Association of red-blood methylfolate but not plasma folate with C677T MTHFR polymorphism in venous thromboembolic disease.
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5,10-Methylenetetrahydrofolate Reductase (FADH2)↗
Biomedical subjects
C Janbon
Publications and source records attributed to C Janbon.
Diagnosis of acute lower limb deep venous thrombosis with ultrasound: trends and controversies.
Acute deep venous thrombosis of the lower limb is a common and threatening condition whose clinical diagnosis is known to be unreliable. Sonography has gradually superseded venography as the primary diagnostic procedure. A review of the medical literature shows that sonography offers a high level of sensitivity and specificity in symptomatic patients but suffers from a lack of sensitivity at the calf level and in asymptomatic patients. Technologic progress, as well as increased operator experience, may improve sensitivity. Nevertheless, several critical issues remain unresolved, such as the significance of free-floating thrombi, the usefulness of calf and bilateral examination, the criteria that are essential to the diagnosis, the risk of compression sonography, and sonography's role in the direct detection of venous emboli.
Acute Disease↗
Effects of homocysteine on acetylcholine- and adenosine-induced vasodilatation of pancreatic vascular bed in rats.
1. Epidemiological and experimental data have shown that homocysteine may provoke vascular lesions and that moderate homocysteinaemia may constitute an independent risk factor for vascular disease. It is now documented that homocysteine damages human endothelial cells in culture, possibly by producing hydrogen peroxide in an oxygen-dependent reaction. 2. In this study, we have examined the direct effect of this sulphur amino acid on pancreatic vascular resistance. Experiments were performed on the vascular bed of the rat isolated pancreas perfused at constant pressure; thus, any change in pancreatic vascular resistance resulted in a change in the flow rate. D,L-Homocysteine perfused for one hour at three different concentrations (200 microM, 2 mM, 20 mM) did not induce any significant change in the flow rate per se. Homocysteine infusion for 30 min at a concentration of 200 microM or 2 mM abolished the endothelium-dependent vasodilatation induced by acetylcholine (0.05 microM), but did not modify adenosine (1.5 microM)-induced vasodilatation. 3. The effect of D,L-homocysteine (200 microM or 2 mM) cannot be ascribed to a direct antimuscarinic effect since 30 min pretreatment of rat ileum with these concentrations did not significantly change the contractile effect of increasing concentrations of acetylcholine (0.015-15 microM). 4. Preincubation of human umbilical vein endothelial cells with D,L-homocysteine (0.2-5.0 mM) had no significant effect on overall cell number or viability during 18 h of incubation; the endothelial cells exposed to concentrations up to 5 mM exhibited a spindle-shaped, whirled pattern. This pattern was reversed 48 h after the removal of homocysteine. A cytotoxic effect was seen after 18 h incubation in 10 mM D,L-homocysteine. 5. In conclusion, an acute infusion of homocysteine altered acetylcholine endothelium-induced vasodilation, whereas the adenosine vasodilatator effect was insensitive to the deleterious action of homocysteine in vitro.
Acetylcholine↗
[The venous valve: non-invasive imaging of its functioning].
B Mode and TM mode Imaging are useful tools to illustrate directly the venous valve motion. Using B Mode, venous valve are echogenic with a particular kinetic as regards its topography. So it's possible to determine in TM Mode a "pseudo-cardiac" valvular motion (jugular vein) and a "pseudo-diaphragmatic" motion for the lower limbs veins. Valvular motion assures unidirectional venous flow.
Humans↗
[Case control studies of the risk factors for deep-vein thrombosis in an adult population hospitalized in internal medicine].
