Search PubMed⌕ Search

Biomedical subjects

B Wechsler

Publications and source records attributed to B Wechsler.

At least 127 records · Page 7Linked to original sources
PubMed1998

Can we advise ovulation induction in patients with SLE?

The prognosis of systemic lupus erythematosus (SLE) has greatly improved during the last two decades, now allowing most patients to have a very long survival including a satisfactory quality of life. Initially considered contraindicated in SLE due to its overwhelming risks, pregnancy is nowadays allowed in a majority of patients, and fair results are usually obtained under appropriate management (1-3). Consequently, patients thought to have infertility ask the question of a possible therapy, i.e. ovulation induction (OI) associated or not with in vitro fertilization (IVF). Considering the importance of estrogens in the pathogenesis of the disease, the use of such procedures raise several questions in SLE. Though data remain to date extremely scarce, the theoretical and practical aspects of OI in SLE will be briefly reviewed here.

Adult↗
PubMed1998

Chronic intestinal pseudo-obstruction in systemic lupus erythematosus.

BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction (CIPO) reflects a dysfunction of the visceral smooth muscle or the enteric nervous system. Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE) but CIPO has not been reported. Features of CIPO are reported in five patients with SLE. METHODS: From 1988 to 1993, five patients with SLE or SLE-like syndrome were hospitalised for gastrointestinal manometric studies. CIPO was the onset feature in two cases. Antroduodenal manometry (three hours fasting, two hours fed) was performed in all patients, and oesophageal manometry in four. RESULTS: Intestinal hypomotility associated with reduced bladder capacity and bilateral ureteral distension was found in four patients and aperistalsis of the oesophagus in three. Treatment, which consisted of high dose corticosteroids, parenteral nutrition, promotility agents, and antibiotics, led to remission of both CIPO and urinary abnormalities in all cases. Antroduodenal manometry performed in two patients after remission showed increased intestinal motility. One patient died, and postmortem examination showed intestinal vasculitis. CONCLUSIONS: CIPO in SLE is a life threatening situation that can be reversed by treatment. It may be: (a) a complication or onset feature of the disease; (b) secondary to smooth muscle involvement; (c) associated with ureteral and vesical involvement; (d) the result of intestinal vasculitis.

Adult↗
PubMed1998

Diffuse peritonitis in steroid-treated patients.

Patients on systemic steroid therapy are at increased risk of diffuse peritonitis, specially from gastrointestinal perforation. We performed a retrospective study of 37 patients on systemic steroid therapy who underwent surgery for diffuse peritonitis. Clinical presentation of peritonitis was usually aspecific, making the diagnosis difficult. The median interval between onset of symptoms and surgery was 3.3 days, reduced to 2.0 days between hospitalization and surgery. The mortality rate was 46% (17 of 37 patients). We emphasize aggressive diagnostic efforts and early abdominal exploration in front of any persisting abdominal pain in patients on systemic steroid therapy.

Abdominal Pain↗
PubMed1998

Pulmonary hypertension in POEMS syndrome: a new feature mediated by cytokines.

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare variant of plasma cell dyscrasia with multiple systemic manifestations. We followed the progress of 20 patients with POEMS syndrome in our institution over a 10-yr period. Pulmonary hypertension (PH) was observed in five patients. All patients suffered dyspnea on exertion, which always appeared during an exacerbation of POEMS syndrome. The typical echocardiographic signs of PH were observed in all of these patients, and the median pulmonary-artery systolic pressure was 57 mm Hg (range, 50 to 65 mm Hg). Mean pulmonary-artery pressure during right side heart catheterization in two patients was 32 mm Hg. No other explanation for the PH could be found. Overproduction of cytokines was found in all cases, with high serum concentrations of interleukin-1beta, interleukin-6, tumor necrosis factor-alpha, and vascular endothelial growth factor. We suggest that PH should be added to the list of symptoms of POEMS syndrome. Cytokines may mediate POEMS syndrome-associated PH, as proposed for the other systemic manifestations of this disorder.

Adult↗
PubMed1997

[Antiphospholipid syndrome. A better codified treatment].

Therapeutic guidelines are progressively emerging for the antiphospholipid syndrome (APS). In the absence of associated systemic lupus erythematosus, i.e. in primary APS, the prevention of recurrent miscarriages is frequently achieved by a combination of heparin plus aspirin. To date, there is no agreement about the type and the dose of heparin to use. Steroids should not be proposed for the prevention of miscarriages in primary APS. Long term warfarin aimed at an International Normalized Ratio (INR) of 3-3.5 is effective for secondary prevention of thrombosis. However, the appropriateness of INR for warfarin monitoring has been recently questioned in the presence of a lupus anticoagulant. Education plays an important role in the management of patients with APS. Particularly, coincident risk factors for thrombosis have to be suppressed or controlled.

Abortion, Habitual↗
PubMed1997

Pregnancy in relapsing polychondritis: twenty-five pregnancies in eleven patients.

