[Headaches, vomiting and left homonymous lateral hemianopsia in a 25-year-old man].
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Biomedical subjects
Publications and source records attributed to S Vignes.
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BACKGROUND: Neurological involvement occurs in 10 to 28% of patients with Behçet's disease. CASE REPORT: We report a case of neurological pseudotumoral presentation of Behçet's in a patient with a long standing disease treated with low dose of prednisone and colchicine (1 mg/day), 2 months after withdrawal of colchicine. CONCLUSION: Neurological manifestations during Behçet disease can be secondary to direct central nervous system involvement (encephalitis, encephalomyelitis) or vascular angitis (essentially cerebral venous thrombosis and, rarely, intracranial aneurysms). Neurological pseudotumoral presentation is rarely reported.
INTRODUCTION: As short-term corticosteroid therapy is widely used in clinical practice, it is important to determine its precise indications and limits of use. CURRENT KNOWLEDGE AND KEY POINTS: Duration of short-term corticosteroid therapy is arbitrarily considered to be up to 21 days. Anti-inflammatory, antiproliferative or analgesic actions represent the main pharmacological features of steroids. They are related to the interactions of steroids with cytokines and immune cells. Results of randomized double-blind and uncontrolled clinical studies were included in this review. Furthermore, clearly demonstrated results that were obtained more particularly in neurology, otorhinolaryngology, pneumology, infectious diseases, rheumatologic and traumatic processes are summarized. FUTURE PROSPECTS AND PROJECTS: Indications for short-term corticosteroid therapy are well established. However, further clinical studies are required, as current prescription of corticosteroid is still empirical in the management of most diseases.
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Adult onset Still's disease is a systemic disorder of unknown etiology. The diagnosis is difficult and based upon Yamaguchi's criteria after exclusion of infectious diseases, hematologic process or autoimmune diseases. Clinical manifestations are various. Functional prognosis depends essentially on articular involvement. Vital prognosis depends on either hepatic failure or hematological or infectious complications, or amyloidosis. Ferritinemia is an important biological parameter which is not included in current criteria. Treatment is not well codified but steroids represent the most efficient therapy to control fever and systemic manifestations. Search for new treatments and specific markers of adult onset Still's disease are needed.
Low-molecular-weight heparins (LMWH) have different properties than non-fractionated heparins. Bioavailability is better after subcutaneous administration and a longer halflife allows a single daily injection. Efficacy is equivalent for postoperative thromboembolism prophylaxis for all types of surgery. In most reports, low-molecular-weight heparins are more effective than non fractionated heparin and lead to fewer episodes of hemorrhage and thrombocytopenia. For treatment of deep vein thrombosis, low-molecular-weight heparins are as effective as non-fractionated heparins after two, or even one, daily injection without hemostasis tests. Other on-going studies are evaluating LMWH indications in pulmonary embolism, artery disease, pregnancy or other medical conditions.
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Since 3 years, a 74 year-old man suffered of swallowing impairment, weight loss, bilateral ptosis and proximal muscular weakness. Electron microscopy disclosed intranuclear tubular filaments and confirmed the diagnosis of oculopharyngeal muscular dystrophy. Upper oesophageal sphincter myotomy was performed with complete improvement. Four months after surgery, swallowing disorders were not recurrent and weight gain was substantial.
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The effect of human recombinant granulocyte colony-stimulating factor (hrG-CSF) in rabbits with aortic endocarditis due to Pseudomonas aeruginosa was investigated. hrG-CSF significantly increased the number of polymorphonuclear neutrophils in blood and in cardiac vegetations and the expression of the adhesin molecule CD11b on the surface of polymorphonuclear neutrophils compared with those of animals that had not received hrG-CSF. When treatment was started 72 h after bacterial challenge, hrG-CSF alone had no antibacterial effect and did not enhance the efficacy of ciprofloxacin when used in combination, even with the higher dosing regimen used (50 micrograms/kg of body weight subcutaneously every 12 h for 4 days), in terms of number of positive blood cultures, bacterial counts in vegetations, and survival. In contrast, when treatment was started 30 min prior to bacterial challenge, hrG-CSF (50 micrograms/kg injected every 12 h) decreased bacterial titers in vegetations 72 h later (6.5 +/- 0.9 versus 7.9 +/- 0.9 log10 CFU/g of vegetation for hrG-CSF and controls, respectively; P = prophylactic administration of hrG-CSF did not increase the antibacterial effect of ciprofloxacin. We concluded that the antibacterial effect of hrG-CSF in experimental endocarditis was related to the timing of its administration since hrG-CSF demonstrated a significant but transient antimicrobial effect only when treatment was initiated before bacterial challenge.
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