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Biomedical subjects

B Wechsler

Publications and source records attributed to B Wechsler.

At least 109 records · Page 6Linked to original sources
PubMed1999

[Pregnancy and systemic lupus erythematosus].

Acute disseminated lupus erythematosus primarily affects young women. The highly unfavorable influence of sex hormones is well known and women are advised against pregnancy. Therapeutic termination of pregnancy has been considered necessary. Regular progress in patient management has however completely changed the short, mid and long-term prognosis, although severe forms still resist treatment. As life expectancy improves, better disease control would allow revisiting the possibility of pregnancy. The spontaneous risk of an acute flare-up during pregnancy is debated but estimated in the 60% range. The risk would be about the same whatever the term, but some suggest risk predominates in the third trimester or in the post partum period. The risk of spontaneous abortion is high, partly due to poor disease control and/or the presence of an associated antiphopholipid syndrome. In such cases, preventive therapy (antiaggregates and/or heparin) has greatly improved fetal prognosis. The risk of neonatal lupus (skin eruptions, atrioventricular block) is essentially related to the presence of anti-Ro (SSA) and anti-La (SSB) antibodies. It cannot be well predicted and prevention must be conducted on an individual basis. Overall prognosis of pregnancy can be improved by authorizing pregnancy when the lupus has reached in a well-controlled quiescent phase for at least one year. A multidisciplinary surveillance associating the medical and obstetric teams is required. Preexisting hypertension and renal involvement are unfavorable factors; serum creatinine above 150 mumol/l is considered a contraindication. When good clinical conditions can be achieved, and possibly with low-dose corticosteroids (10 mg/d), the risk of a flare-up is reduced and the rate of fetal survival is almost the same as in the non-lupus female population. The rates of fetal adrenal insufficiency and infection are not significantly higher. Infants are sometimes hypertrophic at birth and are usually born prematurely. Acute pediatric care must be planned. Prognosis in case of "de novo" lupus during pregnancy or pregnancy in a woman with uncontrolled or poorly-controlled lupus remains poor and can be life-threatening for the mother.

Abortion, Spontaneous↗
PubMed1999

[Recent findings on the genetics of Behçet's disease].

Behçet's disease is a systemic inflammatory disease with a multifactorial genetic and environmental pathogenesis. The main factor of genetic predisposition is located in the HLA region. The disease is significantly linked with the HLA-B51 antigen in different ethnic groups. Recently, a linkage with MICA gene polymophism has been evidenced. This gene, located 46 kb centromerically from the HLA-B gene, codes for a non-classic HLA class I protein induced by stress and probably plays an important role in the destruction of cells targeted by Tgd lymphocytes. The functional significance of this polymorphism in Behçet's disease remains unclear.

Animals↗
PubMed1999

[Cardiovascular manifestations of Behçet's disease].

Vascular involvement in Behçet's disease, recognized since 1946, is peculiar since it occurs in young subjects with no vascular risk factor. Recurrent phlebitis, sometimes associated with fever and biological signs of inflammation, commonly involve the large vessels (superior and inferior vena cava, hepatic veins) and cerebral veins. Arterial involvement was more recently identified and is expressed by thrombosis, stenosis and/or aneurysms diversely associated. Aneurysms, true "arterial aphthae", may be multifocal and can involve all arterial territories with a clear preference for the abdominal aorta and the pulmonary arteries (Hughes-Stovin syndrome). Mortality is significant due to rupture and the risk of recurrence. Cardiac involvement includes coronary artery disease which merits attention since it affects young subjects and is often expressed by myocardial infarction or angina; all three tunics can be involved; mortality is high: 20% in the months or years following diagnosis. A few cases of recurrent pericarditis have been reported. Myocardiopathy can be of inflammatory nature or secondary to coronary artery disease. Endocardiac involvement may be limited to valve disease or spread to the ventricular wall. Endomyocardial fibrosis is exceptional and usually associated with intracavitary thrombus formation. Coagulation disorders have been reported but they cannot explain the different thrombotic manifestations which are probably the consequence of an abnormal response of the vascular endothelial cells.

Behcet Syndrome↗
PubMed1999

[Neurologic manifestations of Behçet's disease].

