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Biomedical subjects

D el Kouri

Publications and source records attributed to D el Kouri.

16 recordsLinked to original sources
PubMed2001

[Horton's disease in elderly patients aged over 75: clinical course, complications of corticotherapy. Comparative study of 164 patients. Towards a reduced initial dose].

PURPOSE: Our study compares clinical and therapeutic courses (corticosteroid response, corticosteroid amount, complications) in people with giant cell arteritis before and over 75 years, during the first year of treatment. METHODS: A series of 164 patients was retrospectively analysed (mean age: 73.3 years) among the two subgroups: before 75 and over 75 years. Patient received (monitoring of reduction in the corticosteroid dosage) a 240 mg intravenous bolus of methylprednisolone followed by 0.5 or 0.7 mg/kg/d of prednisone, or 0.7 mg/kg/d of prednisone without the bolus. RESULTS: Corticosteroid response was identical for the two groups, before and over 75 (patients with corticoresistance: 15% vs 11.4%; NS) and giant cell arteritis-related complications were equivalent (n = 2 vs n = 2; NS). Corticosteroid load was slightly lower in the elderly group (cumulative dose of corticosteroids during the first year of treatment 5.2 g vs 5.8 g; P = 0.03). Patients with rheumatic side effects (collapses of vertebral bodies, mainly) were more frequent in the elderly group (15.5% vs 4.3%; P = 0.01), in spite of a limited mean follow-up period (10.7 months). CONCLUSION: Even if steroid response was identical in the therapeutic course of giant cell arteritis, rheumatic side effects appeared more frequent in the elderly group (over 75 years). In order to obtain a corticosteroid-sparing effect, new studies are necessary to evaluate a reduced initial dosage of corticosteroids.

Age Factors↗
PubMed1999

[Treatment of venous thromboembolic disease in the elderly].

The incidence of deep vein thrombosis and pulmonary embolism is higher in the elderly due to the greater frequency of risk factors among this age group. Classic treatment with heparin and subsequently oral anticoagulant is still the most commonly used. Older patients may be at increased risk for anticoagulant-related bleeding for several reasons: increased anticoagulant effect of warfarin, increased prevalence of comorbidity and incidence of adverse drug reactions. As well as the usual contra-indications to such treatment, the psychological and physical well being of the patient must be assumed before an oral anticoagulant can be given. Careful prescribing is required: a low starting dose, a strict monitoring regime, for a limited duration. The indications for use of an inferior vena cava filter are wider in the older age group, not only for those in whom heparin is contraindicated, or has failed, but also for those who require treatment indefinitely with contra-indications to oral anticoagulant. Careful consideration of risk factors and the use of an individually designed prophylactic treatment are the best way to tackle this difficult problem in the elderly person.

Aged↗
PubMed1997

[Mesenteric venous thrombosis and antithrombin III deficiency: diagnosis before an acute digestive hemorrhage].

Mesenteric venous thromboses are often associated with antithrombin III deficiency. We can suspect this clinical diagnosis in patients with nonspecific abdominal pain syndrome and personal or familial history of mesenteric venous thrombosis. We report the case of a 63-old-male caucasian with antithrombin III deficiency and rectal bleeding who was diagnosed with mesenteric venous thrombosis at exploratory laparotomy. This case emphasizes the necessity of a careful history in all patients without an obvious diagnosis. In this way, we can invoke the diagnosis of mesenteric venous thrombosis quickly and begin the heparin therapy while waiting for the results of further confirmatory tests.

Antithrombin III Deficiency↗
PubMed1996

[Pregnancy in primary antiphospholipid syndrome. Proposal for a common management protocol].

OBJECTIVE: Primary antiphospholipid syndrome (APS) is by definition associated with high obstetric risk. We performed a retrospective study of pregnancies in women with this syndrome in an attempt to define a common means of caring these patients. STUDY DESIGN: Women with APS followed in Internal Medicine Department and in Gynecology Department since 1989 were studied retrospectively. RESULTS: Fifteen women with primary APS had a total of 51 pregnancies, 39 (76%) of which ended in embryonic (n = 24) or fetal (n = 15) loss. Only 6/39 untreated pregnancies led to a live birth, including 2 cases of intrauterine growth retardation. Among the 12 pregnancies treated preventively for obstetric complications, 6 led to a live birth. The treatments used were dissimilar and included aspirin, corticosteroids and heparin, either alone or in association. Four of these 6 live births were obtained by aspirin alone. Gravidic toxemia was observed in one untreated patient. CONCLUSION: The obstetric prognosis for untreated APS is appalling. The benefit of heparin therapy in association with aspirin remains to be demonstrated, ideally in a protocol comparing aspirin alone with aspirin and heparin.

Adrenal Cortex Hormones↗
PubMed1995

Angiomagnetic resonance imaging of iliofemorocaval venous thrombosis.

