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Biomedical subjects

M Legrain

Publications and source records attributed to M Legrain.

36 records · Page 2Linked to original sources
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

Dense deposit disease: long term follow-up of three cases of recurrence after transplantation.

The incidence and early recurrence after transplantation prove the specificity of the appearance of an electron dense alteration of kidney basement membrane often called dense intra-membranous deposit disease. Three new cases with dense deposit disease affecting the original kidneys have been followed-up after transplantation for periods ranging from 4 to 8 years and illustrate the natural history of the recurrence. Serial kidney biopsies showed the predominance of dense deposits near the mesangial area and the vascular pole. These deposits were also seen in some tubular basement membranes. Absence of cell proliferation was noted in all biopsies performed. Immunofluorescence studies revealed fixation of C3 alone. Histological signs of recurrence are compatible with the absence of clinical and biological signs. Transient or permanent proteinuria and microhematuria were common findings. Serum complement levels, measured after transplantation, were low in all three cases. Despite recurrence of the original glomerulonephritis, long-term survival of the graft was commonly observed, two cases being followed-up for 7 and 8 years. Patients with dense intra-membranous deposits glomerulonephritis should not be excluded from a transplantation program. One of the three cases reported here illustrates the exceptional association of recurrence of dense intramembranous deposits, de novo membranous glomerulonephritis and chronic rejection.

Adolescent↗
PubMed1977

[Maintenance hemodialysis and renal transplantation in diabetic patients (author's transl)].

Maintenance hemodialysis and renal transplantation are increasingly used for treating diabetic patients with terminal uremia. Nowadays dialysis techniques may be considered for most of these patients, except those presenting with multiple severe disabling complications. Difficulties in control of glycaemia or of the uremic state or in the management of immunosuppressive drugs in transplanted patients do not, in themselves, constitute special problems in dialysis or transplantation. The high rate of complications and the excess mortality recorded in diabetics, compared with non-diabetic dialyzed or transplanted patients are closely related to the cardiovascular, neurological and microvascular disease that is present to various degress in all diabetic patients. Cardiac and cerebrovascular complications account for most of the deaths. Ocular and neurological status often worsen during dialysis but their stabilization usually occurs after successful transplantation. The choice between therapeutic methods in end-stage uremia must be an individual one for each patient" depending on age, medical and psychological factors and technical feasibility. Renal transplantation gives best results in patients aged less than 50 years and should be carried out early (creatinine clearance 15 - 10 ml/min.) before occurrence of the most disabling complications. If transplantation is not indicated or available, dialysis should be initiated when creatinine clearance is about 10 ml/min. Early multidisciplinary care of uremic diabetics will improve the results of maintenance hemodialysis, the problems and failures of which occur most frequently when treatment is commenced too late in patients with irreversible clinical and/or metabolic conditions.

Age Factors↗
PubMed1977

[Dialysis-computer program. IV. Summary report. Epidemiology of complications].

The Diaphane-program instituted under the authority of the French Society of Nephrology has been steadily expanding since 1972. By December 1977, about 1500 patients treated in 30 public and private Dialysis Centres were followed up by this system. Full coverage of expenses is provided by the participating Centres. The statistical work presented in this report involves 1572 adult patients treated between June 1972 and December 1976 in 24 dialysis centres. The amount of collected data and the duration of the observation period permit to build up evolutive profiles of the population of patients treated in France by maintenance hemodialysis, of the various techniques and strategies used and of the main complications recorded in the patients. 1. Mean age of patients at start of dialysis is steadily increasing, from 40.1 years in 1972 to 48.2 years in 1976. 2. The predominance of male patients, constant over each year, may be explained by an increased proportion in man of chronic glomerulonephritis and renal vascular diseases. The sex-ratio in patients with chronic pyelonephritis is close to the one recorded in the French population. 3. The regular decrease of the mean plasma creatinine level at time of first dialysis recorded since 1972, is probably related to an earlier start of treatment. However, 10.6 per cent of the patients taken on treatment in 1975-1976 still had a plasma creatinine greater than or equal to 200 mg/100ml. 18.7 per cent had a diastolic blood pressure greater than or equal to 120 mmHg, and exsudative lesions at eye fundi examination were found in 33.5 per cent. The delay in initiating dialysis treatment may account for the frequency of early acute cardiopulmonary complications such as pulmonary oedema and pericarditis and also for the increase in the mortality rate recorded during the first year of treatment: 12.1 per cent instead of 6.2 per cent during the second year. This particularly relevant for the younger age group of patients. 4. There seems to be some social disparity concerning the detection of renal disease and the conditions under which dialysis treatment is started: chronic renal disease is detected at an earlier stage and dialysis treatment initiated for lower values of plasma creatinine and of diastolic blood pressure in patients belonging to the "higher income" group of population. 5. The percentage of patients dialysed twice a week is steadily increasing, whereas the average weekly dialysis time decreases, being about 15 hours in 1976. Day and evening dialysis replace overnight dialysis. Disposable flat-plate dialysers are used increasingly. 6. Episodes of hypotension and cramps are the incidents most frequently recorded during the dialysis sessions. Risk factors evidenced in the occurrence of hypotensive accidents are: the female sex, age greater than or equal to 55 years in males, orthostatic blood pressure drop at the end of previous dialysis, weight loss of more than 4 per cent of total body weight during dialysis...

Adult↗
PubMed1977

Hemodynamic evaluation of hypotension during chronic hemodialysis.

