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B Goichot

Publications and source records attributed to B Goichot.

At least 19 recordsLinked to original sources
PubMed1999

[Veno-occlusive disease of the liver and POEMS syndrome].

BACKGROUND: Veno-occlusive disease of the liver is a common cause of morbidity and mortality after chemotherapy and/or radiotherapy and bone marrow transplantation. Non thrombotic hepatic venous obstruction is characteristic, but pathogenesis of this disease remains unknown. CASE REPORT: In june 1993, a 58-year-old man was treated by cyclophosphamide and steroid for a POEMS syndrome. In november 1996, he developed hepatalgia, edema, ascitis and jaundice. The diagnosis of hepatic veno-occlusive disease was obtained by hepatic biopsy. Refractory ascitis was treated by transjugular intrahepatic portosystemic shunt. Gradual improvement in clinical status was observed after this therapy. CONCLUSION: This observation offers three original types of information: there has been no prior report of an association between veno-occlusive disease and POEMS syndrome, the role of low dose cyclophosphamide in hepatic veno-occlusive disease was certain, transjugular intrahepatic portosystemic shunt is an interesting therapy with one years remission.

Cyclophosphamide↗
PubMed1999

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): a form of paraneoplastic polyarthritis?

OBJECTIVE: To describe the clinical and laboratory features and outcome of 6 patients presenting with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) revealing a solid tumor. METHODS: Patients with RS3PE who presented with a solid tumor and who had been seen between January 1, 1994, and December 31, 1996, were included in a retrospective multicenter analysis. These patients fulfilled McCarty's description of RS3PE and the following criteria: (1) bilateral pitting edema of both hands, (2) sudden onset of polyarthritis, (3) age >50 years, and (4) absence of rheumatoid factor (RF). RESULTS: Six male patients with RS3PE are described, of mean age 74 years (range 72-78), presenting prostatic (n = 4), gastric (n = 1), and colic (n = 1) adenocarcinomas. The clini cal picture was characterized by the classical form of RS3PE syndrome and by a deterioration in general condition, sometimes with fever. All patients were negative for RF and antinuclear antibodies. In 2 cases of prostatic adenocarcinoma serum levels of interleukin 6 (IL-6) were high, but decreased with treatment. In these 6 patients, the articular manifestations regressed totally or partially in response to corticosteroids, sometimes at low doses, associated in most cases with specific antitumoral therapy. None displayed erosion or distal bone destruction. The mean survival following discovery of RS3PE was 11 months (range 6-18), 5 patients dying of metastatic dissemination of their cancer and the 6th of myocardial infarction. CONCLUSION: RS3PE is a heterogeneous syndrome that can reveal a solid tumor, notably an adenocarcinoma. There exist no specific criteria to define its forms, but this syndrome should be kept in mind in the face of a deterioration in general health. Although the pathogenic mechanism is unknown, this could involve a type of paraneoplastic polyarthritis linked to the synthesis of a factor such as IL-6.

Aged↗
PubMed1998

[Diffuse digestive tract B-cell lymphoma manifesting as exudative enteropathy].

BACKGROUND: Early manifestations of primary lymphomas of the digestive tract generally include general signs and abdominal pain. Diarrhea is uncommon and may result from several mechanisms. We report a case of primary lymphoma of the digestive tract in a patient presenting exsudative enteropathy. CASE REPORT: A 68-year-old woman was hospitalized for profuse diarrhea of 15 days duration. Laboratory tests showed major hypoalbuminemia. Malabsorption could not be evidenced and no infectious foyer was found. Biopsies at different levels of the digestive tract showed mucosal invasion by MALT type B-cell lymphoma. The clinical course was initially favorable after chemotherapy. DISCUSSION: Classification of digestive tract lymphomas differentiates MALT type B-cell lymphoma (the most frequently encountered type in western countries), Mediterranean lymphomas, and T-cell lymphomas generally complicating coeliac disease. MALT type lymphomas may occur in association with Helicobacter pylori infection, usually in a gastric localization. Multiple localizations are uncommon and diffuse involvement of the digestive tract as in our observation appears exceptional. This extension would explain the exsudative enteropathy which regressed with chemotherapy.

Aged↗
PubMed1998

Evaluation of Elecsys free triiodothyronine assay: relevance of age-related reference ranges.

OBJECTIVE: This study aimed at evaluating Elecsys free triiodothyronine (FT3) assay performed on an Elecsys 2010 system, while paying special attention to age relationship in euthyroid subjects. DESIGN AND METHODS: FT3 levels were measured in 149 euthyroid control subjects aged between 2 and 92 years old, 33 hyperthyroid and particular euthyroid patients: female in the last 3 months of pregnancy (n = 30), nonthyroidal ill hospitalized in medical (NTlm, n = 31), or intensive care units (NTlc, n = 31) and amiodarone-treated (n = 27). RESULTS: FT3 was inversely related to age in controls (r = -0.67). Three reference ranges were used: below 20 years 4.5-9.0 pmol/L, between 20 and 60 years 3.9-7.2, and over 60 years 2.4-6.5. Compared to age-matched controls, FT3 decreased in pregnancy, NTlm, NTlc, and amiodarone groups. Use of age-related reference ranges improved the specificity markedly in amiodarone patients and to a lesser extent in NTlm and TClc patients. CONCLUSIONS: The reliability of the Elecsys FT3 assay was found to be satisfactory for clinical use, when the age of patients was taken into account.

