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Biomedical subjects

P Bourgeois

Publications and source records attributed to P Bourgeois.

At least 145 records · Page 8Linked to original sources
PubMed1990

Comparison of long term evolution of adult onset and juvenile onset Still's disease, both followed up for more than 10 years.

Still's disease is a clinical entity of unknown origin, which can appear before 15 years of age (juvenile onset Still's disease) or later (adult onset Still's disease). There are few reported data about the long term prognosis of Still's disease and no study compares the long term evolution of adult onset and juvenile onset Still's disease. Eighteen patients fulfilling the American Rheumatism Association criteria for Still's disease were followed up for more than 10 years. Ten (group 1) had juvenile onset Still's disease and eight (group 2) adult onset Still's disease. A comparison of the groups showed no significant differences in the initial systemic manifestations of Still's disease, or in the joint lesions. Both groups had severe sequelae, which appeared between six and 10 years after the initial flare up of Still's disease. Nine patients had articular damage and nine had only arthritis without apparent x ray abnormalities. Nine patients had bilateral hip destruction in less than four years. Of these nine, seven required 13 total hip replacements before the age of 45. In the whole group of 18 patients bilateral involvement of the following joints was also seen: carpus (seven patients), knee (four), tarsus (four), ankle (three); three patients had ankylosis of the cervical spine. The occurrence of amyloidosis (three cases, two deaths) was restricted to group 2. This was the only difference between the groups, as the treatments were identical. It is concluded that the articular prognosis of Still's disease is poor, be it adult onset or juvenile onset, with severe joint destruction in half of the patients.

Adult↗
PubMed1990

Longitudinal immunoblotting variations of auto-antibody reactivity of patients with systemic lupus erythematosus.

The purpose of this study was to examine longitudinally the different patterns of nuclear and cytoplasmic antigen recognition by sera from patients with SLE during clinical flare and remission using immunoblotting (IB) techniques. Serum samples (n = 150) were obtained from 35 SLE patients during a follow-up period averaging 4.7 years. Three patients (10 sera) were in complete remission: the IB pattern of these 3 patients remained unchanged; 32 SLE patients experienced one or more clinical flares: in 5 cases (20 sera) the IB analysis showed no detectable antibody. The following dominant IB patterns were seen in the remaining 27 active SLE patients: anti-Sm (n = 7), anti-Sm/RNP (n = 7), anti-SS-B and/or anti-Ro (n = 6), anti-histones (n = 5), anti-70 Kd (unidentified) (n = 2). No IB pattern was able to differentiate mild forms of SLE from severe cases. In 9 of 21 clinical flares, the serum IB pattern was not different from that of the patient's serum drawn during remission (3 severe and 6 mild flares). Diversity of the antibodies increased in 7 cases (5 severe, 2 mild flares); and a shift from one pattern to another was observed 5 times (2 severe, 3 mild flares). Twenty three subsequent remissions were studied: in 14 cases the IB profile was unmodified (5 severe, 9 mild SLE), and the diversity of the antibody narrowed in 4 cases (2 severe, 2 mild SLE). The IB pattern shifted from one pattern to another (2 severe, 4 mild SLE) in 5 instances.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Profile of antinuclear antibodies in 14 cases of extinct systemic lupus erythematosus for more than 3 years].

