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Biomedical subjects

P Godeau

Publications and source records attributed to P Godeau.

At least 37 records · Page 2Linked to original sources
PubMed2000

Percentage of glycosylated serum ferritin remains low throughout the course of adult onset Still's disease.

OBJECTIVE: To determine the evolution of levels of total serum ferritin and percentage of the glycosylated form in patients with adult onset Still's disease (AOSD) at the time of diagnosis and during follow up. METHODS: All patients with AOSD were tested at the time of diagnosis and during follow up. Total serum ferritin levels were analysed by immunoassay, and the percentage of glycosylated ferritin was determined by methods using Sepharose-Con A. RESULTS: 14 patients (eight women, six men) with AOSD were enrolled. At the time of diagnosis, mean (SD) age was 36 (16) years. Mean initial total serum ferritin was 6350 (1300) microg/l (normal <250 microg/l). The mean initial percentage of glycosylated ferritin was 14.7 (13)% (normal >50%). Mean follow up time was 37 (35) months. At the time of the last examination all patients were in remission except one, who presented a chronic articular form. Total serum ferritin remained high in this single patient and was normal in the 13 others, with a mean of 98 (73) microg/l. In all patients the percentage of glycosylated ferritin remained low, with a mean of 16 (16)%. CONCLUSION: Total serum ferritin is a marker of the active phase of AOSD. The percentage of glycosylated ferritin is low both in the active phase and in remission. Further studies are needed to confirm these data and to determine their specificity for AOSD before considering any possible use of a low percentage of glycosylated ferritin as a diagnostic tool in suspected AOSD, especially when atypical or previously treated.

Adolescent↗
PubMed2000

[Edematous syndrome revealing an exudative lymphocytic gastritis: efficacy of omeprazole].

Lymphocytic gastritis is characterized by intense lymphocytic infiltration of gastric epithelium. Excessive gastric protein loss is uncommon. We describe the case of a 49-year-old white woman suffering from generalized edema and abdominal pain. She had severe serum hypoproteinemia, hypoalbuminemia and hypogammaglobulinemia. There was no renal, cardiac or hepatic origin of protein loss, and no protein-losing enteropathy. Endoscopic examination showed diffuse varioliform gastritis and histology confirmed lymphocytic gastritis with > 30% intraepithelial lymphocytes without Helicobacter pylori. The protein loss stopped within two weeks of the beginning of omeprazole and extensive edema disappeared. Four years later, the patient was still free from edema. Inflammatory involvement of the gastric mucosa probably caused protein losing in this patient. Recognition of this exsudative gastropathy is important because long term remission is obtained with omeprazole.

Abdominal Pain↗
PubMed2000

Amyloidosis and cardiac involvement.

BACKGROUND: Amyloidosis is a rare disease characterized by the extracellular accumulation of a protein polysaccharide complex: amyloid. Cardiac involvement may occur with or without clinical manifestations, and is considered as a major prognostic factor. AIM OF THE STUDY: Firstly, to analyze the clinical, electrocardiographic, radiological and echocardiographic features in a group of patients with extracardiac biopsy-proven amyloid infiltration and evidence of echocardiographic amyloid heart disease. Secondly, to compare the survival of amyloidosis patients, with or without cardiac involvement. PATIENTS AND METHODS: We retrospectively analyzed the main echocardiographic features of 47 patients with biopsy proven amyloidosis. No clinical, electrocardiographic, radiological or scintigraphic criterium were selective for cardiac involvement. Thirty patients with echographic features of amyloid heart disease were identified and compared to 17 patients without echographic features of amyloid heart disease. RESULTS: Amyloid disease with heart involvement was AL in 25/30 (83%) patients and occurred more commonly in middle age men (mean age: 53+/-11 years). The main clinical presentation was congestive heart failure (59%), but 37% of patients had no clinical cardiac features. The electrocardiogram was abnormal in 86% and the cardiac silhouette was enlarged on chest roentgenogram in 27% of patients. The main echocardiographic findings were: diffuse ventricular wall thickening in 21 patients (70%) and isolated septal wall thickening in 9 patients (30%); restrictive pattern of left ventricular (LV) diastolic function in 17 patients (57%); pericardial effusion in 12 patients (40%); impaired LV systolic function in 8 patients (27%); atrial enlargement in 8 patients (27%); characteristic granular sparkling of LV myocardium in 8 patients (27%); mitral and/or aortic valve thickening in 4 patients (13%). Cardiac symptoms developed in 72% of the non symptomatic patients having echocardiographic evidence of cardiac involvement. Twenty-five patients died during the study period and the death was due to cardiac disease in 76%. Median survival time was 36 months from time of amyloidosis diagnosis, and it was 23 months from time of amyloid myocardiopathy diagnosis. It shortened to 6 months when congestive heart failure appeared. CONCLUSION: Patients with a histologically proven amyloidosis should be examined by echocardiography, because cardiac involvement is frequently found in patients with no clinical symptoms, and non symptomatic patients having echocardiographic evidence of cardiac involvement will almost always develop cardiac symptoms. Survival actuarial study confirms the significant adverse influence of cardiac involvement in amyloidosis.

