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Biomedical subjects

R Makdassi

Publications and source records attributed to R Makdassi.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Pregnancy-induced hypertension and pre-eclampsia develop in spite of high circulating levels of cardionatrin].

Plasma cardionatrine was measured during pregnancy in 14 normotensive non pregnant women, 15 normotensive pregnant women, 35 pregnancy induced hypertension (PIH) and 10 preeclampsia (PE) and again 2 months after delivery in respectively 7, 15 and 7 cases together with plasma volume, PRA and plasma aldosterone. The plasma levels of cardionatrine are higher in pregnant normotensive women than in non pregnant normotensive women suggesting that pregnancy per se stimulates cardionatrine secretion. The higher levels of cardionatrine in PIH and specially in PE during pregnancy and the greater decrease of plasma cardionatrine after delivery in the hypertensive patients than in the normotensive controls exclude a deficiency of cardionatrine secretion in the pathogenesis of hypertension. These data rather suggest a compensatory role of cardionatrine in the prevention of blood pressure increase. Plasma volume was decreased in PIH (-17 p. 100) and in preeclampsia (-25 p. 100). The simultaneous high levels of cardionatrin may explain the inappropriate stimulation of the renin and aldosterone secretion in these hypovolemic hypertensive states.

Adult↗
PubMed1987

[Evaluation of maximal filtration capacity and renal functional reserve by an oral protein-loading test in adults and children].

After a protein load, the glomerular filtration increases to a maximum called maximal filtration capacity (MFC). The difference of this value with that observed in the fasting state defines the functional renal reserve (FRR). Fifty oral protein loads have been performed in 16 controls (13 adults and 3 children) and 31 patients with kidney disease or hypertension (22 adults, 9 children, 3 tests being performed twice). The load consisted in the adults of 80 g of various proteins. In the children the load consisted in the 100% of the protein intake recommended of the whole day. The urinary samples were made hourly during the 5 hours following the beginning of the meal. The MFC was not always observed during the 2 hours following the end of the meal. However the mean of the clearances measured during these 2 hours allowed an acceptable evaluation of the FRR in 42 out of 50 cases and had the advantage to reduce the errors linked to incomplete bladder voiding. In the adult controls the mean of hourly determined MFC is 156 +/- 27 ml/min, the mean of the clearances measured on the 2 hours following the meal is 136 +/- 21 ml/min and the fasting clearance 96 +/- 22 ml/min. The FRR is null in all patients with a nephropathy with a fasting clearance below 40 ml/min. It is modest or null in patients with acquired or congenital solitary kidney. Three out of five patients with proteinuria have MFC and FRR higher than the mean of the patients with comparable fasting clearances but without proteinuria suggesting that proteinuria is associated with a hyperfiltration state.

Administration, Oral↗
PubMed1985

[Stages of the etiological diagnosis of hypercalcemia].

After confirming hypercalcemia by 3 successive measurements of the total plasma calcium corrected for a plasma protein concentration of 72 g/l, which excludes spurious hypercalcemia due to dehydration, the physician orientates the aetiological diagnosis bearing in mind that primary hyperparathyroidism PHPT is the cause of 85 p. 100 of all asymptomatic forms of hypercalcaemia whilst overt or occult malignancy is the main cause (60 p. 100) of symptomatic forms of hypercalcaemia with PHPT responsible for 20 p. 100 of cases. Other causes, including drug toxicity with Vit D, calcium, Vit A, lithium, thiazide and aluminium hydroxide, sarcoidosis, hyperthyroidism, Addison's disease, pheochromocytoma and familial endocrine disorders are much rarer. Nevertheless, these rarer causes must be excluded on the clinical history and examination followed by radiological (chest X ray, plain abdomen X ray, bone X rays) and simple biological tests. The latter and/or scans tests should also help in a rapid diagnosis of metastatic carcinoma and multiple myeloma, so that the major diagnostic problem is to distinguish primary HPT from occult malignancy. This problem is greatly facilitated by reliable assays of C terminal or medium PTH rather than renal CAMP which is increased in 80 p. 100 of occult malignancies. When PTH assays is unavailable or unreliable Dent's hydrocortisone suppression test may be useful as a fall in'serum calcium is associated with occult malignancy in 70 p. 100 of cases and non-suppression is associated with PHPT in 91 p. 100 of cases. Discriminant analysis of the usual biochemical parameters may be helpful in this differential diagnosis and is accurate in about 90 p. 100 of cases. However, the association of PHPT and malignancy is also possible and not fortuitous.

