P Cathébras

French National Centre for Scientific Research, Lutetia Parisorum, Île-de-France, France

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Publications (273)494.51 Total impact

  • E. Weber · J.-B. Gaultier · S. Paul · I. Guichard · E. Monard · P. Cathébras
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    ABSTRACT: Introduction Relapsing polychondritis (RP) is a rare inflammatory disease characterized by diffuse cartilage involvement, especially those of the respiratory tract, leading to potentially life threatening complications. Corticosteroids remain the first-line empirical therapy. Immunosuppressive drugs such as azathioprine, cyclophosphamide and tumor necrosis factor blockers (anti-TNFα) are commonly used as second-line therapy with varying degrees of success. Case report We report a 40-year-old man with severe RP for whom conventional therapy and immunosuppressive treatments were ineffective. Prolonged clinical remission was obtained after introduction of the anti-interleukin-6 receptor antibody (tocilizumab), which was perfectly tolerated and allowed to taper steroids and methotrexate to a very low dosage. Conclusion Our patient is the fifth published one documenting the efficacy of tocilizumab in severe refractory RP, which strengthens the use of anti-IL-6 in that indication.
    La Revue de Médecine Interne 01/2013; 33(3). DOI:10.1016/j.revmed.2012.10.238 · 1.32 Impact Factor
  • P. Cathébras
    La Revue de Médecine Interne 01/2013; 35(5). DOI:10.1016/j.revmed.2013.11.005 · 1.32 Impact Factor
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    ABSTRACT: INTRODUCTION: Granulomatosis with polyangeitis (Wegener's granulomatosis) (GPA) is a granulomatous vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA). Affected organs usually include upper and lower respiratory tracts, and kidneys. Limited forms of GPA may affect the central nervous system (vasculitis, hypertrophic pachymeningitis, encephalitis), a location in which diagnosis is often uneasy. CASE REPORT: We report a 74-year-old woman who presented with a limited form of GPA affecting the cavernous sinus. Diagnosis was considered in view of a retrospectively suggestive clinical presentation, compatible cerebral MRI and temporal artery biopsy, despite the absence of ANCA. It was supported by a favourable outcome with cyclophosphamide administration. CONCLUSION: GPA presenting as a cavernous sinus syndrome is rare. Three co-existing pathogenic mechanisms may be involved in GPA affecting the central nervous system: contiguous invasion from nasal or orbitary granulomatous sites, vasculitis, or primary intra-cerebral granulomatous inflammation. Lack of biopsy evidence of affected tissues and ANCA negativity should not delay diagnosis and appropriate therapeutic management in central nervous system GPA.
    La Revue de Médecine Interne 12/2012; 34(4). DOI:10.1016/j.revmed.2012.11.007 · 1.32 Impact Factor
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    ABSTRACT: The incidence of venous thromboembolism in multiple myeloma depends on the disease characteristics that include recent diagnosis, persistent or recurrent multiple myeloma, patient characteristics, and the type of treatment received such as thalidomide or lenalidomide especially in combination with high-dose dexamethasone, or combined chemotherapy. Currently, recommendations could be challenged by the results of the first randomized study evaluating aspirin, low molecular weight heparins and vitamin K antagonists in the antithrombotic prophylaxis. The recent data from the literature show that it is not possible to propose a therapeutic management for venous thromboembolism prophylaxis in multiple myeloma and that the use of antithrombotic prophylaxis may not be mandatory.
    La Revue de Médecine Interne 12/2012; 33(12):693–696. DOI:10.1016/j.revmed.2012.05.006 · 1.32 Impact Factor
  • A. Roblès · H. Laurent · C. Douchet · P. Cathébras
    La Revue de Médecine Interne 12/2012; 33:A158-A159. DOI:10.1016/j.revmed.2012.10.274 · 1.32 Impact Factor
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    ABSTRACT: The incidence of venous thromboembolism in multiple myeloma depends on the disease characteristics that include recent diagnosis, persistent or recurrent multiple myeloma, patient characteristics, and the type of treatment received such as thalidomide or lenalidomide especially in combination with high-dose dexamethasone, or combined chemotherapy. Currently, recommendations could be challenged by the results of the first randomized study evaluating aspirin, low molecular weight heparins and vitamin K antagonists in the antithrombotic prophylaxis. The recent data from the literature show that it is not possible to propose a therapeutic management for venous thromboembolism prophylaxis in multiple myeloma and that the use of antithrombotic prophylaxis may not be mandatory.
