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Background: This randomized, double blind trial determined the short and long-term clinical and hemodynamic vasodilator effects induced by percutaneous applications of natural CO2 gas in patients with moderate Fontaine stage II. Patients and methods: 62 patients with intermittent claudication (100-500 meters) were randomized to 18 consecutive days of CO2 treatment or placebo (air). The gas fluids were applied at a constant temperature of 30°C on pre-humidified skin. The effects of the treatment were evaluated by total distance walked (primary criterion) and hemodynamic and microcirculatory findings. Patients also answered a quality of life questionnaire. Results: The Strandness test showed a significant increase in total distance walked (+ 131 meters, 66%; p = 0.001) and pain-free distance (+ 81 meters, 73%; p = 0.02) after 18 days of CO2 treatment. The improvement was maintained 3 and 12 months later. The systolic pressure index (ABI) increased by 37% (p = 0.001) 1 minute after treadmill walking and ABI recovery time decreased significantly by 38% (p = 0.002). Microcirculatory findings showed an increase in systolic pressure of the great toe (13%; p

The total concentration and concanavalin A (ConA)-dependent microheterogeneity of alpha-1 acid glycoprotein (AAG) were studied in thirty hemodialyzed uremic patients and eighteen non-dialyzed uremic patients, by comparison with healthy volunteers. Serum concentrations of AAG were significantly higher in the non-dialyzed uremic (1.27 ± 0.47 g/l) and hemodialyzed patients (1.29 ± 0.33 g/l) than in the volunteers (0.79 ± 0.09 g/l). The proportions of strongly ConA-reactive AAG fractions were also higher in non-dialyzed uremic (16.7%) and hemodialyzed patients (18.5%) than in volunteers (14.1%). These data may be related to an increase in bi-antennary glycans, as observed in patients on peritoneal dialysis, together with a probable change in sialylation. AAG serum levels and microheterogeneity were similar in non-dialyzed and hemodialyzed patients and did not appear in the dialyzed patients to depend on the type of dialysis membrane used, i.e. cuprophan (CU), cellulose acetate (CA), hemophan (HE), polyacrylonitrile (PAN), and polysulfon (PS), in spite of differences in biocompatibility. In patients dialyzed with CA membranes, there was a distinct decrease in the ConA non-reactive fraction (38.0%) and an increase in ConA slightly-reactive (42.2%) and strongly-reactive (19.7%) fractions. Differences in AAG serum levels and ConA reactivity between patients dialyzed with CA and PAN membranes seem to justify further investigations of other acute-phase reactants and immunological parameters.

We report four cases of adult thrombotic microangiopathy associating diarrhea with severe ischemic colitis. In one case, the intestinal complications was severe and diffuse ischemic colitis, in two cases an inaugural colonic perforation requiring colectomy and in the last case a massive mesenteric infarct. In three cases, histologic examination showed vessel occlusion with microthrombi. Despite treatment with plasma exchange and plasma infusion, death ensued in two cases. Principally described in childhood thrombotic microangiopathy, intestinal complications occur exceptionally in adult thrombotic microangiopathy and are associated with a poor prognosis. Inaugural ischemic colitis revealing an adult thrombotic microangiopathy is also uncommon and thrombotic microangiopathy could be evoked in all patients presenting acute ischemic colitis.

To assess the etiologic diagnoses and outcome of acute pericardial effusion associated to acute renal renal failure.A retrospective study from 1978 to 1996 in a 10 bed medical/surgical intensive care unit included 11 patients who have an acute pericardial effusion associated with an acute renal failure.Etiological diagnoses were systemic lupus with extracapillary glomerulonephritis (n = 2), systemic fibrosis with obstructive renal failure (n = 2), anticoagulation accident with hemodynamic renal failure (n = 2), lung adenocarcinoma (n = 2), adenocarcinoma of undetermined origin (n = 1), systemic polyarteritis nodosa (n = 1), and Wegener granulomatosis (n = 1). Intensive care unit deaths was 4, including 2 cases of neoplasic origin.Despite infection or malignancy being claimed as the leading causes of acute pericardial effusion, when associated to acute renal failure other etiologic diagnoses, such connectivite tissue disease or vasculitis, must be evoked that prompt specific treatment and could prevent unfavorable evolution. Neoplasic causes were characterised by receiving pericardial effusion and a high mortality rate.

