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J F Viallard

Publications and source records attributed to J F Viallard.

54 records · Page 3Linked to original sources
PubMed1999

Successful treatment of lupus with fludarabine.

We describe a 58-year old patient with chronic lymphocytic leukemia (CLL) who developed systemic lupus erythematosus (SLE) with severe joint involvement. Dilated myocardiopathy precluded the use of high corticoid doses and a 15 days of prednisone (15mg/d) had no effect on the polyarthritis. Therefore, fludarabine (25mg/m2) was administered for 5 d. One month after the first cycle, fever, muscle stiffness and polyarthritis resolved. A total of 6 cycles were administered. The evolution was complicated by herpes zoster infection and left pneumococcal pneumonia. At this time of writing (July 1999), the patient is symptom free but is profoundly lymphopenic.

Antineoplastic Agents↗
PubMed1999

Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus.

Neuropsychiatric forms of systemic lupus erythematosus (SLE) vary, most commonly consisting of seizures, psychiatric disturbances, or focal central nervous deficits. This is a new case of neuromyelitis optica or Devic's syndrome during the course of SLE. Few reports of this association exist in the literature. Our objective is to report this unique case of Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus. A 28-year-old woman had been diagnosed as having SLE with cutaneous and articular involvement in 1987 when she was 17 years old. She was treated with a synthetic antimalarial agent associated with corticosteroids. In 1994, during the fourth month of pregnancy, she had signs of transverse myelitis with a sensory level at T6 associated with an optic neuropathy suggesting a Devic's syndrome. The patient was managed by plasmapheresis sessions and intravenous corticosteroids. Transverse myelitis recurred postpartum and three years later at the same thoracic level. Management by bolus administration of a steroid and cyclophosphamide resulted in remission again. There have only been around a dozen reports in the literature of patients who had both Devic's neuromyelitis optica and SLE. Magnetic resonance imaging is contributive to diagnosis and therapeutic follow-up, showing spinal cord lesions with increased intensity on T2-weighted sequences. Although the clinical course of the present patient has been favourable so far, the prognosis of this neurologic disease is generally considered to be poor with elevated mortality.

Adrenal Cortex Hormones↗
PubMed1999

Analysis of interleukin-6, interleukin-10 and leukemia inhibitory factor (LIF) production by peripheral blood cells from patients with systemic lupus erythematosus identifies LIF as a potential marker of disease activity.

The objective of this study was to determine the extent of interleukin (IL)-6, -10 and/or LIF involvement in systemic lupus erythematosus (SLE). Specific ELISA were used to measure cytokines in the supernatants of 48 hours cultures of whole blood stimulated or not by lipopolysaccharide and phytohemagglutinin, from controls (n = 10) or SLE patients divided according to the median of the SLE activity measurements (SLAM): < 9, group 1 (n = 11), and 9, group 2 (n = 10). Comparing median basal and stimulated cytokine concentrations from patients and controls, IL-6 was significantly higher in all SLE patients, IL-10 was significantly higher in both non- and stimulated situations only for SLE group 1 patients. With regard to LIF, it was significantly enhanced only in stimulated cultures of whole blood from group 2 patients as compared to control subjects. In conclusion, the production of cytokines involved in B-cell regulation and inflammation was altered in SLE, and LIF appears to be a potential marker of disease activity.

Adult↗
PubMed1999

Three cases of acquired von Willebrand disease associated with systemic lupus erythematosus.

Acquired von Willebrand disease associated with systemic lupus erythematosus (SLE) has been detected in three middle-aged women. In each case the first clinical manifestation was a bleeding syndrome. Plasma levels of von Willebrand factor (VWF) and ristocetin-induced platelet agglutination were as found in type 1 von Willebrand disease for the first patient, type 3 for the second patient, and type 2 for the third patient. Intraplatelet levels of VWF were normal for all three patients. In all cases a mixture of patient's plasma with normal plasma resulted in inhibition of ristocetin-induced binding of VWF to normal platelets. Intravenous immunoglobulin given to patients 2 and 3 corrected the plasma VWF level of the second patient but not that of the third. Therapy with corticosteroids was partially beneficial for patient 3 and patient 2. For patient 2, the severity of the cutaneous lesions also led to the use of cyclophosphamide, and this therapy resulted in total correction of VWF levels. Our observations confirm previous reports of acquired von Willebrand syndrome associated with SLE and show heterogeneity both in the phenotypic form and in the response to treatment.

Aged↗
PubMed1999

[Joint involvement in AL amyloidosis].

