[Extracorporeal lithotripsy of urinary calculi. Results and radiologic criteria of effectiveness. Apropos of 700 cases]. / Lithotritie extra-corporelle des calculs urinaires. Résultats et critères radiologiques d'efficacité. A propos de 700 cas.

The results of extracorporeal shock wave lithotrity (Dornier lithotriptor) for 700 cases of urinary calculi have been reviewed and correlated with the radiological features of the calculi in order to define some predictive radiological criteria of effectiveness. The calculi were broken up in 74.5% of all cases, complete destruction (no residual fragment) was achieved in 34.5% and partial destruction in 40% of cases. The rate of failure (failure to break up or scatter the calculus) is 8.9%. Complications were observed in 2.6% of all cases, a second session of lithotrity or a surgical operation was required in 4.8% of cases (evolution lost to follow-up: 9.2%). The comparison of these results with the radiological data obtained before lithotrity allows distinguishing 2 categories of calculi: 1) Calculi with a favorable prognosis: single, smaller than 1 cm, pyelic, not very opaque and heterogeneous, located in normal-sized cavities; 2) calculi with a poor prognosis: multiple, larger than 2 cm, lower calyceal or ureteral, very opaque and homogeneous, located within dilated cavities.

[Epidemiology of primary glomerulonephritis in Picardie]. / Epidémiologie des glomérulopathies primitives en Picardie.

Between 1 January 1976 and 31 December 1986, primary glomerulonephritis was histologically diagnosed in 319 patients, living in a region of 675,000 inhabitants at the time of renal biopsy. The prevalence of primary glomerulopathy was 0.4/1000 inhabitants. The annual incidence was determined during two 5 year periods: period A (1976-1980) and period B (1981-1985): they were, respectively, 3.4 and 4.5 for 100,000 inhabitants. Berger's focal glomerulonephritis was the most common (30 p. 100) and its incidence was increasing. In contrast, membranoproliferative and acute glomerulonephritides were sharply decreased (almost disappeared), while membranous glomerulonephropathies and glomerulopathies with minimal glomerular lesions or proliferative forms with crescents increased. All primary glomerulonephritides were more prevalent in men and their frequencies increased with age. Our findings lead to the following conclusions: a) the low prevalence and incidence of primary glomerulopathies (3 times less than in other published studies) probably reflect the under medicalization of our region and the attractiveness of neighbouring metropolis, rather than a real decrease in the disease; b) the quasi- disappearance of acute and membranoproliferative glomerulonephropathies and the high incidence of IgA glomerulonephropathies suggest that their pathogenetic associations with infections sensitive to antibiotics are different; c) the increased frequency of membranous glomerulonephropathy and the glomerulopathy with minimal glomerular lesions in aged subjects is most likely due to their polymedication.

Magnesium hydroxide as a complementary aluminium-free phosphate binder to moderate doses of oral calcium in uraemic patients on chronic haemodialysis: lack of deleterious effect on bone mineralisation.

To control hyperphosphataemia without hyperaluminaemia, A1(OH)3, which was given in addition to high doses of oral calcium, was replaced by Mg(OH)2 for 6 months in 20 haemodialysed patients and for 20 months in 12. The treatment during the control period was 110 +/- 91 mmol/day of oral calcium element given as CaCO3 and/or Calcium Sorbisterit and 1.05 +/- 1.47 g/day of A1(OH)3. Haemodialysis treatment was 4 h, thrice weekly. To prevent hypermagnesaemia, dialysate magnesium was decreased from 0.75 mmol/l to 0.375 mmol/l. After a control period of 3 months, Mg(OH)2 was given at a mean dose of 2.6 +/- 2 g/day and oral calcium supplements were decreased to 76 mmol/day. Two subsequent bone histomorphometry studies were performed at 8 month intervals in four patients and at 20 month intervals in seven patients. The results show a good control of plasma calcium (mean +/- SD: 2.43 +/- 0.1 mumol/l); phosphate (1.76 +/- 0.4 to 1.66 +/- 0.3 mmol/l); aluminum (1.3 +/- 0.1 mumol/l to 0.6 +/- 0.1 mumol/l); alkaline phosphatase (135 +/- 65 to 125 +/- 40 IU); and PTH fragments (PTH C terminal decreased from 260 +/- 214 to 185 +/- 182 pg/ml, PTH medium from 4185 +/- 5113 to 2270 +/- 4880 pg/ml). Plasma magnesium increased from 0.96 +/- 0.2 to 1.54 +/- 0.2 mmol/l. Bone histomorphometry shows no change in mineralisation, and a borderline decrease of resorption parameters. The main side-effects are (1) diarrhoea, which was well controlled by transient treatment with karaya gum, and (2) an increased need for potassium binders.(ABSTRACT TRUNCATED AT 250 WORDS)

[Response to influenza vaccine in uremic patients: relation to erythrocyte magnesium and the value of a second injection]. / Réponse au vaccin grippal chez les urémiques: relation avec le magnésium érythrocytaire et intérêt d'une seconde injection.

Humoral response to influenza vaccination being variable in uremic patients and being negatively correlated to red blood cell magnesium (RBC Mg) in non-uremic subjects, RBC Mg as well as plasma concentration of Mg were measured simultaneously with the antibodies titers after 1 and 2 injections of influenza vaccine in 21 non-uremic subjects and 47 patients on chronic hemodialysis. The RBC Mg and plasma Mg (MgP) were significantly higher in the dialysed patients (74 +/- 12 mg/l; 25 +/- 8 mg/l) than in the non-uremic subjects (54 +/- 5 mg/l; 19.4 +/- 1.5 mg/l). Furthermore, in the uremics RBC Mg was correlated to PMg whereas such a correlation was absent in the non-uremic patients. The humoral response of the uremic patients is depressed and becomes comparable to that of the non-uremic subjects after 1 injection only after 2 injections. In the uremic patients, the depressed humoral response is associated with higher RBC Mg (greater than 70 mg/l). The humoral response to influenza vaccine is depressed in uremic patients who have either the HBs antigen or no response to the hepatitis B vaccine but no link has been found between this immune status against the hepatitis B and RBC Mg. In conclusion, the humoral response of the uremic patients to influenza vaccine is depressed so that a second injection is necessary to give them sufficient protection.