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Biomedical subjects

J Rottembourg

Publications and source records attributed to J Rottembourg.

At least 73 records · Page 4Linked to original sources
PubMed1983

[Allogeneic immune response after blood transfusion in patients awaiting renal transplantation].

To investigate the mechanisms of the beneficial effect of blood transfusions (BT) on subsequent kidney transplant survival, we studied the influence of 3 planned BT on lymphocyte reactivity and on lymphocytotoxic antibody (LT) production in previously non-transfused uremic patients. A sustained and non-specific decrease in mixed lymphocyte reactivity (MLR) was observed in approximately 60% of the cases, whereas other patients had only a transient decrease but otherwise normal or even increased responses. Neither the pre-BT degree of immune responsiveness nor the clinical status of the patients had any influence on this phenomenon. Similarly, hepatitis B seroprophylaxy or vaccination did not interfere with this BT effect. Anti-HLA, LT, which are potentially harmful for the transplant, were noted in 13% of cases, while 13% additional cases displayed "cold" anti-B lymphocyte LT which do not have the same prognostic value. In some instances, suppression of cellular reactivity developed concurrently with LT production, which indicates that there is no interaction between cellular and humoral responses induced by BT.

Antibody Formation↗
PubMed1983

Interleukin-2 production after blood transfusions in prospective kidney transplant recipients.

We have investigated whether suppression of the allogeneic response after blood transfusion (BT) could be due to inhibition of the production or activity of Interleukin-2 (IL-2), a soluble mediator involved in T lymphocyte proliferation. Reduction of IL-2 production after BT was less frequent than, but significantly associated with, non specific MLR suppression. However, MLR suppressor cells did not inhibit the release of IL-2 from autologous pre-BT lymphocytes. In addition, post-BT soluble suppressor factors of the MLR did not affect the ability of IL-2 to promote cell proliferation. Thus, although MLR suppression after BT is associated with reduced IL-2 production, this is not a major mechanism involved in this effect.

Blood Transfusion↗
PubMed1983

Is continuous ambulatory peritoneal dialysis the best dialysis choice for insulin dependent diabetics?

In the last eight years 100 insulin dependent diabetics (IDD) have been dialysed at the Hôpital de la Pitié. Since August 1978 31 have been started on continuous ambulatory peritoneal dialysis (CAPD). Cumulative duration of treatment was 336 patient months, with an average time of 10.8 months. The actuarial technique success rate was 82 per cent at one year and 65 per cent at 18 months. Causes of drop out were seven deaths and six transfers to haemodialysis. The peritonitis rate was one episode every year. For some IDD patients and within the period of observation, CAPD offers a unique opportunity to be dialysed at home with excellent clinical and biological results.

Actuarial Analysis↗
PubMed1983

[Heart transplantations. Current status. Experience at the Hôpital de la Pitié].

The experience gathered over the last fifteen years of clinical application of heart transplants has resulted, in the last two years, in much improved results:the survival in our series is 77% at one year and 70% at 2 years. This progress is due to the following factors:improved patient selection, with strict respect of contraindications, in particular, patients over the age of 50 and patients with advanced multi-system failure; improved selection of donors, avoiding, within the limitations of immunological compatibility, grafts in poor condition from subjects over the age of 35 and a refinement of the operative techniques, especially the introduction of more potent immuno-suppressants such as Cyclosporin A and improved post-operative monitoring based on immunological examinations and repeated endo-myocardial biopsies. These advances will lead to a broadening of the operative indications and a wider use of this form of treatment.

Adolescent↗
PubMed1983

Open heart surgery in patients with end-stage renal disease.

Seventeen patients on maintenance dialysis therapy or with severe impaired kidney function required correction of cardiovascular diseases by open heart surgery. Ten aortic, two mitral valvular replacements and five coronary artery bypass grafts were performed. Special attention was taken for these patients, including pre-operative dialysis, cardiopulmonary bypass with complete haemodilution, composition of extracorporeal circuit volumes, arterial and venous access and myocardial protection. Prosthetic valves were preferred to porcine heterografts for valve replacements and autogenous saphenous veins were utilised for coronary artery bypass grafts. Follow-up of 14 patients was available from one to 84 months. Carefully planned open heart surgery can be successfully carried out in uraemic patients without an increased operative risk.

