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Biomedical subjects

J Chanliau

Publications and source records attributed to J Chanliau.

34 records · Page 2Linked to original sources
PubMed1993

Diagnosis and treatment of chronic lead poisoning in CAPD patients.

In order to screen for abstruse lead poisoning in continuous ambulatory peritoneal dialysis (CAPD) patients, delta-aminolevulinic acid dehydratase (ALAD) levels were measured in 18 CAPD patients, 156 patients treated with hemodialysis (HD), and 420 control patients with normal renal function (NRF). An EDTA (ethylenediamine tetraacetic acid) mobilization test was performed in patients with low levels of ALAD (< 0.40 mumol of porphobilinogen formed per milliliter of red blood cells): 1 g of EDTA was infused IV followed by 20 L of hemofiltrate in HD patients and four bags of dialysate in CAPD patients. Lead was assayed in the ultrafiltrate liquid, the bags of dialysate, and in the 24-hour urine. ALAD levels were significantly lower in CAPD and HD patients than in the NRF subjects. ALAD was significantly correlated with EDTA mobilized lead in both dialysis and NRF patients. Using the usual criteria (EDTA mobilized lead > 800 micrograms/24 hours), the rate of lead poisoning observed was similar in the two groups. These results suggest that ALAD assay followed by the EDTA mobilization test is as effective in CAPD patients as in NRF subjects to diagnose and to treat chronic abstruse lead poisoning.

Chronic Disease↗
PubMed1993

Evolution of intraperitoneal hydrostatic pressure following peritoneal catheter implantation.

Intraperitoneal hydrostatic pressure (IPP) was measured in 10 patients for 15 days (until day 15) following peritoneal catheter implantation. Tenckhoff catheters were surgically implanted using a transrectal approach. The patients began peritoneal dialysis (PD) immediately, initially with small intraperitoneal fluid volumes (500 mL), gradually increasing to reach 2000 mL by day 7. In one patient PD was delayed until day 7 because of an initial leakage of dialysate. Inspiratory and expiratory IPP were measured daily, with the zero point fixed at the midaxillary line with the patient in the supine position. Despite the small intraperitoneal fluid volumes used initially (500 mL), IPP was much higher in the first 3 days following implantation than in the next 12 days (17 +/- 3 cm of water vs 11 +/- 1 cm of water). IPP remained high until day 3, then gradually decreased in a linear fashion until day 12, despite the increased intraperitoneal volumes used, and then remained constant. In conclusion, IPP was found to be significantly higher for 3 days following intraperitoneal catheter implantation, whichever intraperitoneal volume was used. This may be due to tense abdominal muscles from pain caused by the surgery or because of reduced intraperitoneal compliance at the beginning of PD.

Adult↗
PubMed1993

Intraperitoneal hydrostatic pressure and ultrafiltration volume in CAPD.

The intraperitoneal hydrostatic pressure (IPP) and overall ultrafiltration (UF) volume were measured in 34 patients after a 2-hour exchange with 2 L of dialysate containing 3.86% glucose. These patients had been treated with continuous ambulatory peritoneal dialysis (CAPD) on average for 26 +/- 20 months under stable conditions. The patients were at rest during the 2-hour exchange. The normal IPP measured with the patient lying completely flat was on inspiration (IPPinsp) 14 +/- 4 cm of water (cmH2O) and on expiration (IPPexp) 12 +/- 3 cm H2O, for an intraperitoneal volume of 2820 +/- 319 mL. The mean UF was 744 +/- 323 mL. The mean IPP (IPPmean), defined by (IPPinsp+IPPexp)/2, had a negative linear correlation to the UF volume (r = 0.66; p = 0.0001). The linear regression test showed that an increase of 1 cm H2O in the IPPmean reduced the overall UF volume by 70 mL in 2 hours. In conclusion, even though the UF is produced by the osmotic pressure of the dialysate, it is also influenced to a great extent by the intraperitoneal hydrostatic pressure, which should not be ignored.

Adult↗
PubMed1992

Routine measurement of hydrostatic intraperitoneal pressure.

A simple, non-invasive and well-tolerated technique for routine measurement of intraperitoneal hydrostatic pressure (IPP) in patients treated with peritoneal dialysis (PD) is presented. The height of the dialysis fluid in the PD line was measured, under atmospheric pressure, before drainage and during inspiration (IPPinsp) and expiration (IPPexp), taking the axillary line as the reference point of the resting subject in strict supine position. Normal values were established for a population of 18 patients treated with PD for 19.8 +/- 20.9 months under clinical and biological stable conditions. For an intraperitoneal volume of 2,820 +/- 419 ml, IPPinsp = 14 +/- 2 cmH2O; IPPexp = 12 +/- 2 cmH2O; IPP mean (defined as (IPPinsp+IPPexp)/2) = 13 +/- 2 cmH2O; IPP (defined as IPPinsp - IPPexp) = 2 +/- 2 cmH2O. IPP could not predict mechanical complications (hernia, hemorrhoids, dialysis fluid leakage) but the maximal IPPexp clinically tolerated was 20 cmH2O.

Female↗
PubMed1992

Intraperitoneal pressure, peritoneal permeability and volume of ultrafiltration in CAPD.

