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Biomedical subjects

J Hubert

Publications and source records attributed to J Hubert.

At least 73 records · Page 4Linked to original sources
PubMed1998

Treatment of end-stage renal failure after heart transplantation.

BACKGROUND: Five to 10% of heart-transplant recipients develop end-stage renal failure (ESRF). Little is known about the outcome of these patients under renal replacement therapy. METHODS: We conducted a retrospective study in 16 men (mean age 52.8+/-7.4 years at heart transplantation) who developed ESRF 5.3+/-2.1 years later. Results. Haemodialysis (HD) was the first-line treatment (mean Kt/V 1.35+/-0.4). Vascular access was unsuccessful in six patients (37.5%) due to peripheral arteriopathy and they were treated with tunnelled catheters for an average 15 months without bacterial infection. Mean weight was 68.4+/-10 kg at onset of HD and 61.7+/-9 kg one month later. Despite this reduction in extracellular overload, one antihypertensive drug was required in 75% of patients and two drugs in 12.5%. One patient tolerated automated peritoneal dialysis (PD) for 16 months (weekly Kt/V 2.1) despite persistent anuria. Renal transplantation (RT) was contraindicated in eight patients because of aortoiliac arteriopathy (n=5), poor general status (n=2), or ischaemic heart disease (n=1). RT was performed in eight patients with no acute episode of heart or renal graft rejection. There were no serious infectious complications. Three months after RT, mean serum creatinine was 115 micromol/l. One patient developed post-transplant lymphoproliferative disorder 3.5 months after RT and was successfully treated with transplant nephrectomy. Sudden death occurred in two patients 18 and 33 months after RT. Overall patient survival was 100, 78, and 59%, 1, 2 and 3 years after HD onset respectively. Using a time-dependent variable, the Cox model analysis demonstrated that heart-transplant recipients with ESRF have a relative risk of death 3.2 times higher than those without ESRF (95% CI = 1.3-7.8). CONCLUSIONS: HD, PD, and RT can be useful for the treatment of ESRF after heart transplantation. After initiating HD, patient survival is nearly the same as that reported in patients in Europe undergoing HD for other causes. But ESRF seems to reduce life expectancy in heart-transplant recipients.

Adult↗
PubMed1998

[Evaluation of spiral computed tomography in the demonstration of kidney stones. Ex vivo study].

OBJECTIVES: The objective of this study was to determine, ex vivo, the limitations of spiral computed tomography (CT) in the detection of renal stones. MATERIAL AND METHODS: Twelve fragments of calcium oxalate stones, 1 to 10 millimetres in diameter, were introduced into 3 porcine kidneys. Spiral CT was then performed on these kidneys. RESULTS: All stones, regardless of their dimensions, were detected with a sensitivity and specificity of 100%. Measurement of these stones on spiral CT showed a magnification factor and a distortion phenomenon which varied according to the table speed and collimation. CONCLUSION: In this study, spiral CT demonstrated excellent performances in the detection of renal stones, even for the smallest stones, measuring 1 mm in diameter.

Algorithms↗
PubMed1998

[Renal harvesting from donors in cardiac arrest: report of 3 cases and surgical technique].

During periods of transplant organ shortage, techniques designed to "salvage" transplants must be developed. The authors report three cases of renal harvesting from donors in cardiac arrest, in which the use of in situ perfusion-cooling with transfemoral introduction of Gillot's catheter resulted in six good quality transplants. The indications, surgical technique, alternatives and results are discussed.

Adult↗
PubMed1998

[Interstitial brachytherapy in infiltrating cancer of the bladder. The Nancy experience].

PURPOSE: From 1975 to 1996, 98 patients with infiltrative vesical carcinomas were treated at the Centre Alexis Vautrin by conservative surgery and interstitial brachytherapy (192lr). The mean follow-up was about eight years. From this retrospective non randomized study, we tried to determine the tolerance to this treatment. MATERIALS AND METHODS: There were 86 men and 12 women. The mean age was 63 years. We found three pTis tumors, 28 stage pT1 tumors, 38 stage pT2 tumors, 24 stage pT3A tumors, four stage pT3B tumors and one stage Tx tumors. The therapeutic scheme consisted of pelvic radiation therapy (3 fractions of 3,5 Gy) immediately followed by lymphadenectomy (for stage pT3 tumors) and by cystotomy or partial cystectomy during which we inserted brachytherapy plastic tubes. The delivered dose was 50 Gy for superficially infiltrative tumors and 30 Gy for deeply infiltrative tumors; at the lowest dose, the treatment ended with external beam irradiation. RESULTS: At 5 years the control rate was 72%, the specific survival 80% and the global survival 71%. Twenty-nine patients had a local recurrence. Of these, seven underwent total cystectomy. Thirty-seven patients developed 43 complications; 35 were intravesical, 10 (28%) were estimated to be higher than grade 2 because of technical problems that led us to modify the technique. CONCLUSION: It is essential to develop close collaboration between surgeons and brachytherapists, to select patients and to use a rigorous technique. Interstitial brachytherapy for infiltrative vesical carcinomas thus yields both high local control and satisfying results in regard to patient's well-being.

