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Biomedical subjects

J C Weber

Publications and source records attributed to J C Weber.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Substitution therapy of drug addicts].

ANALYZING PROPOSED TREATMENTS: The large body of literature on substitution treatments for drug abusers describes a variety of social settings and an extremely heterogeneous set of protocols. Establishing correlations between protocols and practical applications is thus a difficult task. METHADONE: The most widely studied substance is methadone. With methadone treatment, there is a decline in the amount of heroin used and in the number of injections. But there is no response with other drugs, leading to a real risk of increasing cocaine abuse. Methadone is used as a tool to decrease the risk of HIV although its impact is difficult to quantify. The most significant effect of methadone treatment is the social effect with a decrease in delinquency and in the number of drug-abuse related incarcerations. The consequences in terms of employment are less clear and vary depending on the social setting. The therapeutic window is very narrow with methadone and results are highly dependent on practical applications. A multidisciplinary and individualized approach is required. BUPHRENORPHINE: There has been less work on buphrenorphine. Like methadone, there is a dose/efficacy relationship. The results of comparative studies between the two agents are quite similar with a possible advantage for buphrenorphine because of the wider prescription spectrum and the possibility of longer intervals between administrations. EXTRAPOLATING MODELS: The implications of applying models developed in other countries to the social context in France still have to be analyzed on a scientific basis. New trial methodologies are needed to evaluate the social and psychological impact of individualized management.

Analgesics, Opioid↗
PubMed1998

[Soluble tumor necrosis factor receptors in patients with systemic lupus erythematosus].

OBJECTIVE: To study the variations of type II soluble receptors for tumor necrosis factor (sR-TNF) in patients with systemic lupus erythematosus and investigate their use in the clinical setting. PATIENTS AND METHODS: Twenty-six patients with systemic lupus were followed for a mean 3 years. sR-TNF and other immunological parameters (C reactive protein, anti-DNA antibodies, C3 and C4 complement fractions, soluble receptors for interleukin 2) were measured in sera at different points of the disease course. The systemic lupus activity measure (SLAM) was determined at each point, and confronted with the biology results. The study was cross sectional for the group and longitudinal for the patients. RESULTS: sR-TNF was the immunological parameter which correlated best with SLAM. It also correlated with sedimentation rate, C reactive protein, thrombopenia, anemia, creatinine level, anti-DNA antibodies and sR-IL2. The longitudinal study pointed out however that this finding is not consistent for each patient. CONCLUSION: A rise in sR-TNF related to systemic lupus activity but is of limited practical interest for individual patient follow-up.

C-Reactive Protein↗
PubMed1998

[Is there an essence of medicine?].

INTRODUCTION: Medical practice has to move from a one-on-one relationship to consensual organization of the overall management of patients. Issues at stakes and potential consequences following such changes are discussed. EXEGESIS: The evolution of medical practice is introduced as a necessity resulting from both improvements in medical technology and economical pressure. Utilitarian and procedural doctrines are promoted, taking the place of ethical bases. The one-on-one relationship evidences two essential aspects: there is often more in the request made to the practitioner than just the expression of an immediate need, and the patient is not only an organism. Both aspects reflect the specificity of human beings. There is a danger that they will disappear, as they are not included in the definition of "useful", which in fact controls current choices. CONCLUSION: Medical practice is radically modifying its own basis. Practitioners who acknowledge these changes should be aware of their cost.

Clinical Medicine↗
PubMed1998

Relapse of Graves' disease after subacute thyroiditis.

We report the case of a 46-year-old man whose Graves' disease relapsed 5 years after its first appearance. At the time of relapse thyrotropin (TSH) receptor antibodies were very high, as was radioactive uptake in the left lobe of the thyroid. After thyroidectomy, histological analysis of the specimen showed evidence of treated Graves' disease, and there were signs of subacute thyroiditis in the right lobe. The clinical and immunologic characteristics of this observation are discussed as well as the hypothesis explaining the succession of an inflammatory and autoimmune thyroid disease.

Autoantibodies↗
PubMed1997

[Lipomatosis induced by corticosteroid therapy].

Steroid-induced lipomatosis usually presents as a localized hypertrophy of the adipose tissue and seems more common than previously thought. Most patients develop this phenomenon after prolonged administration of moderate to high doses of oral corticosteroids. The localizations are numerous and determine the clinical presentation. Often asymptomatic, they can also be revealed by worrying symptoms usually due to a compressive syndrome. The most frequently reported localizations (spinal epidural, retro-orbital, mediastinal) are also the most clinically apparent. The cessation or reduction of steroid therapy, when medically possible, inconsistently results in the decrease or disappearance of the lipomatosis deposits. Computerized tomography or magnetic resonance imaging are the most helpful diagnostic means. Interestingly, these lipomatoses have rarely been reported in patients with Cushing disease. Their pathophysiology remains poorly elucidated and may imply an inhibition of the brown adipose tissue lipolysis.

Adult↗
PubMed1997

[Obstetrical complications of antiphospholipid syndrome].