We studied the efficacy and safety of ramipril and the kinetics of its active moiety ramiprilat in 12 hypertensive patients receiving regular hemodialysis, after a single dose and after long-term (28 days) administration. Patients received 2.5 mg ramipril after each hemodialysis. On days 1 and 29, ramipril was administered 4 h before the hemodialysis and serial blood samples were obtained for 9 h for determination of pharmacokinetic parameters. Tolerability was good, and all patients completed the study. There was a high degree of angiotensin-converting enzyme (ACE) inhibition throughout the study. Ramipril had a clear-cut antihypertensive effect. Long-term administration of ramipril did not modify the time to peak ramiprilat concentration, but increased the mean maximal concentration significantly: 20.2 +/- 12.7 vs. 10.4 +/- 7.1 ng center dot ml-1. The mean accumulation ratio was 2.2. Ramiprilat hemodialysis clearance was 31.7 ml/min (range 4.2-64.9 ml/min) on day 1 and 21.0 ml/min (range 7.9-56.5 ml/min) on day 29. Ramipril 2.5 mg, administered after hemodialysis, appears to be safe and effective in hypertensive patients receiving periodic hemodialysis. Despite an increase in ramiprilat concentration from day 1 to day 29, the steady state was reached. We describe the role of nonrenal clearance of ramiprilat.

Each year, Royat (Auvergne) receives about 20,000 patients (80 per cent with intermittent claudication), treated by thermal gas (99.5 per cent of CO2). CO2 therapy is dispensed with thermal water or with dry gas (general or local immersion and local subcutaneous injections of gas) during 3 weeks. Local vasodilator effects of CO2 have been demonstrated with several methods in Royat. Physiological and therapeutic effects of thermal CO2 therapy, also used in Germany and Central Europe, were precisely reported during the Consensus Congress of Fribourg in Brisgau (1989); more particularly, this treatment seems provide a reduced ability of haemoglobin to fix oxygen, and therefore a release of oxygen within the cells. Patients with peripheral arterial disease (stage 2) have a walking distance increased and post-exercise ankles' pressures improved after a thermal course of treatment in Royat, while a control group has no significant changes. The discussion will concern also the socio-economic aspects of thermal treatment of arterial diseases.

We determined in a prospective study reticulocyte counts and serum erythropoietin concentrations after renal transplantation in 37 recipients of renal allografts. Erythropoietin decreased in 35 patients out of 37 during surgery. Results concerning reticulocyte counts allowed us to define two groups of patients. Group 1: 33 patients had a reticulocyte peak before d29. Among them the reticulocyte peak followed the first Epo peak in 22 patients (1a) and occurred after several Epo peaks in 11 patients (1b). Patients of groups 1b had a serum creatinine level above 300 mumol/l at the time of the first Epo peak. Group 2: 4 patients with acute tubular necrosis had no reticulocytes peak before d29 despite one or several erythropoietin peaks. Post-operative erythropoietin reduction was not entirely explained by hemodilution or by per-operative blood transfusions. The erythropoietin peak appeared to be efficient only when creatinine at the time of the peak was under 200 mumol/l according to the inhibition of erythropoiesis during renal failure.

Long term effects on creatinine serum level of successful percutaneous transluminal renal angioplasty were retrospectively studied in 140 patients. 3 groups were distinguished: the first one (80 patients) included unilateral renal angioplasties, with normal contralateral kidney and renal artery; the second group (35 patients) included bilateral renal angioplasties; the third group (25 patients) included solitary kidney renal artery angioplasties. In each group, subgroups were defined whether creatinine serum level was upper or lower than 130 mumol/l. Renal function was considered to be improved if serum creatinine was reduced by 20% or more, maintained if serum creatinine variations were below 20%, worsened if its increase was upper than 20%. Global complication rate was 4.9% (9 between 185 patients) of whom 1 (0.54%) needed a surgical revascularization. At the end of follow-up (mean between 4 and 10 months), subgroups improvement and stabilization rates varied between 67 and 100%, with the best scores in the second group (96.2 and 100%) and solitary kidney with renal insufficiency subgroup (77.25%).

