Biomedical subjects
Publications and source records attributed to B Faller.
The authors report their experience on treating two patients, suffering end-stage renal disease, by daily hemodialysis of ultra-short duration with a non-traumatic vascular access. 90 minutes dialysis are realized 6 days a week. Clinical tolerance is excellent and patients' adhesion is satisfactory. However, despite reutilization of the dialyzer, the method remains costly.
Experience influence on treatment success of renal chronic failure by continuous ambulatory peritoneal dialysis comparatively to hemodialysis in center is estimated by the probability variation of still being in dialysis techniques. The retrospective study was realized in 276 dialysed patients who were taken over from 1972 to April 1989. In this population, there isn't any significant difference between the probability to stay in ambulatory peritoneal dialysis or in hemodialysis in center. But, if the study is realizing from the 4 years which followed the technique introduction in the center, the success probability at 30 months, remains the same for hemodialysis in center whether the technique has began in 1972 or 1976, whereas for continuous ambulatory peritoneal dialysis, this probability raises from 52% to 72% if it begins after 1982. Ambulatory peritoneal dialysis treated patients would be maintained more longer in their system than hemodialysis patients. Those results are explaining by prevention of the peritonitis thanks to technological progress and the early prevention of possible complications.
We studied 56 patients who had been receiving peritoneal dialysis for greater than 3 years, to investigate the prevalence of rheumatic diseases suggestive of beta 2-microglobulin (beta 2m) amyloid deposition. Eight patients were found to have carpal tunnel syndrome, 16 had chronic shoulder pain, 8 had subchondral bone cysts, and 13 had destructive arthropathies. Amyloid reacting with anti-beta 2m was demonstrated in the hip synovium of 1 patient. Serum beta 2m levels were elevated in all patients. These data suggest that peritoneal dialysis, like hemodialysis, may lead to the development of an arthropathy associated with beta 2m accumulation and beta 2m amyloid deposition.
During CAPD, the peritoneal cavity is submitted to situations such as the accidental bacterial contaminations and the continuous presence of dialysate, which stimulate immunological factors. The antibacterial defenses include opsonins and cells. Only IgG and fibronectin are present in the peritoneal effluent but they are diluted by the dialysate. Macrophages represent 70 to 80% of the peritoneal cells. Beside good phagocytic capacity, some may have a defective bactericidal activity. The continuous presence of dialysate leads to a chronic local inflammation. Macrophages and lymphocytes will synthesize IL-1, PGE2 and IFN-Y. These substances generate movement, attachment and proliferation of fibroblasts in the peritoneal submesothelial tissue, resulting in progressive fibrosis. This fibrosis, generally asymptomatic, may be responsible for loss of Ultrafiltration (UF) and Sclerosing Encapsulating Peritonitis (SEP).
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The computerized medical specialized records covering the follow-up of hypertension (ARTEMIS), diabetes (MELLITEE), chronic renal failure and the minimum medical record of Nephrology (THESEE) using the temporal database management system LIED, have been developed in several units of University Hospitals. The authors show that these computerized records are usable in a Nephrology Unit in a General Hospital.
Using the "Diaphane" computed medical record system enables multicentric statistical studies to be conducted. With this system, the quality of arterial hypertension control (supine systolic and diastolic arterial pressure before and after dialysis) was evaluated over a 10-year period in chronic haemodialysis patients in comparison with a multicentric population. A continuous statistical study of the results showed a regular voluntary decrease in arterial pressure. The evaluation of the quality of medical care represented by this comparison contributes to a therapeutic improvement.
The authors report the history of two patients treated with CAPD who developed a progressive calcifying peritonitis (PCP). The symptoms include abdominal pain, impairment of bowel movements, sterile effluent dialysate and progressive development of peritoneal calcifications. The etiology of the PCP remains elusive, but dialysate with acetate, high peritonitis incidence and continuous lavage as treatment for peritonitis are suspected to play a role in its evolution.