OBJECTIVE: To determine maternal and fetal outcome in pregnant women with relapsing polychondritis (RP). METHODS: Retrospective review of 11 records selected from among those of 116 female RP (Michet's criteria) patients. RESULTS: In these 11 women, 25 pregnancies occurred after or concomitantly with the onset of RP. The mean (+/- SD) age at RP onset was 25 +/- 5 years (range 15-31). Therapeutic abortion was performed in 1 woman because of ongoing cyclophosphamide treatment. Disease flare occurred in 7 of 24 pregnancies, requiring treatment modification in 2 cases. RP was considered stable in 16 and asymptomatic in 1 of the 24. Treatment of RP was with nonsteroidal antiinflammatory drugs (2 of 24), steroids (13 of 24), dapsone (7 of 24), or plasma exchanges (1 of 24); no treatment was given in 8 of the 24 pregnancies. In 14 pregnancies, the course was uneventful. Ten pregnancies were complicated by ectopic nidation (n = 3), spontaneous abortion (n = 3), premature birth (n = 3), and premature rupture of membranes (n = 1). Eighteen normal children were born. CONCLUSION: Pregnancy does not seem to modify the course of RP. Successful pregnancies may be achieved in women with RP. No RP was observed in the neonates.

Abortion, Spontaneous↗
PubMed1997

Circulating plasma levels of nucleosomes in patients with systemic lupus erythematosus: correlation with serum antinucleosome antibody titers and absence of clear association with disease activity.

OBJECTIVE: To assess nucleosome plasma levels in patients with systemic lupus erythematosus (SLE) and to study the correlations with serum antinucleosome, anti-double-stranded DNA (anti-dsDNA), and antihistone antibody activities, as well as with disease activity (by the SLE Disease Activity Index [SLEDAI]). METHODS: In a cross-sectional study, we assessed 58 SLE patients for their plasma nucleosome levels. Plasma nucleosome levels as well as serum antinucleosome, anti-double-stranded DNA, and antihistone antibody activities were assessed by enzyme-linked immunosorbent assay. SLE activity was evaluated using the SLEDAI: RESULTS: The mean (+/-SD) plasma nucleosome concentration in SLE patients was 52 +/- 159 ng/ml (range 5-1,180), and was significantly higher than that of the controls (16 +/- 8.8 ng/ml, range 8-52; P = 0.03). Thirteen of the 58 lupus patients had levels over the range of normal (defined as the control mean + 3 SD, or 42 ng/ml). An inverse correlation was found between nucleosome plasma levels and serum antinucleosome antibody activity in the entire group of SLE patients, those with active disease, and those with inactive disease, respectively. No correlation was found between the SLEDAI and nucleosome plasma concentrations. CONCLUSION: Nucleosome plasma levels may be normal or increased in SLE, and found in patients with active or inactive SLE. Longitudinal studies are needed to further establish whether high levels of circulating nucleosomes may predict the occurrence of an SLE flare.

Adolescent↗
PubMed1997

Feather pecking in domestic chicks: its relation to dustbathing and foraging

Feather pecking is a serious problem in poultry housing, as it may lead to feather damage, injuries and even mortality. We tested predictions of the two prevalent hypotheses claiming that feather pecking is related to dustbathing and foraging, respectively. Forty-two groups of 30 laying hen chicks, Gallus gallus domesticuswere reared in pens with a slatted floor. Access to sand as a dustbathing substrate and straw as a foraging substrate was varied between groups. The rate of feather pecking was measured in early development up to week 7. The provision of a sand area did not prevent the chicks from developing high rates of feather pecking that caused injuries. Chicks that had access to sand from day 10 showed higher rates of feather pecking than chicks that had access to sand from day 1. The provision of straw to chicks that had developed high rates of feather pecking led to a decrease in this behaviour. Chicks that could use both sand and straw from day 1 on did not show high rates of feather pecking, and no injuries were observed in these groups. There was no significant difference in dustbathing activity between housing conditions characterized by high or low rates of feather pecking. On the other hand, foraging activity was inversely related to the rate of feather pecking, and the occurrence of feather pecking could be delayed from week 4 to week 7 by postponing procedures that led to changes in foraging behaviour. In conclusion, the results show that the presence of an appropriate substrate for dustbathing does not prevent domestic chicks from developing feather pecking. On the other hand, housing conditions that promote foraging behaviour are effective in reducing and preventing feather pecking.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour

Journal Article↗
PubMed1997

Systemic capillary leak syndrome: report on 13 patients with special focus on course and treatment.

