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Biomedical subjects

J Chanard

Publications and source records attributed to J Chanard.

At least 73 records · Page 4Linked to original sources
PubMed1990

Early and late occurrences of destructive spondyloarthropathy in haemodialysed patients.

In a series of 100 patients dialysed for 3 months to 17 years destructive spondyloarthropathy was diagnosed in 11 cases. Lower cervical spine was involved in ten and dorsal spine in one. When compared to patients without arthropathy, spinal involvement was associated with longer duration of dialysis and greater prevalence of parathyroidectomy. The patients with destructive spondyloarthropathy were divided into two groups: Group 1, four patients, in whom arthropathy occurred within the first 41 months of dialysis, and Group 2, seven patients, in whom arthropathy occurred after 106 months of dialysis. Group 1 was associated with greater age, chondrocalcinosis (2 of 4), absence of overt osteoarticular bone defects, and absence of carpal-tunnel syndrome. Parathyroidectomy (PTx) was performed in one patient. Amyloidosis was not found in one patient who came to autopsy. Group 2 was associated with presence of shoulder pain (6 of 7), juxtaarticular bone cysts (6 of 7) and CTS (6 of 7), and absence of radiological chondrocalcinosis. PTx was performed in six of seven patients and amyloidosis was found in three. In conclusion, destructive spondyloarthropathy may be seen early in the course of dialysis, apart from general amyloid involvement of accelereted hyperparathyroidism. A specific finding of this study was the discovery of radiological chondrocalcinosis in association with early arthropathy, which is a well-recognised feature in non-uraemic subjects.

Adult↗
PubMed1990

Destructive spondyloarthropathy in dialysis patients: an overview.

Destructive spondyloarthropathy has been increasingly recognized in dialysis patients. We have reviewed 39 observations published in the literature and added 11 personal cases in order to define the clinical and radiological presentation of the disease. The many hypotheses that have been proposed for its pathogenesis are discussed, including secondary hyperparathyroidism, microcrystal deposition, beta 2-microglobulin-associated amyloidosis and aluminum intoxication.

Adult↗
PubMed1990

[Continuous hemodialysis with low blood flow and low dialysate flow in the treatment of acute renal insufficiency].

Slow continuous hemodialysis (SCHD) was performed in 9 patients with oliguric acute renal failure and cardiovascular instability. The vascular access was a Scribner's shunt in 7 patients and a double lumen venous catheter with a BSM22 blood system in 2 patients. Three different dialyzers were tested. The mean urea clearance was 10.8 +/- 1.5 ml/min with the 0.2 m2 polysulfone hollow fiber dialyzer, 14.3 +/- 2.7 ml/min with the 0.5 m2 AN 69 S parallel plate dialyzer and 13.8 +/- 1.8 ml/min with the 0.6 m2 AN 69 hollow fiber dialyzer. The mean dialysate flow rate was 15.6 +/- 1.9 ml/min, 15.2 +/- 0.7 ml/min and 15.1 +/- 1.6 ml/min for the three dialyzers, respectively. A linear relationship was documented for blood urea clearance and dialysate flow rate indicating clearly that low blood flow from 60 to 100 ml per min was appropriate for optimal diffusive transfer. The technic required continuous heparin anticoagulation. Three patients died of causes not related to the SCHD technic. When used in critically ill patients, SCHD is a simple method, suitable for intensive care unit staff with no trained dialysis nurses and allows an adequate control of uremia, fluid removal, acid base homeostasis and parenteral nutrition.

Acute Kidney Injury↗
PubMed1989

Serum beta 2 microglobulin and extracellular fluid volume during haemodialysis.

Conflicting results have been published concerning serum beta 2 microglobulin (beta 2-M) kinetics during dialysis with a cuprophane membrane which is not permeable for the protein. We have investigated the hypothesis that the apparent increase of free serum beta 2-M could result from extracellular fluid volume (ECV) contraction. Using inulin, ECV was measured before and 1 h after a dialysis session with a sodium dialysate concentration of 145 mmol/l. Dialysis was performed either with a cuprophane or a high-flux membrane. Transcellular water shift and changes in beta 2-M concentration were calculated from total body water changes (ultrafiltration) and ECV. ECV decreased from a predialysis value of 16.6 +/- 3.51 (mean +/- SD) (24.9% bodyweight) to a postdialysis value of 11.9 +/- 2.11 (19.8% bodyweight). Ultrafiltration was only 3.1 +/- 1.01, indicating concomitant water shift from ECV to intracellular fluid space. A significant decrease in corrected beta 2-M concentration was found for high-flux membranes. However, postdialysis beta 2-M did not change significantly after dialysis with cellulosic membranes. In conclusion, the apparent increase of serum beta 2-M concentration measured during dialysis with cellulosic membranes may be explained by ECV contraction. These results have to be taken into account for any pathogenic mechanism of the beta 2-M-associated amyloidosis occurring in long-term haemodialysed patients.

Amyloidosis↗
PubMed1988

[Thallium-technetium scintigraphy for presurgical localization of parathyroid adenomas and hyperplasia].

