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J Emmerich

Publications and source records attributed to J Emmerich.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Pulmonary embolism: the techniques, indications and diagnostic impact of lower limb investigations].

The non-invasive diagnosis of pulmonary emboli is based, in part, on evidencing a deep venous thrombosis (TVP-DVT); one of the principal features of thromboembolic disease with pulmonary emboli. Ultrasonic venograms have been introduced as the best non-invasive morphological examination for the diagnosis of DVT. Its sensitivity in subjects suspected of having pulmonary emboli (but having no frank signs of DVT) is inferior to that observed in cases where there is a clinical suspicion of DVT. On the other hand, only 70 per cent of subjects having pulmonary emboli have a DVT of the lower limbs on phlebography. For these reasons, only a positive ultrasonogram has any value in the diagnostic process as a negative ultrasonic venogram does not allow a pulmonary embolus to be excluded with certainty. A search for a DVT of the lower limbs should thus be integrated into the diagnostic approach which is both reasoned and rigorous in a search for pulmonary emboli.

Humans↗
PubMed1998

[Leiomyosarcoma of the inferior vena cava].

BACKGROUND: The inferior vena cava is an uncommon location for leiomyosarcoma, a malignant tumor which develops from the smooth muscle tissue of the media. CASE REPORT: A 76-year-old woman was hospitalized for swelling of the lower limbs. Ultrasonography, computed tomography of the abdomen and magnetic resonance imaging showed tumoral invasion of the inferior vena cava extending to the atrium. Histology examination of a tumoral fragment obtained by transjugular catheterism affirmed the diagnosis of leiomyosarcoma. DISCUSSION: Prognosis of leiomyosarcoma of the inferior vena cava is very poor. No medical or surgical treatment has given satisfactory results. Two factors would explain the poor prognosis: the tumoral localization and the low degree of tumoral differentiation. Clinical presentation and imaging findings suggest the diagnosis which must be confirmed by pathology examination of a tumoral biopsy specimen.

Aged↗
PubMed1998

Brain involvement in scleroderma: two autopsy cases.

BACKGROUND: Neuropathological data are very scarce in systemic sclerosis and fail to demonstrate primary changes in the brains of such patients. CASE DESCRIPTIONS: A 41-year-old woman with CREST syndrome developed signs of dementia after an episode of severe dehydration and died two months later of septic shock. A 63-year-old woman with CREST syndrome and a history of two unexplained transient ischemic attacks had had balance disorders since age 62. She died of severe pulmonary hypertension. In both cases, the autopsy showed extensive wall calcification of small arteries and arterioles in the brain, primarily in the basal ganglia, and also in the frontal lobes and the cerebellar area in the second case. No known cause of cerebrovascular calcification was found in either patient. CONCLUSION: The neuropathological findings in these two patients suggest that systemic sclerosis may induce primary vascular changes in the brain, of which calcification may be a marker.

Adult↗
PubMed1998

Successful treatment of ergotism with Iloprost--a case report.

A 34-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. An arteriogram showed diffuse arterial spasm and occlusion of right leg distal arteries. Intravenous infusion of a stable prostacyclin analog (Iloprost) was administered. Rapid and complete improvement of arteriospasm was noted within a few hours, confirmed by a further arteriogram. This appears to be one of the rare case reports of successful limb salvage by use of Iloprost for ergotism.

Adult↗
PubMed1998

Pre-exercise acidification induced by ingestion of NH4Cl increases the magnitude of the slow component of VO2 kinetics in humans.

UNLABELLED: Five healthy non-smoking men, aged 22.2 +/- 0.8 years (mean SD), VO2 max 50.2 +/- 6.2 ml.min-1.kg-1) performed two 6 minutes constant power output (PO) bouts of cycling at 70 rev.min-1, separated by a 20 minutes of rest. The power output during the first bout of exercise corresponded to 40% VO2max, while the second exercise corresponded to 75% VO2max. The first bout of exercise was performed at a power output below the lactate threshold (LT)--determined during an incremental exercise test. In the second bout of exercise the subjects exercised above the LT. This experimental protocol was performed twice. Once as a control test (test C) and on a separate day, at about 90 minutes after ingestion of 3 mmol.kg-1 BW of NH4Cl (test A). Ingestion of ammonium chloride developed a state of metabolic acidosis. Antecubital venous blood samples taken every one minute of cycling were analysed for pH, HCO-3, BE, pO2, pCO2 and plasma lactate concentration [La]pl. Oxygen uptake was measured continuously using breath by breath system. The obtained acidotic shift of blood acid-base balance was also present throughout the 6 minutes bouts of exercise. No significant difference in VO2 during the exercise corresponding to 40% VO2 max in the test C and the test A was observed. The total oxygen consumed throughout the 6 min cycling at the PO corresponding to 75% of VO2 max was not significantly different in test C and test A (13.532 vs. 13.422 l O2, respectively). The slow component of VO2 kinetics as expressed by the delta VO2(6-3 min) of exercise was significantly higher (p = 0.03) in test A than in test C (183 +/- 97 vs. 106 +/- 53 ml.min-1 O2, respectively). It should be noted that in each subject, the magnitude of the slow component of VO2 kinetics after pre-exercise acidification was consistently higher than in control experiment. IN CONCLUSION: The original finding of our study is that pre-exercise acidification induced by ingestion of 3 mmol.kg-1 B.W. of NH4Cl was accompanied by a significant increase in the magnitude of the slow component of VO2 kinetics. This is why we postulate that acidosis may play a significant role in the physiological mechanism responsible for the slow component of VO2 kinetics in humans.