BACKGROUND: The ain of this study was to demonstrate risk factors for deep-vein thrombosis in adults in a hospital setting. MATERIALS AND METHODS: From May 1993 to Februrary 1995, 233 patients hospitalized in the internal medicine unit at the Montpellier University Hospital for deep-vein thrombosis were included. Each case was matched to a control case for age, hospitalization unit, and use or not of anti-thrombosis prophylaxy. Venous thrombosis was diagnosed in patients and confirmed to be absent in controls using duplex Doppler when phlebography findings were unconvincing. To eliminate possible false negatives (poor sensitivity of duplex Doppler in asymptomatic patients), all controls were contacted by telephone 3 to 6 months after discharge to ascertain whether or not they had been rehospitalized and if so for what reason. The patients and controls responded to questions designed to identify risk factors for deep-vein thrombosis described in the literature (patient characteristics, personal and family history, surgical history, associated diseases, abnormal blood tests, medical treatment, life style). RESULTS: The three main risk factors for deep-vein thrombosis for all ages and both sexes identified by multivariate analysis were: personal history of venous thrombosis (OR = 4.7, 95% CI = [2.4; 8.9]), family history of venous thrombosis (OR = 3.3, 95% CI [1.8; 5.9]) and surgical during the preceding 45 days (OR = 3.7, 95% CI = [1.2; 10.9]). In non-menopaused women, the main risk factor was minidose oral contraception (OR = 6.9, 95% CI = [1.9; 25.4]). CONCLUSION: In our population of hospitalized patients in an internal medicine unit, the main risk factor for thrombosis appeared to be, in general, a past history of venous thrombosis and in non-menopaused women, minidose oral contraception.
Adult↗
Characteristics of chronic venous insufficiency in 895 patients followed in general practice.
BACKGROUND: This study was designed to describe the main semiological and etiological characteristics of chronic venous insufficiency (CVI) and to determine if there was a relationship between the extent of objective signs, severity of symptoms and aetiology. MATERIALS AND METHODS: 895 outpatients presenting CVI of the lower limbs over a period of at least one year, irrespective of grade of severity or aetiology, were included in this retrospective study. They were treated with 2 different pharmaceutical forms of the same venoactive medication (1000 mg of micronised flavonoid fraction) for 2 months. Organic CVI (OCVI) was classified, in stages of increasing severity, according to the Widmer and Porter classification. In the absence of anatomical lesions of the main veins or their valvular system, CVI was termed functional (FCVI). RESULTS: Analysis indicated that CVI was more frequent in women than in men (sex ratio 10:1). 26% were FCVI and 91% of OCVI were of varicose origin. The mean progression time of the disease was 13+/-11 years. Disease began earlier in women than in men (34+/-14 vs 41+/-14 years). Oedema was the first objective sign in 68% of patients and the only one in 20% of FCVI. Heaviness was more frequent in FCVI and its intensity was not related to the severity of CVI. Trophic complications were more frequent in the advanced stages. CONCLUSIONS: In order to avoid progression to more severe forms which are disabling or expensive to treat, a rational approach to the management of early CVI is essential.
Adolescent↗
A phase II study of 5-fluorouracil, leucovorin and cisplatin (FLP) for metastatic gastric cancer.
The modulation of 5-fluorouracil (5-FU) with folinic acid (leucovorin, LV) is more efficacious than 5-FU alone in the treatment of metastatic colorectal cancer, and the combination of 5-FU with cisplatin is currently one of the most active regimens in advanced gastric cancer. A phase II study was therefore conducted to test the efficacy and toxicity of the combination of 5-FU, LV and cisplatin (FLP) in metastatic gastric cancer. 28 patients entered the study. Metastatic sites were observed in the liver (in 21 patients), the peritoneum (in 8), the lymph nodes (in 7) or the bones (in 1) and a local recurrence was noted in 4 cases. The performance status (using World Health Organisation criteria) was 0 for 13 patients and 1 or 2 for the others. Cycles of treatment were administered every 28 days and consisted of LV 200 mg/m2/day for 5 days followed by 5-FU 400 mg/m2/day for 5 days with cisplatin 100 mg/m2 on day 2. The response rate for the 27 evaluable patients was 51.8% (95% confidence interval (CI), 33-70.6%). There were four complete responses (14.8%) and 10 partial responses (37%). Median survival was 11 months and 4 patients were alive at 2 years. Both response rate and survival were better for patients with a good performance status. The overall toxicity was very low, except for 1 patient who died of dehydration and cardiac failure. In conclusion, the FLP protocol was effective and well tolerated in patients with metastatic gastric cancer.
