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Biomedical subjects

L Guillevin

Publications and source records attributed to L Guillevin.

At least 433 records · Page 24Linked to original sources
PubMed1979

[Echocardiographic study of hyperthyroidism based on 9 cases of Basedow's disease (author's transl)].

An echocardiographic study of nine patients with graves' disease before and after treatment demonstrates changes in myocardial contractility predominantly in the posterior wall and, to a lesser extent, in the intraventricular septum. The parameters most significantly changed were: velocity of posterior wall thickening and posterior left ventricular wall relaxation rate. There was not in any of the cases neither evidence of cardiac insufficiency nor a diminution of VCF. All of the modifications regressed rapidly with the euthyroid state. These results affirm the functional character of this disease dismissing the existence of an autonome cardiomyopathy of thyroid etiology.

Adult↗
PubMed1978

[Nodo-ventricular accessory pathway unmasked by a block in the trunk of the bundle of His].

A case is reported in which, contrary to the unusual finding, conduction was slower in an accessory pathway than in the node-His pathway. Only when this latter became blocked (in the trunk of the bundle of His) following on the longest refractory period, was a pre-excitation syndrome unmasked related to the right nodo-ventricular fibres (the fibres of Mahaim).

Adenosine Triphosphate↗
PubMed1977

[Periarteritis nodosa and Australia antigen. Comparative study apropos of 25 cases].

The authors compared two series of 27 cases of périateritis over a period of 5 years. The determined the frequency of the nodosa HBs+ (series B) and HBs-- (series A) collected clinical and laboratory signs in both series. There resulted that apart from the hepatic signs constant in series B and absent in series A, the only statistically significant differences were the joint sings and the hypertension more common in series B and the respiratory signs more common in series A. Furthermore, the course of HBs+ cases appears much mote severe than that of HBs-- cases which emphasises the importance of the hepatic involvement but this finding should be interpreted with circumspection for the mode of selection of the patients and the treatment were different in the two series.

Adolescent↗
PubMed1976

[Pericarditis in recent myocardial infarct].

Epistenocardial pericarditis, usually associated with anterior infarct, was noted in 64/400 myocardial infarct subjects admitted to an intensive care unit. No significant difference was observed with respect to this group in the case of mortality (20.6% as opposed to 26.2% in the controls) or complications of the acute stage, such as cardiac insufficiency and arrhythmia, though atrial fibrillation was more frequent (25% as against 15%). In all but one case, anticoagulant management was suspended on the appearance of pericarditis. In spite of the high frequency of atrial fibrillation, thromboembolic complications were not more frequent during brief (48-72 hr) suspension of anticoagulants. Dressler's syndrome was noted in 7 cases (1.7%), with epistenocardial pericarditis (4/7) or ventricular ectasia (3/7). Haemopericardium occurred in the case where anticoagulant management was not suspended.

Acute Disease↗
PubMed1976

[Pericarditis and fresh myocardial infarction (author's transl)].

Among 400 patients with myocardial infarction who had been admitted to the intensive care department, pericarditis was observed in 64 cases (16%). It occurred more frequently with anterior wall infarctions. The influence of the pericarditis on the mortality and complications threatening in the acute period were particularly investigated: There was no significant difference with regard to the mortality (20.6% in the group with pericarditis, 26.2% in the control group) or the occurrence of cardiac insufficiency or arrhythmias as complications. Atrial flutter, however, is more frequent (25% against 15%). Anticoagulant therapy was discontinued when pericarditis appeared, with one exception. In spite of the high frequency of atrial flutter, embolic complications were not more frequent after discontinuing the anticoagulant therapy. A postmyocardial infarction syndrome was observed seven times (1.7%), it was frequently found in a pericarditis with angina pectoris (4/7) and with ventricular aneurysm (3/7). Hemopericardium occurred in one patient in whom anticoagulant therapy had not been discontinued.

Acute Disease↗
PubMed1975

[Thrombopenic purpura revealing Hodgkin's disease].

The authors report a case of Hodgkin's disease at the subdiaphragmatic II B b stage with cell type III, revealed by thrombopenic purpura. Laparotomy and splenectomy confirmed the invasion of the spleen whereas there was no clinical splenomegaly and splenic radio-isotope scan was normal. The course is at present favourable, the purpura has been treated by corticotherapy then splenectomy, and the disease has been brought under control by classical treatment (cobalt radiotherapy and chemotherapy). The authors then discuss eight other cases in the world literature. Splenectomy is of dual interest for the assessment of Hodgkin's disease, on the one hand, and for the treatment of thrombopenic purpura on the other hand.

Adult↗
PubMedDate not supplied

Diclofenac, paracetamol, and vidarabine removal during plasma exchange in polyarteritis nodosa patients.

