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Biomedical subjects

M David

Publications and source records attributed to M David.

At least 469 records · Page 26Linked to original sources
PubMed1988

The course and prognosis of pemphigus. A review of 115 patients.

A survey of 115 pemphigus patients who have been followed for 4-24 years was carried out in an attempt to analyze the possible factors influencing the course and prognosis of the disease. At the time of the study, 45 patients were in complete remission, 45 still had lesions, and 25 had died. In 12 cases, the death occurred from causes related to the disease or consequences of treatment. The comprehensive statistical analysis revealed that a good prognosis may be expected for patients who, in the initial stage of the disease, show involvement of the skin only (p less than 0.05) and when systemic steroid therapy is instituted within half a year of appearance of the disease (p less than 0.05). There were no significant differences in the rate of recovery and mortality between the different groups of patients in regard to the initial dose of prednisone. A daily dose of 120 mg of prednisone was sufficient to control the lesions in most of the severe cases and less contributory to death in comparison with previous studies.

Adult↗
PubMed1988

Effects of human chorionic gonadotropin, androgens, adrenocorticotropin hormone, dexamethasone and hyperprolactinemia on plasma sex steroid-binding protein.

This presentation reports the effects of androgens, glucocorticoids and some pituitary hormones on plasma sex steroid-binding protein (SBP). The latter was measured by a solid phase method after desteroidation of the plasma. An hCG test (1500 I.U. every other day X 7) was given to 60 boys. In the children with a normal testosterone (T) rise, plasma SBP decreased (% of basal values) either significantly (38.3 +/- 9.3%, group A; n = 29), or moderately (13.4 +/- 4.4%, group B; n = 9) or did not change (-1.6 +/- 6.4%, group C; n = 10). In the 3 infants tested at an age when SBP normally rise sharply, hCG partially prevented this rise. The administration of either fluoxymesterone (10 mg/m2 for 10 days) or depot-T (4 I.M. injections of 100 mg/m2 every 2 weeks) induced a significant drop (about 2-fold) in plasma SBP in a control group of infants or children, but did not change SBP in 3 infants with the androgen insensitivity syndrome. A single injection of 0.25 mg of ACTH did not significantly alter SBP levels. In contrast, at the end of a 3-day ACTH test (0.5 mg/m2 12 hourly X 6) SBP levels had significantly decreased (mean 35% fall) with no age or sex differences, and with no correlation with the cortisol levels reached. However, the lowering effect of ACTH on SBP levels is likely mediated by glucocorticoids, since its effect was reproduced by high doses (8 mg/day for 3 days) of dexamethasone given at once or after 3 days of treatment at lower dose (20 micrograms/kg BW). It would appear that the depressive effect of ACTH and/or dexamethasone is observed for a threshold dose of glucocorticoids (greater than 5-fold physiological levels) and a certain time (greater than or equal to 3 days) of exposure. The mechanism by which androgens and glucocorticoids lower SBP levels in vivo is not yet understood. From recent experiments, showing that both stimulate the secretion of SBP in hepatoma cells in vitro, it would appear that both hormones may alter SBP metabolism. In a selected population of hyperprolactinemic women, with normal weight and no hirsutism, plasma SBP levels were found in the normal female range. The discrepancy with previous studies in the literature may be explained by differences in the degree of hyperprolactinemia and/or associated hyperandrogenim. This study further documents the multifactorial and intricated hormonal influences involved in the regulation of plasma SBP in vivo.

Adrenocorticotropic Hormone↗
PubMed1988

Undescended testis: comparison of two protocols of treatment with human chorionic gonadotropin. Effect on testicular descent and hormonal response.

A randomized study of two protocols of human chorionic gonadotropin (hCG) treatment was performed in 183 prepubertal boys between 7 months and 12 years of age: protocol I, in which the boys were given 7 injections of 1,500 IU every other day, and protocol II consisting of 4 injections of 100 IU/kg at 4- to 5-day intervals. In both protocols, by the end of the test, testosterone had risen significantly to values within the normal adult male range. However, the amplitude of the rise was slightly but significantly lower using protocol II (4.08 +/- 2.07 ng/ml) than protocol I (5.16 +/- 2.73 ng/ml). It would thus appear that repetition of the hCG injection at intervals of less than 4 days is unnecessary, and that a total stimulation period of 2-3 weeks is sufficient. Although not correlated with testosterone levels, the success rates for treatment were similar in both protocols and comparable to rates reported in the literature.

