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Biomedical subjects

S Herson

Publications and source records attributed to S Herson.

162 records · Page 9Linked to original sources
PubMedDate not supplied

[Fenofibrate induced polymyositis].

In a 65-year old man complaining of myalgias and loss of muscular strength, the creatine phosphokinase level was found to be 35 times higher than normal values. The electromyogram was of the diffuse myogenic type. Muscle biopsy showed necrotic lesions of the muscle fibres associated with perivascular infiltrates of mononuclear cells, leading to the diagnosis of polymyositis. This patient had been treated for 10 years with fenofibrate for hyperlipidaemia; during the last 32 months he had taken this drug in doses of 600 mg per day. Eight days after fenofibrate was discontinued, all clinical and laboratory abnormalities had disappeared. A reintroduction test performed 6 weeks later raised the creatine phosphokinase level up to 43 times the normal value. Withdrawal of fenofibrate therapy resulted in rapid and lasting recovery. This case shows that fenofibrate should be added to the list of drugs that are responsible for iatrogenic polymyositis.

Aged↗
PubMedDate not supplied

[The advantages of histological samples in sarcoidosis. Retrospective multicenter analysis of 618 biopsies performed on 416 patients].

The diagnosis of sarcoidosis is based on the finding of an epithelioid granuloma at histological examination. A retrospective study of 618 biopsies obtained from 416 patients with sarcoid disease showed an average sensitivity of 69 p. 100. The sensitivity of guided biopsies, especially skin and lymph node biopsies, was almost 90 p. 100, whereas that of blind biopsies tended to increase with the degree of hazard involved, ranging from 49 p. 100 in proximal bronchial biopsy to 70 p. 100 in liver needle biopsy. When treatment is not urgently required, the Kveim test is safe, cheap and fairly sensitive (65 p. 100 positive results).

Biopsy↗
PubMedDate not supplied

Features of polymyositis and dermatomyositis in the elderly: a case-control study.

OBJECTIVE: Polymyositis (PM) and dermatomyositis (DM) are uncommon idiopathic inflammatory myopathies (IIM). Little is known about these diseases in the elderly. We attempted to define the characteristics of PM/DM in the elderly by a case-control study involving the retrospective review of medical files of PM/DM patients. METHODS: We drew from among 200 PM/DM patients being followed in our Internal Medicine Department 21 patients (14 F/7 M), aged > or = 65 years at the onset of myositis (17 PM/4 DM) (mean: 69.9 +/- 4.8 yrs.). They were compared with 21 (15 F/6 M) randomly selected younger patients with IIM: PM (14) and DM (7) (mean: 46.4 +/- 12.4 yrs). Clinical, biological, electrophysiological and pathologic features, treatment regimens and side-effects in the 2 groups were collected. RESULTS: Clinical features were similar for the 2 groups. Elderly patients tended to have a higher frequency of cancer (24% vs 9.5%, p = 0.06), particularly of rectal adenocarcinoma. The time from disease onset to diagnosis was significantly longer in older patients (26 +/- 37 months vs 9 +/- 15 months; p = 0.02), normal CK levels were more frequent (40% vs 5%; p = 0.02) and serum CK levels were lower than for the population as the whole (11.5 N vs 22 N, p < 0.03). Electromyography features were more frequently suggestive of a chronic form of the disease in elderly patients. Treatment regimens and short-term side-effects were similar for the 2 groups. CONCLUSION: PM and DM are often diagnosed late in the elderly. Biological data and electromyography features argue for a chronic form of the disease in this age group. Clinical and endoscopic rectal examinations should be carried out in elderly patients with PM/DM.

Adenocarcinoma↗
PubMedDate not supplied

[Exudative enteropathy in disseminated lupus erythematosus].

We present the case of a young woman with a protein-losing enteropathy occurring in the context of systemic lupus erythematosus. This rare complication has limited gastro-intestinal manifestations and must be systematically looked for when hypoalbuminemia occurs in the absence of a lupus nephritis. High dose corticosteroids therapy (> or = 1 mg/kg/day of prednisone) usually leads to recovery, and should be the first treatment attempted. If this treatment is ineffective, bolus injections of methylprednisolone (1 g/day for three days) may be recommended. Immunosuppressive therapy should be given only if the above treatments are ineffective, or in case of cortico-dependency.

Adult↗
PubMedDate not supplied

[Lymphocytic interstitial pneumopathy in AIDS-related complex. Presence of the LAV virus in the bronchoalveolar lavage fluid].

A new case of lymphocytic interstitial pneumonitis developed in the course of a persistent generalized lymphadenopathy syndrome is reported. The patient was a 30-year old Haitian woman with only her ethnic risk factor. Broncho-alveolar lavage showed high cellularity with mostly major lymphocytosis (76%) and a fall of the OK T4/OK T8 ratio to 0.23. The LAV was isolated from the lavage fluid lymphocytes on the same day and within the same culture time as from blood, using lymphocyte culture and measurement of reverse transcriptase activity in the supernatant fluid of cell cultures. This, together with the strongly positive (1/80) LAV serology in fluid as compared with blood (1/640), suggested that the LAV virus was directly or indirectly involved in the pneumonitis, being responsible for lymphocyte proliferation as it is in lymph nodes. No superinfection with a bacterial, fungal or other than LAV viral agent was found in blood or in lavage fluid. Lymphocytic interstitial pneumonitis is uncommon in AIDS or ARC (13 cases reported), but its incidence no doubt is underestimated, as it may be latent. It certainly accounts for the high lymphocyte count observed in broncho-alveolar lavage fluid in the absence of superinfection and, most probably, for many cases of so-called "non-specific pneumonia". In 1986, patients with apparently primary lymphocytic interstitial pneumonitis should be investigated for AIDS or ARC.

