Annales De Medecine Interne[JOURNAL]
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200 papers
[Mesenteric venous thrombosis. A retrospective study of 23 cases].
Rieu V, Ruivard M, Abergel A … +4 more , Pezet D, Fouilhoux AC, Tournilhac O, Philippe P
Ann Med Interne (Paris) · 2003 May · PMID 12910039
UNLABELLED: Mesenteric venous thrombosis is uncommon. Diagnosis is difficult and much remains to be learned about clinical aspects, etiology and treatment options. PATIENTS AND METHODS: We conducted a retrospective study...
UNLABELLED: Mesenteric venous thrombosis is uncommon. Diagnosis is difficult and much remains to be learned about clinical aspects, etiology and treatment options. PATIENTS AND METHODS: We conducted a retrospective study over 5 years concerning patients with isolated mesenteric venous thrombosis or with extension to the portal vein. RESULTS: Twenty-three patients (12 women), mean age 55 years, were included. Abdominal pain (96%), bowel obstruction (35%), fever (26%), diarrhea (17%), gastrointestinal bleeding (13%) were the most common symptoms at presentation. In 78% of patients, at least one underlying condition was identified: thrombophilia, oral contraceptive, cancer, paroxysmal nocturnal hemoglobinuria, essential thrombocythemia, intra-abdominal processes. CT scan and ultrasound diagnostic sensitivity were 89% and 57% respectively. Outcome was favorable for the 18 patients treated with anticoagulants (associated with surgery in 4 patients). Three patients with neoplasm died early. CONCLUSION: Mesenteric venous thrombosis must be kept in mind as a possible diagnosis in patients with abdominal pain. Predisposing factors are frequently associated and should be searched for. Early diagnosis, using CT scan or ultrasound, enables immediate anticoagulation and seems to improve outcome.
[New challenges in medical oncology. From medical oncology to oncological medicine].
Durand JP, Goldwasser F
Ann Med Interne (Paris) · 2003 May · PMID 12910038
Abstract loading — click title to view on PubMed.
[Relationships between alexithymia, depression and interpersonal dependency in addictive subjects].
Speranza M, Stéphan P, Corcos M … +8 more , Loas G, Taieb O, Guilbaud O, Perez-Diaz F, Venisse JL, Bizouard P, Halfon O, Jeammet P
Ann Med Interne (Paris) · 2003 Jun · PMID 12910037
In the scientific literature, the term of addiction is currently used to describe a whole range of phenomena characterized by an irresistible urge to engage in a series of behaviors carried out in a repetitive and persis...
In the scientific literature, the term of addiction is currently used to describe a whole range of phenomena characterized by an irresistible urge to engage in a series of behaviors carried out in a repetitive and persistent manner despite accruing adverse somatic, psychological and social consequences for the individual. It has been suggested that subjects presenting such behaviors would share specific features of personality which support the appearance or are associated with these addictive behaviors. Dimensions such as alexithymia and depression have been particularly well investigated. The aim of this study was to explore the hypothesis of a specific psychopathological model relating alexithymia and depression in different addictive disorders such as alcoholism, drug addiction or eating disorders. Alexithymic and depressive dimensions were explored and analyzed through the statistical tool of path analysis in a large clinical sample of addicted patients and controls. The results of this statistical method, which tests unidirectional causal relationships between a certain number of observed variables, showed a good adjustment between the observed data and the ideal model, and support the hypothesis that a depressive dimension can facilitate the development of dependence in vulnerable alexithymic subjects. These results can have clinical implications in the treatment of addictive disorders.
[Cognitive disorders and chronic use of cannabis].
Karila L, Reynaud M
Ann Med Interne (Paris) · 2003 Jun · PMID 12910036
Cannabis is by far the illegal substance the most widely used by youth aged 12-25 years. One out of five persons living in France has already tried it once in his lifetime. Although the psychiatric symptoms as well as th...