Adolescent↗
PubMed1998

[Cholesterolemia and pathology: update].

The relationship between plasma cholesterol levels and disease is more complex than presumed. If the pathogenic role of hypercholesterolemia in ischemic myocardial disease is now undoubted, the deleterious effect of hypocholesterolemia induced by diet or drugs, mainly on cancer mortality and violent death, is still controversial. In a prognostic point of view it seems that the degree of diminution of cholesterol levels is more important than hypocholesterolemia itself. Several hypothesis were formulated; however, hypocholesterolemia does not appear as a causal factor. A prudent approach of hypercholesterolemia remains desirable but without special alterations of the recent recommendations concerning the management of hypercholesterolemia.

Cholesterol↗
PubMed1998

[Growth hormone: a magical potion?].

INTRODUCTION: The various components of the growth hormone (GH)-insulin-like growth factor (IGF-I) axis and their binding proteins have many peripheral effects, mainly on bone, growth, activation of main cellular functions, energy metabolism and protein anabolism. They contribute to adapt an individual to circumstances of life and illness. CURRENT KNOWLEDGE AND KEY POINTS: The unlimited supply of recombinant GH makes it possible to treat not only children with short stature but other disorders. In adults with GH deficiency, it has a marked effect on subjective well-being and body composition, and improves physical activity. GH may be promoted in new therapeutic areas such as severe hypercatabolic and denutrition states, dilated cardiomyopathy and several other more hypothetical areas. GH is not a wonder drug increasing physical performances in sport competitors or fighting against senescence. FUTURE PROSPECTS AND PROJECTS: GH is a new therapeutic tool. Its efficacy must be evaluated through double-blind, placebo-controlled clinical trials. Currently, only benefits on psychological and physical symptoms of GH deficiency in adults have been validated.

Adult↗
PubMed1998

[Non-thyroid indications of treatment with thyroid hormones].

INTRODUCTION: The use of thyroid hormone is currently strictly limited to thyroid diseases. Several recent papers have examined the effects of thyroid hormone in non-thyroidal diseases. These studies examined either the use of the pharmacological properties of thyroid hormone or the effect of the correction of the decrease in triiodothyronine (T3) associated with non-thyroid illnesses. CURRENT KNOWLEDGE AND KEY POINTS: Intravenous administration of T3 improves the cardiac index during ongoing cardiac surgery, with a paradoxical decrease in the incidence of atrial fibrillation. T3 administered by the oral route also improves the cardiac index in the medium term in dilated cardiomyopathy. No benefit on survival has been demonstrated in non-thyroidal diseases when using the pharmacological properties of thyroid hormone. Other situations, such as transplantation or neural rescue after cardiac arrest, are currently under study. In non-thyroidal diseases, administration of thyroxine (T4) has no effect because of the deeply disturbed metabolism of thyroid hormones. FUTURE PROSPECTS AND PROJECTS: Adverse metabolic effects of T4 and T3 therapy have probably been overestimated and may depend on the dose and on the time of administration in the course of the disease. Indications in cardiac surgery and cardiac diseases need to be clarified. To further understand the value of thyroid hormones in non-thyroidal diseases, placebo-controlled studies using small doses of T3 are required.

Animals↗
PubMed1998

[Euthyroid sick syndrome: recent physiopathologic findings].

INTRODUCTION: Patients with nonthyroidal disease frequently exhibit abnormal thyroid function tests; this is referred to as euthyroid sick syndrome. The clinical significance of this syndrome is unknown: abnormal endocrine reaction with reduced triiodothyronine (T3) at the tissue level, or adaptation to stress protecting the body against exaggerated catabolism. CURRENT KNOWLEDGE AND KEY POINTS: Recent advances in the underlying mechanisms concern the role of deiodinase and of the transport of thyroid hormone in tissues. Various factors acting on deiodinase or on transport system, such as medications and nutritional factors, have been implicated. Considerable interest has raised concerning the role of cytokines. Some cytokines may act at every level of the thyrotropic axis, but their real action in vivo remains unclear. Nutritional factors have a great impact on thyroid hormone metabolism, but the mechanism of the decrease in T3 induced by starvation is not identified. The role of the decrease in type I hepatic deiodinase has been recently challenged. FUTURE PROSPECTS AND PROJECTS: Despite its complexity, euthyroid sick syndrome is a model for the study of thyroid hormone metabolism regulation. Characterisation of the thyroid hormone transport proteins will lead to significant advances in the understanding of the syndrome.

Animals↗
PubMed1998

Effect of the shift of the sleep-wake cycle on three robust endocrine markers of the circadian clock.

