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J L Lejonc

Publications and source records attributed to J L Lejonc.

At least 19 recordsLinked to original sources
PubMed1999

[Congestive heart failure in the aged. Causes and mechanisms of left ventricular dysfunction].

UNLABELLED: AGING PROCESS: Aging can be defined as an association of senescence and disease states. Aging induces changes in adaptive processes, modifying heart failure pathophysiology. MECHANISMS: In a population over 75, half of the patients with congestive heart failure have normal left ventricular systolic function. Heart failure in these patients results from ventricular diastolic dysfunction. Hypertension and coronary heart disease are the main causes of heart failure. THERAPEUTIC IMPLICATIONS: Identifying the etiology and the underlying mechanism (systolic or diastolic) are essential steps guiding further management.

Aged↗
PubMed1999

[Congestive heart failure in the aged. Diagnosis].

THREE DIAGNOSTIC PITFALLS: The difficulty in diagnosing congestive heart failure in the elderly subject is basically caused by three factors. First, clinical expression is often atypical. Secondly, severity is often underestimated as the prevalence of asymptomatic systolic dysfunction increases with age. Half of all cases of left ventricular systolic dysfunction go unrecognized if clinical signs alone are considered. Finally, the pathophysiology of diastolic dysfunction, which predominates in the over 75 population, is still poorly understood. COMPLEMENTARY EXPLORATIONS: As the clinical signs are the same whatever the mechanism of the ventricular dysfunction, echocardiography is the key exploration for diagnosis and for guiding management. Comorbidity is often a confounding factor preventing precise diagnosis and risk stratification.

Aged↗
PubMed1999

[Congestive heart failure in the aged. Therapeutic management].

TOWARDS OPTIMAL CARE: It is essential to distinguish between systolic and diastolic dysfunction to achieve optimal management of patients with congestive heart failure. Data is lacking in the literature for validation of the guidelines usually applied in the elderly population. A specific analysis of therapeutic management of diastolic heart failure has never been performed. Altered response to drugs and associated disease states argue for an assessment of therapeutic options. The therapeutic objectives to test are different in the elderly population where quality of life and morbidity are more important than mortality criteria. In clinical practice, the empirical approach still predominates over evidence based medicine. THERAPEUTIC GOALS: At the acute phase, volume overload requires rapid action diuretics and a treatment of the triggering cause. For chronic situations, diet and lifestyle play a major role (reduced salt intake, regular exercise). Drug therapy, particularly converting enzyme inhibitors have been found to be quite effective. Rehabilitation and secondary preventive measures are the only validated methods proven to improve quality of life.

Aged↗
PubMed1996

Lipid-lowering drugs and mitochondrial function: effects of HMG-CoA reductase inhibitors on serum ubiquinone and blood lactate/pyruvate ratio.

1. Statins inhibit synthesis of mevalonate, a precursor of ubiquinone that is a central compound of the mitochondrial respiratory chain. The main adverse effect of statins is a toxic myopathy possibly related to mitochondrial dysfunction. 2. This study was designed to evaluate the effect of lipid-lowering drugs on ubiquinone (coenzyme Q10) serum level and on mitochondrial function assessed by blood lactate/pyruvate ratio. 3. Eighty hypercholesterolaemic patients (40 treated by statins, 20 treated by fibrates, and 20 untreated patients, all 80 having total cholesterol levels > 6.0 mmol l-1) and 20 healthy controls were included. Ubiquinone serum level and blood lactate/pyruvate ratio used as a test for mitochondrial dysfunction were evaluated in all subjects. 4. Lactate/pyruvate ratios were significantly higher in patients treated by statins than in untreated hypercholesterolaemic patients or in healthy controls (P < 0.05 and P < 0.001). The difference was not significant between fibratetreated patients and untreated patients. 5. Ubiquinone serum levels were lower in statin-treated patients (0.75 mg l-1 +/- 0.04) than in untreated hypercholesterolaemic patients (0.95 mg l-1 +/- 0.09; P < 0.05). 6. We conclude that statin therapy can be associated with high blood lactate/ pyruvate ratio suggestive of mitochondrial dysfunction. It is uncertain to what extent low serum levels of ubiquinone could explain the mitochondrial dysfunction.

Adult↗
PubMed1996

Münchausen's syndrome simulating reflex sympathetic dystrophy.

Rheumatologic presentations of factitious illness such as Münchausen's syndrome are rare. We describe a case of alternate edema of the hands in a 25-year-old man, diagnosed as reflex sympathetic dystrophy. This patient eventually presented all clinical characteristics of Münchausen's syndrome.

Adult↗
PubMed1993

[Severe somatic complications of acute alcoholic intoxication].

Acute alcohol ingestion can affect life expectancy and is directly responsible for 3,500 deaths per year. Acute lung diseases are mainly caused by pneumococci, Gram negative bacilli and anaerobic germs, and are often due to multiple microbes. In this case, evolution toward abscess can be feared. Septicaemia and enterobacterial peritonitis are frequently observed in cirrhotic patients. Ethanol, hypokaliemia and hypophosphoraemia also lead to rhabdomyolysis. Rhabdomyolysis can be complicated with acute renal failure and hyperkaliaemia. Alcoholic ketoacidosis and the hypoglycaemia favored by prolonged inadequate nutrition, are corrected by infusion of glucose solutions. Hyponatraemia can be complicated by convulsions and central pontine myelinolysis. Minor forms of alcoholic hepatitis remiss after stopping alcohol intoxication. The major forms can evolve toward fatal encephalopathy; treatment with corticosteroids improves the prognosis in severe hepatitis. The cardiac failure with lactic acidosis in shoshin beriberi rapidly evolves to collapsus; treatment is based on emergency administration of vitamin B1. Management of patients in acute alcohol episodes requires great vigilance. Careful clinical examination and biological tests should eliminate severe somatic complications before concluding to simple alcoholic intoxication.

