A Fournier

University of Limoges, Limages, Limousin, France

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Publications (528)1485.01 Total impact

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    ABSTRACT: Reversible cerebral vasoconstriction syndrome is characterized by recurrent episodes of thunderclap headaches and the presence of reversible cerebral vasospasm. The syndrome is usually diagnosed after other possible conditions have been ruled out. Triggering factors are present in half of cases. In the absence of stroke (and depending on the underlying etiology), the prognosis is good. Tako-Tsubo cardiomyopathy is a reversible myocardial illness that mimics an acute coronary syndrome and is often triggered by emotional stress. The coronary arteries are healthy but patients show typical morphological and functional features of left ventricular systolic dysfunction. After the acute phase, the prognosis is good. Here, we describe the case of a woman who successively displayed reversible cerebral vasoconstriction syndrome and Tako-Tsubo cardiomyopathy. This observation suggested a possible pathophysiological link and prompted us to review the features shared by these two conditions.
    Pratique Neurologique - FMC 09/2014; 5(3):223–228.
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    ABSTRACT: La hipercalciuria es una frecuente anomalía metabólica, primaria o secundaria a otra patología. Las causas secundarias están representadas por las tubulopatías y las enfermedades hipercalcemiantes, tanto de naturaleza benigna como maligna. La hipercalciuria idiopática (HI) no se acompaña de hipercalcemia; tal vez posee un componente familiar, probablemente autosómico dominante, sin que el gen responsable haya sido identificado todavía. La HI o bien está asociada a una excesiva absorción intestinal de calcio o presenta un origen renal. El diagnóstico diferencial se establece por medio de la cuantificación de la calciuria y de la secreción de parathormona (PTH) en el transcurso de distintos regímenes cálcicos. En los pacientes afectados de HI se comprueba una baja densidad mineral ósea cualquiera que sea el lugar de medición. El tratamiento de las hipercalciurias secundarias se basa en la corrección de su causa, en tanto que en la HI es preciso normalizar el aporte de calcio y de otros alimentos y cuando esto no es suficiente se añaden diuréti-cos tiazídicos, que aumentan la reabsorción tubular de calcio y reducen el riesgo de litiasis cálcica.
    EMC - Aparato Locomotor. 08/2013; 33(2):1–5.
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    ABSTRACT: We have measured simultaneously plasma renin activity (PRA), aldosterone and catecholamines in the plasma of 3 groups of pregnant women after the 20th week:group 1 of 16 normotensive controls, group II of 17 women with rest responding hypertension (RRH), group III of 18 women with permanent hypertension (PIH). All the patientswere ambulatory on a normal salt diet. PRA was significantly higher in the RRH than in the control and PIH groups (15, 8–2, 3ng/ml/1 versus 6, 7±0, 5 and 8, 9±0, 9 respectively). Plasma epinephrine (PE) and norepinephrine (PNE) were significantly higher in the PIH than in the control and RRH groups (jespectively 135–28 pg/ml versus 56±13 and 63±17 for PE and 387±91 versus 206±32 and 200±47 pg/ml for PNE). In the PIH group there was a negative correlation between PEA and blood uric acid. It is concluded that the adrenic system is activated in PIH whereas the renin angiotensin system is activated in RRH of pregnancy.
    Hypertension in Pregnancy. 07/2009; b1(4).
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    ABSTRACT: MgS04 was administered i.v. in 2 patients with eclampsia the first having also a pulmonary oedema. Hemodynamic studies with SWAN GANZ catheter and thermodilution technic were performed before and 30, 60 and 120 mn after the beginning of MgS04 administrztion. The decrease in blood pressure was associated with a decrease of the initially increased cardiac output but not with a decrease in systemic vascular resistance. The vasodilating effect of MgS04 was thus masked by the decrease in cardiac output. Since the wedge pressure did not increase, and the systolic pulmonary pressure decreased, whereas the cumulative water balance did not significantly decrease, the decrease in cardiac output seems to be due to an increase in venous compliance.
