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Biomedical subjects

S Vinzio

Publications and source records attributed to S Vinzio.

33 records · Page 2Linked to original sources
PubMed2003

[Vitamin B12 deficiency with normal Schilling test or non-dissociation of vitamin B12 and its carrier proteins in elderly patients. A study of 60 patients].

PURPOSE: Approximately 15% of people over 60 years old have a cobalamin (Cbl) deficiency in relation with a food-cobalamin malabsorption (FCM). But to date, only case reports or small series have been reported. The aim of this study was to describe the clinical characteristics of the FCM in old subjects. METHODS: Sixty patients, at least 65 years old, presenting a Cbl deficiency related to FCM, were extracted from a cohort study of the Hôpitaux universitaires de Strasbourg, France (n = 169). All these patients had an established diagnosis of Cbl deficiency and met the Carmel's criteria of FCM. Their clinical data were retrospectively analysed. RESULTS: The median age of the 60 patients was 75 years and the female/male ratio was 2.3. The principal clinical symptoms were peripheral neuropathy (35%), confusion and dementia (30%) and anemia-related manifestations such as asthenia and edemas of the legs (20%). Average hemoglobin was 10.7 +/- 2.5 g/dl and average mean erythrocyte cell volume was 95.5 +/- 13.8 fl. There was an anemia, a leucopenia, a thrombocytopenia and a pancytopenia in respectively 27%, 18%, 15% and 8% of the cases. Average serum vitamin B(12) and homocystein levels were with 138 +/- 42 pg/ml and 22.5 +/- 15.2 micro mol/l. No patient had anti-intrinsic factor antibody and the Schilling's test was normal in all patients. Main disorders associated with FCM were atrophic gastritis (59%), long-term metformin or antiacid intake (17%), chronic alcohol intake (8%) and idiopathic FCM (n = 10). Sixteen patients have been successfully treated with oral crystalline cyanocobalamin (500 +/- 280 micro g/d). CONCLUSIONS: This study shows that: firstly, the Cbl deficiency related to FCM may be responsible of severe neurological and hematologic manifestations in approximately 20% of the elderly patients; secondly, the disorders associated with the FCM are multiple in old age, with mainly atrophic gastritis; and thirdly, in clinical practice, oral cyanoCbl treatment may be successful.

Administration, Oral↗
PubMed2003

[Hodgkin's disease manifesting as paraneoplastic limbic encephalitis].

INTRODUCTION: Malignancy is a possible cause of unexplained encephalitis. EXEGESIS: We describe a 59-years-old woman with limbic encephalitis, not explained by other causes, preceding diagnosis of Hodgkin's disease. Successful treatment of Hodgkin's disease was effective against neurological disturbance. CONCLUSION: This case provides evidence that Hodgkin's disease can be uncovered by paraneoplastic limbic encephalitis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Smoking and the thyroid].

The effects of smoking on the thyroid gland have been studied for years. The consequences of smoking on thyroid function and size are however still controversial. It is accepted that an increase in serum thyiocyanate, a potent inhibitor of iodine transport, may contribute to the development of thyroid dysfunction, particularly in geographical areas with borderline iodine deficiency. In the general population, smoking is associated with normal thyroid hormone levels, with a tendency to lower TSH levels and enlargement of thyroid size. There is an increased risk of developing over thyroid disease. The relationship between smoking and relapse of Graves' disease and the incidence and severity of Graves' ophthalmopathy are constantly reported. Smoking also has a potent nodular goitrigenic effect in low iodine areas. Despite the fact that smoking decrease both thyroid secretion and thyroid hormone action, hypothyroidism does not appear to be more frequent. Smoking does however increase the metabolic effects of hypothyroidism. Active and passive smoking have proven deleterious effects on the fetal thyroid. Paradoxically, there is evidence of reduced risk for thyroid cancer in smokers.

Goiter, Nodular↗
PubMed2001

[Autoimmune peripheral neuropathies with anti-MAG antibodies and hematological disorders. Five cases].