"ARTEMIS" is a standardized and computerized medical file which is intended for improving the follow-up of hypertensive patients, the efficacy of treatment and for realising national-wide surveys. The software "LIED" of data base for "ARTEMIS" is nowadays transposable on mini-computer. In Nephrology Unit of General Hospital from Colmar, the system has been working since September 1985 with MICRO-MEGA E 32 (Thomson). The administrative and medical data are directly acquired by the doctors and secretaries of the Unit on a conversational mode from six terminals. There is no writing collecting of data. An evaluation of the system was realized with the 113 first hypertensive patients. The results were compared to those obtained from patients of Paris area.
The authors report the result obtained with CAPD in 20 chronic renal patients treated during 4.6 years in average. The dialysis possibilities have maintained at middle term. Nevertheless, the awaited advantages concerning anemia, calcium and phosphorus disorders, neuropathy, are transient and incomplete. The water and sodium intakes need strongly to be controlled in order to achieve normal blood pressure. Finally the use of "Y" disconnect systems dramatically reduces the peritonitis rate.
Three groups of CAPD patients with different dialysis fluids showed a different risk of peritonitis according to the brand of the dialysate and the buffer acetate or lactate they used. Aseptic peritonitis was more frequent with patients who received lactate-buffered peritoneal fluids. According to the manufacturer of the dialysate, however, different results in terms of risk and type of peritonitis are obtained also within one type of lactate-buffered solution. The factors responsible for the difference in the risk of peritonitis according to the dialysis fluids used are unknown.
A retrospective survey has been undertaken in 7 different centers: 345 patients trained to CAPD between 1978 and 1983 were studied: technic success and survival rate were analysed using actuarial methods. Drop-out has dramatically decreased after May 1981 due to a lower mortality whatever the age. For all patients the actuarial survival at two years after 1981 is 87.1%. Related to a lower mortality, better results are obtained in patients younger than 55. However peritonitis is the main complication since they are involved in 1/3 of drop-out causes. It is concluded that CAPD might be used in almost 30% of chronic renal failure patients and that patients waiting for a kidney transplantation represent the best indication. In aged patients, nutritional status and psychosocial background must be carefully analysed before starting CAPD.
The replacement of the peritoneal dialysis was performed in 18 cases of persistant peritonitis in patients treated with Continuous Ambulatory Peritoneal Dialysis. This method brought the first sterility of the culture of the dialysate within 48 hours after surgery in 83.3% of the cases.
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Since the hydrazino-pyridazine metabolite of cadralazine, CGP 22 639 is believed to contribute to the activity of the drug, its pharmacokinetics and that of cadralazine were investigated in 8 hypertensive patients with renal impairment. The creatinine clearance (CLcr) of patients ranged from 10 to 60 ml/min. The concentrations of cadralazine in plasma and urine, and of CGP 22 639 (plus its possible hydrazones) in plasma were measured after single and repeated administration of 5 mg of cadralazine once daily. A hypotension possibly linked to cadralazine treatment was recorded on day 3 for the patient with CLcr = 10 ml/min. Metabolite concentrations were found to be at least twice as high as in other patients indicating that in this patient, the daily dose of 5 mg was probably too high. The pharmacokinetics of cadralazine were not modified by repeated administration. The drug and its metabolite were eliminated more slowly in patients with low creatinine clearance. The t1/2 of CGP 22 639 was about twice the t1/2 of the unchanged drug. In patients whose CLcr ranged from 19-37 ml/min the mean accumulation factor of apparent CGP 22 639 was 1.7 times that of the unchanged drug. It shows that the apparent CGP 22 639 accumulated more than the unchanged drug. A starting daily dose of 2.5 mg of cadralazine in patients with CLcr < 40 ml/min appears to be suited to take into account the pharmacokinetics of CGP 22 639. This dose can be increased by 2.5 mg steps if the antihypertensive effect is not sufficient (maximum dose with CLcr < 40 ml/min: 10 mg).(ABSTRACT TRUNCATED AT 250 WORDS)
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