[Menopausal hormone substitution].
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Cardiovascular Diseases↗
Biomedical subjects
P Jaeger
Publications and source records attributed to P Jaeger.
Accuracy of magnetic resonance imaging compared to computerized tomography and renal selective angiography in preoperatively staging renal cell carcinoma.
During 1986 and 1987, 47 patients with renal cell carcinoma were evaluated preoperatively with CT, angiography and MRI. The preoperative tumor stage (T), lymph node metastases and venous involvement determined with the three methods were compared to the operative and histopathological findings. For T stage, angiography proved less accurate (54%) than CT (64%) or MRI (63%). MRI was found to be superior to CT in assessing lymph nodes, with an overall accuracy of 89% and sensitivity of 100% compared to 77 and 60%, respectively, of CT. For venous involvement CT was overall more accurate (74%) than angiography (65%) or MRI (63%). All three methods expressed a low sensitivity (between 31 and 41%) and a high specificity (between 95 and 100%) for detecting venous involvement. The minimal advantages of MRI compared to its high cost do not justify its routine use. CT remains the method of choice in staging preoperatively renal cell carcinoma.
Angiography↗
Renal tubular acidosis, a side effect of treatment with pentavalent antimony.
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Acidosis, Renal Tubular↗
Response to retreatment of malignant hypercalcemia with the bisphosphonate AHPrBP (APD): respective role of kidney and bone.
Malignant hypercalcemia is caused by both increased bone resorption and enhanced tubular reabsorption of calcium. First, the response to an infusion of APD was compared in two groups of patients: 23 with breast cancer versus 20 with squamous cell cancer. The decrease in plasma calcium was smaller in the latter group (p less than 0.05 at day 14), due to increased tubular reabsorption of calcium (TmCa/GFR 2.20 +/- 0.05 versus 2.58 +/- 0.06 mmol/liter; p less than 0.001), whereas the degree of bone resorption reflected by urinary hydroxyproline was identical. Therefore, at a given initial plasma calcium level, the type of tumor (on which TmCA/GFR depends) seems to be a determinant for the effectiveness of the treatment. Second, the response to the initial treatment was compared with that to a second treatment with the same dose in 12 patients whose malignant hypercalcemia relapsed. Within 9 days, plasma calcium decreased from 3.46 +/- 0.10 to 2.50 +/- 0.10 mmol/liter after the first course, but only from 3.37 +/- 0.08 to 2.79 +/- 0.09 mmol/liter after the second course (p less than 0.01). TmCa/GFR was similar before the first and the second treatment and did not vary during the days following the infusion of APD. Initial urinary hydroxyproline was slightly but not significantly higher before the second treatment. It dropped following both APD courses, but to a lesser extent after the second treatment, reflecting higher bone resorption or possible resistance to bisphosphonate.(ABSTRACT TRUNCATED AT 250 WORDS)
Bone and Bones↗
Does medullary sponge kidney cause nephrolithiasis?
The prevalence of medullary sponge kidney in patients with nephrolithiasis and the issue of whether or not medullary sponge kidney has a role in the pathogenesis of renal stones are controversial. We studied the excretory urograms of 280 patients with nephrolithiasis and 280 patients without either nephrolithiasis or a history of renal stones to determine the frequencies of medullary sponge kidney in the two groups. The criterion for the diagnosis of medullary sponge kidney was the presence of a minimum of three linear or round collections of contrast material within one renal papilla. In the patients with nephrolithiasis, we also looked for biochemical evidence of metabolic causes of renal stones. The frequency of medullary sponge kidney was 12% in patients with nephrolithiasis compared with 1% in patients without nephrolithiasis. The statistical difference was highly significant (chi square = 27.1; p less than .001). Metabolic disorders accounting for the lithiasis were detected in 93% of the patients with stones without medullary sponge kidney. Such evidence was present in 60% of patients with stones and medullary sponge kidney. The statistical difference was significant (chi square = 25.8; p less than .001). Our results suggest that medullary sponge kidney is a cause of nephrolithiasis.
Adult↗
[Cardiac insufficiency. Definition, mechanisms, principles of treatment].
