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ABSTRACT: INTRODUCTION: Nasal septal perforations are mainly due to trauma. Our review highlights systemic diseases leading to this disorder. CURRENT KNOWLEDGE AND KEY POINTS: Various systemic diseases may be responsible of nasal septal perforation: Wegener's granulomatosis, systemic lupus erythematosus, antiphospholipid syndrome, sarcoidosis, cryoglobulinaemia. But, very few data are available about the frequency of septum nasal perforation in each disease. Clinical manifestations are numerous and not specific: obstruction, epistaxis, postnasal discharge, whistling, crusting. Asymptomatic forms are frequent. Biopsy of nasal septum is poorly useful for the diagnosis except when granuloma or vasculitis is found. Pathophysiologic mechanisms of nasal septal perforation are ischemic, infectious or inflammatory. FUTURE PROSPECTS AND PROJECTS: Systemic disease may be suspected in unclear nasal septal perforation. More, in systemic disease, even when symptoms are absent, intranasal examination is required.
La Revue de Médecine Interne 12/2002; 23(11):919-26. · 0.61 Impact Factor
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La Revue de Médecine Interne 07/2002; 23 Suppl 2:232s-235s. · 0.61 Impact Factor
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B Fautrel,
G Le Moël,
B Saint-Marcoux,
P Taupin, S Vignes,
S Rozenberg,
A C Koeger,
O Meyer,
L Guillevin,
J C Piette,
P Bourgeois
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ABSTRACT: To determine the usefulness of serum ferritin and glycosylated ferritin (GF) levels in diagnosing adult onset Still's disease (AOSD).
We performed a retrospective multicenter study of 205 patients who had ferritin and GF assays in one hospital laboratory. Records of all patients were reviewed, and a standardized questionnaire used to extract all data available at the time of the assay. The clinicians' final diagnosis was also recorded. Patients were classified as having "certain AOSD" (based on Yamaguchi's criteria) or a control disease. The concordance of ferritin and GF levels with final diagnosis was evaluated.
In total 49 AOSD and 120 control patients were eligible. The mean ferritin value was significantly higher in the AOSD group (4,752 +/- 9,599 microg/l) than in the control group (1,571 +/- 3,807 microg/l), p = 0.029. GF was significantly lower in AOSD patients (15.9 +/- 11.9%) than in the control group (31.5 +/- 18.7%), p < 0.001. The combination of a GF level of < or = 20% with ferritin above the upper limit of normal yielded a sensitivity of 70.5% and specificity of 83.2%. The combination of a GF level < or = 20% with ferritin 5 times normal produced a sensitivity of 43.2% and specificity of 92.9%. This latter combination allowed an AOSD diagnosis to be ruled out for 6 of the 8 control patients who met Yamaguchi's positive criteria.
Ferritin and GF levels are powerful diagnostic markers of AOSD. They may be helpful in clinical practice for excluding differential diagnoses.
The Journal of Rheumatology 03/2001; 28(2):322-9. · 3.69 Impact Factor
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ABSTRACT: To determine the evolution of levels of total serum ferritin and percentage of the glycosylated form in patients with adult onset Still's disease (AOSD) at the time of diagnosis and during follow up.
All patients with AOSD were tested at the time of diagnosis and during follow up. Total serum ferritin levels were analysed by immunoassay, and the percentage of glycosylated ferritin was determined by methods using Sepharose-Con A.
14 patients (eight women, six men) with AOSD were enrolled. At the time of diagnosis, mean (SD) age was 36 (16) years. Mean initial total serum ferritin was 6350 (1300) microg/l (normal <250 microg/l). The mean initial percentage of glycosylated ferritin was 14.7 (13)% (normal >50%). Mean follow up time was 37 (35) months. At the time of the last examination all patients were in remission except one, who presented a chronic articular form. Total serum ferritin remained high in this single patient and was normal in the 13 others, with a mean of 98 (73) microg/l. In all patients the percentage of glycosylated ferritin remained low, with a mean of 16 (16)%.
Total serum ferritin is a marker of the active phase of AOSD. The percentage of glycosylated ferritin is low both in the active phase and in remission. Further studies are needed to confirm these data and to determine their specificity for AOSD before considering any possible use of a low percentage of glycosylated ferritin as a diagnostic tool in suspected AOSD, especially when atypical or previously treated.
Annals of the Rheumatic Diseases 06/2000; 59(5):347-50. · 8.73 Impact Factor
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ABSTRACT: To study the association of polyclonal B-cell lymphocytosis with binucleated lymphocytes with clinical manifestations suggesting the existence of an immunodeficiency, to evaluate the effect of cigarette smoking on this 'benign lymphoid proliferation', to analyze the clonality of lymphocytes, to determine the levels of immunoglobulins (Ig) G, A, M.