Adolescent↗
PubMed1988

15-year survey of tinea faciei in the adult.

In a series of 100 adults with tinea faciei various dermatologic manifestations were mimicked, viz.: discoid lupus erythematosus in 52 patients, lymphocytic infiltration in 15, seborrheic dermatitis in 11, rosacea in 8, contacts dermatitis in 7, polymorphous light eruption in 4 and granuloma faciale in 3. Trichophyton rubrum was isolated in 78% of the respective cases, other isolated organisms being Microsporum canis (13 cases), Trichophyton violaceum in 6, Trichophyton mentagrophytes (asteroides) in 2 and Epidermophyton floccosum in 1 case. In 85% of these patients the nails were also involved by the same agent found in the lesions of the face. On the basis of these observations it is recommended that all adult patients with tinea faciei should undergo a comprehensive mycological investigation to find the primary focus, which may be an infected nail.

Adult↗
PubMed1988

Juvenile pemphigus vulgaris: a 4- to 19-year follow-up of 4 patients.

Juvenile pemphigus (JP) is a rare disease. Of 274 pemphigus patients who were under our care during the last 26 years, 4 (1.4%) were in the JP category. The course and prognosis of the disease in the 4 patients who have been followed for 4-19 years are presented. Two patients are still in complete remission and off treatment for 4 and 6 years. In view of the literature and our experience, it appears that the clinical manifestations and course of JP are variable, similar to adult pemphigus. However, it seems that JP has a favorable prognosis quoad vitam.

Adolescent↗
PubMed1988

[A randomized study comparing cisplatin alone or combined in the palliative treatment of carcinoma of the head and neck. Analysis of a series of 209 patients].

Two hundred and nine patients, with locoregional or metastatic recurrences of head and neck epidermoid carcinoma, were randomized to receive a palliative chemotherapy. The chemotherapy regimens were delivered every 3 weeks, and consisted in (1) cisplatin, 80 mg/m2 given alone (CDDP regimen), or (2) in combination with vincristine, 1 mg, methotrexate 10 mg/m2 d 1, 2, 3, and bleomycin 10 mg/m2, d 1, 2 and 3 (1040 regimen). Short-term results were better for patients treated by the 1040 regimen, with a 30% response rate (including 4 complete responses) vs 15% with the CDDP regimen (P = 0.01). A superiority of combination chemotherapy was found for all tumoral sites, but was particularly significant for pulmonary and cutaneous metastases, in previously un irradiated areas (P = 0.001). Tolerance was significantly better with the CDDP regimen (P = 0.001); severe side effects, affecting mainly general status, digestive tract and bone marrow were encountered in 5% of the patients in the CDDP group, vs 21% in the 1040 group, with one death related to pancytopenia. The median duration of remissions was not statistically different in the 2 groups, as well as the 2 years overall survival. Among responders, the survival was slightly better in those treated with CDDP alone; moreover, the quality of long term results was found highly correlated with a good initial general status, and with low levels of side effects. Those results confirm recent data of the literature, and lead to the following conclusions: (1) combination chemotherapy with CDDP give a better response rate than CDDP alone, (2) response rate doesn't influence overall duration of survival, (3) tolerance to treatment is crucial to preserve quality of life, and thus, (4) palliative chemotherapy in head and neck cancer should be efficient but also as short of intensity as possible.

Actuarial Analysis↗
PubMed1988

[Randomized trial of initial chemotherapy with cisplatin alone or in combination in 241 advanced carcinomas of the upper respiratory and digestive tract].

Two hundred and forty-one patients, with advanced squamous cell carcinoma of head and neck, were randomized to receive three courses of induction chemotherapy. The chemotherapy regimens were delivered every 3 weeks, and consisted in 1) cisplatin, 80 mg/m2 given alone (CDDP regimen), or 2) in combination with vincristine, 1 mg, d 1, methotrexate 10 mg/m2 d 1, 2, 3, and bleomycin 10 mg/m2, d 1, 2, and 3 (MOB-P). Tolerance was significantly better with the CDDP regimen (p less than 0.05); severe side effects, affecting mainly digestive tract, and bone marrow, were encountered in 7% of the patients in the CDDP group, vs 15% in the MOB-P group, without death related to pancytopenia. Short-term results were better for patients treated by the MOB-P regimen, with a 42% response rate (including 9 complete responses) vs 22% with the CDDP regimen (p = 0.01). A superiority of combination chemotherapy was more significant for primary sites than regional lymph nodes. The relapse-free survival was not statistically different in the 2 groups, as well as the 2 years overall survival. Among responders, the survival was found highly correlated with a good initial general status (p less than 0.01), and with the highest total doses of cisplatin (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1988

[Pemphigus herpetiformis following D-penicillamine in a patient with HLA B8].

