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Biomedical subjects

P Rousseau

Publications and source records attributed to P Rousseau.

At least 19 recordsLinked to original sources
PubMed1992

Immunoadsorption of anti-HLA antibodies for highly sensitized patients awaiting renal transplantation.

Fifteen end-stage renal disease patients with high titres of panel reactive (PRA) antibodies were treated with immunoadsorption (IA) on sepharose-bound protein A columns in order to remove anti-HLA antibodies and facilitate transplantation. Infectious complications were not observed after IA and transplantation, and the procedure was well tolerated. In spite of the use of adjunctive immunosuppressive treatment with cyclophosphamide and prednisolone, this method produced only variable effects in lowering panel reaction antibodies, and was hampered by high de novo resynthesis of anti-HLA antibodies. Patients whose pre-IA antibody titre was greater than or equal to 1:64 clearly did not benefit from the procedure, but other immunological criteria were not predictive of efficacy. Twelve patients were transplanted on the basis of a negative cross-match with current serum, historical sera being retrospectively tested. Surprisingly, seven patients received a well-matched graft with both pre- and post-IA negative cross-matching. Graft survival was 86% in this group. Conversely, in the group of five transplants which were performed in recipients having a positive historical cross-match with the donor, graft survival was only 40%. One patient died with a functional graft, and two grafts failed due to hyperacute humoral rejection. Humoral rejection in a third patient was successfully treated by a second IA course and administration of polyclonal IgG. We conclude that IA is a safe procedure for managing hyperimmunized transplant candidates. However, its efficacy remains variable, and a better definition of patients who should benefit from IA needs to be found.

Adsorption↗
PubMed1992

Anti-HLA antibodies depletion on protein A-sepharose columns in hyperimmunized patients awaiting renal transplantation.

To reduce anti-HLA immunization, 15 patients waiting for a renal graft received the following treatment: 5 to 7 immunoadsorption sessions on protein A-Sepharose columns, immunosuppressive drugs (corticosteroids 1 mg/kg (bw/day+cyclophosphamide 2 mg/kg bw/day) and iv polyclonal immunoglobulins. Before this treatment, panel-reactive antibodies ranged from 65 to 100% and antibody titers varied from 1/8 to 1/128. In all patients, antibody, titers were decreased. However, antibody resynthesis was incompletely blocked by this protocol. Eight out of 12 grafted patients had a functional kidney transplant 3 months to 3 years post-grafting. There early kidney failures occurred in the subgroup of 5 patients who had had historical positive cross matches prior to treatment. This treatment did not seem to increase the frequency of infectious complications before or after grafting.

Adult↗
PubMed1992

[Multiple intracranial aneurysms. Endovascular treatment by coils].

The authors report the case of a 30 years-old man presenting with 3 intracranial aneurysms, which were treated by endovascular techniques. The aneurysm responsible for two previous subarachnoid hemorrhages was a giant supracavernous left internal carotid artery aneurysm. Endovascular therapy using coils caused intraoperative rupture which was successfully managed by balloon occlusion of the internal carotid artery. The two other aneurysms (basilar top, and right middle cerebral artery) were small and asymptomatic; complete obliteration of both aneurysms was achieved by selective coils embolization. Persistent occlusion of the three aneurysms was documented ad six months angiographic follow up.

Adult↗
PubMed1992

How to deal with the hyperimmunized potential recipients.

End-stage renal disease (ESRD) patients with high levels of anti-HLA panel reactive antibodies (PRA) represent an increasing group in which sensitization, induced by pregnancies, previous transplants, and blood transfusions, considerably delay the opportunity to receive a graft. Currently, more than 50% of the 4700 patients awaiting transplantation in France are sensitized, of which 33% are defined as hyperimmunized (PRA greater than = 80%), and only 9.5% of the total number of transplants have been done in highly sensitized recipients. The magnitude of this problem, similar in Europe and North America, explains why more active strategies for managing hyperimmunized patients have been introduced during the past decade. Clearly, the simplest is finding of a well-matched organ that does not carry the HLA antigens against which the recipient has generated antibody, but that is limited by the number of shared grafts. The second is the development of a new cross-matching technique prior to transplantation. Attempts at immunoregulation of secreting B cell clones have been carried out using either hypertransfusions or injection of polyclonal Ig. Finally, removal and prevention of the resynthesis of HLA antibodies is a most attractive approach using immunoadsorption (IA) system with sepharose-bound protein-A columns. In our unit, fifteen ESRD patients with high levels of PRA were treated with IA. Infectious complications were not observed after IA and transplantation, and the procedure was well tolerated. In spite of the use of adjunctive immunosuppressive treatment with cyclophosphamide and prednisolone, this method produced only variable effects in lowering PRA levels, and was hampered by high de novo resynthesis of anti-HLA antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies↗
PubMed1992

Urinary incontinence in the aged, Part 1: Patient evaluation.

