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Biomedical subjects

M Beaufils

Publications and source records attributed to M Beaufils.

At least 55 records · Page 3Linked to original sources

Alterations in renal hemodynamics during chronic and acute beta-blockade in humans.

Renal hemodynamics of hypertensive patients are characterized by an increased renal vascular resistance (RVR), resulting in low renal plasma flow (RPF). Normal glomerular filtration rate (GFR) is maintained through an increased filtration fraction (FF). This pattern may have long term harmful consequences for the kidneys. Propranolol, given in the short- or long-term, lowers both RPF and GFR. Pindolol, as well as so called cardioselective beta-blockers and labetalol, alter renal hemodynamics only slightly, if not at all. In some studies, nadolol has been shown to increase RPF, leaving GFR unchanged. A new beta-blocker, tertatolol, seems to consistently increase RPF and GFR. These different renal actions of various beta-blockers are poorly explained. They may be, however, of clinical significance, in the short term for patients with already impaired renal function, and possibly over the long term for other hypertensive patients.

Adrenergic beta-Antagonists↗

[Compared course of clinical, biologic, echographic and speedometric parameters in retroplancetal hematoma].

The authors have studied 27 cases of Abruptio Placentae (A.P.) (for an observation time of 15 months). These 27 patients where divided into 3 groups: 6 patients without pregnancy follow-up, 5 with a regular follow-up and 16 with an intensive pregnancy follow-up. In this last group following parameters were studied: blood pressure, proteinuria, uricemia, hematocrit, platelet count, FDP, plasma volume, Fetal (umbilical artery) and Maternal (uterine artery velocities with doppler reclude Fetal heart Rate. The total number of intra uterine death and post natal death remained very high: 15 over 27 cases. However this rate was lower in the intensive group, where 10 fetuses with were delivered safely. Studying the evolution of clinical, biological and ultrasonic parameters during the last month before the AP we tried to establish curves of their mean value (every week for the last 4 weeks and every day for the last week). Almost all parameters showed a late significant variation (in the last week). Two of them were modified in the last two days: (FDP and Fetal heart rate acceleration). Two of them were "positive" (in 60 p. 100 of cases) 3 of 4 weeks before the AP: Maternal Plasma volume decrease, Presence of a Notch on the uterine artery doppler curve. In conclusion fetal or neonatal death after AB remains high and even with an intensive follow-up 30 p. 100 of the cases cannot be predicted.

Female↗

[Measurement of maternal plasma volume during pregnancy].

An increased maternal plasma volume (PV) is a characteristic phenomenon of normal pregnancy, which may be related to a physiological decrease of peripheral resistances. The authors have studied the plasma volume of 1,105 patients distributed as follows: normal (387), permanently hypertensive patients (84), hypertensive patients during pregnancy (390), patients with apparently isolated RCIU (154) or with a pathological past-history during previous pregnancies (90). It appears that the PV is a sign of a severe HBP, and presents a rather early and good predictive value regarding the weight of the fetus and some complications such as severe UCIU and fetal death in utero. In case of pathological past events or pre-existing hypertension, the PV enables to differentiate rather well patients who will be prone to a complicated pregnancy. In view of these results, utilization and interpretation criteria of this parameter during pregnancies with hypertension or pregnancies in which there is a suspicion or a risk of intra-uterine growth delay, are defined.

Adult↗

Factors predictive of perinatal outcome in pregnancies complicated by hypertension.

Perinatal outcome and various indicators of perinatal risk were analyzed in a prospective study of 268 pregnant women with hypertension. Poor perinatal outcome was defined by stillbirth (n = 13), neonatal death (n = 2), and in surviving babies, by birth before 32 weeks or a birthweight below 1500 g (n = 13). In multivariate analysis, proteinuria and onset of hypertension between the 27th and 36th weeks of amenorrhea were the only two independent indicators of poor outcome (relative risks of 4.0 and 3.7, p less than 0.001 and p less than 0.01 respectively). Both these indicators were more frequent in mothers with no history of pre-pregnancy hypertension.

Adult↗

Effects of tertatolol in hypertensive patients with chronic renal failure.

Chronic renal failure (CRF) is often associated with hypertension, as a cause or a consequence. We studied the changes in blood pressure (BP), heart rate (HR), renal function (as measured by creatinine clearance), and plasma renin activity (PRA) in 19 hypertensive patients with CRF before, during and after oral administration once a day for at least 30 days of 5 mg tertatolol, a new beta-blocker. All patients were free of any antihypertensive medication for at least 1 month before administration of tertatolol. The dose of tertatolol given in this study was the same as that commonly used in patients with normal renal function. From day 0 to day 30 of tertatolol, measurements in the supine position were as follows: systolic BP (SBP) decreased from 168.4 +/- 4.6 to 145.3 +/- 4.3 mm Hg (p less than 0.01); diastolic BP (DBP) decreased from 106.1 +/- 2.4 to 87.1 +/- 2.0 mm Hg (p less than 0.01); HR decreased from 77.9 +/- 1.6 to 63.2 +/- 1.7 b.p.m. (p less than 0.01); PRA decreased from 1.816 +/- 0.521 to 1.052 +/- 0.323 ng/ml/h (p less than 0.01). Creatinine clearance remained stable: 37.1 +/- 4.1 versus 37.1 +/- 4.7 ml/min/1.73 m2 (not significant). Similar results (for SBP, DBP, HR and PRA) were obtained in the erect position. It is concluded that tertatolol in hypertensive patients with CRF: significantly lowers BP and HR without excessive bradycardia, significantly lowers PRA, the most important decrease being observed for the highest initial PRA, does not alter renal function, and has a good clinical acceptability.

