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Biomedical subjects

A M Piette

Publications and source records attributed to A M Piette.

At least 37 records · Page 2Linked to original sources
PubMed1996

Management of the antiphospholipid syndrome. Main trends, unsolved questions, practical and educational aspects.

Therapeutic guidelines are progressively emerging in the antiphospholipid syndrome (APS). For primary APS, prevention of recurrent miscarriages is frequently achieved by a combination of heparin plus aspirin. Steroids should not be used in the absence of associated systemic lupus erythematosus. Long term warfarin aimed at an INR of 3-3.5 is effective for the secondary prevention of thrombosis. However, some doubt is raising regarding the pertinence of INR monitoring in patients with a lupus anticoagulant. Education is an important part of the management of patients with APS. Coincident risk factors for thrombosis have to be suppressed or controlled. Psychological aspects also need to be carely considered during the course of this chronic disorder.

Abortion, Habitual↗
PubMed1994

[A new cause of prolonged fever of unknown origin: progesterone substitution therapy].

OBJECTIVES: Over the last 3 years, we examined 15 patients on progesterone substitution therapy who presented prolonged fever. Many explanations had been put forward before the diagnosis was suggested. We recall the thermogenic effect of progesterone. METHODS: Based on a retrospective analysis, we reported the clinical and biological features of 15 patients with prolonged fever due to progesterone substitution therapy and prospectively followed the temperature curves of 9 menopaused women who received substitution therapy for the first time. RESULTS: The 15 case reports were quite typical. Often onset occurred with an acute infectious episode. Following this episode, the patients continued to take their temperature and discovered persistent fever. The context was often one of anxiety-depression rich in functional symptomatology. Laboratory findings included a normal sedimentation rate in all patients. Several days after treatment withdrawal temperature returned to normal. The prospective study confirmed the thermogenetic effect of almost all progesterone substitution drugs. CONCLUSION: The thermogenic effect of natural progesterone is well known but it must be recalled that all progesterone agents with 5-beta metabolites have the same effect. Since metabolic clearance is long, the thermogenic effect may persist for several days after withdrawal.

Adult↗
PubMed1994

[Antiphospholipid syndrome. 20 cases].

OBJECTIVES: We analyzed the clinical and biological characteristics as well as the clinical course and outcome observed in 20 patients with antiphospholipid antibodies and clinical signs including thrombosis or repeated spontaneous abortion to better identify the recently described antiphospholipid syndrome. METHODS: We retrospectively studied all patients observed in our unit from 1981 to 1992 who fulfilled the following inclusion criteria: a) at least one episode of arterial or venous thrombosis and/or repeated spontaneous abortions, b) positive for antiphospholipid antibodies. RESULTS: Twenty patients were included, 3 with systemic lupus erythematosus (according to the American Rheumatism Association criteria). Arterial or venous thrombosis occurred in 9 and 16 respectively, including exceptional cases of cerebral phlebitis and thrombosis of dermal capillaries. High blood pressure was recorded in 8. Only 1 or 2 types of antiphospholipid antibodies were found in most patients. Anticardiolipin, a circulating anticoagulant and a false-positive Bordet-Wassermann reaction were found together in only 3 out of 16. In addition, the antibody level varied independently from the thrombotic events. There was no case with a clinical course from primary antiphospholipid syndrome to systemic erythromatosus lupus. The effect to treatment on occurrence of new thrombotic events was studied. Three patients suffered one or more haemorrhagic events during antivitamin K treatment. CONCLUSION: It is difficult to establish a differentiation between primary antiphospholipid syndrome, systemic lupus erythematosus and lupus-like syndromes, and precise methods of identifying antiphospholipid antibodies should be further developed.

4-Hydroxycoumarins↗
PubMed1994

[Pachydermodactyly: report of a case].

This 20 year old white patient complained of progressive thickening of his fingers over a period of four years. The second, third and fifth fingers of each hand indeed appeared podgy. The soft tissue on each side of the first phalanx was swollen, firm without adherence to the bone. The skin of the interdigital space was hyperpigmented and lichenified. This case illustrates the clinical and histologic features of digital fibromatosis which are discussed.

Adult↗
PubMed1994

[Hyperthyroidism and hypersecretion of chorionic gonadotropin in gastric adenocarcinoma].

We report a case of hyperthyroidism complicating and revealing a metastatized adenocarcinoma of the stomach with high circulating levels of human chorionic gonadotropin and its beta component. To our knowledge, this is the first reported case of a non-trophoblastic tumor with hyperthyroidism and secreting quantities of these hormones. High circulating levels of beta component in such patients have been considered to be a sign of malignancy. The mechanisms of thyroid stimulation could be related to the biological activity of certain forms of the human chorionic gonadotropin.

Adenocarcinoma↗
PubMed1993

[A new cause of unexplained prolonged fever: estroprogestogen treatments, apropos of 12 cases].

Twelve female patients treated by progestogens with or without estrogens presented with prolonged (1 to 48 months) elevation of body temperature above 37 degrees C but below 38 degrees C. They had usually continued taking their temperature after and initial transitory febrile episode. Most had had multiple diagnostic tests which remained negative. Temperature became normal after cessation of hormonal treatment.

Adult↗
PubMed1992

[Does arthritis due to varicella zoster virus exist?].

Occurrence of monoarthritis or oligoarthritis during the course of zoster is exceedingly rare (three previously reported cases). In the additional case reported herein, an immunocompetent female exhibited oligoarthritis (right shoulder followed by two metacarpophalangeal joints in her right hand) a few days before developing a typical zoster eruption in the ipsilateral upper limb. Pathogenesis of zoster-related arthritis is discussed. The most likely hypothesis is infection of the joint via the nerve supply rather than via the bloodstream. Evidence in support of this mechanism includes recovery of the virus from synovial fluid specimens in a previously published case.

