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Biomedical subjects

B Branger

Publications and source records attributed to B Branger.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Evaluation of a classification of newborns and maternity wards in the Loire-Atlantique department].

In order to assess the perinatal health policy in a French department in comparison with other policies, we performed a prospective transversal survey in the Loire-Atlantique for 5 weeks. Newborns were registered according to clinical data using the Paris pediatricians classification (classes 1 to 4) and maternity wards by number of health personnel and facilities using the American Academy of Pediatrician classification (I-III). 1316 newborns were registered. This survey showed that the health care organization in maternity wards is rational in the Loire-Atlantique for newborns in classes 1 and 4. However, care for newborns in classes 2 and 3 could be provided in maternity wards in classes II and III if available personnel and equipment is improved.

Cross-Sectional Studies↗
PubMed1995

Subcutaneous erythropoietin administration in predialysis patients: a single centre prospective study.

Since 1991 we have used subcutaneous administration of recombinant human erythropoietin (rHuEpo) in predialysis patients selected on the basis of chronic anaemia [haemoglobin (Hb) < 7.5 g%] without any extrarenal cause and chronic renal failure with a creatinine clearance of less than 10 ml/min. rHuEpo was given to 16 predialysis patients with nephropathy, due to chronic glomerulonephritis in all 12 of the cases. The sex ratio was 1:1 and mean age was 65 +/- 9 years (range 43-87). Hb was 7 +/- 0.4 g%. rHuEpo was injected subcutaneously thrice weekly while iron was given orally systematically before rHuEpo administration. Follow-up was performed monthly until dialysis (mean 9 months). Anaemia was corrected in all cases (Hb 11 +/- 0.5 g%). Mean Epo dose was 53 +/- 26 IU/kg/week in males and 47 +/- 11 IU/kg/week in females. Iron was systematically added (Fe2+ 8.2 mg/kg/week). Every patient had improved physical and intellectual ability after rHuEpo within the first month. No adverse side effects were noted but all patients were under antihypertensive therapy (one to three drugs). Serum potassium was unchanged. Mean creatinine before treatment was 507 mumol/l, and was 820 mumol/l after the treatment. Progression of renal failure was only affected by rHuEpo in one patient. In this case renal failure progression decreased. There was no significant alteration in the slope of the creatinine curve from 12 months before to after rHuEpo. Ten patients underwent dialysis (five CAPD, five haemodialysis), while six remained dialysis free. From January 1991 to December 1993 rHuEpo was given to 12.3% of the end-stage renal failure patients on dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Pulsed Doppler sonography for the guidance of vein puncture: a prospective study.

Blind deep venous puncture is an invasive procedure with risks of serious complications compromising the availability of veins for future punctures or endangering the patient's life. We designed a new hand-held pulsed Doppler probe for coaxial guidance of the puncture needle and a dedicated pulsed Doppler device displaying the depth of the measurement volume. We used this technique prospectively in two independent centers (the nephrology department and the intensive care unit) involving senior as well as junior staff members. Either the non-Doppler or the Doppler method were randomly selected for subclavian vein catheterization in 100 patients and for internal jugular vein catheterization in 30 patients. The success rate on the first attempt was 86.2% for the non-Doppler method versus 96.8% for the Doppler method (p = 0.03). The failure rate of the non-Doppler method used by junior staff members was 9.2%, reduced to 1.5% (p = 0.05) by secondary use of the Doppler method and/or help from a senior staff member (rescue procedure). Pulsed Doppler guidance reduced significantly the failure rate of venous punctures especially when used by seniors or by juniors after a training period.

Adult↗
PubMed1995

Hemodialysis-related lesions of the hand.

