Ann Med Interne (Paris)
· 2002 Dec · PMID 12610424
Systemic lupus erythematosus is a non-organ-specific autoimmune disease characterized biologically by B lymphocyte hyperactivity and the production of autoantibodies directed against various cellular components, in parti...Systemic lupus erythematosus is a non-organ-specific autoimmune disease characterized biologically by B lymphocyte hyperactivity and the production of autoantibodies directed against various cellular components, in particular nuclear antigens. Different strains of mice spontaneously develop a lupus-like disease and constitute a guidelight for human SLE. Both polyclonal B cell stimulation and clonal expansion induced by self-antigens participate in B cell hyperactivity observed in human and mouse SLE. B cells are hyperactive to various stimuli, in particular those delivered by T cells through surface molecules or cytokines. The consequences are an increased production of immunoglobulins and the development of autoantibodies thought to induce the major part of tissue lesions. B cells also participate in the pathological process as antigen-presenting and cytokine-secreting cells. An intrinsic defect of B cells is suspected to be responsible for B cell anomalies as illustrated by certain spontaneous murine models of SLE (motheaten mice) and by lupus-like syndromes observed in mice rendered deficient for genes controlling the B-cell receptor (BCR) signaling pathway. Genome wide scan analysis of various lupus strains allowed to identify several loci predisposing to lupus among which certain are associated with B cell hyperactivity suggesting that the intrinsic defect is inherited.
Ann Med Interne (Paris)
· 2002 Dec · PMID 12610423
Factitious disorders are characterized by self-produced symptoms and a chronic course, sometimes with severe complications. Pathomimia occurs more often in women, even though the Munchausen syndrome is found especially i...Factitious disorders are characterized by self-produced symptoms and a chronic course, sometimes with severe complications. Pathomimia occurs more often in women, even though the Munchausen syndrome is found especially in men. Among the various clinical features of pathomimia, the most frequent are factitious fevers and cutaneous pathomimia. Factitious psychiatric disorders are not rare, such as factitious psychotic symptoms, mournings or post-traumatic stress disorders. The main elements of diagnostic orientation are the odd expression of the reported symptoms, a capricious and disconcerting course, as well as the multiplicity of the previous history, with many imprecise diagnoses. Concerning the psychopathology, and contrary to the simple simulation, immediate utility of the alleged symptoms is not the expected goal, one of the essential psychological motivations being to challenge the physician. Among comorbid pathological personalities, there seems to be some close relations between pathomimia and hysterical personality, whereas the Munchausen syndrome shares common features with antisocial personality.
Ann Med Interne (Paris)
· 2002 Dec · PMID 12610422
Magnetic resonance spectroscopy (MRS) is a method enabling the analysis of the tissue metabolic content. It may offer a more accurate diagnosis of the intracranial tumors than conventional MRI sequences. MRS of normal br...Magnetic resonance spectroscopy (MRS) is a method enabling the analysis of the tissue metabolic content. It may offer a more accurate diagnosis of the intracranial tumors than conventional MRI sequences. MRS of normal brain parenchyma displays 4 main metabolites: N-acetyl aspartate (neuronal marker), creatine (cellular density marker), choline (membrane activity marker) and myoinositol (glial marker); pathological processes lead to variations of the level of these metabolites and/or the appearance of abnormal metabolites (lactate), following different patterns according to pathological process involved: glioma, meningioma, metastasis, bacterial or toxoplasmic abscess, radionecrosis. The potential clinical use of this method includes positive, differential and etiological diagnosis of tumors, determination of the level of malignancy of gliomas, screening for tumor recurrence following treatment. Our laboratory has been performing MR spectroscopic explorations of brain tumors for many years. Based on this experience, we show how MRS can be routinely performed in the clinical setting, what are its limitations and potential, and what kind of information can be supplied to the clinician.
Vergely N, Mounier C, Guy C
… +2 more, Millot L, Estour B
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598835
Iatrogenic causes of adrenal insufficiency in Addison's disease are exceptional. We report the case of a patient with a history of epilepsy (taking carbamazepine, Tégrétol LP) and Addison's disease (treated by hydrocorti...Iatrogenic causes of adrenal insufficiency in Addison's disease are exceptional. We report the case of a patient with a history of epilepsy (taking carbamazepine, Tégrétol LP) and Addison's disease (treated by hydrocortisone (HDC) 30 mg/d, Dectancyl 0,5 mg/d, Florinef 50 mg/d). Recent digestive disorders required emergency hospitalization. The physical examination was normal and laboratory tests showed hyponatremia, hyperkalemia, and elevated serum ACTH. The course was rapidly favorable after rehydration and up-titration of the drug regimen. No triggering factor was identified, but the Tégrétol LP had been replaced for 3 months by a generic drug with the same quantity of active ingredients and the same bioavailability, but with a different excipient (the generic drug was not encapsulated). Could these differences have increased the serum level of carbamazepine and lead to more rapide HDC metabolism by enzymatic induction? Could poorer digestive tolerance have decreased HDC absorption? The hypothesis of carbamazepine overdosage is unlikely because the assay remained within the therapeutic range and hyperkaliemia would favor adrenal decompensation. In conclusion, this single case cannot prove drug interaction but does point out the importance of being prudent when modifying a well--tolerated regimen in a patient with Addison's disease.