Cannabis is by far the illegal substance the most widely used by youth aged 12-25 years. One out of five persons living in France has already tried it once in his lifetime. Although the psychiatric symptoms as well as the cognitive and acute or chronic behavioral effects linked to repeated use of cannabis are well documented in the literature, search for persistent cognitive effects amongst chronic users has not provided convincing evidence because of methodological biases. The issue is nevertheless most crucial, especially amongst teenagers, due to the potential risks of deteriorated academic, social and occupational performance. The longer the exposure to the effects of the substance, the greater the risk of complications. Based on data reported in the literature, we report the cognitive effects associated with chronic use of cannabis as well as its social and educational consequences.
[Maintenance treatment for opiate dependence. Which should we deliver and how should we prescribe it?].
Jacquiez O
Ann Med Interne (Paris) · 2003 Jun · PMID 12910035
Dr Olivier Jacquiez has practised in the Specialised Care Centre of Dunkerque for 3 years. From his own clinical experience related to the use of methadone and the medical literature, he gives his points of view concerni...
Dr Olivier Jacquiez has practised in the Specialised Care Centre of Dunkerque for 3 years. From his own clinical experience related to the use of methadone and the medical literature, he gives his points of view concerning maintenance treatment delivery, and the eventual influence of the regulations promulgated on January 30th, 2002 by the French Health Authorities (DGS/DHOS 2002/57) allowing each hospital practitioner to initiate a drug maintenance treatment with methadone.
Methadone therapy in Croatia.
Ivani A
Ann Med Interne (Paris) · 2003 Jun · PMID 12910034
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[Voluntary poisoning by ingestion of Datura stramonium. Another cause of hospitalization in youth seeking strong sensations].
Arouko H, Matray MD, Bragança C … +5 more , Mpaka JP, Chinello L, Castaing F, Bartou C, Poisot D
Ann Med Interne (Paris) · 2003 Jun · PMID 12910033
Natural hallucinogenic substances have been used in numerous cultures throughout the world for millenniums, providing a sacred intermediary between men and gods. They were used during initiatory, divinatory rites and pla...
Natural hallucinogenic substances have been used in numerous cultures throughout the world for millenniums, providing a sacred intermediary between men and gods. They were used during initiatory, divinatory rites and played an essential role in the myths of exorcism and charm where the initiated enters a sort of trance which separates the soul from the body before "revival". It resulted that a number of plants were given names reflecting their relationship with the divinities, bestowing upon them an aura of mystery and sacredness. With the development of free information superhighways via the net, recipes using these hallucinogenic substances can now travel anywhere on the planet, offering the non-initiated a means of experimenting their search for strong sensations. At the same time, the science of botany has undergone a major revolution. Patient observation of nature is no longer necessary since a well-conducted computer search can easily yield a large supply of plants offered for on-line purchase. Children and adolescents in primary and secondary schools are becoming a new target for the botanical market: young people exchange the latest recipes and Internet addresses, or more simply the objects of their new on-line purchase. This has led to an outbreak in the use of mushrooms and hallucinogenic plants where the cultural notion of initiation or sacred rites has metamorphosed into a phenomenon of communication between young people, notably during festive parties. Datura stramonium has become quite popular and the number of hospitalizations for acute datura poisoning has increased rapidly, as indicated by the statistics of the Bordeaux Poison Center (14 hospitalizations for voluntary poisonings with datura in 2002, compared with 5 in 2001). Besides the self-inflicted risk, one of the most important problems is the delay to diagnosis, simply because the primary care physician did not think of such an "exotic" cause. We report here the case of a 22-year-old young man hospitalized following ingestion Datura stramonium seeds. He presented confusions and dreamlike frenzy. The clinical course was favorable in 72 hours with symptomatic treatment, marked by amnesia of the episode.
[High dosage buprenorphine and injection practices. A study of 303 patients].
Courty P
Ann Med Interne (Paris) · 2003 Jun · PMID 12910032
In France, by the end of 1999, a study of a naturalistic-type was led by the Louis-Harris Institute on 303 persons taking high dosage (HD) buprenorphine. This study aimed to identify factors likely to be correlated with...