Since plasma exchange (PE) represents a major treatment for patients suffering from systemic diseases, its influence on the kinetics of three drugs was investigated: vidarabine, used in patients with polyarteritis nodosa associated with hepatitis B virus (eight subjects), and diclofenac and paracetamol for investigative purposes (five subjects). This study confirmed that vidarabine is so rapidly deaminated to form hypoxanthine arabinoside (Hx-Ara) that no detectable concentrations were measured. Hx-Ara levels were used to evaluate vidarabine kinetics; 19.5 +/- 14.6 mg of Hx-Ara were removed by one PE during the first week of treatment (15 mg kg-1 d-1, continuous infusion) and 7.8 +/- 10.2 mg were eliminated by one PE during the second week of treatment (7.5 mg kg-1 d-1, continuous infusion). Based on the vidarabine intake per hour and the resulting quantity of Hx-Ara removed per hour, PE recovery was quite important (ca. 30 per cent), during both the first and second weeks of continuous infusion. Data were subject to large interindividual variability. However, these results do not favor vidarabine dosage supplementation in this indication because the duration of PE is less than 8 per cent of a daily administration period. For paracetamol (1 g, single oral dose) and diclofenac (100 mg, single oral dose), the fractions of drug removed during PE effected within 2 h of drug intake, were respectively 5.0 +/- 3.1 per cent and 13.6 +/- 9.5 per cent, while plasmapheretic clearance reached, respectively, 13.0 +/- 10.7 per cent of the systemic clearance for paracetamol and 23.0 +/- 1.0 per cent for diclofenac.

Acetaminophen↗
PubMedDate not supplied

[Circulating anticoagulants excluding hemophilia. Multicenter survey undertaken under the aegis of the French National Society of Internal Medicine apropos of 207 cases].

A retrospective multicentre study, undertaken under the aegis of the French National Society of Internal Medicine, involved 200 subjects with acquired circulating anticoagulants; 130 were female and 77 were male; mean age was 45 +/- 23 years (range: 10 months to 80 years). Mean duration of follow-up was 23 months. In 130 subjects the anticoagulants were detected as a result of a systematic screening examination. The main overt clinical manifestations were haemorrhages, venous or arterial thrombosis and spontaneous abortion. Typing of the anticoagulant, performed in 166 cases, showed the presence of an antiprothrombinase in 141; this enzyme is not responsible for severe bleeding unless it is associated with other disorders of coagulation; less frequent were an anti-factor VIIIc (n = 16) and an anti-factor V (n = 2) anticoagulants. An underlying pathology was found in 172 subjects, including systemic lupus erythematosus (n = 60), induced lupus (n = 11), discoid lupus (n = 3), infection (n = 23), blood disease (n = 19), cancer (n = 15) and vasculitis (n = 15); other factors were pregnancy (n = 5) and medicines (n = 6). The anticoagulant disappeared spontaneously in 10 cases and in 33 of the 115 subjects treated. In subjects with lupus and in children under twelve years of age, an antiprothrombinase was regularly identified at typing.

Adolescent↗
PubMedDate not supplied

Pharmacokinetics of cyclophosphamide (CP) and 4-OH-CP/aldophosphamide in systemic vasculitis.

Cyclophosphamide given in association with corticosteroids has markedly improved the prognosis of systemic vasculitis. Little information has been reported on cyclophosphamide pharmacokinetics in these diseases and data evaluating its metabolite, 4-hydroxycyclophosphamide/aldophosphamide, pharmacokinetics and concentrations are lacking. Cyclophosphamide was administered as a 1-h intravenous infusion every 3 weeks for six cycles to ten vasculitis patients. Serum cyclophosphamide and 4-hydroxycyclophosphamide/aldophosphamide concentrations were assayed on the first cycle of the treatment by reversed-phase high-pressure liquid chromatography with ultraviolet detection. The mean (+/- SD) 4-hydroxycyclophosphamide/aldophosphamide and cyclophosphamide areas under the serum concentration-time curves were, respectively, 1.86 +/- 1.12 and 154.1 +/- 62.7 mg/L x h with a ratio of 1.30 +/- 0.76%. The mean maximum serum 4-hydroxycyclophosphamide/aldophosphamide was reached 2.3 h after cyclophosphamide administration. The mean (+/- SD) cyclophosphamide and 4-hydroxycyclophosphamide/aldophosphamide half-lives were, respectively, 5.5 +/- 3.1 and 7.6 +/- 2.3 h. The results are consistent with those obtained for cancer patients, in spite of a wide interpatient variability of concentrations and pharmacokinetic parameters.

Adult↗
PubMedDate not supplied

Clinical pharmacokinetics during plasma exchange.

Drug removal during plasma exchange (PE) is a complex phenomenon that is defined by the molecule pharmacokinetic characteristics. Plasma-protein binding and the volume of distribution (Vd) are two kinetic parameters that strongly affect the efficiency of drug removal by PE. The effect of PE on drug kinetics has been specifically studied with antivirals, cardiotonic agents, antibiotics, corticosteroids, antalgics, anti-epileptic agents and non-steroidal anti-inflammatory drugs. This effect can be evaluated using different parameters: extracorporeal clearance, half-life, amount eliminated, and fraction of the drug removed. The estimated fraction eliminated (Fe) from the body by PE is the best parameter to evaluate the effectiveness of the exchange procedure; it can account for 0.5-30 per cent. Results reported in the literature showed that PE most influences drugs with a low Vd, regardless of the extent of protein binding. We established that, during PE, there is a linear relationship between Fe and the fraction of the drug in extracellular fluids. The fraction eliminated during PE is approximately one-seventh of the fraction of the drug in extracellular fluids. We propose to use this extracellular fraction as a predictive index: when < 20, extraction is low; the amount eliminated becomes consequential only when the index > 20. Dosage supplementation may be needed to maintain an adequate drug concentration in the body. Practically, for drugs with a low Vd (< 0.3 l/kg), it seems necessary to adjust the dosage.

Algorithms↗