[Importance of gastroscopy in chronic uremic patients (author's transl)]. / Intérêt de la fibroscopie digestive haute chez les insuffisants rénaux chroniques traités par hémodialyses itératives.

In chronic uremic patient, two kinds of digestive troubles can occur: gastric or duodenal lesions secondary to an abnormal gastro-intestinal hormone excretion, and drug-induced disorders. Most of these manifestations were missed by usual barium meal and the use of routine endoscopic check-up can be particularly useful. We performed 70 gastroscopies in 67 chronic hemodialyze patients. Examinations were practiced immediately before dialysis with only a light sedation. We observed 39 lesions: 3 drug-induced gastritis, 15 erosive or pseudopolypoid inflammations of the polyric antrum, 2 gastric ulcers, 5 duodenal ulcers (two of them were linear), 2 peptic oesophagitis and 34 p. cent of our patients had marked duodenitis, most of these digestive abnormalities could be missed or overdiagnosed by using routine barium meal. In presence of the number and the therapeutic importance of these disorders, we think that a gastroscopy should be prescribed in three indications: uremic patients before the beginning of an hemodialyze treatment, chronic hemodialyze patients with unexplained anemia, check-up before renal transplantation where ulcerations are a major contra-indication. In such situations, gastroscopy seems an important progress for the management of this particular group of patients.

[Influence of parathyroidectomy on the anemia of hemodialysis patients (author's transl)]. / Influence de la parathyroïdectomie sur l'anémie des insuffisants rénaux en hémodialyse.

The influence of parathyroid hormone (PTH) as a potential toxin responsible for the anemia in hemodialysed patients is suggested by the fact that 6 patients out of 12 showed improvement of their hematocrit four months after parathyroidectomy. Blood iron levels as well as calcemia, phosphoremia and hematocrit before surgery are not indicative of improvement following the intervention. A direct toxicity of PTH on erythropoiesis seems likely.

[Role of diuretics in arterial hypertension]. / Place des diurétiques dans l'hypertension artérielle.

The place of diuretics in the treatment of hypertension (HT) no longer requires to be proved, but their mode of action remains uncertain. Blood volume measurements allow us to distinguish the cases of HT which are volume-dependent, and which constitute the major indication for this type of treatment. The various groups of diuretics have a specific action on the renal tubule, but may all lead to complications, which imply that their use should be rational and that biochemical follow-up should be close when they are administered for a prolonged period. Used singly, diuretics effectively suppress HT in 40 per cent of cases, and when used in association with a beta-blocker, they produce normal blood pressure in 70 per cent of cases.

[Measurement of plasma renin activity, blood volume and exchangeable sodium: an aid in the orientation of treatment of essential arterial hypertension]. / Mesure de l'activité rénine plasmatique, de la volémie et du sodium échangeable: une aide pour orienter le traitement des hypertensions artérielles essentielles.

95 patients with essential uncomplicated hypertension were mostly submitted to measurement of plasma renin activity, plasma volume and exchangeable sodium. According to the results of the plasma renin activity, we noted variations in blood volume and exchangeable sodium in order to determine the best possible treatment based on these data. Single treatment, based either on diuretics or beta-blockaders was rarely sufficient to bring the blood pressure down to normal. Association of these two types of drug was often very useful. Finally, a critical study of these 3 parameters was made in an economic view of investigations of the blood pressure. The plasma volume seemed to us the most useful investigation, after which came the measurement of plasma renin activity. for the exchangeable sodium seemed of little interest.

[Intra-renal arterio-venous aneurysm after renal puncture biopsy. Supra-selective embolization. Cure (author's transl)]. / Anevrysme artério-veineux intra-reinal après ponction biopsie du rein. Embolisation supra-sélective. Guérison

This case emphasizes the value of: 1. Treatment of malignant hypertension with the combination of hemodialysis and beta-blockers. 2. Supra-selective arterial embolization in inaccessible intra-renal aneurysms or those difficulty accessible to surgery.