Ann Med Interne (Paris)
· 2002 Nov · PMID 12518081
There is evidence that nicotine, the major constituent of cigarette smoking, leads to addiction. Although a high percent of smokers express the desire to quit, only a small percentage of them are successful in achieving...There is evidence that nicotine, the major constituent of cigarette smoking, leads to addiction. Although a high percent of smokers express the desire to quit, only a small percentage of them are successful in achieving sustained abstinence. Until recently, pharmacological options for treatment of tobacco dependence were primarily limited to the various nicotine replacement therapies. Bupropion provides clinicians and patients with a new non-nicotine alternative. The mechanisms by which bupropion acts as an aid in smoking cessation are unknown. This article is a review of the few explanations taken from the literature, to answer questions about the potential risks of the use of this atypical antidepressant.
Loustauneau A, Auriacombe M, Daulouede JP
… +1 more, Tignol J
Ann Med Interne (Paris)
· 2002 Nov · PMID 12518080
In this review of the literature, we collected 102 case reports of newborns exposed in utero to buprenorphine between 1996 and 2000. Reported data show that infants born to a mother taking buprenorphine are delivered at...In this review of the literature, we collected 102 case reports of newborns exposed in utero to buprenorphine between 1996 and 2000. Reported data show that infants born to a mother taking buprenorphine are delivered at term and have a birth weight close to infants not exposed to these substances. The published data also showed that observations have varied concerning the frequency, intensity, and duration of the withdrawal syndrome in newborns exposed in utero to buprenorphine.
Ann Med Interne (Paris)
· 2002 Nov · PMID 12518079
Hepatitis C represents a major public health challenge due to its chronic course and major complications (e.g. liver tumor and cirrhosis). New treatment strategies (pegylated interferon +/- ribavirin) have recently impro...Hepatitis C represents a major public health challenge due to its chronic course and major complications (e.g. liver tumor and cirrhosis). New treatment strategies (pegylated interferon +/- ribavirin) have recently improved the prognosis except in case of poor compliance. Psychiatric comorbidity, especially affective disorders, is commonly associated with hepatitis C and constitutes the main cause of poor compliance and treatment contraindication. The primary aim of our study was to emphasize the utility of a multi-disciplinary approach including psychiatric evaluation and preventive follow-up. The secondary objective was to show that a previous history of depression or attempted suicide should not be considered as a formal contraindication prohibiting the implementation of a specific follow-up. Fifty interferon treated patients were included in a prospective study: 20 were seen in an emergency setting in a context of anxiety or major depressive disorders after the initiation of the interferon treatment and 30 were followed on a systematic basis prior to the initiation of the interferon treatment. Our data confirm the high rate (52%) of major depressive disorders among the population of hepatitis C treated patients. A previous history of alcoholism might be predictive of such a complication. According to the subjective feeling of patients with previous break'off treatment associated with major depressive disorders, specific psychiatric follow-up may improve tolerance for the treatment. In conclusion, a previous history of depressive disorder or attempted suicide should not be considered as a contraindication, but should imply a specific psychiatric follow-up especially when alcoholism and previous break'off treatment are reported.
Ann Med Interne (Paris)
· 2002 Nov · PMID 12518078
Over two decades of rather restrictive regulations have kept the availability of methadone treatment (MT) at low levels in the province of Ontario, Canada. Regulatory changes in the Province of Ontario in the mid-1990s r...Over two decades of rather restrictive regulations have kept the availability of methadone treatment (MT) at low levels in the province of Ontario, Canada. Regulatory changes in the Province of Ontario in the mid-1990s relaxed relevant authorization and treatment practice guidelines. Subsequently, the number of physicians authorized for methadone treatment and treatment spots increased substantially. A large number of the newly authorized physicians are general/local medical practitioners. This study reports on the results of a survey conducted with the majority of MT prescribing physicians in Ontario authorized at the time of study. Physicians were surveyed on their attitudes and practices with regards to the MT authorization system, treatment approaches, requirements and workload, patient 'stability', additional opiate substitution treatment needs, and with regards to general issues and concerns about the new MT governance system. The article also discusses patterns and differences that were found between physicians when comparing their geographic location, whether they see themselves practicing under a 'harm reduction' or an 'abstinence' approach, and whether they received MT authorization under the old or the new guidelines. It is concluded that the liberalized regulations and the increased incorporation of local physicians seems to provide for an overall more desirable system of governance of MT. However, some relevant concerns about the current system exist and are discussed.
