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Biomedical subjects

B Devulder

Publications and source records attributed to B Devulder.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Arteriopathies as occupational diseases].

Arteriopathies of occupational diseases predominate in the upper limbs and are usually expressed as Raynaud's phenomenon ("white finger"), sometimes complicated by digital gangrene. Hand-arm vibration disease, hypothenar hammer syndrome, exposure to silica even without silicosis and vinyl chloride intoxication are the principal causes of occupational diseases acknowledged as such by the laws. In a personal series of 60 patients with complicated upper limb arteriopathies, 25% had a recognized occupational disease. Since December 1992, Erasmus' syndrome and systemic scleroderma due to silica without silicosis have been accepted in France as being occupational diseases. The therapeutic problems are discussed, notably the surgical indications in hypothenar hammer syndrome, the possible medical treatments of finger necrosis occurring in Erasmus' syndrome and, in particular, the role played by spinal cord neurostimulation.

Air Pollutants, Occupational↗
PubMed1993

[Systemic form of sarcoid-like necrotizing granulomatosis with ocular, pulmonary and cerebral involvement].

Sarcoid-like necrotizing granulomatosis is an exceptional condition characterized by lesions of epithelioid granulomatosis and signs of vasculitis. It usually involves the lungs and has a favourable prognosis. We report the case of a young woman with a systemic form of the disease which affected not only the lung, but also the eye and the central nervous system. Under corticosteroid therapy the pulmonary lesions and the biological inflammatory syndrome disappeared, but the brain lesions followed a course of their own despite the addition to steroid treatment of an immunosuppressive therapy. This case highlights the superiority of MRI over CT of the brain in the diagnosis and monitoring of brain lesions: CT became normal after corticosteroid therapy was initiated, where as the neurological signs became worse and the brain lesions progressed on MR images.

Adult↗
PubMed1993

[Comparison of the efficacy between simvastatin and gemfibrozil in primary hypercholesterolemia].

The efficacy on plasma lipids, apo A1 and B of a HMG Co A Reductase inhibitor, simvastatin, and a fibrate derivative, gemfibrozil, were compared in 136 hypercholesterolemic patients. The study was randomized, double-blinded and the active drug was given after a 4 week period of placebo. Gemfibrozil (n = 69) was given at 900 mg q.p.m. during the entire study. The primary dose of simvastatin was 10 mg q.p.m. during the first 6-weeks of treatment. At the end of this period, the dose was doubled if the cholesterol level was above 2 g/l (5,16 mmol/l). The same modification was carried out 12 weeks after the beginning active drug treatment with the same criteria. The baselines of total cholesterol were 3.24 +/- 0.69 g/l (8.38 +/- 1.78 mmol/l) 3.21 +/- 0.72 g/l (8.31 +/- 1.87 mmol/l) for patients with simvastatin and those with gemfibrozil respectively. So, at the end of active treatment, 64% of patients in the simvastatin group (n = 67) received 40 mg q.p.m. After 18 weeks of treatment, 89% of patients treated with Simvastatin and 37% with gemfibrozil had more than 20% reduction in LDL cholesterol. Simvastatin was more efficient on total cholesterol, LDL-C and apo B. The increase of HDL-C is similar in both groups of patients. In contrast, the level of triglycerides was further decreased by gemfibrozil. The tolerance was good in the two groups of patients and no difference in the frequency of side effects was observed.

Adult↗
PubMed1993

Embolization of two bleeding aneurysms with platinum coils in a patient with polyarteritis nodosa.

We describe a patient with polyarteritis nodosa who developed a large retroperitoneal hemorrhage from a ruptured suprarenal capsule artery aneurysm. Platinum coils were embolized selectively during arteriography and successfully controlled the aneurysmal bleeding. The vasculitis was controlled ten weeks later but our patient developed anemia and computerized tomography scan revealed a large retrogastric hemorrhage. A further arteriogram confirmed the presence of a ruptured gastric coronary artery aneurysm. A second embolization was performed with complete success. Selective embolization of small arteries with coils should be considered a good alternative to surgery in patients with polyarteritis nodosa and hemorrhage from a ruptured aneurysm; arteriography may be considered a potent diagnostic and therapeutic tool in the management of the treatment of polyarteritis nodosa.

