[Gastric zoster ulcerations].
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Herpes Zoster↗
Biomedical subjects
P Godeau
Publications and source records attributed to P Godeau.
Morphological study of peripheral nerve changes induced by chloroquine treatment.
Nerve biopsies were performed in four patients with suspected chloroquine induced neuromyopathy. Three of the patients were treated with high doses of chloroquine for connective tissue disease, while one patient was taking this drug as malaria prophylaxis. Morphological studies demonstrated the presence of segmental demyelination and remyelination in all cases. Cytoplasmic inclusions were observed in Schwann cells, in perineurial and endothelial cells, and in some interstitial cells. They were never observed within axons. Occasional curvilinear profiles were seen in perineurial and Schwann cells. Perineurial calcifications were observed in two cases. The results of this morphological study suggest that chloroquine neuropathy is essentially due primary involvement of Schwann cells.
Adult↗
Massive plasma cell infiltration of the digestive tract. Secretory component as the rate-limiting factor of immunoglobulin secretion in external fluids.
A 29-yr-old Tunisian man had a clinical immunoproliferative small intestinal disease, different from alpha-chain disease. Serum contained 52.5 mg/ml of polymeric immunoglobulin A (IgA). Immunohistochemistry revealed a massive diffuse polyclonal IgA (99%)-plasma cell infiltration in the small bowel mucosa, with a smaller increase of IgA-producing cells in gastric and colonic mucosae. Secretory IgA levels were normal in jejunal and bronchoalveolar secretions. However, both fluids contained polymeric IgA devoid of secretory component, and free secretory component was absent. This suggests that secretory component was the limiting factor in transport of IgA in the secretions. A relative deficiency in secretory component, as compared with the huge supply of polymeric IgA, may have limited the secretory component-mediated active transport of IgA into secretions. This resulted in the appearance of high levels of polymeric IgA, unlinked to secretory component, both in serum and in the jejunal and bronchoalveolar fluids.
Adult↗
Diagnosis of primary cardiac sarcoma. Report of 4 cases and review of the literature.
The authors report the most extensive series of malignant primitive cardiac tumours. The patients presented with pericarditis in three cases and with a ventricular rhythm disorder in one patient. The diagnosis was made by non-invasive imaging techniques in three of the four. Angiography was carried out in three cases and was the determining diagnostic procedure in one. Diagnosis of the cardiac tumour was made prior to death in all cases. A histological diagnosis was obtained surgically in two cases. From the therapeutic viewpoint, surgical excision followed by chemotherapy and/or radiotherapy may prolong life. The average survival period of our patients was 11 months. The prognosis appears to be better after early surgical intervention. In view of the variability of the clinical features of cardiac sarcomas, cardiac computed tomography scanning is a valuable complement to cross-sectional echocardiography and, in our opinion, essential for early diagnosis.
Adolescent↗
Clinical findings and prognosis of polyarteritis nodosa and Churg-Strauss angiitis: a study in 165 patients.
Factors influencing the prognosis were studied in 165 patients with polyarteritis nodosa (PAN) and Churg-Strauss angiitis. One hundred and forty-seven of the patients fulfilled histological and/or arteriographic diagnostic criteria, and in 18 patients the diagnosis was based on clinical criteria. The patients' mean age on diagnosis was 48.4 +/- 16.4 years. The main symptoms were fever (69%), weight loss (66%), arthritis (44%), mononeuritis multiplex (67%), cutaneous signs (46%), renal involvement (26%), gastrointestinal symptoms (31%), asthma (29%), hypertension (31%) and cardiac failure (18%). Ninety-two per cent of the patients survived for at least 1 year after diagnosis of the disease, 79% for 2 years, and 63% for 5 years. The immediate causes of death were gastrointestinal bleeding or peritonitis in 11 cases, pancreatitis in two, renal insufficiency in six, cardiac failure in five, infectious complications in four, stroke in three and other causes in 11. We studied the prognosis of necrotizing angiitis in relation to clinical symptoms and laboratory findings. The association of four conditions were associated with a poor prognosis: age over 50, gastrointestinal problems, cardiomyopathy and renal signs. The survival rates in patients with these conditions were: for gastrointestinal problems, 55% 5-year survival (versus 67%); and for age over 50, 68% 3-year survival (versus 78%; p less than 0.09). One hundred and fifty-nine patients were treated with steroids for at least 18 months. Forty-eight also received cytotoxic agents (27%) and 46 plasma exchange. Patients who were treated with plasma exchange and prednisone were randomly assigned to additional treatment with cyclophosphamide. Survival rates were comparable in both groups.