Humans↗
PubMed1985

Magnesium renal wasting in calcium stone formers with idiopathic hypercalciuria contrasting with lower magnesium:calcium urinary ratio.

Plasma magnesium (PMg) and urinary calcium (UCaV) and magnesium (UMgV) were measured after four days of calcium-restricted diet in 60 controls and 82 patients classified according to their calcium excretion in three groups: normo-calciuric (NCa), dietary hypercalciuria (DH) and idiopathic hypercalciuria (IH). When compared to controls, higher UMgV (4.26 +/- 0.28 mmol/d versus 3.4 +/- 0.16, p less than 0.01), lower PMg (0.79 +/- 0.01 mmol/d versus 0.84 +/- 0.01, p less than 0.05) and lower UMg/UCa ratio (0.6 +/- 0.04 versus 1.68 +/- 0.15, p less than 0.001) were observed only in IH. A significant correlation between UMgV and UCaV was found in controls, in NCa and in DH but not in IH. In conclusion, (1) the coexistence of a higher UMgV and of a lower PMg in IH suggests that there is a magnesium depletion in this group of patients; (2) since the lower UMg/UCa ratio may favour a higher propensity for calcium crystallisation and is seen only in IH, magnesium supplements may be specially indicated in this group.

Calcium↗
PubMed1985

[AA amylosis and the nephrotic syndrome complicating a pulmonary epidermoid carcinoma].

A 59 year-old male developed the nephrotic syndrome in the course of squamous-cell lung carcinoma with metastases. Renal biopsy disclosed amyloid deposits. Immunofluorescence was positive with an anti-SAA antiserum. Amyloidosis complicates exceptionally lung tumors, despite extremely high serum levels of SAA in this type of malignancy. This infrequency shows that determinants other than high SAA serum levels are necessary to create tissue amyloid deposits.

Adrenal Gland Neoplasms↗
PubMed1983

Effect of calcium restriction on renal excretion of oxalate and the probability of stones in the various pathophysiological groups with calcium stones.

To evaluate the adequacy of simple calcium restriction for patients with idiopathic calcium stones the effect of 5 days of calcium restriction without oxalate restriction on renal excretion of calcium and oxalate, and the corresponding probability of stones were assessed in 50 controls and 48 patients. Renal excretion of calcium decreased and that of oxalate increased significantly in all groups but the importance of the changes was critically dependent upon the underlying pathophysiological condition. The probability of stones decreased only in patients with absorptive hypercalciuria type II owing to the usual excessive calcium intake and increased in those with absorptive hypercalciuria type I and renal hypercalciuria, which are associated with true hyperabsorption of calcium and represent the 2 forms of idiopathic hypercalciuria. We believe that simple calcium restriction is beneficial for patients with idiopathic calculi only when the hypercalciuria is caused by exaggerated intake of calcium, since it increases the probability of stones in patients with idiopathic hypercalciuria. Calcium restriction always is associated with an increase in oxalate excretion, suggesting that simultaneous oxalate restriction should be added in all cases to decrease the probability of stones.

Adult↗
PubMed1982

Renin angiotensin aldosterone system and adrenergic system in normotensive and hypertensive pregnancy.

We have measured simultaneously plasma renin activity (PRA), aldosterone and catecholamines in the plasma of 3 groups of pregnant women after the 20th week: group 1 of 16 normotensive controls, group II of 17 women with rest responding hypertension (RRH), group III of 18 women with permanent hypertension (PIH). All the patients were ambulatory on a normal salt diet. PRA was significantly higher in the RRH than in the control and PIH groups (15,8 +/- 2,3ng/ml/l versus 6,7 +/- 0,5 and 8,9 +/- 0,9 respectively). Plasma epinephrine (PE) and norepinephrine (PNE) were significantly higher in the PIH than in the control and RRH groups (respectively 135 +/- 28 pg/ml versus 56 +/- 13 and 63 +/- 17 for PE and 387 +/- 91 versus 206 +/- 32 and 200 +/- 47 pg/ml for PNE). In the PIH group there was a negative correlation between PRA and blood uric acid. It is concluded that the adrenic system is activated in PIH whereas the renin angiotensin system is activated in RRH of pregnancy.