Brachytherapy↗
PubMed1998

[Which is the best performing imaging method for demonstrating residual renal calculi?].

OBJECTIVES: To compare the results of plain abdominal films, tomography, ultrasonography and spiral computed tomography in the detection of residual stone fragments after extracorporeal lithotripsy or percutaneous nephrolithotomy. MATERIAL AND METHODS: Prospective study on 31 patients and 40 renal units comparing the results obtained by plain abdominal films, tomography, ultrasonography and spiral CT. RESULTS: This study demonstrates the superiority of spiral CT over the other examinations for detection of renal stones (sensitivity of 100% for spiral CT, 89.2% for tomography, 82.1% for plain abdominal films and 67.8% for ultrasonography), determination of their number (n = 68, 58, 60 and 27, respectively) and demonstration of millimetric stones (100%, 69.4%, 67.8% and 2.7%, respectively). CONCLUSION: Spiral CT is the method of renal stone imaging which provides the most reliable diagnosis of radiopaque, non radiopaque, millimetric or centimetric stones, regardless of local anatomical conditions.

Adult↗
PubMed1997

Persistent efficacy of topical moxidectin against Dictyocaulus viviparus and Ostertagia ostertagi.

The persistent activity of moxidectin topically administered at the dose rate of 0.5 mg kg-1 bodyweight was evaluated against experimental nematode infection in 30 calves randomly allocated to six groups. Five groups were treated on days -42, -35, -28, -21 and -14. The 6th group remained untreated as a control. On Day 0, the calves were infected experimentally with 1000 Dictyocaulus viviparus and 50,000 Ostertagia ostertagi larvae and killed 3 weeks later. The formulation of moxidectin showed excellent activity against both parasites for up to 5 weeks (> 99%). Six weeks after treatment the reduction in the number of D. viviparus was still high (> 90%). No adverse reactions to moxidectin were observed in any of the animals.

Administration, Topical↗
PubMed1997

Three-dimensional CT-scan reconstruction of renal calculi. A new tool for mapping-out staghorn calculi and follow-up of radiolucent stones.

OBJECTIVES: The development of CT scanners (CT scan) with continuous rapid spiral acquisition now allows three-dimensional reconstructions of mobile organs such as kidneys. The aim of this study was to appreciate the merits of this new technique in the field of renal lithiasis. METHOD: This non-invasive technique was applied in 27 renal calculi (23 staghorn and 4 radiolucent stones). The acquisition does not require any injection of contrast material. Reconstruction was carried out by three-dimensional (3D) shaded surface display. RESULTS: 3D reconstruction of calculi permits a precise study of the shape of the stone, and of the number, size and direction of its branches. Therefore, it allows for better planning of the PCNL (number of ports, per-operative pelvi-caliceal exploration ...). Large radiolucent calculi are clearly defined with 3DS, facilitating the follow-up under medical treatment. CONCLUSION: 3D CT scan reconstruction is a noninvasive, cost-effective method which offers high quality 3D images of renal calculi. These results should spur the more widespread use of this technique.

Cost-Benefit Analysis↗
PubMed1997

A high efficiency technique for the long-term preservation of infective nematode larvae.

Improvements are suggested for the existing long term techniques for the preservation of nematode larvae. Haemonchus contortus, Teladorsagia circumcincta, Trichostrongylus colubriformis and Cooperia curticei larvae exsheathed in sodium hypochlorite and then suspended in phosphate buffered saline (PBS pH 7.2) are cooled in the gas over liquid nitrogen at a cooling rate of -1 degree C min-1 down to -50 degrees C. Larvae are then stored in liquid nitrogen at -196 degrees C. After warming at 30 degrees C and reactivation at 20 degrees C for at least 12 h, their percent motility is maintained (approximately 85%) providing that no more than 3000 to 5000 larvae are suspended in 1.8 mL of PBS in cryotubes. Infectivity does not significantly decrease: 46% of larvae cooled for 2 or 6 mo develop to adult stages compared to 52% for larvae stored at 4 degrees C for 2 mo.

Animals↗
PubMed1997

Efficacy of a pour-on formulation of eprinomectin (MK-397) against nematode parasites of cattle, with emphasis on inhibited early fourth-stage larvae of Ostertagia spp.