    Obstetrical and Gynecological Survey 07/2009; b2(3):405-413. · 2.51 Impact Factor
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    Kidney International 03/2008; 73(4):510. · 8.52 Impact Factor
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    Kidney International 07/2007; 71(12):1325; author reply 1325-6. · 8.52 Impact Factor
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    ABSTRACT: We report a case of a retroperitoneal hematoma occurring in a patient under anticoagulation therapy for deep-venous thrombosis and presenting as an anuric acute renal failure. A coexisting polycythemia vera led to misdiagnosis that could have been life-threatening. A woman, known for polycythemia vera and a single functioning right kidney, was admitted with mild abdominal pain in a context of recent deep venous thrombosis under low-molecular weight heparin. Clinical examination revealed hepatomegaly associated with polycythemia vera. Biochemical evaluation disclosed an acute renal failure, and renal ultrasonography showed no dilation of the renal pelvis. Retroperitoneal hematoma resulted in shock, progressive anemia and obstructive renal failure, related to renal pelvic compression. A right renal indwelling catheter was introduced to restore urine flow after one hemodialysis session, and an inferior vena cava filter was placed because of anti-coagulation contra-indication. However, pulmonary embolism occurred, so that oral anticoagulants were introduced. The hematoma resorbed spontaneously, and a year after this episode, the patient is still alive and well. Retroperitoneal hematoma is a rare cause of obstructive acute renal failure and a life-threatening complication of anti-coagulation therapy.
    Clinical nephrology 06/2007; 67(5):318-20. · 1.29 Impact Factor
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    Kidney International 06/2007; 71(9):953; author reply 953-4. · 8.52 Impact Factor
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    Kidney International 02/2007; 71(2):178. · 8.52 Impact Factor
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    ABSTRACT: Henoch-Schonlein purpura is one of the most frequent systemic vasculitis in children. In adults, muscle involvement is extremely rare and not very well characterized. We report a case of Henoch-Schonlein purpura with severe skin and renal involvement in witch multiple intramuscular haematoma leaded to severe anaemia. Histological examination confirms the muscle localization of the disease. A 68 years old man treated by oral anticoagulation for multiple venous thrombosis, was admitted with necrotic vasculitis of the skin, abdominal pain and segmental IgA glomerulopathy. The diagnosis of Henoch-Schonlein purpura was rapidly made and intensive steroid therapy started. After rapid improvement, a haemorrhagic shock due to voluminous intramuscular haematoma was diagnosed by MRI. Histological examination of the muscle, confirms the localization of the disease. Intramuscular haematomas are very uncommon in Henoch-Schonlein purpura. There are usually a consequence of muscular immune complex vasculitis. In our patient, high dose corticosteroid was not unable to control the disease.
    La Revue de Médecine Interne 01/2005; 25(12):927-30. · 0.90 Impact Factor
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    ABSTRACT: A primary antiphospholipid syndrome is a very rare cause of adrenal haemorrhage. A 51 year-old man presented with a unilateral adrenal haemorrhage, enhanced by the prescription of Synacthène during the 4 days that preceded. There was no adrenal deficiency but the immunological control revealed the presence of anti-phospholipid antibodies. After 2 years of follow-up, adrenal controls have not shown any underlying tumour or endocrine insufficiency. Adrenal involvement is described in the anti-phospholipid syndrome and may present in the form of adrenal deficiency in the case of occasionally only microscopic bilateral haemorrhages. Furthermore, Synacthène is known to induce adrenal haemorrhages although this complication remains rare. Moreover, any unilateral adrenal haemorrhage requires subsequent follow-up for several months or even years in order to eliminate any underlying tumour and to control the absence of any adrenal deficiency if the involvement is bilateral.
