Showing papers in "La Nouvelle presse médicale in 1979"

[Acute leukaemias after treatment using cytotoxic agents for rheumatological purpose. 19 cases among 2006 patients(author's transl)].

Abstract: The authors undertook a retrospective study to determine the number of acute leukaemias developing amongst 2006 patients suffering from chronic inflammatory rheumatic conditions and connective tissue disorders, treated with cytotoxic agents. The follow-up period ranged from 1 to 13 years. Nineteen leukaemias were found, essentially granulocytic, with a latent period of 5.7 +/- 2, 8 years after the beginning of treatment. This incidence of almost 1% of leukaemias is probably less than the actual percentage since a number of patients were lost on follow up and since the period of observation is as yet too short. The majority of patients has been treated for more than one year. No cases were seen amongst patients treated for less than six months, or with less than 1g of chlorambucil or 50 g of cyclophosphamide. The risk would seem to be the same for both alkylating agents. No patients treated with azathioprine developed leukaemia, but few patients received this drug. Amongst 35 patients treated for severe psoriatic arthropathy with chlorambucil, 4 developed leukaemia. This particularly high percentage is such that all trials of alkylating agent in this condition should be stopped. The prevalence of leukaemia seen in the series as a whole is comparable to that found in mass studies carried out in various malignant diseases treated by cytotoxics. Awareness of this risk should, lead to even stricter limitations before the use of cytotoxic drugs in rheumatological conditions.

[Deviation in cortisol metabolism induced by rifampicin. Therapeutic consequences in adrenal failure (author's transl)].

Abstract: Deviation of cortisol metabolism in favour of its 6 beta-hydroxylated derivative was demonstrated in two patients with adrenal failure receiving substitution corticosteroid therapy and rifampicin. The existence of a frank increase in the metabolic clearance antipyrin was in favour of an hepatic enzyme induction. After rifampicin treatment was stopped, the 24 hour urinary excretion of 6 beta-OH-F returned to normal, demonstrating the responsability of the drug. This enzyme induction results in a need to increase the dose of hydrocortisone substitution therapy in patients with Addison's disease treated with rifampicin.

[Vasogenic cerebral oedema. Changes in membrane ATPases. Correction by a phospholipid precursor (author's transl)].

Abstract: In vasogenic cerebral oedema, there is progressive quantitative and qualitative impairment of mitochondrial ATPase and of Na/K/ATPase. This impairment, which reflects the intracellular component of cerebral oedema, would appear to be related to changes in the phospholipid environment of the cell membrane enzymes. CDP choline, a metabolic phospholipid precursor, is to a certain extent capable of correcting this disturbed activity and at the same time reduce oedema.

[The treatment of brucellosis using rifampicine (author's transl)].

Abstract: The authors discuss the present value of rifampicin in the treatment of human brucellosis on the basis of: 1) a bacteriological study of 42 strains of Brucella spp. (MIC's of rifampicin, tetracyclin, doxycyclin, minocyclin and streptomycin; results of doxycyclin-rifampicin and doxycyclin-streptomycin combinations), and 2) a clinical study of 38 cases of brucellosis treated with rifampicin, including 25 acute septicemias and 13 osteo-arthritis. Satisfactory results were observed in 92% of the cases with rifampicin alone, but one cannot state that the benefits are significant.

[Initiation in vivo of blood coagulation. The role of white blood cells and tissue factor (author's transl)].

Abstract: Tissue factor is an ubiquitous phospholipid-protein complex, which triggers blood coagulation through the so-called extrinsic pathway. Reactions initiated by tissue factor bypass many of the early stages of coagulation (contact phase) and involve factors VII, X, V, II and fibrinogen but also factor IX (and VIII) as it was recently demonstrated. So, it appears that tissue factor has a key-role in the haemostasic process as it has been suggested by the mildness or the absence of haemorrhagic syndrome in contact factors deficiencies. Tissue factor activity has been found in many types of cells, especially in white bloods cells. Experimental studies have demonstrated the presence of tissue factor activity in polymorphonuclears, lymphocytes, monocytes (or macrophages). This activity is enhanced by gram-negative endotoxin stimulation, inflammation, cell mediated immunologic phenomena or malignancy. These data are in good agreement with a wild range of features observed in human pathology: fibrin deposits in inflammatory lesions, disseminated intravascular coagulation (DIC) during the course of gram-negative septicemias or acute promyelocytic leukemias, local thrombi at the early phase of graft rejection. The protective effect of a phospholipase C against DIC induced in rats by tissue factor infusion suggests in the future, a specific therapy would be possible in man that, in the frequent clinical conditions involving clotting activation through tissue factor pathway.