Aneurysm↗
PubMed1991

[Medical treatment of cholesterol crystal embolism].

Cholesterol crystal embolization is an often fatal disorder in the elderly. Clinical manifestations consist of skin lesions arterial hypertension and renal failure. In some cases the clinical picture is suggestive of vasculitis. The most frequent predisposing factors are operative and radiological vascular procedures and the use of anticoagulants. The diagnosis can be confirmed by skin, muscle or kidney biopsy. Data concerning management are scarce and contradictory. A review of the literature has revealed some controversy as to how and when cholesterol crystal embolization should be treated, and controlled studies are lacking. We discuss the use of various drugs such as anticoagulants, antiplatelet agents and corticosteroids. In practice, the usual treatment is symptomatic and includes therapy of the peripheral vascular disease, adequate control of blood pressure and appropriate management of renal insufficiency. The most effective measure is prevention.

Acute Kidney Injury↗
PubMed1990

[Value of transcutaneous staged dynamic oximetry of stage II arteritis of the leg].

The clinical and prognostic value of transcutaneous oxygen pressure measurements at rest has been established in Leriche Stage III and IV occlusive peripheral arterial disease but is controversial in Stage II because there is an overlap of transcutaneous pO2 (Tc pO2) values with those of normal subjects. The authors report the results of Tc pO2 measurements during exercise testing in a group of patients with Stage II occlusive arterial disease of the lower limbs. Seventy-eight patients with an average age of 53 years (range 40 to 65 years) whose claudication perimeter and site of pain had been carefully assessed and who had also recently undergone Doppler arterial examination and arteriography and 35 control subjects with an average age of 54 years (range 45 to 70 years) were studied. The Tc pO2 was continuously measured with a multimodular Kontron Supermon at 4 different sites simultaneously: precordium (reference probe), thigh, calf and foot in the dorsal recumbent position after 30 minutes rest, during a standardised exercise stress test at 50 watts and during the recovery phase. The results were expressed as ratio of tissue oxygenation (RTO): thigh, calf or foot Tc pO2/precordial Tc pO2 X 100 in order to take into account the patients cardiorespiratory status and adaptation to exercise. The RTO in normal subjects remained at the upper limits of the resting value throughout exercise and then returned slowly to basal values during the recovery phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Significance of arterial Doppler in Horton's disease. Prospective study of 59 case reports].

Several preliminary studies drew attention to the value of Doppler examination in temporal arteritis. This study involving 59 cases aimed to define the value of Doppler examination in the diagnosis of the disease, evaluation of ophthalmic risk and in the monitoring of treatment. The study involved 59 patients and 47 controls with no evidence of temporal arteritis, but of comparable mean age. The following arteries were investigated before treatment: arteries of limbs, subclavian, vertebral, carotid, temporal, occipital, facial and ophthalmic recorded via the internal nasal branch and also transocularly. The results were expressed in the form of a score from 0 to 3 describing the degree of deterioration of the curves. A mean score corresponding to the mean of the scores of the cephalic arteries was calculated for each patient and each control. The specificity and sensitivity of the investigation were studied, based on this mean score by ROC analysis. The progression under treatment was monitored for more than 24 months in 20 patients divided into 3 groups: group I: 6 patients cured; group II: 6 patients with late recurrence of temporal arteritis after steroid withdrawal; group III: 8 patients with progressive disease. 81.5% of temporal arteries were pathological, including 60% with tight stenosis (score 2 and 3). Morphological anomalies in the curves were also noted at the level of the occipital arteries (69%), facial arteries (80%), as well as the ophthalmic artery at both recording sites (internal nasal: 84.5%, transocular: (73%) (table I).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

T lymphocyte activation in systemic lupus erythematosus analysed by proliferative response to nucleoplasmic proteins on nitrocellulose immunoblots.