The concentration and concanavalin A (ConA)-dependent microheterogeneity of serum and urinary alpha 1-acid glycoprotein (AGP) were studied in patients with various degrees of renal impairment and compared with healthy control values. Serum concentrations of AGP were significantly higher in hemodialyzed and uremic patients than in the control subjects (1.54 +/- 0.42 g/l, p < 0.05, and 1.20 +/- 0.40 g/l, p < 0.05, respectively, versus 0.83 +/- 0.17 g/l). There was a similar increase in serum alpha 1-protease inhibitor and haptoglobin concentrations in the uremic patients (r = 0.87 and r = 0.70; p < 0.001). Urinary concentrations of AGP were also significantly higher in the hemodialyzed and uremic patients than in the control subjects, despite wide variability in the patients (20 +/- 14 mg/24 h, p < 0.05, and 126 +/- 160 mg/24 h, p < 0.05, respectively, versus 3 +/- 1 mg/24 h). AGP clearance was significantly higher in the uremic patients than in the hemodialyzed patients (p < 0.01) and the control subjects (p < 0.01). The proportions of strongly ConA-reactive AGP fractions were higher in the serum of the hemodialyzed (18.6 +/- 5.2%; p < 0.05) and uremic patients (18.1 +/- 5.3%; p < 0.05) than in the control subjects (14.5 +/- 2.5%). There was a similar difference in the urine samples (26.7 +/- 8.2%, p < 0.01; 20.1 +/- 6.2%, p < 0.01, respectively, versus 10.3 +/- 4.8%), with also a significant difference between the hemodialyzed and uremic patients (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

This study of serum erythropoietin levels and reticulocytes counts in the first month after kidney transplantation shows that the erythropoietin peak is efficient only when serum creatinine level at the time of the peak is under 200 mumol/l.

After recent treatment with an angiotensin converting enzyme inhibitor, a 62-year old woman with diabetes, hyperlipidemia and hypertension was admitted for oliguric acute renal failure due to bilateral renal artery lesions (right stenosis and left thrombosis). Hemodialysis was instituted. Percutaneous transluminal angioplasty (PTA) of the right renal artery did not improve the patient's condition, whereas left renal PTA, three weeks after admission, restored diuresis and renal function, allowing hemodialysis to be discontinued. This case underlines the capacity of functional recovery after late recanalization of a totally occluded renal artery. The best outcome predictor is the development of a collateral circulation and the visualization of distal renal arteries at arteriography. The kidney can be recanalized by surgery or PTA.

Percutaneous recanalization of a left occluded renal artery has been performed 10 days after percutaneous transluminal angioplasty of a controlateral renal stenosis. Improvement of the renal function is keeping normal 8 months after, although hypertension control is not very well. 26 case-reports have been found. These preliminary results are encouraging and suggest that this technique should be used against severe hypertension, especially if the kidney is functionnaly solitary, to avoid dialysis in patients with increased operative risk.

The total concentration and concanavalin A (ConA)-dependent microheterogeneity of alpha-1 acid glycoprotein (AAG) were studied in thirty hemodialyzed uremic patients and eighteen non-dialyzed uremic patients, by comparison with healthy volunteers. Serum concentrations of AAG were significantly higher in the non-dialyzed uremic (1.27 +/- 0.47 g/l) and hemodialyzed patients (1.29 +/- 0.33 g/l) than in the volunteers (0.79 +/- 0.09 g/l). The proportions of strongly ConA-reactive AAG fractions were also higher in non-dialyzed uremic (16.7%) and hemodialyzed patients (18.5%) than in volunteers (14.1%). These data may be related to an increase in bi-antennary glycans, as observed in patients on peritoneal dialysis, together with a probable change in sialylation. AAG serum levels and microheterogeneity were similar in non-dialyzed and hemodialyzed patients and did not appear in the dialyzed patients to depend on the type of dialysis membrane used, i.e. cuprophan (CU), cellulose acetate (CA), hemophan (HE), polyacrylonitrile (PAN), and polysulfon (PS), in spite of differences in biocompatibility. In patients dialyzed with CA membranes, there was a distinct decrease in the ConA non-reactive fraction (38.0%) and an increase in ConA slightly-reactive (42.2%) and strongly-reactive (19.7%) fractions. Differences in AAG serum levels and ConA reactivity between patients dialyzed with CA and PAN membranes seem to justify further investigations of other acute-phase reactants and immunological parameters.