Neurological involvement in Behçet's disease, the cause of the disease's severe functional sequellae, is reported in 5.3 to 30% of cases. Coagulation disorders have been reported but they cannot explain the different thrombotic manifestations which are probably the consequence of an abnormal response of the vascular endothelial cells. Neurological manifestations include: a) dural sinus thrombosis which can be diagnosed by angio-MRI and whose prognosis is improved with the use of anticoagulants; b) exceptional lesions to arteries supplying the brain; c) aseptic meningitis and meningo-encephalitis; and d) exceptionally, solitary spinal cord involvement and peripheral disease. Neurological involvement can occur early or late after development of skin and mucosal signs and when inaugural make mislead diagnosis. The spinal tap usually gives objective evidence of lymphocyte meningitis. MRI is nonspecific, but the T2 and Flair sequences can evidence hypersignal areas, preferentially in the brain stem, basal nuclei, and subtentorial white matter with no preference for the periventricular regions. Spontaneous aggravation is the rule and the neurological prognosis is severe (dementia, pseudo-bulbar syndrome, loss of independence). Treatment is similar to that used for vasculitis and is aimed initially at reducing the inflammation with corticosteroids and at preventing relapse with the adjunction of an immunosuppressor. Results are better when treatment begins early; restitutio ad integrum has been observed. Duration of treatment is poorly defined: immunosuppressors have been proposed for a minimal duration of 2 years; corticosteroid therapy can be tapered off but interruption would expose to relapse. A maintenance therapy is advisable and, in our opinion, should be proposed indefinitely combining colchicine (1 to 2 mg/d), anti-aggregate doses of aspirin, and low-dose corticosteroids (1/10 mg/kg/d).

Behcet Syndrome↗
PubMed1998

Pacemaker infective endocarditis.

We identified 33 patients with definite pacemaker endocarditis--that is, with direct evidence of infective endocarditis, based on surgery or autopsy histologic findings of or bacteriologic findings (Gram stain or culture) of valvular vegetation or electrode-tip wire vegetation. Most of the patients (75%) were > or = 60 years of age (mean 66 +/- 3; range 21 to 86). Pouch hematoma or inflammation was common (58%), but other predisposing factors for endocarditis were rare. At the time that pacemaker endocarditis was found, the mean number of leads was 2.4 +/- 1.1 (range 1 to 7). The interval from the last procedure to diagnosis of endocarditis was 20 +/- 4 months (range 1 to 72). Endocarditis appeared after pacemaker implantation, early (< 3 months) in 10 patients and late (> or = 3 months) in 23 patients. Fever was the most common symptom, being isolated in 36%, associated with a poor general condition in 24%, and associated with septic shock in 9%. Transthoracic echocardiography showed vegetations in only 2 of 9 patients. Transesophageal echocardiography demonstrated the presence of lead vegetations (n = 20) or tricuspid vegetations (n = 3) in 23 of 24 patients (96%; p <0.0001 compared with transthoracic echocardiography). Pulmonary scintigraphy showed a typical pulmonary embolization in 7 of 17 patients (41%). Pathogens were mainly isolated from blood (82%) and lead (91%) cultures. The major pathogens causing pacemaker endocarditis were Staphylococcus epidermidis (n = 17) and S. aureus (n = 7). S. epidermidis was found more often in early than in late endocarditis (90% vs 50%; p = 0.05). All patients were treated with prolonged antibiotic regimens before and after electrode removal. Electrode removal was achieved by surgery (n = 29) or traction (n = 4). Associated procedures were performed in 9 patients. After the intensive care period, only 17 patients needed a new permanent pacemaker. Overall mortality was 24% after a mean follow-up period of 22 +/- 4 months (range 1 to 88). Eight patients who were significantly older (74 +/- 3 vs 63 +/- 3 years; p = 0.05) died < or = 2 months after electrode removal, whereas 25 were alive and asymptomatic.

Adult↗
PubMed1998

[Pregnancy and acute disseminated lupus erythematosus].

Until recently, pregnancy was thought to induce lupus flares; pregnancy was contraindicated and therapeutic abortion was recommended. Such concepts are now subjected to debate and successful outcome of pregnancy can be expected when lupus has not been active for several months, and with a successful partnership between specialists in high-risk obstetrics and in rheumatology or internal medicine.

Antimalarials↗
PubMed1998

The effect of quality and availability of foraging materials on feather pecking in laying hen chicks.