Polyclonal B cell activity in systemic lupus erythematosus (SLE) may be under T cell control. The use of nitrocellulose immunoblots for the analysis of recognition by peripheral blood lymphocytes of nucleoplasmic proteins in SLE patients led to the characterization of significant proliferative responses to 68K (U1 RNP); SS-B; B-B' and D (Sm) antigen in 15 of 20 patients. Variations of proliferative response were parallel to disease activity over a follow-up period of greater than or equal to 6 months, conferring some prognostic value to the assay of lymphocyte response to nucleoplasmic antigens. The pattern of reactivity differs from the corresponding serum antibody profile, and purified T cell suspensions (greater than 95% pure) were shown to proliferate in response to soluble nucleoplasmic antigens, indicating that T and B cell repertoires against nucleoplasmic proteins may differ. This suggests that activated helper T cells contribute to the fine modulation of B cell reactivity to subcellular particles to determine the particular antibody profile of the patients.

Adolescent↗
PubMed1988

[Clinical value of the determination of urinary antitrypsin activity].

Urinary trypsin inhibitory capacity is mainly due to the excretion of a glycoprotein which is immunologically related to the inter alpha-trypsin inhibitor and may be a proteolytic degradation product of that substance. It was tested in 133 subjects divided into 7 groups: 24 healthy controls (group A), 21 patients with bacterial infection (group B), 37 with bacterial infection under antibiotic therapy (group C), 25 with connective tissue disease (group D), 8 with infected connective tissue disease (group E), 14 with cancer (group F) and 4 with infected cancer (group G). Urinary trypsin inhibitory capacity level was very low in controls (3.32 +/- 0.8 U/g urinary creatinine), but it was dramatically increased when infection was present (149.67 +/- 23.6 U/g urinary creatinine). This test appeared to be more effective than serum C-protein measurement simultaneous carried out in the same patients. Urinary trypsin inhibitory capacity is not related to the degree of proteinuria in the urine sample, but it is increased in patients with chronic renal failure excluded from this study. Thus, its measurement is a sensitive, easy and useful test for detecting and monitoring infections. The return to its physiological value is a very good argument in favour of therapeutic effectiveness.

Bacterial Infections↗
PubMed1987

Subclinical lung inflammation in primary Sjögren's syndrome. Relationship between bronchoalveolar lavage cellular analysis findings and characteristics of the disease.

To directly evaluate whether a subclinical alveolar inflammation is associated with primary Sjögren's syndrome (SS), we evaluated the distribution of cells obtained by bronchoalveolar lavage (BAL) from the lower respiratory tract in 29 patients who had primary SS, but who were free of clinical pulmonary symptoms and had normal findings on chest roentgenograms. There was no difference in total cell counts of specimens from patients versus those of controls. An abnormal differential cell count was noted in 16 patients (55%). Two patterns of alveolitis were observed: a pure lymphocyte alveolitis (greater than 18% lymphocytes, present in 11 patients) and a neutrophil alveolitis (greater than 4% neutrophils, present in 5 patients). There was associated lymphocytosis in 4 of the patients with neutrophil alveolitis. All patients had normal results on pulmonary function tests. Patients with abnormal BAL findings showed clinical and biologic indexes of more severe disease than did those with normal BAL results, as demonstrated by greater extraglandular extension of the disease, higher mean values of serum gamma globulins and serum beta2-microglobulin, and higher prevalence of rheumatoid factor and of antinuclear antibody. Thus, our data demonstrate that BAL permitted the detection of subclinical inflammatory alveolitis in 55% of our patients with primary SS. A long-term followup is required to determine whether these patients will develop obvious pulmonary involvement.

Adult↗