Spontaneous miscarriages and fetal deaths take part of the definition of the antiphospholipid syndrome. Preeclampsia, fetal distress, preterm delivery, intrauterine growth retardation, mother's or newborn's vascular thrombosis are also included in the spectrum of clinical events linked to the antiphospholipid antibodies in pregnant women. The pathogenesis is not fully understood, but involves interactions between antibodies and phospholipidic molecules that are complexed to plasmatic proteins of the coagulation, or present on endothelial cell and platelet surfaces. The poor spontaneous prognosis of pregnancy in the context of the antiphospholipid syndrome is dramatically improved by preventive treatment. Therapeutic options are not codified and are various combinations of low-dose aspirin, heparin, steroids, intravenous immunoglobulins, and fish-oil derivatives. Excellent obstetrical care is mandatory in every case.

Abortion, Spontaneous↗
PubMed1997

A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition.

OBJECTIVE: Intravenous fat infusions are a standard component of total parenteral nutrition (TPN). We studied the effects of withholding fat infusions in trauma patients requiring TPN. DESIGN: Polytrauma patients receiving TPN were randomized to receive a standard fat emulsion dose (L) or to have fat infusions withheld (NL) for the first 10 days of TPN. The two groups received the same amino acid and carbohydrate dose (isonitrogenous, nonisocaloric). MATERIALS AND METHODS: Clinical outcome parameters were measured. T-cell function was assessed by measuring lymphokine activated killer and natural killer cell activity. MEASUREMENTS AND MAIN RESULTS: Demographics including Injury Severity Score (27 +/- 8; 30 +/- 9) and APACHE II scores (23 +/- 6; 22 +/- 5) were similar for the L (n = 30) and NL (n = 27) groups, respectively. Differences (p < 0.05) were found in length of hospitalization (L = 39 +/- 24; NL = 27 +/- 16), intensive care unit length of stay (L = 29 +/- 22; NL = 18 +/- 12), and days on mechanical ventilation (L = 27 +/- 21; NL = 15 +/- 12). The L group had a higher number of infections (72 in 30) than the NL group (39 in 27) and T-cell function was depressed in this group. CONCLUSIONS: Intravenous fat emulsion infusions during the early postinjury period increased susceptibility to infection, prolonged pulmonary failure, and delayed recovery in critically injured patients. It is not clear whether the improved outcome in the NL group was directly related to withholding the fat infusions or due to the hypocaloric nutritional regimen (underfeeding) these patients received.

APACHE↗
PubMed1996

[Involvements of the peripheral nervous system and primary Gougerot-Sjögren syndrome].

Peripheral neuropathy in primary Sjögren's syndrome is common although often unrecognized in mild forms of this affection. They are characterized by a predominently sensory deficiency and can be divided in several entities, of which the most important are: axonal distal symmetric polyneuropathy, either of sensory or sensory-motor presentation, which are supposed to be consecutive to ischemia induced by the vasculitis of the vasa nervorum; sensory neuronopathy mimicking the paraneoplastic syndromes from a clinical and electrophysiological point of view which are supposed to be linked to neuronal degeneration secondary to a lymphocytic infiltration of the dorsal root and ganglia; trigeminal sensory neuropathy, either alone or associated with one of the previously cited forms. The prescribed courses of etiological treatment consisting of corticosteroids and immunosuppressive agents are only effective in some acute forms. Tracking down systematically these peripheral neuropathies in patients affected by Sjögren's syndrome is the best way to recognize them. Alternatively, patients with unexplained neuropathies should be evaluated for the presence of Sjögren's syndrome.

Humans↗
PubMed1996

[Use of urapidil during surgery for pheochromocytoma].

OBJECTIVE: To investigate the efficacy of urapidil, administered either by boluses or a continuous infusion, to control hypertension during resection of phaeochromocytoma. STUDY DESIGN: Prospective open study. PATIENTS: Seven consecutive patients aged between 23 and 60 years, with a hypersecretant phaeochromocytoma. METHODS: Standard anaesthetic technique including thiopentone, opioid, muscle relaxant, nitrous oxide and isoflurane. Invasive haemodynamic monitoring with a Swan-Ganz catheter and radial arterial catheterization. Infusion of cristalloids and colloids (20 mL.kg-1.h-1). Evaluation of two regimens of urapidil administration following the initial injection of a bolus of 25 mg in case of severe hypertension i.e. SAP > 180 mmHg > 1 min: a) boluses of 25 or 50 mg of urapidil injected according to the response obtained after the first bolus or in case of resurgence of a new hypertensive event; b) continuous infusion of 150-200 mg.h-1. RESULTS: Three patients developed hypertension between the induction of anaesthesia and the beginning of the tumor dissection. One bolus of 25 or 50 mg of urapidil was efficient to control this event. During the dissection of the phaechromocytoma, higher doses (75-100 mg) were required to significantly decrease SAP and DAP values (P < 0.001). Heart rate did not change significantly in patients not receiving esmolol. A continuous infusion, used in three patients, did not prevent the occurrence of peaks in two patients, requiring additional doses. After the removal of the tumor, three patients experienced severe hypotension with decreased systemic vascular resistances and high cardiac output. Vasoactive drugs were injected to restore better haemodynamic conditions. CONCLUSION: Urapidil is useful for the management of hypertension during the resection of phaechromocytoma. However further investigations are needed to determine its role in the occurrence of prolonged collapse after the tumor removal.

