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Biomedical subjects

C Jacobs

Publications and source records attributed to C Jacobs.

At least 343 records · Page 19Linked to original sources
PubMed1979

The use of the artificial pancreas in uremic diabetic patients.

Maintenance hemodialysis and renal transplantation are increasingly used for treating diabetic patients with end-stage renal failure. The use of the artificial pancreas is able to prevent large blood glucose fluctuations in these patients with atherosclerosis, advanced retinopathy or neuropathy in which hyper- and hypoglycemia are potentially deleterious. For this purpose, we have developed and are utilizing an artificial pancreas easily utilizable without special training by the staff of a dialysis unit. This artificial pancreas uses a polarographic glucose electrode with a fast response time (45 to 90 seconds), a terminal display for operator communication, and a continuous digital and analogyl display for control of the running operation. There is also a printer to display in tabular and graphical form the values at any time during the operation. In this preliminary study, 7 patients have been studied: five under repetitive hemodialysis for four hours, 3 times a week; one treated by peritoneal dialysis for 12 hours, twice a week and one controlled during, and 48 hours after, renal transplantation. The macroscopic pancreas normalizes blood glucose under these circumstances, helps in a better understanding of blood glucose homeostasis in uremic patients under dialysis, leads to a more precise evaluation of insulin needs, may help to improve the nutritional status of the patients, and has an educational value for the patient and the medical staff.

Artificial Organs↗
PubMed1979

[Society of Nephrology, Computer Technology Commission. Dialysis computer program. VI. - Survival and risk factors].

The sixth report of the "Diaphane Dialyse Informatique" Program concerns 2,518 adult patients (age 15 and over) treated by chronic hemodialysis or hemofiltration in 33 French dialysis centres between June 1972 and December 1978. 1) The number of centers participating to the program is progressively increasing. Overall duration of follow-up represents 4,192 patient-years, allowing precise evolutive studies of terminal renal failure treated by hemodialysis. 2) Mean age at start of treatment continues to increase. Among 709 patients who started treatment in 1977-1978, 8,8 p. 100 of men and 11 p. 100 of women were over 69 years old. 3) Patients with diabetic nephropathy represent 4,4 p. 100 of all patients dialyzed between 1972 and 1978 and 5,9 p. 100 of the patients starting treatment in 1977-1978. 4) The percentage of patients temporarily treated by peritoneal dialysis before hemodialysis decreases from 32,9 p. 100 in 1973-1974 to 15,9 p. 100 in 1977-1978. 5) In 1978, 65,3 p. 100 of patients are dialyzed 3 times a week with a mean weekly duration of 14,0 h for male and 12,9 for female. 73 p. 100 of the patients are dialyzed during the night. 6) Disposable parallel plate hemodialyzers (71,8 per cent of dialysis sessions in 1978) and hollow fiber hemodialyzers (11,6 per cent) progressively replace disposable coil dialyzers and non disposable Kiil dialyzers. 7) Transient hypotensive episodes during dialysis sessions remain the most frequent complications (21,7 per cent of sessions in 1978). Transient hypotensive episodes are more frequently observed with coils than with parallel plate hemodialyzers or with hollow fiber dialyzers. 8) Mean diastolic blood pressure (DBP) +/- SD is 101,9 +/- 21,7 mmHg at start of dialysis and 81,4 +/- 11,8 mmHg when dialysed. During the course of treatment 28,7 per cent of the patients receive long term antihypertensive treatment. In spite of dialysis and antihypertensive treatments 11 per cent of all patients followed up maintain DBP greater than or equal to 95 mmHg. 9) Viral hepatitis remain the most prominent infectious problem with 30 per cent of patients being chronic Hbs antigen carriers. 10) Annual death rate calculated in the 2,518 patients dialyzed between 1972 and 1978 (78/1000) is 12 times superior to the death rate of the French population, adjusted for sex and age to the dialysis population. 43,1 per cent of deaths are of cardiovascular origin. Risk factors for overall mortality are age, sex (male), existence of a vascular or diabetic nephropathy, twice weekly dialysis strategy, elevation of systolic or diastolic blood pressure during the course of dialysis treatment, hypocholesterolemia and to a lesser extent hypotriglyceridemia. On the contrary, hypercholesterolemia, hypertriglyceridemia and hyperuricemia do not appear as risk factors for overall mortality or cardiovascular mortality. These results plead for a perfect control of hypertension and to the extension of thrice weekly dialysis for the whole population of patients treated by maintenance hemodialysis.