Acidosis↗
PubMed1998

[Dyslipidemia: a predisposing or etiologic factor in atherosclerosis].

Epidemiological and experimental data linking hypercholesterolaemia to atherosclerosis is well established and confirms it has a major risk factor for atherosclerosis. The fact that an increase in blood cholesterol is not necessary or obligatory for atherosclerosis to occur, means that it cannot be considered as a causal factor of the disease. On the other hand, the benefits of treatment of hypercholesterolaemia, even in mildly elevated concentrations, have been demonstrated in many randomised trials of primary and secondary prevention in high risk subjects. Thus, beyond the arguments over cholesterol being a predisposing or causal factor, these universally accepted results have added a new therapeutic arm to the cardiological arsenal.

Anticholesteremic Agents↗
PubMed1998

[Epidemiology and etiological factors in giant cell arteritis (Horton's disease and Takayasu's disease)].

Temporal arteritis is without a doubt the most frequent vasculitis. Incidence is age related and most patients are over 50. The incidence in Caucasian populations shows a North-South gradient with a clear predominance in northern Europe and in the northern part of the United States. In these populations, annual incidence is estimated at 15 to 30/100,000 persons over 50 years of age. The sex ratio (F/M) ranges from 2 to 4. Data in France, Scotland, Italy and Israel show an annual incidence below 10/100,000 inhabitants. The disease is very uncommon in persons of African or Asian ethnic origin. Histology and immunohistochemistry studies of the temporal artery walls favor a vasculitis triggered by one or more unknown antigens, but the cause of temporal arteritis remains unknown. A link with HLA DR4 was demonstrated early. The epidemiology of Takayasu's disease is less well known except for the very strong female predominance (90% of cases). The disease is frequent in Japan, Asia, India and South America, more uncommon in Europe and North America. The "gradient" is thus inverted compared with temporal arteritis. In Japan, among 300,000 autopsies, only 0.03% cases of Takayasu disease have been observed. The incidence of the disease in one study was 2.6 cases per million inhabitants per year. Unlike temporal arteritis, most cases begin early in the 10 to 30 year age range. Genetic susceptibility linked to HLA BW52 is observed in Asia while in the United States, it would appear, though on small numbers of cases, that the frequencies of MB3 and DR4 are increased. We emphasize the epidemiological relationship with tuberculosis and Takayasu disease.

Adolescent↗
PubMed1997

[Acrosyndrome in AIDS. Vascular toxicity of bleomycin revisited].

Several cases of vasculitis have been reported in AIDS patients. They may occur as idiopathic disease or result from infection or cryoglobulinemia. In patients with Kaposi's syndrome, treated with bleomycin. Raynaud's phenomenon or digital necrosis can occur. The vascular toxicity of bleomycin is well known and does not seem to be more frequent in AIDS patients compared with other patients treated with this drug. The relation between eumulative dose of bleomycin and occurrence of peripheral vascular disease is undear.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Evaluation of a test for rapid detection of D-dimers for the exclusion of the diagnosis of venous thrombosis].

OBJECTIVES: The SimpliRED whole blood D-dimer assay for exclusion of deep venous thrombosis in symptomatic outpatient appears to be a simple and rapid method; we wanted to confirm its reliability. METHODS: Fifty consecutive outpatients (mean age 57, range 20 to 89) referred to our department between September and December 1996, for clinically suspected deep venous thrombosis (DVT) were included. Hospitalized patients were excluded as well as patients under anticoagulant and pregnant women. DVT was diagnosed with our usual strategy of compression ultrasonography at the levels of the common femoral, the superficial femoral and the popliteal veins including the exploration of sural and saphenous veins. The D-dimer assay was performed, according to the manufacturer recommendation, blindly by a physician unaware of the results of ultrasonography within one hour. RESULTS: Eight of nineteen patients with DVT had a normal D-dimer test result Four had a sural DVT, but four had a proximal DVT. Furthermore four patients with normal D-dimers had superficial venous thrombosis. CONCLUSIONS: Our series does not confirm the high sensitivity and negative predictive value reported previously. To date it is premature to propose this assay as a first line test in the therapeutic management of patients with suspected DVT.

Adult↗
PubMed1997

[New causes of inherited thrombophilia].

Activated protein C resistance is the most frequent cause of thrombophilia. It is found in 20% of patients with an episode of deep vein thrombosis (DVT) and its prevalence in caucasian population is between 3-7%. Activated protein C resistance is secondary to an Arg 506 to Gln mutation of factor V (factor V Leiden). The relative risk of DVT for heterozygotes is 5 to 10, and for homozygotes 50 to 100. There is a 2- to 4-fold increase risk of recurrences in patients bearing the factor V Leiden mutation after a first episode of DVT. Recently a new mutation in the prothrombin gene (20210 G/A) was found to increase the relative risk of DVT by 2 to 4. Finally we also reviewed the association between DVT and hyperhomocysteinemia that is associated with a 2-fold increase risk of DVT.

Humans↗
PubMed1997

[Distal gangrene and cryoglobulinemia related to hepatitis C virus infection with presence of anticardiolipin antibodies].

We report the case of a 63-year old women with toe gangrene, peripheral polyneuropathy, polyarthritis, histologically proven necrotizing vasculitis, in association with type III mixed cryoglobulinemia and hepatitis C virus (HCV) infection. Raised anticardiolipin antibodies (aCL) were found, without beta 2-glycoprotein I. HCV infection is associated with mixed cryoglobulinemia which can cause a vasculitis affecting various organs. The pathogenesis of production and clinical significance of aCL could be associated in this case with HCV infection.

Antibodies, Anticardiolipin↗