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Biomedical subjects

M Lacombe

Publications and source records attributed to M Lacombe.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Arterial stenosis in transplanted kidneys. 86 surgically treated cases].

Eighty-six patients who had undergone renal transplantation three months to five years before, were operated on for a stenosis of the artery supplying the grafted kidney. The diagnosis was made by angiography performed because of refractory hypertension with or without impaired renal function. Surgical repair of the stenosis cured or improved arterial hypertension in 48 patients and improved renal function in 17 of 29 with impaired renal function. Different types of stenosis were recognized: stenosis of the recipient artery, stenosis of the suture line, stenosis of the donor renal artery (segmental or diffuse) and multiple stenoses. The most frequent site of stenosis was the donor artery. There seems to be no single cause of stenosis: atheroma of the recipient vessels, trauma to donor or recipient arteries, faulty suture techniques, hemodynamic disturbances account for some cases whereas in other cases the evidence points to an immune mechanism. This complication of renal transplantation appears now as the most frequent one; therefore, routine vascular investigations should be performed at repeated intervals in all transplanted patients. Surgical repair is indicated in tight stenoses with impending thrombosis and in stenoses responsible for severe hypertension which does not respond to anti-hypertensive treatment. The other patients with mild to moderate hypertension responding to medical treatment, without renal function impairment, and with moderate stenosis can be managed medically. In our experience, surgical correction of the stenosis is indicated approximately in one half of the patients in whom a stenosis has been discovered.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

Chronic B-cell lymphocytosis.

Persistent elevation of lymphocyte counts is usually associated with a malignant monoclonal lymphoproliferative disease. Over the last 8 years, amongst patients investigated in our center for undetermined persistent lymphocytosis, a diagnosis of malignant lymphoproliferation was excluded in 6 cases as studies of surface membrane immunoglobulin light chains showed that they presented a polyclonal expansion of their B-lymphocyte pool. All patients were young-to-middle aged women presenting peculiar immunohematologic findings characterized by 1) persistent (2-7 yr) elevation of lymphocyte counts (4-14 x 10(9)/l), 2) presence of characteristic binucleated B cells on peripheral blood smears, 3) a normal bone marrow histology, 4) a polyclonal increase of serum IgM with low-to-normal IgG and IgA levels. Histologic examination of the spleen in 2 patients and lymph nodes in 1 showed a benign follicular lymphoid hyperplasia. The evolution was benign in every case. We suggest that chronic polyclonal B-cell lymphocytosis is a distinct clinicopathologic entity that should not be confused with malignant lymphoproliferative disorders.

Adult↗
PubMed1989

[Aneurysms of the renal artery. Personal experience in 101 cases].

The authors operated on 101 aneurysms of the renal artery in 97 patients. A great majority of the patients had dysplastic aneurysms. In most cases, the aneurysm was associated with other lesions: of the renal artery (41 cases), of the kidney (17 cases), of the aorta or of other visceral arteries (10 cases) or of other organs (4 cases). Renal artery dysplastic aneurysms are usually saccular and have a fibrous neck. Their walls are frequently very thin, predisposing to rupture. Intrasaccular thrombosis is rare. In nearly all patients, the aneurysms were discovered on angiography performed because of arterial hypertension. When no stenosis of the renal artery is present, the aneurysm itself cannot be held responsible for the hypertension. Treatment consisted of 16 nephrectomies and 85 arterial repairs; 16 of the repairs were performed by ex situ surgery. Modalities of repairs depend on anatomical arrangement of the vessels. Use of an arterial substitute is optional: an arterial autograft is the material of choice. Surgical repair protects against the threat of aneurysmal rupture. Arterial hypertension is cured only when an associated stenosis has been repaired. Surgical treatment is recommended in most cases. Failures have considerably decreased with experience and the use of ex situ repair.

Adolescent↗
PubMed1989

[Surgical treatment of renal artery stenosis in children].

