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Biomedical subjects

X Martin

Publications and source records attributed to X Martin.

At least 181 records · Page 10Linked to original sources
PubMed1991

[Pancreas transplantation in 132 insulin-dependent diabetic patients].

A total of 140 pancreatic transplants have been performed in 132 insulin-dependent diabetic patients at Lyon (France). Most cases received a double pancreatic and renal transplant. The duct obstruction technique was utilized in 113 segmental transplants. A total pancreatic transplant was performed in 27 patients, with duct obstruction in 27, GI tract derivation in 14, urinary tract derivation in 11 and intraductal obstruction in 2 patients. Utilizing quadruple immunosuppression, the one year survival rate was 90% and the transplant survival was 60%.

Actuarial Analysis↗
PubMed1991

[Percutaneous treatment of simple kidney cysts].

Percutaneous treatment of renal cysts is an effective and minimally invasive alternative to surgery for the treatment of simple, symptomatic renal cysts or cysts complicated by renal stones or hydronephrosis. Moderately large cysts and parapelvic cysts should be treated by sclerotherapy, while very large and peripheral cysts should be resected percutaneously. A series of 29 cysts was treated: 6 percutaneous resections, 22 scleroses, 1 simple puncture-aspiration. Pain relief was obtained in 96% of cases. Resolution of hydronephrosis and renal stones was obtained in 100% of cases. The morbidity (infection, haematoma) was low (10%), but 9 patients (32%) presented with a small residual cavity which, in 1 case, evolved towards a true recurrence of the cyst. The long-term outcome of these asymptomatic residual cavities is unknown.

Adult↗
PubMed1991

[Long term results of endoscopic treatment of reflux in hemodialysis patients waiting for transplantation].

Between January 1986 and April 1988, 13 patients (mean age: 35 years) waiting for renal transplantation (mean duration of haemodialysis: 46 months) were treated by means of O'Donnell's technique. Vesico-ureteric reflux was unilateral in 6 patients and bilateral in 7 patients (20 refluxing ureteric units). Reflux was classified as Grade II for 7 ureters, Grade III for 8 ureters and Grade IV for 5 ureters. The volume of Teflon injected ranged from 1 to 4 cm3 and 6 patients received repeated injections. No complications were observed. Complete resolution of reflux was obtained in 9 patients (69%), i.e. 15 ureteric units (75%). Reflux persisted in 4 patients (31%), i.e. 5 ureteric units (25%). Three nephro-ureterectomies were performed in 2 patients with persistent high grade reflux, but 2 patients with Grade I reflux after endoscopic treatment were not operated. All patients were transplanted after endoscopic treatment (mean interval between correction of reflux and transplantation: 13 months) and a follow-up cystography was systematically performed after transplantation (mean follow-up after transplantation: 27 months): no recurrence of the reflux was detected (mean follow-up after endoscopic treatment: 40 months). Endoscopic treatment of reflux avoids the need for nephro-ureterectomy in 80% of haemodialysis patients waiting for renal transplantation and presenting with vesico-ureteric reflux.

Administration, Intravesical↗
PubMed1991

[Treatment of cystine calculi using intra-urologic methods and extracorporeal lithotripsy].

The hardness and frequent recurrence of cystine stones represent a special challenge for the urologist. Fifteen cystinuric patients were treated in our department and followed over a mean period of 30 months. Most patients had a previous history of open surgery (1.5 pyelolithotomy/patient). Diagnosis of cystinuria was confirmed by metabolic studies and stone analysis. Over the follow-up period recurrence was observed in 23 instances in 11 patients thus leading to 38 stone treatments on 74 cystine stones. Stone size was less than 10 mm: 35 (47%); 10-20 mm: 21 (28%); 20-30 mm: 14 (19%); 30 mm: 4 (staghorn stones). A percutaneous approach was used in 9 cases as monotherapy (55% success) and in association with ESWL in 10 cases (50% success). ESWL was employed 18 times as monotherapy (39% success). Medical treatment included high fluid intake, alkalinisation and thiola in 6 patients. In conclusion, results obtained are poor in terms of stone clearance when compared to non-cystine stones. Recurrence rate is very high. Instrumental treatment should not be used excessively and is only indicated in symptomatic stones or refractory to intensive medical therapy.

Adolescent↗
PubMed1990

Extracorporeal lithotripsy of bile duct stones using ultrasonography for stone localization.