Adolescent↗
PubMed1978

Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association.

The practice of reusing dialysers in renal units in the UK was surveyed by examining the patient questionnaires returned to the EDTA registration committee for 1976 and by a special questionnaire sent to all UK renal units. Altogether 65.6% of the 1785 patients treated with non-disposable dialysers and 49.6% of the 1109 treated with disposable dialysers reused their equipment. Reuse of dialysers caused some morbidity but no mortality. Most centres where disposable dialysers were used accepted that their reuse was necessary because of financial constraints and was ethically defensible.

Adolescent↗
PubMed1978

24-hour infusion of cis-platinum in head and neck cancers.

Eighteen patients with advanced squamous cell cancer of the head and neck were treated with cis-diamminedichloroplatinum in a 24-hour infusion. The most frequent dose used was 80 mg/m2 repeated every three weeks. Six were treated preoperatively for Stage III or IV disease, and twelve were treated for recurrent disease. The overall response rate was 72% with one complete remission, greater than 50% regression in six patients, and 25--50% regression in six patients. Toxicity was minimal: creatinine greater than 2 in 6% of courses, leukopenia in 9%, anemia in 29%, vomiting in 76%, and documented minimal hearing loss in one patient. Plasma and urine platinum levels during infusion are presented. The dosage of 80 mg/m2 administered over 24 hours gives a response rate in head and neck cancers equivalent to that reported with higher doses given by rapid infusion, and toxicity is minimal.

Adult↗
PubMed1978

Dialysis and renal transplantation of children in Europe, 1975.

The number of new paediatric patients accepted for treatment by regular dialysis and transplantation increased more slowly than in previous years. Survival in children above 10 years appeared to be better with all modes of therapy than in younger children. The only improvement in survival noted among the different treatments was in patient and graft survival of living donor transplants. A quarter of all children transferred to home dialysis were less than 10 years of age. Nephronophthisis and Henoch-Schönlein nephritis emerged as major primary renal diseases. In 1975 the proportion of retransplants in children rose and living donor grafts from fathers were more common than from mothers. Evening dialysis was practised more frequently in both hospital and home dialysis and rehabilitation in these patients seemed to be better than for those dialysed at other times. Renal osteodystrophy was present in at least half of all children dialysed for more than 1 year. The degree of grouth retardation was affected by sex, chronological age and the primary renal disease. Body height on dialysis and after transplantation progressively reduced in the majority of children. Growth seemed to be more impaired in boys than in girls on dialysis. Bone age advanced faster than height age especially in girls. The pubertal growth spurt was usually delayed and depressed on long-term dialysis and the development of genitalia and pubic hair as well as menarche was retarded.

Bone Development↗
PubMed1978

[Generic symptoms of Hodgkin's disease in relation to other prognostic criteries (author's transl)].

In 1967-1973, 74 patients with histologic classified Hodgkin's disease were treated in Marburg. We proved the incidence of the most important prognostic criteries: stage, histologic type and clinical symptoms. These criteries are evaluated as equally significant and independent. The B-symptoms, fever, weight loss and night sweats we found in 24 patients, 18 (75%) of them were in stage IV. In the remaining 6 patients in stage II and III, the B-symptoms were followed by relapse or generalisation. We think that the good correlation to the stage means, that clinical symptoms as prognostic signs are not independent.

Body Weight↗
PubMed1977

[Maintenance hemodialysis and renal transplantation in diabetic patients (author's transl)].

