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Biomedical subjects

M Legrain

Publications and source records attributed to M Legrain.

At least 73 records · Page 4Linked to original sources
PubMed1981

[Substitutes for renal function. Technical trends and logistics of 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.

Hemodialysis, Home↗
PubMed1981

Is cryoglobulin detection of clinical significance in chronic glomerulonephritis not related to systemic disease?

Sera from 105 adult patients with idiopathic chronic glomerulonephritis (GN) were investigated to assess the diagnostic and prognostic value of cryoglobulin (CG) detection. CG+ sera were found in 49% of cases but also in 34% of normal donors. CG composition in these two groups was different. Concentrations of CG greater than micron g/ml were considered as abnormal, since concentrations did not exceed this value in the controls. Using this criterion 30% of patients with GN had CG; most had membrano-proliferative GN, GN with mesangial IgA deposits, and membranous GN. CG occurred with the same frequency but at higher concentrations in the group of patients with diffuse proliferative GN than in other groups; however, there was no difference in the frequency and concentration of CG when GN was thought to be mediated by immune complexes (IC) than when it was not. No relationship was observed with disease activity. In conclusion low CG might represent an in vitro artifact of a common in vivo immunoregulatory mechanism in normal donors. Although they might be a marker for the presence of IC in adult patients with GN not related to systemic disease, CG detection appears to be of little help in diagnosis, assessment of disease activity, or therapeutic monitoring.

Adult↗
PubMed1980

Hemodynamic changes induced by regular hemodialysis and sequential ultrafiltration hemodialysis: A comparative study.

The effects of a mean ultrafiltration of 2000 ml on hemodynamics during regular hemodialysis (RD) and during sequential ultrafiltration hemodialysis (SUH) have been compared in ten patients on maintenance dialysis. Each patient was submitted to two dialysis sessions at 2 days' interval. The hemodynamic studies were performed with a thermistor Swan-Ganz catheter. The control values of mean systemic arterial pressure, cardiac output, and heart rate were similar with either RD or SUH. During ultrafiltration without diffusion, there was an immediate prolonged and significant decrease in cardiac and stroke indexes and in pulmonary wedge pressure. The mean systemic arterial pressure remained unchanged as long as the total vascular resistance was significantly increased. During the diffusion period of SUH, total vascular resistance decreased, and seven patients became hypotensive. When ultrafiltration was associated with diffusion during RD, the total vascular resistance remained stable, despite a decrease in cardiac index. This was found to result in severe hypotensive episodes, despite a moderate ultrafiltration. These results suggest that diffusion can induce arterial vasodilation and poor hemodynamic adaptation to ultrafiltration-induced hypovolemia SUH, undertaken under careful medical control, appears to be an excellent procedure to deplete severely overhydrated dialyzed patients, but it should not be used routinely as a substitute for RD.

Adult↗
PubMed1980

Risk factors in chronic haemodialysis.

A survival analysis was performed in 1,453 patients treated by chronic haemodialysis and prospectively followed up in the computerised French Diaphane Dialysis Registry. Risk factors found for overall and cardiovascular mortality are age, male sex, high systolic of diastolic blood pressure, low body mass index and low predialysis values of cholesterol, triglycerides, haematocrit, urea, creatinine and potassium. These results confirm the importance of optimal blood pressure control. They indicate that the nutritional state may play a more vital role than certain cardio-vascular risk factors found in the general population.

Adolescent↗
PubMed1979

[Glomerulonephritis: critical evaluation of immunological tests performed routinely (author's transl)].

The clinical value of the immunological tests performed routinely has been evaluated in 91 patients with various histological types of glomerulonephritis. An antigen possibly involved in the pathogeny of renal disease was found in 24% cases. However, in most instances no direct link between the presence of this given antigen and the disease could be observed. Therefore systematic investigations for antigens should be restricted to dosages of antistreptolysin and antinuclear antibodies and to determination of Hbs antigen. Immune complexes, which were observed in many cases, were of no discriminant value for the clinician. Dosages of the complement fractions and the determination of cryoglobulins can be helpful for diagnostic, follow-up and treatment. Our results justify a restricted selection of the routine immunological tests used in patients with glomerulonephritis. More specific investigations remain useful when they are clinically oriented.

Antibodies, Antinuclear↗
PubMed1979

[Society of Nephrology, Computer Technology Commission. Dialysis computer program. VI. - Survival and risk factors].

