[Renal transplantation to-day].
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Biomedical subjects
Publications and source records attributed to J Traeger.
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The pharmacokinetics of two pyridinol carbamate formulations were studied after a single oral administration in 10 healthy volunteers. An open one-compartment model described the evolution of plasma concentrations as a function of time. Pyridinol carbamate was rapidly absorbed (mean lag time from 0.36 to 0.38 hr). Its elimination half-life ranged from 3.3 to 7.9 hr. The two formulations were bioequivalent.
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A potent inhibitor of cell proliferation was found in the urine of a patient with chronic renal failure. This substance included in "middle molecules" (MM) fraction, was obtained by chromatography. This factor was shown to inhibit noticeably the proliferation of various cells : lymphocytes stimulated by allogeneic cells, monolayer cell lines of normal or tumorous origin and leukemic cell lines derived from acute lymphoblastic leukemia. This effect was reversible and thus could not be related to a direct, rapid cytotoxic effect of MM. Such substances could play an important part in uremic symptoms, such as immunodeficiency, anemia, thrombopenia, gastrointestinal or skin manifestations.
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Two patients, 33 and 26 years old, presented with Fabry's disease and minimal renal involvement. They were treated with a transplant of foetal liver cells exhibiting normal enzymatic activities, after plasma transfusions and symptomatic therapies had proved ineffective. In the first patient, objective and subjective clinical symptoms were significantly improved: sweating appeared, cutaneous lesions seemed slightly decreased and pains disappeared. In the second patient, pains were also seemingly decreased. The mechanism which may be held responsible for improvement of our patients, as of recipients of a kidney transplant, is not completely elucidated. The cells, rather than steroids or azathioprine, seemed to be responsible for the improvement.
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A 41-year-old man who had suffered from insulin-dependent diabetes since the age of twenty and who had severe degenerative complications with chronic renal failure, underwent pancreatic transplantation. The graft was prepared by intraduct injection of neoprene in order to suppress the exocrine function of the gland. It was situated in the iliac fossa and has ensured the complete correction of diabetes for more than 10 months. This favourable situation made it possible to carry out a renal transplant which could not have been envisaged previously in this patient with very unstable and progressive diabetes who was dialysed under very difficult conditions.
Injection into the pancreatic ducts of a synthetic liquid gum (neoprene), which polymerises when it comes into contact with the fluid secreted by the gland, would appear to be a simple and effective means of suppressing exocrine secretion of the pancreas in the dog. Endocrine secretion was remained in the short and mid-term. The therapeutic implications of this new technique in the preparation of pancreatic transplants are discussed.
Suicidal attempt using beta-blockers are rare. Overdose by the ingestion of a large number of tablets rarely exceeds the high therapeutic doses suggested for the treatment of certain resistant cases of hypertension. The case described is that of a 65-year-old patient who took 800 mg of propanolol. Observation of plama levels showed that the half-life propanolol in the case of overdose is prolonged: 8.6 hours in this case, with a maximum plasma level of 1536 ng/ml. Plasma renin activity levels were low during the phase of intoxication and showed evidence of a rebound effect at its end. Treatment is above all that of the circulatory insufficiency produced: isopropylnoradrenaline or glucagon. Indications for extra-renal dialysis should take into account knowledge concerning the pharmacokinetics of these drugs and their prolonged physiological action.
beta2-Microglobulin (beta2-M) concentrations were measured by radioimmunoassay in 63 patients treated with maintenance hemodialysis. Serum levels ranged from 12.5 to 92 microgram/ml and were found stable upon sequential measurements over a 6-month period. Excretion of beta2-M was achieved through urinary loss (up to 150 mg/day) and to a lesser extent by ultrafiltration across acrylopolynitrile but not cellophane dialysis membranes. Proximal tubular cells being the major site of beta2-M catabolism, stable levels in anephric patients indicated a defective production of beta2-M in uremic patients. Serum beta2-M levels were not correlated with predialysis urea, creatinine, hematocrit or middle molecule material. In vitro experiments do not support a possible toxicity of purified beta2-M but do not rule out the contribution of other low molecular weight proteins to uremic toxicity.
A new method of eliminating the exocrine function of the pancreas by obstruction of pancreatic duct with neoprene was investigated in dogs and applied to three cases of human segmental pancreatic transplantation. Neoprene is a liquid synthetic rubber which flocculates with changes in pH. In animals, progressive fibrosis of the pancreatic tissue occurs after injection of neoprene in the main pancreatic duct, leaving islets well vascularized and functioning for prolonged periods. Using this technique, three severely diabetic patients received a cadaver segmental pancreatic allograft. Blood sugar returned to normal levels within the first hours or days after operation. All three grafts continue to function 1.5, 2, and 8 months, respectively, following transplantation. If these results are confirmed by further clinical experience, this method may be of considerable assistance in the treatment of severe diabetes by pancreatic transplantation.