Amyloidosis↗
PubMed2000

[Efficacy of colchicine in recurrent acute idiopathic pericarditis].

Acute idiopathic pericarditis is complicated by recurrence in 15 to 30% of cases. The preventive treatment of recurrences is not well codified. Aspirin, non-steroidal anti-inflammatory drugs and corticoids are the commonest prescribed treatments. The objective of this study was to assess the value of colchicine in the prevention of recurrences of acute idiopathic pericarditis. Twenty-eight cases of recurrent acute pericarditis (2 episodes, 1 month between each episode) admitted to a department of internal medicine between 1989 and 1999 were reviewed. Analysis was concentrated on the 13 idiopathic forms. The subjects were 7 women and 6 men with an average age of 41 years (10-62) at the time of the first episode of acute pericarditis. These 13 patients were treated with colchicine (1 to 2 mg/day) after failure of conventional treatment (aspirin 13/13, NSAID 13/13, steroids 9/13 and pericardiocentesis 3/13). Ten patients were followed up regularly (6 months after starting colchicine) and were improved with respect to number, duration and intensity of their recurrences. The average duration of colchicine therapy was 17 +/- 14 months (6-48). Progressive withdrawal of NSAID and steroids was obtained in 8/10 cases. The authors conclude that colchicine is useful in the prevention of recurrence of acute pericarditis. It may be proposed as treatment of choice, especially in the idiopathic forms.

Acute Disease↗
PubMed2000

[Epidemiologic and virologic study of hepatitis C virus infections in Morocco].

OBJECTIVES: We prospectively studied 783 consecutive Moroccan patients to define: 1) the prevalence of anti-hepatitis C virus (HCV) antibody (Ab), 2) the prevalence of other viral infections: HBs Ag, anti-HAV IgM, anti-HGV, HGV RNA, 3) the risk factors of spreading HCV infection, and 4) the distribution of HCV genotypes. RESULTS: 60/783 (7.7%) patients had anti-HCV Ab (48 H/12 F), 26 (3.3%) HBs Ag, and 3 (0.3%) IgM anti-HAV. Anti-HGV Ab was found in 11/60 (18.3%) anti-HCV positive patients, and 6/38 (15.8%) anti-HCV negative patients. 2/22 (9%) serum anti-HCV positive and anti-HGV negative patients were positive for HGV RNA. The 60 HCV positive patients rarely had other viral infections: 3 (5%) HBs Ag, 11 (18.3%) anti-HGV positive, 2 (9%) HGV RNA positive, and none had anti-HBc, IgM anti-HAV, or anti-HIV. HCV positive patients had more often undergone transfusion of blood products (21.7 vs 5.5%; P < 0.0001), and dental treatment (55% vs 8.3%; p < 0.0001). Patients with anti-HCV Ab frequently had hepatitis lesions on liver biopsy, i.e. chronic active hepatitis (n = 44) or cirrhosis (n = 16). HCV RNA was positive in 45/60 (75%) anti-HCV positive patients. HCV genotypes were: 1b (n = 21, 47%), 2a/2c (n = 13, 29%), 1a (n = 6, 13%), et 3 (n = 1, 2%). CONCLUSIONS: In our Moroccan population, the prevalence of HCV was high (7.7%). Other viral infections (HBV, HAV, HGV) were rare.

Adult↗
PubMed1999

[Vitamin B 12 deficiency in the aged].

A COMMON CONDITION: Vitamin B12 deficiency is common in the elderly. Search for deficiency should be undertaken whenever the clinical situation could lead to vitamin deficiency whether macrocytic anemia is present or not as its development may come late. PATHOPHYSIOLOGICAL IMPLICATIONS: The potential relationships between degenerative neuropsychiatric disorders and cerebrovascular or cardiovascular disease, mainly via hyperhomocysteinemia, emphasize the importance of searching for vitamin B12 deficiency in the elderly. SPECIFIC CAUSES: In the elderly, it is important to recognize specific causes of vitamin B12 deficiency, mainly resulting from vitamin malabsorption.

Aged↗
PubMed1999

Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single center.