Chronic hemodialysis patients often have lesions of the hands characterized by distinctive etiopathogenic mechanisms and functional consequences. We conducted a prospective cross-sectional study in 116 patients with a mean age of 55.9 years and a mean hemodialysis duration of 8.17 years. Carpal tunnel syndrome was present in 28.4% of patients. Median nerve entrapment was bilateral in a large proportion of cases. Wasting of the lateral thenar muscles was often present at diagnosis, denoting advanced nerve compression. Amyloid was demonstrated in the carpal tunnel in 74% of cases of carpal tunnel syndrome. Digital flexor tendon lesions responsible for trigger finger or restriction of active flexion were seen in 21.5% of patients. Erosive arthropathy manifesting as deformities, pain and loss of function affected the distal interphalangeal joints in 11% of patients and the proximal interphalangeal joints or trapeziometacarpal joint in a smaller proportion of patients. Thirty per cent of patients had bony cysts located in the carpometacarpal area, carpal bones, or distal forearm bones; communication with the adjacent joint space was seen occasionally, and intracarpal derangement was a feature in some patients. Most patients had several types of lesions. The rate of occurrence of hand lesions increased markedly after ten years on hemodialysis, with devastating functional consequences.

Adult↗
PubMed1994

Increased cardiovascular risk factors and features of endothelial activation and dysfunction in dialyzed uremic patients.

Due to the incidence of symptomatic atherosclerosis in uremic patients, hemostasis-derived cardiovascular risk factors, basal plasma concentrations of some endothelial-derived glycoproteins and desmopressin-induced variations of endothelial-derived proteins were studied in 22 uremic patients on prolonged maintenance hemodialysis with no cardiovascular antecedent. Compared to control subjects, patients had increased predialysis hemostasis-related cardiovascular risk factors: high fibrinogen, proconvertin, and type 1 plasminogen activator inhibitor plasma concentrations; low albumin values; generally low antithrombin III values but sometimes high. They had high predialysis plasma concentrations of endothelium-derived glycoproteins: von Willebrand factor, tissue-type plasminogen activator and urokinase-type plasminogen activator, which are secreted by endothelial cells, but also soluble thrombomodulin, a marker of endothelial cell injury. The desmopressin-induced release of tissue-type plasminogen activator and of von Willebrand factor were lower than in controls. High fibrinogen, type 1 plasminogen activator inhibitor and low albumin plasma concentrations may be linked to repeated acute phase reactions associated with hemodialysis. Data concerning endothelium-related proteins are concordant with the co-existence of a chronic in vivo endothelial activation and endothelial injury in uremia. This could be linked to the initiation and progression of atherosclerosis.

Adolescent↗
PubMed1994

[Microangiopathic hemolytic anemia associated with cancers. Symptomatic treatment by plasma exchange].

OBJECTIVE: To determine the interest of plasmapheresis in the management of cancer-associated microangiopathic haemolytic anaemia (MHA) not due to cancer treatment. MATERIAL AND METHODS: [corrected] National retrospective study using the file of the French Hemapheresis Society. RESULTS: We isolated 6 patients (5 men and a woman aged 32 to 69-year-old) who had prostatic (4 cases) or breast carcinomas or Hodgkin's disease. Diagnosis of cancer preceeded MHA in 3 patients (from 2 to 4 years). Bone or bone marrow metastases were demonstrated in 5 patients. The clinical presentation included anuria (4 cases), bleeding (4 cases), and laboratory findings were consistent with microangiopathic haemolysis and thrombopenia in all cases and intravascular coagulation (2 cases) and/or renal failure (4 cases). MHA symptomatic treatment included 4 to 10 courses of plasmapheresis, extra-renal epuration (4 patients), anticoagulation (4 patients) and/or antiagregant (3 cases), haemodialysis (4 cases) and vincristine (2 cases). Cancer treatment consisted of antitumoural chemotherapy (2 cases) and/or hormonotherapy (5 cases). In all cases, haemolysis, thrombopenia and intravascular coagulation were controlled within 30 days. MHA treatment was effective alone in 3 patients. No relapse were observed in 3 patients whereas the course of cancer continued in 2 patients. Two patients relapsed and died from MHA after 4 and 36 months. Two patients relapsed and died from MHA within a few months and 1 was lost to follow-up. CONCLUSION: Symptomatic treatment of cancer-associated MHA including plasmapheresis may be useful while waiting for an aetiologic management of the tumour.

Adenocarcinoma↗
PubMed1994

[Rapidly progressive glomerulonephritis treated by apheresis. A major economic challenge].

