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Biomedical subjects

G Lorette

Publications and source records attributed to G Lorette.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

[Lymphedema of the limb: predictors of efficacy of combined physical therapy].

BACKGROUND: Limb lymphedema results from incompetence of the lymphatic system, and treatment of both primary and secondary forms involves manual lymphatic drainage and support. The effectiveness of treatment varies from patient to patient and can be unpredictable. OBJECTIVE: To investigate clinical and paraclinical criteria able to predict responses to combined physical treatment (lymphatic drainage and multilayered support) during hospitalization. PATIENTS AND METHODS: A retrospective study was performed in 45 patients admitted for one week's intensive treatment of limb lymphedema in the Lymphology Unit of the Department of Dermatology of the University Hospital of Tours. Lymphoscintigraphy was performed for all patients on admission. Loss of volume in affected limbs was studied to evaluate the effectiveness of treatment. RESULTS: Two criteria were predictive of resistance to combined treatment, i.e. venous insufficiency and continuing lymph node evidence of scintigraphic activity four hours after lymphoscintigraphy. The two factors were significantly related. CONCLUSION: Failure of combined physical treatment for lymphedema appears to be related to venous insufficiency. It is therefore essential to investigate and treat venous insufficiency, particularly in patients with continuing evidence of scintigraphic activity in lymph nodes.

Adult↗
PubMedDate not supplied

[Knowledge and problems regarding the topical treatment of leg ulcers: survey among general practitioners in the Indre-et-Loire area].

INTRODUCTION: The quantity of topical treatments for leg ulcers has increased over the last 15 years. OBJECTIVE: To determine the prescriptions for topical treatments and the problems in the management of leg ulcers using a questionnaire sent to general practitioners. MATERIAL AND METHODS: A questionnaire in 3 parts was sent to 95 general practitioners in the area working in 36 different districts with an explanatory letter. The first part was composed of 29 closed questions regarding prescription of topical treatment for leg ulcers. The second part, also closed, included 3 pictures showing a budding, a necrotic and a fibrinous ulcer. The physicians had to choose which treatment they would have prescribed and the frequency of dressings changes. The third part was composed of two open questions regarding the problems encountered. The survey started on May 1st and was closed on June 30th 2002. No reminders were sent. RESULTS: We received 52 replies, 49 of which were exploitable. Forty-five percent (43/95) did not reply. Occlusive dressings were widely prescribed (mainly hydrocolloid 38/49 and hydrocellular 28/49). Vaseline impregnated gauze were less prescribed (14/49). Dressings with balsam of Peru were prescribed often by 10 and occasionally by 27 general practitioners. Alginate or charcoal dressings were not always used appropriately. Antiseptics were prescribed by 10 physicians. Mechanical debridement of fibrinous or necrotic wounds was rarely used even for necrotic ulcers. Topical anesthetics were prescribed in 21 out of 33 cases of mechanical debridement. Some physicians referred care (n=4), others complained about lack of compliance (n=15), cost (n=14), local intolerance (n=10) and the excessively wide variety of dressings (n=10). We drew-up a synopsis with guidelines for treatment, which was sent to all the general practitioners who had participated in the survey. CONCLUSION: Forty-three of the 95 physicians approached did not reply. This poor response rate, which is common in this type of survey, may include physicians who are not at ease in the management of ulcers and this may bias the results. The physicians who replied to the survey knew the subject well but complained of the costs and variety of dressings. They were all eager to receive further information and guidelines.

Administration, Topical↗
PubMedDate not supplied

[Vulvoperineoplasty for vulvar pain in the posterior fourchette (15 cases)].

BACKGROUND: Vulvar pain is a common presenting complaint in dermatology consultations arising from numerous possible causes. Where such pain is mechanical, resulting from stretching of the vulva, particularly during sexual intercourse, the patient should be checked for anatomical features that could account for the pain, localised anatomical adhesions or sclerosis of the fourchette, and amenable to treatment by vulvoperineoplasty. PATIENTS AND METHODS: A retrospective study of all patients undergoing vulvoperineoplasty for vulvar pain in the fourchette was carried out between 1.1.1993 and 1.1.2003. RESULTS: Fifteen successive patients were included in the study. The mean rate of sexual intercourse doubled between the pre-operative period and the post-operative period, rising from 5 (0 to 30) to 9.8 (3 to 30). Mean pain intensity during intercourse on a scale of 1 to 10 fell from 7.6 (5 to 9) before surgery to 1.6 (0 to 5) after surgery. None of the patients experienced any sequelae. All patients except one (who was no longer sexually active), expressed willingness to undergo vulvoperineoplasty again if necessary. DISCUSSION: Vulvoperineoplasty is a simple procedure and proved useful for female patients presenting vulvar pain and adhesions or sclerosis of the fourchette.

Adult↗
PubMedDate not supplied

[The glucagonoma syndrome. 3 new cases].

We report three new cases of glucagonoma revealed, 6 to 12 months after its onset, by non-specific and misleading skin lesions associated in all 3 cases with diabetes mellitus, severe deterioration of the general condition and hyperglucagonaemia. Non-invasive methods, such as ultrasonography and computerized tomography (CT), are most helpful to locate the pancreatic tumour. Phlebography with tiered venous blood sampling is useful in difficult cases. A false positive result has been recorded with arteriography. Ultrasonography and CT have yielded two false negative results. The alpha-chain of the chorionic gonadotrophin hormone has limited value in the diagnosis of malignant glucagonoma. Treatment is surgical, but despite it, the prognosis is severe (two of our three patients died), due to the risk of thromboembolism, to cachexia and to metastases that are frequent at the time of diagnosis.

