stage renal failure, CAPD should be the dialysis treatment of choice, expecting the preservation of the kidney capacities and further a recovery of renal function.

Aged↗
PubMed1989

[Which is the best peritoneal dialysis solution?].

Peritoneal dialysate is formulated to achieve some therapeutic goals including removal of excess fluid, normalization of serum electrolytes, correction of the acid-base balance. An osmotic agent is necessary to induce an ultrafiltration. Glucose is almost universally used achieving a good ultrafiltration rate, with many advantages and some disadvantages. Alternative osmotic agents have been sought; most of them were other sugars: the longest experience was with the glycerol; but some experience was gained with xylitol and maltose. Other components such as amino acids and glucose polymers were suggested with some experience. The major electrolytes are included in the dialysate at levels calculated to achieve normalization of serum levels: sodium level in the dialysate is between 132 and 136 mmol/l, potassium level between 0 and 2 mmol/l calcium level between 1.6 and 2 mmol/l and magnesium level between 0 and 0.5 mmol/l. To control metabolic acidosis it is necessary to use a buffered dialysate: lactate should be used and acetate abandoned. Recently a new bicarbonate solution was proposed. Water quality has to be compared to intravenous fluids. Aluminum level must be very low (less than 0.30 mumol/l) and other trace elements at the lowest value.

Buffers↗