Adult↗
PubMed1983

[Peritonitis during continuous ambulatory peritoneal dialysis. Lavage treatment or not? A prospective study].

A prospective study. To evaluate the advantages of continuous peritoneal lavage in treating peritonitis occurring during continuous ambulatory peritoneal dialysis a prospective study was planned in one Center during a 5 months period. 32 cases of peritonitis divided in two groups were treated according to 2 different protocols, one with continuous peritoneal lavage, the other one with the standard dialysis technique using the bags. Intraperitoneal administration of antibiotics was similar in both groups. Results show no significant advantages in using peritoneal lavage. Continuous lavage should be restricted to cases whose treatment is started late as well as those with purulent dialysate and fungi infections.

Adult↗
PubMed1983

[Continuous ambulatory peritoneal dialysis (CAPD). 3 years' therapeutic experience in 100 patients].

The pros and cons of CAPD are weighed up on the basis of a 3-year study on 100 patients with renal insufficiency (61 men, 36 women and 3 children). If equal groups are compared, the survival rate corresponds to that of haemodialysis. Continuous detoxication and dehydration lead to a good uraemic metabolic situation (creatinine 960 mumol/l, urea 24 mmol/l, haemoglobin 98 g/l, albumin 31 g/l. The serum electrolytes are well-balanced, anorganic phosphate is normal. The rise in cholesterol and triglycerides observed is a possible negative influence with regard to arterial sclerosis. The functioning of the kidneys is not affected by CAPD. The main risks of this method of therapy are peritonitis and loss of protein via the peritoneal dialysate, which can be favourably influenced by strictly antiseptic handling when changing the dialysate bag and a sufficient protein supply in the diet. In France 10-15% of all patients with terminal renal insufficiency will be treated with CAPD in future.

Adolescent↗
PubMed1983

Evolution of residual renal function in patients undergoing maintenance haemodialysis or continuous ambulatory peritoneal dialysis.

A study has been carried out to compare over an 18 month period the residual glomerular filtration rate (GFR) measured by the creatinine clearance in two matched groups of 25 patients with end-stage renal disease. One group was treated by continuous ambulatory peritoneal dialysis, the other one by maintenance haemodialysis. GFR was similar in both groups immediately before starting dialysis therapy, respectively 4.3 +/- 2.3 and 4.4 +/- 2.4 ml/min. From the beginning of the dialysis treatment to the eighteenth month there was a significant and progressive decrease of GFR in the group of patients treated by haemodialysis, while in the peritoneal dialysis group GFR and peritoneal clearances remained stable.

Adult↗
PubMed1982

Pharmacokinetics of sulfamethoxazole--trimethoprim combination during chronic peritoneal dialysis: effect of peritonitis.

The pharmacokinetics of the fixed combination trimethoprim sulfamethoxazole (TMP--SMZ), including peritoneal transfer, has been studied in patients with end-stage renal disease treated by peritoneal dialysis, intermittent in 18 cases and continuous ambulatory dialysis in 6 cases. After a single oral dose of TMP 4 mg and SMZ 20 mg per kg, peak serum levels of approximately 2.0 micrograms/ml TMP and 28 micrograms/ml SMZ were achieved at 4 hours for TMP, and at 6 hours for SMZ. The protein binding of TMP was 34.7 +/- 1.1% and its distribution volume was 2.2 +/- 0.51/kg. Total plasma clearance of TMP was 66.2 +/- 11.5 ml/min, peritoneal dialysance was 5.1 +/- 0.5 ml/min, and renal clearance was negligible. The protein binding of SMZ was 48.0 +/- 1.4% and the distribution volume was 0.55 +/- 0.071/kg. Total plasma clearance of SMZ was 26.2 +/- 5.7 ml/min, peritoneal dialysance was 1.2 +/- 0.2 ml/min, and renal clearance was negligible. The half lives of TMP and SMZ were 23.7 +/- 4.0 h and 18.1 +/- 3.5 h, respectively. The peritoneal dialysance both of TMP and SMZ after oral administration was very low. In contrast the absorption after intra-peritoneal administration is high. Peritoneal absorption was increased during peritonitis. In patients with peritonitis, the intra-peritoneal administration of TMP-SMZ resulted in an immediate high local concentration, and a serum concentration of both drugs in the therapeutic range within 6 to 12 h.

