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P Roblot

Publications and source records attributed to P Roblot.

At least 19 recordsLinked to original sources
PubMed1999

[When should Horton's disease be suspected?].

The high clinical polymorphism of temporal arteritis is due to the scattering of the vasculitis out of the carotid artery territory. Typical clinical manifestations are present in a majority of patients. The main symptoms are headache, affecting two thirds of the patients, fever and (or) weight loss, or jaw claudication in one third. Ophthalmic disorders are still too frequent and temporal arteritis remains the first cause of vascular blindness in the elderly. Some constitutional symptoms, also frequent like thoracic or hepatic manifestations, are less known but may evoke diagnosis when the clinician is aware of them. Moreover fever may be solitary. Association between such symptoms with a biological inflammatory response, may lead clinician to the diagnosis.

Aged↗
PubMed1999

Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis. French Vasculitis Study Group.

OBJECTIVE: To describe the clinical, biologic, and histologic features of temporal artery biopsy (TAB)-localized systemic necrotizing vasculitides (SNV), and to assess their frequency among elderly patients undergoing TAB for suspected giant cell (temporal) arteritis (GCA). METHODS: The frequency of a TAB localization of SNV was prospectively assessed in a multicenter study of elderly patients undergoing TAB for suspected GCA. All patients with SNV fulfilling the American College of Rheumatology criteria for a specific vasculitic syndrome and with evidence of vasculitis on TAB were included in a retrospective, descriptive study. RESULTS: SNV was diagnosed based on the TAB in 1.4% of the patients with suspected GCA and in 4.5% of the positive (inflamed) TAB specimens. We retrospectively selected 27 patients (18 female, 9 male; mean +/- SD age 62+/-15 years, range 22-79 years) with SNV and TAB-localized vasculitis. Only 2 of these patients were known to have SNV before TAB localization. Twenty-two patients (81%) had cephalic symptoms, including jaw claudication in 33%, clinically abnormal temporal arteries in 33%, and neuro-ophthalmologic symptoms in 11%. All patients had systemic symptoms suggestive of SNV and histologically proven NV in the TAB specimens (70%) or elsewhere in other biopsy sites (74%). Abnormal biologic results suggestive of SNV were present in 17 patients (63%). For 4 patients, the TAB-documented involvement led to initial misdiagnoses of GCA, and systemic manifestations that developed under steroid therapy revealed the correct diagnosis. The final diagnoses of the patients were polyarteritis nodosa (PAN) (n = 11), Churg-Strauss syndrome (n = 6), micropoly-angiitis (n = 3), Wegener's granulomatosis (n = 3), hepatitis B virus-related PAN (n = 2), hepatitis C virus-related cryoglobulinemic vasculitis (n = 1), and rheumatoid vasculitis (n = 1). CONCLUSION: TAB-localized SNV presents a major diagnostic dilemma because it can mimic GCA. Careful analysis of clinical, biologic, and histologic data should lead to the correct diagnosis and help guide the clinician's choice of appropriate therapy.

Adrenal Cortex Hormones↗
PubMed1998

[Down the claws!].

Explore the source record for details and available documents.

Bartonella henselae↗
PubMed1998

[RS3PE: a clinical diagnosis, a prognosis more simple than its name].

INTRODUCTION: RS3PE syndrome (remittive symmetrical seronegative synovitis with pitting edema) was first described by MacCarthy in 1985. It is a rare type of seronegative polyarthritis occurring in the elderly. METHODS: Retrospective report of 13 cases (including eight male and five female patients; mean age 76.7 +/- 3.7 years) and search for previously reported cases, using the Medline database. RESULTS: Pitting edema was present at onset of disease in nine cases. Joint arthritis was bilateral, occurring in the wrist (13 cases), shoulder (six cases), elbow (six cases), knee (six cases), ankle (four cases), metacarpophalangeal (four cases) and hip (one case). Radiographies were normal. Mean erythrocyte sedimentation rate was 62 +/- 19 mm at the first hour and mean C-reactive protein level was 73 +/- 35 mg/L. Mild cholestasis was present in four of the seven patients for whom data were available. HLA B7 was present in five out of 12 cases (42%). Improvement was favorable, occurring over 7 months. Mean follow-up was 22.2 months. Fifty-nine other cases have been described in the literature. This syndrome, which affects the elderly, appears to be rare. Its clinical presentation is quite constant, with sudden onset, symmetrical polyarthritis and pitting edema. Its evolution, often long, is favorable. Rheumatoid arthritis and polymyalgia rheumatica are the main differential diagnoses. CONCLUSION: Due to its favorable outcome and the usefulness of a mild corticotherapy, this syndrome, though rare, should be diagnosed where necessary in elderly patients.