Lewden C, Bonnet F, Bevilacqua S
… +9 more, Heripret L, May T, Morlat P, Jougla E, Dabis F, Chêne G, Salmon D, Groupe d'Epidémiologie Clinique du SIDA en Aquitaine, Groupe "Mortalité 2000"
Ann Med Interne (Paris)
· 2002 Nov · PMID 12518077
Since the decline in mortality among HIV-infected persons after introduction of highly active antiretroviral therapy, concerns related to co-morbidities have increased as they may impair vital prognosis, particularly in...Since the decline in mortality among HIV-infected persons after introduction of highly active antiretroviral therapy, concerns related to co-morbidities have increased as they may impair vital prognosis, particularly in intravenous (IV) drug users. We describe firstly the changes in the distribution of the causes of death between 1995 and 2000 among IV drug users in the "Aquitaine Cohort" based on hospital information system, and secondly the distribution of the causes of death among IV drug users in the French national survey "Mortalité 2000" specifically set up in 2000 for optimal exhaustiveness. The total number of deaths declined between 1995 and 2000 and 1/3 were IV drug users. Deceased IV drug users were younger than other deceased patients, had longer median time from diagnosis of HIV infection and higher median CD4 cell count. Poor socio-economic conditions were notified in 55%. Among IV drug users, the proportion of AIDS-related deaths was above 75% in 1995 and below 30% in 2000. In 2000, 25% of deaths were HCV-related, 12% of deaths were due to accident, overdose or suicide, and 8% were due to non-AIDS non-HCV related cancer. Among IV drug users, improvement in vital prognosis requires to improve management of HCV infection and to take into account socio-economic conditions and other addictive behaviours like alcohol consumption and smoking.
Denes E, Amaniou M, Rogez JP
… +2 more, Weinbreck P, Merle L
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486392
Hypothermia is an uncommon side effect of acetaminophen. We report 4 cases of HIV-infected patients who developed hypothermia after intravenous injection of propacetamol (the parenteral formulation of acetaminophen). The...Hypothermia is an uncommon side effect of acetaminophen. We report 4 cases of HIV-infected patients who developed hypothermia after intravenous injection of propacetamol (the parenteral formulation of acetaminophen). The mechanism of this hypothermia is unknown. AIDS-induced changes in the metabolism of acetaminophen, could be an explanation. AIDS-associated opportunistic diseases may account for part of the mechanism. These hypothermias occur within 6 hours after the injection, are well tolerated and regress spontaneously.
Abouzahir A, El Maghraoui A, Tabache F
… +5 more, Bezza A, Chaari J, Ghafir D, Ohayon V, Archane MI
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486391
UNLABELLED: Ankylosing spondylitis is a very uncommon finding in patients with sarcoidosis. Thirteen cases have been reported in the literature. We report a new case. Observation. - A 40-year-old man had inflammatory low...UNLABELLED: Ankylosing spondylitis is a very uncommon finding in patients with sarcoidosis. Thirteen cases have been reported in the literature. We report a new case. Observation. - A 40-year-old man had inflammatory low back pain since 1983 which formerly responded to nonsteroidal inflammatory drugs (NSAIDs). He developed dyspnea and skin rash in 1993. Physical exam found cervical and lumbar spine stiffness and violaceous and circular lesions on the forehead, nose and right cheek. Laboratory tests showed: ESR at 50 mm, increased serum angiotensin-1-converting enzyme, and negative HLA B27. X-rays showed sacroiliac ankylosis, cervical and lumbar syndesmophytes and cervical facet joint ankylosis. The plain chest x-ray showed an interstitial syndrome. Chest CT scan showed mediastinal adenopathies. Skin biopsy disclosed non-caseating epitheliod and giant-cell granuloma. Outcome was good with steroid therapy but back pain was only improved by NSAIDs. DISCUSSION: - This association raises a diagnostical problem because spine involvement in sarcoidosis can mimic ankylosing spondylitis. It also suggests the hypothesis of a pathophysiological link between the two diseases.