Hypotensive episodes occur frequently during hemodialysis; they are often sudden and difficult to prevent despite careful clinical control. Their etiology was studied by investigating the hemodynamic response of five patients submitted to ultrafiltration during their three first dialyses. A Swan Ganz catheter was inserted and left in position for 5 days. Simultaneous determination of cardiac output, mean pulmonary artery (PAP) and capillary and systemic arterial pressures were recorded. 10 hypotensive episodes were observed. In 3 patients in whom the first hypotensive episode occurred 10 minutes after the start of dialysis, there was a significant drop in PAP, cardiac index and stroke index while heart rate and peripheral resistance remained unchanged. Paradoxical bradycardia was observed. In 4 patients hypotension was observed more than one hour after initiation of dialysis. Before the hypotensive episode there was moderate elevation of heart rate and peripheral resistance and an insignificant reduction in PAP. Cardiac index and stroke index were diminished. The decrease in MAP was only 2 mm Hg. Hypovolemia is the most important factor in hemodialysis-induced hypotension but other factors such as vagal stimulation, autonomic neuropathy and osmotic disequilibrium can interfere with blood pressure control and trigger hypotension. Methods of preventing hypotension during dialysis, including the infusion of low molecular weight dextran, are discussed.

Adult↗
PubMed1976

Simultaneous allotransplantation of kidney and spleen in dogs with or without previous splenectomy.

29 simultaneous kidney and spleen transplantations have been performed on dogs. Time of rejection, similar for both organs, occurs in a delay very close to the control series. No statistically difference of the day of rejection was observed in relation with the implantation of the spleen either on the iliac or on the mesenteric vessels. Splenectomy few weeks prior to transplantation had no effect on the day and the histological type of rejection of both transplanted organs.

Animals↗
PubMed1975

Terminal renal failure due to oxalosis in 14 patients.

The present status of regular dialysis and renal transplantation in patients with end-stage renal disease secondary to primary hyperoxaluria is reported. Clinical studies include one personal case with an 18-month period of follow-up and data concerning thirteen patients treated in 10 centres in Europe which have been collected through a cooperative survey carried out with the assistance of Registry of the EDTA. On January 1 st, 1974, mean survival of patients with oxalosis treated by RDT was 30.4 months (range 6 to 102 months). Five cadaveric renal transplants have been performed in four patients; two patients are surviving with grafts functioning for 18 and 45 months. Dialysis and/or transplantation should be performed in patients with oxalosis early enough to prevent ischaemic, cardiac and neuromusclar complications which occur at the end-stage of the disease. Evidence for blood coagulation disorders, particularly chronic consumption coagulopathy, should be investigated for with adequate laboratory methods and long-term heparin therapy instituted if necessary. No convincing reports concerning the efficiency of the various drugs which have been tried out to reduce the biosynthesis of oxalic acid in patients with oxalosis have been issued to this date.

Acute Kidney Injury↗
PubMed1975

[Criteria of detection and treatment of rejection crises following human cardiac transplantation in a series of 10 cases].

Analysis of a series of 10 cardiac transplantations confirmed that the reject phenomena have a paroxysmal course, the diagnosis of which is different according to the time occurence of the reject crises, whether early (acute early rejection) or late (late acute rejection or chronic rejection). Because of the early diagnosis based on the follow-up of the electrocardiogram, of coagulation, of the graft flow, overcome eight rejection crises on the 3 patients with middle-term survival.

Adrenal Cortex Hormones↗
PubMedDate not supplied

The yeast regulatory gene PHO4 encodes a helix-loop-helix motif.

Evidence is presented, based on sequence comparisons and secondary structure prediction, of the presence of a DNA-binding and dimerization helix-loop-helix motif in the yeast transcription activator PHO4. Interest in the existence of this first known motif in yeast is discussed.

Amino Acid Sequence↗
PubMedDate not supplied

[Prevention of infections in patients subjected to immunosuppressive drugs. Experience of a nephrologist].

Infective complications favoured by non-specific immuno-depression are common after renal transplantation. Often severe, they represent the main cause of mortality. Their prophylaxis is necessary at all stages of treatment. Before transplantation, the eradication of curable infective foci is essential, and certain patients must be excluded from the programme. The operation is simplified to a maximum. The conditioning is such that one does no longer expose to the risk of aplasia. These facts render useless the isolation of the patient on a sterile unit. In cases of poor tolerance of the transplant, with repeated rejection, the reduction and eventually the stopping of immunosuppression is necessary. This attitude implies often early return to treatment by repeated hemodialysis, but it preserves to a maximum the chances of a new transplantation.

Humans↗
PubMedDate not supplied

[Chronic renal insufficiency in the terminal stage. Therapeutic possibilities offered by repeated dialysis and transplantation in the absence of selection. Apropos of 136 cases].

Repeated dialysis in hospital or at home, and renal transplantation, carried out mainly with cadaver kidney, should permit in France, in the near future, treatment of all patients with chronic terminal renal failure. This report shows the results obtained between the 1st of November 1972 and the 1st of January 1975 in 136 patients treated without any selection at the Nephrology Department and Renal Transplantation Unit of the Pitié-Salpĕtrière Hospital in Paris, in connection with 20 public and private dialysis centers. 66 patients, i.e. 45% of all, were "high risk" patients, mainly because of their age or cardiovascular condition. The overall percentage of survival rate at 2 years in dialysed patients was 81%. It was 67% in the high risk group and 94% in the others. About half of the deaths occured because of cardiovascular reasons. 82 patients were considered for transplantation. Owing to the lack of donors, the number of transplanted patients was only 21. 19 transplantations were carried out with cadaver kidneys. On the 31st of December 1974, 15 patients, i.e. 71% lived with a functioning transplant. In the reported series, complete rehabilitation was obtained in 30% of cases. The results obtained justify, in our opinion, the policy of non-selection of patients.

Adolescent↗