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Biomedical subjects

J Revuz

Publications and source records attributed to J Revuz.

At least 181 records · Page 10Linked to original sources
PubMed1994

Increased serum and blister fluid levels of creatine kinase in patients with toxic epidermal necrolysis.

Keratinocytes have recently been reported to contain creatine kinase (CK) of brain-type isoenzyme. The aim of this study was to investigate whether necrosis of keratinocytes induced raised CK levels in toxic epidermal necrolysis (TEN). The serum and blister fluid levels of creatine kinase and its isoenzymes [muscular-type (MM), brain-type (BB), myocardial-type (MB)] were measured in 40 patients with TEN, 10 patients with other bullous dermatoses, and in suction blisters in five controls. The mean serum CK was significantly higher in TEN patients than in patients with other bullous dermatoses (mean +/- SD: 480 +/- 535 U/l vs. 107 +/- 44 U/l, P < 0.05). The MM-isoenzyme was predominant (94%). A positive correlation was found between the level of the serum CK and the percentage of body surface area (BSA) involved (r = 0.49, P < 0.001). The mean blister CK was significantly higher in TEN patients than in patients with other bullous dermatoses or controls (mean +/- SD: 728 +/- 437 U/l vs. 310 +/- 244 U/l and 268 +/- 194 U/l, respectively, P < 0.02). The isoenzyme distribution of blister CK in TEN patients was: 76.8% MM, 18.1% MB and 5% BB. Although a significant part of blister CK comigrating with CK-MB, after preincubation with protein A-Sepharose, appeared to be CK-BB/IgG complex, the CK-BB fraction constituted less than 25% of blister CK. Therefore, the CK present in increased amounts in serum and blister fluid in TEN was not directly produced by keratinocytes.

Adolescent↗
PubMed1994

Immunosuppressive effects of 1,25-dihydroxyvitamin D3 and its analogue calcipotriol on epidermal cells.

1,25-Dihydroxyvitamin D3 (1,25(OH)2D3; calcitriol) is the biologically active form of vitamin D. This hormone is a potent immunoregulatory agent. Calcipotriol is a synthetic analogue of 1,25(OH)2D3, with similar receptor binding, and comparable effects on cell proliferation and differentiation, but less potent effects on calcium metabolism. As a step towards understanding the mechanisms by which vitamin D compounds affect T-cell activation by epidermal cells (EC), we assessed the effects of 1,25(OH)2D3 and calcipotriol on the human allogeneic mixed epidermal cell-lymphocyte reaction. All experiments were performed both with 1,25(OH)2D3, and calcipotriol, with similar results. Both compounds had potent immunoinhibitory properties on this model, and enhanced the immunosuppressive effects of cyclosporin A. Using preincubation experiments, we found that pretreatment of EC with 1,25(OH)2D3 resulted in a more pronounced inhibition than preincubation of lymphoid cells. The epidermal targets of this inhibitory effect have been further investigated, using cultures with freshly isolated Langerhans cells (LC) or LC-depleted keratinocytes, separated by an immunomagnetic particle technique. Pretreatment of LC induced a 30% decrease of proliferation, compared with vehicle-treated LC. These calcitriol-pulsed LC did not decrease the proliferation induced by unmodified autologous EC. As expected, LC-depleted keratinocytes failed to stimulate allogenic lymphocytes. When added to autologous unmodified EC, however, calcitriol-pulsed keratinocytes induced an 85% decrease of proliferation, compared with vehicle-treated keratinocytes. The phenotypic expression of HLA-DR, -DQ, and -DP antigens on EC, assessed by immunoalkaline phosphatase staining, was not modified after a 2-h or 24-h pulse with 1,25(OH)2D3 or calcipotriol.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitriol↗
PubMed1994

Disseminated cutaneous botryomycosis--an unexpected diagnosis after 20-years' duration.

A 35-year-old man presented with nodular suppurative lesions of the buttocks and the neck evolving over 20 years. A diagnosis of botryomycosis was established. Staphylococcus aureus, Acinetobacter baumanii and coagulase negative Staphylococcus were isolated from the biopsy specimen. Surgical excision was performed with success on the buttock.

Acinetobacter Infections↗
PubMed1994

[Acute arthritis during isotretinoin treatment].

We report a case of acute arthritis of the knee which occurred in a dose-dependent manner during treatment with isotretinoin. Recurrence was seen at rechallenge. Only three observations of acute arthritis induced by isotretinoin have been reported in the literature. This side effect is rare and does not require drug withdrawal but rather an adapted dose.

Acne Vulgaris↗
PubMed1994

[Non-bacterial thrombotic endocarditis complicating metastatic melanoma].