Aged↗
PubMedDate not supplied

[Genital papules revealing a Churg-Strauss syndrome].

INTRODUCTION: Cutaneous lesions are rarely inaugural in Churg and Strauss syndrome. We report the case of a patient in whom recurrent papular lesions of the penis revealed a Churg-Strauss granulomatous angeitis. OBSERVATION: A 54 year-old man consulted for recurrent non-infiltrated and painless erythematous papules of the penis over the past 4 years. His past history revealed severe asthma, which had appeared at the same time, nasal polyposis and chronic sinusitis. Other than the genital organs, the clinical examination was normal. Histological exploration of a cutaneous biopsy of the penis showed a necrotic granulomatous vasculitis. The usual biological examinations were normal. Research for proteinuria, hematuria and measurement of polynuclear anticytoplasm antibodies were negative. Pulmonary X-ray revealed a bilateral interstitial syndrome with micronodules. The broncho-alveolar wash revealed moderate granulocyte alveolitis with numerous eosinophilic polynuclears. The electromyogram showed a reduction in the sensitive potential of the nerves explored in the 4 limbs. Churg-Strauss granulomatous angeitis was diagnosed. Treatment with 0.8 mg/kg/day of prednisone was initiated. The cutaneous lesions disappeared rapidly. Since three months later there had been no relapse, corticosteroid therapy was slowly and progressively reduced. Nine months later, the patient exhibited new papular lesions of the glans penis and progressive relapse of asthma. Treatment with cyclophosphamide (Endoxan(R)) combined with systemic corticosteroids was initiated. DISCUSSION: In view of the concomitance of necrotic granulomatous vasculitis in the cutaneous biopsies, severe, recent corticosteroid-dependent asthma, eosinophil-rich pulmonary infiltrate, allergic rhinitis, chronic sinusitis and the onset of a neuropathy, the diagnosis of Churg-Strauss syndrome was retained. The absence of hypereosinophilia in the blood during diagnosis can be explained by the oral corticosteroid therapy at low doses because of the asthma and sinusitis. However, hypereosinophil blood levels had been reported in several prior hemograms. Damage to the genital organ is exceptional during Churg-Strauss syndrome and is usually of granulomatous prostatitis form. Only one other case has been reported. Our observation is original in that it was isolated to the genital skin, which led to the diagnosis of Churg and Strauss granulomatous angeitis with systemic involvement.

Administration, Oral↗
PubMedDate not supplied

[Drugs associated with acute generalized exanthematic pustulosis].

INTRODUCTION: Acute generalized exanthematous pustulosis is a severe eruption which is usually drug related. If the causative drug is discontinued, acute generalized exanthematous pustulosis resolves spontaneously in ten days. The aim of this study was to compare drugs suspected of causing acute generalized exanthematous pustulosis reported to French Pharmacovigilance centres and those reported in the literature. MATERIALS AND METHODS: All cases of "pustular eruption" qualified as "serious" reported to the French Pharmacovigilance Centers between January 1985 and December 2001 were analyzed. Cases for which the diagnosis of acute generalized exanthematous pustulosis was not clearly identified were reviewed by a dermatologist. The relationship between acute generalized exanthematous pustulosis and drug exposure was re-examined by one of us. An exhaustive review of the literature was also performed. RESULTS: Review of the data base revealed 207 cases of serious acute generalized exanthematous pustulosis leading to death in 4 cases (2%). Of these cases of acute generalized exanthematous pustulosis, only one drug was suspected in 107 cases (51.6%). The main drugs involved were: pristinamycin (18 cases), amoxicillin (+/- clavulanic acid) (16 cases), hydroxychloroquine (8 cases) and a combination of spiramycin + metronidazole (5 cases). DISCUSSION: The most frequent causal drugs in our study and in the literature are: amoxicillin +/- clavulanic acid, pristinamycin, hydroxychloroquine, ampicillin, diltiazem, co-trimoxazole, terbinafine, carbamazepine and spiramycin +/- metronidazole. Only pristinamycin and diltiazem have information in their summary of product characteristics regarding the risk of acute generalized exanthematous pustulosis. Because it is essential to discontinue the causative drug as soon as possible if a pustular eruption occurs, physicians must be informed of the risk, which should be added to the "adverse events", and "warnings" sections of the summary of product characteristics of the drugs concerned. CONCLUSION: Our results show the relevance of notification of side effects by physicians to pharmacovigilance centres, leading to the identification of a signal and public health dissemination of warnings.

Acute Disease↗
PubMedDate not supplied

[Community-acquired cutaneous infections: causal role of some bacteria and sensitivity to antibiotics].

OBJECTIVE: Identify the bacteria responsible for cutaneous infections observed in private practice and test their sensitivity to currently used antibiotics. PATIENTS AND METHODS: The patients were examined by dermatologists. A bacteriological sample was taken and sent to a central laboratory for identification of the germ and antibiograms were performed and the minimal inhibiting concentrations (MIC) determined. RESULTS: Folliculitis, impetigo and furuncles were the three most frequent primary infections. Four hundred and forty-three patients were included and 442 samples were placed in culture. Cultures were positive in 265 cases (a single bacterial strain in 231 cases). Staphylococcus aureus was isolated in 208 cases, streptococci in 11 and enterobacteria in 3; occasionally several germs were present. Eight strains of staphylococci were meti-R (4 p. 100). All the strains were sensitive to pristinamycin and mupirocin and 90 p. 100 were sensitive to fusidic acid. CONCLUSION: The occurrence and diffusion of resistant strains is a daily concern in hospitals. In general practice, although care must be taken, the problem rarely occurs and the antibiotics used remain effective.

Adolescent↗