Feather pecking resulting in feather damage, injuries and mortality causes severe welfare problems in laying hens. In the present study, we tested whether there is an inverse relationship between feather pecking and foraging behaviour (exploratory and manipulative behaviour away from the feeder). Forty-eight groups of 30 or 31 chicks, Gallus gallus domesticus, were reared in pens and provided with different types of foraging material. Feather pecking and foraging behaviour were quantified when the chicks were 4 and 5 weeks of age. In experiment 1, chicks with access to long-cut straw showed more foraging behaviour and less feather pecking than chicks that were provided with the same straw but in shredded form. On the other hand, there was no difference in foraging behaviour and feather pecking between chicks reared with access to long-cut straw and polystyrene blocks. In experiment 2, the importance of the form of the foraging material was confirmed. Chicks provided with polystyrene blocks performed more foraging behaviour and less feather pecking than chicks with access to polystyrene beads. The provision of an area with a layer of wood-shavings to promote scratching behaviour had no significant effect, however, on the incidence of feather pecking. In experiment 3, polystyrene blocks and beads were offered during the whole day or only in the morning. Both the quality and the availability of the foraging materials had a significant effect on foraging behaviour and a significant but opposite effect on feather pecking. Focal animal observations showed that the chicks performed different types of foraging behaviour at polystyrene blocks and beads. This suggests that not only the quantity but also the quality of foraging behaviour elicited by a given material may be important to prevent the development of feather pecking. Feather pecking should thus be considered as redirected foraging behaviour. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1998

Acquired hemophilia due to factor VIII inhibitors in 34 patients.

BACKGROUND: Acquired hemophilia is a rare disease caused by the development of auto-antibodies against factor VIII. SUBJECTS AND METHODS: We studied the characteristics and outcomes of 34 patients (19 women and 15 men) with acquired hemophilia from 1980 to 1997. RESULTS: The mean age of the patients was 61 years (range, 22-93 years). An underlying disease was observed in 18 (53%) patients: 5 patients had cancer, 4 an autoimmune disorder, 2 a dermatologic disorder, 3 asthma, 3 were postpartum, and 1 had an adverse reaction to ampicillin. Factor VIII level was <5% in 30 (90%) patients; factor VIII antibodies were elevated (>10 Bethesda units) in 23 (69%) patients. Bleeding requiring transfusions was reported in 25 (75%) patients. Human factor VIII was given to 14 patients and porcine factor VIII to 5. Six patients received prothrombin complex concentrates and one desmopressin. Several immunosuppressive treatments were used, mainly corticosteroids, cyclophosphamide, and intravenous immunoglobulin. Bleeding stopped in all but one patient within 2 weeks. Most patients achieved complete remission, although two relapses were observed subsequently. CONCLUSION: This large study helps to clarify the presentation and clinical course of acquired hemophilia. Prospective studies are needed to determine the efficacy of treatment.

Adult↗
PubMed1998

Whipple's syndrome (uveitis, B27-negative spondylarthropathy, meningitis, and lymphadenopathy) associated with Arthrobacter sp. infection.

OBJECTIVE: To report an unusual case of Whipple's disease, including uveitis, seronegative spondylarthropathy, meningitis, and lymphadenopathy, associated with an Arthrobacter sp. infection. DESIGN: Interventional case report. PATIENT AND INTERVENTION: A 60-year-old white man presenting with severe chronic uveitis and systemic inflammatory manifestations was treated efficiently for Whipple's disease after histopathologic analysis of vitreous and inguinal adenopathy biopsy specimens. The authors performed a retrospective, laboratory-based evaluation of stored tissue specimens. MEASUREMENTS: Molecular analysis based on 16S ribosomal RNA gene amplification was applied to pretreatment biopsy specimens of inguinal lymph node to identify a causative bacterial agent. RESULTS: Tropheryma whippelii genome was not detected in these specimens. However, an amplification product was obtained after the first polymerase chain reaction run and subsequently was sequenced. It corresponded to an Arthrobacter sp., a gram-positive agent presenting diagnostic patterns and therapeutic management similar to those of Whipple's disease caused by T. whippelii. CONCLUSION: The absence of T. whippelii identification by molecular amplification during a clinically and histologically oriented Whipple's syndrome should not rule out the diagnosis. Arthrobacter infection may represent a new bacterial etiology of systemic inflammatory disorders involving the eye and associated with periodic acid-Schiff-positive inclusions.

Arthrobacter↗
PubMed1998

[Tuberculosis and systemic diseases. Apropos of 16 cases].

