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M Kessler

Publications and source records attributed to M Kessler.

At least 199 records · Page 11Linked to original sources
PubMed1994

Experimental articular toxicity of aluminum compounds in vivo.

OBJECTIVE: To investigate the articular toxicity of 2 aluminum derivatives, one insoluble (hydroxide) and/or the other soluble (lactate), after a single administration in rabbits and rats. METHODS: First, aluminum levels in plasma, urine, synovial tissue, liver and kidney were measured in saline treated rabbits and 1 to 2 days after an articular injection of 75 mg of aluminum compounds into their right knee. The methodology used was argon plasma emission spectrometry. Thereafter, the joint toxicity of aluminum lactate at the same dose regimen was evaluated for 2 days by a qualitative histological examination of synovial tissue and articular surfaces and a colorimetric assay (1,9-DMB) of patellar articular cartilage proteoglycan content. Secondly, the single injection of 50 mg of aluminum derivatives as an inducer of inflammation was studied in the rat subcutaneous air pouch, a model for a synovial-like space. Leukocytes and eicosanoids levels were measured in pouch washout fluids from 1 to 72 h after injection. RESULTS: After injection into rabbit knee, aluminum lactate largely distributed within the body while hydroxide remained locally. However, aluminum lactate resulted in perivascular edema, sparse infiltration of inflammatory cells in the synovium and a hemorrhagic effusion. Proliferation of the synovial cell layer coexisted with an apparent loss of proteoglycan in superficial zones of tibial and femoral cartilages when patellar proteoglycan content remained unchanged. Aluminum hydroxide did not affect joint structures. In the air pouch experiment, aluminum lactate increased prostaglandin E2 (PGE2) levels from 3 to 10 h after its injection and less intensively leukotriene B4 (LTB4) levels after 6 h, in the absence of leukocytes migration into the cavity. In contrast, aluminum hydroxide increased leukocytes count in pouch-washout fluid from 3 to 24 h after its injection when PGE2 and LTB4 levels were little modified. CONCLUSION: Although some differences attributable to dissimilarities in the experimental model used, aluminum compounds, even in a soluble form, may damage joint structures either directly or through stimulating the secretion of eicosanoids by synovial-like cells.

Aluminum Compounds↗
PubMed1994

APD: clinical measurement of the maximal acceptable intraperitoneal volume.

In automated peritoneal dialysis (APD) patients treated with 3-L dwell, intraperitoneal volumes can easily be increased up to 4 or 4.5 L using hypertonic solutions without objective control of their good tolerance. In 20 adult patients treated with continuous ambulatory peritoneal dialysis (CAPD) in good conditions, hydrostatic intraperitoneal pressure (IPP) and pulmonary vital capacity (VC) were measured in strict supine position, after infusing isotonic dialysate in 0.5-L increments from 2 up to 5 L as tolerated, according to intraperitoneal volumes (IPV). None of the patients had cardiac or pulmonary dysfunction. IPP was measured following a routine method previously described. In all cases, experience was stopped when IPP increased over 20 cm H2O and/or VC decreased over 25%. IPV is linearly and positively correlated with IPP (p < 0.0001), and negatively with VC (p = 0.0012), but the reliability of VC is less than that of IPP, particularly in old patients. Clinical symptomatology of bad IPV tolerance never occurred alone and was always associated with an increase in IPP over 20 cmH2O and/or a decrease in VC over 25%. The maximal acceptable IPV is better defined by an IPP less than 18 cmH2O, according with a decrease in VC of less than 20%. Routine measurement of IPP can be used to determine maximal IPV and for optimal PD prescription.

Adult↗
PubMed1994

[Acute postoperative renal insufficiency in renal transplantation. Incidence and risk factors].

Delayed renal function (DFG) is known to influence both the short and long-term outcome of transplanted kidneys. Data collected retrospectively on all 129 cadaveric renal transplants performed between January 1991 and January 1993 within a single center were analyzed. 42 (32.55%) cases of acute renal failure (ARF) occurred during the immediate postoperative period and 28 patients required dialysis. When compared with immediate good allograft function, DGF was associated with previous failed transplant (7/15 vs 35/114, p = 0.01), donor age (39.2 +/- 13 vs 30.1 +/- 12 years, p = 0.01), and episodes of collapsus of the donor (11/25 vs 31/104, p < 0.01). The graft function of the recipient was not correlated with the serum creatinine of the donor. There was no apparent relationship between the cold ischemia or the anastomosis time and the occurrence of DGF. One-year patient and graft survival were similar in the two groups (respectively for the group ARF and without ARF: 96.4% and 96.5%; 88.8% and 89%), but patients with DGF had higher serum creatinine values at 12 months post DGF (185.6 +/- 44.8 mumol/l vs 157.5 +/- 30.8 mumol/l, p = 0.06). This study suggests that DGF is related to the characteristics of the donor graft and is more frequently encountered in previously transplanted recipients.

Acute Kidney Injury↗
PubMed1994

[Carcinoma of the native kidney in patients with renal transplantation. A French multicenter study].