Alcoholic Intoxication↗
PubMed1993

Neurotrichinosis. A cerebrovascular disease associated with myocardial injury and hypereosinophilia.

The clinical features, brain computerized tomography (CT) scans and cardiological findings of nine patients with neurotrichinosis are reviewed. Neurological signs consisted of encephalopathy and focal deficits with small hypodensities in the cortex and white matter, detected by the CT scans. Various cardiovascular events were also observed in eight out of nine patients. They were usually concomitant with neurological symptoms and mainly consisted of myocardial injury as assessed by electrocardiographic and plasma creatine phosphokinase (CPK)-MB isoenzyme changes. The cardio-neurological syndrome developed early in the course of the disease at a time of marked hypereosinophilia and the percentage of patients with eosinophilia > or = 4000 mm3 was significantly higher in the patients with neurological dysfunction than in those without neurological signs. We selected the following criteria to describe the distinctive cardio-neurological syndrome related to trichinosis: (i) early onset of neurological symptoms (within a few days) after the first general symptoms; (ii) central nervous system involvement consisting of both diffuse encephalopathy and focal neurological deficits, usually of simultaneous onset; (iii) concomitant acute myocardial injury and/or infarction; (iv) marked hypereosinophilia (> or = 4000/mm3) at time of first cardio-neurological events; (v) brain CT scan showing small hypodensities in the hemispheric white matter or cortex. Post-mortem examination of one patient revealed ischaemic lesions with multiple arteriolar microthrombi in the brain and myocardium. This was consistent with the brain CT scan and electrocardiographic data and suggested that neurotrichinosis is an expression of a multi-organ disorder associated with hypereosinophilia, that is characterized in most patients by simultaneous neurological and myocardial manifestations basically related to ischaemia.

Aged↗
PubMed1991

[Münchhausen syndrome].

Münchhausen's syndrome is characterized by fictitious illnesses associated with hospital peregrination, pseudologia fantastica with a mythomanic discourse that includes strongly structured medical elements, passivity and dependance at examinations, and aggressiveness. The whole picture is so typical that the syndrome can easily be recognized. Cases of Münchhausen's syndrome by proxy (Meadow's syndrome) have been reported during the last few years; the condition concerns children suffering from diseases which are entirely due to their parents and can be compared with the battered child syndrome. In terms of nosology, among pathomimias Münchhausen's syndrome figures as a borderline state. Since it is impossible to establish positive relations with these patients, treatment fails in almost every case.

Adolescent↗
PubMed1988

Randomized trial of albendazole versus tiabendazole plus flubendazole during an outbreak of human trichinellosis.

To determine the therapeutic usefulness of benzimidazoles in trichinellosis, 117 patients from a single outbreak were treated either with albendazole alone (N = 59) or with a regimen including tiabendazole followed by flubendazole (N = 58). The criteria of disease activity were evaluated at days 1, 7, 15, and 45. No difference was found between the two groups with regard to the evolution of myalgia, fever, fatigue, new clinical manifestations, or laboratory and serologic data. Both treatment regimens were well tolerated. In all, 30 patients of the albendazole group and 29 of the tiabendazole-flubendazole group were reevaluated 16 months later. Serology was negative in 70% of the albendazole-treated patients vs 34.5% of the tiabendazole-flubendazole-treated patients (P less than 0.01). The muscle biopsy examination of nine patients suggested less parasitic infection in the albendazole group. In conclusion, no difference was noted during the early therapeutic responses to the drugs used, but albendazole might be more effective than the other regimen in treating residual larval infestation estimated 16 months after the onset of the disease.

Adult↗
PubMed1986

Suicide attempts in hypo-oestrogenic phases of the menstrual cycle.

The phase of the menstrual cycle in women who had attempted suicide was determined by structured interview. 108 young women were investigated within 24 h of the attempt. Patients were grouped according to menstrual week and whether they used oral contraception (OC) (n = 73) or not (n = 35). In OC non-users suicide attempts were associated with low plasma oestradiol: they tended to happen during the first week of the menstrual cycle (42%) and after the fourth week (12%). Frequency of suicide attempts did not vary significantly during the menstrual cycle in OC users. In OC non-users, low oestradiol production may predispose to depression and attempted suicide.

Adult↗
PubMed1986

Allopurinol hypersensitivity syndrome as a cause of hepatic fibrin-ring granulomas.

Hepatic fibrin-ring granulomas were found in a 35-yr-old man who developed fever, myalgias, rash, eosinophilia, and abnormal liver function tests 4 wk after the beginning of allopurinol treatment. All clinical and biochemical abnormalities spontaneously resolved within 6 wk after cessation of therapy. There was no evidence for Q fever or Hodgkin's disease, which are the recognized causes of hepatic fibrin-ring granulomas. It is suggested that allopurinol hypersensitivity might be an additional cause of these peculiar granulomas.

Adult↗
PubMed1985

Peripheral neuropathy in patients treated with almitrine dimesylate.

Sensory peripheral neuropathy developed in 5 patients treated with almitrine dimesylate, 60-100 mg/day. Onset was insidious, beginning symmetrically in the legs with stocking sensory loss and loss of ankle-jerks. Cerebrospinal fluid protein levels were slightly increased and there was electrophysiological and histological evidence of distal axonopathy. The interval between the first dose of almitrine dimesylate and onset of symptoms ranged from 2 to 4 months in 4 patients. All patients had noted a recent weight loss of 4-15 kg which may have resulted in release of previously bound drug.

Aged↗