METHODS: We analyzed retrospectively 16 patients between 1976 and 1993 (six men, ten women, mean age: 49-year-old) suffering from connectivitis. HIV-negative and receiving corticosteroids, combined for six of them with immunosuppressive therapy, and suffering from tuberculosis. RESULTS: The mean period between first signs and diagnosis was 51 days (3-190 d). Tuberculosis was pulmonary (n = 10) of which 4 miliary, pleurisy (n = 3), lymphadenitis (n = 5). We only observed one meningitis, one otitis and one female genital tuberculosis. Six patients had more than one localisation. Diagnosis was proven bacteriologically eight times, histologically six times and for three patients diagnosis was certain because of efficacy of antituberculosis antibiotherapy. Evolution was always good, with antituberculosis antibiotherapy of maximum 18 months, without sequella. Because rifampicin enzymatic induction, connectivitis worsened in five patients. An increase in corticotherapy was necessary for these five patients. CONCLUSION: This series confirmed the frequently extrapulmonary feature of tuberculosis in immunosuppressed patients, the long delay of diagnosis and the risk of exacerbation of underlying disease with rifampicin.

Adrenal Cortex Hormones↗
PubMed1998

[Pseudotumorous presentation of neuro-Behçet: role of the withdrawal of colchicine?].

BACKGROUND: Neurological involvement occurs in 10 to 28% of patients with Behçet's disease. CASE REPORT: We report a case of neurological pseudotumoral presentation of Behçet's in a patient with a long standing disease treated with low dose of prednisone and colchicine (1 mg/day), 2 months after withdrawal of colchicine. CONCLUSION: Neurological manifestations during Behçet disease can be secondary to direct central nervous system involvement (encephalitis, encephalomyelitis) or vascular angitis (essentially cerebral venous thrombosis and, rarely, intracranial aneurysms). Neurological pseudotumoral presentation is rarely reported.

Anti-Inflammatory Agents↗
PubMed1998

[Sarcoidosis and pregnancy. A retrospective study of 11 cases].

PURPOSE: To analyze the evolutive profile of sarcoidosis together with reciprocal interactions between pregnancy and sarcoidosis. METHODS: All events that occurred during pregnancy in 11 women presenting with sarcoidosis were analyzed. Histological confirmation was obtained for the 11 cases. For all pregnancies were analyzed the course of both sarcoidosis and pregnancy, and the influence of pregnancy on the disease evolution. RESULTS: Among 33 pregnancies, 23 led to the birth of healthy fetuses (five spontaneous abortions, four voluntary abortions, and one therapeutic abortion). The major event was fetal hypotrophy in six cases. Three of them occurred during pregnancy in prednisone-treated patients with active sarcoidosis. No relapse of cured sarcoidosis or further evolution of sarcoidosis that was inactivated as of the beginning of pregnancy were observed. The course of active sarcoidosis varied, as improvement (one case), worsening (two cases) and stabilization (two cases) were observed. During the first year of follow-up after delivery, four relapses and, in two cases, preliminary signs of the disease were observed. CONCLUSION: Apart from the hypothetical but not definite risk of hypotrophy, no negative interaction between sarcoidosis and pregnancy could be established. Pregnancy does not seem to interfere with the course of sarcoidosis. Considering the risk of relapse after delivery, pregnant women presenting with sarcoidosis should benefit from clinical and radiological follow-up.

Abortion, Induced↗
PubMed1998

[Role of corticosteroid therapy in non-malignant diseases].

INTRODUCTION: As short-term corticosteroid therapy is widely used in clinical practice, it is important to determine its precise indications and limits of use. CURRENT KNOWLEDGE AND KEY POINTS: Duration of short-term corticosteroid therapy is arbitrarily considered to be up to 21 days. Anti-inflammatory, antiproliferative or analgesic actions represent the main pharmacological features of steroids. They are related to the interactions of steroids with cytokines and immune cells. Results of randomized double-blind and uncontrolled clinical studies were included in this review. Furthermore, clearly demonstrated results that were obtained more particularly in neurology, otorhinolaryngology, pneumology, infectious diseases, rheumatologic and traumatic processes are summarized. FUTURE PROSPECTS AND PROJECTS: Indications for short-term corticosteroid therapy are well established. However, further clinical studies are required, as current prescription of corticosteroid is still empirical in the management of most diseases.

Adrenal Cortex Hormones↗
PubMed1998

[An unknown cause of prolonged fever: apropos of 6 cases of chronic aortic dissection].