Adult↗
[Rheology and occlusive arterial disease of the legs].
Peripheral occlusive arterial disease (P.O.A.D.) is one of the situations in which hemorheological abnormalities are usually described. However the clinical relevance of hemorheological measurements in angiologic practice remains to be defined. The aim of the study was to investigate whether hemorheological disturbances are associated with alterations in oxygen diffusion and prognosis of the arterial disease. Three groups of patients were included in this work. First, a study was realized on 160 nondiabetic P.O.A.D patients (suffering from intermittent claudication to critical limb ischemia) in order to evaluate the possible influence of hemorheological disturbances on oxygen diffusion in distal tissue. A control group of 30 subjects matched for age and sex was also studied. A second study was performed on 80 diabetic P.O.A.D. patients (stage III and IV of Leriche and Fontaine classification) to determinate if hemorheological parameters could be considered as prognostic factors in the P.O.A.D. course. Hemorheological parameters were determined on different devices: red blood cell (RBC) aggregation by Myrenne aggregometer, blood and plasma viscosities by MT 90 falling ball viscometer. Transcutaneous oxygen pressure was measured by Radiometer TCM2 oxygen monitor. Several rheological parameters of non diabetic patients suffering from P.O.A.D. were significantly higher than those of control group subjects : blood viscosity (p < 0.05), plasma viscosity (p < 0.001), erythrocyte rigidity index (p < 0.01) and fibrinogen level (p < 0.0001). In the nondiabetic patients TcPO2 was negatively correlated with RBC aggregation, erythrocyte rigidity index and hematocrit /viscosity ratio. The diabetic patients who needed major amputation (above or below knee) presented significantly increased hemorheological parameters (blood viscosity, RBC aggregation, RBC rigidity index, hematocrit/viscosity ratio, fibrinogen level) compared to diabetic who had not been major amputated (no amputation or only toes' amputation). Our finding suggests that hemorheological factors (1) may influence oxygen transfer to distal tissues by maldistribution of blood flow and (2) may have prognostic significance in chronic peripheral occlusive arterial disease.
Aged↗
Treatment of Waldenstrom's macroglobulinemia with very low doses of alpha interferon.
Waldenström's macroglobulinemia (WM) is a differentiated B-cell malignancy which is usually less responsive to standard chemotherapy because of low-proliferating cells. Interferon alpha has been shown to possess a therapeutic action in numerous B-cell malignancies including the early stage of chronic lymphocytic leukemia, multiple myeloma, follicular lymphoma and hairy cell leukemia. Fourteen patients with progressive WM were included in a pilot study using very low dose of interferon alpha-2a (1 Million Units 3 times a week). The mean duration of treatment was 10.3 months (range 2-44). Six of 14 (42%) patients presented an increase in the hemoglobin level (> or = 0.9 g/dL) and 4/14 (28%) had a substantial decrease of the monoclonal component (> or = 20% of reduction). Only two patients presented both types of response, while the others with an increase in the hemoglobin level had a slight decrease in the monoclonal component (MC) (1 patient), a stable MC (1 patient) or a slight increase of MC (1 patient). One additional patient had a 15% decrease of the MC with a stable hemoglobin level. Response was observed within 3 months with a median duration of 6 months. Treatment was stopped for 3 patients because of flu-like symptoms (2 patients), or thrombocytopenia (1 patient). Follow up was possible in 12 patients lasting up to a maximum of 30 months after discontinuing treatment. Seven patients died, including 4 with progressive disease, two of infection and one of cardiac failure. In the view of these results, very low dose of interferon alpha may constitute a new approach for treatment of some cases of WM.