The purpose of this study was to assess the value of parathyroid Thallium 201-Technetium 99m scintigraphy in 45 patients with hyperplasia or parathyroid adenomas with or without associated thyroid abnormalities. The prevalence of parathyroid abnormalities found during examination was 42/45: 36 adenomas (35 patients) and 16 hyperplasias (7 patients). Seventeen patients (38%) had thyroid abnormalities. The sensitivity and specificity of the three image analysing methods (visual analysis, simple subtraction, sophisticated subtraction) were determined by assessing answers given by 3 observers. The population was divided into 6 groups: adenomas and hyperplasias with (group I, n = 42) or without (group II, n = 25) thyroid abnormalities, adenomas alone with (group III, n = 35) or without thyroid abnormalities (group IV, n = 22), hyperplasias alone with (group V, n = 7) or without thyroid abnormalities (group VI, n = 5). The highest overall sensitivity was obtained, whichever the group, by applying the sophisticated image subtraction technique; for any given method, the best results were observed in the group comprising adenomas alone, especially without associated thyroid abnormalities. On the other hand, in the groups comprising hyperplasias alone, sensitivity was low. This leads us to conclude that, together with ultrasonography, parathyroid scintigraphy is currently the best preoperative technique for localizing parathyroid adenomas, even in the presence of associated thyroid abnormalities. However this must be carried out in conjunction with a sophisticated image subtraction technique.

Adenoma↗
PubMed1987

[Magnesium hydroxide treatment of hyperphosphatemia in chronic hemodialysis patients with an aluminum overload].

The control of hyperphosphatemia in dialysis patients is frequently achieved using aluminium hydroxide (A1(OH)3) and/or calcium carbonate (Ca CO3). However, this effect is counterbalanced by risk of aluminium intoxication and hypercalcemia. An alternative to the use of these phosphate binders is the prescription of magnesium hydroxide (Mg(OH)2) in association with a magnesium free dialysate. 19 patients with subtoxic plasma aluminium concentration received such a therapy. 9 months after starting the essay 4 patients had been excluded for digestive intolerance (3 cases) and neuro-psychic symptoms related to hypermagnesemia (1 case) after therapy with maximal doses of 6 to 12 g/d. Plasma inorganic phosphorus was decreased from 2.47 +/- 0.32 to 1.86 +/- 0.40 mmol/l (P less than 0.05) and plasma aluminium from 3.03 +/- 0.93 to 1.52 +/- 0.15 mumol/l (P less than 0.05). The results have been obtained without any significant increase in plasma and red cell magnesium levels. Metabolic alkalosis has been observed in association with the increase of ion exchange resin (sodium polystyrene sulfonate: Kayexalate) to treat progressive hyperkalemia. With the exception of possible metabolic effects occurring on a long term basis, Mg(OH)2 in association with magnesium-free dialysate seems of value to treat dialysis hyperphosphatemia.

Adult↗
PubMed1985

[Continuous arteriovenous hemofiltration in acute renal failure. Value of regulating the rate of ultrafiltration].

Continuous arteriovenous hemofiltration (CAVH) requires constant supervision and frequent readjustment of the rate of infusion of the substitution fluid because of variable filtration rate. In order to lighten the management of patients treated with CAVH, an ultrafiltration-pump assisted CAVH was used in 16 patients with oliguric renal failure and cardiovascular instability treated in the intensive care unit. A plate hemofilter (Biospal) was used which is equipped with the high hydraulic permeability AN 69 S membrane. The driving pump was set in order to modulate the ultrafiltration rate from 400 to 1000 ml/h. Ultrafiltration-pump assisted CAVH was given for 8.1 +/- 5.3 days and the filtration volume was 16.3 +/- 3.1 l/day. The mean life span of the hemofilter was 36.4 +/- 27.3 hours. No adverse reaction toward the artificial membrane was detected. Adequate control of fluid balance and electrolyte and acid-base homeostasis were obtained allowing parenteral nutrition. However, in two instances additional hemodialysis was required to adequately control urea generation. Ultrafiltration-pump assisted CAVH proved to be a simple and effective method of fluid removal and urea subtraction by convective transport. Maintenance of stable fluid balance and parenteral nutrition without osmotic disequilibrium was allowed. The pump driven hemofiltration allows optimal use of the filter.

Acute Kidney Injury↗
PubMed1984

[Hemorrhagic fever with renal syndrome due to Hantaan virus or a serologically related virus].

Seven cases of acute renal failure consecutive to haemorrhagic fever with renal syndrome (HFRS) due to the Hantaan virus or to a serologically related virus are reported. These cases were observed in north-eastern France between March, 1983 and January, 1984. All patients were of rural origin and had been in contact with field mice. The predominant initial clinical symptoms were signs of infection and diffuse muscle pain, without evidence of haemorrhage. However, massive proteinuria was noted, and acute anuric renal failure unaccompanied by oedema or arterial hypertension developed. Renal biopsy performed in 2 patients showed tubular and interstitial nephritis but no glomerular or vascular lesions. Two patients only required haemodialysis. All patients recovered within 2 to 8 weeks without sequelae. Antibodies directed against the Hantaan virus were detected by indirect immunofluorescence tests, and seroconversion could be demonstrated in 2 patients seen at a sufficiently early stage. The risk of epidemics suggested by this small outbreak of HFRS can only be evaluated after an exhaustive epidemiological study.

Acute Kidney Injury↗