The sixth report of the "Diaphane Dialyse Informatique" Program concerns 2,518 adult patients (age 15 and over) treated by chronic hemodialysis or hemofiltration in 33 French dialysis centres between June 1972 and December 1978. 1) The number of centers participating to the program is progressively increasing. Overall duration of follow-up represents 4,192 patient-years, allowing precise evolutive studies of terminal renal failure treated by hemodialysis. 2) Mean age at start of treatment continues to increase. Among 709 patients who started treatment in 1977-1978, 8,8 p. 100 of men and 11 p. 100 of women were over 69 years old. 3) Patients with diabetic nephropathy represent 4,4 p. 100 of all patients dialyzed between 1972 and 1978 and 5,9 p. 100 of the patients starting treatment in 1977-1978. 4) The percentage of patients temporarily treated by peritoneal dialysis before hemodialysis decreases from 32,9 p. 100 in 1973-1974 to 15,9 p. 100 in 1977-1978. 5) In 1978, 65,3 p. 100 of patients are dialyzed 3 times a week with a mean weekly duration of 14,0 h for male and 12,9 for female. 73 p. 100 of the patients are dialyzed during the night. 6) Disposable parallel plate hemodialyzers (71,8 per cent of dialysis sessions in 1978) and hollow fiber hemodialyzers (11,6 per cent) progressively replace disposable coil dialyzers and non disposable Kiil dialyzers. 7) Transient hypotensive episodes during dialysis sessions remain the most frequent complications (21,7 per cent of sessions in 1978). Transient hypotensive episodes are more frequently observed with coils than with parallel plate hemodialyzers or with hollow fiber dialyzers. 8) Mean diastolic blood pressure (DBP) +/- SD is 101,9 +/- 21,7 mmHg at start of dialysis and 81,4 +/- 11,8 mmHg when dialysed. During the course of treatment 28,7 per cent of the patients receive long term antihypertensive treatment. In spite of dialysis and antihypertensive treatments 11 per cent of all patients followed up maintain DBP greater than or equal to 95 mmHg. 9) Viral hepatitis remain the most prominent infectious problem with 30 per cent of patients being chronic Hbs antigen carriers. 10) Annual death rate calculated in the 2,518 patients dialyzed between 1972 and 1978 (78/1000) is 12 times superior to the death rate of the French population, adjusted for sex and age to the dialysis population. 43,1 per cent of deaths are of cardiovascular origin. Risk factors for overall mortality are age, sex (male), existence of a vascular or diabetic nephropathy, twice weekly dialysis strategy, elevation of systolic or diastolic blood pressure during the course of dialysis treatment, hypocholesterolemia and to a lesser extent hypotriglyceridemia. On the contrary, hypercholesterolemia, hypertriglyceridemia and hyperuricemia do not appear as risk factors for overall mortality or cardiovascular mortality. These results plead for a perfect control of hypertension and to the extension of thrice weekly dialysis for the whole population of patients treated by maintenance hemodialysis.

Adolescent↗
PubMed1978

[The prognosis in primary chronic glomerulonephritis in the adult. 298 clinicopathological cases (author's transl)].

The study involved 298 cases of chronic glomerulonephritis (GN) in adults. The results of renal biopsy were used to classify the patients into four groups: Membranous GN, 81 cases; focal glomerulo sclerosis, 80 cases; Membrano-proliferative GN, 62 cases; GN with mesangial deposits of IgA, 75 cases. The patients were observed over a period ranging from 1 month to 36 years. The average period of surveillance for each category was between 4 and 6 years. The course in each histological type was assessed on the basis of actuarial tates of renal death, of moderate renal insufficiency (plasma creatinine greater than 1.5 mg%( and of hypertension. Renal survival at 10 years was was arounds 90% for membranous GN. 85% for GN with mesangial deposits of IgA, 70% for focal glomerulo sclerosis and 50% for membrano-proliferative GN. The prognosis should be based upon a combination of histological and clinical findings. Severity of prolonged nephrotic syndrome, regardless of the histological type of the nephropathy, is worthy of emphasis. In the group fo focal glomerulo sclerosis, prognosis differs greatly in relation to the presence or absence of a nephrotic syndrome. Complete remission may be seen in the group of focal glomerulo sclerosis, and in membrano-proliferative GN despite the persistence or worsening of histological lesions seen on repeated biopsies.

Adult↗
PubMed1978

[Effect on serum aluminium levels of continued ingestion of aluminium gels by patients with chronic renal insufficiency (author's transl)].

Atomic spectrometric absorption without flame allows reliable determination of serum aluminium levels (S.A.). Serum level in 59 normal subjects taking no aluminium gel (A.G.) is 24.3 +/- 8.4 microgram/l. Similar value were observed in 27 patients with renal insufficiency even severe who do not take A.G. Mild elevation of S.A. (40 +/- 12 microgram/l) was observed in 21 dialysed patients receiving no A.G. S.A. elevation is related to the aluminium content of dialysis fluid. A.G. intake in patients with renal insufficiency is followed by increase of S.A. The levels increase in relation with the daily dose of A.G. The highest values are observed among dialysed patients. In 41 dialysed cases A.S. values are between 70 and 600 microgram/l. In 17 patients dialysed for a mean period of 47 months mean serum A.S. is 165 +/- 40 microgram/l. The precise role of aluminium intoxication in the genesis of the dialysis encephalopathy syndrom remains controversial. From a clinical point of view aluminium intoxication should be looked for in any patient with encephalopathy who is taking aluminium gels and/or who is dialysed.

Aluminum↗
PubMed1978

Focal glomerulosclerosis: natural history and treatment. A report of 70 cases.

70 cases of focal glomerulosclerosis (FGS) followed for periods ranging from 1 to 24 years are reported. 39 patients had a nephrotic syndrome. 31 patients had asymptomatic proteinuria. 97 renal biopsies were performed. At least one biopsy specimen from every patient showed focal and segmental involvement of glomeruli, but no lesions were observed on the first biopsy in 6 patients. 26 of the 35 patients with a nephrotic syndrome were treated with steroids alone and/or chemotherapy and/or indomethacin. Resistance to treatment was encountered in 21 patients. Complete remission was observed in 6 cases, despite persistence or accentuation of histological lesions on serial biopsies in 3 cases. Actuarial renal survival rate at 10 years was 45% in the group with a nephrotic syndrome versus 91% in patients with proteinuria. FGS with a persistent nephrotic syndrome represents the 'malignant' form of the disease. Recurrence of the disease was observed after transplantation in 2 cases and was absent in 1.

Adolescent↗