Although magnetic resonance imaging has been proposed for the diagnosis of deep venous thrombosis (DVT), its role in diagnostic strategy remains to be defined. We compared prospectively magnetic resonance angiography (MRA) with two-dimensional time-of-flight with contrast venography (CV) and colour duplex sonography (CDS) in 25 patients with DVT of the pelvis confirmed by CV. All patients were examined by CV (gold standard) and MRA and 17 by CDS. These studies were compared for DVT diagnosis in the pelvis and inferior vena cava and analysis of thrombotic spread. MRA was positive in 25 patients whose DVT was diagnosed by CV (100% sensitivity). MRA sensitivity and negative predictive value were 100%, specificity 98.5% and positive predictive value 97.5% for the diagnosis of thrombosis at each anatomic level. There were discrepancies between MRA and CV (2 false-positive results for 2 venous segments) and between CDS and CV (2 false-positive and 3 false-negative results). CV was uninterpretable for 8.8% of segments and CDS was often technically limited to the pelvic level, whereas all venous segments explored were analysable in MRA. MRA gave excellent results for positive diagnosis and DVT spread. MRA is a potentially valuable technique for assessing iliofemorocaval venous thrombosis.

Adult↗
PubMed1994

[Diagnosis of venous thrombosis. Evaluation of immunoscintigraphy with 99M technetium labelled antifibrin].

OBJECTIVES: We evaluated the interpretation, reliability and usefulness of 99m technetium labelled antifibrin immunoscintigraphy for the diagnosis of deep vein thrombosis in the lower limbs. METHODS: The diagnostic value of 99m technetium labelled antifibrin immunoscintigraphy was assessed in 44 patients with suspected venous thrombosis. The reference examination was bilateral ascending phlebography; 40 patients had doppler ultrasonography of the veins; 0.5 mg of antibody labelled by 17.5 mCi on average of 99m technetium were injected intravenously, and serial scintigraphic images were collected 1 min, 90 min and 18 hours after injection. RESULTS: The best results were obtained by comparison between the 90 min and the immediate post-injection images, with 86 percent sensitivity, 73 percent specificity and 81 percent accuracy. Heparin therapy and past history of phlebitis had no influence on the results. The doppler ultrasonography/immunoscintigraphy combination had a 100 percent specificity. 99m Technetium labelled antifibrin immunoscintigraphy had about the same diagnostic value as 111 indium labelled antifibrin immunoscintigraphy. CONCLUSION: The introduction of 99m technetium as isotopic marker will make immunoscintigraphy easier and available in numerous nuclear medicine centres. Antifibrin immunoscintigraphy can be an additional diagnostic tool for the difficult diagnosis of deep vein thrombosis.

Adult↗
PubMed1994

99Tcm-labelled anti-fibrin Fab' fragment for evaluating the course of venous thrombosis in the rabbit.

Immunoscintigraphy was performed using the Fab' fragment of 99Tcm-labelled T2G1s anti-fibrin monoclonal antibody in a rabbit experimental model of venous thrombosis of known and increasing age (1, 3 and 7 days). Scans were positive in 3/7 cases for 1-day thrombosis (fibrin-poor network) and in 7/7 cases for 3-day thrombosis (fibrin-rich network). In rabbits with 7-day thrombosis, the scan was positive (2/4 cases) only when connective tissue was not present in the clot. Scintigraphic results were concordant with those of biodistribution studies showing the mean percentage of injected dose per gram 99Tcm-T2G1s present in the thrombosed vein wall (0.043, 0.082 and 0.07 for thrombi at 1, 3 and 7 days, respectively). Mean thrombosed vein wall-to-blood ratios were 1.027, 2.291 and 1.301, respectively. Immunoscintigraphy with T2G1s anti-fibrin monoclonal antibody thus enabled hematological status to be evaluated.

Animals↗
PubMed1993

[Septic Campylobacter fetus thrombophlebitis: a new case].

The diagnosis of septic thrombophlebitis is difficult and often delayed, but it must be borne in mind in all cases of venous thrombosis accompanied by signs of local and/or systemic infection, or deteriorating under heparin therapy. We report a case of septic thrombophlebitis caused by Campylobacter fetus subspecies fetus. The characteristic features, obtained from the literature, of septic thrombophlebitis caused by Campylobacter spp are presented.

Campylobacter Infections↗
PubMedDate not supplied

Experimental venous thrombosis: what animal model?

A new experimental venous thrombosis model is described and its role relative to other models is defined. Previous models are not satisfactory for all types of investigation. Opposite, present model based on the three classic thrombogenic factors is suitable for venous scintigraphy and evaluation of different forms of therapy for venous thrombosis of the limbs. So this model permits research on diagnosis and therapy of thromboembolic disease.

Animals↗