Peritoneal permeability (PP), hydrostatic intraperitoneal pressure (IPP) and the overall volume of ultrafiltration (UF) were measured in 23 patients treated by CAPD under stable conditions. PP, IPP and UF were measured during the same exchange with a 2-liter bag with 3.86% glucose, dwell time of 2 hours. PP was evaluated with 3 indices: glucose peritoneal desaturation at 2 hours, urea peritoneal saturation at 2 hours, and crossing time of glucose and urea peritoneal equilibration curves. IPP was evaluated at inspiration (IPPinsp) and at expiration (IPPexp)-giving IPPmean-by measuring the height of the dialysis fluid in the PD line under atmospheric pressure, with point zero located on the axillary line of the subject in strict supine position. Net UF volume was inversely correlated with IPPmean. The net UF volume was strongly affected by IPP since a 1 cmH2O increase in IPPmean caused a decrease of 74 ml in global UF in 2 hours, probably by modification of the lymphatic reabsorption and perhaps of the transcapillary UF.

Adult↗
PubMed1990

[Allergic risks of hemodialysis. Results of an allergologic investigation in 138 patients].

One hundred and thirty eight unselected hemodialysis patients were screened for allergic symptoms, atopy, total IgE, eosinophil count, specific IgE against ethylene oxyde (ETO), formaldehyde (FA) and isocyanates (Iso) and delayed hypersensitivity to formaldehyde. Six patients demonstrated hypersensitivity to formaldehyde. Six patients demonstrated hypersensitivity reactions at the beginning of hemodialysis; one had recurrent urticaria and one aggravated a preexistent asthma. There were no predicting factors but 6 out of these 8 patients (62%) had positive RAST against ETO, FA or Iso. Eczematous lesions occurred in 40 patients (20%) mainly located around the fistula. Eczema is significantly more frequent in men, atopic patients, and patients using a type of machine where we measured high residual FA concentrations (greater than 50 mg/l). A positive FA patch test was observed in 22% of the patients with an eczema compared to 1.3% in the asymptomatic patients (p less than 0.01).

Adult↗
PubMed1990

[Osteo-articular manifestations in dialysis of patients over 70 years].

A clinical, biological and radiological prospective study was carried out in 21 patients over 70 years of age and treated by hemodialysis or chronic ambulatory peritoneal dialysis (CAPD) to evaluate the frequency and specificity of rheumatic diseases observed in aged chronic renal failure patients. Some are caused or favored by old age and are not in any way related to renal failure and its replacement therapy. Such was the case with arthrosis which was present in 85% of patients, ankylosing vertebral hyperostosis (14%), Paget's disease (5%) and gouty arthritis (10%). Elsewhere there is an implication between abnormalities due to aging and those linked to renal failure and/or dialysis, some of which can worsen or accelerate others. Secondary hyperparathyroidism seems less frequent in the elderly than in the young patients. Common vitamin dependent osteomalacia should not be neglected because it can be either prevented or efficiently treated. Osteoporosis is another important factor in osteopenia. Extra-skeletal calcifications are frequent: periarticular calcifications (38%), chondrocalcinosis (14%) and disc calcifications (24%). Dialysis arthropathy comprising: carpal tunnel syndrome, erosive lesions of large and intermediate limb joint articulations and destructive spondylarthropathy is observed in 43% of patients after an average dialysis period of 44 months. The advent of this complication seems to be quite early in the elderly, as compared to the young population, which confirms the role played by age as a favoring factor.

Aged↗
PubMed1990

[Error of dialysis concentrate: a cause of severe metabolic acidosis not detected by certain generators].

The authors report three cases of severe metabolic acidosis caused by errors of concentrate during hemodialysis "acide concentrate" instead of "acetate" bath. Symptoms began towards the second hour of the session with sickness and important vomits. Blood chemistries showed in all severe acidosis with hyperchloremia and hyperkaliemia while proper conductivity was obtained without alarm. Reconnection on dialysis with a correct bath was able to improve the above mentioned abnormalities. In vitro errors with different types of concentrates and machines have been simulated and the safeguards are discussed. The pH meter with alarm is proposed for all proportioning equipments, not only on "bicarbonate" generator but also on "acetate" delivery systems and especially in centers where these two types of concentrates are prescribed. Being vigilant remains nevertheless the best safeguard against human errors.

Acetates↗
PubMed1988

[Joint complications in patients with chronic renal failure hemodialyzed for over 10 years. 40 cases].

A retrospective study of 40 patients with chronic renal failure who underwent haemodialysis for more than 10 years (mean: 153 months) showed that 18 patients (45 p. 100) had arthralgia in the shoulders, hands, wrists and knees, 13 (32 p. 100) had carpal tunnel syndrome requiring surgery, and 20 (50 p. 100) were found to have bone cavities in the humeral head, external supra-acetabular region, carpus and patella. Aluminium overload was present in 47 p. 100 of the patients, and amyloid deposits were found in 10 of the 12 patient operated upon for carpal tunnel syndrome. This study confirms the frequency in patients under long-term haemodialysis of an articular pathological entity consisting of arthralgia, carpal tunnel syndrome, juxta-articular bone cavities and amyloid deposits which are now known to be made of beta 2-microglobulin. The initial lesion seems to affect the synovial membrane; it appears to be facilitated by age and is often associated with aluminium overload. The mechanism(s) responsible for amyloid deposits remain (s) to be elucidated.

Adolescent↗