Aged↗
PubMed1998

[Distinctive features of tuberculosis in the aged].

INTRODUCTION: Current recrudescence of human tuberculosis is ascribed to HIV. Nevertheless, other at-risk individuals, particularly the elderly, have been reported. METHODS: A retrospective study aimed at defining distinctive features of tuberculosis in the elderly was conducted. Eighty-two records of patients aged 18 to 64 years were compared to those of 58 patients of 65 years of age and over. RESULTS: In the French area considered in this study, the elderly represent the most at-risk group. Institutionalization is a significant risk factor for tuberculosis (RR = 4). Despite a past history of tuberculosis and public awareness campaigns, first-intent diagnosis was evoked in only 22% of the older patients. The mean number of infectious localizations was higher in the elderly (1.3/patient) than in younger patients (1.1/patient). Results of tuberculin skin tests are unreliable. Prognosis is poor in the elderly. In the present study, 14 of the 18 encountered deaths occurred in the elderly, of which eight were due to tuberculosis. CONCLUSION: To decrease the current incidence of tuberculosis, evaluations of preventive measures in the elderly should be validated and implemented, especially in institutionalized patients.

Adult↗
PubMed1998

Absence of anti-beta2 glycoprotein I antibodies in giant cell arteritis: a study of 45 biopsy-proven cases.

OBJECTIVE: To search for a relationship between serum anti-beta2 glycoprotein I (anti-beta2GPI) antibodies and the occurrence of ischaemic complications in giant cell arteritis (GCA), since the latter do not correlate with anti-cardiolipin antibodies (ACL), which are frequently observed in GCA. METHODS: IgG and IgM anti-beta2GPI antibodies and ACL were measured by enzyme-linked immunosorbent assays in sera, collected before treatment, from 45 unselected patients with biopsy-proven GCA, including 15 patients with ischaemic events. RESULTS: IgG and IgM anti-beta2GPI antibodies were not detected in any of the patients, contrasting with the presence of ACL in 51%, of them, without correlation with ischaemia. CONCLUSION: Anti-beta2GPI antibodies are not detectable in GCA, contrasting with the occurrence of ACL, and ischaemic complications are apparently unrelated to the most frequent anti-phospholipid antibodies.

Aged↗
PubMed1998

Acute Q fever pneumonia: a review of 80 hospitalized patients.

STUDY OBJECTIVES: To emphasize epidemiologic, clinical, or radiologic characteristics whose detection could lead to an early diagnosis and to enhance therapeutic efficacy. PATIENTS: Eighty hospitalized patients from 1982 to 1996. DESIGN: The diagnosis of Q fever infection was serologically confirmed in all the patients (phase II Coxiella burnetii antibody) using the complement fixation test and/or the indirect immunofluorescence antibody test. RESULTS: Patients from rural and urban areas were noted in the same proportion; however, the usual epidemiologic factors such as contact with cats or farm animals were found in 40% of the patients. Mean age+/-SD was 49+/-20 years, and there was a higher sex ratio of male to female patients (1:3.44). We found a specific seasonal distribution since 80% of the cases occurred between February and May. Delay before referring to hospital was 8.2+/-7.8 days, while 69.3% of the patients received an antibiotic treatment that was mainly penicillin or cephalosporin. The dominant clinical features were dry cough and high fever, as the maximal temperature reached more then 40 degrees C in 58% of the patients. Digestive symptoms were rare. WBC count remained within normal range in 80% of the cases with a low proportion of lymphocytes in half of the patients, and the sedimentation rate was usually elevated (55+/-34 mm). Altered liver function consisted more frequently in an elevated level of alkaline phosphatase (70% of the cases) than transaminases, while hyponatremia was frequently mentioned (28.2% of the patients). We found radiologic evidence of unique lobar or segmental alveolar opacity involving more likely the lower lobes in 55 patients, and multiple or interstitial opacities in the others. Chest radiographs were considered normal in eight patients. The clinical response was favorable in all the patients with a reduction in fever 4.8+/-3.9 days after the start of treatment with the second antibiotic that included mainly erythromycin or quinolones, and chest radiographs returned to normal in 81% of the patients within the first month.

Acute Disease↗
PubMed1998

[Desquamative interstitial pneumopathy: a rare form of diffuse interstitial pneumopathy].