In order to study the profile of antinuclear antibodies (ANA) and anticytoplasm in the clinical recovery period, we searched for ANA by 4 methods (indirect immunofluorescence on HEp-2 and Crithidia luciliae cells, double diffusion in agar against veal thymus and human spleen, immunoprint with a total extract of HeLa cells) in 14 patients with SLE extinct since more than 3 years. The population under study consisted of 12 women and 2 men, aged 43 years on average at the time of study (extremes: 28-64 years). The average lapse of time between the diagnosis of SLE and date of sampling is of 12.6 years (extremes: 3-22 years). The average remission/clinical recovery time during the study is of 8.9 years (extremes: 3-22 years). Seven patients were administered mild corticotherapy (average dose of prednisone: 4.7 mg/day). All the sera preserved ANA or anticytoplasm, distributed in the following way: presence of antinucleus: 10/14 (71.5%); average titre 40; speckled aspect: 10/10; presence of anti-DNA: 0/14; presence of anti-ECT: 2/14 (14.3%): anti-SSB 1 case, anti-RNP 1 case; positive immunoprint: 12/14 (85.7%): anti-Sm 5 cases (isolated or associated), isolated anti-SSB 2 cases; isolated anti-Ro 2 cases; various unidentified 3 cases. These results suggest that the production of ANA and anticytoplasm other than anti-DNA continues during the period of clinical extinction of SLE, underlining the rarity of a complete biological recovery and the necessity of long term clinical surveillance.

Adult↗
PubMed1990

[Have lupus characteristics changed?].

The features of lupus have been changing for 30 years. The aim of this study was to determine the main modifications and to search for the possible causes. Lupus epidemiology, the clinical symptoms and the prognostic subsets were investigated. The rising incidence of lupus closely paralleled improvements in diagnostic techniques (LE cell testing, anti-nuclear antibodies) but has since remained stable. The prevalence progressively increased over this time, but this evolution is associated with better detection of benign subsets and improvement in the management of the disease and its complications. More sensitive serological methods have attributed new symptoms to lupus, revealing that some forms are benign. Survival has been improving and infection has become the primary cause of death. Opportunistic infections in lupus are increasing, however the majority of them remain undiagnosed until the autopsy.

Humans↗
PubMed1990

[Analysis of prognostic factors in cervicofacial carcinology using the Cox model. An example of piriform sinus cancer].

Analysis of prognosis factors was performed on a surgical series of 34 of piriform sinus cancer, based on the use of a multivariate study according to the Cox model. The presentation is essentially didactic emphasizing the main points: how to collect data, what data to collect, and what judgment criterion to use. The authors detail the interpretation to be drawn from the analysis results using Cox model.

Aged↗
PubMed1989

Myasthenic syndrome caused by direct effect of chloroquine on neuromuscular junction.

Chloroquine induced a myasthenic syndrome in a patient taking the drug for presumable reticular erythematous mucinosis. Clinical features and results of single-fiber electromyography were typical for a failure of neuromuscular transmission, while peripheral nerves and muscles were intact on clinical, biochemical, electrophysiologic, and pathologic investigation. The time course of the clinical and electrophysiologic findings during provocation with chloroquine and the absence of autoantibodies indicate that the syndrome was due to a direct effect of the drug on the neuromuscular junction. While not taking chloroquine, the patient showed a decremental response on a modified double-step nerve stimulation test and a mean consecutive difference on single-fiber electromyography that was at the upper limit of normal, indicating a subclinical impairment of neuromuscular transmission. These findings can explain the apparent rarity of the syndrome described, as a direct effect of chloroquine on the neuromuscular junction may only have clinical relevance in patients with a reduced neuromuscular safety factor.

Adult↗
PubMed1989

Genetic analysis of CR1 expression on erythrocytes of patients with systemic lupus erythematosus.

The role of genetic factors in decreased expression of CR1 in patients with systemic lupus erythematosus (SLE) was investigated by assessing the frequency of genotypes determining the numbers of CR1 on erythrocytes obtained from 52 patients with SLE and from 84 normal individuals. The expression of CR1 was quantitated using flow cytometry. Genotypes were determined by analyzing the CR1 gene restriction fragment length polymorphism using the CR1.1 complementary DNA probe and the Hind III restriction enzyme. In normal subjects, the distribution of the HH, HL, and LL genotypes fit the Hardy-Weinberg law. The frequency for the H allele did not differ between the 2 groups. No individual homozygous for the LL genotypes was found among the SLE patient population. Taken together, data from this and previous studies indicate an under-representation of the LL homozygous genotype in patients with SLE. SLE patients expressed decreased numbers of CR1 per erythrocyte within each genotype compared with these numbers in normal subjects. The results suggest that defective expression of CR1 in SLE patients is acquired and that the presence of the L allele is not linked to a genetic susceptibility for SLE.