Arthritis, Infectious↗
PubMed1992

[Electrolyte abnormalities in elderly people. Prevalence and relation to drug treatment. Multicenter study of 631 subjects aged 70 years and over].

In order to assess the responsibility of medicinal drugs for the disorders in electrolytes observed in elderly people, the prevalence of abnormal natraemia and kalaemia was prospectively established in 631 subjects aged 70 or more on the first day of hospitalization. Among 337 subjects not taking drugs likely to create problems (diuretics, angiotensin-converting enzyme inhibitors, anti-inflammatory agents) 3.6 percent had hyponatraemia (below 130 mmol/l) and 12.2 percent had hypokalaemia (below 3.5 mmol/l). Subjects with normal renal function who were taking angiotensin-converting enzyme inhibitors or non-steroidal anti-inflammatory agents showed no more electrolytic abnormalities than those who did not take them. Conversely, subjects on thiazides were more frequently hyponatraemic (11.8 percent) or hypokalaemic (16.2 percent; 20 percent in the absence of associated distal diuretics). These abnormalities were more frequent in women than in men (21.7 and 13 percent). This, together with the fact that 68 percent of subjects taking thiazides were women accounts for the marked female predominance of electrolytic abnormalities reported in the literature.

Aged↗
PubMed1992

["Primary" pulmonary arterial hypertension associated with HIV infection. Two cases].

We report two cases of pulmonary arterial hypertension (PAHT) in HIV infected patients who never were, or had ceased to be, drug addicts. A study of these cases and a review of the literature show that this association is not fortuitous and persists after the classical causes of PAHT (pulmonary embolism, toxic factors, cirrhosis) have been excluded. The clinical features and the results of complementary cardiovascular examinations are identical with those of the so-called "primary" PAHT. The prognosis is severe: 50 percent of the patients died of the consequences of PAHT 1 year after the first clinical signs. Histology displays signs of plexogenic pulmonary arteriopathy, as in primary PAHT. In HIV patients pulmonary arterial hypertension occurs independently of the degree of immunodeficiency. Its relation with other HIV-related vasculites and their physiopathology are discussed.

Adult↗
PubMed1992

Urinary trypsin inhibitory activity for the diagnosis of bacterial infection: a prospective study in 690 patients.

OBJECTIVES: During the acute phase response, interleukin-1 induces production of inter-alpha-trypsin inhibitor. The measurement of urinary trypsin inhibitory activity which results from the effects of inter-alpha-trypsin inhibitor degradation products is easy, quick and inexpensive. We conducted a prospective study to investigate its value as a diagnostic tool in comparison with C-reactive protein. METHODS: Comparisons were made in 690 consecutive patients at admission to a department of internal medicine. RESULTS: The level of urinary trypsin inhibitory activity was significantly higher in patients with bacterial infection (mean = 123 IU/g creatinine) than in patients with either viral infection (34 IU), cancer (50 IU), elevated erythrocyte sedimentation rate without infection (45 IU), miscellaneous non-inflammatory diseases (27 IU) or in non-organic controls (19 IU) (Dunnet's test, p << 0.01). The receiver operating characteristic curve showed that sensitivity and specificity of urinary trypsin inhibitory activity were higher than those of C-Reactive protein for the diagnosis of bacterial infection. For levels > or = 60 IU, sensitivity was 75% and specificity 89%. Urinary trypsin inhibitory activity levels fell within 2 days in patients treated for acute bacterial infection. CONCLUSION: Urinary trypsin inhibitory activity could be a useful marker of bacterial infection particularly in patients with fever of unknown origin and/or elevated erythrocyte sedimentation rate.

Alpha-Globulins↗
PubMed1992

[Primary Nocardia asteroides deltoid abscess in treated Horton disease].

In a patient treated with high doses of corticosteroids for giant cell arteritis, a renewed rise in sedimentation rate accompanied by painful limitation of mobility of the shoulder led to the discovery of an intra-deltoid fluid collection. Aspiration yielded pus, culture showing the presence of Nocardia asteroides (NA). No portal of entry nor extramuscular sites of infection were found, justifying a diagnosis of primary nocardial muscle abscess. To the best of our knowledge, this is the first reported case. The opportunity is taken to review the epidemiological and clinical characteristics of NA infections as well as new management approaches.

Abscess↗
PubMed1991

[Deep phlebitis of the lower limbs. Diagnostic value of D-dimer assays].

D-dimers are specific fibrin degradation products which have been measured in plasma and used as a diagnostic test for deep vein thrombosis of the lower limbs. However, the results published so far have often been conflicting. We compared the results of D-dimer assays by the latex method (positivity threshold: 0.5 microgram/ml) in 3 groups of patients: 22 patients with clinically suspected thrombophlebitis confirmed by doppler ultrasound; 22 patients with clinically suspected thrombophlebitis not confirmed by doppler ultrasound; and 17 hospital patients with other diseases serving as controls. The sensitivity of a D-dimer concentration higher than 0.5 microgram/ml was 96 percent and its specificity 69 percent. In an internal medicine unit where the prevalence of thrombophlebitis was 50 percent, the positive predictive value of a D-dimer concentration higher than 0.5 microgram/ml was 81 percent, and its negative predictive value was 94 percent. Thus, because of its low specificity as compared with imaging methods the D-dimer assay test cannot be used to diagnose deep vein thrombosis, but as it has good sensitivity and is rapidly performed, safe and inexpensive it can be used as an emergency examination which, when negative, makes this diagnosis unlikely.

Fibrin Fibrinogen Degradation Products↗