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Biomedical subjects

J Rottembourg

Publications and source records attributed to J Rottembourg.

At least 91 records · Page 5Linked to original sources
PubMed1981

[Substitutes for renal function. Technical trends and logistics of 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.

Hemodialysis, Home↗
PubMed1981

[Immediate renal function after kidney transplantation (author's transl)].

The postoperative course management of kidney transplant patients appears to be easier when a large efficient diuresis resumes without delay. A decreased hemodialysis rate is observed and diagnosis of rejection is easier. Immediate diuresis resumed in 180 out of 186 (97%) recipients who received a large fluid load, given under mean pulmonary arterial pressure (PAP) monitoring. The purpose of fluid load is to provide the graft with an optimal blood flow immediately after vascular clamp release. The optimal filling pressure required varies according to initial PAP value. Fluid load aims to raise PAP to reach 25 mm Hg when the initial value is below this figure whereas it merely maintains the initial value when PAP is at 25 mm Hg or above. Mean peroperative fluid load reaches 3860 ml of water with 33 g of sodium chloride, 600 ml of 20% albumin and 3 units of packed red blood cells. During the immediate postoperative course a minimal 400 ml/h urine output is aimed at. Good hemodynamic tolerance is maintained through deliberate controlled ventilation during the first six postoperative hours. Application of this protocol was associated with general improvement of kidney transplantation outcome.

Adolescent↗
PubMed1981

[Familial paroxysmal polyserositis: modern therapeutic possibilities (author's transl)].

Prognosis of familial paroxysmal polyserositis is primarily related to the presence of renal insufficiency due to the amyloidosis. Current treatment of terminal renal failure--haemodialysis and renal transplantation--has increased survival in these patients, but prognosis remains relatively poor because of the extrarenal, mainly cardiac deposits which have had time to develop. Preventive treatment is therefore all that can be hoped for, and initial results of the use of colchicine in this amyloid affection, by Israelian authors, appear encouraging.

Adolescent↗
PubMed1980

Hemodynamic changes induced by regular hemodialysis and sequential ultrafiltration hemodialysis: A comparative study.

The effects of a mean ultrafiltration of 2000 ml on hemodynamics during regular hemodialysis (RD) and during sequential ultrafiltration hemodialysis (SUH) have been compared in ten patients on maintenance dialysis. Each patient was submitted to two dialysis sessions at 2 days' interval. The hemodynamic studies were performed with a thermistor Swan-Ganz catheter. The control values of mean systemic arterial pressure, cardiac output, and heart rate were similar with either RD or SUH. During ultrafiltration without diffusion, there was an immediate prolonged and significant decrease in cardiac and stroke indexes and in pulmonary wedge pressure. The mean systemic arterial pressure remained unchanged as long as the total vascular resistance was significantly increased. During the diffusion period of SUH, total vascular resistance decreased, and seven patients became hypotensive. When ultrafiltration was associated with diffusion during RD, the total vascular resistance remained stable, despite a decrease in cardiac index. This was found to result in severe hypotensive episodes, despite a moderate ultrafiltration. These results suggest that diffusion can induce arterial vasodilation and poor hemodynamic adaptation to ultrafiltration-induced hypovolemia SUH, undertaken under careful medical control, appears to be an excellent procedure to deplete severely overhydrated dialyzed patients, but it should not be used routinely as a substitute for RD.

Adult↗
PubMed1980

Visual function can be preserved in insulin-dependent diabetic patients treated by maintenance haemodialysis.

Evolution of visual function was assessed in 43 insulin-dependent diabetic (IDD) patients treated by maintenance haemodialysis (MH) for a cumulative duration of 1248 patient-months. At start of MH, 23 patients (46 eyes) still had good vision, 20 patients (40 eyes) were blind. All 40 blind eyes had severe proliferative retinopathy (PR) with additional irreversible complications in 32. Of the 46 eyes with preserved vision, PR was present in 24 (52.2%) with only 2 additional severe complications. Restoration of sight was obtained either spontaneously or after ophthalmic surgery in 6 eyes (7%). Stabilisation was achieved in 74% of eyes which retained vision at the start of MH. Two patients with eyesight at start of MH became blind (8.7%). Aggravation of visual function is mainly related to development of PR and not to haemodialysis per se. Careful ophthalmic follow-up, together with close control of diabetes, blood-pressure and uraemia can ensure preservation of vision in most IDD patients treated by MH.

Adult↗
PubMed1979

The use of the artificial pancreas in uremic diabetic patients.

