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Biomedical subjects

M Krempf

Publications and source records attributed to M Krempf.

155 records · Page 9Linked to original sources
PubMedDate not supplied

[Arterial hypertension in patients with obesity. Role of hyperinsulinism and insulin resistance].

The association between arterial hypertension and obesity has been known for many years and demonstrated by epidemiological studies. The physiopathological mechanisms involved consist of increased extracellular volumes, hyperactivity of the sympathetic nervous system and the renin-angiotensin-aldosterone system, and abnormal ion exchanges between extra- and intracellular compartments. Recent studies have demonstrated an association between arterial hypertension and insulin resistance. Insulin resistance may well be the most important aetiological factor in this type of arterial hypertension as it stimulates both renal sodium reabsorption and sympathetic nervous system activity and reduces vascular Na-K-ATPase activity.

Humans↗
PubMedDate not supplied

Recommendations regarding obesity surgery.

In France, 1,000 obese persons per month undergo a bariatric operation. Obesity surgery requires coordination and monitoring of aftercare. The French public health-care insurer asked the medical associations involved in obesity management to provide guidelines for obesity surgery. The recommendations were developed by the national associations of Obesity, Nutrition and Diabetes: the Association Française d'Etudes et de Recherches sur l'Obésité (AFERO), member of the EASO and IASO; the Association de Langue Française pour l'Etude du Diabète et des Maladies Métaboliques (ALFEDIAM); the Société Française de Nutrition (SFN); and the Société Française de Chirurgie de l'Obésité (SOFCO). This article presents the short version of the guidelines.

Bariatric Surgery↗
PubMedDate not supplied

[MICROALB study: screening for microalbuminuria in type 2 diabetic hypertensive patients by general practitioners in France].

OBJECTIVE: To determine the prevalence of microalbuminuria (MAU) detected by a specific urinary strip in type 2 diabetic hypertensive patients in metropolitan France. METHOD: Screening for MAU with a semi-quantitative strip measuring the albumin/creatinine ratio was performed by general practitioners (GPs) in 6 type 2 diabetic hypertensive patients. This screening method was considered reliable if a preliminary search for proteinuria was performed with a usual strip and the quality of the MAU reading was good. RESULTS: 3347 GPs screened 19,714 patients (60% M, average age 64 +/- 10 years): 43.3% had MAU. MAU screening was considered reliable for 6679 patients (61.8% M, average age 65 +/- 10 years): 48.5% had MAU (alb/creat ratio between 30 and 300 mg/g), and 10.7% had manifest MAU (alb/creat ratio >300 mg/g). In all cases, the prevalence of MAU increased with the severity of hypertension. In the population with a reliable MAU screen, the analysis of risk factors according to the level of MAU yielded the following results: [table: see text]. In the MAU+ group, the need for multiple antidiabetic (including insulin) and antihypertensive drugs was more frequent. In contrast to current guidelines, only a minority of patients received an antiplatelet agent (approximately 33%). CONCLUSION: Despite recommendations, screening for proteinuria in type 2 diabetic hypertensive patients is seldom performed. However, the prevalence of MAU was high in this patient population. The prevalence of comorbidities and risk factors was significantly higher in the MAU+ group, with less frequent BP control despite a more aggressive antihypertensive treatment.

Aged↗
PubMedDate not supplied

Treatment of malignant pheochromocytoma with [131I]metaiodobenzylguanidine: a French multicenter study.

Six Medical Centers in France were involved in a prospective study evaluating the efficacy of [131I]metaiodobenzylguanidine (131I-MIBG) in the treatment of malignant pheochromocytoma. Fifteen patients aged from 28 to 75 years bearing tumor sites demonstrating a good MIBG uptake were included in this study. Catecholamines were elevated in 13/14 cases, VMA in 9/14 and metanephrines in 13/14. Two to 11 therapeutic activities of 131I-MIBG were administered, with a mean number of therapeutic doses per patient of 4 and a mean single activity of 4.7 GBq (range 2.9 to 9.25 GBq). Seven patients were alive, and seven patients died 6 to 29 months after their first MIBG administration (mean follow-up of 36 months); 1 patient was lost to follow-up. Two patients had a partial tumor response only, 4 had a hormonal response only, and 3 had both a partial tumor response and a hormonal response (complete in 2 cases). Six patients did not respond to the treatment, 4 of them died. Of the 9 responding patients, 4 relapsed, 3 of whom died subsequently. Haematological toxicity was always transient and mild, except in 1 case.

3-Iodobenzylguanidine↗
PubMedDate not supplied

[Study of home ventilation in severe respiratory insufficient patients (author's transl)].

Results of our study of 91 cases show that many indications of ventilation at home are debatable:--Tracheostomized patients submitted to continuous ventilation with short disconnected periods;--Patients using the respiratory apparatus more than 4--6 hours per day, through a mouth-piece. The existence of a reserve closely related to the intensive care department and mobile emergency unit (S.A.M.U.) facilitates supervision and eventual technical or medical assistance. In addition, the running cost remains small because of the adaptability of the system. However, it seems of interest to point out a group of 11 patients whose treatment was interrupted either because of their improvement (physical therapy, suppression of tobacco mainly), inadequate indications, or poor cooperation.

Aged↗
PubMedDate not supplied

[Application of residual positive pressure during assisted ventilation at home using pressure relaxator devices (author's transl)].

A residual postive pressure (R.P.P.) of low magnitude (1 to 4 cm of water) was used during assisted ventilation by pressure relaxator in an attempt to decrease the expiratory dynamic compression of the airways. A ventilatory test involving 80 respiratory insufficient patients (73 men and 7 women) shows that with assistance the tidal volume of half of the subjects increased by more than 20% (average gain: 32%). The patients with the highest RV/TC ratio benefitted most from the method. Finally, the arterial blood gases were not significantly modified. A longitudinal study involving 46 subjects observed for an average period of 24 months revealed a marked subjective improvement in the patients' condition without significant modification of the blood gas figures. No incident or accident was attributed to the use of R.P.P.

Bronchitis↗
PubMedDate not supplied

Short term effect of an aldose reductase inhibitor on urinary albumin excretion rate (UAER) and glomerular filtration rate (GFR) in type 1 diabetic patients with incipient nephropathy.

OBJECTIVE: Increased activity of the enzyme aldose reductase in the polyol pathway, occurring with hyperglucaemia, has been implicated in the development of late diabetic complications. The effect of an aldose reductase inhibitor (Ponalrestat) on renal function in type 1 diabetes with incipient nephropathy (urinary albumin excretion rate > 20 micrograms.min-1) was evaluated. RESEARCH DESIGN AND METHODS: Thirty Type 1 diabetic patients (age: 34.4 +/- 3.1 yrs; diabetes duration 13.1 +/- 1.3 yrs) were treated with 600 mg of Ponalrestat per day for 3 months using a randomized double blind placebo controlled crossover design. Urinary albumin excretion rate and glomerular filtration rate were measured. RESULTS: Twenty three patients completed the entire study. Compared to placebo, there was no significant change in urinary albumin excretion rate and glomerular filtration rate during the Ponalrestat treatment period. Blood pressure and HbA1 were also unchanged during the placebo and Ponalrestat periods. Treatment with Ponalrestat appeared to be safe and there were no side effects. CONCLUSION: We conclude that three months aldose reductase inhibition with Ponalrestat had no effect on urinary albumin excretion rate and glomerular filtration rate in Type 1 diabetic patients with incipient nephropathy.

Adolescent↗