    La Revue de Médecine Interne 10/2012; · 1.32 Impact Factor
  • Pascal Cathébras · Pauline Régny
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    ABSTRACT: "Hysterical" conversion hasn't vanished, and remains a diagnostic, therapeutic and relational challenge for the clinician. Conversion may be associated with organic disease. From the clinical point of view, two subtypes of conversion symptoms, namely psychogenic nonepileptic seizures and functional movement disorders, have been individualized. Physical signs of neurological inconsistency, and classical arguments in favor of a psychological etiology have been recently reevaluated, which allows, along with the progress of neurological investigations, to minimize the rate of misdiagnosis. Functional neuroimaging has shed light on the brain mechanisms involved in conversion phenomena. From a nosological point of view, there is a tension between the whish to "banalize" the conversion symptoms as mere "functional neurological symptoms", which makes easier to communicate the diagnosis to the patient and may remove the stigma from the diagnosis; and the wish of certain authors to "revive" hysteria, emphasizing the core phenomenon of dissociation and its close relationship with trauma. Proposed treatment of conversion disorder are numerous, although poorly evaluated and often insatisfactory, but recent publications insist on the importance of communicating the diagnosis to the patient in a honest, nonjudmental and understandable way, at the earliest phase of the disorder.
    La Revue du praticien 10/2012; 62(8):1119-25, 1127-30.
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    ABSTRACT: To assess clinical features, treatment and outcome of Hypothalamo-pituitary (HP) sarcoidosis and to determine whether HP is associated with a particular clinical phenotype of sarcoidosis. Multicentric retrospective study. Retrospective chart review. Each patient was matched with two controls. Twenty-four patients were identified (10 women, 14 men). Their median age at the sarcoidosis diagnosis was 31.5 years (range: 8-69 years). HP involvement occurred in the course of a previously known sarcoidosis in 11 cases (46%), whereas it preceded the diagnosis in 13 patients (54%). All but two patients had anterior pituitary dysfunction, 12 patients presented with diabetes insipidus. The most common hormonal features were gonadotropin deficiency (n = 21), TSH deficiency (n = 15) and hyperprolactinemia (n = 12). Magnetic Resonance Imaging (MRI) revealed infundibulum involvement (n = 8), pituitary stalk thickness (n = 12) and involvement of the pituitary gland (n = 14). All but two patients received prednisone. After a mean follow-up of 4 years, only two patients recovered from hormonal deficiencies. MRI abnormalities improved or disappeared in 12 cases under corticosteroid. There was no correlation between the hormonal dysfunctions and the radiologic outcomes. Patients with HP sarcoidosis had significantly more frequent sinonasal localizations and neurosarcoidosis and required a systemic treatment more frequently than controls. Although HP sarcoidosis is unusual, physicians should be aware that such specific localization could be the first manifestation of sarcoidosis. HP involvement is associated with general severity of sarcoidosis. MRI abnormalities can improve or disappear under corticosteroid treatment, but most endocrine defects are irreversible.
    QJM: monthly journal of the Association of Physicians 06/2012; 105(10):981-95. DOI:10.1093/qjmed/hcs121 · 2.46 Impact Factor
  • La Revue de Médecine Interne 06/2012; 33:S52. DOI:10.1016/j.revmed.2012.03.036 · 1.32 Impact Factor
  • P. Cathébras
    La Revue de Médecine Interne 02/2012; DOI:10.1016/j.revmed.2011.08.003 · 1.32 Impact Factor
  • Pharmacien Hospitalier et Clinicien 02/2012; 47:S15. DOI:10.1016/j.phclin.2011.12.034
  • E. Weber · S. Charmion · P. Cathébras
    La Revue de Médecine Interne 12/2011; 32:S385-S386. DOI:10.1016/j.revmed.2011.10.170 · 1.32 Impact Factor
  • La Revue de Médecine Interne 12/2011; 32:S417-S418. DOI:10.1016/j.revmed.2011.10.237 · 1.32 Impact Factor
  • La Revue de Médecine Interne 12/2011; 32:S327. DOI:10.1016/j.revmed.2011.10.043 · 1.32 Impact Factor
  • Q Lacoin · J-B Gaultier · S Charmion · I Guichard · P Cathébras