Maintenance hemodialysis and renal transplantation are increasingly used for treating diabetic patients with end-stage renal failure. The use of the artificial pancreas is able to prevent large blood glucose fluctuations in these patients with atherosclerosis, advanced retinopathy or neuropathy in which hyper- and hypoglycemia are potentially deleterious. For this purpose, we have developed and are utilizing an artificial pancreas easily utilizable without special training by the staff of a dialysis unit. This artificial pancreas uses a polarographic glucose electrode with a fast response time (45 to 90 seconds), a terminal display for operator communication, and a continuous digital and analogyl display for control of the running operation. There is also a printer to display in tabular and graphical form the values at any time during the operation. In this preliminary study, 7 patients have been studied: five under repetitive hemodialysis for four hours, 3 times a week; one treated by peritoneal dialysis for 12 hours, twice a week and one controlled during, and 48 hours after, renal transplantation. The macroscopic pancreas normalizes blood glucose under these circumstances, helps in a better understanding of blood glucose homeostasis in uremic patients under dialysis, leads to a more precise evaluation of insulin needs, may help to improve the nutritional status of the patients, and has an educational value for the patient and the medical staff.

Artificial Organs↗
PubMed1978

[Effect on serum aluminium levels of continued ingestion of aluminium gels by patients with chronic renal insufficiency (author's transl)].

Atomic spectrometric absorption without flame allows reliable determination of serum aluminium levels (S.A.). Serum level in 59 normal subjects taking no aluminium gel (A.G.) is 24.3 +/- 8.4 microgram/l. Similar value were observed in 27 patients with renal insufficiency even severe who do not take A.G. Mild elevation of S.A. (40 +/- 12 microgram/l) was observed in 21 dialysed patients receiving no A.G. S.A. elevation is related to the aluminium content of dialysis fluid. A.G. intake in patients with renal insufficiency is followed by increase of S.A. The levels increase in relation with the daily dose of A.G. The highest values are observed among dialysed patients. In 41 dialysed cases A.S. values are between 70 and 600 microgram/l. In 17 patients dialysed for a mean period of 47 months mean serum A.S. is 165 +/- 40 microgram/l. The precise role of aluminium intoxication in the genesis of the dialysis encephalopathy syndrom remains controversial. From a clinical point of view aluminium intoxication should be looked for in any patient with encephalopathy who is taking aluminium gels and/or who is dialysed.

Aluminum↗
PubMed1978

Importance of the plasma refilling rate in the genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration-haemodialysis.

The effects of ultrafiltration (UF) on plasma volume (PV) have been studied in eight patients using regular dialysis (RD) and controlled sequential ultrafiltration-haemodialysis (CSU) performed with a Rhodial 75 dialysis system. For a given value of UF the reduction of PV is determined by the plasma refilling rate. During CSU ultrafiltration induces a rapid increase in oncotic pressure without decreasing plasma osmolality. The high plasma refilling rate which can reach 1500 ml/hr allows moderate hypovolaemia despite high rates of UF and contributes to the usual good clinical tolerance of CSU. During RD a rapid decrease in plasma osmolality contributes to a water shift from the vascular space towards the interstitial and intracellular spaces and severe hypovolaemia can occur despite moderate ultrafiltration. CSU offers an adequate treatment for sodium overloaded patients with hypervolaemia, but is of no benefit in routine conditions.

Humans↗
PubMed1977

[Current aspects of human heart transplantation. II. Postoperative surveillance and results].

The cardiac transplantation program of the Pitié-Salpêtrière Hospital has, since October 1973, involved 17 transplants with 15 recipients. Seven patients are alive. Real progress has been achieved in all areas: --selection of the recipient, now more strict is dependent upon precise criteria; --choice of the donor should take into account the best possible tissue and haemodynamic compatibility; --immuno-depressive therapy involves the combination of corticosteroids, azathioprine, antilymphocytic globulins and heparin. It is varied as necessary in relation to episodes of rejection; --the diagnosis of rejection is based upon clinical, radiological and electrical criteria, but also upon new and precise haemodynamic and biological criteria; --long term control is facilitated by regular telephone transmission of the electrocardiogram. The prognosis remains reserved but with socio-professional rehabilitation to help in overcoming the initial slight degree of "hospitalism", the sensation of a new life is such that cardiac transplantation represents an acceptable solution in the treatment of certain cardiac diseases.

Bacterial Infections↗
PubMed1977

Cellular presensitization to alloantigens in haemodialyzed patients.

The state of cellular alloimmunity in haemodialyzed patients has been assessed by a microcytotoxicity assay and compared with that in healthy donors. Some of the patients were also studied during the weeks following a first kidney transplant rejection. For comparison, lymphocytes of multiparous women have been studied. Skin fibroblasts from a panel of normal donors were used as targets, and effector cells were cryopreserved peripheral blood lymphocytes. Lymphocyte-mediated cytotoxicity (LMC) demonstrated restricted reactivity against target cells, an indication of specificity. It detected presensitization more often than a standard test for cytotoxic antibodies. This difference is not attributable to differences in sensitivity of the two tests, since some patients were at least once LMC negative and cytotoxic antibody positive, and the antigens detected by both tests were different in patients who had positive LMC and cytotoxic antibodies simultaneously. In some experiments, LMC target determinants were not HLA serologically detectable antigens. Furthermore, lymphocytes obtained after transplant rejection were cytotoxic for targets which did not share the donors' serological mismatches. These results suggest that antigens other than HLA-A and B may be the determinants recognized in the microcytotoxicity assay.

Antibody Specificity↗