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Biomedical subjects

J Rottembourg

Publications and source records attributed to J Rottembourg.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Comparison between treatments of severe forms of familial hypercholesterolemia by total plasma exchange and selective removal of low density lipoproteins (LDLapheresis)].

A plasma exchange program for familial hypercholesterolaemia was started in 1982. Ten patients aged from 7 to 58 years were progressively included: 3 had an heterozygous form of the disease with ischaemic heart disease; 3 had an homozygous form with defective low density lipoprotein receptor activity, 4 had a receptor-negative homozygous familial hypercholesterolaemia and had previously undergone portacaval shunt. During total plasma exchange against human albumin (470 sessions in 9 patients) low density lipoprotein cholesterol values, but also high density lipoprotein cholesterol values, decreased by 40 per cent. More recently, 5 patients had selective low density lipoprotein absorption on dextran sulfate column (Liposorber); 90 exchanges were performed. High density lipoprotein cholesterol values decreased by 55 per cent and high density lipoprotein cholesterol values by only 27 per cent. The patients' attitude to treatment was excellent, with less fatigue and better compliance.

Adult↗
PubMed1988

[Prevention of peritonitis during continuous ambulatory peritoneal dialysis. Value of disconnectable systems].

Peritonitis remains the major obstacle to the acceptance of continuous ambulatory peritoneal dialysis as a long-term dialysis technique. In January, 1985, Y connectors were introduced into our continuous ambulatory peritoneal dialysis programme, and a two-year prospective randomized trial for all new patients was initiated in which the Y connection system was compared with the conventional technique in the prevention of peritonitis (group I). At the same time, 16 patients (group II), with a high incidence of peritonitis episodes were switched from the conventional technique to the Y connection system, while 55 patients (group III), remained on the conventional technique. Group IA patients (27 new patients using the Y connection system), developed peritonitis every 23 patient-months. Group IB patients (28 new patients using the conventional technique), developed peritonitis every 12.2 patient-months. The difference between these two sub-groups was statistically significant (P less than 0.02). Before their transfer to the Y connection system, group II patients developed peritonitis every 10 patient-months and thereafter one every 24 patient-months (P less than 0.001). Group III patients were divided into 12 continuous cyclic peritoneal dialysis patients with peritonitis every 24 patients-months, and 43 continuous ambulatory peritoneal dialysis patients with peritonitis every 11.7 patient-months. The Y connector therefore proved to be a simple and safe procedure effective in reducing the peritonitis rate in patients on continuous ambulatory peritoneal dialysis.

Adult↗
PubMed1988

Renal function and blood pressure in patients treated with cyclosporin A for uveitis.

Renal function has been evaluated in 21 patients treated with cyclosporin A (CyA) for 9 months for idiopathic uveitis. Serum creatinine, which was 82 mumol.l-1 before treatment, was significantly elevated after 1 month (111 mumol.l-1). After 9 months of treatment, and despite a decrease in CyA dosage, the mean plasma creatinine remained elevated at 132 mumol.l-1. Hypertension developed in 6 patients, five of them being concomitantly treated with corticosteroids. In 8 patients serum creatinine 3 months after CyA had been stopped had decreased from 148 to 93 mumol.l-1. Two of those patients remained hypertensive 3 months after CyA treatment had ceased. In patients with idiopathic uveitis CyA induces a reversible increase in serum creatinine. However the reversibility of such a biochemical marker does not preclude a histopathological lesion. Chronic renal damage may be responsible for the persistence of hypertension after cessation of CyA treatment.

Adult↗
PubMed1988

Plasma concentrations of atrial natriuretic peptide in patients with artificial and transplanted hearts.

