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Biomedical subjects

G Choukroun

Publications and source records attributed to G Choukroun.

At least 55 records · Page 3Linked to original sources
PubMed1995

Factors influencing progression of renal failure in autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) frequently leads to end-stage renal failure (ESRF) in the sixth decade of life, but considerable heterogeneity exists in the rate of progression of renal failure. The respective contribution of genetic factors and of potentially amendable factors, such as blood pressure control or protein intake limitation, on the rate of progression in ADPKD patients is still debated. To evaluate the role of factors influencing the rate of progression of renal failure in ADPKD, we retrospectively analyzed the annual rate of decline of creatinine clearance (Ccr) in 109 ADPKD patients followed from the time a Ccr value of 30 to 50 mL per min/1.73 m2 was measured until ESRD and need for hemodialysis (Study A), and in 48 undialyzed ADPKD patients followed for at least 4 yr from the time a Ccr value of 50 to 60 mL per min/1.73 m2 was measured (Study B). In Study A, the decline in Ccr (delta Ccr) (mean +/- SE) was 5.8 +/- 0.2 mL per min/1.73 m2 per year in the whole series, and was lower in females than in males (5.0 +/- 0.2 versus 6.4 +/- 0.2, P < 0.001). Accordingly, ESRF was reached at a later age in female patients (55.1 +/- 1.2 versus 50.6 +/- 1.2 yr, P < 0.01). The age at ESRF in male patients was lower when the disease was transmitted by mother than by father (46.3 +/- 1.9 versus 54.1 +/- 1.8 yr, P < 0.01), whereas no significant effect of the gender of the affected parent was apparent in female patients. By regression analysis, there was a positive but weak relationship between delta Ccr and mean arterial pressure (average value during follow-up, 107 +/- 1 mm Hg, r = 0.224, P < 0.05) but not with dietary protein intake (mean value in follow-up, 0.87 +/- 0.03 g/kg per day, r = 0.10, P = 0.33) nor with proteinuria at baseline, which was lower than 0.3 g/day in 104 cases (r = 0.10, P = 0.28). There was a negative relationship between age at ESRF and delta Ccr (r = 0.245, P < 0.05), with a later and slower progression in older subjects. In Study B, the mean decline in renal function during follow-up was 5.3 +/- 0.4 mL/min/1.73 m2 per year, a value close to that observed in Study A. By multiple regression analysis of the overall population (studies A and B combined), only MAP, age and gender were independent predictive factors of delta Ccr but all studied parameters taken together accounted for at best 20% of delta Ccr variation. We conclude that the rate of progression of renal failure in ADPKD patients is mainly determined by gene expression, with female gender and older age associated with a slower progression, whereas blood pressure control, but not protein intake, exerts a limited beneficial influence on the rate of progression in patients with advanced polycystic kidney disease who already have significant renal insufficiency.

Adult↗
PubMed1991

[Formation of a knot in a J spiral metallic guide: a complication of the Seldinger method].

Central venous catheter insertion by Seldinger's technique uses a wire guide which could be cause of complications. This case reports a blocked wire guide of which J tip was responsible for knotting. Utilization of vessel dilator of central venous catheterization set (Arrow) permitted to liberate and withdraw the wire guide without surgical operation. A larger use of this wire guide could increase the frequency of such complications.

Aged↗
PubMed1990

[Treatment of systemic diseases with pulse cyclophosphamide: 15 cases].

Fifteen patients suffering from severe systemic diseases were treated with monthly pulses administration of cyclophosphamide (0.7 g/m2 of body surface): 8 acute systemic lupus erythematosus, 2 Wegener's granulomatous, 1 polyarteritis nodosa, 1 rheumatoid vasculitis, 1 progressive systemic sclerosis, 1 relapsing uveitis and 1 dermatopolymyositis. The indications for cyclophosphamide were: glomerulonephritis (6 cases), resistance to previous treatments (7 cases) and undesirable side effects of corticosteroid therapy (2 cases). After 3 pulses, the disease was controlled in 12 patients (80%) and corticosteroids could be decreased in all 12 cases without an evolutive relapse of the disease. Five patients developed infections (2 septicemia, 1 zona, 1 herpes gingival stomatitis and 1 viral meningitis) which were treated without sequelae. One patient developed cystitis with hematuria after the 3rd pulse; association of mesna, a urinary tract protective agent, enabled the continuation of treatment without a cystitis relapse. At the end of our retrospective study, the efficacy of pulse cyclophosphamide administration seems to be satisfactory but the risk of undesirable side effects should limit its use to severe systemic diseases or those resistant to conventional therapies.

Adult↗
PubMed1990

Blood pressure changes induced by ciclosporin A in type I diabetes.

The determinants of ciclosporin A-induced blood pressure changes were analyzed initially and after 3 months in 30 recent type I diabetics submitted to chronic treatment with ciclosporin as single immunosuppressive drug. Prevalence of hypertension was 17% and relatively low as compared to those reported in organ transplantation. Ciclosporin induced a slight decrease in glomerular filtration rate and renal plasma flow, with unchanged filtration fraction, a mild average increase in blood pressure and a more pronounced increase in renal vascular resistance. There was a trend toward decrease in absolute urinary sodium excretion whereas fractional excretion of sodium was unchanged. Presence of familial history of essential hypertension was characterized by a slightly insignificantly lower renal plasma flow and did not affect the renal effect of ciclosporin except that the renal plasma flow was significantly lower in the groups of patients genetically predisposed.

Adult↗
PubMed1988

[The cost of care related to AIDS at the Henri Mondor Hospital].

A retrospective analysis of the cost of hospital care related to AIDS was undertaken at Henri Mondor hospital, Créteil, to prepare the hospital budget for 1988. Eight representative cases of the type of medical care were thoroughly evaluated with inventories of all direct expenses (medico-technical, pharmaceutical, accommodation) incurred between the first hospital admission of each patient and June 1987 or the patient's death. The study comprises 17 hospital stays of over 24 hours or 439 days of diagnosis and treatment. The total daily direct expenditure varied from 979 to 1119 FF/day (depending on whether the drug Zidovudine was used), that is to say an increase of 7 to 23% compared with the previous average daily cost in the same hospital unit (909 FF/day). The density of personnel is lower than recommended for units receiving patients with advanced AIDS. This lack of personnel is responsible for an underevaluation of total cost of about 10%. Should the number of admissions with this disease increase, the hospital personnel budget would suffer the most, even if hospital admission for AIDS continues to substitute for other decreased or abandoned activities and do not therefore appear in total overexpenditure.

Acquired Immunodeficiency Syndrome↗