Search PubMed⌕ Search

Biomedical subjects

L Guillevin

Publications and source records attributed to L Guillevin.

At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

Comparison of cell-ELISA, flow cytometry and Western blotting for the detection of antiendothelial cell antibodies.

OBJECTIVE: There is still great uncertainty in the detection of antiendothelial cell antibodies (AECA). The aim of our study was to compare the results obtained using different methods. METHODS: Sera were obtained from 71 patients with a variety of vasculitides. Three assay methods were used: cell ELISA, flow cytometry (FACS) and Western blot (WB). RESULTS: In the ELISA 12/17 patients with systemic lupus erythematosus (SLE), 1/12 with Churg Strauss (CS) disease, 3/12 with micropolyarteritis (MPA) and 5/30 with Wegener's granulomatosis (WG) tested positive. Most of the sera that were positive on ELISA were not by FACS. Among the negative sera, 50% of WG, 40% of MPA, 20% of CS and 40% of SLE became positive on WB. There were some specific patterns of reactivity for a given disease, so that some bands could be assigned to a disease. CONCLUSION: The discrepancies in the results may most probably be accounted for by differences between the antigenic preparations. Caution must thus be exercised when interpreting the results of any of these three tests.

Arteritis↗
PubMedDate not supplied

Skin manifestations in vasculitis and erythema nodosum.

Cutaneous lesions are frequent in medium-sized and small vessel systemic vasculitides. The classic cutaneous manifestation of vasculitis is palpable purpura; however the clinical manifestations greatly depend on the size of the vessels affected. They usually do not affect prognosis but relapsing or intractable forms have been described. When skin manifestations are only one of the clinical signs of vasculitis, treatment with corticosteroids and, when indicated, an immunosuppressant, is mandatory, which usually leads to the rapid disappearance of cutaneous lesions. Conversely, when skin lesions are isolated, the diagnosis can be more challenging, but initial treatment may be less aggressive, e.g., dapsone or colchicine, reserving corticosteroids only for those patients in whom the former are ineffective. Erythema nodosum (EN) is the most frequent septal panniculitis. In general it is characterized by the sudden eruption of one or more erythematous and tender nodules or plaques located mainly over the extensor sides of lower extremities. EN resolves with complete "restitutio ad integrum" of the skin in 3-6 weeks. Relapses are uncommon but in patients with idiophatic, streptococcal or EN associated with other upper respiratory tract infections they are more frequent. The main treatment of EN is that of the underlying associated conditions, if demonstrated. Aspirin and other NSAIDs in full doses are often sufficient.

Cryoglobulinemia↗
PubMedDate not supplied

Vasculitides secondary to infections.

Many viruses can be responsible for systemic vasculitis, the most frequent being hepatitis B virus-related polyarteritis nodosa (HBV-PAN), even though its incidence has decreased over the past few decades. Mixed cryoglobulinemia has been shown to be associated with hepatitis C virus (HCV) infection in more than 80% of the patients, but it remains asymptomatic in most of them with only a minority developing vasculitis. Human immunodeficiency virus (HIV), erythrovirus B19, cytomegalovirus, varicella-zoster virus and human T-cell lymphotropic virus (HTLV)-1 have also been reported to be associated with or implicated in the development of vasculitides. On the other hand, some bacteria, fungi or parasites can also cause vasculitis, mainly by direct invasion of blood vessels or septic embolization, leading, e.g., to the well-known feature of 'mycotic aneurysm'. Syphilitic aortitis and/or cerebrovascular disease and rickettsial diseases are other, more specific, bacteria-induced vasculitides. Recognizing an infectious origin of vasculitides is of great importance because treatment strategies differ from those applied to non-infectious forms. Effective antimicrobial drugs are mandatory to treat bacterial, parasitic or fungal infections, while the combination of antiviral agents and plasma exchanges has been proven to be effective against HBV-PAN. This latter strategy might also be effective against HIV-associated vasculitis and, unlike cytotoxic agents, does not jeopardize the outcome of HIV-infected patients. In the context of HCV-related cryoglobulinemic vasculitis, antiviral drugs are necessary to achieve recovery, in combination with low-dose corticosteroids and/or rituximab. In the near future, newer antiviral agents will probably also have their place in the therapeutic armamentarium for these patients.

Anti-Infective Agents↗
PubMedDate not supplied

Hepatitis C virus in patients with polyarteritis nodosa. Prevalence in 38 patients.

