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Biomedical subjects

B Goichot

Publications and source records attributed to B Goichot.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Anemia caused by vitamin B 12 deficiency in subjects aged over 75 years: new hypotheses. A study of 20 cases].

PURPOSE: New hypotheses have recently been developed on vitamin B12 deficiency and the frequently observed occurrence in the elderly subject of food cobalamin malabsorption, i.e., the non-dissociation of B12 and its carrier protein (ND B12), and the possibility of rectifying this imbalance by oral crystalline B12 supplementation. The aim of this study was therefore to confirm these hypotheses in a series of patients aged over 75 years with anemia due to B12 deficiency. METHODS: A retrospective study was carried out over a 5-year period on patients aged over 75 years presenting with megaloblastic anemia (hemoglobin [Hb] < 12 g/dL) and vitamin B12/cobalamin deficiency (B12 < 160 pg/mL). RESULTS: Twenty cases were analyzed. The average age of the patient population was 82.5 +/- 6 years, and the F/M sex ratio was 1:2. Mean Hb levels were 7.9 +/- 2.4 g/dL, mean serum B12 levels were 83 +/- 24 pg/mL, and mean homocysteinemic levels were 35 +/- 27 mumol/L. The diagnosis was as follows: food cobalamin malabsorption/ND B12 (n = 10), Biermer's disease/pernicious anemia (n = 5), malabsorption due to pancreatic insufficiency (n = 1), and low dietary B12 levels (n = 1). Disorders associated with ND B12 were: atrophic gastritis and Helicobacter pylori infection (n = 6), antacid or biguanide intake (n = 3), alcohol abuse (n = 2), or idiopathic syndrome (n = 2). In the patients who were followed up (n = 10), i.m. (n = 5) or oral (n = 5) administration of crystalline B12 resulted in the correction of hematological abnormalities. CONCLUSION: In the elderly subject, food cobalamin/ND B12 malabsorption appears to be the main cause of B12 deficiency, and is frequently associated with atrophic gastritis. In these cases, administration of oral crystalline B12 may be an efficient means of treating this disorder.

Aged↗
PubMed2000

[Unusual cause of chronic iron-deficiency anemia and insulin resistance: cholesterol embolism].

BACKGROUND: Cholesterol embolism disease (CED) is an extremely polymorphous clinical entity. Rare reports mention digestive or endocrine manifestations. CASE REPORT: A 73 year-old female patient developed CED disclosed by iron deficiency anemia with chronic digestive bleeding associated with major insulin resistance. DISCUSSION: Solitary iron deficiency anemia as the inaugural sign of CED is exceptional. Rare reports in the literature suggest it is related to polymorphous nonspecific lesions (ulcers, pseudotumoral lesions...) leading to chronic bleeding. Careful histopathology study of the lesions of fragments of healthy mucosa provides the correct diagnosis showing biconcave and optically empty slits. Insulin resistance has not been reported although prior diabetes is often mentioned as a predisposing factor for atherosclerosis. In our case, the role of CED was not determined, but pancreatic or inflammatory involvement can be envisaged.

Aged↗
PubMed2000

[Hypersensitivity syndrome : a rare but severe adverse effect of antithyroid drugs].

We report the case of a female patient with a severe hypersensitivity syndrome caused by carbimazole. She was treated for Graves' disease for a few weeks when she was referred for skin rash, increased liver enzymes and hypereosinophilia. No immunological abnormalities were detected. Discontinuation of carbimazole resulted in quick recovery. Pathogenesis of the hypersensitivity syndrome is discussed. Antithyroid drugs are rarely involved in the syndrome but cases with vasculitis have been described. In our patient, the role of excessive dose is possible.

Aged↗
PubMed2000

[Guillain-Barré syndrome and Mycoplasma pneumoniae infection].

Guillain-Barré syndrome subsequent to Mycoplasma pneumoniae is uncommon and difficult to confirm. We report one case. Clinical presentation and therapy were unremarkable. The interest of antibiotics (preventive or curative) is unresolved. The pathophysiology remains hypothetical but Mycoplasma pneumoniae and some surface gangliosides of peripheral nerves share homologous epitopes leading to the production of antibodies. Induced antibodies to ganglioside may cross-react with neural tissues.