This review is aimed at defining the frequency, the clinical, biological and radiological presentation and the therapeutic possibilities for AL amyloid arthropathies. The frequency of AL amyloid arthropathy is estimated to be between 2 and 5%. There is usually a bilaterally progressive symmetrical arthritis of multiple joints (predominantly in the upper limb joints) with a chronic evolution. Neurologic or cutaneous symptoms are common. The analysis of synovial fluid sediments is a key test for the diagnosis of amyloid arthropathy. Patients with amyloid arthropathy must be screened for monoclonal gammapathies. The synovectomy is the best symptomatic treatment. A better knowledge of the pathogenesis of amyloid deposits should permit to improve therapeutical strategies.

Adult↗
PubMed1998

[Exudative enteropathy in disseminated lupus erythematosus. Report of 3 cases and review of the literature].

Protein-losing enteropathy (PLE) is characterized by loss of essentially protein substances into the gastrointestinal tract. Few reports of PLE supervening in patients who have systemic lupus erythematosus (SLE) have appeared in the literature. We report three new cases. All three were women who had a severe form of SLE involving several organs. PLE was diagnosed on the basis of an increased clearance of alpha 1 antitrypsin. The severeness of the clinical picture in all three patients justified the use of immunosuppressive agents (corticosteroids and pulse cyclophosphamide therapy) which were effective. These cases are compared to the 24 previously reported. The frequency of PLE during an SLE flare-up is probably underestimated. It should be looked for in SLE patients who have edema by means of the simple alpha 1 antitrypsin test. PLE is often found in severe clinical forms of SLE and should be managed using corticosteroids either alone or in association with immunosuppressive drugs.

Adult↗
PubMed1995

[A rare cause of paroxysmal eosinophilia: eosinophilic gastroenteritis].

The authors report the case of a 16 year-old boy admitted for the seventh acute occurrence in 18 months of abdominal pain associated with hypereosinophilia. Each episode was identical in nature and receded spontaneously after 5 or 6 days. Biopsy of a fiber colonoscopically obtained specimen of small intestine was performed. The diagnosis of eosinophilic gastroenteritis was based upon an infiltration of the digestive mucosa by eosinophils, the absence of elements in favor of other types of digestive-tract disease (parasitic, allergic, hematologic, or inflammatory), and the absence or other illness outside the digestive system. However, the incidental discovery of a distal dilation of both of the patients ureters during one such episode, that disappeared with the other symptoms, raises the possibility of a bladder location as well, and thus of a hypereosinophilic syndrome. Corticoids were administered then tapered down. A relapse occurred 2 months later. Currently, he is taking 20 mg of a corticoid every other day and has presented no manifestations over the last 9 months.

Adolescent↗
PubMed1994

Colony-stimulating factors and cell cycle in the chemotherapy of acute myelogenous leukemia.

Over the past decade, Hematopoietic Growth Factors (HGFs) have been shown to improve the treatment of malignant blood diseases. They reduce the duration of leucopenia after chemotherapy and the associated infectious morbidity, without affecting remission duration, or percentage of patients resistant to chemotherapy. Moreover, HGFs are able to increase the percentage of leukemic cells in the S phase. In consequence, HGFs have been used in acute myeloblastic leukemia (AML) to recruit quiescent clonogenic blasts to improve the cytotoxic effects of cell cycle specific drugs. The clinical results are divergent and do not allow definite conclusions. However, in vitro, the efficacy of HGFs to enhance cytosine arabinoside (ara-C)-mediated cytotoxicity has been reported. Whether the HGFs-mediated increase in the antileukemic activity of ara-C is caused by changes in the cell cycle status of AML blasts or by other mechanism(s) is currently debated.

Acute Disease↗
PubMed1993

[Metabolic aspects of hemodynamic behavior in left ventricular hypertrophy by 13C NMR].