OBJECTIVE: To evaluate efficacy of topically applied eprinomectin against inhibited early fourth-stage larvae (IL4) of Ostertagia spp in calves. ANIMALS: 4 groups (n = 6 [replicates]) for dose titration; 2 groups (n = 8 calves [replicates]) for dose confirmation. PROCEDURE: 2 dose titration studies-0, 125, 250, and 500 micrograms of eprinomectin/kg of body weight-Louisiana and Georgia- and 2 dose confirmation studies of selected therapeutic dosage (500 micrograms/kg) in Scotland and France. Monitor calves were used to determine inhibition percentage of Ostertagia IL4. Test calves were ranked by weight in replicates of 4 (titration trials) or 2 (confirmation trials) animals each, and within replicates, were randomly allocated to treatment groups. Drug treatments were done on day 0, and animals were euthanatized by replicate, with holding time between treatment and euthanasia varying among trials from 14 to 27 days. RESULTS: Observations indicated high efficacy (> 99%) of 500 micrograms of eprinomectin/kg in removal of Ostertagia IL4. Ostertagia and Cooperia were only genera common across sites, with efficacy of aforementioned dosage against adult and larval stages of both genera consistently high (> 99%). Results of 1 or both titration studies (500 micrograms/kg) indicated > 99 to 100% efficacy against adult Haemonchus placei, Trichostrongylus axei, T colubriformis, Bunostomum phlebotomum, Dictyocaulus viviparus, and Oesophagostomum radiatum. Lower efficacy values were observed at minimal (125 micrograms/kg) dosage. In France, 500 micrograms/kg was 85% effective against Trichostrongylus spp adults; however, numbers of control calves infected with Trichostrongylus spp and degree of infection were low. Adverse reactions were not evident. CONCLUSION: Eprinomectin given topically (500 micrograms) was highly effective against Ostertagia IL4 and other common nematodes of cattle.

Administration, Topical↗
PubMed1997

Relationship between blood pressure and renin, angiotensin II and atrial natriuretic factor after renal transplantation.

The objective of the study was to assess the evolution of renin, angiotensin II, atrial natriuretic factor (ANF) and blood pressure (BP) in the first trimester following renal transplantation in man Thirty-two recipients were investigated for 3 months post-transplantation. Twenty had a history of hypertension with moderate cardiac hypertrophy. Thirty-one retained their native kidneys. Five kidney donors had a history of mild hypertension. The recipients were perioperatively volume-expanded with 0.9% saline and diuresis was maintained for 48 h with furosemide and dopamine. The sodium intake was 25 mEq/24 hours. Prophylactic immunosuppressive therapy was antilymphocyteglobulins (25 cases), or anti-LFA1 (7 cases) and maintenance therapy was cyclosporine-prednisone (8 cases), or cyclosporine-prednisone-azathioprine (24 cases). Mean BP, serum creatinine, urinary sodium excretion (UNA) and hormonal (renin, angiotensin II and ANF) parameters were collected every other day for the first week after transplantation and then twice monthly. Twenty (62.5%) patients developed hypertension and hypertension was more frequent in patients with a delayed graft function, than in patients with immediate good graft function (10/20 vs. 4/12, p < 0.05%). Both hypertensive (group HBP) and normotensive (group NBP) patients had similar very low renin and angiotensin II plasma levels, after an initial early peak. Analysis of covariance with multiple regression analysis showed that in the HBP patients, BP was negatively correlated with UNA (p = 0.02) and positively with plasma ANF (p < 0.01). The normal BP patients also showed a correlation between BP and UNA, although it was limit of statistical significance (p = 0.05); there was no correlation between ANF and BP. We conclude that the RAS is rapidly depressed after renal transplantation and does not interfere with BP regulation. The hypertension in the early stage of post-transplantation varies inversely with the urinary sodium excretion. The defective sodium excretion, which dominates the effect of the low sodium diet, results in volume overload, increased ANF and volume-dependent hypertension.

Adult↗
PubMed1997

Flutamide versus orchidectomy in the treatment of metastatic prostate carcinoma.