OBJECTIVE: The aim of this study was to report our experience with autoimmune neuropathies associated with hematological disorders and to describe their etiological and clinical polymorphism. PATIENTS AND METHODS: A retrospective study was conducted in five patients with autoimmune peripheral neuropathies with anti-MAG (myelin-associated glycoprotein) antibodies. RESULTS: Autoimmune neuropathies were associated with Waldenström's macroglobulinemia (n=2), Hodgkin disease (n=1), chronic lymphocytic leukemia (n=1) and idiopathic polyclonal B lymphoproliferation (n=1). Most of the patients had a sensorial polyneuropathy, predominant in the legs, exhibiting slow progress. Our patients showed a disappointing response to chemotherapy with stabilization or short response.

Adult↗
PubMed2000

[Adult celiac disease: importance of delay to diagnosis].

OBJECTIVE: Adult celiac disease is a genetically determined condition resulting from intolerance to gluten. This familial disease is associated with HLA B8 DR3 and is characterized by cytotoxic T-lymphocyte reaction in the digestive wall leading to a maladsorption syndrome. Adult celiac disease would be an expression of a silent disease already present in childhood. PATIENTS AND METHODS: We conducted a retrospective study in 19 patients. Diagnosis was established in a department of internal medicine in adulthood. We analyzed histological findings and the clinical history and course. RESULTS: The age curve at diagnosis peaked at 22 years and 67 years. Female sex predominated. Average delay to diagnosis was 3.1 years. The patients were admitted for reasons other than digestive disorders in 17 out of 19 cases. Careful history taking did however disclose subtle digestive signs. The principal manifestations were hematological disorders such as chronic anemia, abnormal liver function tests, and poor control of associated diseases. Type 1 diabetes mellitus was the main associated disease (4/19). Patients with prolonged nutritional deficiencies experienced serious situations. CONCLUSION: Adult celiac disease is a clinical variant suggesting the presence of other non-digestive disorders. Specific antibodies should be assayed in patients with even minimal signs of deficiency in order to identify associated diseases. The principal cause of mortality is digestive T-cell lymphoma. A gluten-free diet is essential to control the course of this chronic disease.

Adult↗
PubMed2000

[Capillary hyperpermeability syndrome of the face].

BACKGROUND: Capillary leak syndrome is a rare disorder, with various clinical features, characterized by episodes of diffuse edema. CASE REPORT: We report the case of a 83 year-old woman with capillary leak syndrome of the face characterized by recurrent episodes of edamata. We found a follicular non-Hodgkin's lymphoma and high levels of plasma interleukin (IL) 2 and IL 6. Regression of edema and remission of hematology disease have been obtained with corticoids and chloraminophene. DISCUSSION: This case illustrates that capillary leak syndrome may present as an edema of the face and may be in some cases considered as a paraneoplastic syndrome. The role of cytokines seems important. This case suggests that corticoids may be useful in the management of neoplasm induced capillary leak syndrome.

Aged↗
PubMed2000

[Do hematopoietic growth factors have a role in the treatment of drug-induced agranulocytosis?].

PURPOSE: Our study was aimed at determining the role of hematopoietic growth factor in drug-induced agranulocytosis. METHODS: Fifty-five cases of drug-induced agranulocytosis were reviewed and subdivided retrospectively into a G-CSF group (n = 15) and an untreated group (n = 40). Mortality and hematological recovery (number of days required for neutrophil counts to exceed 1.5 x 10(9)/L) were studied in the two groups. RESULTS: The mean granulocyte count was 0.09 x 10(9)/L. All patients presented infection. In the G-CSF group, no mortality (0% versus 5%, P = 0.85) and a shorter recovery time (8.1 versus 9.5 days P = 0.39) were observed. No significant difference between the two groups was observed in either the duration of antibiotic therapy (9.3 days in the G-CSF group versus 10.1 days in the untreated group, P = 0.51) or duration of hospitalization (10 days in the treated group versus 11 days in the G-CSF group, P = 0.46). CONCLUSION: Our results as well as a literature review indicate that G-CSF could decrease the time to hematological recovery and perhaps reduce mortality. However, the exact role of hematopoietic growth factors requires further investigations.

Aged↗
PubMed2000

[Unusual cause of chronic iron-deficiency anemia and insulin resistance: cholesterol embolism].