Adolescent↗
PubMed2000

[Hypothalamo-pituitary-adrenocortical function during and after steroid therapy: recent data and critical review].

Prolonged corticosteroid treatment is considered to be the main cause of adrenal insufficiency (AI). AI is due to adrenal atrophy caused by the inhibition of ACTH secretion. Risk factors for AI after corticosteroid treatment remain unknown. Various functional tests, particularly the "standard" Synacthene 250 microg, demonstrate frequent abnormal responses in these patients. However, these abnormalities are not predictive of the risk of AI in particular in case of stress. More recent tests (CRH, "low dose" Synacthene) need to be further evaluated in this situation. Several recent studies in animals and in humans have demonstrated that the need for glucocorticoid coverage during a surgical stress has been greatly overestimated and that maintenance of the usual daily dose seems to be sufficient and safe in most patients with minor surgical stress. Revision of guidelines for more important surgical stress or for other medical conditions in patient treated with glucocorticoids is necessary.

Adrenal Cortex Hormones↗
PubMed1999

[Sepsis syndrome and bone marrow granulomatosis after intravesical instillation of BCG].

BACKGROUND: BCG therapy is an effective treatment for superficial bladder carcinoma. Exceptionally, systemic disorders including hypersensitivity reactions or infections may occur. CASE REPORT: A 70-year-old man developed septicemia with bone marrow granulomatosis with a favorable course after intravesicle administration of bacillus Calmette-Guérin for bladder carcinoma. DISCUSSION: High grade fever, septicemia, hepatitis or pulmonary granulomatosis as well as bone marrow involvement are reported in less than 1% of all cases of BCG therapy. The pathogenic mechanisms are complex. Anti-tuberculous drugs are generally given.

Administration, Intravesical↗
PubMed1999

[Veno-occlusive disease of the liver and POEMS syndrome].

BACKGROUND: Veno-occlusive disease of the liver is a common cause of morbidity and mortality after chemotherapy and/or radiotherapy and bone marrow transplantation. Non thrombotic hepatic venous obstruction is characteristic, but pathogenesis of this disease remains unknown. CASE REPORT: In june 1993, a 58-year-old man was treated by cyclophosphamide and steroid for a POEMS syndrome. In november 1996, he developed hepatalgia, edema, ascitis and jaundice. The diagnosis of hepatic veno-occlusive disease was obtained by hepatic biopsy. Refractory ascitis was treated by transjugular intrahepatic portosystemic shunt. Gradual improvement in clinical status was observed after this therapy. CONCLUSION: This observation offers three original types of information: there has been no prior report of an association between veno-occlusive disease and POEMS syndrome, the role of low dose cyclophosphamide in hepatic veno-occlusive disease was certain, transjugular intrahepatic portosystemic shunt is an interesting therapy with one years remission.

Cyclophosphamide↗
PubMed1999

[Paraneoplastic Cushing's syndrome and small cell bronchial carcinoma].

Approximately 30% of small-cell bronchogenic cancers are associated with hypersecretion of ACTH. However, in most cases, there is no clinical expression. When a paraneoplastic Cushing syndrome occurs, it is an independent factor of poor prognosis. Management is extremely complex. Treatment must be based on high dose inhibitors prior to chemotherapy. Opportunistic infections, often fungal infections, are the main complications, even outside periods of aplasia, and cause significantly earlier mortality.

Adrenocorticotropic Hormone↗
PubMed1999

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): a form of paraneoplastic polyarthritis?

