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Biomedical subjects

Y Pirson

Publications and source records attributed to Y Pirson.

At least 127 records · Page 7Linked to original sources
PubMed1986

Renal side effects of nonsteroidal antiinflammatory drugs: clinical relevance.

Nonsteroidal antiinflammatory drugs (NSAIDs) induce a variety of renal side effects. We review their prevalence and clinical relevance, and identify the patients who are most at risk for these complications. NSAIDs induce hemodynamic renal failure in states of compromised renal perfusion and in the presence of a preexisting nephropathy. Association of triamterene and indomethacin is especially nephrotoxic and should be avoided. NSAIDs cause sodium retention and impair the natriuretic effect of diuretics: this side effect is clinically relevant in edema-forming states. Hyperkalemia induced by NSAIDs is harmful in case of renal failure and hypoaldosteronism. NSAIDs may induce an acute interstitial nephritis often associated with the nephrotic syndrome; the event is rare and unpredictable, and mainly propionic acid derivatives have been incriminated. NSAIDs are reported to attenuate the hypotensive effect of various drugs; further studies are warranted to better delineate the clinical relevance of this observation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1986

[Kidney transplantation in a case of amyloidosis].

Renal transplantation was performed in five patients with various forms of amyloidosis (familial amyloidosis, Mediterranean fever and Crohn's disease). All grafts were functioning one year after the operation. Only one patient died of cardiac shock more than 10 years after transplantation; the other recipients are alive with a functioning graft from 12 to 67 (mean, 41) months after transplantation. No early severe infection was observed in any patient. Graft biopsy obtained in three patients disclosed amyloid deposits in only one: deposits initially (72 months post-transplantation) mild and perivascular, became more prominent in the vessels and extended into the mesangium 4 1/2 years later. Extrarenal amyloid involvement observed in four cases did not lead to serious clinical consequences during the follow-up period. Renal transplantation thus provides an effective treatment of terminal renal failure due to amyloidosis whatever its cause.

Adolescent↗
PubMed1986

Six human pancreas transplants: results and perioperative management.

Satisfactory results were obtained in 5 type I diabetic recipients of 6 human pancreas transplantations. We chose the three following options: diversion of the pancreatic juice by a pancreaticojejunostomy, simultaneous kidney transplantation from the same donor and cyclosporin A as the basic drug in the immunosuppressive regimen. Further conclusions were also drawn from our experience. Firstly, biological data alone might not be relevant for donor selection: histologic examination of the non transplanted cephalic portion of the donor pancreas is needed to rule out pancreatitis. Secondly, donor management usually needs large amounts of fluids and blood. Finally, besides the general rules of recipient management common to kidney transplantation, pancreas transplantation further requires heparinization, insulin therapy and parental nutrition during the immediate postoperative period.

Adult↗
PubMed1986

Anesthetic protocol in human renal transplantation: twenty-two years of experience.

This paper reviews the experience of 22 years of transplantation. From June 1963 to December 1984, 1362 human renal grafts were performed in our center. Throughout this period, advances in surgical techniques, kidney preservation methods and immunosuppressive regimen have improved patient and graft survival. Simultaneously, progress in anesthetic monitoring and techniques (particularly the use of new muscle relaxants and isoflurane) led to better and safer surgical conditions. A protocol of maximal intraoperative hydration using pulmonary arterial pressure monitoring was progressively developed. This protocol has allowed to reduce significantly the incidence of delayed graft function.

Adult↗
PubMed1986

The peroperative management in multiple organ donors: a crucial phase in organ transplantation.

Recent developments in organ transplantation led to the fact that any potential cadaver donor might be considered as a multiple organ donor (MOD). The anesthesiologist's role is to maintain good hemodynamic conditions during the long and complex harvesting procedure, taking into account that in renal cadaver transplantation, donor's stable hemodynamic conditions play a crucial role in the immediate function of the graft. Taking the opportunity of a case of simultaneous liver, pancreas and kidneys procurement in the same cadaver donor performed for the first time in our country, we are reviewing the different phases of the donor peroperative management. This implies a strict control of the systolic blood pressure (SBP) and central venous pressure (CVP). The first step was to maintain the blood volume: during the 3 hours procedure, 5.5 liters of crystalloid, 1.2 liters of colloid and 1 liter of blood were perfused to maintain a CVP higher than 8 mm Hg and a SBP above 110 mm Hg. To obtain the best possible renal and hepatic perfusion, 4 micrograms/kg/min. dopamine is injected continuously, along with 100 mg phenoxybenzamine since the beginning of the operation in order to avoid any local arterial spasm. After heparinization (3 mg/kg 10 minutes prior to clamping), all organs are simultaneously perfused in situ with 3 liters of Euro-Collins solution at 4 degrees C, for cold storage in optimal conditions. The pancreas along with one kidney was transplanted in a diabetic women in preterminal end-stage renal disease: current creatinine (2 months post-transplant) is 1.3 mg/dl and C-peptide is 0.8 pmol/ml. The other kidney was successfully transplanted in another center. The liver graft was implanted in a cirrhotic patient: current bilirubin is 6 mg/dl, S.G.O.T. and S.G.P.T. respectively 50 and 149 U.I.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1985

[Non-traumatic rupture of the Achilles tendon after renal transplantation].

Two renal transplant recipients who had been grafted for 6 and 17 years respectively and whose transplants were perfectly well tolerated presented with non traumatic rupture of Achilles tendon. A few days to a few weeks previously, they had experienced pain in the Achilles tendons of both legs. No sign of so-called systemic disease or hyperparathyroidism was present. The suspected pathogenic factors were chronic corticosteroid therapy and arteritis of the lower limbs. The case of a third renal transplant recipient showed that total rupture can be avoided if the tendon is allowed to rest during the phase of premonitory pain.

Achilles Tendon↗
PubMed1985

Late urinary tract infection after transplantation: prevalence, predisposition and morbidity.

We have evaluated the incidence, prevalence, predisposing factors and evolution of urinary tract infection (UTI) developing late after transplantation in 63 patients whose graft had lasted at least 3 months and whose follow-up averaged 7 years. Beyond 3 months after transplantation incidence of UTI decreases progressively, from 25 to 0%, 50% of the patients remaining free of infection throughout the period of observation. Neither the original kidney disease except perhaps diabetic nephropathy nor the presence of vesicoureteral reflux were predisposing factors. Incidence and prevalence in females were twice that in male. Late UTI did not affect graft or patient survival, or graft function at 5 years. Most UTI were asymptomatic and had a benign course. However, in 3 patients septicemia or graft dysfunction ensued demonstrating the need for continuous monitoring of urine cultures.

Actuarial Analysis↗
PubMed1985

Aetiology and prognosis of de novo graft membranous nephropathy.

In order to investigate the aetiology and prognosis of de novo graft membranous nephropathy (DNGMN), we review 25 such cases observed among 1258 grafts. Coexistence of chronic rejection lesions and their parallel progression with DNGMN suggest that DNGMN may be part of the rejection process. DNGMN developed in 12 per cent of HLA-identical living donor recipients vs only two per cent of both haplo-identical and cadaver donor recipients; in the latter group, all DNGMN patients had less than or equal to 2 HLA-AB mismatches. Graft survival after diagnosis of DNGMN is only 49 per cent at five years. We conclude that DNGMN is associated with chronic rejection, develops preferentially in well-matched grafts and carries a rather poor prognosis.

Adolescent↗