Description and analysis of the results obtained in four patients and literature review.
Polyclonal B-cell lymphocytosis is associated with both a decrease in IgA and IgG and an increase in IgM. Recurrent infectious episodes (bronchitis) were observed in two patients. Transient smoking cessation allowed a decrease in lymphocytosis and IgM levels in two patients. No hematological malignancy occurred during the follow-up, while biological abnormalities persisted.
Persistent polyclonal B-cell lymphocytosis may be associated with minor clinical features of immunodeficiency. Smoking cessation may sometimes lead to a decrease in lymphocytosis and IgM.
La Revue de Médecine Interne 04/2000; 21(3):236-41. · 0.61 Impact Factor
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Annales de Dermatologie et de Vénéréologie 05/1999; 126(4):339-40. · 0.72 Impact Factor
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Revue Neurologique 03/1999; 155(2):158-64. · 0.49 Impact Factor
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ABSTRACT: INTRODUCTION: Adult onset Still's disease is a rare systemic disorder of unknown etiology occurring in young adults. The diagnosis is based upon Yamaguchi criteria. Treatment is difficult and not well codified. CURRENT KNOWLEDGE AND KEY POINTS: Non steroidal anti-inflammatory drugs (salicylates, indomethacin) are used as first-line therapy but are not efficient. Steroids are needed in 80% of cases to control systemic manifestations of adult onset Still's disease. Immunosuppressive agents, such as methotrexate, are necessary when a high dose of steroids are required. The use of intravenous immunoglobulin was rarely reported, in particular in patients refractory to non steroidal anti-inflammatory drugs. Intravenous immunoglobulin was administered at 2 g/kg of body weight during two or five days. Infusion was given monthly for four-six cycles. Long-term remission was obtained in half of the patients. Precise mechanisms of action of intravenous immunoglobulin in adult onset Still's disease remain unclear. FUTURE PROSPECTS AND PROJECTS: Intravenous immunoglobulin may represent a new treatment, particularly in patients refractory to non steroidal anti-inflammatory drugs before the use of steroids. Further prospective works are needed to confirm these preliminary optimistic data.
La Revue de Médecine Interne 02/1999; 20 Suppl 4:419s-422s. · 0.61 Impact Factor
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ABSTRACT: INTRODUCTION: As short-term corticosteroid therapy is widely used in clinical practice, it is important to determine its precise indications and limits of use. CURRENT KNOWLEDGE AND KEY POINTS: Duration of short-term corticosteroid therapy is arbitrarily considered to be up to 21 days. Anti-inflammatory, antiproliferative or analgesic actions represent the main pharmacological features of steroids. They are related to the interactions of steroids with cytokines and immune cells. Results of randomized double-blind and uncontrolled clinical studies were included in this review. Furthermore, clearly demonstrated results that were obtained more particularly in neurology, otorhinolaryngology, pneumology, infectious diseases, rheumatologic and traumatic processes are summarized. FUTURE PROSPECTS AND PROJECTS: Indications for short-term corticosteroid therapy are well established. However, further clinical studies are required, as current prescription of corticosteroid is still empirical in the management of most diseases.
La Revue de Médecine Interne 12/1998; 19(11):799-810. · 0.61 Impact Factor
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La Revue de Médecine Interne 07/1998; 19(6):445-6. · 0.61 Impact Factor
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ABSTRACT: Neurological involvement occurs in 10 to 28% of patients with Behçet's disease.
We report a case of neurological pseudotumoral presentation of Behçet's in a patient with a long standing disease treated with low dose of prednisone and colchicine (1 mg/day), 2 months after withdrawal of colchicine.
Neurological manifestations during Behçet disease can be secondary to direct central nervous system involvement (encephalitis, encephalomyelitis) or vascular angitis (essentially cerebral venous thrombosis and, rarely, intracranial aneurysms). Neurological pseudotumoral presentation is rarely reported.
La Revue de Médecine Interne 02/1998; 19(1):55-9. · 0.61 Impact Factor
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ABSTRACT: Adult onset Still's disease is a systemic disorder of unknown etiology. The diagnosis is difficult and based upon Yamaguchi's criteria after exclusion of infectious diseases, hematologic process or autoimmune diseases. Clinical manifestations are various. Functional prognosis depends essentially on articular involvement. Vital prognosis depends on either hepatic failure or hematological or infectious complications, or amyloidosis. Ferritinemia is an important biological parameter which is not included in current criteria. Treatment is not well codified but steroids represent the most efficient therapy to control fever and systemic manifestations. Search for new treatments and specific markers of adult onset Still's disease are needed.