    La Presse Médicale 04/2004; 33(6):385-8. · 0.87 Impact Factor
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    ABSTRACT: Cirrhosis (Cir) is often associated with chronic renal failure (CRF) in Egyptian patients on regular hemodialysis (RHD). This is largely attributed to hepatosplenic schistosomiasis and concomitant Hepatitis C viral infection. As the liver has a major role in vitamin D3 activation, we designed this study to envisage the impact of Cir on renal osteodystrophy (ROD). It included 130 consecutive age- and gender-matched subjects in 4 categories. Group I: 39 patients (34 male and 5 female; mean age 48.8 years) with Cir normal renal function; group II: 37 patients (30 male and 7 female; mean age 49.0 years) with CRF and normal liver function, on RHD for a mean duration of 6 ± 3.9 years; group III: 41 patients (30 male and 11 female; mean age 50.7 years) with CRF and concomitant Cir, stable on RHD for a mean duration of 7.0 ± 4.0 years; and group IV: 16 normal volunteers (13 male and 3 female; mean age 46.3 years). The prevalence of diabetes as well as previous infection with schistosomiasis was similar in all patient groups and that of HCV infection was alike in groups I and III. In all subjects, conventional parameters of liver and renal function were tested; in addition to measurement of serum total protein, albumin, calcium, phosphate, total and bone-specific alkaline phosphatase (B-ALP), parathormone (PTH), 5-hydroxycholecalciferol (5HD), 1,25-dihydroxycholecalciferol (1,25HD), Cross Laps (CXL) as a marker of bone resorption, and aminoterminal propeptide of type I procollagen (PINP) as a measure of bone formation. Bone mineral density (BMD) was measured by either Dual Energy X-ray Absorptiometry (DEXA) or Computerized Tomography (CT). Group II patients displayed the typical CRF profile comprising hypocalcemia, hyperphosphatemia, increased total and bone-specific alkaline phosphatases, high PTH and 25HD, low 1,25HD, increased PINP as well as CXL, and generally decreased BMD. Cir (Group III) significantly (p value at least <0.5) modified this profile in several aspects: it checked hypocalcemia (mean 8.8 vs. 7.9 mg/dL in groups II and III, respectively), hyperphosphatemia (5.15 vs. 4.9 mg/dL), and the elevation of B-ALP (62 vs. 30.5 μg/L) and PTH (89 vs. 78 pg/mL). It lowered the serum level of 25HD (18.7 vs. 13.7 ng/mL), augmented the deficiency of 1,25HD (13.4 vs. 8.0 pg/mL), did not appreciably affect the increase in bone formation (PINP 77.9 vs. 75.5 ng/mL), but ameliorated its excessive resorption (CXL 21 860 vs. 30 328 pmol/L) noticed in group II. This was associated with amelioration of the dialysis-associated osteopenia (70 vs. 33.5%) and increased incidence of osteosclerosis (30 vs. 61%), as measured by bone mineral density.Conclusion: Our data indicate that Cir ameliorates ROD through decreased bone resorption. This is associated with better tolerance to 1,25HD deficiency, which initiates the cascade of hypocalcemia, hyperparathyroidism, and increased bone resorption in CRF. Such tolerance may reflect upregulation of vitamin D receptors as a consequence of the humoral perturbation supervening in Cir, involving IGF-1, estrogens, or other vitamin D metabolites as 24,25 HD.
    Hemodialysis International 01/2004; 8(1):86 - 87. · 1.44 Impact Factor
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    ABSTRACT: Introduction A primary antiphospholipid syndrome is a very rare cause of adrenal haemorrhage. Observation A 51 year-old man presented with a unilateral adrenal haemorrhage, enhanced by the prescription of Synacthène® during the 4 days that preceded. There was no adrenal deficiency but the immunological control revealed the presence of anti-phospholipid antibodies. After 2 years of follow-up, adrenal controls have not shown any underlying tumour or endocrine insufficiency. Comments Adrenal involvement is described in the anti-phospholipid syndrome and may present in the form of adrenal deficiency in the case of occasionally only microscopic bilateral haemorrhages. Furthermore, Synacthène® is known to induce adrenal haemorrhages although this complication remains rare. Moreover, any unilateral adrenal haemorrhage requires subsequent follow-up for several months or even years in order to eliminate any underlying tumour and to control the absence of any adrenal deficiency if the involvement is bilateral.
