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Biomedical subjects

R Touraine

Publications and source records attributed to R Touraine.

At least 55 records · Page 3Linked to original sources
PubMed1987

Toxic epidermal necrolysis. Clinical findings and prognosis factors in 87 patients.

Eighty-seven patients with toxic epidermal necrolysis were observed at Hôpital Henri Mondor in Créteil, France, over the last 12 years. The mean percentage of body surface area involved was 39%. Erosive mucous membrane lesions, identical to those of Stevens-Johnson syndrome, were present in all but three cases. Necrolysis was sometimes generalized within 24 hours but usually spread progressively after a Stevens-Johnson syndrome-like aspect at the onset. Mortality was 25%. Infection, mainly with Staphylococus aureus and Pseudomonas aeruginosa, was the first cause of death, clearly responsible in ten of 20 cases. Age, extension of necrolysis, idiopathic nature of toxic epidermal necrolysis, ingestion of many drugs, elevation of urea, creatinine, and glucose levels, neutropenia, lymphopenia, and thrombocytopenia were statistically linked to a bad prognosis. A multivariant analysis showed that three of these prognosis factors are of paramount importance, namely: age, area of necrolysis, and serum urea level. Pigmentary changes and sicca syndrome were frequently observed sequelae in survivors.

Adolescent↗
PubMed1987

[Subacute cutaneous lupus: critical study].

Subacute cutaneous lupus erythematosus has been identified as a bioclinical entity associating particular clinical signs (diffuse superficial cutaneous lesions evolving without atrophy or scarring), biological markers (anti-Ro/SSA, HLA A1 B8 DR3) and a good prognosis. We assessed the reality of this entity: 1) all the anti-Ro/SSA sera at H.-Mondor Hospital was examined over a 2 year period; 58 of the 963 sera tested were positive. Thirty one of the 58 positive patients had lupus (53 p. 100), but only 12 (21 p. 100) had subacute cutaneous lupus; 2) a photographic dossier was examined by three dermatologists who classified the photos of 74 patients independently. All three observers agreed on the diagnosis of subacute cutaneous lupus erythematosus in only 32 p. 100 of cases. The 17 patients in whom the diagnosis was retained did not differ clinically from the 23 cases of systemic lupus. Anti-Ro/SSA antibodies were found in 42 p. 100 of cases of subacute cutaneous lupus and in 23 p. 100 of cases of systemic lupus erythematosus (not significant). The results of this double blind study indicate that the reality of subacute cutaneous lupus erythematosus as a separate entity is debatable.

Diagnosis, Differential↗
PubMed1987

Genetic susceptibility to toxic epidermal necrolysis.

The pathophysiologic events leading to toxic epidermal necrolysis (TEN) remain unknown. With the idea of an immunologically mediated reaction occurring in predisposed subjects we performed HLA-A, -B and -DR typing in 44 patients surviving TEN. We observed a significant increase of only HLA-B12, previously found associated with ocular complications of Stevens-Johnson syndrome. When patients were stratified according to the drugs involved as causes for their TEN, we found other HLA phenotypes associated with B12, varying with each category of drugs. Sulfonamide-related cases of TEN were linked to A29, B12, and DR7, while oxicam-related cases of TEN were linked to A2 and B12. These results suggest that a genetic background, related to the major histocompatibility complex, may contribute to severe blistering drug reactions.

Adolescent↗
PubMed1987

The culprit drugs in 87 cases of toxic epidermal necrolysis (Lyell's syndrome).

Between 1972 and 1985, 87 patients with toxic epidermal necrolysis (TEN) were admitted to the dermatological intensive care unit at Hôpital Henri Mondor, Créteil, France. The culpable drug was determined by standardized criteria. Only three patients had received no drugs before the onset of TEN. Most patients (71 of 87) were receiving more than one drug. Patients had taken an average of 4.4 +/- 3.4 drugs each. A culpable drug was determined in 67 patients (77%). The mean time from first drug administration to onset of TEN was 13.6 +/- 8.4 days. The culprit drugs included the following: sulfonamides, 18 cases, and especially sulfamethoxazole and trimethoprim, 12; anticonvulsants, seven (barbiturates and carbamazepine only); nonsteroidal anti-inflammatory drugs, 29 (especially the phenylbutazone derivative, 16, and oxicam derivatives, 10); allopurinol, three; chlormezanone, three; and others, seven. Aspirin, antipyretics, and antibiotics are infrequently implicated in this series. The pattern of culprit drugs changed with years. The level of sulfonamide-related TEN remained the same, while incidence of nonsteroidal anti-inflammatory drug-induced TEN increased sharply, the introduction of oxicam derivatives being in part responsible.