In order to assess the prevalence of hepatitis C virus (HCV) in polyarteritis nodosa (PN), 38 patients with systemic necrotizing angiitis were retrospectively tested for the presence of anti-HCV antibodies (Ab). Twenty-one patients were hepatitis B virus (HBV) positive, comprising group A, and 17 were HBV negative, comprising group B. Two patients from group A had anti-HCV Ab (2/21: 9.5%). One was treated unsuccessfully with corticosteroids, then with vidarabine and plasma exchanges; HBe/anti-HBe seroconversion was not observed and anti-HCV Ab disappeared 8 months after the onset of PN. The second patient was successfully treated with corticosteroids, then vidarabine and plasma exchanges; he recovered from PN, HBV seroconversion occurred, and the anti HCV Ab remained detectable. These results show that: 1) the prevalence of anti HCV Ab in PN related to HBV is nearly the same (9.5%) as the prevalence of HCV Ab observed in patients with chronic hepatitis related to HBV infection; 2) the course of these two viral infections can be different and the role of HCV as an etiologic factor in PN has not been established.

Adult↗
PubMedDate not supplied

[Extraction of drugs in plasma exchange].

Plasma exchange has been proposed for treating diseases mediated by circulating immune complexes. Removal of drugs during plasma exchange is a complex function of pharmacokinetic characteristics and specifications of the plasma exchange procedure: the time of plasma exchange, the filtered volume of plasma, the number of procedure. The effect of plasma exchange on the kinetics of drugs can be evaluated by different parameters: amount eliminated, extracorporeal clearance, fractional drug removal, extracorporeal elimination rate constant. Knowledge of the impact of plasma on the elimination of drugs is essential to the design of the dosage regimen in patients treated with plasma exchange. The fraction of the estimated amount in body removed by plasma exchange is the best parameter to evaluate the effectiveness of the exchange procedure, but it is necessary to know the proportion of body pool of drug at the start of the plasma exchange. Drug recovery by each exchange may account for 0.5%-30% of the dose. Controlled studies are needed to quantify the effects of plasma exchange on drug therapy. Dosage adjustment is sometimes required.

Humans↗
PubMedDate not supplied

Side effects of therapeutic plasma exchange during treatment of polyarteritis nodosa. Comparison of filtration and centrifugation. 718 sessions in 63 patients.

Between 1981 and 1984, 72 patients (22-75 years) were included in a prospective study for treatment of Polyarteritis Nodosa (PN) which associated therapeutic plasma exchanges (TPE), corticosteroids (CS) 1 mg/kg/day, and a randomized trial of cyclophosphamide (CP) 2 mg/kg/day. We observed the incidence and analysed side effects (SE) occurring during TPE considering the technology of plasma removal. Full data were available for 63 patients. Seven hundred and eighteen TPE were performed. Centrifugation was used in 594 PE (82.7 per cent) with intermittent flow centrifugation (IFC) 320 times (44.5 per cent) and continuous flow centrifugation (CFC) 274 times (38.2 per cent). Filtration (F) was used in 124 sessions (17.3 per cent). Replacement fluid was 4 per cent albumin in 650 TPE and fresh frozen plasma (FFP) in 89 TPE. A total of two hundred and eleven SE were reported in 53 patients (84.1 per cent) during 173 TPE (24.1 per cent). Forty-six TPE were temporarily stopped because of SE (6.4 per cent). The mean volumes of removed plasma (ml/kg/TPE) were: 60.7 +/- 8.7 ml/kg when CFC was used 54.5 +/- 20 ml/kg with F and 52.5 +/- 9.6 ml/kg with IFC (n.s.) Main SE were: technical difficulties in 80 TPE, moderate or severe hypotension in 47, allergy to replacement fluid in 39. Hepatitis B antigen appeared in one patient. No death occurred during TPE and SE were usually minor and transient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Horton's disease. Current problems].

Much that has been written in the last few years concerning temporal arteritis has allowed us to better clarify the clinical picture, and for example frequency of hepatic involvement. The atypical forms of the disease such as those that involves large arteries, or those in which sedimentation rate is normal, are better known. It is in such atypical cases, particularly in a young patient, that an external carotid arteriography is most useful. Though the pathophysiology of the disease is not well understood, serologic and histologic arguments exist in favor of an autoimmune etiology, in which the antigen would be the alestin, found in the internal elastic lamina of the artery. Temporal arteritis is theorically well classified amongst the giant cell granulomatous arterities but there are some atypical forms difficult to distinguish from Takayasu's arteritis or even periarteritis nodosa.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Fatal polyarteritis nodosa following Graves' disease (author's transl)].