PURPOSE: Aortic arch dissection may be sometimes misdiagnosed due to the lack of mild to moderate chest pain. Definite diagnosis is often made while dissection has already occurred more than 15 days ago, being thereafter considered as chronic. Aortic dissection may then present as a prolonged febrile illness with fever and/or inflammation as main symptoms, with little or no pain. METHODS: We retrospectively reviewed cases of chronic aortic dissections seen in a department of internal medicine and a department of neurology between 1975 and 1992. RESULTS: We report six cases of patients presenting with aortic dissection and describe their outcome and treatments after the diagnosis was made based on either thoracic computerized tomography or trans-esophageal echocardiography evidence. Four patients had surgical aortic arch repair while one patient was treated with beta-blockers. CONCLUSION: Chronic aortic dissection has rarely been reported to cause fever or increased sedimentation rate. Treatment has to be discussed between medical and surgical teams involved in the therapeutical management of these unusual patients.

Aged↗
PubMed1998

[Endogenous infectious endophthalmitis].

INTRODUCTION: Endogenous endophthtalmitis is an intraocular infection of hematogenous origin. EXEGESIS: It is generally a panuveitis that may be mixed-up with a non-infectious inflammatory disease, promoting delayed treatment and compromising the visual prognosis, as the visual loss rate reaches up to 37.5%. Antibiotherapy should be started immediately after bacteriological examinations and without waiting for vitrectomy. Identification of the causative microorganism is absolutely necessary. It may require aqueous or vitreous culture if cultures from other body fluids are negative and infection progresses. The most common infections are endocarditis and digestive and renal diseases. Virectomy is indicated for first line treatment of ocular abcess and improvement of antibiotic absorption. However, it may lead to retinal detachment. Vitrectomy is also indicated in case of unsuccessful therapy. To decrease the inflammatory reaction and risks of vitreous organization, local or systemic corticotherapy is prescribed after control of the infection. CONCLUSION: Although rare, endogenous endophthalmitis should be diagnosed as it may be mixed-up with inflammatory uveitis, leading to inappropriate corticotherapy. Furthermore, antibiotherapy with good intraocular penetration should be started immediately, but it should be kept in mind that the functional prognosis is poor.

Aged↗
PubMed1998

Aggressive pecking by males in breeding groups of Japanese quail (Coturnix japonica).

1. Head injuries caused by aggressive pecking are an important welfare problem in quail farming. The aim of experiments one to three was to reduce the rate of aggressive pecking in breeder groups. 2. The quails were housed in pens containing litter, nest boxes and a dustbathing box. The experimental groups consisted of 2/14, 3/14, 5/15 or 5/35 (males/hens) quails which were introduced into the experimental pens at the age of 4, 6 or 7 weeks. 3. None of the 5 factors that varied between the pens (visual barriers, age of introduction into the pens, number of hens per 5 males, number of males per 14 hens and light intensity) had a significant effect on the rate of aggressive pecking interactions between males. 4. Because of serious head injuries 20%, 17.5% and 12.5% (experiments 1, 2, 3) of the males had to be removed from their groups. 5. In single-male groups containing 8, 12, 16 and 20 hens (experiment 4) the percentages of fertilised eggs were 92%, 84%, 77% and 69% (medians, n = 4 pens per group size). No males were seriously injured in these groups. 6. It is concluded that for welfare reasons multi-male breeding groups of Japanese quail cannot be recommended. Given the satisfactory fertility observed in groups with a sex ratio of 1:8 or 1:12, single-male groups are also of interest for economic reasons: food costs are reduced.

Aggression↗
PubMed1998

Feather pecking in growers: a study with individually marked birds.

1. The aim of the present study was to investigate whether individual birds specialise in feather pecking. Growers were individually marked and reared in groups of 30 or 31 in pens with a slatted floor. At an age of 4 to 6 weeks feather pecking was frequent in all pens. 2. On average 83% of all group members (10 groups, experiment 1) were recorded at least once as initiator of a feather pecking interaction. In each group 2 to 6 individuals feather pecked more than twice as often as the average for the group, and were defined as 'high rate peckers'. They initiated 39% of all recorded feather pecking interactions. 3. Every interaction was classified (with increasing intensity) as pecking, pinching, pulling or plucking. Compared to the others, 'high rate peckers' had more of their feather pecking classified as plucking and less classified as pecking. 4. There was no evidence that particular individuals specialised in pecking at other specific birds, at specific areas of the body or at birds engaged in specific activities. 5. Growers (3 groups, experiment 2) that had just feather pecked engaged in more feather pecking during a subsequent 2-min focal observation than control birds that had not pecked before the start of the observation. 6. It was concluded that feather pecking interactions are clustered in time and that the behaviour is not performed by just a few members of a group. However, some individuals are characterised by relatively high rates and more severe forms of feather pecking.

Aggression↗