[Dose-effectiveness relationship of cicletanine at short-term in moderately to severely hypertensive patients]. / Etude de la relation dose-efficacité du ciclétanine à court terme chez des hypertendus modérés à sévères.

In this double-blind trial, four-group study the effectiveness and safety of cicletanine in doses of 100 mg/day (n = 30, two of whom were excluded), 150 mg/day (n = 30) or 200 mg/day (n = 28, one of whom was excluded) were studied in patients with moderate or severe arterial hypertension (DBP greater than 95 mmHg). In patients with moderate hypertension (DBP less than 120 mmHg), the three dosage levels resulted in normalization of DBP (less than 95 mmHg) in 80 to 85 p. 100 of the cases, but in those with severe hypertension only doses of 150 and 200 mg/day were effective in significantly reducing DBP in 50 to 65 p. 100 of the cases. There was an important reduction of symptoms (palpitations, vertigo, headache) with all three doses, but only the 200 mg dose reduced dyspnoea. The drug was well tolerated both clinically and biochemically. In patients with severe hypertension, cicletanine 150 mg/day seems to be useful in short-term treatment, while in patients with moderate hypertension doses of 150 or 200 mg/day do not seem to be necessary, even in short-term treatment.

[Beta-2 microglobulin and amyloid osteoarthropathy in patients undergoing chronic hemodialysis]. / Bêta-2-microglobuline et ostéo-arthropathies amyloïdes de l'hémodialysé chronique.

The incidence of beta-2 microglobulin amyloidosis was assessed in two populations of chronic hemodialysis patients. Out of 34 patients who underwent biopsy during orthopedic surgery (33 cases) or autopsy (1 case), 26 had amyloid deposits which fixed anti-beta microglobulin serum. Out of 55 unselected patients treated for over months at the dialysis centre, 14 (25%) had clinical symptoms suggesting amyloidosis and out of 43 patients who had a systematic radiological skeletal survey, 23 (53%) had bone deposits. The plasma beta microglobulin concentrations (about 20 times the normal value) we not significantly different whether or not the patients had histological proven amyloidosis, clinically or radiologically probable amyloidosis, no detectable amyloidosis. However, the duration of hemodialysis was longer in those with proven or highly probable amyloidosis. The finding illustrate the indirect role of elevation of beta-2 microglobulin in the genesis of this pathology and also the necessity of lowering its concentration in order to avoid the long term complications of osteoarticular deposits, the functional consequences of which may be very serious.

[Plasma catecholamines, free and conjugated, in the hemodialyzed chronic renal failure patient]. / Catécholamines plasmatiques, libres et conjuguées, chez l'insuffisant rénal chronique hémodialysé.

Free, sulfo and glucuro-conjugated catecholamines (dopamine, noradrenaline and adrenaline) were measured to study their metabolism in 35 non-selected patients with chronic renal failure, and under hemodialysis for various periods of time. Our data demonstrate a statistically significant increase of free dopamine, and free noradrenaline concentration in these patients, while that of free adrenaline was not different from controls. However a careful scrutiny of 35 individual data suggests that sub-groups of patients with either high normal or low plasma free noradrenaline concentration could exist; this likely heterogeneity could be a good explanation for conflicting conclusions provided by previous reports. Suspecting that conjugated catecholamines might be altered in these patients, plasma sulfo and glucuro-conjugated amines were measured. We have found a predictable and highly significant increase of sulfo-conjugated catecholamines; glucuroconjugated dopamine and noradrenaline were unchanged, while glucuroconjugated adrenaline was significantly increased. The physiological meaning, if any, of these new observations on conjugated catecholamines cannot be assessed at the moment.

Oral load of tyrosine or L-dopa and plasma levels of free and sulfoconjugated catecholamines in healthy men.

The levels of free and sulfoconjugated catecholamines were measured in the plasma of fasting, recumbent normal subjects before and after an oral load of the catecholamine precursors tyrosine or L-dopa. Basal values of sulfoconjugated catecholamines, measured in plasma samples diluted 1:100 were 7998 +/- 540 pg/ml for dopamine sulfate, 2938 +/- 281 pg/ml for norepinephrine sulfate, and 2958 +/- 288 pg/ml for epinephrine sulfate (n = 37 tests in 15 men); these basal values are higher than those reported previously. Neither free nor sulfoconjugated catecholamine concentrations were changed by a tyrosine load (100 mg/kg) that induced a doubling of the plasma tyrosine level or by a meal low in phenylalanine and tyrosine (but otherwise supplying constituents of normal nourishment) that induced a greater than 50% reduction in the plasma tyrosine concentration. After an oral load of L-dopa (125 mg) the following were observed. (1) An extremely large increase (greater than 100-fold) in dopamine sulfate levels was noted, an increase that was less marked in the same subjects given L-dopa (125 mg) plus the peripheral dopa-decarboxylase inhibitor carbidopa (12.5 mg); as expected, free dopamine concentration also was increased. (2) Neither free nor sulfoconjugated norepinephrine concentrations were altered. (3) Epinephrine sulfate but not free epinephrine concentration was increased (more than ten-fold) after L-dopa ingestion alone; this result was unexpected and has to be confirmed before considering its physiological meaning, if any.

[Glomerulopathies in the aged (excluding diabetes)]. / Les glomérulopathies des personnes âgées (en dehors du diabète).