    Presse Medicale. 01/2004; 33(6):385-388.
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    ABSTRACT: Malignant hypertension combines high blood pressure and stage III or IV retinopathy. This rare pathology may still cause fatalities. Cardiovascular, cerebral, and renal failure are the main complications. Admission in the ICU and intravenous drugs administration are recommended and allow to reduce mortality. An etiology for high blood pressure is more frequently found than in patients with non malignant hypertension. Antihypertensive drugs must be given intravenously including nicardipine, urapidil, labetalol or clonidine in order to obtain a gradual decrease (about 25%) of arterial blood pressure over 2 to 3 h. Due to cerebral autoregulation, it has been demonstrated that a higher drop in blood pressure could be deleterious.
    Réanimation. 06/2003; 12(4).
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    ABSTRACT: Alpha interferon is increasingly used in the treatment of malignancies and viral hepatitis. Renal involvement after its use consist in more cases on proteinuria. We report one case of acute renal failure without nephrotic syndrome but with tubulointerstitiel infiltration by mononuclear cells in 65 old man who had before interferon therapy 151 mumol/l of serum creatinine. Interferon was administrated for digestive carcinoid neoplasia and bone and liver metastasis. Outcome was improvement of renal function after withdrawn of interferon, dialysis and steroid treatment.
    Néphrologie 02/2003; 24(4):181-5.
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    Stroke 02/2003; 34(1):8-9; author reply 8-9. · 6.16 Impact Factor
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    ABSTRACT: OPTIMAAL study having shown that in patients with recent myocardial infarct (MI) and heart failure (HF), cardiovascular mortality is higher with losartan than with captopril, the first choice in these patients is still ACEI, unless intolerance. In patients with CHD but without HF, HOPE study has established ramipril as the reference treatment because it decreased the risk of MI, HF and stroke independently of BP and in patients with uncomplicated hypertension ANBP-2 trial has recently suggested an edge of ACEI over thiazide in global cardiovascular protection in spite of lower cerebral protection. Paradoxically no trial has yet been launched to compare ARB to ACEI in 3 populations in which the chance of ARB superiority over ACEI are the greatest thanks to a better cerebral protection mediated by non-AT1-receptors whereas comparable protection for CHD is expected since comparable MI recurrence risk between losartan and captopril was observed in OPTIMAAL. These populations are those in which MI risk is lower than that of stroke because of a low initial prevalence of CHD (≥ 16%) but in which stroke risk is high because of stroke history as in PROGRESS and PATS, of severe hypertension as in LIFE or of age as in SCOPE. Indeed the experimentally proven non-AT1-receptor-mediated brain-antiischemic mechanisms have been recently supported by following clinical evidences: (1) the contrast between the lack of stroke protective effect (SPE) with AII-inhibiting perindopril (PROGRESS) and the 29% SPE with AII-stimulating of indapamide (PATS) for the same BP decrease. (2) the 25% greater selective SPE with AII-stimulating losartan than with the AII-suppressing atenolol for the same BP decrease. (3) the contrast between the 10% BP-independent SPE of AII-stimulating candesartan comparatively to the AII-neutral association of β -blocker and DHP in SCOPE.Conclusion: To base the preferential recommendation of ARB over ACEI in populations without CHD on evidence, a large trial comparing these 2 drugs is urgently needed in these populations.