INTRODUCTION: Non-bacterial thrombotic endocarditis is defined by the presence of cardiac aseptic valvular vegetations made of fibrin and platelets. We report a case diagnosed ante mortem that occurred in a patient with metastatic melanoma. CASE REPORT: M. S., presented with a metastatic melanoma associated with an acute neurological deficit. Cerebral computerized tomographies and nuclear magnetic resonance showed occipital ischaemic lesions in the territory of the posterior cerebral artery. Cardiac echography showed large vegetations of the mitral valve. Bacterial endocarditis was eliminated. The diagnosis of non-bacterial thrombotic endocarditis was made, confirmed by post mortem examination. DISCUSSION: Non-bacterial thrombotic endocarditis is the second cause of neurological manifestations in patients with cancer. The presentation of our case was unusual because of an audible heart murmur and vegetations visible on echography.

Adult↗
PubMed1994

Additive effects of calcipotriol and cyclosporine A: from in vitro experiments to in vivo applications in the treatment of severe psoriasis.

We report that calcipotriol (CPT) is a potent inhibitor of lymphocyte proliferation in mixed epidermal cell lymphocyte reactions. In this model, CPT and cyclosporine A (CsA) have synergistic effects. These results have led to a randomised double-blind therapeutic study protocol in patients with severe psoriasis. In these patients, topical CPT and sub-therapeutic doses of CsA (2mg/kg/d) induce disappearance of cutaneous lesions. This therapeutic association may minimize secondary side effects of both drugs.

Adult↗
PubMed1994

Thalidomide neuropathy incidence and clinico-electrophysiologic findings in 42 patients.

BACKGROUND AND DESIGN: Thalidomide therapy was shown to be effective in numerous dermatologic diseases. As reliable methods of contraception are now available, neurotoxicity has become the most important side effect limiting the use of thalidomide. The incidence of this neuropathy and its relationship to thalidomide doses are still matters of debate. In a retrospective study, we reviewed the files of 42 patients who had received thalidomide between 1987 and 1992 for various dermatologic diseases. The incidence and the conditions of occurrence of the neuropathy were analyzed. RESULTS: Evidence of a thalidomide-induced neuropathy was present in nine patients (21%), who had both clinical and electrophysiologic typical abnormalities. Twelve other patients (28%), however, presented with isolated clinical or electrophysiologic signs. Thus, the diagnosis of thalidomide neuropathy could not be affirmed. The occurrence of the neuropathy did not appear to be related to the daily dose nor to the duration of treatment. The highest risk of developing a thalidomide neuropathy was found in female and elderly patients. Two monozygotic twin sisters, who received thalidomide for Behçet's disease, both developed a neuropathy. CONCLUSIONS: These data suggest that the incidence of thalidomide neuropathy may be between 21% and 50%. Individual susceptibilities with possible genetic predisposition seem to be more important than daily dose and duration of thalidomide therapy.

Adult↗
PubMed1994

Lichen planus and hepatitis C virus--related chronic active hepatitis.

BACKGROUND AND DESIGN: An increased prevalence of chronic liver disease has been reported in patients with lichen planus (LP). We report six cases of LP associated with chronic active hepatitis and actively replicating hepatitis C virus (HCV). RESULTS: We studied six patients (three men and three women; mean age, 61 years; age range, 47 to 70 years) with various forms (cutaneous and/or mucosal) of LP and abnormal liver test results. Four patients had severe mucosal lesions. Cutaneous and mucosal lesions had a long-term evolution. Liver disease was discovered 2 to 6 years before LP in three cases and was diagnosed at the same time as LP in the three other cases. Liver biopsy performed in five patients showed chronic active hepatitis without cirrhosis in all five cases. Anti-HCV antibodies were detected in all cases by second-generation enzyme-linked immunosorbent assay and confirmed by second-generation recombinant immunoblot assay. Hepatitis C virus RNA was evidenced by means of polymerase chain reaction in the serum samples from the six patients, proving active viral replication. CONCLUSIONS: Lichen planus may be associated with HCV-related chronic active hepatitis. As interferon treatment may induce viral inactivation in some patients with HCV-related chronic liver disease, a search for HCV infection should be systematically performed in patients with chronic LP.

Aged↗
PubMed1993

Reducing unnecessary laboratory use with new test request form: example of tumour markers.

To limit the ordering of serum tumour marker tests that are clinically irrelevant, we designed a new request form. This is a matrix of boxes, rows being individual markers and columns body organs. The box at the intersection of line and column is colour-coded to indicate whether the test is appropriate or not. These ratings were allocated on the basis of published data and local consensus. This new form replaced the form in use at our hospital at the beginning of 1992, and resulted in a 25% decrease in the ordering of tumour markers. Adapting the design of the test request form is a low-cost intervention that combines both economic and clinical requirements in reducing the prescription of tests that are useless in a given clinical situation.