In 19 patients, extraction of bile duct stones through the papilla using a Dormia basket or a mechanical lithotripter was not possible following endoscopic sphincterotomy. After the insertion of a nasobiliary drain, extracorporeal lithotripsy was performed with intravenous sedation using an ultrasonographic stone localization system. The number and location of stones were first determined by retrograde cholangiography. At the time of lithotripsy, saline was injected in the bile ducts to modify the acoustic impedance of tissues surrounding the stones, and subsequent ultrasonography was effective in localizing all stones present in 4 of 5 (80%) patients with intrahepatic stones, and 13 of 14 (93%) with common bile duct stones. In 10 patients (53%), fragmentation was satisfactory and the bile ducts were cleared completely. The mean single stone diameter was significantly smaller in successful cases of fragmentation compared with failures (22.8 +/- 6.6 mm vs. 40 +/- 10 mm). The results in patients with multiple stones were significantly worse than those in patients with single stones of similar size (25% vs. 100% successful fragmentation). Reasons for this difference in results included the small size of the focal area and the reduced ability of ultrasonography (1) to adequately visualize multiple calculi individually and (2) to assess the degree of stone destruction. Care was taken to first await the resolution of infection or the correction of coagulation abnormalities when present; no morbidity following extracorporeal lithotripsy was observed. Despite its 3-step approach (endoscopic sphincterotomy, lithotripsy, and endoscopic extraction), the need for only intravenous sedation and the absence of patient immersion in water render this technique attractive for elderly and frail patients.

Adult↗
PubMed1990

Continent cutaneous Ileostomy (Kock pouch) prior to renal transplantation.

Two patients in end-stage renal failure and with neurogenic bladders due to spina bifida complicated by myelomeningocele were considered for renal transplantation. One patient had had a right nephrectomy and urinary diversion via an ileal conduit; the other, after various external drainage procedures (cystostomy, bilateral nephrostomy), had had a tubular ileocystoplasty. Both underwent 2 surgical procedures prior to renal transplantation: in case 1 we performed a left nephrectomy and then ileal conduit removal + Kock pouch; in case 2 a bilateral nephrectomy was performed via 2 posterior incisions and then we removed the ileocystoplasty and formed the pouch. The continent ileostomy was formed according to the original technique with slight modifications. The patients have been followed up for 12 and 15 months after transplantation.

Acute Kidney Injury↗
PubMed1990

Percutaneous treatment of benign renal cysts.

The percutaneous treatment of benign renal cysts has been proposed in alternative to conventional surgery. It minimizes the complication rate and assures good clinical results. In our Department, 15 patients with 16 symptomatic benign renal cysts underwent either percutaneous cyst aspiration + sclerosis (10 cases) or percutaneous resection of the cyst wall (6 cases). In the first group, all patients were relieved from symptoms, and 70% had no residual cavity. Two patients presented a secondary infection of the cyst, treated with systemic antibiotics and percutaneous drainage (1 case). In the second group, we did not observe any complication, all patients were relieved from symptoms, and only 1 cyst recurred, probably due to incomplete resection.

Adolescent↗
PubMed1990

[Autotransplantation in the treatment of isolated dissection of the renal artery].

Isolated dissection of renal artery is uncommon; 150 cases were reported in the literature, whose 2/3 diagnosed during patient's life and 1/3 post mortem, during autopsy. From 1976 to 1988 4 cases of isolated dissection of the renal artery were diagnosed and treated in our Institution. Three men and one woman with age ranging from 39 to 46 yrs (mean age 41.75) were seen at our Institution for intense abdominal pain and blood hypertension (mean blood pressure 196.25/113.75 mmHg) of recent occurrence. In 2 cases angiography showed dissection of the left renal artery, with involvement of peripheral branches; in 1 case the dissection involved the right renal artery with complete occlusion of an upper pole branch and upper pole infarction; our youngest patients presented a bilateral dissection, limited to the main trunk on the right side and involving prepelvic and retropelvic branches on the left side. Surgical treatment consisted of renal autotransplantation in the iliac fossa after extracorporeal reconstruction of the arterial pedicule; a branched hypogastric graft was used in 3 patients; in the patient with bilateral dissection an hypogastric graft was used on the right side and a sapehenous graft on the left side (3 months later). Partial nephrectomy was also performed in the patient having right upper pole infarction. Histologic examination showed that dissection always started from lesions of the lamina media. All patient were alive from 6 to 48 months after renal revascularization, with normalization of blood pressure (mean BP 125/80 mmHg); postoperative angiographic control showed thrombosis of 2 small branches in 1 case and partial stenosis of 3 anastomoses in another patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Segmental duct-obstructed pancreas grafts versus pancreaticoduodenal grafts with enteric diversion.