Adrenergic beta-Antagonists↗

Prevention of pre-eclampsia by early antiplatelet therapy.

102 patients at high risk of pre-eclampsia and/or fetal growth retardation were randomly allocated to treatment with 300 mg dipyridamole and 150 mg aspirin daily from 3 months' gestation onwards (group A) or to the control group (group B, no treatment). Group A was twice as likely as group B to have a normal pregnancy. Pre-eclampsia occurred in 6 patients in group B and none in group A. Major complications (fetal death or severe growth retardation) occurred in 9 patients in group B and none in group A. Platelet count and plasma volume were significantly higher in group A than in group B throughout pregnancy. The treatment did not produce serious adverse effects. Antiplatelet therapy given early in pregnancy to high-risk patients may thus protect against pre-eclampsia and fetal growth retardation.

Adult↗

[Immunoglobulin A glomerular nephropathy associated with inflammatory colitis. Apropos of 2 cases].

Two patients, one with ulcerative colitis, the other with Crohn's disease, developed glomerulonephritis due to IgA mesangial deposits. Following symptomatic treatment of the intestinal disease, haematuria subsided in both patients while a second renal biopsy showed disappearance of the mesangial proliferation and IgA deposits. It is suggested that the intestinal and the renal diseases may be linked by abnormal secretion of IgA by the intestinal mucosa with formation of immune complexes, subsequently trapped in the glomerular mesangium.

Adult↗

Renal failure in myeloma: relationship with isoelectric point of immunoglobulin light chains.

Renal failure is a frequent but inconstant complication of myeloma related to light chain excretion. Since it has been suggested that cationic light chains (lc) are most likely to induce renal damage, we have studied the isoelectric point (pI) of light chains produced by 17 patients with myeloma and related the results to the type and severity of renal damage assessed clinically and pathologically. In order to do so, we have applied immunoenzymatic techniques which allow identification of light chain types as well as measurement of pI without prior purification. Ten of fifteen patients with renal failure produced lambda light chains. There was no simple relationship between the isoelectric point and nephrotoxicity. However, light chains with the lowest pI observed in this series were associated with normal renal function in two cases and with acute reversible but severe renal failure requiring dialysis in five cases. By contrast, pI values above 6.0 observed in the remaining patients were associated with moderate renal failure in six patients with recently diagnosed myeloma and with irreversible renal failure, and in two patients in whom myeloma had been evolutive for several years. We thus suggest that further pI measurements may help to identify light chains with different nephrotoxic potentials.

Acute Kidney Injury↗

[Epidemiologic aspects of hypertension in pregnancy. Study of 442 cases].

We studied retrospectively the case records of 442 women who were followed because of hypertension during a pregnancy. Pregnancy hypertension was more frequent in white european than in black or arabic women. It occurred more frequently in women with an important professional activity than it did in housewives. 58% of patients had a familial history of high blood pressure, 35% were obese, 12% had glucose intolerance and 18% had hypercholesterolemia. Those frequencies were out of proportion with those in the control population. Finally, 32% of patients remained hypertensive after pregnancy. It is concluded that pregnancy hypertension occurs mainly in women whose genetic and metabolic background is that of essential hypertension.

Adult↗

[Controlled trial of preventive treatment of preeclampsia. Preliminary results].

We selected 100 patients at high risk for having preeclampsia and/or intrauterine growth retardation, on the basis of their past obstetrical history. At three months, they were randomly allocated to treatment group (group A) receiving dipyridamole (300 mg/day) and low dose aspirin (150 mg/day) until delivery, or control group (group B). Age and parity were similar in both groups. 90 patients have delivered at this time. The pregnancy was normal in 54% of patients in group A and 23% in group B (p less than 0.01). Preeclampsia occurred in 6 patients in group A, none in group B (p less than 0.01). Fetal loss occurred in 5 patients in group B, none in group A (p less than 0.01). Duration of pregnancy, as well as fetal and placental weights were significantly higher in group A, and IUGR significantly less frequent. It is concluded that inhibition of platelet aggregation, when used early in pregnancy, may have a significant protective effect against preeclampsia and IUGR in high risk subjects.

Adult↗

Clinical significance of anti-Sm antibodies in systemic lupus erythematosus.

Case records of 34 patients with systemic lupus erythematosus (SLE) were analyzed. Twelve patients had both anti-DNA and anti-Sm antibodies (Group I) and 22 had anti-DNA antibodies only (Group II). The disease patterns were comparable, except for (1) cutaneous vasculitis, which was observed in six of 12 patients in Group I and one of 22 in Group II (p less than 0.01); (2) pulmonary manifestations, nine of 12 in Group I and two of 22 in Group II (p less than 0.001); (3) cardiac manifestations, eight of 12 in Group I and four of 22 in Group II (p less than 0.01); and (4) renal biopsy, which showed milder lesions in Group I than in Group II (p less than 0.05). Evolution was fatal in four patients in Group I and in none in Group II. It is suggested that in SLE, the presence of anti-Sm antibody is associated with a much higher incidence of vasculitis, resulting in peculiar visceral manifestations, which can be poorly responsive to therapy. Whether there is a direct association between anti-Sm antibody and vasculitis or whether the common denominator is a genetic selection remains to be determined.

Adolescent↗