共查询到20条相似文献,搜索用时 31 毫秒
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Thierry Petitclerc 《Néphrologie & thérapeutique》2013,9(1):38-49
Water balance control is aimed at normalizing cellular hydration, and sodium balance control at normalizing extracellular volume. Water balance control is based on the regulation of body fluid tonicity, while the control of sodium balance is based on the regulation of effective arterial volume. Disorders of water balance act on cellular hydration: primary disorders induce a proportional change in tonicity; secondary disorders are induced by a change in tonicity or effective arterial volume. Disorders of sodium balance act on extracellular volume: primary disorders of sodium balance induce a change in effective arterial volume; secondary disorders are induced by a change in effective arterial volume. Physical examination of the patient allows assessing the extracellular volume and the severity of the sodium balance disorder. Natremia – that generally reflects tonicity – allows to assess cellular hydration and to determine the type of water balance disorder. In the case of natremia disturbance, the assessment of both the tonicity and the extracellular volume allows the determination of the type of water and/or sodium balance disorder that is necessary for prescribing the adequate therapy. 相似文献
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《Revue du Rhumatisme》2001,68(9):843-849
Objectives. To compare the efficacy and safety of etidronate and alendronate in patients with postmenopausal osteoporosis and to assess the efficacy of either bisphosphonate in combination with hormone replacement therapy (HRT). Patients and methods. In this pragmatic study, the main efficacy criterion was the mean annual change in bone mineral density (BMD). Patients who had a past or current history of etidronate or alendronate treatment for postmenopausal osteoporosis with at least 18 months follow-up and an evaluation in 1999 were eligible. Recruitment was in an outpatient clinic with a special focus on metabolic bone diseases. Osteoporosis was defined as at least one low-energy fracture or as a lumbar spine or femoral neck BMD decrease to at least 2.5 SD below the mean in young women. HRT was not an exclusion criterion provided treatment duration was longer than one year. Etidronate was given cyclically (14-day courses in a dosage of 400 mg/d separated by 76-day intervals with calcium and vitamin D supplementation) and alendronate was given daily in a dosage of 10 mg/day. Results. Of the 99 patients who met our inclusion criteria, 53 received etidronate (including 23 on HRT) and 46 alendronate (18 on HRT). Repeat BMD measurements were obtained in 88 patients, including 11 who stopped their bisphosphonate therapy within the first year of use because of adverse events. Lumbar spine BMD (mean ±SD) increased significantly both in the etidronate group (+2.1%±0.7%/year) and in the alendronate group (+5.3%±0.9%/year). The increase was significantly greater with alendronate (P<0.01). The lumbar spine BMD increase was largest in the patients on alendronate and HRT (+6.5%±1.4%/year) and was smallest (and nonsignificant) in the patients on etidronate without HRT (+1.2%±0.8%). Femoral neck BMD showed no significant changes in any group. In the intention-to-treat analysis, fractures occurred in 12 etidronate patients (22.6%) and six (13.0%) alendronate patients (nonsignificant). Adverse events requiring bisphosphonate discontinuation before the scheduled date of the follow-up BMD measurement occurred in one patient (1.9%) in the etidronate group (generalized osteomalacia) and in ten patients (21.7%) in the alendronate group (upper or lower gastrointestinal tract symptoms in six and four patients, respectively; P<0.01). Conclusion. Both etidronate and alendronate significantly increased lumbar BMD, but the effect was significantly more marked with alendronate. Conversely, adverse effects, most notably gastrointestinal symptoms, were more common with alendronate, so that premature treatment discontinuation because of adverse events were more common in the alendronate group. Both differences should be taken into account when selecting the best drug for a patient with postmenopausal osteoporosis. 相似文献
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Catherine Monet-Didailler Jean-François Chateil Lise Allard Astrid Godron-Dubrasquet Jérôme Harambat 《Néphrologie & thérapeutique》2021,17(1):58-66
Nephrocalcinosis is defined by calcium phosphate or calcium oxalate deposits in the kidney parenchyma, particularly in tubular epithelial cells and interstitial tissue. It should be differentiated from urolithiasis where calcium salts deposits are located in the kidney and urinary tract. The epidemiology of nephrocalcinosis in children is unknown but the condition is not so rare, with an increased incidence in preterm infants. Often detected as an incidental finding, nephrocalcinosis may be classified according to the radiological type: medullary, cortical or diffuse. Nephrocalcinosis in children can be caused by a variety of etiology. The most common causes concern medullary nephrocalcinosis and include hereditary tubular disorders, in particular distal renal tubular acidosis and Dent disease, metabolic disorders such as idiopathic hypercalciuria and hyperoxaluria, and iatrogenic causes such as vitamin D intoxication. In the newborn, the main cause is hypercalciuria of the premature baby, whose multifactorial origin is largely iatrogenic. Primary hyperoxaluria which can lead to early onset nephrocalcinosis and usually to chronic kidney disease should always be considered and further investigated. In order to provide a specific diagnosis, it is essential to take into account the family history, the clinical context and complete laboratory data. Early initiation of an appropriate etiological treatment is recommended and may prevent or delay the progression to chronic kidney disease in some cases. 相似文献
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《EMC - Rhumatologie-Orthopédie》2005,2(1):80-94
The hemiplegic hand is a spastic and paralytic hand due to central neurological lesions. Two completely different types must be distinguished: the hand of the child with cerebral palsy which is the subject of almost all the studies on surgery of the hemiplegic hand, and the hand of the brain damaged adult (after vascular hemiplegia or brain traumatism). In this second type, the indications in a functional aim are very rare, due to the associated cerebral disorders. However, the indications in a hygienic or aesthetic aim are common and make this surgery, which is not very well known and which can greatly improve the global functions of these patients, a winning surgery. The surgical indications are based on a specific clinical study of the hand completed by the use of anaesthetic blocks, electromyographic studies and use of botox. Apart from this lesional study, they must take into consideration general and cognitive conditions. It is thus possible to distinguish two types of hands: the “Potentially Functional Hand” which can recover after treatment its functional possibilities which will never be total but will be useful, and the “Potentially Non Functional Hand” which will remain functionally unusable. The aim of this surgery is to correct muscular disorders between agonist and antagonist and the osteo-articular deformations that they bring about. For this, the nerve can be treated (hyponeurotisation, neurectomy, neuro-surgery) or on the muscle by relaxing the agonist muscles (muscular disinsertion, tendon lengthening…) or by strengthening the action of the antagonist muscles by tendon transfers. The articular stabilisation of the wrist, of the digital chains and of the thumb in a good position can be performed by arthrodesis or tenodesis. 相似文献
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《Annales fran?aises d'anesthèsie et de rèanimation》1995,14(2):218-221
We report a case of intimal rupture of aortic isthmus in a severe polytrauma patient diagnosed with transoesophageal echocardiography (TEE). TEE findings were as follows: localized intimai tear without increased aortic diameter or pseudoaneurysm, absence of mediastinal haematoma or false lumen. CT scan and MRI confirmed the diagnosls. Because of the assoclated Injuries, surgery was delayed. Conservative management was successful and the patient was discharged without aortic surgery. A follow up TEE, 3 and 6 months later showed a thrombosls of the intimai tear without false aneurysm. This case underlines the value of TEE in patients with thoracic trauma, for surgical or nonsurgical management of aortic rupture and for the follow up of the patients. 相似文献
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