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Biomedical subjects

R Milongo

Publications and source records attributed to R Milongo.

16 recordsLinked to original sources
PubMed1997

[Mesenteric ischemia in hemodialyzed patients].

OBJECTIVES: Mesenteric ischemia is uncommon in the general population but is frequently encountered in chronic hemodialysis patients. We present here four cases which occurred in our unit within one year while only six cases had been observed in the preceding twenty years. OBSERVATIONS: Four chronic hemodialysis patients (age: 57 to 76 years) with renal failure due to diffuse atheromatous disease, presented non-occlusive mesenteric ischemia. One patient died and one underwent resection of the colon. For the final two patients, prophylactic therapy was initiated. DISCUSSION: Mesenteric ischemia is a severe condition which appears to occur more frequently in end-stage renal disease. In the chronic hemodialysis patient excessive ultrafiltration or a too rapid filtration rate can favor ischemia. Prophylactic measures must be taken at the first sign of ischemia, especially since clinical and biological features of mesenteric ischemia remain largely non-specific.

Aged↗
PubMed1996

213 elderly uremic patients over 75 years of age treated with long-term peritoneal dialysis: a French multicenter study.

UNLABELLED: We report our experience in 213 elderly patients over 75 years treated by peritoneal dialysis (PD) as first and exclusive dialysis therapy. The mean age at start of PD was 79.4 +/- 3.6 years, and the cumulative time on PD was 4551 months (mean time: 21.4 +/- 19.8 months). Twenty-six patients lived in institutions and 187 lived at home. Thirty patients had an effective autonomy with the ability to carry on normal activities. One hundred and two patients were cared for by a private nurse at home, and 46 patients were cared for in a family environment. Most cases were treated by three exchanges per day (152 cases) and used a nondisconnect system (175 cases) on account of absence of autonomy. The rate of peritonitis per patient-month was one episode per 16.8 patient-months. Patient survival (Kaplan-Meier curves) was 74%, 59%, 45%, and 19% at one, two, three, and five years, respectively. The causes of death were various with a higher frequency of cardiovascular causes (48.3% of the 116 deaths). Thirty-three patients died in less than six months including 18 patients in less than three months. IN CONCLUSION: elderly uremic patients can be treated with long-term PD with relatively good results. Mortality is high but essentially due to age and poor general status-the dedication of private home nursing is very important in treating elderly PD patients. This fact often is a necessary condition in maintaining these elderly patients at home.

Aged↗
PubMed1996

[Twenty one years of hemodialysis in a patient with primary hyperoxaluria].

We report a male patient with primary hyperoxaluria from childhood who survived more than 21 years on conventional haemodialysis. Despite the severity of his bone disease, he was married and actively employed up until 2 years before his death. His condition really worsened a few months before his death. He presented with only renal and bone involvement and had hardly any cardiovascular complications, that was probably a reason for his prolonged survival. Such an evolution is very unusual and we speculate that the length of haemodialysis sessions in addition to the large surface of the membrane probably contributed to such an outcome. During the time period on HD, anemia was transiently controlled by recombinant erythropoietin despite oxalate involvement of the marrow. He was refused a liver-kidney transplant and died from malnourishment at 43 years of age. To our knowledge, such an outcome has not yet been reported. It shows that careful prolonged hemodialysis sessions should be helped in admet patients without severe cardiovascular involvement.

Adult↗
PubMed1996

[Ophthalmologic manifestations of dialysis. Retrospective study on 81 patients].

In this work, we looked at the results of a retrospective study carried out in our unit on the ocular manifestations in the dialysed chronic renal failure patient. Eighty-one of our 189 patients had an ophtalmic examination. Thirty-six showed a retinopathy, 26 suffered from a corneoconjunctival alterations, 19 from a cataract, 6 a vascular thrombosis, 4 a glaucoma and one motor-ocular paralysis. There was no significant difference for age and sex between the 81 patients and the group of 108 who did not have an ophtalmic examination. But this difference was positive for duration of time on dialysis (p = 0.01). There is a correlation between the presence of a cataract and the age of the patients (p = 0.01). There was no link between the different types of ophtalmic problems on the one hand, and the age, sex, time on dialysis, type of dialysis, original nephropathy, hypertensive history or anterior renal transplantation on the other hand.

Cataract↗
PubMed1995

[What are the prerequisites for establishing a peritoneal dialysis treatment? (Training center, the place of private practice nurses, the administrative structure of management)].