Castelnovo G, Bouly S, Brière C
… +4 more, Ripart J, Jean B, Bonafé A, Labauge P
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486390
Headaches were classified in 1988 by the International Headache Society (IHS). Postural headache is related to intracranial hypotension, most often secondary to lumbar puncture. We report three observations where headach...Headaches were classified in 1988 by the International Headache Society (IHS). Postural headache is related to intracranial hypotension, most often secondary to lumbar puncture. We report three observations where headache of unknown cause led to the diagnosis of spontaneous intracranial hypotension.
Rainfray M, Bourdel-Marchasson I, Dehail P
… +1 more, Richard-Harston S
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486389
Comprehensive geriatric assessment is a useful complement to the standard clinical examination of elderly people. It focuses on a systematic evaluation of functional status, dependency, cognitive functions, psychological...Comprehensive geriatric assessment is a useful complement to the standard clinical examination of elderly people. It focuses on a systematic evaluation of functional status, dependency, cognitive functions, psychological status, continence, nutritional status and social way of life, administered by a multidisciplinary team. Standardized test, well-validated in the elderly, are used. Most studies have demonstrated the efficacy of geriatric assessment programs in outpatients, hospitalized patients or in emergency unit patients. Mostly useful in frail elderly patients, geriatric assessment results in a decrease in morbidity and dependency, shorter hospital stays and fewer referrals to nursing homes. By introducing adequate medical and social interventions, comprehensive geriatric assessment, even in very old people, is useful in preventing acute situations leading to emergency referrals.
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486388
The prevalence of systemic diseases depends on patient age. One third to one half of the patients with Wegener's granulomatosis are over 60 years at the diagnosis. In the elderly, renal insufficiency, lymphopenia and cen...The prevalence of systemic diseases depends on patient age. One third to one half of the patients with Wegener's granulomatosis are over 60 years at the diagnosis. In the elderly, renal insufficiency, lymphopenia and central nervous system involvement are more frequent, and upper airways involvement and hemoptysis less frequent. Signs suggestive of temporal arteritis may initiate the disease. Mortality is increased in the elderly, and aging is an independent predictor of poor prognosis. Henoch-Schönlein purpura is uncommon in adulthood; one quarter of adult cases involves an elderly patient. End-stage renal failure and association with neoplasia are common. In some cases, synchronous course of purpura and neoplasia leads to consider it as a true paraneoplastic syndrome. Periarteritis nodosa in the elderly is characterized by an increased frequency of the association with viral B hepatitis and skin vasculitis. Histological location of necrotizing arteritis involving the temporal artery is possible. It should be considered as a borderline disease, and treated as the more severe disease. Aging is predictive of poor prognosis. Cholesterol emboli are a classic complication of atheroembolic disease and may mimic an inflammatory and multisystemic disease with renal, cardiac, pulmonary, digestive, neuropsychiatric, skin and muscle involvements due to ischemic phenomena leading to necrosis. One-year mortality is over 60% in the symptomatic forms.
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486387
Amyloidosis is a heterogeneous group of extracellular protein deposition diseases. Age-related amyloidosis may be systemic or localized. The systemic forms include associated-myeloma AL amyloidosis and senile systemic am...Amyloidosis is a heterogeneous group of extracellular protein deposition diseases. Age-related amyloidosis may be systemic or localized. The systemic forms include associated-myeloma AL amyloidosis and senile systemic amyloidosis which is the only clear-cut systemic form related to age and derived from normal transthyretin. In localized amyloidosis, the fibril protein precursors are synthesized in the tissue involved by the amyloid. In most cases, localized age-related amyloidosis does not appear to cause clinical disease with the exception of amyloid associated with Alzeihmer's disease and type 2 diabetes mellitus. The significance of aortic amyloidosis, amyloidosis of seminal vesicles, amyloid of the endocrine glands, and articular amyloidosis remains unknown.
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486386
Sjögren's syndrome is an immune exocrinopathy. This paper will deal with the primary Sjogren's syndrome non associated with another rheumatologic disease (polyarthritis or systemic lupus erythematosus). Its prevalence is...Sjögren's syndrome is an immune exocrinopathy. This paper will deal with the primary Sjogren's syndrome non associated with another rheumatologic disease (polyarthritis or systemic lupus erythematosus). Its prevalence is claimed to increase with age. The main clinical manifestation is salivary and/or ocular dryness due to a lymphocytic infiltration of the salivary or lacrimal glands or both. However, sicca symptoms are very frequent in the elderly, most often iatrogenic. The problem, particularly in this population, is the diagnosis of Sjögren's syndrome. There are yet no consensual criteria, the most used in the literature are the European criteria, published in 1993 and revised in 1996. Some tests, such as the Schirmer's test and non stimulated salivary flow, are not specific over 60 years. The results of other tests are discussed as the focus score on the lip salivary glands biopsy. The diagnosis of Sjögren's syndrome should be envisaged in the elderly, when systemic manifestations are associated with sicca symptoms.