Fifty six children with renal artery stenosis (unilateral in 42, bilateral in 14) underwent surgical treatment. Ten nephrectomies and 63 vascular repair procedures were performed. Postoperative follow-up varied from 1 to 14 years. After surgery, blood pressure returned to normal and subsequently remained so in 51 patients without any antihypertensive medication. This represents a 91% success rate. In five patients blood pressure remained high due to lesion of the renal parenchyma. Fibrous dysplasia of the renal artery was the prevailing pathologic findings. In children, associated lesions are especially frequent: coarctation of the abdominal aorta, stenosis, occlusion, aneurysms of the splanchnic arteries, pheochromocytoma. Postoperative prognosis of renovascular hypertension in children is good since atheroma and visceral or renal lesions are usually lacking.

Adolescent↗
PubMed1989

[Ex situ surgical repair of complex lesions of the renal artery].

Forty one patients underwent ex situ repair of complex renal artery lesions. This series includes 22 males and 19 females, 10 children and 31 adults. Ages of the patients were comprised between 17 months and 70 years. The operated lesions were: --aneurysms of the renal artery and/or of its branches with or without associated stenosis: 16 cases; --spontaneous dissection of the renal artery with extension to the branches: 7 cases; --extensive dysplasia extended to distal branches: 16 cases; --dysplasia of the artery with segmental lesion of the kidney: 2 cases; --reoperation on the renal artery: 2 cases. In all cases, the kidney was exteriorized after transsection of its vessels. It was cooled by perfusion of cold Eurocollins solution. After repair, the kidney was reimplanted either in the lumbar (16 cases) or in the iliac fossa (27 cases). An arterial substitute was used in 32 cases: 26 arterial and 6 venous autografts. No mortality was observed in this series. Two postoperative thromboses occurred leading to kidney loss (4.6%). Segmental thrombosis leading to partial atrophy of the kidney occurred in 3 cases (7%). During the late follow-up, one iterative stenosis was observed and required nephrectomy; two fusiform dilations of venous autografts were also observed. In all other cases (35 patients, 85.3%), repair of the lesion was successful. Ex situ repair must be reserved to: 1) lesions involving several branches of the artery whose repair requires prolonged renal circulatory arrest and 2) lesions profoundly situated in the renal sinus, especially aneurysms, whose repair is difficult by conventional in situ surgery.

Adolescent↗
PubMed1988

Renal artery stenosis after renal transplantation.

Stenosis of the transplant renal artery was discovered in 113 of 971 (11.6%) renal transplantation patients between three months and five years after transplantation. Diagnosis was reached by angiography performed because of hypertension, with or without impaired renal function. The stenosis was repaired in 63 patients with cure or improvement of hypertension in 35, and improvement of renal function in 12 of 23 patients with impaired renal function. The different types of stenosis were: recipient renal artery stenosis, suture line stenosis, donor artery stenosis (the most common), and multiple stenoses. The causes implicated were: recipient atheroma, faulty suture technique, hemodynamic disorders, trauma, and immunologic mechanisms. As the incidence of this complication is underestimated, routine angiography in all transplant recipients is suggested.

Blood Vessel Prosthesis↗
PubMed1988

Renal artery emboli: the role of surgical treatment.

Twelve cases of emboli to the renal artery (one of which was recurrent) were reviewed. In seven patients, emboli were unilateral and the opposite kidney was functional. In five patients, emboli were bilateral or occurred in a solitary kidney, leading to anuria. Cardiac rhythm disorders were encountered in eight patients and were responsible for emboli in other areas in three. Arteriography in ten patients demonstrated seven complete truncal occlusions (one bilateral), two incomplete truncal occlusions, and one distal embolus. One patient with a distal embolus was treated by heparin alone with satisfactory results. One patient in poor general condition was treated with intraarterial streptokinase, resulting in incomplete lysis of the clot. The five patients with anuria were operated on: four regained satisfactory renal function whereas the other patient died. In five patients without anuria who were operated upon, renal function returned to normal in four, and one patient required nephrectomy. Surgical treatment is imperative with anuria and is indicated in unilateral emboli with a functional contralateral kidney, especially when there is complete occlusion of the renal trunk. If the embolus is recent, intraarterial fibrinolytic treatment or percutaneous embolectomy can be attempted, but these techniques are not of proven efficacy. Patients with distal emboli or contraindications to operation should be treated by anticoagulant therapy, alone or with local fibrinolytic treatment.

