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Biomedical subjects

E Toussirot

Publications and source records attributed to E Toussirot.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Use of methotrexate in spondylarthropathies. Review of the literature].

Methotrexate (MTX) is one of the most effective treatments of rheumatoid arthritis. It has also been used in other conditions such as spondylarthropathies (SPA). The literature concerning MTX in SPA was reviewed. Thus, MTX has been mainly prescribed in psoriatic arthritis and Reiter's syndrome with success for dermatological manifestations of these diseases. However, only a few controlled trials have been conducted in psoriatic arthritis and only one placebo controlled study did not demonstrate a real beneficial effect. Furthermore, it seems that MTX has no influence on the radiological outcome of psoriatic arthritis. There has been no controlled study upon the efficacy of MTX in Reiter's syndrome, ankylosing spondylitis or arthropathy associated with inflammatory bowel diseases. Such studies in SPA are required to evaluate the responding conditions, the efficacy, the side-effects, and the effective dose of MTX.

Antimetabolites↗
PubMed1996

Sarcoidosis and spondylarthropathy. Three case-reports.

Coexistent sarcoidosis and seronegative spondylarthropathy have rarely been reported. We add three new cases to the nine previously published. Two men and one woman with sarcoidosis met Amor's criteria for spondylarthropathy. The diagnosis of sarcoidosis was based on histologic findings in two cases and on roentgenographic and laboratory test findings in one case. The features of each of the two diseases were unremarkable. The two diagnoses were confirmed at about the same time. Osteoarticular manifestations of sarcoidosis are reviewed. Our case-reports illustrate the diagnostic difficulties raised by discovery of sacroiliitis in a patient with sarcoidosis: sarcoid osteitis, infection, or a spondyloarthropathy can be the cause of the sacroiliac lesions. Moreover, the pelvic and spinal manifestations of sarcoidosis can mimick a spondylarthropathy. Coexistence of sarcoidosis and spondylarthropathy is probably due to chance, since there are no shared predisposing genetic factors and the number of reported cases is small.

Aged↗
PubMed1996

Proximal paraparesis following spinal anesthesia.

A 70-year-old man with prostatic cancer extending to the urinary bladder underwent transurethral resection of the bladder neck under spinal anesthesia and developed weakness of the proximal lower limbs a few hours after the procedure. The weakness persisted for several months. Because there were no local surgical complications (hematoma, infectious epiduritis, abscess) or bone metastases responsible for nerve root or spinal cord compression, a causal relation between the neurologic deficit and the spinal anesthesia was considered likely. Neurologic deficits are uncommon after spinal anesthesia and can be produced by complications of the surgical procedure (direct nerve injury, hematoma, abscess), arachnoiditis, neurotoxicity of disinfectants or of preservatives added to solutions of anesthetic drugs, or spinal cord ischemia. Precipitating factors for spinal cord ischemia include faulty patient position during the procedure, intraoperative arterial hypotension and injection of vasoconstricting agents.

Aged↗
PubMed1996

Rheumatoid arthritis and bronchiectasis. A retrospective study of fourteen cases.

Since 1928, 288 cases of rheumatoid arthritis and bronchiectasis have been reported in the medical literature. The interactions between these two conditions and the etiopathogenic mechanisms they involve remain unclear. During a retrospective study of 100 rheumatoid arthritis patients and 80 bronchiectasis patients, we identified 14 additional patients with both conditions. There were 10 females and four males (ratio 2.5/1). Bronchiectasis was confirmed either by computed tomography of the chest or by bronchography. The respiratory manifestations antedated the joint disease in 12 patients, by a mean interval of 28.5 years. An infectious cause was identified in six cases. Neither the age at onset nor the duration of rheumatoid arthritis were influenced by the presence of bronchiectasis. Seven patients had 15 extraarticular manifestations suggesting potentially severe joint disease. The flares of joint and respiratory symptoms were concomitant in six patients. In six patients, the respiratory manifestations worsened after onset of the joint disease. Tests for rheumatoid factors were positive in 73% of cases. Panhypogammaglobulinemia was found in one case. Ten patients underwent lung function tests, which showed evidence of nonspecific obstructive disease. Overall, our findings are consistent with previous reports in the literature. In patients with predisposing immunogenetic factors, bronchiectasis may be involved in the genesis of rheumatoid arthritis.

