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Biomedical subjects

Emmanuel Héron

Publications and source records attributed to Emmanuel Héron.

5 recordsLinked to original sources
PubMed2006

Hyperglycemia after repeated periocular dexamethasone injections in patients with diabetes.

PURPOSE: To assess the hyperglycemic effect of 3 consecutive daily periocular steroid injections in patients with diabetes. DESIGN: Retrospective observational study in a national eye center. PARTICIPANTS: Twenty-five hospitalized patients with type 2 diabetes who received a subconjunctival (n = 11) or a peribulbar injection (n = 14) with 4 mg dexamethasone disodium phosphate once a day for 3 consecutive days for ocular conditions. METHODS: Baseline patient characteristics were recorded as well as serial blood glucose measurements and hypoglycemic interventions, both performed according to a written protocol. MAIN OUTCOME MEASURES: Serial blood glucose measurements and hypoglycemic interventions. RESULTS: Each ocular injection with dexamethasone was followed around 6 hours later by an increase of blood glucose up to a median doubling from baseline (+100% increase) followed by falls until the next injection, toward a median 13% increase from baseline before the next ocular injection. Older age (P<0.05), duration of diabetes (P = 0.01), and microangiopathy or macroangiopathy (P = 0.01) were associated with higher blood glucose rises. Using a 14-mmol/l threshold for intervention, the probability of requiring additional hypoglycemic treatment during ocular steroid therapy in patients with HbA1c >7.5% and up to 7.5% was 100% and 60%, respectively. CONCLUSIONS: Periocular injections with dexamethasone in patients with type 2 diabetes induce a marked hyperglycemic effect, similar to that observed during intravenous pulse methylprednisolone.

Adult↗
PubMed2005

Short-term tolerance of pulse methylprednisolone therapy in patients with diabetes mellitus.

PURPOSE: To assess the short-term tolerance of pulse methylprednisolone in patients with diabetes. DESIGN: Retrospective study in a national eye center. PARTICIPANTS: Eighty patients with type 2 diabetes, half of them also treated for hypertension, who received 3-day pulse methylprednisolone between January 1999 and December 2002 for eye disorders and were monitored according to a written protocol. MAIN OUTCOME MEASURE: Potentially serious side effects, serial blood glucose measurements, and hypoglycemic interventions during pulse therapy. RESULTS: Each pulse induced about 10 hours later a mean 2-fold peak increase of blood glucose. According to a 14-mmol/l (250 mg/dl) threshold glucose level for intervention, rapid insulin was required in 27 of 27 (100%) and 24 of 53 (45%) patients with glycosylated hemoglobin levels higher than 8% and up to 8%, respectively. In the latter group, patients older than 70 years had a 3-fold increased risk of requiring insulin. Significant side effects were systolic and/or diastolic blood pressure elevation > or = 180/110 mmHg (n = 6), ketosis without acidosis (n = 5), silent myocardial ischemia (n = 1), and disorientation (n = 1). All side effects were transient or controlled successfully by medical intervention. No infectious complication occurred during the treatment period. CONCLUSIONS: Pulse methylprednisolone is globally well tolerated in diabetic patients, but requires strict blood glucose and clinical monitoring.

Aged↗
PubMed2003

Intravenous pulse methylprednisolone therapy in eye disease: effect on glucose tolerance.

PURPOSE: To determine which subjects need close glycemic monitoring during intravenous pulse methylprednisolone therapy for eye disease. DESIGN: Retrospective study in a national eye center. PARTICIPANTS: Two hundred twenty-four subjects who received over a one-year period 250 to 1000 mg daily intravenous methylprednisolone over 3 consecutive days for ophthalmologic conditions. METHODS: Blood glucose monitoring during pulse methylprednisolone therapy followed a protocol written in 1995. We analyzed the effects of 3 days of pulse methylprednisolone therapy on glucose tolerance and their clinical implications in diabetic and nondiabetic subjects treated during 2000. MAIN OUTCOME MEASURE: Serial morning fasting blood glucose; that is, before the first pulse and the day after each pulse, blood glucose self-monitoring for diabetic subjects and specific hypoglycemic drug interventions were recorded. RESULTS: All subjects showed a median 50% increase in fasting glucose after the first steroid infusion, without a significant difference between diabetic and nondiabetic subjects. Thereafter, the 196 nondiabetic subjects showed spontaneous decreases of their fasting glucose toward baseline values despite the following infusions, whereas the 28 diabetic subjects (all type 2) demonstrated further increases of blood glucose, and 7 received rapid-release insulin to maintain blood glucose lower than 14 mmol/l. All 5 diabetic subjects with baseline glycosylated hemoglobin >/==" BORDER="0"> 8.3% required insulin therapy. CONCLUSIONS: Close glycemic monitoring seems necessary only for subjects with diabetes during intravenous pulse methylprednisolone therapy for ophthalmologic conditions. The probability of subjects with type 2 diabetes requiring insulin during this therapy does seem to be positively related to the level of pretreatment glycosylated hemoglobin.

Amino Acids↗
PubMed2003

Polyarteritis nodosa presenting as acute leg ischemia.

We describe a 33-year-old hypertensive woman with otherwise apparently good health, in whom acute leg ischemia by acute occlusion of the 3 infrapopliteal arteries led to the diagnosis of polyarteritis nodosa (PAN). Angiography and ultrasound imaging showed multiple microaneurysmal and thrombotic lesions, notably in the kidneys and the 4 extremities. Cutaneous biopsy showed necrotizing angiitis. She was treated with corticosteroids. Ischemia improved progressively, with normal walking after several months. Three points were remarkable in this case of PAN: (1) its unusual presentation; (2) the absence of constitutional symptoms despite the diffuse distribution of vascular lesions; (3) the good visualization of peripheral microaneurysms by ultrasonography (US), suggesting a potential diagnostic interest for US examination of the limbs in PAN.

Acute Disease↗