Administration, Oral↗
PubMed1982

Erythrocyte organic phosphates and whole blood oxygen affinity in patients on continuous ambulatory peritoneal dialysis.

Whole blood oxygen affinity, erythrocyte pH and organic phosphates were studied in five anaemic untransfused patients with end stage renal disease undergoing continuous ambulatory peritoneal dialysis. Decreased whole blood oxygen affinity with increased adenosine triphosphate and normal 2.3 diphosphoglycerate (DPG) values were observed. Normal and stable serum phosphate and permanent mild metabolic acidosis may be important factors contributing to maintain DPG levels within the normal range despite anaemia. Continuous dialysis avoids cyclic fluctuation of blood oxygen affinity as described during and after dialysis sessions in patients on maintenance haemodialysis.

2,3-Diphosphoglycerate↗
PubMed1982

[Renal function substitutes. Technical and logistic orientation of the treatment].

In France about 50 new patients per million of inhabitants per year with end stage renal disease (ESRD) require treatment with dialysis and/or transplantation. For the last few years new dialysis methods as hemofiltration and continuous ambulatory peritoneal dialysis have been extended. It is too early to predict what will be the role and the future of such methods as compared to hemodialysis, the gold-standard. Appropriate logistics of treatment of ESRD rely on an integrated dialysis-transplantation program. In France the percentage of some modes of therapy, including home dialysis and transplantation, should be increased.

Blood↗
PubMed1982

[Hyperkeratosis of the keratotic plug type in patients with chronic renal failure and metabolic diseases].

We have noticed in eight male patients transepithelial keratotic plugs which appeared preferentially on zones of supporting points. These plugs evoked in a more or less accurate way, Kyrle's disease or other related syndromes, particularly reactive perforating collagenosis and perforating folliculitis. Seven cases were associated with chronic and severe renal failure complicating a serious diabetes in four cases, one of them with a viral hepatitis. One case has been observed during an important denutrition with digestive disorders.

Adult↗
PubMed1981

Intraperitoneal insulin in uraemic diabetics undergoing continuous ambulatory peritoneal dialysis.

The kinetics of absorption of intraperitoneally administered insulin were studied in nine uraemic insulin-dependent diabetics undergoing continuous ambulatory peritoneal dialysis (CAPD). In each of three studies 20 U of regular insulin was directly injected as a bolus into the peritoneal cavity through an indwelling Tenckhoff catheter. In two procedures the insulin injection was followed by the instillation of either 2 litres of 1.5% dextrose dialysates or 2 litres of 4.5% dextrose dialysate. In the third 20 ml of saline was used to flush the tubing. Plasma free insulin values rose more rapidly and reached significantly higher concentrations (55.6 +/- 18.8 mU/l) when the insulin had been injected into an empty peritoneal cavity than when it was followed by dialysate. These differences were observed despite the fact that most of the insulin injected was retained by the patients. Since the plasma insulin values did not differ after instillations of dialysate containing 1.5% and 4.5% dextrose, the osmolality of the dialysate seemed not to affect insulin absorption, and the dilution of the insulin probably delayed its transfer through the peritoneum. These findings suggest that insulin given intraperitoneally to patients undergoing CAPD will be most effective if it is given into an empty peritoneal cavity at least 30 minutes before the dialysate is instilled.

Blood Glucose↗