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Biomedical subjects

G P Alexandre

Publications and source records attributed to G P Alexandre.

At least 73 records · Page 4Linked to original sources
PubMed1983

[Minoxidil treatment of refractory arterial hypertension following a kidney transplant].

Twenty-two patients with a functioning renal graft and in whom hypertension was resistant to conventional drug treatment were treated with minoxidil. After eight days of treatment, mean blood pressure falls significantly (p less than 0.001) - from 180/115 to 147/89 mm Hg supine and from 156/104 to 136/87 mm Hg standing. A supine diastolic blood pressure less than or equal to 100 mm Hg is obtained in 82% of the patients. Efficacy and side-effects of minoxidil were analyzed in 12 patients after a 6 months' treatment. Mean blood pressure and response rate to therapy remain similar to those observed at 8 days. Body weight, heart rate, and serum creatinine values are unchanged compared to preminoxidil values. Hirsutism develops in all subjects, limiting the use of minoxidil in female patients. We conclude that minoxidil is an effective treatment of resistant post-transplant hypertension. In our series no major side effect is observed except for hirsutism.

Adolescent↗
PubMed1983

[Lymphoceles after renal transplantation].

Lymphocele following renal transplantation occurs in 1 to 10 p. cent of cases. Pathogenesis and symptomatology are discussed, based on findings in 8 cases. Diagnosis can usually be established by combining ultrasonography and intravenous urography. Asymptomatic lymphoceles require no treatment, but therapy is essential for those producing symptoms or venous or urinary compression. External drainage should be reserved for lymphoceles with spontaneous skin rupture: colloidal gold injections into the fistula orifice may assist drying up of lymphatic leakage. Intra-peritoneal marsupialization appears to be the most widely employed method in other cases, but recurrence is common when used alone. However it constitutes the treatment of choice, when combined with an epiploplasty.

Adult↗
PubMed1983

Haemodialysis or renal transplantation in the treatment of end-stage diabetic nephropathy.

We have reviewed 27 diabetic patients treated between 1971 and 1981 by haemodialysis and/or by transplantation. Overall patient survival is 43 per cent at five years (vs 78 per cent in non-diabetics of similar age). Two year patient survival is identical (73%) with haemodialysis and after transplantation. One year graft survival is 55 per cent. Progression of extrarenal diabetic complications is similar in haemodialysis and after transplantation. Recurrence of diabetic glomerulosclerosis was documented in two grafts. Haemodialysis thus offers a suitable alternative for diabetic patients who cannot be transplanted.

Adolescent↗
PubMed1983

Prevalence and causes of hypertension late after renal transplantation.

We analysed the prevalence and causes of hypertension in 77 patients followed greater than or equal to 7 years after renal transplantation. Prevalence of hypertension remains stable, around 55 per cent, up to 11 years post-transplant. Age, sex, type of original nephropathy, graft source or prednisolone dosage are not related to hypertension; body weight is greater in hypertensive patients. Presence of native kidneys is responsible for hypertension in about one-quarter of non-nephrectomised patients. No renal artery stenosis was observed in this group. At seven years, serum creatinine is greater in hypertensive patients, suggesting that graft dysfunction is an important cause of hypertension in long term survivors.

Adolescent↗
PubMed1983

[Importance of continuous positive pressure ventilation in kidney transplantation: a pilot study].

Continuous positive airway pressure ventilation (CPAP) tends to reduce the risk of post-operative pulmonary infection by recruiting poorly ventilated areas. In human renal transplantation, pulmonary infection is a major problem with a high mortality rate in these immuno-depressed patients. The risk is further increased by the need for recipient maximal hydration during surgery to ensure satisfactory graft function. We therefore thought that it would be appropriate to use CPAP preventively during the immediate post-operative period. In a series of 60 successive patients who benefited from CPAP, the incidence of pulmonary infections was only 5%, which compared favourably with a 14.3% incidence in a previous series of 77 patients without preventive CPAP. Moreover, the 3 pulmonary infections that occurred were rapidly cured and the transplanted kidney could be saved in 2 cases; one patient required dialysis. No death was recorded.

Adult↗
PubMed1982

De novo membranous nephropathy in human renal allografts: report of nine patients.

Nine new patients with de novo membranous nephropathy (MN) are reported. The onset of MN, as defined by onset of nephrotic-range proteinuria, ranged from 11 to 30 months after transplantation. Five of the nine patients returned to hemodialysis within 4 to 26 months after the onset of nephrotic syndrome. No known exogenous (for example, ALS or HBsAg) or endogenous antigens could be demonstrated as the cause in any of the nine patients. The possibility that excellent tissue compatibility might increase the risk of subsequent de novo MN is suggested by the finding of four patients with "full house" HLA-A,B mismatch. This phenomenon occurs in approximately one in 100 to 200 transplants. It is suggested that de novo MN is not as unusual as heretofore believed and that its prognosis is poor.

Adolescent↗
PubMed1982

Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants.

The recipient's hemodynamic condition during anesthesia for renal transplantation has a major influence on the early diuresis of the graft. The effect of maximal hydration during operation was studied in a series of 120 primary human cadaver kidney transplantations performed under peroperative monitoring of the pulmonary arterial pressures (PAPs). The PAPs levels before and at the time of clamp release were correlated with the frequency of postoperative acute tubular necrosis (ATN). The 120 patients were divided in two groups according to the PAPs levels before release of the vascular clamps: group 1 (22 patients) with a mean PAP (PAP) of less than or equal to 20 mm Hg and a diastolic PAP (DPAP) of less than or equal to 15 mm Hg was compared with group 2 (98 patients) with a PAP of greater than 20 mm Hg and a DPAP of greater than 15 mm Hg. Both groups were comparable with regard to the donor's data and the quantity of peroperative fluids. The frequency of ATN was 36% in group 1 versus only 6% in group 2. This difference is attributed to the different hemodynamic conditions in both groups: at the beginning of the transplant procedure, PAP, DPAP, and central venous pressure (CVP) were higher in group 2; at the time of clamp release, PAP, DPAP, CVP, and systolic blood pressure (SBP) were also higher in group 2. This study emphasizes the importance of the PAPs levels at the time of release of vascular clamps to avoid postoperative ATN of a kidney transplant.