La Revue de Médecine Interne 02/1997; 18(8):626-37. · 0.61 Impact Factor
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ABSTRACT: Low-molecular-weight heparins (LMWH) have different properties than non-fractionated heparins. Bioavailability is better after subcutaneous administration and a longer halflife allows a single daily injection. Efficacy is equivalent for postoperative thromboembolism prophylaxis for all types of surgery. In most reports, low-molecular-weight heparins are more effective than non fractionated heparin and lead to fewer episodes of hemorrhage and thrombocytopenia. For treatment of deep vein thrombosis, low-molecular-weight heparins are as effective as non-fractionated heparins after two, or even one, daily injection without hemostasis tests. Other on-going studies are evaluating LMWH indications in pulmonary embolism, artery disease, pregnancy or other medical conditions.
Annales de medecine interne 02/1997; 148(2):154-62.
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La Revue de Médecine Interne 02/1997; 18 Suppl 3:279s-281s. · 0.61 Impact Factor
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La Revue de Médecine Interne 02/1997; 18(2):167-8. · 0.61 Impact Factor
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La Revue de Médecine Interne 02/1996; 17(9):769-70. · 0.61 Impact Factor
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ABSTRACT: Since 3 years, a 74 year-old man suffered of swallowing impairment, weight loss, bilateral ptosis and proximal muscular weakness. Electron microscopy disclosed intranuclear tubular filaments and confirmed the diagnosis of oculopharyngeal muscular dystrophy. Upper oesophageal sphincter myotomy was performed with complete improvement. Four months after surgery, swallowing disorders were not recurrent and weight gain was substantial.
La Revue de Médecine Interne 02/1996; 17(12):1017-9. · 0.61 Impact Factor
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ABSTRACT: Acquired hemophilia is associated with diverse conditions such as post-partum period, autoimmune diseases, cancers, and lymphoproliferative diseases. We report a case of acquired hemophilia occurring in Sjögren's syndrome which was treated with corticoid therapy. A review of the different treatments of acquired hemophilia is presented.
Clinical and experimental rheumatology 14(5):559-60. · 2.15 Impact Factor
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ABSTRACT: Adult onset Still's disease (AOSD) is a systemic disorder with an uncertain outcome at the time of diagnosis. The clinical response to nonsteroidal antiinflammatory drugs (NSAIDs) is often unsatisfactory in adult patients. Chronic use of steroids is frequently required, but may result in severe side effects. We report the results of an uncontrolled, unblinded trial of intravenous immunoglobulin (IVIG) in 7 patients with AOSD.
Seven consecutive patients unresponsive or poorly responsive to NSAIDs were enrolled. None of them had received steroids previously. AOSD was defined by the Yamaguchi criteria (J Rheumatol 1992; 19: 424). IVIG were administered every 4 weeks. NSAIDs were initially maintained. A positive response was defined by the disappearance of fever and arthritis within 2 weeks after the first IVIG infusion.
Two patients failed to respond. Five patients initially considered to be good responders were given a total of 4 to 6 IVIG infusions. One of them relapsed at the time of the fourth IVIG infusion. The four others had a favourable clinical and biological course. At the time of evaluation 3 patients were symptom-free and off therapy, while one was still receiving low dose NSAIDs.
This short, uncontrolled, unblinded study suggests that IVIG might represent a potential alternative to classical steroid therapy in patients with AOSD refractory to NSAIDs. These preliminary results need to be confirmed, however, in a double-blind randomized study.
Clinical and experimental rheumatology 16(3):295-8. · 2.15 Impact Factor
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ABSTRACT: PurposeTo study the association of polyclonal B-cell lymphocytosis with binucleated lymphocytes with clinical manifestations suggesting the existence of an immunodeficiency, to evaluate the effect of cigarette smoking on this ‘benign lymphoid proliferation’, to analyze the clonality of lymphocytes, to determine the levels of immunoglobulins (Ig) G, A, M.MethodsDescription and analysis of the results obtained in four patients and literature review.ResultsPolyclonal B-cell lymphocytosis is associated with both a decrease in IgA and IgG and an increase in IgM. Recurrent infectious episodes (bronchitis) were observed in two patients. Transient smoking cessation allowed a decrease in lymphocytosis and IgM levels in two patients. No hematological malignancy occurred during the follow-up, while biological abnormalities persisted.ConclusionPersistent polyclonal B-cell lymphocytosis may be associated with minor clinical features of immunodeficiency. Smoking cessation may sometimes lead to a decrease in lymphocytosis and IgM.
La Revue de Médecine Interne.