Adult↗
Skin collagen from scleroderma patients before and after cyclosporin A treatment.
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Adult↗
[Causes of death in systemic vasculitis of polyarteritis nodosa. Analysis of a series of 165 patients].
The case histories of the 49 patients who died in a series of 165 patients admitted to the Medical Unit between 1958 and 1984 with polyarteritis nodosa (PAN) were reviewed. The causes of death of the 29 men and 20 women, mean age 51.44 +/- 7.4 years, were classified into 6 groups. Infection accounted for 26.5% (13/49) of deaths, the initial site of infection being pulmonary, complicated by septicaemia in 6 cases. Cardiovascular events were responsible for death in 24.4% (11/49): terminal cardiac failure (4 cases), myocardial infarction (1 case), ventricular tachycardia (1 case), stroke (1 case), pulmonary embolism (2 cases), fulminant hemoptysis (1 case). Gastrointestinal complications were the cause of death in 16.3% (8/49): ischemic necrosis (5 cases), acute pancreatitis (2 cases), oesophageal ulceration (1 case). Renal failure was observed in 10.2% (5/49), all occurring before 1972: acute renal failure (3 cases), chronic renal failure (2 cases). Cancer was the cause of death in 10.2% (5/49): primary bronchial carcinoma (2 cases), laryngeal carcinoma (1 case), carcinoma of the vulva (1 case), bone metastases (1 case). Finally, 14.2% (7/49) could not be classified in the preceding groups. Sudden death occurred in 3 patients, shock in 1 patient, multivisceral PAN in 2 patients and anaphylactic shock in 1 patient. Three of the 12 patients who had post-mortem studies had signs of progressive vasculitis. The results are compared with other reports in the literature and the pathogenic mechanisms are discussed. The infections and cardiovascular deaths occurred early or late and were not related to the state of the activity of the vasculitis. Immunosuppressive treatment seems to play an important role in their pathogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Behçet's disease, a current disease].
The treatment of Behçet's is essentially symptomatic and depends on the severity of the manifestations. Colchicine is useful in the minor forms, especially the mucocutaneous, forms. It can be safely used at a dose of 1 mg/day as maintenance treatment to prevent or limit the acute episodes. Other immunomodulators have been proposed : levamisole, disulon, thalidomide, the indications for which are limited by the side effects. Non-steroidal anti-inflammatory agents are indicated in the articular forms. Steroid therapy remains essential in the severe neurological and ophthalmological forms at an initial dose of 1 mg/kg/day. It can be preceded by the intravenous bolus administration of high doses of methylprednisone. Immunosuppressants are useful in the same indications. Although some authors propose them right from the start, we prefer to reserve them for second line treatment in the event of steroid dependence or recurrence, because of their short-term infectious and long-term oncogenic risks. Cyclosporin, which has been proven to be effective by randomised studies, is difficult to manage and responsible for complications, in particular renal. It can therefore only be used as second line treatment by experienced users. Plasmapheresis is reserved as an emergency procedure for functionally threatening forms. Venous or arterial thromboses justify longterm anticoagulation, possibly associated which platelet anti-aggregants. In this chronic disease, the quality of follow-up and the patient's cooperation are essential in order to intervene rapidly and to detect as early as possible the complications of the disease and of the treatment.
Adolescent↗
[Venous thrombosis in Behçet's disease].