A study was undertaken to investigate the development of carcinoma in patients' own kidneys after renal transplantation. Twenty carcinomas were diagnosed among 16,755 patients grafted from 1952 to February 1993. It was possible to collect data for 17 detected carcinomas. These tumours developed in 17 patients, 14 male and 3 female, aged 31 to 64 years old. They appeared an average of 40 (range 1-204) months after transplantation. The maintenance treatment consisted of cyclosporine in 15 recipients. Four patients demonstrated clinical signs. The other 13 carcinomas were diagnosed as an incidental finding on ultrasound (n = 10), at autopsy (n = 1) or by examination of kidneys from nephrectomy (n = 2). In the patient group with incidental diagnosis, tumors were larger than 4 cm in 3 out of the 9 cases studied; they were confined to the kidney in 5 cases and lymph node invasion or renal vein involvement were noted in 1 case. Distant metastases were present in 3 symptomatic patients and in 1 "incidental" case. Except for tumours discovered on nephrectomies or autopsy, a nephrectomy was performed in all cases. Death occurred 1 to 12 months after diagnosis in the recipients with metastatic tumours. A colic carcinoma was diagnosed 6 months after nephrectomy in one patient. The other 11 patients are doing well as the immunosuppressive treatment is being continued.

Adult↗
PubMed1994

[Lymphoproliferative lesions localized in the renal graft. A French multicenter study].

Thirty-two French transplant centers participated in the study of lymphoproliferative disease (LPD) confined to the renal allograft. For the period from 1952 to February 1993, 16 cases were recognized from 16,755 renal transplant recipients. The mean age of the patients was 44 years (range 19-67 years). Fourteen of these recipients received anti-lymphocyte globulin as induction therapy and 13 received cyclosporine as their maintenance immunosuppressive treatment. Acute rejection was reported in 9 cases and was treated with methylprednisolone in 6 cases and with mono- or polyclonal antibodies for 3 episodes. The mean interval from transplantation to development of LPD was 14 months (range, 1-144 months). Most of the patient (12/15) showed symptoms. Renal failure was noted in 7 recipients. Renal ultrasound demonstrated hydronephrosis in 4 cases, a hilar mass in 5 cases, a mass lesion within the graft in 2 cases. Pathological examination showed a high grade malignant lymphoma with extensive necrosis and atypical large cells. Immunohistochemical study was consistent with B-cell lymphoma in all of the 8 cases analyzed and monotypia was noted in 4 cases. The presence of Epstein-Barr virus genome in the LPD was demonstrated in 5 of the 6 cases studied. Nine patients were managed with discontinuation of immunosuppression and transplant nephrectomies. Four patients died. The remaining recipients are alive with no evidence of recurrence after 25 months (range 3-68 months).

Adult↗
PubMed1993

Cyclothiazide decreases [3H]AMPA binding to rat brain membranes: evidence that AMPA receptor desensitization increases agonist affinity.

The effects of cyclothiazide, a drug which blocks AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor desensitization, were tested on binding of [3H]AMPA to rat brain membranes. Cyclothiazide reduced [3H]AMPA binding by lowering the apparent affinity of the AMPA receptor. The magnitude of the decrease was temperature dependent and greater for membrane-bound than for solubilized receptors. These data provide evidence that desensitization increases the affinity of the AMPA receptor for agonists and indicate that a significant percentage of AMPA receptors in conventional equilibrium binding assays are in a desensitized state.

Animals↗
PubMed1993

Bacteremia in patients on chronic hemodialysis. A multicenter prospective survey.

A prospective epidemiologic survey of bacterial infections in chronic hemodialysis patients was conducted from September 1, 1989 to February 28, 1990 in 27 dialysis units. Of the 1,455 patients enrolled in the study, 55 presented 63 episodes of bacteremia (incidence of 0.7 bacteremia per 100 patient-months). The portal of entry of sepsis was the vascular access in 50.8% of the episodes. The causative microorganisms were most often gram-positive cocci (69.8%). 23% of the teremic patients had a serum ferritin > 1,000 micrograms/l versus 7% of the nonbacteremic infected patients (p = 0.005). 39.7% of the patients had undergone a surgical operation during the month preceding the bacteremia. Eight patients had a recurrence during the study period and 8 had a metastatic localization: spondylodiscitis 2, septic pulmonary embolus 2, endocarditis 1, arthritis 1, liver abscess 1 and endophthalmia 1. 66% of the episodes required a hospitalization that lasted an average of 20 days. Mortality rate was 6.3%. This prospective study showed a trend towards a reduction in incidence and mortality of bacteremia in patients on chronic hemodialysis.

Adult↗
PubMed1993

Dialysis-associated arthropathy: secondary ion mass spectrometry evidence of aluminum silicate in beta 2-microglobulin amyloid synovial tissue and articular cartilage.

The role of aluminum accumulation in articular tissues of patients affected by dialysis-associated arthropathy (DAA) is questioned. The aim of this work is to identify the nature of these aluminum accumulations by the use of secondary ion mass spectrometry (SIMS). Al/Si ratios of about 1, measured by SIMS, strongly suggest for the first time the presence of aluminum silicates and possibly aluminum hydroxides in amyloid synovial tissue and articular cartilage of 1 patient with DAA and aluminum intoxication. This is thermodynamically consistent with the total dissolved Al and Si contents and pH measured in the synovial fluids. These results are similar to the abnormal Al distribution recently found by SIMS in the forebrain of chronic renal dialysis patients and to the amorphous aluminum silicates identified in the core of senile plaques in Alzheimer's disease.

Aluminum Silicates↗
PubMed1993

Confidentiality.

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Civil Rights↗