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J Rottembourg

Publications and source records attributed to J Rottembourg.

124 records · Page 7Linked to original sources
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Renal function and blood pressure in heart transplant recipients treated with cyclosporine.

Cyclosporine, a cyclic endecapeptide of fungal origin, has been used for nine years in clinical transplantation to suppress allograft rejection. Nephrotoxicity represents the most frequent and severe complication associated with its use and may ultimately define the limits of its utility as a drug for long term immunosuppression. However, this nephrotoxicity cannot be truly assessed in kidney transplant recipients for obvious reasons. It has recently been reported in heart transplant recipients. In addition, cyclosporine therapy is responsible for a persistent elevation of blood pressure requiring intensive and combined anti-hypertensive regimens. This hypertension develops within the first weeks post-transplantation in 60% to 90% of heart allograft recipients. This study analyzes the renal function and blood pressure of patients operated on in our department where cyclosporine was introduced in 1981.

Actuarial Analysis↗
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[Bilateral nephrectomy by embolization of the renal arteries: a report on five cases (author's transl)].

Selective bilateral renal artery embolization was performed in 5 patients because of severe hypertension not responding to conventional medical treatment, in two patients on repeated dialysis; severe nephrotic syndromes with chronic renal insufficiency in the three other patients. A significant drop in blood pressure occurred in only two of the hypertensive patients, about 40 days after embolization. Bilateral surgical nephrectomy was required in the other patient because of persistence of residual vascularization and high RAP. Excellent results were obtained in the 3 patients with a nephrotic syndrome, with disappearance of proteinuria and anuria following the embolization. For this method to be effective, the arterial obliteration has to be complete and definitive. When symptoms persist or there is a relapse, especially in the cases with hypertension, a repeated arteriographic examination and complementary embolization has to be envisaged. Further experience with this method is necessary in order to compare the results with those obtained after bilateral surgical nephrectomy. Medical treatment with agents toxic to the tubules, in cases of the nephrotic syndrome, has apparently not produced the results expected. The relative simplicity of this embolization procedure has to be underlined, together with the fact that it is free from major complications when performed by surgeons trained in its use, on the condition that purification be carried out immediately following embolization.

Adult↗
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[Surgery in patients with chronic renal failure on maintenance dialysis (author's transl)].

Among 606 patients on maintenance dialysis in the same unit, 111 (18.3%) underwent various surgical procedures. 14 additional patients on dialysis in other units were included in this group. A total of 138 surgical procedures were performed in these 125 patients, of which 112 were on hemodialysis. In 57 patients, surgery was warranted by a complication directly related to the chronic renal failure. In 81 patients, surgery was indicated because of an associated condition, a complication resulting from therapy, or a coincidental surgical affection. After these 138 procedures, 27 post-operative complications (19,6 %) and 15 deaths (10,86 %) were reported. The mean age for deceased patients is 66 years. These findings show that surgical morbidity and mortality, even after major procedures, are not prohibitive in patients on dialysis, if certain measures are taken during dialysis, anesthesia, surgery, and post-operative care. These measures are reviewed in the study.

Anti-Bacterial Agents↗
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[Kidney transplantation from living related donors: experiences from one center].

Living related donor (LRD) renal transplantation has remained underdeveloped in France up until now. The reduction of the number of available grafts and especially the superiority of the results of LRD transplants recently led us to develop this type of transplantation. We present the retrospective analysis of our experience of 63 cases from March 1973 to June 1995. The actuarial graft survival rate was 91% at 1 year and 87% at 3, 5 and 10 years. The 5- and 10-year survival rates of HLS-identical transplants (n = 17) was 100%. The donor morbidity was minimal (2 cases of parietal suppuration, 1 pulmonary atelectasis). These results emphasize the superiority of LRD transplantation, which also has the advantage of allowing transplantation of hyperimmunized patients in whom the waiting time for a brain-dead donor kidney is long and unpredictable.

Actuarial Analysis↗