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    ABSTRACT: Hypertrophic osteoarthropathy (HOA) located to lower extremities may be the initial manifestation of an infected aortic graft. We report two patients with HOA secondary to aortobifemoral vascular prosthesis infection and aortoenteric fistula. As reported in the literature, initial manifestations included fever, painful swelling of limbs, joint pain, clubbing and in one case intestinal bleeding. These symptoms preceded frank episodes of septicaemia due to a wide variety of bacteria (microbial enteric flora). Bone scan was an appropriate tool for confirming the diagnosis of HOA. Abdominal computed tomography, and PET-scan were useful for detecting vascular infection. Aortoenteric fistula remained difficult to identify. Mechanisms involved in the pathogenesis of HOA associated with infected graft are poorly understood, but vascular endothelial growth factor (VEGF) could play a major role. The mortality of infected aortic grafts remains high, but knowledge of this association could lead to early diagnosis and accurate treatment.
    La Revue de Médecine Interne 07/2011; 32(7):432-5. DOI:10.1016/j.revmed.2011.02.015 · 1.32 Impact Factor
  • La Revue de Médecine Interne 06/2011; 32. DOI:10.1016/j.revmed.2011.03.079 · 1.32 Impact Factor
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    La Revue de Médecine Interne 06/2011; 32. DOI:10.1016/j.revmed.2011.03.065 · 1.32 Impact Factor
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    ABSTRACT: PurposeThe aim of the medical autopsy is to define the causes of a patient's death. Although its rate has dramatically decreased, the post-mortem examination remains one of the basic tools for the assessment of medical care. The objective of this study was to identify the factors influencing the acceptance of medical autopsies.
    La Revue de Médecine Interne 04/2011; 32(4):205-211. DOI:10.1016/j.revmed.2010.09.008 · 1.32 Impact Factor
  • The Journal of Rheumatology 04/2011; 38(4):775-6. DOI:10.3899/jrheum.101052 · 3.17 Impact Factor
  • P. Cathébras · P. Lachal
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    ABSTRACT: I termini di sintomi «funzionali» oppure «inspiegabili dal punto di vista medico» si riferiscono a dei disturbi soggettivi senza cause organiche lesionali sottostanti né fisiopatologie confermate. I sintomi funzionali rappresentano quasi un terzo dei sintomi presentati nelle cure primarie e sono presenti a tutti i livelli del sistema sanitario. La nosologia dei disturbi funzionali è complessa e ambigua e rispecchia dei punti di vista diversi su uno stesso fenomeno: la «somatizzazione». La gestione dei pazienti funzionali fluttua tra lo scientismo biomedico che conduce a una ricerca vana di organicità e un approccio fondato sulla presunta psicogenesi dei sintomi, al quale la maggior parte dei soggetti tende a resistere, anche se molti lasciano la porta aperta a una spiegazione psicosociale. Nell’iter diagnostico, gli «interventi somatici» (esami diagnostici, consulenza specialistica, trattamenti fisici), possono rivelarsi iatrogeni in questo contesto e devono essere proposti con parsimonia. Alcuni sintomi funzionali derivano da meccanismi fisiopatologici relativamente semplici: attivazione del sistema nervoso autonomo, tensione muscolare, iperventilazione, conseguenze dei disturbi del sonno, effetti dell’inattività, fenomeni «di ipersensibilità centrale» e così via; altri, invece, sono il risultato di causalità circolari più complesse che fanno intervenire dei fattori fisiologici, psicologici e socioculturali che, a loro volta, svolgono, a seconda dei casi, un ruolo predisponente, precipitante o di mantenimento e di rinforzo dei sintomi. Nell’approccio terapeutico, la «rassicurazione» è un atto medico essenziale, più difficile di quanto non sembri a prima vista. La rassicurazione non si riduce all’affermazione «che non c’è nulla di grave», ma deve essere fondata su delle spiegazioni personalizzate, che collegano fattori fisici e psicosociali. La medicina «centrata sulla malattia» è, in effetti, inattiva e iatrogena di fronte ai sintomi inspiegabili dal punto di vista medico e solo una medicina «centrata sul paziente» può offrire delle spiegazioni medicalmente plausibili, congrue con i modelli esplicativi del paziente e accettabili per entrambe le parti.
    01/2011; 13(3):1–7. DOI:10.1016/S1634-7358(11)70647-7

Publication Stats

866 Citations
494.51 Total Impact Points

Institutions

  • 2013
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 1991–2013
    • Centre Hospitalier Universitaire de Saint-Étienne
      • • Department of Internal Medicine
      • • Department of Neurology
      Saint-Étienne, Rhône-Alpes, France
    • Université du Québec à Montréal
      Montréal, Quebec, Canada
  • 2009
    • University Joseph Fourier - Grenoble 1
      Grenoble, Rhône-Alpes, France
  • 2005–2008
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • Centre Hospitalier Universitaire de Nancy
      Laxou, Lorraine, France
  • 2003
    • Centre Hospitalier Universitaire de Lyon
      Lyons, Rhône-Alpes, France
  • 1990–1992
    • Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France