In France, by the end of 1999, a study of a naturalistic-type was led by the Louis-Harris Institute on 303 persons taking high dosage (HD) buprenorphine. This study aimed to identify factors likely to be correlated with stopping or continuing HD buprenorphine injections. We carried out a comparative study of four groups of HD buprenorphine users: "non-injectors" (n=90), "ex-injectors" (n=71), "monitored injectors" (n=69) and "un-monitored injectors" (n=72), with intra-group representativeness. The data was gathered in the context of anonymous interviews, by objective interviewers, in 20 regions. Most of the interviewees were also users or ex-users of more than one psychoactive substance. The "un-monitored injector" group was younger than the "non-injector" group and not as well integrated into society. The injection frequency was lower in patients receiving medical care. Research into the reasons for stopping and cutting down on HD buprenorphine injections revealed indicators such as the impossibility of breaking the injection habit, the fact that users seek the immediate sedation effect, and associating with friends who also inject. These factors seem to be greatest during critical periods, such as depression or the absence of well being. We showed that the factors involved in cutting down included: revaluation of the way in which the medicine was taken with the doctor, and becoming aware of the problems resulting from injection through information received from the doctor and/or by experiencing problems firsthand. In all the groups, the benefits associated with taking HD buprenorphine were observed and evaluated, starting with a list of 14 items. Five main benefits were found: cutting down on or stopping heroine, taking better care of oneself, making new plans, being in better physical shape, and finally, sleeping better. The improvement was greatest in the "non-injector" and "ex-injector" groups. The work that would be necessary to establish effective medical support involves a global approach including an appropriate initial prescription, paying special attention during critical periods, and verification of the mode of use so as to avoid under-dosing, and constant evaluation of the risk of resorting to injections. The fact that there are ex-injectors and that some regular injectors have not resorted to injecting during the last month shows the benefits of medical support.
[Sporting activities and psychoactive substance use. Data abstracted from the French part of the European School Survey on Alcohol and other Drugs (ESPAD 99)].
Arvers P, Choquet M
Ann Med Interne (Paris) · 2003 Jun · PMID 12910031
Few studies have analyzed in the general population psychoactive substance use among athletes, especially among females. In fact, sporting activity is often promoted in prevention actions, as an alternative to addiction...
Few studies have analyzed in the general population psychoactive substance use among athletes, especially among females. In fact, sporting activity is often promoted in prevention actions, as an alternative to addiction or alcohol, tobacco or other substance misuse. So, we propose an analysis of the ESPAD 1999 sample among students (16-18 years old), focused on the relationship between sporting activities and substance use. Boys play sport more frequently than girls (71.5% versus 49.5%) and report 8 hours and more a week 4 more times than girls (14% versus 3.5%). Sixty-eight percent of boys and 36% of girls have already participated in sport competitions, more often at a local, departmental or regional level; a minority of them (26% of boys and 20% of girls) have already participated in sport competitions at a national or international level. Sporting activity is decreasing with age among girls, students from general lycée play sport more frequently than others do (vocational lycée); the higher the father's education level, the more frequently the students play sport. Moderate sporting activity (1-8 hours a week) is a protective factor against regular smoking (OR=0.54 in boys and OR=0.60 in girls) and against regular cannabis use among boys (OR=0.64). Intensive sporting activity (>8 hours a week) is a risk factor for illicit drugs (except cannabis) use (OR=2.74) and sleeping drugs/tranquillizers (OR=1.82) only among girls. Competition level is the most important risk factor for substance misuse as well in boys (except sleeping drugs/tranquillizers) as in girls. Practical implications are: adjusting health policy concerning the beneficial effects of sporting activity, raising sports associations abilities and avoiding doping and addiction in high-level sporting activities.
[Analysis of drug consumption among ambulatory patients in a drug agency of Northern France (Lens)].
Brunelle E
Ann Med Interne (Paris) · 2003 Jun · PMID 12910030
The aim of this study was to describe and analyze the patterns of illicit psychoactive drug consumption, and the utilization of buprenorphine (BHD) in opiate-dependent patients interviewed in the drug agency of Lens. In...