Adrenal Gland Neoplasms↗
PubMed1996

[Surgical treatment of synchronous hepatic metastases of colorectal cancers. Simultaneous or delayed resection?].

The surgical strategy for resectable synchronous hepatic metastases of colorectal cancer remains controversial. The retrospective analysis of our series of resectable synchronous hepatic metastases focused on the percentage of simultaneous resections, the circumstances, the indications and the results of the one-step procedure compared to the two-step strategy. From January 1, 1982 to December 31, 1995, 129 patients were operated on for resection of hepatic metastases of colorectal cancer. Forty one patients (32%) presented with synchronous hepatic metastases, 20 of whom (49%) underwent simultaneous resection of the primary tumor and the hepatic metastases (simultaneous resection group: SR). For the other 21 patients (51%), the hepatic resection was delayed for a mean interval of 5.2 +/- 4.2 months (delayed resection group: DR). The mean age of the 2 groups was not significantly different (54 years versus 58 years). When the primary tumor was located on the ascending colon, the hepatic excision was performed simultaneously in 9 out of ten cases. The need for blood transfusion and the volume required were not significantly different between the two groups. The length of each surgical operation was comparable between the two groups (331 +/- 76 minutes SR vs 330 +/- 88 minutes DR). Postoperative complications were observed in 20% of patients in the SR group and 10% of patients in the DR group (no significative difference). There was no postoperative mortality in either group. Survival was 83%, 44% and 37% at 1, 2 and 3 years respectively in the SR group and 79%, 59% and 49% in the DR group, with no significant difference between the groups. These results show that simultaneous resection of the primary tumor and the hepatic metastases did not increase either morbidity or mortality in our study, and that it should be proposed especially to patients presenting with a primary tumor of the ascending colon with metastases resectable by means of a minor hepatectomy.

Actuarial Analysis↗
PubMed1995

Association of intermediate uveitis with HLA-A28: definition of a new systemic syndrome?

BACKGROUND: Endogenous posterior uveitis (PU) can be associated with systemic diseases, and certain forms have strong association with HLA antigens. Much less is known regarding intermediate uveitis (IU). The purpose of this study was to determine whether IU is associated with the HLA system and whether it can be associated with systemic symptoms. METHODS: In 179 consecutive patients consulting for uveitis, a detailed history was obtained and a physical examination performed. HLA typing for 71 HLA-A, B, DR and DQ antigens, laboratory tests, and radiography of the chest, sinuses, and sacroiliac joints were systematically performed. RESULTS: Thirty-two patients (18%) had IU; 51 (28.5%) had PU and constituted our internal control group. Nine of the patients with IU (28%) had the HLA-A28 antigen, compared with 8.1% of a healthy control population and 8.6% of the patients with PU (P < 0.001). An associated disease was found in four patients with IU (12.5%) (none was HLA-A28) and in 45% of the patients with PU (P < 0.01). Some 67% of HLA-A28 patients with IU had arthralgias affecting the knee(s), compared with 17% of non-HLA-A28 patients and 18% of patients with PU (P < 0.05 and P < 0.01 respectively); 55% had gonalgias and hypocomplementemia compared with 9% and 2% respectively (P < 0.01 and P < 0.001). CONCLUSIONS: IU is significantly associated with HLA-A28; patients having this antigen may represent a subset of the disease characterized by an increased prevalence of arthralgias and hypocomplementemia.

Adolescent↗
PubMed1995

[Treatment of lupus glomerulonephritis with intravenous cyclophosphamide].

The treatment of severe lupus nephritis remains problematic. We have analysed retrospectively 17 patients with corticoresistant lupus nephritis treated with pulse cyclophosphamide. Single monthly doses (500 mg/m2) were given by intravenous infusion with a mean of 10.4 infusions per patient (3 to 18). A comparison of parameters at entry and at the end of the treatment revealed an improvement in proteinuria (4.8 vs 1.9 g/24 h; p < 0.013) whereas mean serum creatinine level and SLAM (Systemic Lupus Activity Measure) remained stable. The results were identical at follow up (mean: 14.5 months). Most of the therapeutic effect was achieved as soon as the 6th pulse. Further treatment was beneficial for four patients only. None of the studied parameters (serum creatinine level, renal biopsy, SLAM) was predictive of a response to an extended course of pulse cyclophosphamide. The infusions were definitively stopped in one patient and delayed in two others because of serious adverse effects. The data indicate that, in mean term, monthly intravenous cyclophosphamide was associated with a substantial amelioration of 24 hours urinary protein level. An amelioration of the renal function was however, uncommon.

Adult↗