Cardiac failure is defined as the inability of the heart to provide the necessary blood flow for the metabolic and functional needs of the vital organs under normal conditions. The underlying physiopathological mechanisms are multiple: cardiac failure without ventricular failure, ventricular failure with or without abnormal ventricular systolic function, prolonged tachycardias or tachyarrhythmias in normal hearts. The association of several mechanisms aggravates the prognosis. Peripheral and central compensatory mechanisms in such situations are not always beneficial. The principles of treatment depend on the type of cardiac failure encountered. The medium and long-term therapeutic objectives are not only to correct the haemodynamic abnormalities but to improve the quality of life and, if possible, the duration of survival.
Arrhythmias, Cardiac↗
[Does extracorporeal shock wave lithotripsy injure the female reproductive tract?].
Female reproductive tract lies near the distal ureter where extracorporeal shock wave lithotripsy (ESWL) of calculi is performed. The question whether ESWL may induce morphological changes in ovary, tube or uterus should be investigated in animal experiments. The female reproductive system of 28 Wistar rats was exposed to 600 or 1200 shock waves. After 24 hours or 35 days the animals were sacrificed and examined by light microscopy and scanning electron microscopy (SEM). Acute after ESWL 2/14 rats revealed minimal subcapsular bleeding in the ovaries. SEM showed a desquamation of superficial cells and a loss in microvilli. In long-term groups there was no morphological lesion. Besides the correlation between healthy and atretic follicles were unchanged. In animal experiment no sign of long lasting changes in female reproductive tract after ESWL could be observed.
Animals↗
Familial spontaneous pneumothorax.
In a three generation family with 27 members we examined a relationship could be found between spontaneous pneumothorax and HLA-haplotypes, alpha 1-antitrypsin phenotypes or concentration or lung volumes and ventilatory capacity. Eight individuals in the family suffered from spontaneous pneumothorax. No relationship with the investigated markers could be found in this informative family. All patients showed normal lung volumes and ventilatory capacity after recovery.
Adolescent↗
[Do shock waves damage the kidney? Morphologic and functional changes of the kidney following exposure to shock waves].
The introduction of extracorporeal shockwave lithotripsy (ESWL) as a routine procedure has brought about a dramatic change in the therapy of urolithiasis. More than 500,000 patients have been treated successfully. Although a tissue damaging effect of the shock wave on the kidney was regarded as non-existent, phenomena such as hematuria during ESWL treatment and subsequent subcapsular hematomas suggest the possibility of damage in the region of the renal parenchyma by the shockwave itself. To investigate this possibility canine kidneys were examined histologically at different intervals after shockwave exposure. Extensive histological changes such as hemorrhage and sometimes direct tubular damage were found, with scar formation after three months. These changes are limited to the areas exposed to ESWL treatment.
Animals↗
Hemodynamic action of nicorandil in chronic congestive heart failure.
Nicorandil is a new compound that has shown potent vasodilator activities on venous and arterial beds in experimental pharmacology. This study was designed to evaluate the magnitude and the time course of hemodynamic effects of different doses of nicorandil in congestive heart failure. Eleven patients with severe congestive heart failure (New York Heart Association class III or IV), with a cardiac index less than 3 liters/min/m2 and a pulmonary wedge pressure greater than 15 mm Hg were enrolled in the study. Three patients had ischemic dilated cardiomyopathy and 8 had idiopathic dilated cardiomyopathy. Hemodynamic assessments were performed by right-sided cardiac catheterization (Swan-Ganz catheter) with cardiac output determination (thermodilution) at baseline and from 30 minutes to 12 hours after single oral administration of nicorandil; 3 patients were given 40 mg, 6 patients 60 mg, and 2 patients 80 mg. Maximal hemodynamic changes were observed 30 minutes after dosing and remained statistically significant at 3 hours. Thirty minutes after drug administration, pulmonary wedge pressure decreased 34 +/- 6%, cardiac index increased by 55 +/- 13% and diastolic and mean arterial pressures decreased by 15 +/- 3% and 9 +/- 2%, respectively, from baseline values. The decrease in systolic blood pressure was slight (5 +/- 2%) and not statistically significant. Calculated systemic vascular resistances decreased by 36 +/- 6% and heart rate did not significantly change. Nicorandil was well tolerated. Thus, the results of this first study of nicorandil in congestive heart failure demonstrated the unloading action of this compound on the failing heart, leading to an improvement in cardiac function; further investigation of nicorandil in this therapeutic area is needed.
Adult↗
[A single infusion of Pamidronate (APD) in Paget's disease of bone].
