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Biomedical subjects

P Godeau

Publications and source records attributed to P Godeau.

At least 289 records · Page 16Linked to original sources
PubMed1989

[AL amyloidosis and primary fibrinolysis. Study of the mechanism of fibrinolysis].

A 45 years old woman with AL amyloidosis presented with a hypofibrinogenemia (fibrinogen 100 mg/dl) without severe bleeding. There was laboratory evidence of fibrinolysis with shortened euglobulin lysis time, decreased alpha-2 plasmin inhibitor and decreased plasminogen. The mechanism of this primary fibrinolysis remains unclear, since there is no enhancement of the tissue-type plasminogen activator. Analysis of the 8 cases related in the literature of excessive fibrinolysis associated with amyloidosis demonstrated improvement of bleeding manifestations and abnormal fibrinolysis following the administration of antifibrinolytic agents.

Amyloid↗
PubMed1989

[Prognostic factors of hypereosinophilic syndrome. Study of 40 cases].

Forty patients with hypereosinophilic syndrome (HES), defined according to the criteria established by Chusid et al., were studied retrospectively in order to determine the prognostic factors in this heterogeneous disease. A myeloproliferative syndrome (MPS) was diagnosed 17 times when splenomegaly and/or a greater than 5 times the normal vitamin B12, level existed. Cutaneous-visceral involvement was almost always present (95%), but could appear after several years of evolution. Twenty-three patients had cardiac involvement, determined by clinical, radiological, electrocardiographic and echocardiographic examinations; 12 of these had endomyocardiac fibrosis. The overall survival rate was 80% at 5 years and 42% at 10 and 15 years. Among the factors evaluated that are capable of influencing this survival, 5 were found to impair the prognosis; presence of an MPS; non-response of the hypereosinophilia to corticoids; existence of a cardiopathy; being male; and an elevated maximum eosinophilia; the last two factors were significantly associated with the cardiopathy. Because hematological or cardiac anomalies are not always present at the time of the first examination, HES patients require very close surveillance.

Actuarial Analysis↗
PubMed1989

[Popliteal venous aneurysm revealed by recurring pulmonary embolism. Echographic, phlebographic, x-ray computed tomographic and nuclear magnetic resonance aspects].

We report a characteristic case of popliteal vein aneurysm which was demonstrated not only by Doppler ultrasonography and venographic examination, but also by CT scan and magnetic resonance imaging. A review of the literature underlines the rarity of these aneurysms, since less than 20 cases have been published. They are always true aneurysms, most often revealed after an episode of pulmonary embolism. Doppler ultrasonography and venography confirm the diagnosis. The place of CT scan and magnetic resonance imaging remains to be defined. Even if asymptomatic, the embolic risk necessitates surgical resection of the aneurysm and restoration of venous continuity.

Aneurysm↗
PubMed1989

[Ungueal capillaroscopy in fasciitis with eosinophilia: a distinctive feature of systemic scleroderma. Apropos of 15 cases].

Eosinophilic fasciitis (EF) is a recently described disease whose distinction from progressive systemic sclerosis (PSS) is still being discussed. PSS has a characteristic microcirculation pattern. We performed nailfold microscopy on 15 patients with EF and compared the results to those of 98 PSS patients and 75 normal control subjects. EF patients have a normal microcirculation pattern (13/15) or discrete, non-specific anomalies: none had the typical capillary pattern associated with PSS and associated diseases. The findings of this study justify making a distinction between EF and PSS and demonstrate that nail fold microscopy can be a useful tool for an early differential diagnosis between these two disorders.

Adult↗
PubMed1989

[Histopathologic aspects of polymyositis and dermatomyositis. Correlation with the clinical course. Study of 57 cases].

Muscle biopsies from 57 patients with dermatomyositis or polymyositis were histologically evaluated and compared with the disease's clinical course. Perifascicular atrophy, perivascular infiltrates and tubular inclusions in endothelial cells were significantly more frequent in young patients with dermatomyositis. On the other hand, in adult polymyositis, which evolves more slowly, necrosis with slight muscular atrophy and perinecrotic infiltrates was observed. This division into two groups was clear when the clinical evolution and histological patterns were compared. The mean age of each group was different, but there was a large overlap. Two different pathogenetic mechanisms can be envisaged: primary involvement of muscle capillaries with muscle ischemia in young patients with dermatomyositis and primary involvement of muscle fibers in adults afflicted with polymyositis.

Adolescent↗
PubMed1989

[Plasma exchange in dermatomyositis and polymyositis. Retrospective study of 38 cases of plasma exchange].

In order to evaluate the efficacity of plasma exchanges (PE) in dermatomyositis and polymyositis, the case histories of 38 patients, who had undergone plasma exchanges between 1980 and 1986 in 10 French plasmapheresis centers, were studied. Large volume PE were performed in 34 patients after failure of conventional therapy and were part of the initial regimen for the 4 others. The initial activity of the muscle disease was acute in 27 patients and subacute or chronic in 11 cases. Clinical results were evaluated on a functional scale based on changes in muscle force: 24 patients improved (10 appreciably and 14 moderately) and 14 remained unchanged. PE were well tolerated in 23 patients. But side effects occurred in 15 patients, necessitating treatment withdrawal in 4 cases. PE seem to be more effective when the dermatomyositis is acute and evolutive than when it is chronic and insidious. The encouraging results of this exhaustive retrospective study prompt us to set up a prospective randomized trial.

