PubMed Health⌕ Search

Biomedical subjects

J Rottembourg

Publications and source records attributed to J Rottembourg.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Treatment of chronic renal insufficiency in the diabetic by dialysis and transplantation].

The number of diabetics with end stage renal disease (ESRD) is growing. The best treatment at the lowest cost possible should be offered to all diabetics if therapeutic 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 insulin and non insulin-dependent 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. Adequate medical care, including excellent control of high blood pressure and good control of blood glucose levels should reduce the frequency of severe complications including cardiac, ocular and peripheral vascular lesions. In diabetic patients under forty years of age, renal transplantation using a kidney from a cadaver or a related donor should be the first choice. However, for most patients dialysis methods are required as the only treatment or while waiting for a transplant. Very encouraging results are obtained with both hemodialysis and peritoneal dialysis. If home dialysis is considered, continuous ambulatory peritoneal dialysis (CAPD) offers the opportunity to treat many insulin-dependent or non dependent diabetics at home even those in the high risk population because of age and/or cardio-vascular instability. CAPD offers excellent control of blood glucose levels using the intraperitoneal route to administer insulin. Results obtained are discussed from data in the literature and from a survey of 124 insulin-dependent diabetic cases with ESRD treated in the Department of Nephrology of the Hospital de La Pitié from 1973 to 1984.

Diabetic Nephropathies↗
PubMed1985

[Open heart cardiac surgery in severe renal insufficiency and dialysis patients].

Surgically remediable cardiovascular complications are common in patients with renal failure treated by dialysis. 20 such patients were operated in our department (16 men and 4 women), aged 27 to 61 years (mean 44.5 years). 12 patients had undergone haemodialysis for 1 to 84 months; 4 patients were treated by peritoneal dialysis; the remaining four patients all had severe renal failure with creatinine clearances of less than 10 ml per minute. All patients were operated immediately after a session of dialysis. Particular attention was paid to preserving the peripheral arterial and venous vessels during anaesthesia and cardiopulmonary bypass. The jugular veins were used whenever possible to spare the upper limb veins and the dorsalis pedis arteries were used for the monitoring of systemic blood pressure to spare the radial arteries for eventual arteriovenous fistulae. Weight gain during the operation was limited by cardiopulmonary bypass techniques. The circuit was filled with 200 cc of B 21, 500 cc of isotonic bicarbonate solution and 800 cc of frozen plasma with potassium supplements. Mean weight gain was moderate (1.1 +/- 0.4 kg). 12 patients underwent valve replacement. The surgical indication was acute endocarditis in 6 cases. The aortic valve was replaced in 10 cases and the mitral valve in 2 cases by mechanical valve prostheses because of the high risk of calcification of bioprostheses in severe renal failure. 8 patients underwent coronary bypass graft surgery. Arterial blood pressure was maintained at over 60 mmHg and large doses of heparin were used to protect the arteriovenous shunts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Visual function, blood pressure and blood glucose in diabetic patients undergoing continuous ambulatory peritoneal dialysis.

Over the last five years, 46 insulin dependent diabetic patients (mean age 52 +/- 13 years) have been treated by continuous ambulatory peritoneal dialysis (CAPD). Fourteen patients have been on treatment for more than two years. Visual acuity assessed every six months showed that improvement has been observed in 14 eyes (19%), stabilisation in 36 eyes (46%), worsening in 17 eyes (21%), five eyes had a minimal function during the entire follow-up. Systolic blood pressure decreased from 173 +/- 42 mmHg at start of dialysis to 149 +/- 30 and 146 +/- 32 after one and two years. Mean fasting and post-prandial blood glucose assessed monthly in 36 patients treated with four daily intraperitoneal injections of insulin (660 determinations) were respectively 7.5 +/- 3.5 and 8.5 +/- 3.5mmol/L.

Adult↗
PubMed1985

[Vascular access lines: use of biologic grafts].

To ensure vascular access, a biological graft was inserted in 44 patients from August 1982 to February 1985 at the Department of Urology, Pitié Hospital, Paris. Forty-nine grafts were used, including 39 saphenous veins and 10 carotid arteries from calves. Four patients free of renal failure had insertion of a graft to allow chemotherapy (3 cases) or plasmapheresis (1 case). Graft patency rate in these four patients is 50%. Among the 40 patients with renal failure, 11 have not yet had dialysis, 26 are currently under dialysis, 2 have been lost to follow up, and 1 died before dialysis. All but one of the patients with renal failure not treated by dialysis have a patent graft. Graft patency rate after one year in the 26 patients under dialysis is 83% for non-reoperated patients and 91% for reoperated and non-reoperated patients as a group. As concerns complications, an interesting fact is that thrombosis of the graft usually required graft replacement, whereas most delayed stenoses were treated by surgery with preservation of the graft. No case of infection or aneurysm was recorded throughout follow up. These results pertain chiefly to saphenous vein grafts as use of carotid arteries from calves is recent. In view of the 95% immediate graft patency rate and of the satisfactory results at one year in these patients usually selected because of the poor condition of accessible arteries and veins, we believe biologic grafts constitute an outstanding material in vascular access surgery for hemodialysis.

Arteriovenous Shunt, Surgical↗
PubMed1984

Serum concentration and peritoneal transfer of aluminum during treatment by continuous ambulatory peritoneal dialysis.