Adult↗
PubMed1995

[Rheumatoid arthritis: its relationship with HLA DR molecules].

Over the last two decades, much progress has been made in our understanding of the genetics of rheumatoid arthritis since the discovery of a link between the HLA DR4 antigen and rheumatoid arthritis in 1974. In molecular biology, the precise alleles of the HLA DRB1 gene which encode for different specific molecules have been identified. They have been used to link rheumatoid arthritis to certain HLA DRB1 subtypes recognized as "high risk" alleles. It has been hypothesized that the shared epitope would be one way for a molecular approach to susceptibility of allelic variants in rheumatoid arthritis. More recently, the notion that high risk DRB1 alleles might contribute to disease severity has also been put forward. HLA DRB1 alleles carrying a risk of rheumatoid arthritis would have two properties: they could serve as a marker of the risk of developing the disease and of disease severity both essential elements for the clinician.

Arthritis, Rheumatoid↗
PubMed1994

Serum levels of interleukin 1-beta, tumor necrosis factor-alpha, soluble interleukin 2 receptor and soluble CD8 in seronegative spondylarthropathies.

Seronegative spondylarthropathies are disorders with the same predisposing antigen, namely HLA B27, a class I molecule of the HLA system. The mechanisms of the different diseases are unknown, and there is no proof of immune system participation. We have investigated patients with spondylarthropathies in order to search for an immunological component in the pathophysiology of these disorders, by measuring the serum level of two inflammatory cytokines--IL1 beta and TNF alpha--by a radioimmunological assay and the serum level of two soluble T cell activation markers--soluble IL2 receptor and soluble CD8--by an enzyme-linked immunosorbent assay. The choice of soluble CD8 can be explained by the strong link between HLA B27 and spondylarthropathies. Our series compared 24 patients to 24 healthy matched controls. A similar IL1 beta serum level was observed in both groups, while in the patients there was a nonsignificant increase in the TNF alpha level, a significant decrease in the soluble IL2 receptor level and a significant increase in the soluble CD8 serum level. The normal or moderately increased serum IL1 beta and TNF alpha levels in the disease group do not exclude a local role for these cytokines in the synovium or other inflammatory areas. However, we found a higher soluble CD8 serum level in the patient group. Most of these patients were in clinical exacerbation of their disease. As the serum level of soluble CD8 is well correlated with T CD8 lymphocyte activation, our data suggest that this lymphocyte subset is stimulated and consequently probably involved in seronegative spondylarthropathies.

Adult↗
PubMed1994

Association of cerebral vasculitis with a lupus anticoagulant. A case with brain pathology.

The authors report the case of a sixty-five year old woman initially suffering from a thrombocytopenia. The patient was diagnosed as having an autoimmune disease with a lupus anticoagulant, positive antinuclear antibodies and negative anti-DNA antibodies. She then developed an encephalopathy which was fatal despite corticosteroids. Brain pathology revealed a vasculitis with some giant cells, evoking a granulomatous angiitis of the central nervous system. These clinical and biological features suggest a systemic lupus erythematosus with vasculitis or a primary granulomatous angiitis of the central nervous system. Taking into account the clinical manifestations and the presence of a lupus anticoagulant, we finally preferred to identify it as a primary antiphospholipid antibodies syndrome, despite absence of anticardiolipin antibodies. Contrary to thrombosis, vasculitis is rarely associated with an anticardiolipin antibody or a lupus anticoagulant. However, vasculitis in the course of primary antiphospholipid antibodies syndrome has been reported previously as in this case report.

Adrenal Cortex Hormones↗
PubMed1994

Coexisting kappa light chain multiple myeloma and primary hyperparathyroidism.

The authors report the case of an 82 year old woman hospitalized for hypercalcemia associated with low serum phosphate. Multiple myeloma was first diagnosed. However, despite chemotherapy, hypercalcemia persisted and she was subsequently diagnosed as primary hyperparathyroidism; eucalcemic state was then obtained after parathyroidectomy. Fifteen similar cases are reported in the literature and the mechanisms and implications of such an association are discussed.

