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Biomedical subjects

B Charra

Publications and source records attributed to B Charra.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Comparison of the functional survival in chronic renal insufficiency of Permcath jugular catheters according to their mode of insertion].

The functional survival of the same silicone double lumen catheter (DLC) was analyzed in relation with the mode of its insertion. Thirty-seven catheters were surgically inserted (34 in the right internal Jugular vein, 3 in the left internal Jugular vein), while 28 were percutaneously inserted (25 in the right internal Jugular vein, 3 in the left internal Jugular vein). The functional survival was calculated using Kaplan Meier method. Significant survival difference was looked for with log rank test. The maximum follow-up time was 62 months for surgically inserted DLC and 12 months for their percutaneous counterpart. There was no significant functional survival difference between the two groups at one year. At this term 86% of DLC were still in use. We conclude from our experience that the mode of insertion does not significantly modify the success rate of this type of blood access. The simplest and lightest method (i.e. percutaneous) should therefore be preferred.

Adult↗
PubMed1994

[Effect of catheter type on the functional survival of jugular access ports in chronic hemodialysis].

Silicone catheter (C) can be used in the hemodialysis setting as an alternative for the blood access. We analysed retrospectively the 3 types of the catheters used in 45 patients. 58 catheters were percutaneously inserted in the internal jugular vein (9 Bard (B)-Hickman; 17 Canaud (CD)-Vygon; 32 Permcath (PC)-Quinton). The indications were thrombosis or dysfunction of an arterio-venous fistula (A-V F) (52%), absence of a A-V F (21%), Thomas' shunt infection (8%), infection or extrusion of a previous catheter (19%). The functional survival curve of the C shows the best results for the PC and the worse with the B (Log-Rank test = 6,602, p < 0.037). The main cause of failure was the catheter's extrusion (3 of the 5 failures for the B; 4 of the 6 for the CD). None of the PC was extruded. Infection and inadequate blood flow were equally found in the 3 groups. In our experience, PC give the best results because of the quality of the cuff making a good attachment in the sub-cutaneous tunnel.

Aged↗
PubMed1993

Functional study of hands among patients dialysed for more than 10 years.

Sixty-six haemodialysed (HD) in centre patients (24 h/m2/week, acetate bath, cuprophane membrane), with a mean age of 59.2 years, treated for 16.7 +/- 4.5 years, underwent clinical examination of their hands to determine anatomical and functional alterations. For each hand a functional score was calculated from a medicolegal technique based on sensitivity and angulation amplitude (rating from 0 to 100). Dialysis-related arthropathy (DRA), including carpal-tunnel (CT) syndrome, was scored as well as hand muscle amyotrophia. Trigger fingers, abnormal synovial hypertrophy, and one or more non-functional tendons were found in 15, 26, and 33% of the patients respectively. Thirteen percent had pseudoporphyria. Amyotrophy was moderate or severe in 39%. The global functional score (mean of the two unilateral functional scores) decreased with time spent on haemodialysis and was correlated with the DRA score. The unilateral functional score was linked to tendinous lesions, amyotrophy, and presence of pulses, but not to CT surgery or presence of AV fistula. Hands with ulnar insult at the elbow shown by electromyography had significantly lower functional scores. Repercussions of hand functional alteration may have an important social and psychological impact in daily life. The responsibility of amyloidosis is evidenced by tendinous lesions and nervous entrapment. Ulnar palsy is also important because of the vital motor role of that nerve in hand function.

Aged↗
PubMed1992

Survival as an index of adequacy of dialysis.

To examine how patient survival substantiates dialysis adequacy, 20-year actuarial survival experience was calculated for 445 unselected hemodialysis (HD) patients (97 patients accepted on a temporary basis--and usually kept on their regular dialysis scheme--were left out). The dose of dialysis has been the same and unchanged for all patients since beginning: 24 square meter hours of Kiil dialysis (cuprophane) per week with acetate buffered dialysate. KT/V mean (SD) was 1.67 (0.41). Six months after starting dialysis, 98% of patients were normotensive and off all blood pressure (BP) medication. The mean population hematocrit, excluding the only 6 patients receiving erythropoietin supplementation, was 28%. Survival rate was 87% at 5 years, 75% at 10 years, 55% at 15 years, and 43% at 20 years of HD. The satisfactory control of BP without using potentially toxic BP drugs and the higher than usual dose of dialysis are two possible explanations for survival data better than usually reported. We suggest that patient survival should be considered as the best overall index of adequacy of dialysis.

Adult↗
PubMed1992

Dose of dialysis: what index?

