Biomedical subjects
Publications and source records attributed to O Pourrat.
The authors present the case of a patient undergoing late surgery following bilateral trauma of the renal hilum. Despite revascularization and a certain urine output the patient remains on hemodialysis. A highly pragmatic study of the literature follows the clinical presentation.
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The authors present a case of acute renal ischemia resulting from embolism of its main artery on the occasion of the transient interruption of anticoagulant treatment for dental extraction, in a patient bearing a Björk-Shiley valvular prosthesis in the mitral position. Its progression is marked by the complete repermeabilisation of the artery under heparin therapy with complete recuperation of renal function. This classically exceptional observation suggests that the delay occurring between the initial obstruction and repermeabilisation does not alter the degree of renal distress, the estimation of which is unpredictable. The relative resistance of the kidney to ischemia and the occurrence of efficacious fibrinolysis suggests the possibility of therapy other than surgery. Prevention demands the maintenance of coagulants under guarantee of local hemostatic processes.
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The authors report a case of a 58 year old male presenting with bilateral ureteral compression by peri-aneurysmal retroperitoneal fibrosis. A ureterolysis and prosthetic replacement of the abdominal aorta gave good results. Eighteen months postoperatively, proteinuria and an edema of the lower limbs revealed an extramembranous glomerulitis, for which no cause could be found. Was this rare association fortuitous, or does it result from the action of some unknown antigen?
Intrathecal serotherapy appears to be effective in the treatment of tetanus, and it has been claimed that human immune globulins are innocuous. In the 4 cases reported here reversible paraplegia developed a few hours after intrathecal injection of 1500 to 2000 UI of human immune globulins prepared by the French Blood Transfusion Centre. We believe that paraplegia was related to the high doses administered. The fact that intrathecal serotherapy is normally used in severely ill patients whose impaired consciousness precludes motricity and sensitivity testing may explain why this complication has not previously been reported. The need for high doses of intrathecal immune globulins is discussed. It has recently been suggested that high doses are superior to low doses. We consider that this form of treatment is justified, even in the least severe forms of tetanus, but we feel that doses higher than 1000 IU are not without danger.
20 patients under therapy or intoxicated by benzodiazepines were studied. A partial inhibition of (Ca2+, Mg2+)ATPase on 'B' membranes (CaM rich membranes) was evident in 2 cases. A total inhibition of (Ca2+, Mg2+) ATPase on both 'B' and 'A' (CaM depleted) membranes was noted in 1 case: the patient who was severely intoxicated had pronounced hemolysis. As an attempt to elucidate the mechanism of this action, the effect of diazepam chosen as model compound was studied on 'B' and 'A' membranes prepared from normal human RBC previously incubated with diazepam. A high concentration of diazepam, corresponding to a 20-fold therapeutic level results in a 50% inhibition of the maximal activity of the enzyme on 'B' membranes. It may be speculated from these experiments that the effect of high concentration of benzodiazepines on CaM dependent (Ca2+, Mg2+) ATPase leads to accelerated RBC destruction.
A case of severe hypertension with secondary hyperaldosteronism developing in a 71 year old woman affected by "Crest" syndrome is reported. The patient was treated by nifedipine, which led to the correction of blood pressure, plasma renin activity and serum aldosterone. The role of renal arteries vasospasm and renin-angiotension system in the genesis of scleroderma is discussed.
A case of chronic lymphoid leukaemia complicated by a nephrotic syndrome is reported. There was no evidence of amyloidosis or renal vein thrombosis. Percutaneous renal biopsy disclosed lobular membranoproliferative glomerulonephritis with subendothelial deposits of IgG, C3, C4 and C1q. Circulating immune complexes, IgG lambda cryoglobulin and low CH50 levels due to activation of the classical pathway were demonstrated in serum. Immunosuppressive treatment of the leukaemia resulted in complete regression of the nephrotic syndrome.
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Interstitial nephritis with acute renal failure was observed in 5 cases out of 6 treated by the association of methicillin and gentamycin, wheras no case, was observed when each of these antibodies was used separately. The mechanisms which might explain the potentialisation of these two drugs are discussed.
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A case of acute respiratory failure revealing amyotrophic lateral sclerosis is reported. The other neurological diseases with diaphragmatic paralysis are recalled.
The possibility of indigenous Legionnaires' disease should be known as suggested by the following case : a 69-year-old man, diabetic, having never travelled out of Poitou, suffers from serious pneumonia with dyspnea needing mechanical ventilation with positive end-expiratory pressure. After failure of ampicillin, the evolution seems favourable with cotrimoxazole. However the discontinuation of this last drug is followed by a relapse which is treated with success by erythromycin. Serodiagnoses will be positive for Legionella Pneumophila serogroup I. This case, typical by its clinical features, makes itself noticed by its epidemiology and the relapse under cotrimoxazole, proving that erythromycin remains the choice antibiotic for these infections.