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C Jacobs

Publications and source records attributed to C Jacobs.

At least 37 records · Page 2Linked to original sources
PubMed1991

The use of probenecid as a chemoprotector against cisplatin nephrotoxicity.

Probenecid inhibits cisplatin (CP) secretion in humans and protects against CP-induced nephrotoxicity in rats. The authors conducted a Phase I trial of escalating doses of CP using probenecid as a chemoprotector. Fifty-four courses of CP at doses ranging from 100 to 160 mg/m2 were given by 24-hour infusion to 36 patients. There was no renal impairment at any dose. Ototoxicity, however, became the dose-limiting toxicity; 14 patients experienced a 20 or greater decibel (dB) loss. Seven percent of courses were associated with a leukocyte count of less than 1.5 x 10/microliters, and 19% with a platelet count of less than 50 x 10(3)/microliters. Only three patients developed neurotoxicity. Correlating pharmacokinetic data and toxicity, the authors found that high cumulative dose, area under the curve (AUC) for unbound platinum, and cumulative AUC were associated with ototoxicity and peripheral neuropathy. It was concluded that probenecid may protect against CP nephrotoxicity and warrants further investigation. Its unique mechanism of action and lack of toxicity make it ideal to combine with other chemoprotectors.

Adult↗
PubMed1991

Interleukin-1 beta regulation of islet and thyroid autoimmunity in the BB rat.

Daily injections of high dose human recombinant interleukin-1 beta (IL-1 beta) accelerated the onset of both insulin-dependent diabetes mellitus and lymphocytic thyroiditis in genetically prone BB rats. In diabetes-resistant BB rats, high dose IL-1 beta failed to induce diabetes. Additionally, the presence of neutralizing IL-1 beta antibodies in these rats strongly correlated with inhibition of lymphocytic thyroiditis. Since low dose IL-1 beta protects diabetes-prone rats from IDDM, we conclude that IL-1 beta is a potent modulator of autoimmune diabetes and thyroid disease in genetically susceptible rats.

Adrenal Glands↗
PubMed1991

Renal tolerance for ioxaglate in patients with chronic renal failure.

The authors sought to evaluate renal tolerance for ioxaglate sodium meglumine used as a contrast agent in patients with chronic renal failure. Eight male patients (mean age, 55 years +/- 5) with chronic renal insufficiency (glomerular filtration rate less than 60 mL/min) who underwent diagnostic cardiac catheterization were enrolled. Renal clearance of inulin and rho-aminohippuric acid and urinary enzyme excretion were studied 1 day before and 1 day after administration of 167 mL +/- 43 of ioxaglate. None of the patients experienced any adverse reactions. All the patients had markedly depressed renal clearance values before angiography. Mean serum creatinine level, glomerular filtration rate, effective renal plasma flow, and urinary beta 2-microglobulin excretion were unaltered by angiography. After the procedure, only one patient had an increase in serum creatinine level of more than 10% (from 115 to 159 mumol/L [1.3 to 1.8 mg/dL]), with a decrease in glomerular filtration rate from 34 to 27 mL/min. In this patient, serum creatinine level and glomerular filtration rate normalized within 72 hours. Using accurate and sensitive renal function tests, the authors have shown that ioxaglate may be used safely in patients with chronic renal failure.

Adult↗
PubMed1991

Nephrotoxicity of contrast media in high-risk patients with renal insufficiency: comparison of low- and high-osmolar contrast agents.

We have compared the renal effects of ioxitalamate, ioxaglate, and iopamidol in patients with chronic renal failure. Sixty consecutive patients with an estimated creatinine clearance (ECRCl) less than 60 ml/min were randomly assigned to receive either ioxitalamate, iopamidol, or ioxaglate. All patients received 500 cm3 isotonic saline before the procedure. Serum creatinine and ECRCl were estimated before, 1 and 2 or 3 days after the procedure. There was no statistical difference between the three groups with respect to age, sex, weight, renal function, amount of iodine, and type of procedure. Mean serum creatinine and ECRCl remained unchanged after administration of contrast media. No patient had nephrotoxicity or acute oliguria requiring dialysis as a result of the administration of contrast material. The number of patients with an increase in the serum creatinine level greater than 10% from the basal value did not differ in the treatment groups. The maximal increases in serum creatinine were 52 mumol/l (29%) in the ioxitalamate group, 56 mumol/l (18%) in the ioxaglate group, and 57 mumol/l (23%) in the iopamidol group (p = NS). Using a population carefully randomized and matched for renal insufficiency, we could not show any differences in nephrotoxicity between these three contrast agents. Clinically serious renal impairment was uncommon in our study, regardless of the contrast agent used. However, the interpretation of these favorable findings requires a cautionary note. All patients in this study were well hydrated before and after uro-/angiography, and none had a recent renal injury or a treatment with a nephrotoxic agent that would predispose to injury from contrast material.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Combined kidney-pancreas transplantation. Experience at the Urologic Clinic of the La Pitié Hospital].