Adolescent↗
PubMed1986

[Pleural mesothelioma. Developmental and therapeutic aspects apropos of 37 cases].

Thirty-seven cases of pleural mesothelioma seen in our unit between 1974 and 1984 have been reviewed. In cases with limited lesions early thoracotomy with an attempt at pleurectomy/lung decortication seemed to be justified. Thereafter - or initially in patients with extensive lesions - we resort to radiotherapy and/or chemotherapy. Although the final result was mediocre, we found it difficult to abstain from any treatment. Owing to the lack of large series and to the heterogeneity of those that have been published, no fixed rule can be laid down for the treatment of mesothelioma. Nevertheless, it would appear that using multiple therapeutic methods results in a somewhat longer survival.

Adult↗
PubMed1986

[Pulmonary metastases of a placental choriocarcinoma].

Pulmonary metastases of a placental choriocarcinoma are common but they are rarely the presenting factor, and whenever there are pulmonary metastases in a young woman a systematic search is required. We report on 7 cases and emphasize several important points. The diagnosis rests on the level of Beta H.C.G. One should be cautioned about transparietal aspiration or fibreoptic biopsy in view of the haemorrhagic nature of the lesion. An extensive work-up should be performed before classifying patients as low, medium or high risk as on this will determine the type of chemotherapy, either monotherapy with Methotrexate or polychemotherapy. The duration of treatment will depend on the clinical, radiological and biological outcome.

Adult↗
PubMed1986

[Pneumopericardium complicating bronchial cancer].

We report an observation of pneumopericardium occurring, without iatrogenic trauma in the preceding days, during the course of an epidermoid bronchial carcinoma, treated for a year by radio- and chemotherapy. The pneumopericardium produced a very attenuated clinical picture and was resorbed without incidence. But the patient died a few weeks after an overwhelming haemoptysis. The radiological picture is very characteristic. The differential diagnosis is above all that of a pneumo-mediastinum. But in the latter case, the clear zone exceeds the level of the great vessels and subcutaneous cervical emphysema in generally very clear both clinically and radiologically.

Aged↗
PubMed1985

[Treatment of bullous pemphigoid by plasma exchange and prednisolone].

Between March, 1983 and March 1984, 12 previously untreated patients (7 men, 5 women) with biopsy proven active bullous pemphigoid entered this open study. Their initial therapy associated oral prednisolone 0.5 mg/kg in divided daily doses with 4 large volume plasma exchanges (one and half the theoretical plasma volume) over 2 weeks. The disease was considered under control when new blisters and pruritus were absent for 2 consecutive weeks. This initial treatment was well tolerated by these elderly patients (mean age 80 +/- 9 years), with no death and no major complication. Eight patients were controlled within 29 +/- 4 days. During progressive decrease of steroid dosage 5 of these 8 patients remained well (mean follow-up 7 months), 2 relapsed and one died of marasmus. Among the 4 patients who were not controlled, 3 needed only a slight increase in prednisolone doses (0.75 mg/kg/d) and 1 required up to 1 mg/kg/d and 4 additional plasma exchanges. This study suggests that a combined treatment with moderate doses of prednisolone and 4 large volume plasma exchanges is well tolerated and highly effective in bullous pemphigoid.

Aged↗
PubMed1985

Sjögren-like syndrome after drug-induced toxic epidermal necrolysis.

7 of 9 patients recovering from a drug-induced toxic epidermal necrolysis (TEN) which they had had 2 months to 4 years before had xerostomia, or keratoconjunctivitis sicca, or both. 5 patients had symptoms; 2 had severe visual impairment. In 5 cases there was lymphocytic infiltration of small salivary glands; in 2 patients this was identical to that of Sjögren syndrome. None of the patients had antinuclear antibody. TEN may occur during acute graft-versus-host disease (GVHD) and these observations are reminiscent of the sicca syndromes reported during chronic GVHD. They suggest that autoimmune mechanisms may be involved in drug-induced TEN and that Sjögren syndrome may occur as the result of a drug reaction.

Adult↗
PubMed1985

Lymphopenia and abnormal balance of T-lymphocyte subpopulations in toxic epidermal necrolysis.

A lymphopenia (peripheral-blood-lymphocyte count less than 1,000/mm3) was observed in seven out of ten patients with toxic epidermal necrolysis (TEN). The enumeration of T-lymphocyte subsets with monoclonal antibodies showed a decreased number of pan T-lymphocytes (OKT3-positive), which was related to a profound depletion of OKT4-positive cells. In contrast, OKT8-positive cell counts were not significantly changed. This abnormal balance of T-lymphocytes was linked to the acute phase of the disease and was not found after recovery. The pathogenetic mechanisms of such T-lymphocyte abnormalities in TEN remain unclear.

Adolescent↗