Between January 1985 and September 1987, we performed a prospective comparative study between segmental-pancreas transplantation with duct obstruction by neoprene (n = 17) and pancreaticoduodenal transplantation with enteric diversion to a Roux-en-Y intestinal loop (n = 14). All recipients had insulin-dependent diabetes. The immunosuppressive protocol consisted of low doses of the steroids cyclosporin A and azathioprine. Mean follow-up was 16.5 mo for the enteric-diversion group and 13.5 mo for duct-obstructed groups. Two-year patient and pancreas- and kidney-graft actuarial survival rates were 92.9, 75.5, and 74.2%, respectively, in the former group and 92.3, 58.4, and 63.7%, respectively, in the latter group (NS). Five whole-organ grafts were lost (3 vascular thromboses, 1 pancreatitis, 1 rejection), and four segmental grafts were lost (2 vascular thromboses, 1 bleeding, 1 patient's death with functional graft). More surgical complications occurred in the recipients of whole-organ grafts and were often related to the intestinal anastomosis. A satisfactory blood glucose control was observed at 3 mo and 1 yr in both groups. Provocative tests showed higher and prompter insulin secretion in patients with whole-organ grafts. In patients with segmental grafts, the response was lower and delayed with a general tendency to impaired glucose tolerance. A marked hyperinsulinemia after meals was observed in whole-organ graft recipients. Slight nocturnal hyperinsulinemia was observed in both groups. At 1 yr, glycosylated hemoglobin was normal in both groups. The absence of a significant difference between the two groups, in terms of survival and graft function, and the lower surgical complication rate seen with segmental grafts have made us return to neoprene-injected segmental grafts.

Circadian Rhythm↗
PubMed1989

Impact of immunosuppression on improvement of results in clinical pancreas transplantation.

Since November 1975, 103 pancreas transplantations have been performed in 97 insulin-dependent diabetic patients. Pancreas and kidney were grafted simultaneously in 84 patients (plus 1 double retransplantation). Eighty-nine pancreas grafts were prepared by duct obstruction with neoprene, and 14 were pancreaticoduodenal grafts with enteric diversion in a Roux-en-Y loop. Five immunosuppressive protocols were subsequently used. With the latest protocols, patient and pancreas survival improved to 93 and 72% at 1 yr, respectively. The improvement in graft survival appeared to be particularly related to the reduction of the number of pancreas grafts lost in rejection. The patients treated with the last protocols, including cyclosporin A (CsA) and only low doses of steroids, showed a better glucose tolerance after provocative tests. Pancreas-graft function did not appear to be influenced by CsA treatment.

Antilymphocyte Serum↗
PubMed1989

Kidney-graft survival in simultaneous kidney-pancreas transplantation.

Patient and kidney survival rates were compared between 69 diabetic patients undergoing simultaneous kidney-pancreas transplantation (group 1) and 723 nondiabetic patients undergoing kidney transplantation (group 2). The patients were treated with different immunosuppressive regimens over the years: steroids plus antilymphocyte globulin (ALG) plus azathioprine (Aza); cyclosporin A (CsA) plus ALG; steroids plus ALG plus Aza, replacing Aza 1 mo posttransplantation; or low doses of steroids plus CsA plus Aza. One-year kidney survival rates with the different regimens were 50, 42, 54, and 76%, respectively, in group 1 and 71, 74, 78, and 84%, respectively, in group 2. Patient survival was 60, 57, 71, and 86%, respectively, in group 1 and 93, 95, 94, and 96%, respectively, in group 2. Differences between the two groups were statistically significant for the first three protocols but not for the one used in this study. In group 1, 38 patients (55%) had a functioning kidney graft, whereas 15 (21%) lost their kidney to rejection. Between these two patient categories, there was no significant difference in age, sex, duration of diabetes, time on dialysis, blood transfusion number, HLA immunization, or HLA matching. Thus, since 1984, kidney-graft survival has not been inferior in diabetic patients. This improvement is mainly due to a decreased mortality related to better patient preparation and improvement in immunosuppression.

Graft Survival↗