During myocardial hypertrophy, histological modifications induce a partial ischemic state and hemodynamic perturbations are responsible for an increased myocardial oxygen demand. The purpose of this study is to better characterize the alterations of intermediary metabolism linked to hemodynamic perturbations by carbon 13 NMR using enriched substrates. Left ventricular hypertrophy was consecutive to a renal hypertension (Goldblatt 2K-1C, 9 weeks). Myocardial compliance and contractility (left ventricular end diastolic pressure (LVEDP), +dP/dt max, +dP/dt max normalized to developed pressure (+dP/dt max/DEVP)) were estimated on Langendorff isolated perfused hearts at a constant perfusion pressure (normo and hypertensive rats (RHR)). Using (2-13C) acetate enriched (10 nm) substrate, 13C NMR spectra were obtained from tissue perchloric extracts. Mathematical model proposed by Malloy was used to analyze these 13C NMR spectra terms of metabolic fluxes: Fc2 = The fraction of (2-13C) acetyl-CoA entering the tricarboxylic acid cycle; y = The ratio between the activity of anaplerotic reactions to that of citrate synthetase. The results showed after hypoxia: an increase of LVEDP more pronounced in RHR (RHR: 48 +/- 15 mmHg VS SHAM: 22 +/- 6 mmHg, p < 0.01); a significant impairment of coronary blood flow more important in RHR; a significant increase of the ratio y in hypertrophied hearts (RHR: 0.062 +/- 0.09 VS SHAM: 0.15 +/- 0.02, p < 0.05). In conclusion, this study allowed a new approach to correlate diastolic dysfunction with metabolic data consecutive to an increased sensitiveness hypertrophy to hypoxic damages.

Animals↗
PubMed1993

Origin and evaluation of depressed inotropism in hypertensive cardiomyopathy.

Left ventricular pressure overload results in the development of left ventricular hypertrophy (LVH) which is considered an adaptive mechanism of the heart to normalize systolic wall-stress. Impairment of both contractility and relaxation occurs, implying that the hypertrophied myocardium is very sensitive to ischaemia, alterations in coronary haemodynamics and to mechanisms incompletely understood. Experimental data from papillary muscles and isolated coronary perfused hearts (renovascular hypertensive rats) demonstrated respectively: a decrease in velocity of shortening, an increase in isometric timing parameters, and an increase in developed pressure. In contrast, the first derivative of left ventricular pressure, normalized to developed pressure, was decreased for large balloon volumes, suggesting an impairment of systolic function at major loading in LVH. In humans, left ventricular systolic dysfunction occurs later (congestive heart failure) when ejection fraction is impaired. Increases in total minimal vascular coronary resistances observed both in humans and in animals could be related to structural and functional alterations in coronary microvessels. Studies of LVH regression under treatment with angiotensin-converting enzyme inhibitors, calcium-channel blockers and beta-receptor blockers have confirmed that only drugs that block the renin-angiotensin system or the sympathetic nervous system are effective in maximizing the reversal of LVH.

Animals↗
PubMedDate not supplied

Effect of stem cell factor on leukemic progenitor cell growth and sensitivity to cytosine-arabinoside.

Recruitment of quiescent, clonogenic blasts from patients with acute myeloid leukemia (AML) by hematopoietic growth factors (HGFs) may improve the cytotoxic effects of cell-cycle-specific drugs like cytosine-arabinoside (Ara-C). Using the culture methods described by Nara and McCulloch and making a distinction between self-renewing and post-deterministic mitoses, we analyzed the effects of stem cell factor (SCF), a growth factor acting on early hematopoietic progenitor and stem cells. First, we demonstrated that SCF, used in combination with other HGFs included in fetal calf serum (FCS) and/or in 5637 cell line supernatant (5637-CM), stimulated both colony formation and self-renewal of blast progenitors from 10 patients, unlike SCF alone. We tested the effects of SCF on the recruitment of cells in the S-phase by using a bromodeoxyuridine/DNA (BrdUrd/DNA) staining method in flow cytometry (FCM). We showed that SCF stimulated proliferation of AML cells significantly in 9/18 patients with AML. Second, we tested the influence of SCF on the sensitivity to Ara-C of self-renewing leukemic cells from 18 patients with AML. We showed that SCF was efficient in increasing the toxicity of Ara-C on the self-renewing blast progenitors, especially with high concentrations of Ara-C. However, a large patient-to-patient heterogeneity was found and the activity of SCF was not correlated with its effect on the cell cycle. These data indicate that SCF can enhance sensitivity to Ara-C of some leukemic cells with self-renewing capacity.

Acute Disease↗
PubMedDate not supplied

[Acute myeloid leukemias: role of growth factors to improve the efficacy of chemotherapy].

Haematopoietic colony-stimulating factors are a group of molecules that can stimulate haemopoiesis. With the advent of recombinant DNA technology and the cloning of their genes, they can be utilized against malignant blood diseases. They might be useful in therapy of acute myelogenous leukaemia either by increasing the efficacy of antileukaemic drugs or by shortening the duration of granulocytopoenia following chemotherapy or bone marrow transplantation. Encouraging results have been obtained, but stimulation of leukaemic cells is not ruled out. Further clinical and biological investigations are required to provide insight into the role of cytokines in treatment of acute myelogenous leukaemia.

Amsacrine↗