Adult↗
PubMed1982

[Results of dialysis and transplantation in the treatment of patients with diabetic renal failure ].

The respective merits of hemodialysis (HD) and transplantation (TP) in the treatment of 25 patients with diabetic renal failure are analyzed. Overall patient survival whatever the method of treatment is 72% at one year and 50% at 4 years. One year survival is 67% for patients treated only by HD and 81% after TP. This difference results in part from the fact that early death after the initiation of therapy occurs usually during HD prior to TP. Death results mainly from cardiovascular disease (6/7 deaths) in HD and from infectious complications (5/9 deaths) after TP. Taken together with death, rejection of 11/19 grafts reduces graft survival to 56% at one year and 33% at 2 years. Progression of cardiovascular, ocular and neurologic complications is similar whatever the mode of treatment. Recurrence of diabetic renal disease was documented in the graft of one patient. All patients with a 2 year survival (6 grafted, 1 dialyzed) have an excellent rehabilitation. Altogether both methods of treatment appear satisfactory. The initial pessimism regarding the outcome of HD treatment appears unwarranted. Unfortunately, both HD and TP remain marred by a greater number of complications in diabetic than in non-diabetic patients. Initiation of therapy at an earlier stage of the disease and better control of the diabetes might further improve results.

Adult↗
PubMed1981

Recurrence of de novo graft membranous glomerulonephritis.

Graft membranous nephropathy (MN) appears mainly de novo or, less frequently, develops in patients whose original disease was MN. The rarity of the latter occurrence contrasts with the frequency of MN as the original disease: the existence of renal recurrence may thus be questioned. We report a patient with terminal renal failure due to focal glomerulosclerosis; typical MN developed de novo in the first and recurred in the third graft. This observation establishes that recurrence of MN is a real phenomenon and demonstrates that the factor(s) determining recurrence may appear only after transplantation. Neither HBs nor antilymphocyte serum antigens were found along the basement membrane. The late onset of proteinuria after the third demonstrates that the delayed appearance of clinical signs of glomerular disease does not rule out the occurrence of MN.

Child↗
PubMed1981

Renal transplantation in children: a comparative study between parental and well-matched cadaveric grafts.

We review our results of transplantation performed during the last 10 years in 65 children less than 15 years old: 32 parental grafts (group P) are compared with 35 grafts from well-matched (mean HLA-A,B mismatches: 1.7) cadavers (group C). Group P patients' survival is slightly but not significantly better than that of group C recipients (96.6 versus 82.7% at 5 years). Graft survival is significantly (P less than 0.02) better in group P than in group C (85.2 versus 51.2% at 5 years). At the end of the study, 3 grafts (2 from rejection) are lost in group P versus 14 (8 from rejection) in group C (P less than 0.01). The number of acute rejection episodes treated during the first 3 months is significantly lower in group P recipients. Epiphyseal osteonecrosis is observed in none of the patients of group P but in five of group C. Hypertension is significantly less frequent in group P than in group C. The results obtained in group P are attributed largely to a better non HLA-A,B compatibility, although the potential role of splenectomy performed in 25 recipients of group P and in none of group C cannot be excluded. Furthermore, the improved technical conditions inherent in living donor transplantation probably play an additional role. We conclude that in children the fate of parental kidneys is significantly better than that of cadaver transplants selected for their good HLA-A,B compatibility.

Adolescent↗
PubMed1979

Haemodialysis and transplantation in Wegener's granulomatosis.

Two men with Wegener's disease began immunosuppressive treatment during severe renal insufficiency. Despite an initial temporary remission new lesions appeared and renal failure progressed. Haemodialysis was started, cytotoxic drugs were stopped, and steroid dosage was reduced. All extrarenal manifestations of the disease remitted, however, suggesting a favourable effect of either the immunosuppression induced by terminal renal failure or the haemodialysis itself. Renal transplantation was then undertaken in both patients. Thirteen and 55 months after the operations respectively renal function was satisfactory and no signs of reactivation of Wegener's disease had appeared. These results show that whatever the activity of Wegener's disease and its initial response to immunosuppressive agents, dialysis and transplantation are fully warranted once irreversible renal failure is established.

Adult↗
PubMed1979

The evolution of hyperlipidaemia late after renal transplantation.

We have evaluated the incidence, long term evolution and pathogenesis of posttransplant hyperlipidaemia (HL) in 88 transplanted patients without nephrotic syndrome followed for 2 to 13 years by the same staff. Incidence of HL decreased strikingly over the years from 51% at 2 years to 25% at 10 years. This fall was due solely to the return to normal of the lipid profile in 13 patients between 2 and 8 years after transplantation. This progressive decrease should be taken into account when the frequency of posttransplantation dyslipaemia is assessed. The incidence of hyperlipidaemia increases with age. Above 40 years, hyperlipidaemia is more frequent in females than in males. Obesity and reduced renal function are both associated with a higher incidence of dyslipaemia. No relationship was found between lipid disorders and either steroid dosage or fasting blood glucose levels. Dyslipaemia appears thus to be due to the interplay of several factors. Normalisation of the lipid profile occurred in 13 patients without significant decrease in bodyweight, serum creatinine or prednisone dosage. At 8 years atheromatous lesions were not more frequent in dyslipaemic than in normolipaemic subjects.

Adolescent↗