Bisphosphonates are strong inhibitors of bone resorption and have become the treatment of choice of Paget's disease of bone. Second generation compounds such as amino-hydroxypropylene bisphosphonate (Pamidronate or APD) have not been found to impair bone mineralization, but to induce sustained remission of Paget's disease after short or medium courses. Gastrointestinal side effects may limit compliance. Therefore, 11 patients with mild but symptomatic Paget's disease of bone were treated with APD administered as a single intravenous infusion of 60 mg over 24 hours. The follow-up, with clinical and biochemical evaluations, was between 6 months and one year. Clinical improvement and normalization of biochemical parameters were observed in all patients. On average, plasma alkaline phosphatase activity fell progressively and significantly from 256 +/- 29 U/l (means +/- SEM) to 97 +/- 6 U/l after 6 months and to 102 +/- 11 U/l after one year (normal less than 120 U/l). Urinary excretion of hydroxy-proline decreased within 7 days to normal (from 4.3 +/- 0.5 mumol/lGF to 1.7 +/- 0.2 mumol/lGF, normal less than 2.2). Thereafter it remained within the normal range until one year later (1.8 +/- 0.2 mumol/lGF after 6 months and 1.9 +/- 0.3 mumol/lGF after 1 year). Side effects were negligible, with only a transient increase in body temperature in 2 patients. When bone scintigraphy was repeated after 6 months it revealed a marked decrease in the activity of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Extracorporeal shock wave lithotripsy as monotherapy of staghorn renal calculi: 3 years of experience.
From May 1985 to February 1988, 61 patients with renal staghorn calculi (41 with incomplete C4 and 20 with complete C5 lesions) underwent extracorporeal shock wave lithotripsy monotherapy. Of the patients 37 were treated without preoperative Double-J* stenting, while 24 underwent Double-J stenting before extracorporeal shock wave lithotripsy. Of the patients with incomplete staghorn calculi (C4) and a preoperative ureteral stent 85% were free of stones after 6 months in contrast to only 52.4% of those without a stent and 85.7% of those with infected C4 calculi who underwent preoperative stenting. Hospitalization decreased from 17.7 days in patients without a stent to 14.2 days after stenting, followed by the number of auxiliary procedures (nephrostomy, Zeiss loop and ureteroscopy) and postoperative complications. Complete staghorn calculi (C5) without a preoperative stent had the smallest success rate of stone elimination: only 43.7% of the patients were free of stones after 6 months with a rehospitalization rate of 62.5%. For incomplete staghorn renal calculi (C4) extracorporeal shock wave lithotripsy monotherapy with a preoperative Double-J stent is the noninvasive method that offers excellent stone elimination (85%), comparable to the results of percutaneous nephrolithotripsy (with or without complementary extracorporeal shock wave lithotripsy) and anatrophic nephrolithotomy.
Combined Modality Therapy↗
Management of ureteral stones by extracorporeal shock wave lithotripsy. 3 years of experience.
From April 1985 to March 1987 181 patients with ureteral stones were treated by means of extracorporeal shock wave lithotripsy (ESWL). Management for proximal calculi changed from in situ ESWL treatment (group n = 27) or placement of a ureteral catheter below calculi (group II, n = 30) to retrograde stone manipulation into renal pelvis (group IV, n = 52) or ESWL treatment under intraoperative irrigation of saline in cases where repositioning failed (group III, n = 50). The best stone-free rate for upper ureteral stones was obtained in group IV with 96% after 6 weeks, presenting also the shortest hospital stay (4.2 days) and lowest quota of postoperative auxiliary procedures (2%). Stones, not being dislodged into renal pelvis (49%), could be treated successfully in 86% by irrigation with saline during ESWL (group III). The stone-free rate decreased in patients with in situ treatment (group I: 67%) or ureteral catheter placement (group II: 83%). Treatment of these stones increased the need of postoperative ancillary procedures to approximately 30%. For distal ureteral stones ESWL and preoperative Zeiss placement achieved a stone-free rate of 95%.
Adult↗
Cystinuria: pathophysiology and treatment.
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Captopril↗
[Physical properties of the aorta in normotensive insulin-dependent diabetic subjects. Study using Doppler echocardiography].