Fifty-five cases of glomerular disease in non-diabetic patients above sixty years of age were studied retrospectively. Primary glomerular disease was found in 36 cases, among which 14 cases with minimal changes glomerulopathy (25.4%) and 7 cases with membranous glomerulopathy (12.7%). The remaining 19 patients had secondary glomerular disease, mainly with amyloidosis (12 cases: 21.8%). In these three main forms of glomerulopathy, symptoms were similar, making differential diagnosis impossible before histological examination. Significant responses to treatment can be achieved in minimal changes and extracapillary proliferative glomerulopathies: among the 14 patients given corticosteroids, 9 recovered or experienced very significant improvement. However, one patient under cortico-steroids died from perforation of the sigmoid. In order to establish the best treatment, investigations should be carried out as in younger patients, since they do not seem to involve a significantly higher risk.

[Pseudocoarctation caused by a calcified intra-aortic mass]. / Pseudo-coarctation due à une masse intra-aortique calcifiée.

Weak or absent lower limb pulses and a thoracic systolic murmur in a fifty-seven-year-old woman with hypertension suggested coarctation. Thoracic X-Ray showed a narrowing of the thoracic aorta over 10 cm due to an intraluminal calcified aortic mass. The remaining aorta and its branches were normal. Histologic examination of the operative specimen found atherosclerotic lesions with thrombosis. This very unusual condition seems to represent an individual entity of which a few cases have been reported in the literature.

[Sarcoidosis disclosed by renal insufficiency (3 cases)]. / Sarcoïdose révélée par une insuffisance rénale (trois cas).

Sarcoidosis was found in three patients referred for etiologic diagnosis of chronic or rapidly progressive renal failure. One patient presented as an isolated interstitial nephropathy and renal biopsy showed granulomatosis. The two other patients had hypercalcemia. In one, hyperparathyroidism was discussed and cervicotomy disclosed a sarcoidosic adenopathy. Under corticosteroid therapy, renal function improved in each of the three patients. It is pointed out that accurate diagnosis of this setting is of significance since effective therapy is possible.

[Arterial hypertension in elderly patients, and difficulties in its treatment]. / L'hypertension artérielle des sujets âgés et les difficultés du traitement.

In treating elderly patients with hypertension, specific characteristics should be taken into account. These are related to general hemodynamics, renal function and neurohormonal systems. Medications are the same as those used in middle-aged hypertensive patients. In the elderly, management requires great caution because of maximum difficulties. Satisfactory clinical and biological tolerance is an essential goal. The best initial therapy seems to be a diuretic drug given in low dosages. Some patients may require addition of a central sympatholytic, a beta-blocking agent or a vasodilator.

[Intermittent claudication disclosing amyloidosis in a chronically hemodialysed patient with light-chain myeloma]. / Claudication intermittente révélatrice d'une amylose chez un hémodialysé chronique porteur d'un myélome à chaînes légères.

The occurrence of amyloid deposits in skeletal muscle and its vessels has been noted from a long date in amyloidosis. However, their clinical manifestations have been seldom noticed. The authors report the case of a patient with light-chain myeloma in which an arterial intermittent claudication led to the discovery of muscle vascular amyloid deposits. Muscle signs and symptoms due to amyloidosis and their mechanisms are reviewed.

[Chronic renal failure after CCNU treatment (author's transl)]. / Insuffisance rénale chronique après traitement par le CCNU.

Terminal chronic renal failure was discovered in a patient who had received CCNU 1 940 mg/m2 during the previous two years. The renal function was normal before treatment, and there was no evidence of other causes of renal failure. The clinical picture was identical with that observed in patients receiving such treatment and recently published. This case emphasizes the need for limiting the dose of nitrosyl-urea compounds to 1 200 mg/m2 and for monitoring the renal function very closely during and towards the end of the treatment.

[Tomodensitometry: localizing value in hypertension of adrenal origin (author's transl)]. / Tomodensitométrie: intérêt localisateur au cours des hypertensions artérielles d'origine surrénalienne.

Computarized axial tomography has shown the localization of adrenal lesions in four cases of hypertension of adrenal origin: two phaeochromocytomas, one primary hyperaldosteronism, one Cushing's syndrome. This method has the advantage of being neither invasive, nor time-consuming. Unfortunately, it cannot localize tumors smaller than two cm in diameter. It seems to be highly beneficial in phaeochromocytoma, where it can advantageously take the place of arteriography. It is less fruitful in primary hyperaldosteronism and in Cushing's syndrome because lesions are smaller.

[Study of the effect of dopamine on renal excretion in chronic renal failure (author's transl)]. / Effets de la dopamine sur l'excrétion rénale dans i'insuffisance rénale chronique.

The effects of dopamine on renal excretory function were studied in 20 patients with chronic renal failure (plasma creatinine higher than 30 mg/i). Effects were marked at a dose of 2 micrograms/kg/mn and were no greater at a dose of 5 micrograms/kg/mn (10 subjects in each case). In general, creatinine clearance increased by 28%, urea excretion by 45%, urine output by 77% and urinary sodium output by 164%. In ten patiens with terminal renal failure (plasma creatinine greater than 100 mg/i), the effects of dopamine were maintained. In these individuals, furosemide (250 mg by single intravenous injection) resulted in a higher total urine and urinary sodium output but had a less favourable effect upon creatinine.

[A treatment of mild and moderate hypertension with timolol (author's transl)]. / Traitement par le timolol de l'hypertension artérielle légère ou modérée.

21 patients with essential sustained mild or moderate hypertension were treated with timolol for an average of 6 months at a mean dosage of 3,14 tablets per day. The mean decreases of supine systolic and diastolic blood pressures were respectively of 17,8 and 7,3 mm Hg. The efficacy of timolol was considered excellent or good in 11 cases (52,4 p. cent) and its tolerance perfect in 15 cases (71,4 p. cent). The study was extended in 15 cases with one dose of timolol per day. Effectiveness remained excellent in 12 cases. There was neither orthostatic hypotension nor brady-cardia of less than 55 beats per minute nor water retention. Side effects appeared in 6 cases requiring discontinance of therapy in only one case (exertional dyspnea).