The first attempts of pancreas transplantation were made in the middle of the 1960s and were further developed in the early 1980s with the coming of Cyclosporine. Various surgical techniques were used to carry out pancreas grafts; a total pancreatic transplantation with duodenovesical anastomosis was selected for 7 combined kidney-pancreas transplantations carried out during the past 18 months in our group. After a time lapse ranging from 18 months to 30 days, all patients were alive with functional kidney grafts. One patient only, who had lost his pancreatic graft, showed biological and histological signe of chronic rejection of his kidney graft. Five pancreas grafts are functioning, as is proved by the normal blood glucose and the normality of the markers. An immunosuppressant treatment was used in all similar cases, comprising, after an initial bolus of one gram of Methyl-Prednisolone, an initial four-drug treatment on 1/3 mg/kg/day of Prednisone, 7 mg/kg/day of Cyclosporine, 1 mg/kg/day of Imurel and, during the first fifteen days, the use of rabbit antithymocytic globulins. Ana analysis of the postoperative period revealed frequent local infectious complications, probably due to pancreatitis of the graft; however, in our experience so far, no pancreas graft was lost. The credit for this specific feature of our short series may be due to an exclusively subperitoneal approach for both the pancreas and the kidney transplantation, thus limiting the seriousness of postoperative infectious complications to a large extent.

Anastomosis, Surgical↗
PubMed1991

Chemotherapy for recurrent and metastatic head and neck cancer.

At the present time, the treatment of recurrent and metastatic head and neck squamous and salivary gland cancers with chemotherapy is palliative. Pain relief, improvement in functional parameters, and improved survival are important goals. Although survival benefits are small, palliation can be significant. For squamous cancers, the median duration of response to chemotherapy is 2 to 4 months, and overall survival is about 6 months. Responses can be achieved with acceptable toxicity for good palliation in approximately 30% of patients treated with the standard regimens. Although more intensive chemotherapy regimens often result in higher response rates in pilot trials, they do not offer significant gains in effectiveness or survival. In salivary gland malignancies, results are substantially better, but this may only reflect the different natural history of this heterogeneous group of tumors. A small number of patients will have excellent and very durable responses to chemotherapy. Unfortunately, at this time we are unable to select these patients or determine which regimen will produce this desired result. The optimal use of currently available drugs is in the process of refinement. The timing of palliative chemotherapy represents a major challenge to oncologists and patients. Chemotherapy may in the future have a role in the cure of patients with recurrent disease, but innovative therapy, combined modality approaches, and new drug development will all need to be investigated. We look forward toward a new understanding of tumor biology and the development of agents that may substantially improve the control of these tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Can cisplatin renal toxicity be prevented?].

Cis diamminedichloroplatinum (CDDP) is a widely used anticancer agent particularly effective in the treatment of solid tumors. Dose limiting toxicity of CDDP was shown to be renal. Numerous methods to reduce this nephrotoxicity have been proposed. Hydration remains the best protection against acute CDDP nephrotoxicity in both the clinical and experimental setting. In man, no controlled studies have demonstrated the efficacy of furosemide and mannitol in the reduction of the CDDP renal toxicity. Studies have shown, however, that sodium thiosulfate offers some nephroprotection. To date, no controlled studies have demonstrated any benefit in the use of calcium channel blockers on CDDP renal toxicity in man. New drugs such as carboplatin have recently been introduced that theoretically have less renal toxicity, but evidence to support these claims are lacking. CDDP nephro protection remains a problem of current clinical interest and has yet not to be totally resolved.