Wider patient acceptance criteria in hemodialysis (HD) programs do not seem to completely explain the increasing mortality reported in the United States at a time characterized by reduced treatment time and dose. This raises the question of HD standard and adequacy. It stimulated us to analyze patient survival with unchanged 'old-times' methods. 445 unselected patients have been treated for 22 years by the same unchanged methods (24 m2/week, flat-plate dialyzers, cuprophane membrane, acetate buffer). Their survival data were compared to major HD registries and series. Survival was also evaluated as a function of mean arterial pressure (MAP), urea fractional clearance (Kt/V), and middle-molecule dialysis index (DI). Kaplan-Meier (with log-rank test) analysis and Cox proportional hazard model were used. Survival at short and long term was better in our series. This favorable survival difference was more obvious for older patients at the start of HD. It could not be accounted for by selection bias, but correlated with good MAP control without medication and with higher than usual Kt/V (1.67 +/- 0.41) and DI (1.47 +/- 0.38). Cox analysis including five covariates confirmed that survival was linked to MAP. It suggested that survival improvement might be expected from a DI increment of over 1.38 but not from a Kt/V increment of over 1.60. Adequate dialysis cannot be reduced to numbers; it should include both sufficient small- and middle-molecule diffusion and ultrafiltration with arterial pressure control without need for antihypertensive medication. The long-term satisfactory survival remains the best index of overall dialysis adequacy.

Adult↗
PubMed1989

Asymmetric septal hypertrophy and left atrial dilatation in patients with end-stage renal disease on long-term hemodialysis.

Some literature reports associate a reduced weekly duration of treatment (3 x 4 h/week) for patients on maintenance hemodialysis with an increased cardiovascular mortality. To determine whether the improved survival of patients on long weekly hemodialysis (LHD: 3 x 8 h/week) can be associated with different cardiac changes, the cardiac characteristics of a group of 50 patients on LHD were analyzed in a non-invasive assessment. The main findings were an increased left ventricular (LV) muscle mass (176 + 54 g/m2), mass/volume ratio (1.69 + 0.37 g/ml) and left atrial diameter (39.7 + 5.7 mm). The increase in LV muscle mass was due mainly to a high prevalence of asymmetric septal thickening. The ratio septum/LV posterior wall was directly correlated with the left atrial diameter (r = 0.52), LV end-diastolic diameters were inversely correlated with hemoglobin concentration (r = 0.62). LV dilatation and/or LV systolic dysfunction were not characteristic findings: Only 6% of patients had a moderately enlarged (less than 65 mm) LV diameter, LV ejection fraction was decreased in 12%. There was no significant correlation between the degree of LV hypertrophy or left atrial dilatation and patient age, total dialysis duration, interdialytic weight gain, hemoglobin concentration, parameters of blood purification, blood pressure before and after dialysis, history of hypertension. We conclude that cardiac characteristics in patients on LHD are comparable to those described for large patient groups on short hemodialysis. Our findings do not explain improved survival on LHD.

Adult↗
PubMed1985

Carpal tunnel syndrome, shoulder pain and amyloid deposits in long-term haemodialysis patients.

Carpal Tunnel Syndrome (CTS), and Shoulder Pain and Stiffness (SPS) are common in very long-term haemodialysis patients. To know whether this is a fortuitous association or if there is a link between these two manifestations a retrospective analysis of clinical charts, CTS surgical reports, tendon and synovia biopsies (Congo red, Crystal violet and Thioflavin T) was undertaken for 110 patients treated by haemodialysis (HD) for eight years or more. SPS was less frequent (24%) in 58 patients not operated on for CTS than in 52 operated patients (SPS incidence: 77%). Furthermore the 38 patients with amyloid deposits at carpal biopsy had a very significantly (p less than 0.001) higher incidence of SPS (95%) than the 14 operated patients free of amyloid deposits (SPS incidence: 28%). Hence, amyloid deposits represent a pathological link between these two correlated manifestations in very long-term haemodialysis patients.

Amyloidosis↗
PubMed1983

Control of hypertension and prolonged survival on maintenance hemodialysis.

52 patients started dialysis in our center prior to 1971. When this study ended in December 1980, 8 patients had been lost to follow-up, and 7 had died, none of stroke or myocardial infarction. The overall actuarial survival rate was 85% at 10 years. For all patients treatment consisted of a long (24-30h/week) slow hemodialysis on standard Kiil dialysers throughout the 10 years. Good blood pressure (BP) control was achieved by a strict maintenance of dry weight alone (low salt diet, but no antihypertensive drug), even in 12 patients dialyzing only twice a week. This population remained completely free of both myocardial infarctions and cerebrovascular accidents. This experience suggests that if BP is well controlled, accelerated atherosclerosis is not the inevitable complication of long-term hemodialysis. The authors believe that the long, slow dialysis technique they use is the key to the good BP control achieved uniformly in this series.

Adult↗