Alleles↗
PubMed1989

Adenocarcinoma and wood.

The relation of adenocarcinoma of the facial sinuses and exposure to wood dust has been recognized for 20 years. As the tracheobronchial mucosa is similar to that lining the sinuses, a link between bronchial adenocarcinoma and wood dust exposure has been postulated. To test this hypothesis, a case-control study was conducted, based on all the histologically proven cases of adenocarcinoma of the lung reported to the tumor registry of the Doubs region of France from 1978 to 1985 and random population controls matched for age and residence. A questionnaire on occupational exposure and tobacco consumption was completed by 53 cases and 160 controls. Exposure to wood was similar for both groups, the crude relative risk (odds ratio) being 1.06; adjustment for tobacco consumption did not modify this value. Exposure to wood dust does not seem to be an occupational risk factor in the genesis of bronchial adenocarcinoma.

Adenocarcinoma↗
PubMed1989

Bone marrow scintigraphy in breast cancer.

Bone marrow scintigrams (BMS) have been performed in 101 women with histologically proven breast cancer (36 stage IV among them at the time of the first investigation, follow-up examinations available in 41, disease evolution observed in 17). They have been compared to conventional bone scintigram (CBS) as well as to radiological, clinical, biological and follow-up data obtained in the same patients. Only three (7.4%) out of the 41 patients with radiologically or/and histologically proven skeletal metastasis had normal BMS and 33 had corresponding bone marrow scintigraphic defects (BMS ++). On the other hand, only three patients of the 32 with normal BMS had documented skeletal abnormalities. Abnormal bone marrow extension, observed in 61.4% of the patients (62/101), seems to represent a reaction of the reticulo-endothelial system to the disease dissemination - even microscopic - and, as such, to have prognostic implications. As BMS demonstrated skeletal invasion earlier or more precisely than CBS in ten cases, the technique appears of value and of interest in breast cancer management.

Adult↗
PubMed1989

Anti-Scl-70 antibodies detected by immunoblotting in progressive systemic sclerosis: specificity and clinical correlations.

One hundred and forty five serum samples from patients with a connective tissue disease and 30 serum samples from healthy blood donors were analysed by immunoblotting. The presence of anti-Scl-70, which seems to discriminate between progressive systemic sclerosis (PSS) and the CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) syndrome, was found in 31/64 (48%) patients with PSS, in 6/55 (11%) patients with systemic lupus erythematosus, in 2/26 (8%) patients with mixed connective tissue disease, and in none of 30 healthy blood donors. These data resulted in a specificity of 93% for this antibody in systemic sclerosis. For patients with PSS the duration of disease was significantly shorter in those with anti-Scl-70 antibodies than in those without, whereas the presence of anti-Scl-70 did not correlate with severity of disease. An 82% prevalence of anticentromere antibodies in patients with the CREST variant compared with a 4% prevalence in patients with PSS or with overlap syndrome confirms the high diagnostic value of this autoantibody for the CREST variant of PSS.

Aged↗
PubMed1989

Immunoblotting profiles in 55 systemic lupus erythematosus sera lacking precipitating antibodies to extractable nuclear antigens.

Serum samples from 55 patients with systemic lupus erythematosus (SLE) were selected for the absence of anti-extractable nuclear antigen antibodies after routine immunodiffusion tests. These sera were immunoblotted for anti-Sm and anti-RNP antibodies on a HeLa cell nuclear extract. Ten (18%) were negative and 45 (82%) produced complex patterns: 10 (18%) suggestive of anti-Sm, three (5%) anti-RNP, and 32 (58%) a combination of anti-Sm and anti-RNP antibodies. These data were very similar to those obtained from sera from a control group of 28 SLE sera selected for positivity of anti-Sm and anti-RNP precipitins with the immunodiffusion test. IgM isotype antibodies to the D peptide were significantly more prevalent than IgG isotype antibodies, whereas antibodies to the 68 kD polypeptide were of both IgM and IgG isotypes. Sera with an anti-Sm/RNP immunoblotting pattern stemmed from a group of patients with SLE with a higher titre of anti-dsDNA antibodies. Among clinical symptoms, the incidence of haemolytic anaemia was higher in the group of patients with the anti-Sm immunoblotting profile. Patients with an anti-RNP immunoblotting profile showed a higher incidence of cutaneous symptoms. It is concluded that immunoblotting for anti-Sm or anti-RNP antibody determination is a very sensitive diagnostic tool in patients with SLE.

