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Biomedical subjects

M Legrain

Publications and source records attributed to M Legrain.

At least 55 records · Page 3Linked to original sources
PubMed1984

Dialysis treatment of insulin dependent diabetic patients: ten years experience.

From January 1973 to March 1983, 108 IDD patients with a mean age of 46 years were accepted to the dialysis program of the Hôpital de la Pitié. Since January 1973, 67 patients have been treated by hemodialysis. Since August 1978, 38 patients have been treated by CAPD. Three patients have been treated by intermittent peritoneal dialysis. Although diabetic patients remain at a higher risk compared to patients of the same age group, very encouraging results are observed including a 75% survival rate at three years among hemodialyzed patients less than 50 years old. Since 1978, CAPD, when home dialysis was possible, was selected as a first choice treatment. Some severe peritoneal complications still jeopardize the advantages of this method. Diabetics with ESRD, even in the older age group, should not be excluded from treatment. They should be offered within an integrated program all dialysis methods and transplantation.

Acute Kidney Injury↗
PubMed1983

The influence of blood transfusions on lymphocyte reactivity in man.

The effect of planned blood transfusion (BT) on lymphocyte reactivity in previously non-transfused uraemic patients has been investigated. A sustained and non-specific decrease in MLR was observed in approximately 60 per cent of the cases. Other patients had only a transient decrease, normal or increased response. Lymphocyte suspensions whose proliferation was reduced after BT suppressed the response of autologous cells taken before BT. Neither pre-BT degree of immune responsiveness nor clinical status of the patients had any influence on this phenomenon.

Blood Grouping and Crossmatching↗
PubMed1983

Is continuous ambulatory peritoneal dialysis the best dialysis choice for insulin dependent diabetics?

In the last eight years 100 insulin dependent diabetics (IDD) have been dialysed at the Hôpital de la Pitié. Since August 1978 31 have been started on continuous ambulatory peritoneal dialysis (CAPD). Cumulative duration of treatment was 336 patient months, with an average time of 10.8 months. The actuarial technique success rate was 82 per cent at one year and 65 per cent at 18 months. Causes of drop out were seven deaths and six transfers to haemodialysis. The peritonitis rate was one episode every year. For some IDD patients and within the period of observation, CAPD offers a unique opportunity to be dialysed at home with excellent clinical and biological results.

Actuarial Analysis↗
PubMed1983

[Peritonitis during continuous ambulatory peritoneal dialysis. Lavage treatment or not? A prospective study].

A prospective study. To evaluate the advantages of continuous peritoneal lavage in treating peritonitis occurring during continuous ambulatory peritoneal dialysis a prospective study was planned in one Center during a 5 months period. 32 cases of peritonitis divided in two groups were treated according to 2 different protocols, one with continuous peritoneal lavage, the other one with the standard dialysis technique using the bags. Intraperitoneal administration of antibiotics was similar in both groups. Results show no significant advantages in using peritoneal lavage. Continuous lavage should be restricted to cases whose treatment is started late as well as those with purulent dialysate and fungi infections.

Adult↗
PubMed1983

[Continuous ambulatory peritoneal dialysis (CAPD). 3 years' therapeutic experience in 100 patients].

The pros and cons of CAPD are weighed up on the basis of a 3-year study on 100 patients with renal insufficiency (61 men, 36 women and 3 children). If equal groups are compared, the survival rate corresponds to that of haemodialysis. Continuous detoxication and dehydration lead to a good uraemic metabolic situation (creatinine 960 mumol/l, urea 24 mmol/l, haemoglobin 98 g/l, albumin 31 g/l. The serum electrolytes are well-balanced, anorganic phosphate is normal. The rise in cholesterol and triglycerides observed is a possible negative influence with regard to arterial sclerosis. The functioning of the kidneys is not affected by CAPD. The main risks of this method of therapy are peritonitis and loss of protein via the peritoneal dialysate, which can be favourably influenced by strictly antiseptic handling when changing the dialysate bag and a sufficient protein supply in the diet. In France 10-15% of all patients with terminal renal insufficiency will be treated with CAPD in future.

Adolescent↗
PubMed1983

Evolution of residual renal function in patients undergoing maintenance haemodialysis or continuous ambulatory peritoneal dialysis.