Acid Phosphatase↗
PubMed1993

Pemphigus foliaceus in young women. An endemic focus in the Sousse area of Tunisia.

BACKGROUND AND DESIGN: With the exception of some areas in Brazil, pemphigus is an exceptional disease. Several previous observations suggested that pemphigus foliaceus occurred more frequently than expected in Tunisia. To confirm these observations, a 15-month prospective survey was undertaken at the University Hospital of Sousse in Tunisia. RESULTS: During the survey, 23 patients with pemphigus were observed. Twenty of 23 cases were of pemphigus foliaceus that affected only young women. Seven patients had the clinical features of pemphigus herpetiformis. The estimated incidence of pemphigus foliaceus in the Sousse area was four new cases per million inhabitants per year, far above European or North American incidence but lower than the incidence in the most severely affected areas in Brazil. The high prevalence of the herpetiform clinical variant, the young age, the feminine exclusivity, and the absence of familial cases differentiated this Tunisian pemphigus both from pemphigus foliaceus observed in Europe and North America and from the Brazilian fogo selvagem. No etiologic factor was identified. CONCLUSIONS: This study suggests the existence in Tunisia (and possibly in all North Africa) of an endemic form of pemphigus foliaceus restricted to young women.

Adult↗
PubMed1993

Comparative study of availability of prednisolone after intestinal infusion of prednisolone metasulfobenzoate and prednisone.

The role of intestinal absorption in the differential availability of prednisone (PN) and prednisolone metasulfobenzoate (PO-MS), which might account for clinical resistance to PO-MS, has been studied by an infusion technique. In a randomized cross-over design trial, a solution in isotonic saline of PN or PO-MS (115 mg.l-1 was infused at 5 ml.min-1 for 2 h, into a 25 cm segment of jejunum in 8 healthy fasting subjects. The intestinal content was partly collected and the flow rate at the end of the test segment was determined by using a water movement marker (PEG 4000). Plasma, intestinal and urine concentrations of PN and PO were determined by liquid chromatography. From the data on PO, the active molecule, the systemic availability of PO-MS was significantly smaller than of PN, with the respective mean AUCs being 1.71 and 3.60 mg.h-1. The difference was associated with smaller mean Cmax, 0.20 vs 0.64 mg.l-1, higher mean tmax, 2.94 vs 2.06 h and lower mean ka, 0.98 vs 2.18 l/h after PO-MS. No significant difference was found in the half-life or renal clearance of the formulations tested. The mean MRT was significantly increased after PO-MS, 6.82 vs 5.30 h. The observed difference probably reflected a difference in intestinal absorption. The mean absorption in the test segment of PO-MS was significantly smaller at 17.4 vs 85.5% for PN. The ester form may be a limiting factor in the intestinal absorption of PO.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cutaneous side effects associated with interleukin 2 administration for metastatic melanoma.

BACKGROUND: Cutaneous changes associated with recombinant interleukin 2 (r IL-2) administration are frequent but have been rarely studied in a large series. OBJECTIVE: We analyzed these clinical, microscopic, and immunologic changes. METHODS: Patients with metastatic melanoma treated with r IL-2 were studied. The eruption was scored as mild or severe. Biopsy specimens were obtained for histopathology, ultrastructural analysis, and immunophenotyping. Chi-square and t tests were used for statistics. RESULTS: Twenty-five patients were included. Eruptions were observed in 56 of 78 cycles (72%); 53 were mild with a burning pruriginous erythema, and 3 were severe with urticaria, necrotic lesions, and blisters. Regression was constant without sequelae. Pathologic changes were mild with a mononuclear cell infiltrate of activated helper T phenotype, expressing LFA-1. Keratinocytes and endothelial cells displayed intercellular adhesion molecule-1 and HLA-DR. Cells rarely expressed CD25. CONCLUSION: Administration of r IL-2 triggers non-treatment-limiting cutaneous inflammation.

Adult↗
PubMed1993

Protein S deficiency in a patient with necrotizing cellulitis.

A case of necrotizing cellulitis of the penis is reported. In this patient, transient functional protein S deficiency during the infectious process was demonstrated with a marked decrease of free protein S and elevated C4b-binding protein levels. Moreover, by investigating other members of this patient's family it was possible to demonstrate a subclinical inherited protein S deficiency. In this study it is suggested that the profound and transient decrease of functional protein S observed in this patient during infectious cellulitis, may have contributed to the pathogenesis of tissue necrosis.

Adult↗