The evolution of the aluminum (A1) serum levels during a 2-year follow-up and the peritoneal transfer of A1 were studied in 22 patients treated by continuous ambulatory peritoneal dialysis (CAPD), using a dialysate with a very low A1 concentration (r = 0.25 - 0.30 mumoles/liter). Patients were divided in three groups. A transfer of A1 from the patient to the dialysate was observed in all patients. In group 1, patients exclusively treated by CAPD and who have never received aluminum-containing phosphate binders (ACPB), mean level (+/- SD) of serum A1 stabilized within a safe range (0.60 +/- 0.28 mumoles/liter). In group 2 the oral administration of ACPB in patients exclusively treated by CAPD induced a slow and progressive increase of A1 serum concentration despite the increase of the A1 excretion through the peritoneal route. In group 3, patients previously treated by hemodialysis and receiving ACPB, the high serum A1 levels observed before treatment by CAPD decreased rapidly on CAPD. A1 removal through the peritoneum was higher in group 3 than in group 2 despite serum A1 levels not statistically different in both groups. A1 removal through the peritoneum is mainly influenced by serum and dialysate A1 concentration. A1 body stores could play a role in the transfer of A1 through the peritoneum. Three cases of A1 poisoning due to the accidental use of a dialysate with a high A1 content are reported.

Adult↗
PubMed1984

[Heart transplantation. Experience at La Pitié hospital. Apropos of 82 cases].

Since 1968, 320 patients with severe irreversible myocardial failure, have been referred to our department for transplantation; 78 p. 100 had dilated cardiomyopathies; 14 p. 100 had ischaemic heart disease and 8 p. 100 had valvular heart disease. One hundred and five patients had absolute contra-indications and were excluded (pulmonary hypertension, diabetes, gastro-duodenal ulcer, age, or other major organic disease). Of the remaining 215 patients, only 82 were transplanted because of the limited number of available donor hearts. The most commonly used technique was orthotopic grafting as described by Lower and Shumway; Barnard's method of heterotopic grafting was used in 1 case and a block heart and lung transplantation by Reitz and Shumway's method was performed in 3 cases. The main postoperative complications, apart from technical problems (7 deaths), were related to rejection (107 episodes, 27 deaths), infection (82 episodes, 13 deaths), atherosclerosis of the graft (4 cases, 2 deaths, 1 retransplantation) and malignant tumours (3 deaths). After transplantation, 82 p. 100 of patients were discharged after an average hospital stay of 2 months; 47 p. 100 survived the first year and lead almost normal socio-professional activities. Thirty patients are still alive, the longest postoperative survival being 9 years. Significant advances have been made in the last 3 years. Classical immuno-suppressor therapy (steroids, azathioprine, horse antilymphocytic serum) has given way to more effective antilymphocytic sera and more powerful immuno-suppressor drugs (cyclosporine A). This treatment has greatly changed the postoperative course of events. Rejection phenomena, though still as common, are much less serious and, above all, more insidious.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Early failures in the creation of arteriovenous fistulas for hemodialysis in adults. Analysis of a series of 104 patients].

The preoperative assessment required for the creation of a vascular access for hemodialysis is reviewed in relation to a series of 104 patients. The immediate or early failure rate works out at 11%, which is in line with the experience reported in the literature for other series. Emphasis is laid on the good results that can be obtained in polycystic disease, an on the difficulty of creating an access in patients under continuous ambulatory peritoneal dialysis. The preoperative management of patients with chronic renal insufficiency is also discussed.

Aneurysm↗
PubMed1984

[The use of a Buselmeier shunt as initial vascular access for repeat hemodialysis].

The construction of an arteriovenous fistula is not always immediately feasible. Temporary recourse to a Buselmeier shunt and the subsequent conversion of the shunt into an arteriovenous fistula, using the same vessels, provides an economy of the vascular sites. This technique precludes the need for permanent or frequent recourse to central venous catheters.

Arm↗
PubMed1984

Dialysis treatment of insulin dependent diabetic patients: ten years experience.

From January 1973 to March 1983, 108 IDD patients with a mean age of 46 years were accepted to the dialysis program of the Hôpital de la Pitié. Since January 1973, 67 patients have been treated by hemodialysis. Since August 1978, 38 patients have been treated by CAPD. Three patients have been treated by intermittent peritoneal dialysis. Although diabetic patients remain at a higher risk compared to patients of the same age group, very encouraging results are observed including a 75% survival rate at three years among hemodialyzed patients less than 50 years old. Since 1978, CAPD, when home dialysis was possible, was selected as a first choice treatment. Some severe peritoneal complications still jeopardize the advantages of this method. Diabetics with ESRD, even in the older age group, should not be excluded from treatment. They should be offered within an integrated program all dialysis methods and transplantation.

Acute Kidney Injury↗
PubMed1983

[Heart transplantation. Current status at La Pitié Hospital].

Since 1972, 280 patients with severe irreversible myocardial damage have been referred to La Pitié Hospital, Paris, for heart transplantation; 95 were excluded on account of absolute contra-indications. Owing to the limited number of available transplants, only 66 of the 185 remaining patients were transplanted. Transplantation was orthotopic in all but 3 cases: 1 patient had heterotopic transplantation and 2 had heart-lung transplantation. The most common post-operative problems were graft rejection and complications of the immunosuppressive treatment; 82% of the transplanted patients were discharged 2 months on average after surgery; 47% overcame the first year problems and resumed an almost normal social and professional life; 21 are still alive, one of them after 9 years. During the last 2 years, technical refinements and the advent of more potent immunosuppressive agents (anti-lymphocyte serum from rabbits, cyclosporin A) and better diagnostic methods (repeated endomyocardial biopsies and immunological surveillance) have resulted in considerable improvement in the patients' outcome, with an actuarial survival rate of 77% at one year and 70% at two years. Since transplants are now better tolerated after the second year and since they possess remarkably good and durable functional properties, this reduction in early and late mortality, which used to be the main cause of failure, raises hopes of a marked increase in prolonged and satisfactory survival.

Cardiomyopathies↗