Plasma atrial natriuretic peptide (ANP) concentrations were measured by radioimmunoassay 1 to 12 days after operation in six patients with artificial hearts. The mean levels were significantly higher in artificial heart recipients (58.2 pg.ml-1) than in controls (12.6 pg.ml-1). The mechanism underlying the raised values is not clear, although it is suggested that elevated atrial pressure may have been the stimulus for higher ANP release. In 3 patients plasma ANP concentrations were also measured 1 to 5 days after orthotopic transplantation. In all of them ANP concentrations had increased by 20 to 74% despite lower right atrial pressure. An increase in atrial tissue mass may have contributed to the raised plasma ANP after orthotopic transplantation. It also suggests that the functioning sympathetic nervous system is not a necessary condition for ANP release.

Adult↗
PubMed1988

[Plasma exchange with very low molecular weight heparin CY 222. Biological profile and therapeutic value].

In a clinical, between-patient study we investigated the effects of a VLMW Heparin fragment (CY 222) versus standard heparin (SH) in plasma exchanges (n = 10) on coagulation factors (CF). Fibrinogen (FGN), II, V, VIIF + X, IX, XI, XII, VIIIc, VIIIRag, VIIIvwf and ATIII, ProtC, ProtS, Plasminogen (PGN), Activated Thromboplastin time (APTT), Prothrombin time (PT), Thrombin time (TT), anti factor Xa (Axa), DDimer, Platelet count. Heparin was administered as a bolus and by infusion during the session, CY 222 as a bolus dose only; 1 to 1.5 plasma volume was exchanged with substitution by 5% albumin. Results (mean, s.d.) at the end of the session (End) and 4 hours later (T4) were analyzed and showed no differences between groups (with CY 222 and with SH) for technical and clinical findings. Biologically, CF were similar in both groups except for Factor XII levels at the end of the session, and Factors II, V, XII at T4. Prolonged APTT in all samples appear related to low FGN. Significant differences in Axa activities were found for each treatment when compared with its own standard, suggesting different ranges of activities of both drugs. Changes in D-dimer levels differed during the session and four hours after the session with the drug tested, and could be related to their mode of administration. Clinical efficiency and tolerance were excellent both with CY 222 and SH.

Adult↗
PubMed1988

[Clinical aspects of continuous ambulatory peritoneal dialysis in diabetics].

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). 81 patients, mean age 51.3 years, were treated over the past nine years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, account for qualifying these patients as a high risk population. The technique was modified in order to inject insulin intraperitoneally, four times per day, to control blood glucose level. Peripheral vascular disease was prospectively studied in 19 patients. Actuarial survival was 92% at one year, 50% at four years mainly influenced by age: 85% survival at two years in 35 patients aged less than 50 years and 62% at two years in 46 patients aged more than 50 years. The main causes of death were of cardiovascular origin: arteritis, myocardial infarction, stroke. The main causes for transfer to an alternative method of treatment were technical complications. Peritonitis rate was one episode ever 14 months. Satisfactory control of blood pressure, blood glucose levels, main biological parameters, visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD can be the technique of first choice in young diabetics awaiting a kidney transplant and the reference technique for home dialysis.

Adult↗
PubMed1988

[HIV1 infections in dialysis centers. Prospective studies in 4 centers in Ile-de-France].

A prospective multicenter study was undertaken between february 1985 and august 1986 in 4 haemodialysis centers in the Paris area (France) in order to assess the prevalence of HIV1 infection and the risk of transmission of the virus within the centers. Every four months a follow-up was carried out in 221 patients undergoing haemodialysis (HD) and in 40 staff members caring for the patients in 2 centers. 62 patients undergoing peritoneal dialysis (PD) and 126 haemodialysis patients who transited through a center (HDT) were screened once. A questionnaire exploring risk factors was completed for each patient and staff member. Sera were tested for HIV1 antibodies by ELISA (ELAVIA) and confirmed by Western Blot. Of the 347 HD + HDT patients, 4 were found to be positive. Of the 221 HD patients, 1 multi-transfused haemophiliac and 1 multitransfused Nigerian without other risk factors were positive in the first screening. Another patient seroconverted after blood transfusion during the study; no other risk factors existed and the donor has not yet been found. One of the 126 HDT patients had received infected plasma. No staff members or PD patients were positive. Thus there is no evidence within the centers of transmission, from patient-to-patient or patient-to-staff. Although HIV1 seems to be less infectious than HBV, precautions to prevent transmission of HIV1 in dialysis centers should be maintained.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Removal of prednisone and prednisolone during plasma exchange].