Aged↗
PubMed1988

One-month prophylactic use of OKT3 in cadaver kidney transplant recipients.

Fifty-five recipients of first cadaveric renal allografts were randomly assigned to three treatment groups in order to compare the safety and efficacy of a mouse antihuman T cell monoclonal antibody (OKT3) given prophylactically for a one-month period. This long period of administration was made possible by concomitant administration of azathioprine. The immune response against the foreign immunoglobulin was thus delayed and decreased in both intensity and severity, and OKT3 treatment could be given during almost the entire month in the majority of patients. The 18 patients who were enrolled in this treatment group had significantly (P less than 0.01) fewer rejection episodes during the first month posttransplantation than the 19 patients allocated to the high-dose (HD) steroid control group or the 18 patients allocated to the low-dose (LD) control group. Actual 2-year as well as actuarial 4-year graft survival rates were 89% in the OKT3 group, whereas they were 70% and 67% respectively in the steroid control groups. Four-year serum creatinine levels were normal and doses of steroids and other immunosuppressive agents were lower in the OKT3 group as compared with the control groups. Tolerance to OKT3 was good, and while viral infections were more frequently observed in OKT3 treated patients, the total number and the severity of infectious episodes were similar in all groups. The combination of one-month OKT3 plus azathioprine prophylaxis followed by conventional azathioprine plus low-dose steroid maintenance produced very satisfactory long-term results comparable to the best results now being obtained with cyclosporine regimens.

Adult↗
PubMed1988

Delayed hypertension after blunt renal trauma.

Severe hypertension developed in 4 patients who had sustained blunt renal trauma 2-32 years previously. A protracted period of normal blood pressure separated the renal injury from the onset of hypertension. Angiography disclosed lesions which had been underestimated by intravenous pyelography. These lesions consisted of traumatic dissection of branches of the renal artery, leading to renal infarct. In 3 cases, unilateral high renin secretion was demonstrated, and in 1 case this was confirmed by immunofluorescence with an anti-renin antiserum which showed abundant renin granules within the infarcted zone. In all patients, total or polar nephrectomy was followed by return of blood pressure to normal or near-normal levels. Blunt renal trauma is an underestimated cause of renovascular hypertension.

Adult↗
PubMed1987

[Preventive treatment of rejection by the prolonged administration of OKT3: decrease of the immune response of the host].

Clinical use of OKT3 for the treatment of ongoing rejection episodes has already been demonstrated as being highly effective. This work shows for the first time that combining azathioprine and OKT3 was able to delay as well as to decrease both the intensity and the quality of the anti-OKT3 immunization, allowing a 1-month prophylactic use of the MoAb. It also proves that OKT3 used prophylactically during one month can lead to 4-year first cadaver graft and patient survival rates better than those ever reported with any other immunosuppressive regimen. These results were obtained with lower doses of steroids and other immunosuppressive agents than in conventionally treated control patients. After the first two injections of OKT3, tolerance was perfect allowing out-hospital administration, and side effects consisted only in an increased number of viral infections instead of the bacterial infections observed in the conventional treatment groups. The prophylactic use of OKT3 should give even better results if it were possible to reach a 1-month administration schedule in all patients by modulating the dose of OKT3 according to the T3+ cell count and the monitoring of serum OKT3 levels.

Antibodies, Monoclonal↗