UNLABELLED: We studied 16 normotensive insulin-dependent diabetic patients (D) (11 males + 5 females) aged of 25-51 years old (mean = 35 +/- 6) with a good glycemic control, without microangiopathy and previous heart disease and 16 healthy control of 25 subjects (C) matched for sex age and body area. We measured: Systolic blood pressure (SBP) with a mercury sphygmomanometer, aortic diameter (AD), end diastolic left ventricular radius (r) and wall thickness (Th) by Echocardiography TM with 2 D echo control, the pulse wave delay (PWD) by measurement of time between the feet of aortic velocity tracings, recorded in the isthmus and near the diaphragm, Sternal length (L). Parameters calculated were: the ratio th/r. The pulse wave velocity PWV = L/PWD and the ratio PWV/AD which represents an indirect index of aortic characteristic impedance. (table; see text) PWV and the radio Th/r are significantly increased in diabetic patients as compared to the control group. Th/r is not significantly correlated with PWV in the 2 groups. This lack of correlation could be explained in the control group by the small rang of values of PWV (5-7.3 ms-1) and Th/r (0.26-0.38). It is not the case in the diabetic group where values are widespread (PWD 5-10 ms-1 and Th/r 0.23-0.53). IN CONCLUSION: in normotensive young insulin-dependent diabetic patients studied by doppler echocardiography: aortic rigidity measured by the pulse wave velocity is increased. Th/r ratio is also increased but this change of left ventricular geometry is not related to aortic rigidity in this group of patients.
Adult↗
[Aorta-left ventricle coupling in permanent arterial hypertension using Doppler echocardiography].
We have studied 12 sustained hypertensive patients (H) (9 men and 3 women) untreated and without other heart disease than a left ventricular hypertrophy, 37 to 70 years of age (mean 56 +/- 12) and 12 normotensive subjects (N) of the same sex and 35 to 77 years of age (mean 52 +/- 16 ans). We have measured 1) arterial pressure (AP) by a standard mercury sphygmomanometer, 2) diameter of ascending aorta (AD), end diastolic left ventricular radius (r) and thickness (Th) by M mode echocardiography with 2D echo control., 3) isthmus-diaphragm pulse wave delay (PWD) from aortic velocity curves recorded in the isthmus and diaphragm aortic crossing by pulsed doppler. We derived 1) the pulse wave velocity (PWV) as PW = SL/PWD where SL is the sternal length, 2) PWV/AD ratio as an indirect index of characteristic impedance, 3) Th/r and LV mass (m) according to Teichholz formula: (table; see text) In both groups 1) m is significantly correlated with SAP (r = 0.67 p less than 0.001), PP (r = 0.61 p less than 0.001), PWV (r = 0.52 p less than 0.01) but not with PWV/AD; 2) Th/r ratio is significantly correlated with SAP (r = 0.64 p less than 0.001), PP (r = 0.63 p less than 0.001), PWV (r = 0.53 p less than 0.001) and PWV/AD (r = 0.41 p less than 0.05). Relationship between PWV and age of H is linear (r = 0.75 p less than 0.001) and shifted at left of that of N which is also linear (r = 0.061 p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[The staghorn calculus: anatrophic nephrolithotomy versus percutaneous litholapxy and extracorporeal shockwave therapy versus extracorporeal shockwave lithotripsy monotherapy. A report of over 6 years' experience].
From 1982 to December 1987, 71 with incomplete (C4 by Rocco) and 37 with complete (C5 by Rocco) staghorn calculi underwent anatrophic nephrolithotomy (AN; n = 29), or combined percutaneous nephrostolithotomy and ESWL (PCNL + ESWL; n = 21), or ESWL monotherapy without or with preoperative JJ stenting (n = 37/21). The patients with incomplete staghorn calculi (C4) and preoperative ureteral stenting were free of stones after 6 months in 15 of 17 cases (88%), which is comparable to our results with AN (90%) and combined PCNL + ESWL (85%). ESWL without JJ stenting were free of stones in only 52%. The treatment of infected C4 calculi with JJ stenting was especially successful (92%). Complete staghorn calculi (C5) represented the best results after AN (78%) and combined PCNL + ESWL (75%), in contrast to ESWL without JJ stenting (44%). Four patients with C5 calculi were treated with ESWL and preoperative stenting, three of them were free of stones after 6 months. For incomplete staghorn calculi (C4), ESWL monotherapy with JJ stenting seems to be a justifiable noninvasive method which offers excellent results in stone elimination (88%), with lower costs than AN or PCNL + ESWL. More invasive procedures should be reserved for complete staghorn calculi.
Combined Modality Therapy↗
[Reduction of ventricular tachycardia by Valsalva's maneuver].
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Aged↗