A study has been carried out to compare over an 18 month period the residual glomerular filtration rate (GFR) measured by the creatinine clearance in two matched groups of 25 patients with end-stage renal disease. One group was treated by continuous ambulatory peritoneal dialysis, the other one by maintenance haemodialysis. GFR was similar in both groups immediately before starting dialysis therapy, respectively 4.3 +/- 2.3 and 4.4 +/- 2.4 ml/min. From the beginning of the dialysis treatment to the eighteenth month there was a significant and progressive decrease of GFR in the group of patients treated by haemodialysis, while in the peritoneal dialysis group GFR and peritoneal clearances remained stable.

Adult↗
PubMed1982

Pharmacokinetics of sulfamethoxazole--trimethoprim combination during chronic peritoneal dialysis: effect of peritonitis.

The pharmacokinetics of the fixed combination trimethoprim sulfamethoxazole (TMP--SMZ), including peritoneal transfer, has been studied in patients with end-stage renal disease treated by peritoneal dialysis, intermittent in 18 cases and continuous ambulatory dialysis in 6 cases. After a single oral dose of TMP 4 mg and SMZ 20 mg per kg, peak serum levels of approximately 2.0 micrograms/ml TMP and 28 micrograms/ml SMZ were achieved at 4 hours for TMP, and at 6 hours for SMZ. The protein binding of TMP was 34.7 +/- 1.1% and its distribution volume was 2.2 +/- 0.51/kg. Total plasma clearance of TMP was 66.2 +/- 11.5 ml/min, peritoneal dialysance was 5.1 +/- 0.5 ml/min, and renal clearance was negligible. The protein binding of SMZ was 48.0 +/- 1.4% and the distribution volume was 0.55 +/- 0.071/kg. Total plasma clearance of SMZ was 26.2 +/- 5.7 ml/min, peritoneal dialysance was 1.2 +/- 0.2 ml/min, and renal clearance was negligible. The half lives of TMP and SMZ were 23.7 +/- 4.0 h and 18.1 +/- 3.5 h, respectively. The peritoneal dialysance both of TMP and SMZ after oral administration was very low. In contrast the absorption after intra-peritoneal administration is high. Peritoneal absorption was increased during peritonitis. In patients with peritonitis, the intra-peritoneal administration of TMP-SMZ resulted in an immediate high local concentration, and a serum concentration of both drugs in the therapeutic range within 6 to 12 h.

Administration, Oral↗
PubMed1982

Erythrocyte organic phosphates and whole blood oxygen affinity in patients on continuous ambulatory peritoneal dialysis.

Whole blood oxygen affinity, erythrocyte pH and organic phosphates were studied in five anaemic untransfused patients with end stage renal disease undergoing continuous ambulatory peritoneal dialysis. Decreased whole blood oxygen affinity with increased adenosine triphosphate and normal 2.3 diphosphoglycerate (DPG) values were observed. Normal and stable serum phosphate and permanent mild metabolic acidosis may be important factors contributing to maintain DPG levels within the normal range despite anaemia. Continuous dialysis avoids cyclic fluctuation of blood oxygen affinity as described during and after dialysis sessions in patients on maintenance haemodialysis.

2,3-Diphosphoglycerate↗
PubMed1982

Regulation of glutamine synthetase from Saccharomyces cerevisiae by repression, inactivation and proteolysis.

Glutamine synthetase activity is modulated by nitrogen repression and by two distinct inactivation processes. Addition of glutamine to exponentially grown yeast leads to enzyme inactivation. 50% of glutamine synthetase activity is lost after 30 min (a quarter of the generation time). Removing glutamine from the growth medium results in a rapid recovery of enzyme activity. A regulatory mutation (gdhCR mutation) suppresses this inactivation by glutamine in addition to its derepressing effect on enzymes involved in nitrogen catabolism. The gdhCR mutation also increases the level of proteinase B in exponentially grown yeast. Inactivation of glutamine synthetase is also observed during nitrogen starvation. This inactivation is irreversible and consists very probably of a proteolytic degradation. Indeed, strains bearing proteinase A, B and C mutations are no longer inactivated under nitrogen starvation.

Glutamate-Ammonia Ligase↗
PubMed1982

Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study.

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.

Adolescent↗
PubMed1982

[Renal function substitutes. Technical and logistic orientation of the treatment].

In France about 50 new patients per million of inhabitants per year with end stage renal disease (ESRD) require treatment with dialysis and/or transplantation. For the last few years new dialysis methods as hemofiltration and continuous ambulatory peritoneal dialysis have been extended. It is too early to predict what will be the role and the future of such methods as compared to hemodialysis, the gold-standard. Appropriate logistics of treatment of ESRD rely on an integrated dialysis-transplantation program. In France the percentage of some modes of therapy, including home dialysis and transplantation, should be increased.

Blood↗