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Biomedical subjects

E Cogan

Publications and source records attributed to E Cogan.

At least 37 records · Page 2Linked to original sources
PubMed1999

[A case of Kimura disease treated with interferon and general corticoid therapy].

INTRODUCTION: A case of Kimura's disease that occurred in a 5-year-old Caucasian boy after a tick bite is reported. When the child was 16 years old, symptoms developed. They included voluminous bilateral neck and head lymph nodes associated with hypereosinophilia (1,640/mm3), and increased IgE levels (18,866 KU/L). Clinical and immunological effects of treatment by interferon-alpha and steroids are presented. EXEGESIS: Pathological and histological examination showed typical features of dense lymphoid cell infiltrates containing many eosinophils, mast cells, and vascular hyperplasia. Percentages of CD4+, CD27-, CD7- cells were increased In the blood and lymph nodes, showing a profile typical of TH2. IL-5 production by these cells was markedly increased and was inhibited by IFN-alpha and IFN-beta in vitro. No etiology was found. The role of antigens of Ixodes ricinus is discussed. Three surgical excisions of adenopathies were not successful. Treatment by IFN-alpha (Introna, Schering-Plough, 5.10(6) U/week) and a bolus of methylprednisolone hemisuccinate (1 g/month) was started. Eight months later, the size of the lymph nodes had decreased; however, eosinophil counts and ECP and IgE levels were still high. The decrease in corticosteroid induced a subsequent, slight increase in the size of the lymph nodes and a marked increase in ECP. CONCLUSION: This is the first description of treatment of Kimura's disease by interferon-alpha and steroids. The disease outcome does not suggest that interferon-alpha may predominate.

Adolescent↗
PubMed1999

Zidovudine in primary Sjögren's syndrome.

OBJECTIVE: To evaluate the efficacy of the administration of zidovudine (AZT), an antiretroviral drug, in patients with primary Sjögren's syndrome (SS). METHODS: Seven female patients (age 57 +/- 8.6 yr) with primary SS were enrolled in an open, uncontrolled trial of AZT (250 mg b.i.d.) for the treatment of primary SS. The efficacy variables were oral and ocular dryness symptoms, fatigue, tender points, physician's and patient's global assessments (GA), ocular function tests (fluorescein tear break-up time, Schirmer's test, Rose Bengal staining) and laboratory parameters [erythrocyte sedimentation rate (ESR), serum IgG, IgA and IgM]. RESULTS: A significant improvement was observed in all subjective manifestations, as well as the objective parameters of ocular dryness. The treatment was well tolerated, except for mild and transitory gastrointestinal disturbances in 6/7 patients. Laboratory parameters did not change significantly. The clinical benefit persisted in 5/7 patients 1 month after the end of therapy. CONCLUSION: AZT seems to be effective and well tolerated in patients with primary SS.

Anti-HIV Agents↗
PubMed1998

Reactivation of hepatitis B after transplantation in patients with pre-existing anti-hepatitis B surface antigen antibodies: report on three cases and review of the literature.

BACKGROUND: Patients who have been exposed to the hepatitis B virus (HBV) and who were able to clear the hepatitis B surface antigen from the serum and to develop anti-hepatitis B surface antigen (anti-HBs) antibodies are not considered at risk for HBV reactivation after solid organ transplantation. METHODS AND RESULTS: We, however, observed three solid organ transplant recipients who demonstrated clinically significant HBV reactivation after transplantation. All patients presented normal liver enzymes and serological stigmates of healed HBV infection at the time of transplantation, as indicated by the absence of hepatitis B surface antigen and the presence of anti-HBs and anti-hepatitis B core antibodies in the serum. Patient 1, a renal transplant recipient, presented HBV reactivation 3 years after transplantation and developed chronic HBV hepatitis. Patient 2 developed HBV reactivation 7 months after a second cadaveric renal graft and died of cirrhosis four and a half years after transplantation. Patient 3, a heart-lung transplant recipient, developed HBV reactivation within months after transplantation, but died of unrelated causes. HBV reactivation in the presence of anti-HBs antibodies has been previously reported in other settings of immunosuppression, mainly in patients with acquired immunodeficiency syndrome and after bone marrow transplantation, and may lead to fatal liver disease. Data from our renal transplant recipients suggest that the incidence of HBV reactivation among patients with anti-HBs and anti-hepatitis B core antibodies is about 5%. CONCLUSIONS: Transplant physicians should be aware of the risk of HBV reactivation in patients presenting with healed HBV infection before transplantation.