The aim of this study was to describe and analyze the patterns of illicit psychoactive drug consumption, and the utilization of buprenorphine (BHD) in opiate-dependent patients interviewed in the drug agency of Lens. In our sample, multiple drug use was a massive phenomenon. Misuse of BHD was related to young age, multiple drug injection, gender (male) and risky injecting behavior. Multiple drug use was less frequent among patients with a BHD prescription. It is urgent that health professionals and decision-makers be aware of the heterogeneity of drug consumption habits and their impact on the utilization of drug maintenance treatment. Research is needed to understand the history and motivations for misuse and persistent injecting among some drug users. A national conference of consensus on how to implement and maintain treatments is a necessary step forward in caring for opiate drug addicts.
[High-dose buprenorphine prescription in southern France from 1999 to 2001].
Mancini J, Thirion X, Masut A … +5 more , Ronflé E, Coudert C, Pradel V, Frauger E, Micallef J
Ann Med Interne (Paris) · 2003 Jun · PMID 12910029
Several reports have focused on prescription of high-dose buprenorphine using data electronically transmitted to the French health reimbursement system. This study deals with high-dose buprenorphine prescriptions in the...
Several reports have focused on prescription of high-dose buprenorphine using data electronically transmitted to the French health reimbursement system. This study deals with high-dose buprenorphine prescriptions in the Bouches-du-Rhone region between 1999 and 2001. We determined the number of maintained patients followed by practitioners (either short- or long-term care), the doses administered, and the associated prescription of psychotropic treatments. The number of general practitioners involved in 84% of the prescriptions of high-dose buprenorphine grew with a high turnover (20%). More than 25% of the general practitioners in the region prescribed this drug, but only 38% of them were involved in long-term follow-up of more than one maintained patient. The number of maintained patients and the mean daily treatment dose delivered (13.4 mg/d during 2001) increased. The associated prescriptions of benzodiazepines concerned 47% of the patients during 2001 (on the rise), but the associated prescription of flunitrazepam tended to decrease (29% of the subjects during 2001 versus 32% during 2000). This study shows a tendency for deviant behaviors to increase, constituting a public health concern.
[Thinking of cocaine].
Sanchez M
Ann Med Interne (Paris) · 2003 Jun · PMID 12910028
Abstract loading — click title to view on PubMed.
[Pleural effusion as a first sign of Ig D lambda multiple myeloma].
Maachi M, Fellahi S, Diop ME … +3 more , Francois T, Capeau J, Bastard JP
Ann Med Interne (Paris) · 2003 Feb · PMID 12746663
Immunoglobulin D (IgD) multiple myeloma is rare, accounting for less than 2% of all patients with multiple myeloma. The main presenting features are bone pain in 70% of patients. Extramedullary involvement is less common...
Immunoglobulin D (IgD) multiple myeloma is rare, accounting for less than 2% of all patients with multiple myeloma. The main presenting features are bone pain in 70% of patients. Extramedullary involvement is less common. We report a case of Ig D lambda multiple myeloma in a 74-year-old man that was revealed by pleural effusion and dyspnea. This effusion was found to be caused by multiple myeloma after electrophoretic and cytologic assays. The patient received a course of chemotherapy with melphalan and prednisone. The patient died one month later with signs of septic shock. Pleural effusion as a first sign of Ig D multiple myeloma is rarely described and the prognosis associated with such a localisation is very poor.
[Non-metastatic thrombosis of the superior sagittal sinus complicating Burkitt's lymphoma. A case report].
Landolsi A, Ben Fatma L, Ben Ammou S … +6 more , Kallel L, Aloulou S, Gharbi O, Monastiri K, Kraïem C, Ben Ahmed S
Ann Med Interne (Paris) · 2003 Feb · PMID 12746662
We report a case of non-metastatic superior sagittal sinus thrombosis complicating a Burkitt's lymphoma of the small bowel, and review similar cases of this cerebrovascular disorder associated with lymphoma.
We report a case of non-metastatic superior sagittal sinus thrombosis complicating a Burkitt's lymphoma of the small bowel, and review similar cases of this cerebrovascular disorder associated with lymphoma.
[Hypoalbuminemia and invalidating edema in an elderly subject: treatment with parenteral albumin infusion].