In spite of the same quality of results in term of five year survival by peritoneal dialysis (PD) compared to hemodialysis (HD), this method of renal substitutive therapy is concerning no more than 7% ESRF patients in France. What structural inadaptations could account for such striking differences between the two modalities? We present here the results of a French multi-center survey and our proposal for improving the actual tendency. Nonante PD centers were included representing a total number of 1592 patients, among them 90% were on continuous ambulatory peritoneal dialysis. We could observe a predominant proportion of public district services and non-profit associations. Sixty per cent of PD units were part of hemodialysis centers and 20% were totally independent. Patient mean age was very old, with limited autonomy, necessitating frequent visits of liberal nurses for 57% patients. We suggest to reinforce the role of non-profit making associations and to reorganize the existing centers on two levels in term of facilities, personal services and on functional modalities according to the number of treated patients.

France↗
PubMed1992

[Atypical pleural effusion by transdiaphragmatic communication. Apropos of two cases: chylothorax and hydrothorax].

We report two cases of pleural effusion in which a subdiaphragmatic cause was noted. In both cases it was necessary to obliterate a defect in the diaphragm via a thoracic incision. In one case, a left chylothorax occurred in a patient with hepatic cirrhosis. In this case, it was postulated that the normal lymphatic pathway through the right hemidiaphragm could have been stopped by pleural sequelae from right lobectomy. In the other case, a right pleural effusion occurred after peritoneal dialysis. It is a well known pathological entity: the structural defect can be observed by separation of collagen bundles in the tendinous diaphragm. This type of pleuro-peritoneal communication is well known in women suffering from menstrual pneumothorax or in patients treated by peritoneal dialysis.

Aged↗
PubMed1992

[Atypical pleural effusion secondary to transdiaphragmatic communication. Apropos of two cases: a chylothorax and a hydrothorax].

We report two cases of pleural effusion in which a subdiaphragmatic cause was noted. In both cases it was necessary to obliterate a defect in the diaphragm via a thoracic incision. In one case, a left chylothorax occurred in a patient with hepatic cirrhosis. In this case, it was postulated that the normal lymphatic pathway through the right hemidiaphragm could have been stopped by pleural sequelae from right lobectomy. In the other case, a right pleural effusion occurred after peritoneal dialysis. It is a well known pathological entity: the structural defect can be observed by separation of collagen bundles in the tendinous diaphragm. This type of pleuro-peritoneal communication is well known in women suffering from menstrual pneumothorax or in patients treated by peritoneal dialysis.

Aged↗
PubMed1989

[Short- (1 session) and long-term (6 months) course of the serum level of zinc in 33 hemodialysis patients].

In patients with chronic renal insufficiency undergoing hemodialysis, the seric zinc level was significantly lower than in normal subjects. In 7 patients this was even more marked prior to their first hemodialysis session. Following hemodialysis this level increased, but by comparing the zinc level to that of the binding proteins it could be seen that this result was a reflection of the hemo-concentration phenomenon. During hemodialysis there was no change in the zinc level of dialysate. Finally, a significant increase in the seric level of the 7 new patients was noted after 6 months of hemodialysis treatment. This increase reached the mean level observed in the 26 other patients who had been undergoing hemodialysis from between 8 and 87 months, but pre-dialysis normalization of seric zinc levels was not attained. The reasons for this increase in the 7 recently hemodialysed patients receiving no zinc treatment are discussed.

Female↗
PubMed1987

Acute anaphylactoid reactions during hemodialysis in France.

A retrospective survey of anaphylactoid reactions during dialysis in France was conducted. In 52 of 112 hemodialysis units surveyed 111 patients who had suffered one or more anaphylactoid reactions during dialysis were identified. According to the Hamilton/Adkinson classification, in 31 patients reactions were minor, in 54 patients moderate, and in 26 patients severe. Four patients died of their reactions. A preponderance of reactions (75 and 11%) occurred with cuprammonium cellulose hollow-fiber and plate dialyzers, respectively. Severe dialyzer reactions were found to occur more frequently after the long (weekend) interdialytic interval. In an in vitro study, six brands of cuprammonium cellulose hollow-fiber dialyzers were rinsed with water and the eluates analyzed by size exclusion chromatography for contaminant particles. Substantial variation in the amount of extractable material was found between dialyzers of different brands, despite the fact that all dialyzers used membranes from the same manufacturer. Previous data by others has suggested that this extractable material is a derivative of cellulose. Results of our epidemiologic survey in France are similar to those previously reported in the United States and suggest an increased incidence of dialyzer reactions with ethylene oxide-sterilized cuprammonium cellulose dialyzers. The presence of cellulose-derived particles in the rinsing fluid of such dialyzers and the possible increased incidence of reactions after the long (weekend) interdialytic interval suggest that allergy to cellulose-derived particles eluted from cellulosic dialyzers may contribute to dialyzer hypersensitivity reactions.

Anaphylaxis↗