Venous lesions in Behçet's disease (BD) were defined by Adamantiades and represent one of the most suggestive signs of the disease. They are occasionally the first sign of the disease and are frequently the basis for the diagnosis in a case of recurrent thrombosis in a young subject, the preferential context of BD. Involvement of superficial vessels is virtually constant. Venous vasculitis is responsible for non-specific hypersensitivity and erythema nodosa, which constitute some of the major diagnostic criteria. Ocular periphlebitis is one of the elements responsible for posterior uveitis. The originality of the venous involvement is due to the involvement of deep territories. Any vein may be affected, but the remarkable features are the size of the thrombosed vessels: superior and inferior vena cava, iliofemoral veins and the unusual site of the involvement: supra-hepatic veins, cerebral vessels, etc. Inferior vena cava thrombosis may be associated with aneurysms of the pulmonary arteries in the context of Hughes-Stovin syndrome. Cerebral phlebitis, which can now be identified more easily by means of digital angiography, is responsible for a typical picture: headaches, bilateral papilloedema and raised CSF pressure. The classical pictures of optic chiasmatic arachnoiditis and so-called benign intracranial hypertension actually correspond to unrecognised phlebitis. They may also be associated with other neurological lesions. In one half of cases, phlebitis cutaneous manifestations. However, they may precede the diagnostic signs or may occur very late in the course of the disease. They are recurrent and affect a number of different territories.(ABSTRACT TRUNCATED AT 250 WORDS)
Anti-Inflammatory Agents↗
[Medical treatment of Behçet's disease].
The treatment of Behçet's disease is essentially symptomatic and depends on the severity of the manifestations. Colchicine is usefull in the minor, particularly mucocutaneous forms. It can be safely used at a dose of 1 mg/day as maintenance treatment to prevent or limit the acute episodes. Other immunomodulators have been proposed: levamisole, disulon, thalidomide, the indications for which are limited by the side effects. Non-steroidal anti-inflammatory agents are indicated in the articular forms. Steroid therapy remains essential in the severe neurological and ophthalmological forms at an initial dose of 1 mg/kg/day. It can be preceded by the intravenous bolus administration of high doses of methylprednisolone. Immunosuppressants are useful in the same indications. Although some authors propose them right from the start, we prefer to reserve them for second line treatment in the event of steroid dependence or recurrence, because of their short-term infectious and long-term oncogenic risks. Cyclosporin, which has been proven to be effective by randomized studies, is difficult to manage and responsible for complications, in particular renal. It can therefore only be used as second line treatment by experienced users. Plasmapheresis is reserved as an emergency procedure for functionally threatening forms. Venous or arterial thromboses justify long-term anticoagulation, possibly associated with platelet anti-aggregants. In this chronic disease, the quality of follow-up and the patient's cooperation are essential in order to intervene rapidly and to detect as early as possible the complications of the disease and of the treatment.
Adjuvants, Immunologic↗
[Subacute infectious endocarditis in the elderly. Retrospective study of 33 cases].
The authors reviewed 33 cases of infectious endocarditis in patients over 65 years of age and classified according to Von Reyn's diagnostic criteria. Twenty-four patients had organic valvular disease, 4 had a prosthetic valve, and in 4 cases the diagnosis of the murmur was uncertain. Positive blood cultures were obtained in 79 p. 100 of cases. The commonest infecting organism was the streptococcus (21 out of 26). In 11 patients, it was a Group D streptococcus and a recto-sigmoid colonic tumour was found in 3 cases. A dental portal of entry was suspected in 55 p. 100 of patients and this should guide the choice of prophylactic antibiotic therapy. The initial choice of antibiotic had to be changed in 19 patients, usually because of poor tolerance. Eight patients died and one underwent valve replacement within two months of hospital admission.
Aged↗
[Wegener's granulomatosis. Clinical aspects, nosologic problems. Review of the literature apropos of 30 cases].
Thirty cases of Wegener's Granulomatosis are reported, 16 men and 14 women aged 49.3 +/- 14 years at the onset of their illness. The presenting symptoms were oto-rhino-laryngeal in 22 cases and pulmonary in 16 cases. Renal disease was initial in only 1 case. The complete picture comprised oto-rhino-laryngeal (29 cases), pulmonary (26 cases), renal (27 cases), articular (16 cases), muco-cutaneous (19 cases), ocular (15 cases), neurological (13 cases), and muscular (10 cases) involvement. An increased sedimentation rate, leukocytosis, anaemia and thrombocytosis were common findings. The treatment comprised steroid therapy associated with immunosuppressor drugs (28 cases) and plasma exchanges (8 cases). External radiotherapy was used in 5 patients, including 3 with bronchopulmonary lesions, but was not effective. The probability of survival after the initial symptoms was 84 p. 100 at 1 year, 69 p. 100 at 3 years and 59 p. 100 at 5 and 10 years. Eight patients died; infection and renal failure were the principal causes. Late relapse occurred in 3 patients justifying long-term follow-up and the necessity of using the term "cure" with reserve. The clinical and therapeutic aspects are described in the light of the authors' experience and a review of the literature. The concept of localised form of the disease and bordeline forms with atrophic polychondritis, periarteritis nodosa, Churg and Strauss syndrome and lymphomatous granulomatosis are also discussed.