Polyarteritis nodosa (PAN), with a fatal outcome, developed during the course of a therapeutically controlled Graves'disease. A review of the published literature confirms that two mechanisms may be involved in the onset of PAN in hyperthyroid patients: an immune response, which is probable in the case reported, or a toxic effect related to the treatment of the hyperthyroidism. This case also emphasizes the therapeutical difficulties encountered, in spite of the corticoid and cyclophosphamide associated treatment with plasmapheresis.

Adolescent↗
PubMedDate not supplied

[Cardiac localizations of lymphomas. A case report and review of the literature (author's transl)].

A case of malignant lymphoma with cardiovascular manifestations is reported. It is a febrile form with compression of the aortic ring provoking a murmur simulating aortic valve disease with an Osler's graft. An analysis of the various complications due to lymphomas reported in the published literature emphasizes the iatrogenic nature of some of them: cardiac toxicity of chemotherapy, post-radiotherapy pericarditis, and increased incidence of coronaritis after both cobalt and radiotherapy. The diagnosis of lymphomas in the cardiac area is difficult but should be evoked in case of febrile and chronic cardiopathy, no other etiology being detectable.

Aged↗
PubMedDate not supplied

[Cardiac manifestations of scleroderma. Prospective study of thirty cases (author's transl)].

A prospective study was conducted to evaluate cardiac effects of scleroderma by means of phonomyography (30 patients) and ultrasound cardiography (18 patients). Clinically silent effusions can be detected by ultrasound cardiography, and 50 p. cent of the patients were found to have pericarditis through this investigative technique. Valvular lesions (mitral prolapsus) were present in a more important number than simply a coincidence. Measurement of myocardial relaxation appears to give the best indication of the specific myocardial lesion in this disease, and even may be of some prognostic value.

Adult↗
PubMedDate not supplied

[Systemic diseases and ulceronecrotic angiodermatitis].

The discovery of ulceronecrotic angiodermititic ulceration should mean that systematic clinical and paraclinical examination is carried out to look for a general cause. During these examinations the search should be for infectious causes on the one hand, and haemoglobinopathy on the other, and an examination of the ganglionic areae and of the spleen should be carried out. The examination might also lead to the discovery of localised or systemic vascularitis: the clinical examination should check for any disintegration of the general state, temperature, signs of neurological, digestive, cardiac, pulmonary localization, etc. The biological examination should show up any signs of inflammation and, eventually, a biopsy of cutaneous elements or of muscle should be able to show vascularitis. Ulceronecrotic angiodermititis should therefore not always be considered as a local pathology but sometimes as an element of systemic affection.

Arteriosclerosis↗
PubMedDate not supplied

[Ureteral manifestations of collagen diseases (author's transl)].

Ureteral lesions are rarely observed during the course of collagen diseases, and when they do occur, are specific localizations of these disorders. Diagnosis is made by intravenous urography. This usually demonstrates uni- or bi-lateral segmentary stenoses that may be calcified, with the lesions being most frequently present in the lumbar region. In rare cases there is dilatation of the "necklace of pearls" type. The stenosis usually increases in severity, especially when corticotherapy is reduced, and resection of the affected ureteral segments may be necessary.

Adolescent↗
PubMedDate not supplied

Persistence of antineutrophil cytoplasmic antibodies (ANCA) in asymptomatic patients with systemic polyarteritis nodosa or Churg-Strauss syndrome: follow-up of 53 patients.

OBJECTIVE: We retrospectively analyzed the significance of persistent ANCA positivity after clinical remission in 53 consecutive patients with histologically and/or angiographically proven polyarteritis nodosa (PAN), or Churg-Strauss syndrome (CSS) followed between 1981 and 1993. METHODS: ANCA were detected using an immunofluorescence assay and ELISA: Each patient met the American College of Rheumatology 1990 criteria for PAN or CSS. Clinical and biological evaluations were always essential factors in the decision to intensify therapy. RESULTS: ANCA were initially present in 15 patients (28.3%): 3/26 (11.5%) with HBV-related PAN, 6/18 (33.3%) with PAN of unknown etiology and 6/9 (66.7%) with CSS. Five patients remained ANCA-positive after clinical remission: 3 with PAN (one of them relapsed) and 2 with CSS who both relapsed. Among the 12 patients who died during follow-up, only 1 (8.3%) was initially ANCA-positive. Fifteen of the 41 survivors (29.2%) were ANCA-positive. CONCLUSION: Persistence of ANCA positivity in PAN and CSS may be a marker of an underlying disease process, but does not adequately reflect disease activity and, thus, in no case should be the only indication for therapeutic intensification.

Aged↗