The occurrence of expanded-spectrum-beta-lactamase-producing strains was prospectively studied in 56 patients in an intensive care unit. Ten patients were infected or colonized; some of these patients had asymptomatic intestinal colonization. Four different expanded-spectrum beta-lactamases were identified and used as epidemiological markers to survey nosocomial infections.

This biocompatibility of the new cellulosic membrane hemophane (HE) is compared to that of cuprophane (CU) in ten maintenance hemodialysis (HD) patients dialyzed on the two types of membranes in randomized order, under otherwise similar technical conditions. Total white blood cell (WBC) and differential counts, blood concentrations of C3a, and C3d and histamine are determined at start of dialysis (TO) and 10, 20 and 180 minutes thereafter. HE is distinct from CU in exerting a minor effect on the generation of C3a, a minor drop of leucocytes during the course of dialysis (P less than 0.01) and also by a lesser increase in blood histamine concentration (P less than 0.05). Histamine liberation is observed on CU together with the generation of anaphylotoxin C3 and with a diminution of circulating basopolymorpho-nuclear cells. According to the variations observed for these three parameters (C3a, leucocytosis and blood histamine concentration), HE appears as being more biocompatible than CU.

The authors report the experience of a new kidney collection centre organised at Clermont-Ferrand, which rapidly became involved in the collection of multiple organs. The difficulties encountered during the collection of organs from the first 30 cadavres are presented: 19 kidneys were not grafted, sometimes for anatomical reasons, but especially because of surgical reasons (during the following period, this number fell to 3 for a series of 21 cadavres). 13 hearts and 2 livers were also removed. In conclusion, the authors stress that such organ collection centres can only be created when transplantations are also performed, because of inevitable psychological reasons affecting both the health care team as well as the population of the region.

This case report deals with an eight-year duration severe high renin hypertension and its consequences. In 1975, a 13 years old girl was found to have blood pressure (BP) levels of 240/150 mmHg with bilateral papilloedema. Hypokalemic alkalosis, a 45 mm Sokolow index (SI) and very high peripheral renin activity (PRA) were also noticed. Renal vein renin sampling (RVRS) suggested secretion from the left kidney but intravenous pyelography and renal arteriography were normal. BP levels were first controlled by triple treatment but rose one year later, despite adjunction of beta-blockers. High PRA was again found, but without hormonal gradient on a second RVRS. From 1977 to 1982, BP never fell to normal levels despite quadruple treatment. In 1982, a stage II optic fundus, a 58 mm SI and 2 g/day proteinuria are noticed, so that a new complete etiologic work up is undertaken in 1983: PRA is still high, with a dramatic acute BP fall after captopril and no gradient on a third RVRS, but intravenous pyelography, tomodensitometry and selective arteriography disclose a 4 cm diameter poorly vascularized tumour on the surface of the lower pole of the right kidney. BP levels are controlled for three months by captopril + chlorothiazide. The tumour is removed in january 1984. RVRS by direct peroperative punction indicates (a posteriori) hormonal secretion from the right kidney lower pole. Histologic examination and immunofluorescence with antirenin serum corroborate the juxtaglomerular origin of the tumour. Eighteen months later, BP is permanently normal, SI is 30 mm, and there is no proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)

A renal biopsy was performed in a 41 year old man with Refsum's disease, following the onset of renal failure. 30% of the glomeruli were sclerosed, the others appeared normal. Ultrastructural examination revealed several types of inclusions within the tubular epithelial cells: dense bodies, simple or complex lipidic vacuoles and particularly structures composed of quadrangular microtubules with sides measuring 400 angstrom, rarely encountered in renal pathology. These dense elements, devoid of membrane and often in close contact with lipidic vacuoles, are found within the epithelial cells of the distal convoluted tubules and Henle's loops. They were localized extramitochondrially and no specimen was suggestive of a degraded form of the mitochondria. Some analogy can be made with the renal inclusions observed in Gaucher's disease.