A 57-year-old patient with rheumatoid arthritis, who was being treated with D-penicillamine, developed a bullous eruption 2 months after the onset of treatment. On the basis of the clinical, histological and immunofluorescent findings, the diagnosis of herpetiform pemphigus was made. The eruptions disappeared within 2 weeks after the discontinuation of D-penicillamine treatment. During the 16-month follow-up period there was no recurrence. It is noteworthy that a patch test with potassium iodide was positive and that testing for HLA antigens revealed HLA B8, A1, A2, and BW39.

Arthritis, Rheumatoid↗
PubMed1988

New retinoids for dermatologic diseases. Uses and toxicity.

Systemic administration of retinoids is frequently associated with mucocutaneous side effects, liver toxicity, and abnormalities of the serum lipid profile. Currently, the main factors limiting more common use of retinoids are their teratogenicity and chronic bone toxicity. Treatment with retinoids requires appropriate selection of patients, careful periodic monitoring of the clinical response, and appropriate laboratory tests. Careful therapeutic management is necessary in order to prevent or minimize side effects.

Acne Vulgaris↗
PubMed1988

[An intercenter study of the validity of nutritional evaluation].

Malnutrition is one of the most frequent consequences of neoplastic disease. During specific therapies, in order to improve the quality of life of cancer patients, it is necessary to correct their bad nutritional status, allowing thus a better quality of response to the treatment and a better survival. Therefore, it may be needful to realize repetitive nutritional evaluations. The authors have tested the validity of a nutritional assessment in patients with head and neck cancer undergoing radiotherapy, and known to have a progressive impairment of pre-existent nutritional alterations during this therapy. Results show the interest of ponderal curve and serum prealbumin level monitoring, associated with a quantified evaluation of alimentary practice of the patients ("Nutritional Status Index") during cancer therapy. Those investigations are cheap and easy to realize, and could be done often and regularly, giving thus essential data for nutritional status evaluation; the consequence is the possibility of improving the correction of malnutrition.

Adult↗
PubMed1988

[Attempt at in vitro decalcification of aortic valves using various types of lasers].

The effects of three types of laser were studied in vitro on calcified aortic valves removed in the course of valve replacement. These were: 1) argon laser; 2) Nd-YAG laser with a long (1 ms) impulse, and 3) Nd-YAG laser with a short (10 ns) impulse. With the first two types of laser, lesions of carbonization and fragments detached from the areas treated were observed. With the 10 ns ND-YAG laser, a mean energy of 100 mj per shot excavated the calcified valves by drilling holes that were 0.5 to 1.5 mm in diameter and had clear-cut non carbonized borders. No residue was found during the procedure: the substance was simply vaporized. The splitting of several calcareous nodules on a valve made it more pliable. If it were possible to transfer this high peak energy onto a flexible optic fibre, the aortic valves could be decalcified by interventional catheterization.

Calcinosis↗
PubMed1988

[Muscle metastases: ultrasonic and x-ray computerized tomographic aspects. Apropos of 9 cases].

Clinical, ultrasound and CT scan examinations were carried out in 9 patients with secondary muscle lesions. All muscles can be affected but there was a marked predominance of psoas lesions (6 of the 9 cases). Two contrasting clinical pictures are seen. Secondary muscle tumors can occur during evolution of a known treated cancer (5 of the 9 cases), revealed usually by large, rarely painful, mass. CT scan imaging shows a heterogeneous mass taking up contrast and often partially necrotic, the lesions appearing hypoechogenic or heterogeneous on ultrasound examination. Certain lesions can be totally necrotic. In some cases (4 of the 9 patients) the muscle metastases revealed the presence of a tumor. Symptomatology may be atypical and lead to a delay in diagnosis. Fine needle puncture biopsy can detect the secondary origin of the muscle lesion and also the primary tumor site (4 out of 9 cases), bronchopulmonary and colon cancer predominating. Images are however non-specific and in the absence of NMR imaging the muscle or lymph node metastases can be confused, although this has no practice consequences since treatment is identical.

Adult↗