OBJECTIVE: To describe the clinical and laboratory features and outcome of 6 patients presenting with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) revealing a solid tumor. METHODS: Patients with RS3PE who presented with a solid tumor and who had been seen between January 1, 1994, and December 31, 1996, were included in a retrospective multicenter analysis. These patients fulfilled McCarty's description of RS3PE and the following criteria: (1) bilateral pitting edema of both hands, (2) sudden onset of polyarthritis, (3) age >50 years, and (4) absence of rheumatoid factor (RF). RESULTS: Six male patients with RS3PE are described, of mean age 74 years (range 72-78), presenting prostatic (n = 4), gastric (n = 1), and colic (n = 1) adenocarcinomas. The clini cal picture was characterized by the classical form of RS3PE syndrome and by a deterioration in general condition, sometimes with fever. All patients were negative for RF and antinuclear antibodies. In 2 cases of prostatic adenocarcinoma serum levels of interleukin 6 (IL-6) were high, but decreased with treatment. In these 6 patients, the articular manifestations regressed totally or partially in response to corticosteroids, sometimes at low doses, associated in most cases with specific antitumoral therapy. None displayed erosion or distal bone destruction. The mean survival following discovery of RS3PE was 11 months (range 6-18), 5 patients dying of metastatic dissemination of their cancer and the 6th of myocardial infarction. CONCLUSION: RS3PE is a heterogeneous syndrome that can reveal a solid tumor, notably an adenocarcinoma. There exist no specific criteria to define its forms, but this syndrome should be kept in mind in the face of a deterioration in general health. Although the pathogenic mechanism is unknown, this could involve a type of paraneoplastic polyarthritis linked to the synthesis of a factor such as IL-6.

Aged↗
PubMed1998

[Diffuse digestive tract B-cell lymphoma manifesting as exudative enteropathy].

BACKGROUND: Early manifestations of primary lymphomas of the digestive tract generally include general signs and abdominal pain. Diarrhea is uncommon and may result from several mechanisms. We report a case of primary lymphoma of the digestive tract in a patient presenting exsudative enteropathy. CASE REPORT: A 68-year-old woman was hospitalized for profuse diarrhea of 15 days duration. Laboratory tests showed major hypoalbuminemia. Malabsorption could not be evidenced and no infectious foyer was found. Biopsies at different levels of the digestive tract showed mucosal invasion by MALT type B-cell lymphoma. The clinical course was initially favorable after chemotherapy. DISCUSSION: Classification of digestive tract lymphomas differentiates MALT type B-cell lymphoma (the most frequently encountered type in western countries), Mediterranean lymphomas, and T-cell lymphomas generally complicating coeliac disease. MALT type lymphomas may occur in association with Helicobacter pylori infection, usually in a gastric localization. Multiple localizations are uncommon and diffuse involvement of the digestive tract as in our observation appears exceptional. This extension would explain the exsudative enteropathy which regressed with chemotherapy.

Aged↗
PubMed1998

Evaluation of Elecsys free triiodothyronine assay: relevance of age-related reference ranges.

OBJECTIVE: This study aimed at evaluating Elecsys free triiodothyronine (FT3) assay performed on an Elecsys 2010 system, while paying special attention to age relationship in euthyroid subjects. DESIGN AND METHODS: FT3 levels were measured in 149 euthyroid control subjects aged between 2 and 92 years old, 33 hyperthyroid and particular euthyroid patients: female in the last 3 months of pregnancy (n = 30), nonthyroidal ill hospitalized in medical (NTlm, n = 31), or intensive care units (NTlc, n = 31) and amiodarone-treated (n = 27). RESULTS: FT3 was inversely related to age in controls (r = -0.67). Three reference ranges were used: below 20 years 4.5-9.0 pmol/L, between 20 and 60 years 3.9-7.2, and over 60 years 2.4-6.5. Compared to age-matched controls, FT3 decreased in pregnancy, NTlm, NTlc, and amiodarone groups. Use of age-related reference ranges improved the specificity markedly in amiodarone patients and to a lesser extent in NTlm and TClc patients. CONCLUSIONS: The reliability of the Elecsys FT3 assay was found to be satisfactory for clinical use, when the age of patients was taken into account.

Adolescent↗
PubMed1998

[Cholesterolemia and pathology: update].

The relationship between plasma cholesterol levels and disease is more complex than presumed. If the pathogenic role of hypercholesterolemia in ischemic myocardial disease is now undoubted, the deleterious effect of hypocholesterolemia induced by diet or drugs, mainly on cancer mortality and violent death, is still controversial. In a prognostic point of view it seems that the degree of diminution of cholesterol levels is more important than hypocholesterolemia itself. Several hypothesis were formulated; however, hypocholesterolemia does not appear as a causal factor. A prudent approach of hypercholesterolemia remains desirable but without special alterations of the recent recommendations concerning the management of hypercholesterolemia.

Cholesterol↗