Aged↗
[History of the treatment of varices].
Diseases of the vein and particularly varicose veins have been recognized since antiquity. The Ebers papyrus, dated 1550 b.c., mentions serpent-shaped dilatation of the lower limbs. The Acropolis tablet of the IVth century b.c. concerning Dr Amynos allows us to visualize an enlarged lower limb clearly showing a varicosity. From 460-377 b.c., Hippocrates noted that a loose tourniquet leads to haemorrhages but that when the tourniquet is tight gangrene ensues and finally that standing up can exaggerate leg ulcerations. Of course much progress has been made since Hippocrates. The school at Alexandria, with Herophilus and Erasistrates speak of vascular ligatures. Their work was unfortunately lost in the fire of the Alexandria library in 391 a.d. Galien himself described varicose vein ligatures in 200 a.d. Leonardo de Vinci's magnificent anatomic studies of veins are widely known. In 1525, Ambroise Paré described leg bandaging for ulcers beginning from the foot up to the knee. In 1585, Fabrice d'Acquapendente described venous valves. In 1676, Wiseman invented the first supportive stockings made of leather and in 1854, Unna described in Vienna the supportive boot which now carries his name. Shortly thereafter new medical and surgical techniques were developed for the treatment of varicose veins. Pravaz, in 1860, invented a syringe which now carries his name and initiated sclerotherapy. At the end of the XIXth century, Trendelenburg performed the first ligatures of the greater saphenous veins. In 1905, and 1906, Keller and Mayo performed the first ablation of the greater saphenous vein and in 1906, Carrel reported the first venous transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
Europe↗
[Pulsatile vaginal expansion: Case report of an internal iliac aneurysm detected after an injury].
After a pelvic trauma, in a 78 years old women, systematic radiograms showed a polycyclic mass in the left side of the pelvis. This finding was confirmed by B-mode ultrasound echography. The vaginal touch found a pulsatile and expanding mass. At surgery, the diagnosis of a fissuring aneurysm of the internal iliac artery was confirmed, and a curative treatment was undertaken. Reviewing the literature, the authors emphasize the diagnostic usefulness of rectal and vaginal touch, and the importance of an early diagnosis using noninvasive imaging techniques. Surgery is the only treatment for isolated internal iliac aneurysms.
Aged↗
Portal hypertension in lymphoproliferative and myeloproliferative disorders: hemodynamic and histological correlations.
The pathogenesis of portal hypertension in patients with lymphoproliferative and myeloproliferative disorders is not fully understood. We investigated 20 patients with myeloproliferative disease and 47 patients with lymphoproliferative disease. Transvenous liver biopsies and hepatic vein pressure gradient measurements were performed in all patients, and portal vein blood flow was measured by pulsed Doppler sonography in 31 of these patients and in 22 normal volunteers. The hepatic vein pressure gradient was significantly higher in patients with hepatic infiltrates, fibrosis or both than in patients without hepatic lesions (8.3 +/- 5.0 mmHg vs. 4.1 +/- 2.3 mmHg; p < 0.01). Portal vein blood flow was significantly higher in patients with hematological disease than in normal volunteers (31.2 +/- 15.5 ml/min.kg vs. 14.2 +/- 4.6 ml/min.kg;p < 0.01). In 81.8% of patients with hepatic infiltrates, fibrosis or both and increased portal vein blood flow, the hepatic vein pressure gradient was greater than 6 mm Hg. Although we saw a significant correlation between splenic vein blood flow and portal vein blood flow (n = 20; p < 0.01), we found no significant correlation between splenic vein blood flow and hepatic vein pressure gradient or spleen size. Hepatic infiltration and fibrosis appear to be major determinants of increased hepatic vein pressure gradient, probably because they increase intrahepatic vascular resistance. The role of increased splenic blood flow is probably not determinant. However, because portal pressure was not measured directly in this study, the incidence of portal hypertension may have been underestimated.