Urinary incontinence affects a large percentage of persons over age 65 and predisposes them to social isolation, depression, and premature nursing home placement. Transient incontinence may be precipitated by such factors as delirium, infection, atrophic vaginitis/urethritis, medication use, and restricted mobility. Persistent incontinence may be of the urge, stress, overflow, or functional type. The patient history and simple tests such as bedside urodynamics generally isolate the cause. In this first part of a two-part article, we discuss the primary care evaluation of the older patient with urinary incontinence. In part 2 (page 37), we discuss a primary care management strategy.

Aging↗
PubMed1992

Urinary incontinence in the aged, Part 2: Management strategies.

Treatments for urge incontinence associated with uninhibited bladder contractions include medications with anticholinergic and smooth muscle relaxant properties as well as habit training, bladder retraining, contingency therapy, and biofeedback. Pelvic floor (Kegel) exercises improve stress incontinence in 60 to 90% of female patients. For patients who fail to improve with pelvic floor exercises, a combination of an alpha-adrenergic agent and conjugated estrogen is recommended. Surgery is particularly effective in elderly women with significant pelvic prolapse. Management of overflow incontinence requires surgery or intermittent/chronic catheterization. Functional incontinence may be improved with correction of the underlying disorder and availability of a motivated caregiver.

Aging↗
PubMed1991

A modified method of CT pelvimetry.

The authors describe a simplified routine procedure for CT pelvimetry. The procedure was successfully performed in 122 women with a 2% false positive rate corresponding to obese women. The originality of the procedure consists in the development of a simple technique of correction of the widest transverse diameter based on the anteroposterior topogram. The values obtained are transformed into real values of the transverse inlet diameter measurements. The procedure presented is simple, accurate, and enables considerable reduction of fetal radiation exposure.

Cesarean Section↗
PubMed1990

Antituberculous drug susceptibility testing of Mycobacterium bovis BCG strain Montréal.

Testing of Mycobacterium bovis BCG strain Montréal for susceptibility to four primary antituberculous drugs (isoniazid, ethambutol, streptomycin, and rifampin) and to one secondary drug (p-aminosalicylic acid) showed the strain to be susceptible to all five substances. Mycobacterium bovis strains ATCC 35735, which is isoniazid sensitive, and ATCC 35747, which is isoniazid resistant, were included in the test; with the exception of their respective susceptibility to isoniazid, both were inhibited by the other four drugs.

Aminosalicylic Acid↗
PubMed1990

[Isolated persistent thrombocytopenia after autologous bone marrow grafting].

An 11 year-old boy was treated for acute promyelocytic leukemia (ALM3) with chemotherapy according to the LAME 86 protocol (aracytin and rubidomycin). The first complete remission was consolidated by two autologous bone marrow transplantations. Following autologous graft, a persistent thrombocytopenic purpura appeared. Autoimmune origin was indicated by a decrease in platelet survival time and by the presence of high levels of antiplatelet antibodies.

Autoimmunity↗
PubMed1990

[Financial impact of anemia in patients with chronic renal insufficiency undergoing hemodialysis at centers].

The aim of this study was to evaluate the financial impact of anemia and transfusions in patients undergoing hemodialysis. Among a total population of 309 patients treated in 6 French hemodialysis centers, 30 have been selected to enter in a detailed evaluation: 15 (Group 2) having received in 1987 eight blood units or more, and 15 (Group 1) not transfused during the period of study. The expenditures were calculated for both groups in each category, excluding the direct cost of dialysis sessions. The analysis shows that transfused patients cost roughly 28542 FF more per capita and per year than nontransfused patients. The most important causes of increasing expenditure were not only the cost of blood units (10140 FF per patient and per year), but also direct and indirect costs of medical and biologic follow-up of transfused dialysis patients, such as outpatient visits, surgery and hospitalizations (19061 FF per capita and per year). A major center effect was evidenced, the center variation being influenced by the variation in inpatient enrollment, and variation in medical policies. Since the cost of the end-stage renal failure would be strongly affected by the costly addition of human recombinant erythropoietin to the therapeutic armamentorium, it would be advisable to take into account in economic outcomes for dialysis patients savings through reduced need for blood transfusions and perhaps fewer hospitalizations.

Anemia↗