Novella JL, Jochum C, Kack S … +2 more , Garron S, Blanchard F
Ann Med Interne (Paris) · 2003 Feb · PMID 12746661
Many factors can lead to edema. Hypoalbuminemia and the inability of the renal distal tubule to excrete salt are a common cause of edema, that can be due to a defect of albumin synthesis or malnutrition, kidney disease,...
Many factors can lead to edema. Hypoalbuminemia and the inability of the renal distal tubule to excrete salt are a common cause of edema, that can be due to a defect of albumin synthesis or malnutrition, kidney disease, protein-losing enteropathy, or increased protein catabolism. Hypoalbuminemia is frequent amongst elderly people. Its prevalence ranges from 4% to 50% depending on whether they live at home or in hospice. In normal circumstances, albumin has a double function to maintain oncotic pressure and to transport endogenous or exogenous substances. Lack of albumin is thus responsible for numerous pathological states. In this article, we report two clinical observations in patients aged over 65, suffering from generalized, highly invalidating edema, with low albumin states due to malnutrition. A rapid long-term recovery was observed after administrating albumin, and produced a far better quality of life for the patients. The clinical results obtained following this specific indication warrant further research work to verify their scientific validity on a larger scale.
[Insulin autoimmune syndrome revealing systemic lupus erythematosus].
Rouabhia S, Ramanoelina J, Godmer P … +3 more , Reach G, Dutel JL, Guillevin L
Ann Med Interne (Paris) · 2003 Feb · PMID 12746660
A 22-year-old woman was admitted in August 2001 for loss of consciousness due to hypoglycemia. Her serum insulin level during the hypoglycemic episode was high at 121 mU/l (normal range: 5-25 mU/l). She had never receive...
A 22-year-old woman was admitted in August 2001 for loss of consciousness due to hypoglycemia. Her serum insulin level during the hypoglycemic episode was high at 121 mU/l (normal range: 5-25 mU/l). She had never received an insulin injection. Insulin antibodies by radioimmunoassay were positive. During hospitalisation, the patient presented clinical and biological features of systemic lupus erythematosus (SLE). Treatment with high-dose corticosteroids and cyclophosphamide resulted in restoration of euglycemia associated with resolution of circulating anti-insulin antibodies and parallel improvement in clinical and laboratory features of SLE.
[Anti-phospholipid syndrome nephropathy].
Nochy D, Daugas E, Hill G … +1 more , Piette JC
Ann Med Interne (Paris) · 2003 Feb · PMID 12746659
In the course of the antiphospholipid syndrome (APS), the renal involvement attributable to primary APS, APS nephropathy (APSN), corresponds to vaso-occlusive lesions of the intrarenal vessels, associated side-by-side, a...
In the course of the antiphospholipid syndrome (APS), the renal involvement attributable to primary APS, APS nephropathy (APSN), corresponds to vaso-occlusive lesions of the intrarenal vessels, associated side-by-side, acute thromboses with chronic arterial and arteriolar lesions, leading to zones of cortical ischemic atrophy. A second retrospective study of 114 lupus patients was undertaken to determine whether APSN can be found in the course of systemic lupus and if there are biologic or clinical predictive factors of the presence of APSN. We showed the following
[Ovulation induction therapy and systemic lupus erythematosus].
Lê Thi Huong D, Wechsler B, Piette JC
Ann Med Interne (Paris) · 2003 Feb · PMID 12746658
Improvement in the prognosis of SLE prognosis has led to considering infertility therapy. The earliest reports displayed complications such as SLE revealed by ovulation induction or thrombophlebitis. Fertility is known t...