Adult↗
PubMed1989

The contribution of 99mTc-pyrophosphate tomoscintigraphy in the evaluation of necrotic myocardial lesions.

Diagnostic contribution of Conventional Planar Scintigraphy (CPSc) and Single Photon Emission Computed Tomoscintigraphy (SPECT), using 99mTc-Pyrophosphate (99mTc-PYP), have been compared in 49 patients with either transmural (T.I., N = 40), or non-transmural (N.T.I., N = 9) infarction. Sensitivity ratios were, respectively for CPSc and SPECT, 75% and 100% in T.I., 78% and 88% in N.T.I. CPSc was non-diagnostic in 6 out of 49 patients, SPECT in only 1. Extent of the necrotizing process was better delineated on SPECT studies than on CPSc. Specificity of 99mTc-PYP tomoscintigraphy evaluated in a group of 6 young (under 40 years old) normal patients was 6/6 (100%). In nine out of ten additional patients without proven infarction who had underwent contrast coronarography within two weeks after a positive 99mTc-PYP SPECT study, significant stenosis (greater than 50%) were found on arteries supplying blood to pathologic territories as demonstrated on tomoscans. It is concluded that 99mTc-PYP SPECT is a very sensitive and specific way--better than CPSc--in the diagnosis as well as in the evaluation of the extent of necrotic myocardial process.

Aged↗
PubMed1989

Axillary dissection in breast cancer revisited.

The pathological status of the axillary nodes remains the single most determining factor for survival, local recurrence and disease-free interval in operable breast cancer. Radical axillary dissection results in better local control with or without systemic disease in all operable cases. In pathologically negative cases, radical axillary dissection decreases local recurrence rates and perhaps prolongs disease-free survival. In pathologically positive cases, radical axillary dissection improves local control only. Radical axillary dissection avoids axillary irradiation and so decreases the risk and the importance of lymphoedema. Perfect axillary dissection does not show a decisive advantage over less complete axillary dissection when the 'quality' of surgery is measured by lymphoscintigraphy, but it should be kept in mind that only total control of the local situation can ensure a patient free of distal spread at the time of first therapy.

Axilla↗
PubMed1989

[Antinuclear and anticytoplasmic antibodies in 24 cases of dermatomyositis. Value of western blotting].

Antinuclear and anticytoplasmic antibodies were detected, using 4 methods, in 96% of the sera (23/24) from 24 dermato- or polymyositis patients, who were followed in the Rheumatology Department. Immunofluorescent (IF) labeling of Hep-2 cell smears was more sensitive than IF staining of liver sections (72 vs 67%), and the patterns observed were in agreement 20/24 times. Gelose precipitation is even less sensitive (29%), but enables a characterization of the antigens recognized: 3 anti-RNP, 3 anti-J01, 1 anti-PMScl, 1 anti-SSB and 1 anti-Ro; the latter two specificities were associated with a sicca syndrome. Western-blotting was the most informative method because it was highly sensitive (79%) and identified the principle antigen-antibody systems: anti-U1-RNP (33%) and anti-Scl70 (33%), both associated with myositis with an overlap syndrome (p less than 0.02); anti-J01 (25%) associated with various forms of myositis; and, more rarely, anti-SSB and anti-Ro (both 4%) when a sicca syndrome was present. Finally, non-identified specificities were observed in 37% of the cases.

Adolescent↗