PURPOSE: To compare in a randomized clinical trial the therapeutic efficacy of the nonsteroidal antiandrogen flutamide 250 mg tid to testicular androgen suppression by orchidectomy in patients with metastatic prostate cancer. PATIENTS AND METHODS: Between 1989 and 1991, 104 patients aged 74 +/- 8 years with newly diagnosed metastatic prostate cancer, an ECOG performance status 0-2 and no prior hormone manipulation or chemotherapy, were randomized to receive flutamide 250 mg tid (54 patients) or orchidectomy (50 patients). Patients were evaluated at entry and at months 3, 6, 12, 18 and 24. The primary endpoint was duration of progression-free survival, progression being defined as an increase in PSA> 50% over the nadir value at 2 consecutive months or a single PSA rise > 50% over the nadir value with another objective parameter. At progression, the treatment was left to the discretion of the attending urologist. RESULTS: 16 patients (10 flutamide, 6 orchidectomy) are not evaluable. 86 had a minimum follow-up of 36 months, 36/42 and 41/44 have progressed in the orchidectomy and flutamide group with a time of failure of 419 and 496 days (p = 0.32); median time to progression was almost identical in both groups (370 vs. 396 days p = 0.9); overall survival at 69 months irrespective of treatment at relapse was identical in both groups. Side effects were dominated by gynecomastia, hot flushes in both groups, breast tenderness and diarrhea in the flutamide group. Overall, 4 (10%) of the patients in the flutamide group withdrew from therapy because of side effects. The impact of flutamide on sexual potency was not assessed because of the advanced age of the patients. Serum testosterone rose by 50% over baseline level at month 3 to plateau at 25% over baseline level at month 12. CONCLUSION: Although affected by the lack of a clear statistical power due to the small number of patients in each arm, this study shows that in spite of a constant elevation of serum testosterone (25% over baseline) flutamide 250 mg tid may be a reasonable alternative to castration in highly selected patients with well to moderately differentiated low volume metastatic prostate cancer and wishing to avoid the side effects of androgen deprivation, provided they are closely monitored and ready to switch to standard androgen deprivation in the presence of untolerable side effects or suboptimal treatment efficacy as assessed by the inability to achieve a low PSA nadir.

Aged↗
PubMed1997

[Conservative surgery and iridium 192 in stage pT2 bladder tumor. A 5-year follow up].

OBJECTIVE: Study of the 5-year oncological results of a series of 24 patients treated by conservative surgery and Iridium 192 for stage pT2 bladder transitional cell carcinoma. MATERIAL AND METHODS: Retrospective study of 24 patients (mean age: 60 years) treated between March 1979 and June 1988, for a solitary bladder tumour, with a diameter less than 5 cm, without lymphadenopathy or detectable metastases at the time of treatment. Treatment successively consisted of TUR of the lesion for histological diagnosis, preoperative pelvic irradiation of 10.5 Gy, lymph node dissection in 3 patients, insertion of brachytherapy tubes at the resection site (5 cases), associated with lumpectomy (9 cases) or partial cystectomy (10 cases). 18 patients underwent a brachytherapy with doses of 45 to 60 Gy, while 6 patients received a half-dose protocol: brachytherapy 30 Gy + postoperative external beam irradiation (20 to 30 Gy to the tumour site, 30 to 40 Gy to pelvic lymph node chains). RESULTS: At 5 years, 2 out of 6 deaths were attributable to bladder cancer. 4 other patients died without recurrence, 4 patients relapsed at the site of brachytherapy and/or away from this site, requiring salvage cystectomy in one patient, and repeated TUR +/- BCG therapy in the other three patients. Overall, 18 out of 24 patients were alive at 5 years, 17 had a functional bladder, and 14 were free of recurrence. CONCLUSION: Conservative surgery associated with Iridium 192 brachytherapy can be an oncologically reasonable alternative to total cystectomy for selected pT2 bladder tumours: unifocal tumours, less than 5 cm in diameter.

Adult↗
PubMed1996

Efficacy of an albendazole slow-release capsule for the control of susceptible or resistant nematode parasites of dairy goats.

The efficacy of albendazole slow release capsules-ASRC- (Proftril-Captec) on gastro-intestinal nematodes of dairy-goats was assessed both for benzimidazole (BZ) susceptible and resistant strains. For BZ susceptible strains, the efficacy of ASRC, assessed by controlled test, ranged from 92% for Trichostrongylus colubriformis to more than 99% for Haemonchus contortus on existing worm burdens. The administration of the ASRC prevented infection with the same strains for 85 to 91 days post treatment. In a dairy goat farm, where both in vitro and in vivo tests indicated a high level of BZ resistance, the efficacy of ASRC on present infections, assessed by Faecal Egg Count Reduction test, ranged from 20 to 60% according to the sampling date (13 to 88 days post treatment). On the same farm the ASRC given at turnout to non infected (primiparous) goats prevented egg shedding up to 72 days (30 for controls). In contrast the ASRC given to infected (multiparous) goats did not prevent egg shedding. The present results show that the ASRC is an efficient device for controlling BZ susceptible nematodes. The ASRC prevents infection with BZ resistant larvae whereas existing infections are not reduced.

Albendazole↗