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Biomedical subjects

L Guillevin

Publications and source records attributed to L Guillevin.

At least 289 records · Page 16Linked to original sources
PubMed1991

Plasmapheresis and subsequent pulse cyclophosphamide versus pulse cyclophosphamide alone in severe lupus: design of the LPSG trial. Lupus Plasmapheresis Study Group (LPSG).

A group of clinics are collaborating in the Lupus Plasmapheresis Study Group (LPSG) to investigate whether repeated plasmapheresis prior to pulse cyclophosphamide improves the therapeutical results in severe systemic lupus erythematosus (SLE). The underlying rationale is the hypothesis that plasmapheresis 1) eliminates pathogenic autoantibodies and immune complexes and 2) induces compensatory lymphocyte activation via feedback mechanisms between circulating antibodies and their respective clones ("antibody rebound"). It should be possible to utilize this enhanced activity for increased clonal deletion if pulse cyclophosphamide is applied shortly after plasmapheresis. Accordingly, in a randomized study, the LPSG will be comparing the repeated application of pulse cyclophosphamide alone with a treatment involving repeated plasmapheresis prior to the cyclophosphamide pulses in severe SLE. A third arm of the study will be gathering experience with a more intensified procedure. This overview summarizes the most important details of the planned study.

Combined Modality Therapy↗
PubMed1991

Zidovudine removal during plasma exchange.

Pharmacokinetics of zidovudine (azidothymidine, AZT) were investigated after oral administration (300 mg every 8 hours) in a human immunodeficiency virus seropositive patient who was also treated with plasma exchange (60 ml/kg). Plasma AZT concentrations were measured using high performance liquid chromatography assay. Plasma exchange clearances reached 1-3.8% of the total clearance. The fraction of AZT removed from separated plasma accounted for only 1% of the administered dose. The contribution of plasma exchange to the elimination of AZT appears to be negligible. Solely on the basis of AZT pharmacokinetic data, no particular dose adjustment appears to be necessary in patients treated with multiple plasma exchanges.

Adult↗
PubMed1991

Churg-Strauss angiitis. Arguments favoring the responsibility of inhaled antigens.

A 27-year-old man presented with relapsing vascular limb purpura, pulmonary infiltrates and cranial nerve palsies occurring after exposure to pigeons. A lung biopsy specimen showed Churg-Strauss angiitis. Actinomycetes were observed in pneumocytes. The circumstances preceding clinical manifestations and pathologic findings favored the diagnosis of pulmonary vasculitis as a consequence of inhaled antigen. Recovery was obtained after treatment with prednisone, cyclophosphamide, and plasma exchanges.

Adult↗
PubMed1991

Longterm followup after treatment of polyarteritis nodosa and Churg-Strauss angiitis with comparison of steroids, plasma exchange and cyclophosphamide to steroids and plasma exchange. A prospective randomized trial of 71 patients. The Cooperative Study Group for Polyarteritis Nodosa.

We attempted to define the most effective treatment for polyarteritis nodosa and Churg-Strauss angiitis, with a prospective, randomized, multicenter trial of cyclophosphamide in conjunction with corticosteroids and plasma exchanges, compared to corticosteroids and plasma exchanges. A total of 71 patients who fulfilled clinical, histological and/or arteriographic diagnostic criteria were randomly designated to receive either prednisone and plasma exchanges (group A, n = 39) or cyclophosphamide, prednisone and plasma exchanges (group B, n = 32). The end points of the study were control of the disease (recovery and remission) and death. Upon study entry clinical and laboratory features did not differ in the 2 groups. Treatment was stopped in 19 patients because of ineffectiveness in 10 (9 in Group A) and side effects in 9 (8 in Group B). Initial control of the disease was similar in both groups. At 5 years, 27 patients had completely recovered and 14 patients were in clinical remission. The cyclophosphamide-prednisone-plasma exchange association was beneficial in preventing relapses during longterm followup. Nineteen deaths were reported during the followup period. There was no difference between the 10 year cumulative survival rates of the 2 groups (respectively, 72 and 75%). Thus, the association of cyclophosphamide with corticosteroids and plasma exchanges reduced the incidence of relapses and improved the quality of the clinical response to therapy.

Adolescent↗
PubMed1991

[Vasculitis and neoplasms. 14 cases].

Fourteen cases of vasculitis associated with a neoplasm are reported. The vasculitides were classified as: leukocytolytic vasculitis 7, periarteritis nodosa 4, purpura rheumatica 1, cutaneous granulomatous vasculitis 1, microvasculitis nervosa 1. The neoplasms were diagnosed as: 10 hemopathies (including 4 cases of refractory anemia) and 5 solid tumors (1 patient had 2 tumors). The cutaneous manifestations (purpura, papules, subcutaneous nodules, etc.) and fever were the most common, while joint and neurological involvement were the rarest. The evolution of the vasculitis was usually corticosensitive and independent of the underlying neoplasm. A review of the literature revealed that these vasculitides (primarily leukocytolytic) were frequently associated with dysplastic myelogenous syndromes and hairy cell leukemia, while bronchopulmonary and colonic neoplasms were the most common solid tumors. The mechanisms giving rise to these vasculitides are discussed.

Aged↗
PubMed1990

Circulating immune complexes in systemic necrotizing vasculitis of the polyarteritis nodosa group. Comparison of HBV-related polyarteritis nodosa and Churg Strauss Angiitis.

Levels of immune complexes (IC) were measured before treatment in 16 patients affected with classic polyarteritis nodosa (PN) or Churg Strauss Angiitis (CSA). The six patients with PN were positive for HBV markers. The others presented severe asthma. IgG containing immune complexes were measured using Raji cell assay. Normal level was 4,642 +/- 509 (mean +/- SEM). IC levels were significantly different in patients with and without HBV markers. When HBV was present, mean IC level was 7,185 +/- 2,472. In the absence of HBV markers, mean IC level was 26,462 +/- 10,796. These results confirm that systemic vasculitis is an heterogeneous group of diseases and further suggest that pathogenesis of vasculitis is different in patients with asthma and those with HBV markers.

Antigen-Antibody Complex↗
PubMed1990

Pulmonary Wegener's granulomatosis. A clinical and imaging study of 77 cases.

We studied 77 patients with biopsy-proven WG and pulmonary manifestations, to characterize the nature and frequency of the clinical, imaging and endoscopic features of this condition. Pulmonary symptoms were cough, mild dyspnea, hemoptysis and chest pain. Five patients had no pulmonary symptoms. Imaging features consisted of nodules, infiltrates and pleural opacities. A CT scan proved useful by disclosing cavities in opacities or opacities which were not seen on an x-ray film. Fiberoptic bronchoscopy was performed in 74 patients, and it was macroscopically abnormal in 55 percent (showing bronchial inflammation or stenosis or both or isolated hemorrhage). Six patients presented with alveolar hemorrhagic syndrome. Four patients had a pleural exudate rich in polymorphonuclear leukocytes. The WG was limited to the lung in seven patients. Sixteen patients died because of active disease or iatrogenic complications (two). An improved knowledge of clinical and imaging features of WG could help the clinician reach an earlier diagnosis.

Adolescent↗