[Thyroid hemiagenesis (single thyroid lobe). 8 cases (author's transl)].

Abstract: Thyroid agenesis would appear to be a rare abnormality (50 cases, including 8 personal). In fact, it is a simple anatomical curiosity which may be found in the presence of any type of thyroid condition (simple goitre: 4 cases, thyrotoxicosis: 2 cases, cold nodule: 2 cases, as far as our own patients were concerned). Our 8 patients were all women, hemiagenesis being more commonly discovered in the female sex. In 2 patients the right lobe was absent, and the left in the other 6. In general, the abnormality affects the left lobe three times more commonly than the right. The differential diagnosis essentially lies with autonomic thyroid nodules, which are much more common, and isotope scanning provides the answer.

[Hydroxy 9-methyl 2-ellipticinium acetate (NSC 264-137). Toxicologic study and therapeutic effect in 100 cancers (author's transl)].

Abstract: A new derivative of ellipticine, hydroxy-9-methyl-2-ellipticinium acetate, was found to be a useful anti-tumor drug in advanced cancers which could not be treated any longer successfully by any other procedure. In our series of 100 patients, the best results were obtained with bone metastases from breast carcinomas and with anaplastic thyroid carcinomas. Most patients usually received a weekly perfusion of 80 mg/m2. The main characteristic of this drug is its lack of hematologic, and hepatic toxicity. No renal trouble was observed during the first year, but 2 deaths from renal insufficiency occured during the 18th and 15th month of treatment. The most frequent side effect consists of digestive troubles (nausea, vomiting) which rarely compelled to stop the treatment (4 times in 100 patients).

[Fabry's disease: two patients improved by fetal liver cells (author's transl)].

Abstract: The first patient reported was a 33 years old male with clinical manifestations of Fabry's disease. The diagnosis was confirmed by ophthalmologic, histological and enzymatic studies. Because of inefficacity of treatment with plasma transfusions and of symptomatic therapies, a transplant of cells with normal enzymatic activities was envisioned. In this patient without renal failure, a renal transplant was not justified and a transplant of fetal liver cells was decided. The improvement of extra-renal manifestations of the disease with this new treatment was comparable to that obtained with kidney transplantation. In particular, objective and subjective clinical symptoms were significantly improved: sweating appeared became normal, cutaneous lesions appeared slightly decreased and pains disappeared. This improvement was still persistent 3 years after the fetal liver transplant, the viability of which was initially followed using dosages of circulating alphafoetoprotein. The second case-report is comparable. Fabry's disease was diagnosed in a 26 years old male on the clinical manifestations, the histological lesions and the enzyme deficiency. After failure of one plasma transfusion, the patient received a fetal liver transplant. It is still too early to evaluate the efficacy of the transplant in this second case, especially as the patient had normal sweating and relatively few pains except at the cold season. The mechanism which may be held responsible for possible improvement in our patients, as in recipients of a kidney transplant, is not completely elucidated. The cells, rather than steroids or azathioprine, seemed to support the efficacy. Was the enzyme activity exerted in situ? Was there a "colonization" by lysosomial enzymes? From the results observed after several years will derive the significance of this therapeutic approach in Fabry's disease, more generally, in many diseases associated with a genetic enzyme deficiency.

[Aorto-coronary venous bypass. The value of microsurgical techniques (author's transl)].

Abstract: The application of microsurgical techniques to myocardial revascularisation surgery by aorto-coronary venous bypass makes it possible to extend the indications for operation to patients with severe coronary lesions, generally considered to be unsuitable. A technique of vascular suture in two layers combined with a widening angioplasty is described. Their value is illustrated by the blood flow studies and the clinical results in 66 bypass performed on 32 patients.

[Progressive myoclonic encephalopathy in dialysis patients: presence of high concentrations of aluminium in the lysosomes of the cerebral cells (author's transl)].

Abstract: Sampling of brain tissue of two patients who died of dialysis encephalopathy syndrome have been studied using a combined electron microscope-electron microprobe x-ray analyzer. X-ray microanalysis showed that aluminium is present in high concentration in lysosomes of brain cells. This concentration is approximately one thousand-fold that which is normally measured in the grey matter. In these lysosomes, aluminium is present in needle like microcrystalline form of 0.006 micron diameter and 0.08 micron long on the average; in these crystals, aluminium is associated with phosphorus in a ratio of one atom of aluminium per atom of phosphorus. Similar lesions have been observed in the rat after intraperitoneal injections of water-soluble aluminium salts.