Charts of 180 patients (147 women, 33 men) with systemic lupus erythematosus (SLE) complicated by renal involvement were retrospectively analyzed from a series of 436 patients. Mean age at renal disease onset was 27 years. Thirty-six percent of the patients had renal involvement after diagnosis of lupus, for 30.7% of that group it was more than 5 years later. Renal involvement occurred more frequently in young male patients of non-French non-white origin. Patients with renal involvement suffered more commonly from malar rash, psychosis, myocarditis, pericarditis, lymphadenopathy, and hypertension. Anemia, low serum complement, and raised anti-dsDNA antibodies were more frequent. According to the 1982 World Health Organization classification, histologic examination of initial renal biopsy specimen in 158 patients showed normal kidney in 1.5% of cases, mesangial in 22%, focal proliferative in 22%, diffuse proliferative in 27%, membranous in 20%, chronic sclerosing glomerulonephritis in 1%, and other forms of nephritis in 6.5%. Distribution of initial glomerulonephritis patterns was similar whether renal involvement occurred before or after the diagnosis of lupus. Transformation from 1 histologic pattern to another was observed in more than half of the analyzable patients (those who underwent at least 2 renal biopsies). Nephritis evolved toward end-stage renal disease in 14 patients despite the combined use of steroids and cyclophosphamide in 12. Initial elevated serum creatinine levels, initial hypertension, non-French non-white origin, and proliferative lesions on the initial renal biopsy were indicators of poor renal outcome. Twenty-four patients died after a mean follow-up of 109 months from SLE diagnosis. Among our 436 patients, the 10-year survival rate was not significantly affected by the presence or absence of renal involvement at diagnosis (89% and 92%, respectively).

Adolescent↗
PubMed1999

Impact of the consensus conference on polycythemia vera. An opportunity to change or a sign of change?

OBJECTIVE: To assess the impact of guidelines on drug use issued by a consensus conference on polycythemia vera held in Paris in June 1993. 32Phosphorus (32P) was recommended for patients over 70 and/or at risk, whereas pipobroman and hydroxyurea were recommended for patients under 70. METHODS: A questionnaire was sent to all 119 departments of nuclear medicine in France 1 year after the conference to find out whether and how often they measured plasma volume and red cell mass (the recommended diagnostic tests for polycythemia vera). Time-series analyses were performed on sales of 32P, pipobroman (both virtually exclusively prescribed for polycythemia), and hydroxyurea over a 4-year span (January 1992-December 1995). RESULTS: The average number of plasma volume determinations per year did not change significantly after the conference (22 +/- 26 before vs 21 +/- 25 after). 32P and pipobroman sales were stable until July 1993, when 32P sales decreased while pipobroman sales rose steadily. Hydroxyurea sales increased over the whole period with no change in trend after the guidelines were published. CONCLUSIONS: The guidelines apparently influenced clinical practice since sales of drugs that are specifically used to treat polycythemia vera showed clear changes in trend after publication of the guidelines. This type of study seems to be an effective way of assessing the impact of consensus conferences.

Drug Utilization Review↗
PubMed1998

[Tuberculosis and systemic diseases. Apropos of 16 cases].

METHODS: We analyzed retrospectively 16 patients between 1976 and 1993 (six men, ten women, mean age: 49-year-old) suffering from connectivitis. HIV-negative and receiving corticosteroids, combined for six of them with immunosuppressive therapy, and suffering from tuberculosis. RESULTS: The mean period between first signs and diagnosis was 51 days (3-190 d). Tuberculosis was pulmonary (n = 10) of which 4 miliary, pleurisy (n = 3), lymphadenitis (n = 5). We only observed one meningitis, one otitis and one female genital tuberculosis. Six patients had more than one localisation. Diagnosis was proven bacteriologically eight times, histologically six times and for three patients diagnosis was certain because of efficacy of antituberculosis antibiotherapy. Evolution was always good, with antituberculosis antibiotherapy of maximum 18 months, without sequella. Because rifampicin enzymatic induction, connectivitis worsened in five patients. An increase in corticotherapy was necessary for these five patients. CONCLUSION: This series confirmed the frequently extrapulmonary feature of tuberculosis in immunosuppressed patients, the long delay of diagnosis and the risk of exacerbation of underlying disease with rifampicin.

Adrenal Cortex Hormones↗
PubMed1998

[Sarcoidosis and pregnancy. A retrospective study of 11 cases].

PURPOSE: To analyze the evolutive profile of sarcoidosis together with reciprocal interactions between pregnancy and sarcoidosis. METHODS: All events that occurred during pregnancy in 11 women presenting with sarcoidosis were analyzed. Histological confirmation was obtained for the 11 cases. For all pregnancies were analyzed the course of both sarcoidosis and pregnancy, and the influence of pregnancy on the disease evolution. RESULTS: Among 33 pregnancies, 23 led to the birth of healthy fetuses (five spontaneous abortions, four voluntary abortions, and one therapeutic abortion). The major event was fetal hypotrophy in six cases. Three of them occurred during pregnancy in prednisone-treated patients with active sarcoidosis. No relapse of cured sarcoidosis or further evolution of sarcoidosis that was inactivated as of the beginning of pregnancy were observed. The course of active sarcoidosis varied, as improvement (one case), worsening (two cases) and stabilization (two cases) were observed. During the first year of follow-up after delivery, four relapses and, in two cases, preliminary signs of the disease were observed. CONCLUSION: Apart from the hypothetical but not definite risk of hypotrophy, no negative interaction between sarcoidosis and pregnancy could be established. Pregnancy does not seem to interfere with the course of sarcoidosis. Considering the risk of relapse after delivery, pregnant women presenting with sarcoidosis should benefit from clinical and radiological follow-up.

Abortion, Induced↗