Adult↗
[Diagnosis by Doppler color echography of dural carotid-cavernous fistula of ophthalmological manifestation].
The case reported here, concerns a spontaneous low-flow fistula between the external carotid arterial network and the cavernous sinus, with ophthalmological symptoms (exophthalmos, red eye) in an old woman with cardiac failure. The shunt was diagnosed by color-Doppler-imaging, which showed a flow reversal with a systolic component in the superior and inferior enlarged ophthalmic veins. This finding led the authors to extend the arterial filling sequence since the shunt was not detectable on standard arterial views. Embolization was performed during angiography which remains necessary to localize the shunt and to treat the fistula. The clinical symptoms progressively returned to normal and the correction of the hemodynamic disturbances could be followed by color-Doppler imaging, a non-invasive technique which can be easily repeated.
Aged↗
Renal microaneurysms in rheumatoid arthritis.
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Aged↗
[Severe ischemic hepatitis after taking cibenzoline].
The authors report the case of a 77 year old man suffering from chronic congestive heart failure, who presented a severe hepatic failure. Since 9 days the patient was treated by cibenzoline for serious ventricular arythmias. Hepatic failure was not due to drug hepatotoxicity but to an indirect effect of cibenzoline diminishing cardiac output. Arguments for ischaemic hepatitis and also two mechanisms of hepatic involvement in cardiac diseases are developed. In most cases association of two mechanisms, vascular stasis and low cardiac output is necessary to create hypoxic hepatitis.
Aged↗
[Hip pain-dystrophy in Whipple's disease].
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Hip Joint↗
[Severe rectal bleeding cured by appendectomy].
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Appendectomy↗
Micro-osteoclast resorption as a characteristic feature of B-cell malignancies other than multiple myeloma.
Multiple myeloma (MM) is characterized by the presence of lytic bone lesion and frequent hypercalcaemia. These are due to an excessive osteoclastic resorption in association with a low bone formation, as demonstrated by bone histomorphometry. Conversely, B-cell malignancies other than MM are rarely associated with lytic bone lesion and/or hypercalcaemia. In this study we have analysed quantitative bone histology in 65 patients with B-cell malignancies other than MM at diagnosis: chronic lymphocytic leukaemia (CLL, n = 20), non-Hodgkin's lymphoma (NHL, n = 25), Waldenström's disease (WD, n = 14), hairy cell leukaemia (HCL, n = 6). Fifty patients presented no clinical evidence of increased bone resorption, including no lytic bone lesions radiologically detectable and/or no hypercalcaemia. 80% of these patients (40/50) had increased bone resorption parameter using quantitative bone histology, including 19/29 (65.5%) patients with CLL or WD and 21/21 (100%) patients with NHL or HCL (P less than 0.01). As a control group, seven patients lacking bone marrow involvement on bone sample presented no excessive bone resorption. However, eight patients presented lytic bone lesions and/or hypercalcaemia. All of these patients had increased resorption parameters with high numbers of osteoclasts per surface trabecular bone (mean = 35.3), as opposed to the patients lacking lytic bone lesions and/or hypercalcaemia (mean = 6.6, n = 28) and to normal individuals (mean +/- SD = 3.8 +/- 1.7 and 6.3 +/- 2.6, respectively before and after 60 years). In all the cases, excessive histologic bone resorption was mediated by mononuclear small osteoclasts (mean osteoclast length +/- SD = 27.3 +/- 4.1 as compared to normal range = 35.0 +/- 1.0, P less than 0.001). In different in vitro models, these small mononuclear osteoclasts are considered as progenitors. These data suggest an abnormal osteoclast differentiation in B-cell malignancies other than MM, probably due to differences in the production of local factors acting on bone remodelling.
Adult↗