Improvement in the prognosis of SLE prognosis has led to considering infertility therapy. The earliest reports displayed complications such as SLE revealed by ovulation induction or thrombophlebitis. Fertility is known to be normal in women with SLE, excepting amenorrhea accompanying severe flare-ups, renal insufficiency-related hypofertility and ovarian failure secondary to cyclophosphamide therapy. Anti-phospholipid antibodies are suspected to cause defective nidation and placental ischemia. An exponential rise of serum estradiol is observed irrespective of the ovulation induction protocol used, leading to SLE flare-up and thrombosis. We have experience with 114 cycles in 21 women with SLE and/or APS. A complication (fetal loss, SLE flare-up, thrombophlebitis) revealed the underlying disease in 8 women. Eighteen pregnancies led to 9 live-births, 4 fetal deaths and 5 embryonic losses. Pregnancy rate was higher after ovulation induction using gonadotropins (25% per cycle), than clomiphene (4%). Pregnancy rate was similar after IVFETE, whether the protocol was planned or not. However, three-quarters of the pregnancies after unplanned IVFETE led to abortions. On the contrary, 6 out of 7 pregnancies after planned IVFETE led to live-births. Two women developed thrombophlebitis after gonadotropins therapy. A SLE flare-up appeared after 13 out of 62 cycles, with a flare-up rate higher after gonadotropins (27% per cycle) than clomiphene therapy (6%), and after an unplanned (30%) than a planned procedure (10%). In conclusion, ovulation induction therapy can reveal SLE or APS. Clomiphene complications are uncommon. When gonadotropin therapy is considered, a preventive anti-inflammatory therapy should be discussed in SLE patients, in conjunction with heparin and/or anti-aggregate therapy for those with asymptomatic anti-phospholipid antibodies or prior thrombotic events.
[Classification of dermatologic manifestations in lupus erythematosus].
Francès C, Barete S, Ayoub N … +1 more , Piette JC
Ann Med Interne (Paris) · 2003 Feb · PMID 12746657
Various dermatologic manifestations are observed in the different lupus subsets. Lupus lesions are characterized by a dermo-epidermal dermatitis. Other lesions, vascular or non vascular, are essentially present in associ...
Various dermatologic manifestations are observed in the different lupus subsets. Lupus lesions are characterized by a dermo-epidermal dermatitis. Other lesions, vascular or non vascular, are essentially present in association with systemic lupus erythematosus. Acute, subacute and chronic lupus erythematosus are distinguishable according to their clinical aspects, pathological features and evolution. Acute lesions are either localized to the midface or widespread. Subacute lesions may be annular or psoriasiform. Chronic lupus erythematosus includes localized or widespread discoid lupus, lupus tumidus, chilblain lupus and panniculitis. Therapy of cutaneous lupus is mainly based on antimalarials and avoidance of sun irradiation. In refractory cutaneous lupus, no universal guidelines are currently available. Except for acrosyndromes and urticaria-like lesions, vascular lesions may be due to vasculitis or thrombosis. An accurate diagnosis is absolutely necessary since therapy is different in thrombosis and vasculitis. Non vascular and non lupus lesions are numerous, some of them require special treatment such as dapsone for bullous lupus.
[Role of the nucleosome in the physiopathology of systemic lupus erythematosus].
Amoura Z, Piette JC
Ann Med Interne (Paris) · 2003 Feb · PMID 12746656
Evidence is to date accumulating to suggest that the nucleosome, the fundamental unit of chromatin and ubiquitous product of cell apoptosis, plays a key role in the pathogeny of systemic lupus erythematosus (SLE). Nucleo...
Evidence is to date accumulating to suggest that the nucleosome, the fundamental unit of chromatin and ubiquitous product of cell apoptosis, plays a key role in the pathogeny of systemic lupus erythematosus (SLE). Nucleosomes play a central role in the antinuclear antibody response in SLE. Lupus anti-dsDNA and antihistone antibodies are directed towards nucleosomes and belong together with nucleosome-specific antibodies to a broad anti-nucleosome antibody family. Besides anti-dsDNA, nucleosome-specific antibodies have a major role in the pathophysiology of SLE and emphazise the role of nucleosome-antinucleosome immune complexes. Antinucleosome IgG antibodies are a more sensitive marker of SLE than anti-dsDNA. High levels of antinucleosome IgG are almost exclusively found in SLE. Antinucleosome IgG3 are strongly correlated with the SLE disease activity index. Nucleosome can bind to the surface of several cell types and mediate the binding of antinucleosome antibodies. Understanding of the key role of the nucleosome has opened new therapeutic intervention in SLE, such a tolerance induction to the subnucleosomal particles.
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