A case of acute acrolein poisoning

Abstract: A four and a half year old boy was hospitalised with acute respiratory failure due to the inhalation during two hours of the smoke from an overheated frier. Oxygen, corticosteroids and furosemide led to clinical stabilisation but after 24 hours asphyxia developed. The trachea was found to be obstructed by a firm elastic substance which prevented intubation or bronchoscopy. Autopsy revealed massive cellular desquamation of the bronchial lining. The lumen was occupied by miscellaneous debris. There were multiple pulmonary infarcts. This is the second case of acute intoxication by acroleine. In the light of these two cases, treatment should consist of corticosteroids, antibiotherapy, inhalation therapy, and repeated bronchial aspiration.

[Compressive extradural lipomatosis as an unusual complication of corticosteroid therapy: one case (author's transl)].

Abstract: In a 43 year old man we reported a spinal cord compression by extradural lipomatosis associated with long term corticosteroid therapy for periarteritis nodosa. Decompressive surgery at the 16th month of corticosteroid treatment resulted in regression of symptoms and signs. Corticosteroid therapy was felt to be responsible for this neurological complication, which is unknown in periarteritis nodosa, but has been seen in association with intraspinal lipomas.

Pharmacokinetics of flunitrazepam

Abstract: Congenital clefts and aplasias of the atlas vertebra, while rare, are often first encountered in the emergency room setting. Thirty-six patients with atlas malformations and 10 with Jefferson fractures were encountered. Sixteen of the patients with congenital malformations showed bilateral atlantoaxial lateral offset, a finding generally considered to be the result of fracture. The diagnosis of these abnormalities is readily made from plain films by noting their characteristic features. Anomalies produce lateral offset of 1–2 mm. Jefferson fractures produce a greater offset (over 3 mm).

[Measurements of serum C3d in primitive chronic glomerular nephropathies (author's transl)].

Abstract: Measurement of serum C3 does not provide precise informations concerning an eventual consumption of this complement component during an immunological process. An increased synthetic rate may compensate an accelerated catabolism. The study of breakdown products of C3, such as C3d is a more sensitive approach of the role of complement in some immunological disorders. Therefore C3d was measured in the serum of patients with chronic non systemic glomerular diseases. High values of serum C3d were found in all cases of hypocomplementemic glomerulonephritis. Circulating C3d was also increased to a lower extent, in patients with normocomplementemic nephritis such as minimal change disease, mesangial nephritis with IgA deposits and membraneoproliferative (type I) glomerulonephritis. The data suggested the involvement of complement in a number of glomerulonephritis. Participation of complement in immunological disorders particularly in chronic non systemic glomerulonephritis could require a reevaluation when functional tests are performed in addition to static measurements.

[Nutritional status in critically ill patients. Relationship with mortality (author's transl)].

Abstract: Plasma proteins, triglyceridemia, body composition and delayed hypersensitivity were determined in 154 critically ill patients after admission. Plasma proteins levels were significantly increased in patients that were subsequently discharged vs. those that died: albumin: 33 +/- 6 g/l vs 28 +/- 6 g/l (p < 10(-6)); transferrin 2,18 +/- 0,65 g/l vs. 1,54 +/0 0,55 g/l (p < 10(-7)); prealbumin: 14,32 +/- 7,79 mg/100 ml vs. 7,28 +/-5,36 mg/100 ml (p < 10(-7)) and triglyceridemia was decreased: 1,07 +/- 0,38 g/l vs. 1,66 +/- 1,12 g/l (p not equal to 10(-3)). Body weight, fat weight and lead body mass were not correlated to subsequent mortality. Muscle cell mass was decreased (-17%, p < 10(-2)) and extracellular water was increased (+14%, p < 10(-4)), in patients who subsequently died. Total body water and visceral cell mass did not change. Initial anergy (tested with 3 antigens: candidin, tuberculin, varidase) did correlate with mortality: 35/62 died when delayed hypersensitivity was negative vs. 13/71 when it was positive (p < 10(-4)). Mortality was associated with decreased total lymphocyte count: 884 +/- 1025 vs. 1270 +/- 870 (p < 0,02) and serum iron: 51 +/- 40 micrograms/100 ml vs. 74 +/- 45 micrograms/100 ml (p < 10(-2)). Sepsis correlated with mortality (p < 10(-3)) and could produce these changes. These results suggest that critically ill paients have a protein-calorie malnutrition syndrom marktly different from that observed in simple starvation. Nutritional therapy must be, in this group of patients, adapted to this concept.