BACKGROUND: Systemic capillary leak syndrome (SCLS) is a rare condition characterized by unexplained episodic capillary hyperpermeability due to a shift of fluid and protein from the intravascular to the interstitial space. This results in diffuse swelling, weight gain, and renal shut-down. From the first publication in 1960, only 34 cases have been reported. OBJECTIVE: To collate enough patients to observe the natural history of the disease and evaluate the efficacy of empiric treatments. DESIGN: Multicentric retrospective study. RESULTS: Thirteen patients (6 women and 7 men) were collated with a mean follow-up of 6.4 years. Eight patients are still alive after a mean of 5.6 years (range 1 to 15). Three patients out of the 11 who were not lost to follow-up died; 1 during an attack and 2 because of a progression towards multiple myeloma. CONCLUSIONS: Our series shows an improvement in the prognosis of SCLS due most likely to improved management during attacks. Some patients' disease could evolve into a multiple myeloma. Treatment is still empiric and no prophylactic therapy, including terbutaline associated with aminophylline, has clearly proven its efficacy.

Acute Disease↗
PubMed1997

[Still disease].

Adult onset Still's disease is a systemic disorder of unknown etiology. The diagnosis is difficult and based upon Yamaguchi's criteria after exclusion of infectious diseases, hematologic process or autoimmune diseases. Clinical manifestations are various. Functional prognosis depends essentially on articular involvement. Vital prognosis depends on either hepatic failure or hematological or infectious complications, or amyloidosis. Ferritinemia is an important biological parameter which is not included in current criteria. Treatment is not well codified but steroids represent the most efficient therapy to control fever and systemic manifestations. Search for new treatments and specific markers of adult onset Still's disease are needed.

Adult↗
PubMed1997

'Localized amyloidosis': 123I-labelled SAP component scintigraphy and labial salivary gland biopsy.

In apparently localized amyloidosis, there is no appropriate test to determine whether systemic deposits exist. We studied the value of serum amyloid P component (SAP) scintigraphy and labial salivary gland (LSG) biopsy on patients with apparently localized amyloidosis in 12 patients who had neither clinical nor biological evidence of systemic amyloidosis. All patients had an LSG biopsy and echocardiography. Iodine-123-labelled serum amyloid P component (123I-SAP) scintigraphy was performed in all patients. Whole-body scintigraphy was done, and tissue retention was evaluated at 24 h and 48 h. Of these 12 patients, three had amyloidosis in their LSG and had abnormal 123I-SAP scintigraphy; these three had a secondary clinical history of systemic amyloidosis. Three other patients had abnormal 123I-SAP scintigraphy without detectable systemic amyloid deposits, but one had a previous history of bilateral carpal tunnel syndrome treated with infiltration. 123I-SAP scintigraphy in association with LSG biopsy may be helpful in determining the localized or systemic character of amyloid disease.

Adult↗
PubMed1997

Complete recovery of right intraventricular thrombus and pulmonary arteritis in Behçet's disease.

We report on a patient who presented with sustained fever, weight loss, haemoptysis and elevated erythrocyte sedimentation rate. The diagnosis of Behçet's disease was based on recurrent oral and genital aphthae, pseudofolliculitis and a history of thrombophlebitis. A right intraventricular thrombus and bilateral pulmonary aneurysms were discovered. Their complete recovery was observed within 6 months after a combination of prednisone, azathioprine, colchicine and aspirin therapy was started.

Adrenal Cortex Hormones↗
PubMed1997

Outcome of planned pregnancies in systemic lupus erythematosus: a prospective study on 62 pregnancies.

We conducted a prospective study in order to determine planned pregnancy outcome in systemic lupus erythematosus followed in a tertiary referral centre. Pregnancy was authorized if disease was inactive on 20 mg/day prednisone or less for at least 1 yr. Upon the diagnosis of pregnancy, systematic corticosteroids consisting of 10 mg/day prednisone or more were started. In the case of antiphospholipid antibodies, 100 mg/day aspirin was added, replaced by heparin in the pre-partum period. In the case of antiphospholipid syndrome complicated by previous thrombotic events or fetal losses despite aspirin, heparin was prescribed. One woman with a history of atrioventricular block was treated with dexamethasone. Patients were monitored by medical and obstetrical examination, and laboratory tests carried out at least monthly and a quarterly echography. Among 62 pregnancies in 38 women, lupus flare was observed in 27% of the cases, 6% of which occurred in the post-partum period. Flares were moderate except in one renal involvement in a woman with prior diffuse proliferative glomerulonephritis. Therapy was not modified in half of the cases. Pregnancy ended in early spontaneous abortion not related to lupus flare (n = 10), stillbirth (n = 2). induced abortion (n = 2), preterm birth (n = 29) and full-term birth (n = 19). Caesarean section was performed in nine cases. A severe infection occurred in two premature neonates. Another premature neonate was growth retarded. Two children had cutaneous neonatal lupus. No child died, neither had atrioventricular block. Stillbirth and severe prematurity were more common in mothers with antiphospholipid syndrome. After exclusion of early spontaneous and induced abortions, the live birth rate was 96%, that is close to the French general population. The main problem remains a high rate of prematurity, but without maternal or neonatal death.

Adrenal Cortex Hormones↗