Adult↗
PubMed1998

Primary cardiac lymphoma: diagnosis by transvenous biopsy under transesophageal echocardiographic guidance.

A 64-year-old woman presenting with dizziness and atrioventricular conduction disturbances was found to have a right atrial mass by two-dimensional transthoracic echocardiography. Transesophageal echocardiography allowed further delineation of the tumor and safe performance of transvenous biopsy, thereby obviating the need for surgery. Pathological examination of the biopsy specimen as well as the absence of extracardiac location established the diagnosis of primary cardiac lymphoma.

Biopsy, Needle↗
PubMed1998

Serum creatine kinase levels in overt and subclinical hypothyroidism.

Overt hypothyroidism is known to be associated with increased serum creatine kinase (CK) levels. However, there is little information on CK levels in subclinical hypothyroidism. The aim of the study was to assess the relationship between CK levels and thyroid function in overt and subclinical hypothyroidism. Thyroid function tests (thyrotropin [TSH], free thyroxine [FT4], free triiodothyronine [FT3]) and the serum levels of CK were obtained from 23 patients admitted to a general hospital for illnesses other than thyroid or muscular diseases, myocardial ischemia, or brain damage. Overt hypothyroidism, based on thyroid function tests, was present in 10 patients, whereas hypothyroidism could be classified as subclinical in the other 13. A positive correlation was observed between CK and thyrotropin, and to a lesser extent between CK and thyroid hormones. Moreover, the correlation between CK and TSH and between CK and FT4 was detectable in subclinical hypothyroidism. Our data suggest that even in subclinical hypothyroidism there is some degree of dysfunction in skeletal muscle metabolism.

Adult↗
PubMed1998

The idiopathic hypereosinophilic syndrome: clinical presentation, pathogenesis and therapeutic strategies.

The idiopathic hypereosinophilic syndrome (HES) is a heterogenous disease entity characterized by persistent unexplained hypereosinophilia generally complicated by end-organ damage. Correct diagnosis and management are important in order to prevent long-term complications. Furthermore, it appears that HES represents a premalignant state in some patients, and close follow-up is necessary to detect early signs of malignant transformation. Previous studies of patient cohorts have led to the identification of a subgroup of patients with various clinical and biological features of primitive myeloproliferative disease. Patients in this subgroup have a clinically more aggressive disease in terms of organ damage and eventually develop acute myeloid leukemia. Among the remaining patients, it appears that some present an underlying T-cell disorder characterized by overproduction of Th2-type cytokines in vivo. Indeed, lymphocytes belonging to the Th2 subset are implicated in the maturation, activation and recruitment of eosinophils, essentially through the production of IL-5. Such patients appear to present a more benign disease at short term; however, they may develop T-cell lymphoma years after initial diagnosis. Therapy of HES includes glucocorticoids, hydroxyurea and more recently, interferon-alpha. Prednisone is generally recommended initially, followed by hydroxyurea in case of treatment failure. Until now, interferon-alpha has been reserved for refractory cases of HES. Our proposal for a new treatment strategy, based on current understanding of the pathogenesis of different subgroups of HES and on the mechanisms of action of the proposed therapeutic agents, which will be discussed in detail. Moreover, prevention of malignant transformation has become a new subject of concern when considering the beneficial effects of drugs.

Journal Article↗
PubMed1997

Undifferentiated carcinoma of the nasopharynx and leukemoid reaction: report of case with literature review.

