Showing papers by "Georges Kaltenbach published in 2005"

Carences en vitamine B12 chez l'adulte : étiologies, manifestations cliniques et traitement

Abstract: Resume Propos. – Cet article developpe les acquisitions recentes, utiles au clinicien, concernant les carences en vitamine B12 chez l'adulte. Actualites et points forts. – Des definitions plus precises de la carence en cobalamine permettent de mieux cibler les carences averees en vitamine B12 et de determiner leur impact epidemiologique reel. Des donnees cliniques recentes permettent de proposer et d'individualiser le syndrome de non-dissociation de la vitamine B12 de ses proteines porteuses comme l'etiologie probablement la plus frequente de carence en cobalamine chez l'adulte. Le tableau clinique classique de carence en vitamine B12 est enrichi de nouvelles manifestations cliniques, en particulier neurologiques, gynecologiques et vasculaires. Enfin, de nouveaux modes d'administration de la vitamine B12 sont suggeres, comme les voies orales, sublinguale et nasale. Perspectives et projets. – Les etudes actuelles et les projets futurs dans le domaine des carences en vitamine B12 tendent a etablir, de facon formelle, le lien entre les nouvelles manifestations cliniques decrites et la carence vitaminique et a confirmer l'efficacite des nouveaux modes d'administration de la vitamine B12, en particulier de la voie orale.

Effects of oral crystalline cyanocobalamin 1000 μg/d in the treatment of pernicious anemia: An open-label, prospective study in Ten Patients.

Abstract: Background: Standard treatment of cobalamin (vitamin B12) deficiency involvesregular (1000 μg/mo) IM cyanocobalamin administration. It has been suggested that high-dose (>2000 μg/d) oral cyanocobalamin may be effective in patients with pernicious anemia.

L’hypertension artérielle est-elle associée à la maladie d’alzheimer ?

Abstract: Case-control transversal studies have suggested the existence of an association between low blood pressure and Alzheimer's disease, although there is some doubt on the cause to effect relationship A drop in blood pressure preceding the onset of dementia has been evoked but never confirmed Longitudinal studies, with long term follow-up on the existence of hypertension during middle-age, have demonstrated a significant increase in the risk of developing Alzheimer's disease in cohorts of hypertensive patients compared to normotensive subjects The potential benefit of preventive treatment with antihypertensive drugs in decreasing the risk of Alzheimer's disease has not been confirmed in clinical trials The hypothesis of the formation of a cerebrovascular disease that would combine with the neuropathological lesions has been evoked, raising doubts on the diagnostic criteria used to define Alzheimer's disease The novel concept that vascular risk factors could directly induce the formation of neuropathological lesions is interesting but warrants confirmation

Marked decrease of rest-activity rhythm amplitude with time in non-demented disabled nursing home residents

Abstract: Rest-activity rhythm is disturbed in nursing home residents and several factors may contribute to this disturbance, such as dementia or poor light exposure. The aim of this study was to assess rest-activity rhythm and light exposure in-non-demented disabled nursing home residents and its evolution with time in patients without evolutive associated disease. Twenty-four non-demented disabled patients living in the same nursing home unit for at least 3 months were included in the first session, 15 of them participated in the second part of the study 1 year later. A two-weeks wrist actimeter recording coupled with light exposure measurement was performed. A second session was conducted 1 year after the first one in patients who did not have significant evolution of their health, disabling and cognitive status. There was a clear measurable rest-activity rhythm in all the residents. The amplitude of the rest-activity rhythm dramatically decreased after 1 year, without change in its temporal characteristics. Light exposure did not decrease between both periods with even a trend to increased light exposure during the second session. This study shows that the amplitude of the rest-activity rhythm decreases rapidly with time in non-demented disabled nursing home residents despite maintaining stable day to day environment and particularly light exposure. This suggests that this decrease is mainly due to the aging process.

The etiology, eepidemiology and management of idiosyncratic drug-induced agranulocytosis

Abstract: OBJECTIVE: To review the literature concerning idiosyn- cratic drug-induced agranulocytosis, a rare but life-threatening potential ad- verse event of most drugs. DATA SOURCES: Articles were identified through searches of MEDLINE (January 1966 to March 2005). Unpublished data from our cohort of drug-induced agranulocytosis in the University Hospital of Strasbourg, France were also considered. DATA EXTRACTION AND SYNTH- ESIS: All of the papers and abstracts were reviewed by at least two senior re- searchers that selected the data used in the study. The incidence of idiosyn- cratic drug-induced agranulocytosis remains stable in the past twenty years: 2.4 to 15.4 cases per million, despite the emergence of new causative drugs, mainly antibiotics, antiplatelet agents and antithyroid drugs. To date, drug- induced agranulocytosis remains a serious adverse event due to the frequency of severe sepsis with severe deep infections (such as pneumonia), septicemia and septic shock in around 2/3 of patients. In this setting, old age (>65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutro- phil count below 0.1 x 10 9 /L are poor prognostic factors. Nevertheless, with the aid of appropriate management using pre-established procedures, intrave- nous broad-spectrum antibiotic therapy and hematopoietic growth factors, the mortality rate is currently ~5%. CONCLUSIONS: Given the increased life ex- pectancy and subsequent longer exposure to drugs, as well as the develop- ment of new agents, health care professionals should be aware of the adverse event associated with idiosyncratic drug-induced agranulocytosis as well as its management. REVIEW

Low vitamin B12 levels in elderly patients cured within one week by oral cobalamin therapy

Abstract: Objectif La non-dissociation de la vitamine B12 (ND B12) de ses proteines porteuses est la cause la plus frequente d'hypovitaminose B12 chez le sujet âge. Le but de cette etude a ete de preciser la posologie initiale de cyanocobalamine orale permettant de corriger en une semaine les hypovitaminoses par ND B12. Methodes Il s'agit d'une etude prospective ouverte incluant 30 personnes âgees ayant une hypovitaminose (B12 < 0,20 μg/L) par ND B12. Dix patients (groupe I) ont ete traites quotidiennement par 1000 μg de cyanocobalamine orale (de J1 a J8), 10 (groupe II) par 1000 μg tous les 2 jours (J1, J3, J5 et J7), 5 (groupe III) par 1000 μg tous les 4 jours (J1 et J5) et 5 (groupe IV) par 1000 μg uniquement a J1. La reponse biologique a ete appreciee par un dosage de controle de la vitaminemie B12 effectue au 8 e jour. Resultats La vitaminemie B12 moyenne a augmente significativement (p < 0,01) dans les groupes I, II et III, mais pas dans le groupe IV. L'effet-dose, apprecie par l'elevation moyenne de la vitaminemie B12, etait significativement (p < 0,05) plus marque dans les groupes I (0,25 μg/L) et II (0,18 μg/L), que dans les groupes III-IV (0,09 μg/L). Conclusion Cette etude prospective a montre qu'une posologie de 1000 μg de cyanocobalamine orale tous les 4 jours, correspondant a 250 μg par jour, etait suffisante pour corriger en une semaine les hypovitaminoses par ND B12. Toutefois, des posologies initiales de l'ordre de 1000 μg par jour ou tous les 2 jours seraient preferables, en raison d'un effet-dose plus marque pour des posologies quotidiennes superieures a 500 μg. Une etude randomisee est necessaire pour valider ces resultats preliminaires.