Aged↗
PubMed1994

[Severe laryngeal involvement in rheumatoid arthritis requiring permanent tracheostomy].

A 72-year-old woman with severe rheumatoid arthritis developed atlantoaxial subluxation requiring surgery. Tracheal intubation was performed during the procedure. Gradually worsening dysphonia and dyspnea developed postoperatively. Laryngoscopy showed palsy of both vocal cords and coalescence of the arytenoid cartilages. Despite surgical treatment, permanent tracheostomy was required. There is evidence that laryngeal involvement is common but usually subclinical or mild in rheumatoid arthritis patients. Tracheal intubation can cause the laryngeal lesions to flare. Clinical manifestations are nonspecific and sometimes misleading (e.g., cough or pharyngeal and laryngeal pain). Direct laryngoscopy and computed tomography of the larynx allow evaluation of the lesions of the different components of the larynx. The case reported herein demonstrates that rheumatoid arthritis patients should be screened for laryngeal involvement by history and ENT examination and that any laryngeal abnormalities should be reported to the anesthesiologist if tracheal intubation is planned.

Aged↗
PubMed1993

Astasia-abasia revealing a primary Sjögren's syndrome.

A 63-year-old woman presented with mild arthralgias and inability to stand and walk without other significant neuropsychiatric abnormality. Neurological explorations showed intrathecal oligoclonal immunoglobulin production in CSF and numerous bright foci at brain MRI. A primary Sjögren's syndrome was concomitantly evidenced and was thought to be the cause of the astasia-abasia symptom by multiple brain involvement. Patient's condition gradually improved with hydroxychloroquine and corticosteroid therapy. Central nervous system involvement by primary Sjögren's syndrome is discussed.

Brain↗
PubMed1993

[Disclosing muscular metastases. Their peculiarities apropos of 3 cases].

Three cases of muscular metastasis as the first manifestation of malignancy are reported. These patients had no previous history of malignancy. All three were male. One had a single metastasis in the gluteus minimus muscle, and the other two had multiple metastases which were located in the adductor compartment of the thigh in one case and in the biceps brachii, quadriceps femori, and paraspinal muscles in the other. These metastases first manifested as a painful mass. The various imaging techniques (ultrasonography, computed tomography, and magnetic resonance imaging) determined the location and extension of the masses, although the images were nonspecific. The metastatic nature of the tumors was confirmed only upon histological studies. With reference to these three cases, features of muscular metastases are reviewed. The development of muscular metastases is an infrequent occurrence during the course of a cancer. The mechanisms which may explain the low incidence of muscular metastases are discussed.

Adenocarcinoma↗
PubMed1993

Autonomic nervous system involvement in rheumatoid arthritis. 50 cases.

OBJECTIVE: To investigate the involvement of the autonomic nervous system (ANS) in rheumatoid arthritis (RA), which is rarely discussed. METHODS: Fifty cases of RA were selected, excluding all patients liable to develop dysautonomia or having a treatment interfering with ANS. They were investigated by cardiovascular tests of heart rate variations in deep breathing, Valsalva maneuver and orthostatic change in posture. These quantified tests were reported as ratios: breathing, Valsalva and 30/15. A control series of 82 healthy subjects was tested to determine the abnormal threshold for each one of the 3 tests and allowed a correlative study. Dysautonomia was defined when 2 of the 3 tests were pathological. According to these criteria, 30 patients with RA with ANS dysfunction were retained. RESULTS: The clinical examination of these patients showed no neurological sign or autonomic sign but there was an inflammatory syndrome. Rheumatoid factors (RF) were frequently present as were slowly progressive articular destructions. The statistical study revealed a significant difference between the series of RA patients and the control series, only for the Valsalva maneuver (p < 0.01) and there was no obvious correlation between ANS dysfunction in RA and markers of inflammation, presence of RF, duration of disease or degree of articular destructive lesions. CONCLUSION: Our study is in agreement with the literature which reports an ANS involvement in RA with a same frequency but remaining primarily subclinical and probably isolated from other peripheral or central nervous system damage. The physiopathology of this form of dysautonomia is discussed and an immunological mechanism is suggested.

Adult↗