Adult↗
PubMed1982

[Does 24,25 dihydroxycholecalciferol have a physiological and pathophysiological role?].

The authors review recent experimental and human data concerning the potential physiological and pathophysiological role of 24,25 (OH)2D3, the dihydroxylated metabolite of vitamin D which is synthetisized with preference over 1,25 (OH)2D3 in organisms that have been replenished with vitamin D. For the major known effects of vitamin D such as stimulation of intestinal absorption and bone resorption of calcium and phosphorus, 24,25 (OH)2D3 is less effective than the 1,25 (OH)2D3 metabolite and consequently of lesser physiological importance. Some recent in vitro experiments have shown, however, that 24,25 (OH)2D3 intervenes in the stimulation of proteoglycan synthesis, inhibition of PTH, vitamin A and heparin induced resorption, whereas 1,25 (OH)2D3 does not. Although there is controversy as to its direct inhibitory effect on secretion of PTH, it seems to act with 1,25 (OH)2D3 to prevent hyperplasia of parathyroids in vitamin D deficient chicken. From a pathophysiological point, the presence of 24,25 (OH)2D3 seems vital to allow normal bone formation and mineralisation and possibly to counteract excessive bone resorption.

24,25-Dihydroxyvitamin D 3↗
PubMed1982

Cimetidine and circulating calciotropic hormone levels in uremic patients: evidence for a suppressive effect on calcitonin secretion.

The effect of oral cimetidine on parathyroid hormone and calcitonin plasma levels was evaluated in 12 uremic patients on chronic hemodialysis. Compliance to treatment was monitored by measuring cimetidine plasma concentrations. Plasma cimetidine was measurable in 7 patients and undetectable in 5. In compliant patients, there was no change in plasma concentration of calcium and parathyroid hormone but a significant fall of 75% in plasma calcitonin levels during treatment, followed by an increase towards initial values after cimetidine discontinuation. No significant change occurred in the other 5 patients. Cimetidine therefore appears to be of little value in the treatment of uremic hyperparathyroidism.

Adult↗
PubMed1981

Lack of antagonism in the antihypertensive effects of clonidine and prazosin in man.

1. In four patients, whose hypertension was not controlled (supine blood pressure greater than 150--90 mmHg) by addition of 5 mg/day of prazosin to previous treatment (diuretics and beta-blockers), clonidine (150--450 microgram/day) led to control of hypertension in three cases. 2. In ten patients whose hypertension was not controlled by a treatment including clonidine (300--450 microgram/day), the progressive addition of prazosin to a maximal dose of 4--22.5 mg/day led to control of hypertension in nine cases (mean supine blood pressure decreased from 174--102 to 144--88 mmHg). 3. In 13 hospitalized patients, clonidine was abruptly interrupted whereas prazosin was continued. Mean blood pressure (+/- SEM) rose from 145 +/- 1/85 +/- 2 to 169 +/- 7/104 +/- 5 mmHg 48 h after clonidine withdrawal whereas plasma noradrenaline and adrenaline rose from 328 to 758 pg/ml and from 75 to 137 pg/ml. No subjective symptoms were noted. There was a negative correlation between blood pressure increase and the dose of prazosin. 4. It is concluded that (a) there is no antagonism between clonidine and prazosin in their antihypertensive action in man when used at usual clinical doses, (b) a protective effect of prazosin against an eventual clonidine withdrawal syndrome is suggested by the negative correlation between blood pressure increase and the dose of prazosin.

Adult↗
PubMed1981

[Control of hypertension and blood lactate during exercise. Comparison of central antihypertensive agents with the cardio-selective beta blockers metoprolol and atenolol].

To assess whether betablockers (BB) would better control blood pressure than central antihypertensive drugs (CAD) clonidine or alpha methyldopa in hypertensive patients during exercise, comparable triangular ergometric bicycle exercises were performed by the same patients while their hypertension had been controlled at rest either with CAD or BB. Blood pressure, heart rate and blood lactate before and during exercise were compared in II patients treated with metoprolol and CAD, and in 12 other patients treated with atenolol and CAD. Systolic and diastolic blood pressure on exercise were significantly lower with BB than with CAD. Heart rate and rate-pressure product were always lower with BB than with CAD. Blood lactate increase was greater with BB than with CAD. The work capacity was greater with atenolol than with CAD, but comparable between metoprolol and CAD.

