[A case of multiple myeloma with a 21-year preclinical biological stage].
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Biomedical subjects
Publications and source records attributed to D Gouet.
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Dysimmune lymphadenopathies during carbamazepine treatment. A report of two cases. We report on two cases of dysimmune lymphadenopathies with histological aspect of angio immunoblastic lymphadenopathy (AIL) developing after administration of carbamazepine. Clinical manifestations consisted of fever, erythroderma, generalized pruritus, facial edema, lymphadenopathy, liver enlargement. The two patients had anemia, hypogammaglobulinemia, impaired liver function and a negative Coomb's test. Lymphocyte stimulation test with carbamazepine in vitro was positive in both cases. Lymph node biopsy disclosed the angioimmunoblastic proliferation characteristic of AIL. After discontinuing carbamazepine, a complete remission was obtained.
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The authors report the case of a 81 years-old-woman who had simultaneously atypical Cogan's syndrome, cutaneous vasculitis and diverticular sigmoiditis. The relations being between these three diseases are discussed.
A case of severe hypertension with secondary hyperaldosteronism developing in a 71 year old woman affected by "Crest" syndrome is reported. The patient was treated by nifedipine, which led to the correction of blood pressure, plasma renin activity and serum aldosterone. The role of renal arteries vasospasm and renin-angiotension system in the genesis of scleroderma is discussed.
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A case of chronic lymphoid leukaemia complicated by a nephrotic syndrome is reported. There was no evidence of amyloidosis or renal vein thrombosis. Percutaneous renal biopsy disclosed lobular membranoproliferative glomerulonephritis with subendothelial deposits of IgG, C3, C4 and C1q. Circulating immune complexes, IgG lambda cryoglobulin and low CH50 levels due to activation of the classical pathway were demonstrated in serum. Immunosuppressive treatment of the leukaemia resulted in complete regression of the nephrotic syndrome.
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Eighteen insulin-dependent diabetic patients received insulin in a continuous subcutaneous infusion delivered by a portable pump. Short-term glycemic control was evaluated on the average glycemia (serum glucose was assayed seven times per 24 hours for three to five days), on the MAGE coefficient which gives an estimate of glycemic lability, and, in eight patients, on serum C-peptide concentrations. Results were compared to those recorded with two daily subcutaneous injections of a combination of regular and intermediate insulin. The average glycemia and the MAGE coefficient were 1.32 + 0.05 milligram (m + SEM) and 1 + 0.05 milligram respectively under continuous infusion, compared to 2.05 + 0.12 and 1.76 + 0.12 milligram respectively under insulin injections. Insulin requirements were significantly lower under continuous infusion (0.99 + 0.08 U/kg versus 1.35 + 0.11 U/kg). In three patients with brittle diabetes the use of the pump ensured rapid metabolic control. The advantages and drawbacks of portable insulin pumps are discussed in the light of this experience.
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