AIDS-Related Complex↗
PubMedDate not supplied

[Short-term tracheobronchial clearance in apparently pure Gougerot-Sjögren syndrome].

Bronchopulmonary involvement in the Sjögren syndrome can lead to distal obstructive airway disease. This syndrome induces a decrease in secretions which become rare and thick, and consequently a slowing down of mucociliary activity. This activity, which can be estimated by tracheobronchial clearance studies, was investigated in seven non-smoking women (mean age = 56.7 yr) with the Sjögren syndrome but without patent distal bronchial impairment. After oral inhalation of radioactive particles labelled with 111In during spontaneous breathing (MMAD = 3 micrograms; sigma g = 1.4; energies gamma 173 and 247 keV, radioactive half-life = 2.8 days), the incorporated radioactivity was measured by a gamma-camera at the end of inhalation and then every 5 min throughout 90 min and 2, 4, 5, 6 and 24h thereafter. Biological decrease in radioactivity was exponential in form. Considering, as may authors do, the clearance of the tracheobronchial compartment to be completed within 24h, we calculated an initial biological period corresponding to the beginning of this clearance. It was equal to 101 +/- 27 min in 12 normal subjects. It was normal in three of our patients (T = 90, 91 and 101 min) and longer for the four others (T = 178, 203, 240 and 304 min). We hypothesize that three of these four patients with slow clearance and normal penetration index (tracheobronchial deposition/pulmonary deposition) had bronchiolar involvement, creating anomalies in the mucociliary escalator which were undetectable by clinical, radiological or functional examinations. These results argue in favour of strict pulmonary surveillance in patients with altered short-term clearances to enable early detection of bronchiolar disease.

Adult↗
PubMedDate not supplied

[Calcinosis universalis associated with dermatomyositis. A report on five cases (author's transl)].

Five patients with dermatomyositis developed calcinosis universalis, the calcinosis lesions being diffuse in three cases and localized to a subcutaneous site in the other two. The diffuse lesions developed in young subjects with severe dermatomyositis, and increased progressively during recovery from the muscle disease. Treatment was ineffective. Subcutaneous calcifications can be detected at an early stage by technetium pyrophosphate scintigraphy, while the fluid nature of the swellings due to a local inflammatory reaction is proved by ultrasonography. Good results are obtained after excision of those calcified masses requiring removal because of their size, site, or superinfection.

Adolescent↗
PubMedDate not supplied

[Clinical and diagnostic features in seven cases of sacro-iliac tuberculosis. Contribution of bone scintigraphy (author's transl)].

Sacro-iliac tuberculosis was detected in seven African immigrants following attacks of sacrolumbar pain with fever, over a period of five years. Two of the patients had a previous history of tuberculosis, and in six out of the seven cases the osteo-articular affection was part of a multifocal tuberculous disease. The value of bone scintigraphy is discussed. Surgical treatment was performed together with medical therapy in three cases.

Adult↗
PubMedDate not supplied

[Cardiac manifestations of scleroderma. Prospective study of thirty cases (author's transl)].

A prospective study was conducted to evaluate cardiac effects of scleroderma by means of phonomyography (30 patients) and ultrasound cardiography (18 patients). Clinically silent effusions can be detected by ultrasound cardiography, and 50 p. cent of the patients were found to have pericarditis through this investigative technique. Valvular lesions (mitral prolapsus) were present in a more important number than simply a coincidence. Measurement of myocardial relaxation appears to give the best indication of the specific myocardial lesion in this disease, and even may be of some prognostic value.

Adult↗
PubMedDate not supplied

Imbalanced "memory" T lymphocyte subsets and analysis of dendritic cell precursors in the peripheral blood of adult patients with Langerhans cell histiocytosis.

OBJECTIVES: To investigate the phenotype of lymphocytes and dendritic cell precursors in the peripheral blood of adult patients with histiocytosis X. METHODS: Data were obtained on patients with histiocytosis X treated in La Pitié-Salpetrière Hospital. Peripheral blood mononuclear cells from 10 patients (4 with unifocal and 6 with disseminated disease) were studied by flow cytometry. A method was set up to detect circulating Langerhans cells, dendritic cells and their precursors. RESULTS: An abnormal repartition of "memory" T lymphocyte subsets was observed, with a significant decrease of CD4CD45RO and CD8CD45RO and a reciprocal increase of CD4CD45RA "naive" cells, while CD4+ cells displaying the accessory molecule CD28 were decreased in some patients. These abnormalities disappeared in vitro after triggering of the CD3 and CD28 molecules in the absence of antigen presenting cells, hence demonstrating that there was no constitutive defect in the capacity of CD4+ and CD8+ T cells to convert from the CD45RO- to the CD45RO+ isoform. Langerhans cells were undetectable in the peripheral blood, and dendritic cells and their precursors were present in normal proportions (0.5 +/- 0.2% and 2.8 +/- 1.2%, respectively), but the latter were more numerous (4% and 6% of the PBMC) in the two patients with the more severe form of the disease. CONCLUSIONS: We found in these patients some T lymphocyte phenotype abnormalities which suggest alterations in antigen-driven activation processes. The number of dendritic precursor cells was not consistently elevated in the peripheral blood from histiocytosis X patients.

Adult↗