Desquamative interstitial pneumonia (PID) is a rare disorder initially described by Liebow in 1965. It is characterised by the presence of an interstitial pneumonia consisting of minimal lesions of interstitial fibrosis and by the accumulation of a rich intraalveolar cellular material principally composed of macrophages. Numerous aetiologies have been found particularly that due to long term Nitrofurantoin. We report the observation of a 57 year old patient, a cigarette smoker, in whom the diagnosis of PID was made after histological examination of a lung biopsy. Based on this observation the pathogenesis and possible different aetiologies of PID are discussed.

Anti-Infective Agents, Urinary↗
PubMed1998

[Immunosuppressive agents in Horton's disease. Which drug for which indication?].

Corticosteroids remain the cornerstone treatment of giant cell arteritis. Steroid-related toxicity and needs for alternative therapeutic regimens in patients experiencing recurrent active or steroid-resistant diseases, are the main reasons for searching a steroid-sparing agent. Regarding disease pathogenesis, immunosuppressive agents might be useful drugs. Methotrexate is the most widely studied agent in this indication. However, available data are incomplete and studies have included only polymyalgia rheumatica or both polymyalgia rheumatica and giant cell arteritis affected patients. Results of these studies evoke the possibility of using methotrexate in steroid-dependent or resistant diseases, as well as a steroid-sparing agent in order to taper off and stop steroids quickly; with an acceptable toxicity. Azathioprine may be used to control steroid-dependant or resistant diseases, but toxicity appears to be higher. An open prospective study compared azathioprine and methotrexate and concluded to the superiority of methotrexate. Available data concerning cyclophosphamide and cyclosporine A are too incomplete. A satisfactory steroid-sparing agent in giant cell arteritis is still unknown. Currently, methotrexate, and probably azathioprine, appear to be the most useful agents in this indication. However, there is no demonstration that using an immunosuppressive agent in giant cell arteritis could reduce steroid-related morbidity.

Anti-Inflammatory Agents↗
PubMed1997

[Are the anatomopathological classifications of primary Gougerot-Sjögren syndrome correlated with each-other and with clinical symptoms?].

Seventy-two cases of primary Sjögren's syndrome, according to the European classification criteria, were studied looking for a correlation between anatomic criteria and clinico-biological signs in this disease. Labial salivary gland biopsy was performed in all patients and anatomic criteria were evaluated according to both Chisholm and Chomette scales. Work-up included recording of functional and clinical signs. Our study shows no clinico-histological correlation in Sjögren's syndrome. Moreover, we did not find any correlation between the two histological scales. We think, therefore, that labial salivary gland biopsy appears to be an important step in Sjögren's syndrome diagnosis according to European criteria. However, it does not present any benefit in patient treatment.

Adult↗
PubMed1997

The usefulness of skin culture in the diagnosis of chronic meningococcaemia.

We deal with the second reported case of chronic meningococcaemia in which the culture of skin biopsy led to the diagnosis. A 46-year-old man presented a history of recurrent fever and rash. Laboratory studies revealed an inflammatory syndrome. Serologic tests as well as blood culture tests were negative. The histological examination of skin lesions revealed a perivascular infiltrate in the dermis without any picture of leukocytoclastic vasculitis. A culture of skin specimen tested positive for Neisseria meningitidis (N. meningitidis). After a week of antibiotic treatment, the patient recovered with no recurrence of either fever or rash over a two year period.

Bacteremia↗
PubMed1997

Lupus syndrome after parvovirus B19 infection.

Systemic lupus erythematosus is uncommon in elderly individuals. A 72-year-old woman developed parvovirus B19 infection followed by a systemic lupus erythematosus-like syndrome with persistent thrombocytopenia and Raynanud's phenomenon. Few cases of systemic lupus erythematosus after parvovirus B19 infection have been reported, and none had thrombocytopenia.

Aged↗
PubMed1997

[Non-antibiotic effects of antibiotics: from side effects to therapeutic uses].

Sometimes therapeutic needs to tap drugs side effects of a treatment to show new indications for those drugs. Antibiotics, which are somewhat some often-used drugs, are frequently prescribed in non-infectious pathologies. Some indications are reported in the literature: immunosuppressive or antiinflammatory (disulone, salazopyrine, cotrimoxazole, clofazimine, fusidique acid), small bowel prokinetic action (macrolides), endocrine effects (déméclocycline, kétoconazole), enzymatic effects (rifampicine, cyclines), sclerotherapy (cyclines), pro- or anti-tumoral effects. This incomplete list is growing up every days.

Anti-Bacterial Agents↗