A case of undifferentiated carcinoma of the nasopharynx presenting as a cervical mass associated with a paraneoplastic neutrophilic leukemoid reaction is reported. The diagnosis of undifferentiated nasopharyngeal carcinoma of the Regaud type was established by the presence of aggregates of epithelial neoplastic cells separated by areas of reactive lymphoid cells; the epithelial nature being confirmed by the positivity for epithelial markers (AE1/AE3, EMA). Serum IL-1a, GM-CSF and TNF alpha remained undetectable suggesting that these factors were not involved in the occurrence of the paraneoplastic leukemoid syndrome.

Adult↗
PubMed1996

Recombinant interferon-alpha selectively inhibits the production of interleukin-5 by human CD4+ T cells.

The effects of recombinant IFN-alpha on the production of IL-5 by human CD4+ T cells were first analyzed on resting CD4+ T cells purified from normal PBMC and stimulated either with a combination of PMA and anti-CD28 mAb or anti-CD3 mAb cross-linked on B7-1/CD32-transfected mouse fibroblasts. We found that IFN-alpha profoundly inhibited in a dose-dependent manner IL-5 production by resting CD4+ T cells whereas IL-10 was upregulated in both systems. The addition of a neutralizing anti-IL-10 mAb to PMA and anti-CD28 mAb upregulated IL-5 production by resting CD4+ T cells but did not prevent IFN-alpha-induced IL-5 inhibition. We then analyzed the effect of IFN-alpha on the production of cytokines by differentiated type 2 helper (Th2) CD4+CD3- cells isolated from peripheral blood of two patients with the hypereosinophilic syndrome. In both cases, IFN-alpha markedly inhibited IL-5 production while it induced mild upregulation of IL-4 and IL-10. Finally, the inhibitory effect of IFN-alpha on IL-5 production was confirmed on a panel of Th2 and Th0 clones generated in vitro. In 2 out of 6 clones, IL-5 inhibition was associated with upregulation of IL-4 and IL-10. We conclude that IFN-alpha selectively downregulates IL-5 synthesis by human CD4+ T cells.

Animals↗
PubMed1996

Subacute mitochondrial liver disease in a patient with AIDS: possible relationship to prolonged fluconazole administration.

Azole-derived antifungal medications are particularly involved in drug-induced hepatic injury encountered in patients with AIDS. Fluconazole may induce multiple hepatic abnormalities usually characterized by asymptomatic and reversible mild hepatic necrosis. We here describe severe subacute liver damage occurring in a patient with AIDS who was receiving fluconazole maintenance therapy for a cryptococcosis. Hepatotoxicity was essentially characterized by mixed cytolytic and cholestatic liver tests abnormalities which improved after fluconazole discontinuation and worsened on fluconazole rechallenge. Optical microscopy demonstrated nonspecific abnormalities including granular aspect of the cytoplasm of the hepatocytes. In contrast, analysis of electron microscopy revealed unusual unreported features characterized by giant mitochondria with paracrystalline inclusions and enlarged smooth endoplasmic reticulum. All microscopic abnormalities were reversed after discontinuation of fluconazole. We suggest that persistent increased hepatic enzymes in HIV-infected patient taking fluconazole should prompt suspension of the treatment. Prospective studies are needed to determine whether careful monitoring of hepatic tests should be recommended in AIDS patients on prolonged fluconazole maintenance therapy.

AIDS-Related Opportunistic Infections↗
PubMed1994

Secondary psoas abscess twenty-seven years after nephrectomy.

Abscesses of the psoas muscle are due to a hematogenous dissemination, to the spread of infection from adjacent intestinal structures, to osteomyelitis of the spine or to tuberculous infection of a disc space. In contrast, psoas abscesses related to the urological tract have only been described on exception. The present report focuses on a right psoas abscess which developed 27 years after a nephrectomy. The infectious process resulted from the spread of an acute vesical infection through the residual ureter. Analysis of 4 other cases reported in the literature allows us to delineate the clinical features of psoas abscesses of urological origin.

Aged↗