Calcium Channel Blockers↗
PubMed1991

Renal vasoconstriction after low and high osmolar contrast agents in ischemic and non ischemic canine kidney.

We have assessed the effect of contrast media on renal blood flow before and after inducing renal ischemia. Diatrizoate, iopamidol and ioxaglate were injected within 15 seconds at 20 min intervals, at the dose of 1 ml/kg during a control period and 15 min after applying an aortic clamp to reduce the renal perfusion pressure to 70 mmHg. During the control period iopamidol, ioxaglate (17 +/- 13%) and diatrizoate (16 +/- 2%) induced a comparable decrease in renal blood flow (RBF). During the ischemic period the effects of diatrizoate on renal hemodynamic were dramatically enhanced. Ioxaglate andiopamidol induced a 20 +/- 12 and a 32 +/- 9% decrease in RBF at 1 minute, respectively. Iopamidol induced an increase in renal vascular resistance (RVR) from 0.8 +/- 0.08 to 1.46 +/- 0.26 mmHg min/ml (p less than 0.05). Ioxaglate induced an increase in RVR from 0.8 +/- 0.09 to 1.36 +/- 0.38 (p less than 0.05). Diatrizoate induced a 77 +/- 10% decrease in RBF and a maximum increase in RVR at 1 minute from 0.9 +/- 0.09 to 26 +/- 12 mmHg min/ml. There was still a 36 +/- 14% and a 23 +/- 13% decrease in RBF 10 and 20 min after diatrizoate administration. These changes were significantly higher than those observed with all contrast media during the control period and low osmolar contrast media during the ischemic period. We have thus shown that ischemia potentiates the renal vascular effect of contrast media.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1990

[Drug-induced interstitial nephropathy with nephrotic syndrome].

A new syndrome is which immunoallergic interstitial nephropathy is associated with nephrotic syndrome has recently been described. The interstitial nephropathy is usually due to the consumption of non steroidal anti-inflammatory drugs, and it is characterized by interstitial lesions associated with minimal glomerular lesions. The typical clinical complex includes nephrotic syndrome, renal impairment, eosinophilia, microscopic haematuria, leucocyturia and, more rarely, clinical signs of hypersensitivity. The outcome is favourable as a rule, with recovery of the renal function ad integrum and complete recession of the nephrotic syndrome. The pathogenesis of the syndrome is no entirely clear, but it probably implies a delayed hypersensitivity reaction. Treatment consists of withdrawing the responsible drug(s) and applying medical intensive care methods. Whether or not corticosteroids influence the rapidity and quality of recovery remains uncertain.

Acute Disease↗
PubMed1990

The internist in the management of head and neck cancer.

The general internist has an important role in the management of head and neck squamous cell cancers. This heterogeneous group of cancers must be accurately diagnosed and staged before planning treatment. Curability is directly related to stage at presentation and, because most patients with such cancers present to internists first, these physicians must be familiar with presenting symptoms and must be suspicious enough to refer patients with symptoms for appropriate evaluation. The work-up of patients with suspected unknown primary cancer presenting as adenopathy is detailed, and the physician is cautioned not to immediately proceed to open biopsy. As many as 10% of such primary cancers remain undetected, although, with proper therapy, the 5-year survival rate for squamous cell cancer of the head and neck is 60%. Those patients cured of head and neck cancer still face significant psychosocial and medical problems, including hypothyroidism, xerostomia, and a 20% rate of second primary cancer. Head and neck cancer is highly preventable; 75% of cases are related to tobacco and alcohol use. Smokeless tobacco has gained popularity among young Americans and is associated with an increased incidence of head and neck cancer at several sites. Education is crucial, and internists must seek strategies to stop patients from using tobacco products. Other etiologic factors include industrial carcinogens, Epstein-Barr virus, and diet. Retrospective serologic and dietary recall studies of vitamin A suggest an etiologic role of diet; vitamin A analogs have been tested in preneoplastic lesions. To reduce mortality from head and neck cancers, the general internist must play a central role in prevention and early detection.

Carcinoma, Squamous Cell↗
PubMed1990

The clinical presentation of Wilms' tumour in black children.

The pattern of presentation of black children with Wilms' tumour is reported. Differences between children from rural and urban areas are emphasised. Factors which distinguish these groups from First-World population groups are highlighted and the possible implications for treatment design stressed.

Age Factors↗