Adrenergic beta-Antagonists↗
PubMed1981

[Intravenous pyelography with visualization of renal arteries and pyelogram wash-out, as the method of choice for the diagnosis of renovascular hypertension (author's transl)].

The authors review the various techniques of intravenous arteriography before an excretory urogram and discuss their role in the etiological diagnosis of hypertension. Detection of renovascular disease classically implied Seldinger arteriography, with its limited indications, because of side effects and cost. This classical approach should now be systematically replaced by the visualization of renal arteries during the intravenous pyelography procedure which appears to be a method more effective, as well as less expensive and hazardous. The pyelogram wash-out should still be performed when the visualization of the renal arteries is poor because of its value in the screening for renovascular hypertension. Furthermore, when a renal artery stenosis is clearly defined, the wash-out of the pyelogram should also be performed because of its prognostic value. As the classical approach for the etiological diagnosis of hypertension, this technique has limited indications. It is indicated in severe hypertension in the young, when medical treatment does not control blood pressure satisfactorily or when renal failure progresses rapidly. Furthermore, this technique allows a non traumatic follow up of operated or dilated stenoses.

Cost-Benefit Analysis↗
PubMed1981

[Diuretics and vascular risk factors. Comparison between tienilic acid and chlorothiazide (author's transl)].

Tienilic acid (250 mg/day) was compared with chlorothiazide (500 mg/day) in 25 hypertensive patients in a randomized cross-over study (2 periods of 2 months). Mean supine arterial pressure was lower with tienilic acid than with chlorothiazide (106 +/- 3 vs 111 +/- 3 mm Hg, p less than 0.05) whereas no difference could be noted in body weight, natriuresis and plasma renin activity. Glucose tolerance tests were altered in the same fashion. Serum cholesterol (234 with tienilic acid and 239 mg/dl with chlorothiazide) and serum triglyceride levels (178 with tienilic acid and 179 mg/dl with chlorothiazide) were not different. Serum urate concentrations were lower with tienilic acid (4.8 mg/dl) than with chlorothiazide (7.8 mg/dl) whereas fractional excretion of urate was much higher with tienilic acid (17 +/- 2%) than with chlorothiazide (7 +/- 2%). Thus, the only metabolic advantage of tienilic acid over chlorothiazide is its hypouricemic effect which warrants long term studies to evaluate its vascular prognostic significance.

Adult↗
PubMed1981

Blockers of beta and H2 receptors and secondary hyperparathyroidism in uraemia.

The suppressive effect on PTH secretion of propranolol, a beta 1 and beta 2 blocker, and that of atenolol a specific beta 1 betablocker was compared in 24 uraemic patients not yet on dialysis in a cross over study. Although plasma PTH concentrations were comparable, plasma bicarbonate was higher with propranolol suggesting that the initial suppression of PTH secretion by propranolol was greater as a higher bicarbonate should lead to lower ionised calcium. The suppressive effect of cimetidine on PTH secretion was assessed in 12 patients on chronic haemodialysis. In the seven compliant patients there was no change in N and C terminal plasma PTH values but plasma calcitonin concentrations significantly decreased with cimetidine and returned to initial values after cimetidine was discontinued.

Adult↗
PubMed1980

Effect of propranolol and metoprolol on parathyroid hormone and calcitonin secretions in uraemic patients.

Nine uraemic patients not being treated by dialysis received intravenous propranolol 1 microgram/kg/min for 85 minutes after a priming dose of 1 mg. Fifteen days later, six of them received intravenous metoprolol 1.2 microgram/kg/min after a priming dose of 1.2 mg. Plasma concentrations of parathyroid hormone (PTH) and calcitonin fell significantly after propranolol but not after metoprolol, whereas no change in plasma concentrations of ionised calcium and phosphate occurred with either drug. Heart rate fell similarly with both drugs. The fact that propranolol acutely suppressed PTH and calcitonin secretion in uraemic patients indicates that further studies are warranted to assess the long-term effects of the drug on the secretion of these hormones and on renal osteodystrophy. The contrast between the responses to propranolol and metoprolol supports the concept that PTH and calcitonin secretion is modulated through specific beta 2-receptors.

Adult↗