To determine the effect of a phase shift in sleep on the circadian clock, thyroid-stimulating hormone (TSH), cortisol, and melatonin, three robust markers of the circadian clock, were analyzed using a 10-min blood sampling procedure. In an initial experiment eight subjects were studied during two experimental sessions: once under baseline conditions with normal nighttime sleep from 2300 to 0700 (baseline) and once after a night of sleep deprivation followed by daytime sleep from 0700 to 1500 (day 1). In a second experiment, carried out on seven subjects, the 24-h hormone profiles of the first day (day 1) were compared with those of the second day (day 2) of the sleep shift. During the night of sleep deprivation (day 1) the TSH surge was higher than during baseline conditions, whereas melatonin and cortisol rhythms remained unaffected. On day 2 the amplitude of the nocturnal TSH surge was reduced in comparison to day 1, whereas the amplitudes of melatonin and cortisol rhythms were unchanged. There was a clear phase shift in the three endocrine rhythms. Triiodothyronine levels were slightly higher in the morning after the first night of sleep deprivation. These results demonstrate that 2 consecutive days of sleep shift are sufficient to affect the timing of the commonly accepted circadian markers, suggesting the existence of a rapid resetting effect on the circadian clock. TSH reacts in a distinctive manner to the sleep-wake cycle manipulation by modulating the amplitude of the nocturnal surge. This amplitude modulation is probably an integral part of the phase-shifting mechanisms controlled by the circadian clock.

Adult↗
PubMed1997

[Treatment of malignant adrenal cortex carcinoma].

UNCOMMON MALIGNANCY: Adrenocortical carcinoma is a very rare malignancy with poor prognosis. Median survival ranges from 12 to 25 months. Most clinicians recommend aggressive surgical management of either local or recurrent and metastatic disease. ANTICORTISOL AGENTS: Mitotane, the most tested agent against inoperable and metastatic adrenocortical carcinoma, procures overall response rates of 20 to 25%, but recent data do not support its use in the adjuvant setting. CHEMOTHERAPY: The efficacy of cytotoxic chemotherapy is low but new agents or associations (with platinum salts), new concepts (dose-intensification, MDR (the chemoresistance gene) reversing agents) may be useful and five some hope in this difficult disease. RADIOTHERAPY: The role of radiation therapy must be developed.

Adrenal Cortex Neoplasms↗
PubMed1997

[Iodine and thyroid function].

Iodine is a raw material for the thyroid production of hormone which is on the major external control of TSH. The thyroid adaptation to iodine deficiency consists in an increasing iodine concentration from the circulation, an enhancing iodination of the tyrosyl residues in thyroglobulin, a decreasing iodine storage associated to a better recycling of non hormonal iodine and thyroid hyperplasia to provide more synthetic possibilities. Genetic variation and environmental factors explain the wide variation of individuals response to iodine deficiency resulting in a high prevalence of goiter, a mild TSH level increase or overt hypothyroidism. At long term iodine deficiency may have severe pathological consequences and induce neuropsychological deficits in school-children. A policy of iodine supplementation mainly by iodized salt must be undertaken in many areas in the world. Effects of an iodine excess on thyroid function are variable depending upon the underlying thyroid disorder and ambient iodine intake. The most subjects remain euthyroid by mechanisms of autoregulation based on an inhibition of thyroid hormone synthesis and a decrease in the thyroid iodide trap. Euthyroid individuals from high iodine intake areas or those with a history of lymphocytic thyroiditis, treated Graves' disease or subtotal thyroidectomy develop hypothyroidism. On the other hand iodine induced hyperthyroidism is more common in areas of iodine deficiency and in older patients with nodular goiter.

Humans↗
PubMed1997

[Muscular metastases disclosing adenocarcinoma].

The authors report the case of a 67-year old man, with no particular medical history, presenting a large swelling of the left thigh. Investigations conclude to metastases located in muscles of the left thigh and of the pelvis, secondary to an adenocarcinoma of presumed pancreatic origin. With reference to this case, features of muscular metastases are reviewed. Muscular metastases seldom occur during the course of a cancer and are exceptionally the first manifestation of a neoplastic process. They are usually described as a painful mass, but symptoms can be misleading and delay diagnosis. Images obtained by ultrasonography, tomodensitometry and magnetic resonance imaging are not specific and histological examination is necessary to confirm the diagnosis.

Adenocarcinoma↗
PubMed1996

[Secretion of thyrotropin during states of wakefulness and sleep. Physiological data and clinical applications].

Rhythmic hormone secretion appears to be a common characteristic of several endocrine systems. Alterations in these secretions are associated with the pathophysiology of certain diseases. Thyrotropin (TSH) exhibits a nocturnal surge in normal subjects. The time and the amplitude of the surge depend on the waking or the sleeping state. The TSH surge is decreased or abolished in various pathological conditions. Assessment of the surge is of particular interest for the early detection of central (pituitary) hypothyroidism, and in the exploration of isolated decreased TSH to predict further evolution toward hyperthyroidism. However, the characterization of the TSH surge needs simplification and standardization before this index could be used for the practical evaluation of thyroid function.

Adrenocortical Hyperfunction↗