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598834
Nephrogenic ascites is a clinical diagnosis defined as a refractory ascites in patients with end-stage renal disease. The exact cause of ascites formation is unknown. Patients frequently present with moderate to massive...Nephrogenic ascites is a clinical diagnosis defined as a refractory ascites in patients with end-stage renal disease. The exact cause of ascites formation is unknown. Patients frequently present with moderate to massive ascites and cachexia. The ascitic fluid is an exudate. The diagnosis is one established only by exclusion of the others causes of exudative ascites. Only continuous ambulatory peritoneal dialysis and renal transplantation appear to be effective in controlling ascites formation. The prognosis is dismal. We described here one patient case with nephrogenic ascites and review of the literature.
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598832
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic disorder with serum monoclonal immunoglobulin less than 30 g/l. It preferentially affects elderly patients; MGUS prevalence is about 1% in the...Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic disorder with serum monoclonal immunoglobulin less than 30 g/l. It preferentially affects elderly patients; MGUS prevalence is about 1% in the general population and about 10% in patients aged over 80 years. MGUS diagnosis is based on elimination of other causes of serum monoclonal immunoglobulin, particularly multiple myeloma. Within the 20 years following diagnosis of MGUS, about 25% of patients will evolve towards myeloma or other malignant lymphoproliferative disorder. No factor has been identified to date which can efficiently predict this evolution. Recent data concerning immunophenotype, cytogenetics and molecular biology of plasma cells demonstrate the link between MGUS and multiple myeloma. MGUS clearly appears now as a plasma cell monoclonal pathology with reduced malignity. Soon, new biological data would help to discriminate patients with MGUS who will remain asymptomatic life-long from those who will evolve towards malignant lymphoproliferative disorder.
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598831
Vasculitis of the nervous system are rare in the elderly. When present, they may constitute an urgent diagnosis and a therapeutic emergency. Clinical expression is rich and without specificity. Atypical signs (unusual co...Vasculitis of the nervous system are rare in the elderly. When present, they may constitute an urgent diagnosis and a therapeutic emergency. Clinical expression is rich and without specificity. Atypical signs (unusual course of dementia, systemic signs) or atypical laboratory results (inflammatory syndrome) may suggest the diagnosis of vasculitis. However, as multiple comorbidity is the rule in elderly subjects, searching for intercurrent factors (e.g. atrial fibrilation due to infectious disease causing embolic stroke) may be more contributive than searching for proof of a rare disease (vasculitis) with invasive procedures in this population. Giant cell (temporal) arteritis is the only vasculitis specifically related with age; the vital prognosis of vision may be compromised. Corticosterid therapy must be instituted without delay. Periartritis nodosa begins in 30% of cases after 60 years of age. The clinical features are the same as in younger subjects. Other vasculidis are rare in the elderly. In absence of specific studies in this population, therapeutic protocols are the same as in younger subjects but may have to be adjusted.
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598830
Global malnutrition (reduced intake or increased requirements for protein and calories) is the most common nutritional deficit in the elderly population. Micronutrients (vitamins and trace minerals) deficiencies are also...Global malnutrition (reduced intake or increased requirements for protein and calories) is the most common nutritional deficit in the elderly population. Micronutrients (vitamins and trace minerals) deficiencies are also common in older adults. Malnutrition consequences on immunity are characterized by a decrease in cell mediation immunity with a reduction in naive T cells and in cytokine production. During infection, the treatment must be specific and after infection it has to associate nutritional supplementation and exercise. The lack of clear benefit in the use of specific micronutrient should discourage the use of high-dose supplementation for an immunologic indication.
Moulias R, Raynaud-Simon A, Moulias S
… +1 more, Meaume S
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598829
Immune deficiency is not an age-related process, but rather a progressive process where predominantly cellular immune response is gradually, but never totally, replaced by antibody response. Cellular immune response appe...Immune deficiency is not an age-related process, but rather a progressive process where predominantly cellular immune response is gradually, but never totally, replaced by antibody response. Cellular immune response appears to be associated with the intrinsic mechanisms of pathological aging. Cellular immunity resulting from induction of macrophage stimulation and cytokine secretion appears to involved. These immuno-inflammatory changes mimic the effects of pathological aging in the different organs. Are they essential factors or simply accessory phenomena? Switching towards an antibody response appears to be a mechanism of adaptation rather than a mechanism of deterioration. Immune status provides a good means of assessing general status in an elderly subject. An attempt should be made to identify the cause of any immune deficiency since age is not in itself an underlying cause. Etiological treatment is indicated.