Maintenance hemodialysis and renal transplantation are increasingly used for treating diabetic patients with terminal uremia. Nowadays dialysis techniques may be considered for most of these patients, except those presenting with multiple severe disabling complications. Difficulties in control of glycaemia or of the uremic state or in the management of immunosuppressive drugs in transplanted patients do not, in themselves, constitute special problems in dialysis or transplantation. The high rate of complications and the excess mortality recorded in diabetics, compared with non-diabetic dialyzed or transplanted patients are closely related to the cardiovascular, neurological and microvascular disease that is present to various degress in all diabetic patients. Cardiac and cerebrovascular complications account for most of the deaths. Ocular and neurological status often worsen during dialysis but their stabilization usually occurs after successful transplantation. The choice between therapeutic methods in end-stage uremia must be an individual one for each patient" depending on age, medical and psychological factors and technical feasibility. Renal transplantation gives best results in patients aged less than 50 years and should be carried out early (creatinine clearance 15 - 10 ml/min.) before occurrence of the most disabling complications. If transplantation is not indicated or available, dialysis should be initiated when creatinine clearance is about 10 ml/min. Early multidisciplinary care of uremic diabetics will improve the results of maintenance hemodialysis, the problems and failures of which occur most frequently when treatment is commenced too late in patients with irreversible clinical and/or metabolic conditions.

Age Factors↗
PubMed1977

[Dialysis-computer program. IV. Summary report. Epidemiology of complications].

The Diaphane-program instituted under the authority of the French Society of Nephrology has been steadily expanding since 1972. By December 1977, about 1500 patients treated in 30 public and private Dialysis Centres were followed up by this system. Full coverage of expenses is provided by the participating Centres. The statistical work presented in this report involves 1572 adult patients treated between June 1972 and December 1976 in 24 dialysis centres. The amount of collected data and the duration of the observation period permit to build up evolutive profiles of the population of patients treated in France by maintenance hemodialysis, of the various techniques and strategies used and of the main complications recorded in the patients. 1. Mean age of patients at start of dialysis is steadily increasing, from 40.1 years in 1972 to 48.2 years in 1976. 2. The predominance of male patients, constant over each year, may be explained by an increased proportion in man of chronic glomerulonephritis and renal vascular diseases. The sex-ratio in patients with chronic pyelonephritis is close to the one recorded in the French population. 3. The regular decrease of the mean plasma creatinine level at time of first dialysis recorded since 1972, is probably related to an earlier start of treatment. However, 10.6 per cent of the patients taken on treatment in 1975-1976 still had a plasma creatinine greater than or equal to 200 mg/100ml. 18.7 per cent had a diastolic blood pressure greater than or equal to 120 mmHg, and exsudative lesions at eye fundi examination were found in 33.5 per cent. The delay in initiating dialysis treatment may account for the frequency of early acute cardiopulmonary complications such as pulmonary oedema and pericarditis and also for the increase in the mortality rate recorded during the first year of treatment: 12.1 per cent instead of 6.2 per cent during the second year. This particularly relevant for the younger age group of patients. 4. There seems to be some social disparity concerning the detection of renal disease and the conditions under which dialysis treatment is started: chronic renal disease is detected at an earlier stage and dialysis treatment initiated for lower values of plasma creatinine and of diastolic blood pressure in patients belonging to the "higher income" group of population. 5. The percentage of patients dialysed twice a week is steadily increasing, whereas the average weekly dialysis time decreases, being about 15 hours in 1976. Day and evening dialysis replace overnight dialysis. Disposable flat-plate dialysers are used increasingly. 6. Episodes of hypotension and cramps are the incidents most frequently recorded during the dialysis sessions. Risk factors evidenced in the occurrence of hypotensive accidents are: the female sex, age greater than or equal to 55 years in males, orthostatic blood pressure drop at the end of previous dialysis, weight loss of more than 4 per cent of total body weight during dialysis...

Adult↗