Adult↗
[Behcet's disease in France. Apropos of 60 autochtonous subjects].
Based on a retrospective study of a series of 196 patients followed up from 1974, to 1986, 60 cases of Behcet's disease are reviewed in autochthonous French patients, defined as born of French parents in Metropolitan France. The group included 36 men and 27 women (sex ratio 1.45) age range 32 +/- 7 years at time of diagnosis. Semeiology and outcome were compared with those of North African patients, the bias related to their female under-representation being eliminated by analysis of findings in males only. No significant difference was noted between the two groups, particularly with respect to ocular, neurological and vascular lesions. Neither the sex nor the existence of HLA B5 (28/40 tests) had any influence on semeiology. Three deaths related to the disease were reported two pregnancies were conducted to term without neonatal effects despite maternal acute ocular episodes. Treatment was with corticoids (n = 33), immunodeppressants (n = 15), colchicine (n = 29) and anticoagulant and/or anti-aggregant therapy (n = 31). Lasting disappearance of aphthosis was obtained in 34 cases, of cutaneous signs in 27, articular signs in 26 and vascular signs in 16. The ocular lesions present initially in 41 patients had disappeared over long periods in 29 cases, and presented a satisfactory prognosis since less than 39 p. 100 of the patients had any significant handicap at 5 years. Among the relapses, 5 appeared after too hasty withdrawal of colchicine. The diagnosis of Behcet's disease should be evoked in autochthonous subjects if necessary, and confirmed on the basis of usual clinical criteria alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Localized tracheobronchial amyloidosis. A new case studied with x-ray computed tomographic and nuclear magnetic resonance. Review of the literature].
We report a new case of localized primary tracheobronchial amyloidosis revealed by haemoptysis and effort dyspnea. The CT scan image was a homogeneous and circumferential thickening of the bronchial wall measuring 282 on the Hounsfield scale. At magnetic resonance imaging the amyloid substance was a slightly less intense than fat tissue in T1 and T2-weighted sequences. Treatment using Yag laser photoresection stabilized the lesions with one year follow-up. The review of the literature enables us to summarize the clinical, endoscopic, morphological, prognostic and therapeutic features of tracheobronchial amyloidosis, as well as pathogenic hypotheses and relationship with tracheobronchopathia osteoplastica.
Adult↗
[Is Behçet's disease associated with characteristic abnormalities of coagulation and fibrinolysis? Apropos of 70 case reports].
The frequency of thrombotic episodes in patients with Behçet's disease prompted us to study their hemostasis. Seventy patients were investigated and 27 of them (38%) had history of venous thrombosis; they were compared to 27 healthy subjects and to 16 hospitalized patients in whom the diagnosis of Behçet disease was ruled out. Fibrinolytic activity after a 10 minute venous occlusion was significantly decreased while fibrinogen, factor VIII and von Willebrand factor was increased as well as the tPA inhibitor (PAI-I): the last 3 proteins are synthetized by the endothelial cell. No significant difference was observed between patients with or without history of thrombosis. Coagulation and fibrinolysis changes observed are not specific of Behçet disease since they were also found in a population of patients without Behçet disease and without history of thrombosis.
Adolescent↗
[Primary hyperparathyroidism and secondary polycythemia].
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Humans↗
[Neuromuscular forms of hyperparathyroidism. Apropos of 2 cases].
The authors report two cases of hyperparathyroidism presenting mainly with muscular weakness. In the first case, a 74 year old woman had become completely bed-ridden and muscular recovery was obtained in 18 months. In the second case, a 24 year old sportsman had to stop all competition. Hypercalcaemia was suspected after finding radiological muscular calcification; the patient was able to start his sporting activities again two months after excision of the adenoma. After a review of the literature the authors discuss the principal physiopathogenic mechanisms; a direct action of parathormone is the probable cause but this has not been proved. Muscular forms of hyperparathyroidism are rare but this "pseudo-myopathic" presentation justifies the systematic exclusion of hyperparathyroidism in all cases of unexplained muscle weakness.
Adolescent↗