Zahiri K, Hachim K, Fatihi el M
… +3 more, Benghanem MG, Ramdani B, Zaïd D
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598828
Parathyroidectomy changes the homeostasis of calcium balance in patients under dialysis for kidney failure. The aim of this work is to value calcium needs in 20 hemodialysed patients who underwent parathyroidectomy, in t...Parathyroidectomy changes the homeostasis of calcium balance in patients under dialysis for kidney failure. The aim of this work is to value calcium needs in 20 hemodialysed patients who underwent parathyroidectomy, in the department of nephrology of UHC Ibn Rochd of Casablanca from January 1994 to June 1999. These patients, 12 women (60%) and 8 men (40%), aged between 14 and 70 years (mean=46.10+/-13.62 years). Hungry bone syndrome was noted in 8 patients and postoperative hypocalcemia in 15 (75%). Mean minimal serum calcium was 196+/-0.21 mmol/l, with clinical signs in 6 patients. Mean calcium supplement the first postoperative week was 18.1+/-0,54 g/day in the 8 patients with hungry bone syndrome and 14.28+/-0,86 g/day in the 12 remaining patients. Between 6 and 18 months postoperatively, required calcium supplementation was 4.5 to 12 g/day in patients with hungry bone syndrome compared with 3 to 6g/day at the remaining patients. Mean serum calcium remained stable between 2.16 mmol/l to the 3(rd) month and 2.48 mmol/l to the 36(th) month. Postoperative hypocalcemia remains a major concern after parathyroidectomy requiring massive substitution with calcium and active vitamin D metabolite under close supervision to spare these patients from hypercalcemia resulting from parathyroid dysfunction.
Salmon-Ceron D, Groupe Recherche Anti-TNF et Infections Opportunistes, Agence Française de Sécurité Sanitaire des Produits de Santé
Ann Med Interne (Paris)
· 2002 Nov · PMID 12598827
An unusually large number of cases of tuberculosis, often with miliary or widespread dissemination, has been reported in patients taking infliximab for rheumatoid arthritis or Crohn's disease. Recommendations have been i...An unusually large number of cases of tuberculosis, often with miliary or widespread dissemination, has been reported in patients taking infliximab for rheumatoid arthritis or Crohn's disease. Recommendations have been issued in France regarding the definition of high-risk patients, the screening methods to be used in these patients, and possible prophylactic treatments. The present update is also intended to help physicians manage tuberculosis occurring before or during infliximab therapy.
Berthoz S, Ringuenet D, Corcos M
… +2 more, Martinot JL, Jeammet P
Ann Med Interne (Paris)
· 2002 Nov · PMID 12518087
Among the brain imaging studies that have been conducted in eating disorder patients, some focused on the morphological alterations associated with these disorders, and others aimed at investigating functional cerebral a...Among the brain imaging studies that have been conducted in eating disorder patients, some focused on the morphological alterations associated with these disorders, and others aimed at investigating functional cerebral alterations of these patients. However, very few studied the links between the observed morphological and functional alterations and cognitive functioning of these patients more specifically. Here we report the results provided by the various brain neuroimaging techniques that were used to assess brain structure and functioning, and neuroendocrine dysregulation of eating disorders patients. A number of abnormalities evidenced by neuroimaging studies, notably the structural ones, do not seem completely reversible with clinical improvement. This article stresses the need for more imaging studies examining to which extent these alterations are reversible. Based on animal and human literature describing the neural bases of eating behavior, that highlight potential pathophysiological mechanisms that may be involved in the etiology of eating disorders, we will try to determine how understanding eating disorders pathophysiology could benefit from the use of neuroimaging.
Bydlowski S, Corcos M, Consoli SM
… +5 more, Paterniti S, Laurier C, Chambry J, Loas G, Jeammet P
Ann Med Interne (Paris)
· 2002 Nov · PMID 12518086
According to clinical reports, patients with eating disorders (EDs) are unable to differentiate and regulate emotional states. They are hypothesized alexithymic and lacking of emotional awareness. We investigate EDs capa...According to clinical reports, patients with eating disorders (EDs) are unable to differentiate and regulate emotional states. They are hypothesized alexithymic and lacking of emotional awareness. We investigate EDs capacity to experiment pleasure and levels of emotional awareness, in a comparative study. As expected, EDs show a global deficit of emotional functioning, with inability to identify and describe their own emotions, as well as an impairment in mentalising others' emotional experience, and an anhedonia. No relations between the duration of illness and the emotional dimensions were found. This trouble in regulation of emotions either follows the eating disorder and constitutes a lasting sequel, or appears to be a personality trait