Chevalet P, Masseau-Imbert A, Durand-Fix MH
… +4 more, Agard C, Brisseau JM, Rodat O, Barrier JH
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486385
Despite its increasing incidence giant cell arteritis is not well detected in the elderly. Response to corticosteroid treatment is the same before and after the age of 75, but there are many steroid-induced side effects,...Despite its increasing incidence giant cell arteritis is not well detected in the elderly. Response to corticosteroid treatment is the same before and after the age of 75, but there are many steroid-induced side effects, particularly bone fractures, in the elderly. Therefore, it is important to reduce the corticosteroid load in elderly and frail people. In this cases, 0.3 to 0.5mg/kg, or 15 to 25mg daily prednisone-equivalent dose at start seems to be enough to prevent blindness in simple forms. This dose has to be rapidly reduced whenever the C-reactive protein remains moderately elevated. Moreover, an anti-agregant or anticoagulant treatment must be associated at the beginning of steroid treatment to prevent ischemic complications, as well as biphosphonates, which could prevent corticosteroid-induced osteoporosis.
Godart N, Perdereau F, Flament M
… +1 more, Jeammet P
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486384
This review of literature summarizes current knowledge concerning family functioning and comorbidity in families of adolescents with eating disorders. We discuss involvement of the family in the treatment of eating disor...This review of literature summarizes current knowledge concerning family functioning and comorbidity in families of adolescents with eating disorders. We discuss involvement of the family in the treatment of eating disorders.
Ann Med Interne (Paris)
· 2002 Oct · PMID 12486383
The purpose of this article is to clarify interactions between oral contraception (using low- and high-dose oral contraceptives) and the main neurological diseases occurring in genitally active women. Vascular disorders...The purpose of this article is to clarify interactions between oral contraception (using low- and high-dose oral contraceptives) and the main neurological diseases occurring in genitally active women. Vascular disorders predominate, since contraception is in itself a well-recognized a risk factor, especially in case of other intercurrent risk factors (high blood pressure, smoking, diabetes, history of vascular event) contradicting contraception. Low-dose oral contraception can be proposed for women free of these risk factors. There is however a formal contraindication for oral contraception, even with mini-dose contraceptives, for women with a history of cerebral venous thrombosis. In case of migraine headache, which is also a risk factor of vascular disease (especially in case of aura), oral contraceptives should be discussed on an individual basis, depending on the presence of other risk factors. Contraception has no effect on epilepsy but oral contraceptives may be inhibited by inducing anti-seizure drugs. Non-inducing drugs are preferable. The course of certain brain tumors known to express estrogen or progesterone receptors (particularly meningiomas and hemangioblastomas) may worsen with oral contraception, which is formally contradicted except when search for hormone receptors is negative. Oral contraception has no influence in other disease such as multiple sclerosis
Ann Med Interne (Paris)
· 2002 Sep · PMID 12442082
Bullous pemphigoid is the most frequent autoimmune blistering skin disease. There have been few reports of an association with primary biliary cirrhosis and vitiligo. We report the simultaneous occurrence of bullous pemp...Bullous pemphigoid is the most frequent autoimmune blistering skin disease. There have been few reports of an association with primary biliary cirrhosis and vitiligo. We report the simultaneous occurrence of bullous pemphigoid and primary biliary cirrhosis in an 86-year-old patient who also suffered from vitiligo. Multiple autoimmune syndrome, proposed by Humbert and Dupond, can be divided into three groups based on preferential associations of autoimmune disorders. The association of bullous pemphigoid, cirrhosis biliary primary and vitiligo has been reported three times in the literature. This association is probably not fortuitous and suggests a pathogenic relationship. This association is not typical of the multiple autoimmune syndrome as defined by Humbert and Dupond but the collection of such observations may contribute to revise the classification of autoimmune disease and provide a better understanding of the pathophysiological mechanisms of autoimmunity.