Prednisone and prednisolone extraction was determined during seven sessions of plasma exchange in four patients. Each patient received 0.5 mg/kg of prednisone administered orally 2 hours before plasma exchange. Concentrations of prednisone and prednisolone were determined in blood before, every half hour during and at the end of plasma exchange. Both drugs were also determined in removed plasma, mean volume of removed plasma being 0.96 plasmatic mass. The amount of combined prednisone and prednisolone removed by plasma exchange was 1.70% of the administered prednisone dose. This quantity appears minimal and supplemental dosing of prednisone or modification of administration time would seem to be unnecessary.

Chromatography, High Pressure Liquid↗
PubMed1988

Prospective study of HIV I seropositive patients in hemodialysis centers.

A prospective multicenter study was undertaken between February 1985 and August 1986 in 4 hemodialysis centers in the Paris area (France) in order to assess the prevalence of HIV I infection and the risk of transmission of the virus within the centers. A four-month follow-up was carried out in 221 patients undergoing hemodialysis (HD) and in 40 staff members caring for the patients in 2 centers. 62 patients undergoing peritoneal dialysis (PD) and 126 hemodialysis patients who transited through a center (HDT) were screened once. A questionnaire exploring risk factors was completed for each patient and staff member. Sera were tested for HIV I antibodies by ELISA (ELAVIA) and confirmed by Western Blot. Of the 347 HD + HDT patients, 4 were found to be positive. Of the 221 HD patients, 1 multi-transfused hemophiliac and 1 multitransfused Nigerian without other risk factors were positive in the first screening. Another patient seroconverted after transfusion during the study; no other risk factors existed and the donor has not yet been found. One of the 126 HDT patients had received infected plasma. No staff members or PD patients were positive. No transmission within centers, from patient-to-patient or patient-to-staff was evidenced. Although HIV I seems to be less infectious than HBV, precautions to prevent transmission of HIV I in dialysis centers should be maintained.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Treatment of kidney failure in diabetics].

Diabetes mellitus is the only cause of end stage renal disease that is increasing. During a 13-year period 156 diabetics were treated by dialysis and/or renal transplantation. The overall survival rate was 50% at 4 years. Survival was not influenced by the dialysis technique (hemodialysis or peritoneal dialysis) but by age and period of treatment. The main cause of death remained cardiovascular. Adequate medical care, including good control of blood glucose levels and control of high blood pressure, should reduce the frequency of severe complications, especially ocular and peripheral vascular lesions. In diabetics under the age of 50, renal transplantation using a kidney from a cadaver or a related donor should be the first choice. However, for most patients dialysis is required as the only treatment or while awaiting transplantation. When home dialysis is suitable peritoneal dialysis should be preferred. If not, hemodialysis in a dialysis center should be considered.

Adult↗
PubMed1987

Glucuronoconjugates in chronic renal failure. Comparative determination with values in healthy adult.

We have isolated substances of molecular weight ranging between 350 and 2,000 daltons from ultrafiltrates of patients traited by maintenance haemodialysis for chronic renal failure (CRF). Such substances might have a role in the genesis of uremic toxicity. They were found to be glucuronoconjugates. We have studied 22 patients with CRF and 16 with end stage renal failure, 8 of them were traited by peritoneal dialysis, 8 by haemodialysis. We have evaluated the concentration of glucuronic acid in the serum, the urine and dialysis fluid. The patients with chronic renal failure have plasma levels of free and conjugate glucuronic acid higher than normal subjects. Urinary elimination is very lower in patient with CRF. Nevertheless the glucuronoconjugates are removed to a large extend by haemodialysis and peritoneal dialysis.

Glucuronates↗