BACKGROUND: Cholesterol embolism disease (CED) is an extremely polymorphous clinical entity. Rare reports mention digestive or endocrine manifestations. CASE REPORT: A 73 year-old female patient developed CED disclosed by iron deficiency anemia with chronic digestive bleeding associated with major insulin resistance. DISCUSSION: Solitary iron deficiency anemia as the inaugural sign of CED is exceptional. Rare reports in the literature suggest it is related to polymorphous nonspecific lesions (ulcers, pseudotumoral lesions...) leading to chronic bleeding. Careful histopathology study of the lesions of fragments of healthy mucosa provides the correct diagnosis showing biconcave and optically empty slits. Insulin resistance has not been reported although prior diabetes is often mentioned as a predisposing factor for atherosclerosis. In our case, the role of CED was not determined, but pancreatic or inflammatory involvement can be envisaged.

Aged↗
PubMed2000

[Hypersensitivity syndrome : a rare but severe adverse effect of antithyroid drugs].

We report the case of a female patient with a severe hypersensitivity syndrome caused by carbimazole. She was treated for Graves' disease for a few weeks when she was referred for skin rash, increased liver enzymes and hypereosinophilia. No immunological abnormalities were detected. Discontinuation of carbimazole resulted in quick recovery. Pathogenesis of the hypersensitivity syndrome is discussed. Antithyroid drugs are rarely involved in the syndrome but cases with vasculitis have been described. In our patient, the role of excessive dose is possible.

Aged↗
PubMed2000

[Guillain-Barré syndrome and Mycoplasma pneumoniae infection].

Guillain-Barré syndrome subsequent to Mycoplasma pneumoniae is uncommon and difficult to confirm. We report one case. Clinical presentation and therapy were unremarkable. The interest of antibiotics (preventive or curative) is unresolved. The pathophysiology remains hypothetical but Mycoplasma pneumoniae and some surface gangliosides of peripheral nerves share homologous epitopes leading to the production of antibodies. Induced antibodies to ganglioside may cross-react with neural tissues.

Adolescent↗
PubMed1998

[Diffuse digestive tract B-cell lymphoma manifesting as exudative enteropathy].

BACKGROUND: Early manifestations of primary lymphomas of the digestive tract generally include general signs and abdominal pain. Diarrhea is uncommon and may result from several mechanisms. We report a case of primary lymphoma of the digestive tract in a patient presenting exsudative enteropathy. CASE REPORT: A 68-year-old woman was hospitalized for profuse diarrhea of 15 days duration. Laboratory tests showed major hypoalbuminemia. Malabsorption could not be evidenced and no infectious foyer was found. Biopsies at different levels of the digestive tract showed mucosal invasion by MALT type B-cell lymphoma. The clinical course was initially favorable after chemotherapy. DISCUSSION: Classification of digestive tract lymphomas differentiates MALT type B-cell lymphoma (the most frequently encountered type in western countries), Mediterranean lymphomas, and T-cell lymphomas generally complicating coeliac disease. MALT type lymphomas may occur in association with Helicobacter pylori infection, usually in a gastric localization. Multiple localizations are uncommon and diffuse involvement of the digestive tract as in our observation appears exceptional. This extension would explain the exsudative enteropathy which regressed with chemotherapy.

Aged↗
PubMedDate not supplied

Hematological response to short-term oral cyanocobalamin therapy for the treatment of cobalamin deficiencies in elderly patients.

OBJECTIVES: The aim of this trial was to demonstrate the efficacy of one month of oral cobalamin (vitamin B12) therapy in elderly patients with cobalamin deficiency related to food-cobalamin malabsorption (FCM). PATIENTS AND METHOD: Twenty elderly patients (mean age: 78+/-17 years) with established cobalamin deficiency related to FCM were included in an open-label, non-randomized, non-placebo trial. They were treated with a maximum of 1,000 microgram per day of oral crystalline cyanocobalamin for at least 1 month. Serum cobalamin levels (primary endpoint), blood count abnormalities and reticulocytes count (secondary endpoints) were determined at baseline and during the first month of treatment. RESULTS: 85% of the patients normalized their serum cobalamin levels with a mean increase of+167 pg/ml (p<0.001 compared with baseline). 100% of the patients corrected their initial macrocytosis and 25% their anemia; 100% of the patients had medullar regeneration with a mean increase of reticulocytes count of 32+/-11.3 x 106/l (p=0.03 compared with baseline). CONCLUSIONS: Our findings support the view that one month of oral crystalline cyanocobalamin is effective to correct serum vitamin B12 levels and to obtain hematological responses in elderly patients with cobalamin deficiency related to FCM.

Administration, Oral↗