Since 1983, 28 patients with a rapidly progressive glomerulonephritis were treated with apheresis. Seventeen patients had a primary glomerulonephritis, while 11 had a secondary form. Pathological pattern showed crescentic glomerulonephritis in all cases but one. In 23 cases of 28, renal survival was compromised within a few months. Apheresis were performed with the filtration technique, using a single needle device and central venous catheter. Plasmafilters were reused since 1984. In 1987, cascade filtration was introduced. The procedure was under permanent medical control. Mean reuse rate was 6 time. Renal actuarial survival curve showed a 60%, 42% and 21% survival rate at respectively 1, 2 and 5 years. Five deaths were noted. No death occurred during the apheresis procedure. The mean cost of filters and blood lines was 490 French francs (FF) per session; the mean cost of an haemodialysis session was 1900 FF. When the real survival time was compared to the expected renal failure without apheresis (assuming a linear progression of the disease), patients with a positive response to apheresis saved 488 dialysis months. The amount saved was 12 MFF. The additive cost of inefficient apheresis was 0.06 MFF. These data have to be considered on a 0.5 M inhabitants population basis during a 10 year survey.

Adolescent↗
PubMed1994

[Continuous guidance for venous punctures using a new pulsed Doppler probe: efficiency, safety].

Serious complications may occur after "blind" profound venous puncture in intensive care units. To secure these punctures, we designed a new fingertip pulsed Doppler (FPD) 5 MHz probe with a lateral to center indentation to guide the needle into the ultrasonic flux. A specific ultrasound analyzer indicating depth and diameter of the vessel was made for this use. The material was first tested in an experimental animal study. Results of animal venous punctures were successful 20/21. This material was then tested on patients with previous failure of "blind" punctures: results of 4 FPD punctures were successful in all 12 cases but one (catheterization not completed). We started a prospective multi-unit randomized study with various operators (junior residents, senior staff members), compared the success rate and type, the procedure duration of blind standard versus FPD punctures. We conclude in the safety and easy use of the FPD for central venous punctures.

Animals↗
PubMed1994

[Tunneled jugular catheters in chronic hemodialysis: report from a Center apropos of 101 cases].

Since 1984, internal jugular vein cannulation (I.J.V.C.) was performed in our Center for ESRD patients. 202 catheters were implanted in 79 patients. Our population was divided in 2 groups: group I corresponding to a rescue procedure for the chronic vascular access failure, group II corresponding to chronic implantation. Outcome analysis indicate the follows results: in both groups, the first I.J.V.C. withdrawal cause was a functional AV fistula. Infections were observed only in group II. Thrombosis is not infrequent requiring fibrinolytic drugs with a 54 FF per patient year additive cost. A special nurse training protocol is also required to reduce the thrombosis incidence. Accidental withdrawal occurred in 11% cases of group II. This observation underlines the need of better fixation devices.

Adult↗
PubMed1994

[Hospital transfer of newborn infants in the Loire-Atlantic area (France)].

The rate of neonatal referral from the site of birth to a special care centre is generally related to the conditions of the pregnancy and the status of the neonate. The purpose of this study was to investigate other factors affecting referral including obstetric procedures, and equipment and personnel environment. A prospective survey of the neonatal population in 9 maternity hospital in the Loire-Atlantique area in France was conducted. There were, 1.316 births and the referral rate was 10.3% with a range of 1 to 24% depending on the originating hospital. After adjustment for gestational age, multivariate analysis revealed that the medical variables were the main factors affecting referral rate (positive gastric smear, adjusted odds ratio, ORa = 62.6; disease, ORa = 37.7; Apgar score 1 min < 7, ORa = 9.4; monitoring abnormality, ORa = 3.2; coloured amniotic fluid, CORa = 2.7; birthweight, ORa = 0.3). A high risk of referral was observed in only one maternity hospital (ORa = 9.4) related to a poor environment index. This center was in close vicinity to another maternity hospital. In a regional referral programme, high risk neonates should be delivered in maternity hospitals near a special care centre. But, in order to keep the rate of referral, with its adverse effect on the mother-baby relation, low, care for neonates with minor disease or only slightly underweight at birth should be cared for in these centers without referral.

France↗