    01/2003;
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    ABSTRACT: The acute brain ischemia model by unilateral carotid ligation in the gerbil has shown that angiotensin II infusion accelerates recovery of blood flow in the ipsilateral brain and that preadministration of ACEI when compared to that of ARB was associated with a higher mortality rate. Furthermore ACEI co-administration with an ARB canceled the SPE of this latter. This suggests a SPE of non-AT1 receptor-activation since AII-formation is increased with ARB but decreased with ACEI. The clinical relevance of this mechanism has been strongly supported by LIFE trial which has shown that, at comparable BP, losartan compared to atenolol conferred a selective 25% greater SPE while the higher AT1-blockade evidenced by greater LVH regression did not lead to greater prevention of cardiac complications. Indeed the hypothesis that higher AT1-blockade was responsible for this selective cerebral protection would imply a higher density of plaques in cerebral than in coronary arteries; which is unlikely, given the twice higher initial prevalence of CHD versus stroke in this population. SCOPE also supports this non-AT1-mediated brain anti-ischemic effect by showing also a selective 23%greater SPE of candesartan ±thiazide versus a placebo± thiazides, betablocker and dihydropyridine (DHP). However SBP was 3 mmHg lower with candesartan and according to HOPE trial this lower BP could account for a 13% stroke risk decrease so that the BP-independent SPE of candesartan is only 10%. Lower SPE of candesartan compared to losartan cannot however be infered from these percentages because the comparator in SCOPE had a neutral effect on AII whereas in LIFE the comparator atenolol had an AII-suppressing effect, which accounts for the 25% lower SPE of atenolol than that expected from the BP-decrease this drug induced comparatively to placebo in MRC 1992 trial. Thus had candesartan been LDcompared to atenolol, its SPE would have actually been 35%, ie higher than that of losartan.Conclusion: BP-control and comparator-effect on AII are important in the evaluation of ARB-SPE.
    American Journal of Hypertension - AMER J HYPERTENS. 01/2003; 16(5).
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    ABSTRACT: This paper deals with the interpretation of parathyroid hormone assays in case of renal failure and use of bone remodeling markers for patients undergoing hemodialysis or transplantation.
    Immuno-analyse & Biologie Specialisee - IMMUNO-ANAL BIOL SPEC. 01/2003; 18(2):67-74.
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    ABSTRACT: Kidney stone, with or without lumbar pain, is a major health care problem because of its prevalence and cost for both the patient and the society. Although, surgical procedures are well known, medical treatment and recurrences prophylaxis are uncodified. Fifteen stone recurrence prevention studies have been reviewed, evaluating dietary intake and drugs. The most important factor is a daily diuresis of at least 2 liters. Calcium intake shouldn't be restricted, whereas oxalate, sodium, and protein intakes have to be limited. Hyper and normocalciuretic kidney stone formers improve their outcome with thiazide or indapamide treatment. Hyperuricosuria justifies allopurinol. Potassium citrate (without sodium) may decrease recurrence risk, even in patients without hypocitraturia.
    Néphrologie 01/2003; 24(6):303-7.

Publication Stats

3k Citations
1,485.01 Total Impact Points

Institutions

  • 2001
    • University of Limoges
      Limages, Limousin, France
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France
  • 1991–2001
    • Centre Hospitalier Universitaire d'Amiens
      • • Service de Neurologie
      • • Service de Rhumatologie
      Amiens, Picardie, France
  • 1987–1998
    • Centre Hospitalier Universitaire de Nice
      Nice, Provence-Alpes-Côte d'Azur, France
  • 1995–1996
    • Université de Technologie de Compiègne
      Compiègne, Picardie, France
  • 1989–1992
    • Centre hospitalier Laennec de Creil
      Creil, Picardie, France
    • Centre Hospitalier de Saint-Quentin
      Saint-Quentin, Picardie, France
  • 1989–1991
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 1982–1991
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 1988
    • Centre Hospitalier Universitaire de Lyon
      • Service de Néphrologie
      Lyon, Rhone-Alpes, France
  • 1987–1988
    • Université de Picardie Jules Verne
      Amiens, Picardie, France