Adolescent↗
PubMed1989

Temporal arteritis revealed by upper limb gangrene.

An 80-year-old white man presented with gangrenous lesions involving several distal phalanges of his left hand and an elevated erythrocyte sedimentation rate (ESR). Temporal artery biopsy showed patchy destruction of the internal elastic lamina by mononuclear cell infiltration, consistent with the diagnosis of temporal arteritis. After amputation of gangrenous lesions, he was discharged taking prednisone (60 mg/day). Twelve months after discharge there was no recurrence of ischemic manifestations and ESR was normal. Association of digital gangrene and elevated ESR should alert the clinician toward this diagnosis once other diseases such as atherosclerosis, scleroderma, lupus erythematosus, periarteritis nodosa have been ruled out.

Aged↗
PubMed1989

[Plasma exchange in dermatomyositis. A retrospective study of 21 cases].

We have reviewed the results obtained in 21 dermatomyositis patients who were treated with plasma exchanges (PE) in 8 french centres between 1980 and 1986. Patients and methods. Seven of the 21 patients studied were male and 14 were female; 16 were children under 15 years of age. The disease was initially acute in 17 cases, subacute in 3 cases and chronic in 1 case. Plasma exchanges were performed as first-line therapy in 13 patients and after failure of the usual treatments in 18 patients. The decision to use PE therapy was prompted by an increase in muscle weakness in 14 of these 18 patients and by a lack of improvement despite treatment in the remaining 4 patients. PE therapy was started 17 months on average after the beginning of treatment. At the time 10 patients were under systemic corticosteroid therapy (prednisone or prednisolone greater than 1 mg/kg/day in 7 cases); 7 patients were receiving immunosuppressants jointly with corticosteroids (prednisone or prednisolone greater than 1 mg/kg/day in 5 cases); and 1 patient had systemic corticosteroids (3 mg/kg/day), methotrexate and antilymphocyte serum. In 3 patients, 2 of whom had severe muscle weakness. PE's were performed from the start. Our 21 patients underwent a total of 234 plasma exchanges. Each patient had a mean series of 11 +/- 6 PE's spread over 11 +/- 3 weeks. In addition to PE therapy, 12 patients received corticosteroids (greater than 1 mg/kd/day in 7 cases) and 8 had corticosteroids (greater than 1 mg/kd/day in 5 cases) together with immunosuppressants. One patient who was put on TE therapy from the start received no other treatment. It must be noted that in 12 patients the introduction of PE was accompanied by another therapeutic change.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Aortic aneurysm with vena cava thrombosis occurring in Behcet's disease].

We report a case of Behcet's disease complicated by aortic aneurysm and contiguous vena cava thrombosis due to compression. Arterial aneurysms are uncommon in the course of Behcet's disease and are associated with a poor prognosis owing to the risk of rupture. Vena cava thrombosis is found in 10% of cases; pulmonary embolism is infrequent. Venous and arterial lesions usually evolve independently. In most cases they are consecutive to vasculitis. The case reported herein is uncommon because of simultaneous and contiguous venous and arterial lesions. Eighteen months after aorto bi-iliac graft and inferior vena cava ligature, there is no recurrence of thrombosis nor aneurysm with a treatment including heparin, colchicine and azathioprine.

Adult↗
PubMed1989

[Encapsulating peritonitis in periodic disease. Apropos of a case studied by x-ray computed tomography].

A case of encapsulating peritonitis complicating the course of familial Mediterranean fever is reported. This encapsulating peritonitis was responsible for abdominal pain and had a "pseudocystic" appearance on ultrasonography and computed tomography. Ultrasound guided aspiration produced a yellowish fluid rich in proteins and poor in cells. Surgical operation revealed a congested appearance of the peritoneum associated with a richly fibrinous appearance of the external wall of the mass. The differential diagnosis is discussed.

Adult↗
PubMed1988

[Wegener's granulomatosis in elderly subjects. 37 cases].

The clinical, biochemical and prognostic characteristics of 37 patients with Wegener's granulomatosis were studied in relation to age. Eleven patients were older than 60 years when the first sign of the disease appeared. Except for the fact that the renal lesions seemed to be more severe in these patients, there was no significant clinical or biochemical difference between them and patients under 60. Five patients over 60 years of age died during the first 2 years of Wegener's granulomatosis. Death was due to infection in 3 cases, to acute renal failure as complication of intra-alveolar haemorrhage in 1 case and to metastatic cancer in 1 case. Age-related comparisons of survival rates showed that the probability of surviving was lower in elderly subjects: 78 per cent at 1 year and 39 per cent at 3 and 5 years, as opposed to 96 per cent at 1 and 3 years and 84 per cent at 5 years in younger subjects (P less than 0.01). This poor prognosis is probably due to the renal lesions which constitute an important cause of death in the published series. Rapidly progressive glomerulonephritis being amenable to an early and intensive treatment, elderly patients should be treated as energetically as younger patients.

Adrenal Cortex Hormones↗
PubMed1988

[Cardiac involvement in Behçet's disease. 12 cases].

Fifteen cardiac manifestations observed in 12 of a series of 196 patients with Behçet's disease are reported. In this retrospective study conducted in an internal medicine department, 5 cases of pericarditis and 4 cases of myocardial infarction were encountered. The other cardiac manifestations were observed only once. They included ventricular aneurysm, endomyocardial fibrosis of the right heart, aortic insufficiency, mitral valve insufficiency, mitral valve prolapse, and right heart failure consecutive to pulmonary arterial hypertension. There was no relationship between the severity of cardiac lesions and that of the extracardiac manifestations of the disease. Comparison of these data with those found in the literature showed that pericarditis is the most frequent pathology, but it usually regresses rapidly. Lesions of the coronary arteries, with or without myocardial infarction, consist of stenosis, occlusion or pseudoaneurysm requiring surgical treatment. Myocardial lesions (with the possibility of pseudoaneurysm) and endomyocardial right heart fibrosis are exceptional but fairly characteristic of Behçet's disease which they should suggest. Hughes-Stovin's syndrome may be complicated by pulmonary arterial hypertension, although death is generally caused by massive haemoptysis.

Adult↗
PubMed1988

[Specificity of CA 125 tumor marker. A study of 328 cases of internal medicine].

The sensitivity and specificity of CA 125 were evaluated retrospectively in 328 patients, some of them with several diseases, seen between January, 1985 and December, 1986. High levels of CA 125 were found in 110 assays performed in patients with solid tumour (43 cases), peritoneal, pleural or pericardial effusion (39 cases), infection (34 cases), malignant blood disease (3 cases) and various non-malignant and non-infective diseases (45 cases). High CA 125 levels were most frequently observed in patients with effusion. The frequency of cancer increased with the CA 125 titre. CA 125 levels were particularly high in ovarian, peritoneal and uterine carcinomas. It was higher in ovarian cancer than in other types of cancer and further elevated in the presence of effusion, irrespective of the primary cancer. All patients with ovarian carcinoma had ascites. The sensitivity of CA 125 was 59 per cent and its specificity 74 per cent in solid tumours and malignant blood diseases. The corresponding figures in solid tumours alone were 72 per cent and 75 per cent respectively. While there can be no doubt that CA 125 is valuable in the follow-up of patients with ovarian carcinoma, the clinical context and notably the presence of an effusion must be taken into account when asking for a CA 125 assay to evaluate the cause of an inflammatory syndrome or of an alteration of the general condition, since CA 125 levels may be raised in a wide variety of non-malignant diseases, and especially in effusions and infections. In this study, a CA 125 titre higher than 1,000 U/ml was always due to the presence of cancer; lower titres must be interpreted according to the clinical context and sometimes the course of the disease.

Adolescent↗
PubMed1988

[Value of the cyclophosphamide bolus in severe systemic diseases. Preliminary results].

Twenty patients with severe systemic disease were treated intermittently with bolus intravenous injections of cyclophosphamide in doses of 0.5 to 1 g. The diseases were systemic lupus erythematosus in 9 cases, systemic necrotizing angiitis in 5 cases, Behçet's disease in 4 cases, Horton's disease in 1 case and dermatomyositis in 1 case. The rationale for this treatment was resistance to previous therapies in 9 patients, initial severity of the disease in 8 and the need for prompt reduction of corticosteroid dosage owing to side-effects in 3 other patients. No death or haemorrhagic cystitis was observed over a cumulative 120 month-patients period. Bacterial infection occurred in 6 cases, including pneumonia (3), and 1 case each of staphylococcal septicaemia, purulent meningitis and urinary infection: none of these infections were life-threatening, and all were cured without sequelae. The drug was well tolerated biologically, except for a moderate fall in neutrophils, lymphocytes and platelets. The systemic disease was stabilized or improved in 16 patients. It remained active and required corticosteroids at the same dosage level in 4 cases. It is concluded that bolus injections of cyclophosphamide are well tolerated in short-term treatments but that their effectiveness must be confirmed by controlled studies.

Adolescent↗
PubMed1988

[Retroperitoneal fibrosis].

Neoplastic and non-neoplastic retroperitoneal fibrosis share the same macroscopic and histological features and the same clinical signs which mainly consist of abdominal pain followed by signs of compression. All carry a risk of extension to adjacent structures and may therefore produce serious complications. They may also be associated with a "systemic" syndrome with fever, altered general condition and high erythrocyte sedimentation rate. The necessary laboratory and radiological examinations are detailed. Non-neoplastic retroperitoneal fibrosis may be due to a variety of causes, the most frequent of which today are medications and aortic atheroma. Surgery is usually needed when the disease is life-threatening or of poor functional prognosis. Some authors have suggested that surgery should be combined with corticosteroid therapy. In some cases, regression of the fibrosis could only be obtained by giving steroids in high doses.

Adrenal Cortex Hormones↗