Biomedical subjects

Françoise Thivolet-Béjui

Publications and source records attributed to Françoise Thivolet-Béjui.

7 recordsLinked to original sources

PubMed2005

Improvement of refractory rheumatoid arthritis-associated constrictive bronchiolitis with etanercept.

Rheumatoid arthritis (RA)-associated constrictive bronchiolitis is a severe condition with no established efficient treatment. A 55-year-old woman with seropositive RA developed rapidly progressive constrictive bronchiolitis confirmed by lung biopsy. Her clinical condition worsened despite steroids and azathioprine. Treatment with etanercept-a tumor necrosis factor (TNF)-alpha inhibitor-combined with methotrexate, resulted in a marked improvement of both her clinical condition and pulmonary function tests. Treatment with TNF-alpha inhibitors and methotrexate may be proposed in RA-associated constrictive bronchiolitis, a severe condition hitherto not amenable to improvement.

Antirheumatic Agents↗

PubMed2005

[Thymic neuroendocrine tumors: report on 6 cases].

AIM: the aim of our study was to analyze a series of 6 thymic neuroendocrine tumors (TNET). METHODS: we report the clinical and pathological features of 6 TNET reclassified according to the last WHO classification (2004). RESULTS: there were 4 men and 2 women, (mean age of 61.3 years), presenting with local symptoms in 4 cases. The tumors were reclassified as 3 atypical carcinoids (AC), 2 small cell carcinomas (SCC) and 1 large cell neuroendocrine carcinoma (LCNEC). Cytokeratin, EMA and neuroendocrine markers were expressed in poorly-differentiated tumors. Two patients were lost of follow-up. Two patients with AC died of disease at 20 and 36 months. One patient with SCC died of disease at 2 years and the patient with the LCNEC died of disease in 3 months. CONCLUSION: TNET are poor prognosis tumors with a prognosis similar to thymic carcinomas. Adequate surgical resection is a strong prognosis factor.

Aged↗

PubMed2005

Active infectious endocarditis: postoperative outcome.

OBJECTIVE: Many changes have occurred in the natural history and the management of active infectious endocarditis (AIE) in recent years. Therefore, the records of patients admitted in a tertiary care specialized hospital presenting with the Duke criteria were reviewed. METHODS: Adults operated on to treat AIE were included during a 3-year period. Patients presenting with AIE associated with a pacemaker were not included. Bacteriologic investigations included blood cultures, intraoperative samplings (including polymerase chain reaction), and serologies. Clinical and bacteriologic factors associated with hospital mortality were studied by univariate regression analysis (p < 0.05). RESULTS: Ninety-eight of 164 patients (60%) admitted with the diagnosis of AIE underwent valvular surgery. The duration between the beginning of AIE and surgery was 23 +/- 16 (mean +/- standard deviation) days. Only 45 patients had a previous history of valvular disease. Seventy-two patients presented with aortic and 41 with mitral valve AIE. Fifty suffered from embolic events. Streptococcus species were responsible in 64 cases (23 were Streptococcus bovis) and Staphylococcus species in 24 cases. Death occurred postoperatively in 19 patients. The factors associated with fatal outcome were preoperative hemodynamic instability, age, Parsonnet and Simplified Acute Physiology Score II scores, diabetes mellitus, preexisting valvulopathy, antiarrhythmic treatment, hypoalbuminemia, renal dysfunction, duration of extracorporeal circulation, and red cell allogeneic transfusions. The type of bacteria did not influence mortality. The mean intensive care unit and hospital stays were 10 and 39 days, respectively. Eleven patients suffered from neurologic sequelae; 2 years later, 2 of them presented with severe deficit and 1 had died. CONCLUSIONS: AIE necessitating cardiac surgery should be considered as a severe and resource-consuming disease.

Adult↗

PubMed2004

Cardiac valves in patients with Whipple endocarditis: microbiological, molecular, quantitative histologic, and immunohistochemical studies of 5 patients.

The pathological features of Whipple endocarditis, which is caused by Tropheryma whipplei, were histologically evaluated in cardiac valves from 5 patients. We used quantitative image analysis to compare the valvular fibrosis, calcifications, vegetations, inflammation, and vascularization due to Whipple endocarditis with those due to non-Whipple endocarditis and degenerative valves. We also studied the presence of T. whipplei in valves by immunohistochemical analysis, culture, and polymerase chain reaction (PCR). In histologic analysis, Whipple endocarditis was characterized by significant fibrosis, a lack of calcifications, slight inflammation and vascularization, and vegetations of intermediate size. Inflammatory infiltrates consisted mainly of foamy macrophages and lymphocytes. We found that the detection of T. whipplei in cardiac valves, by immunohistochemical analysis, was correlated with the detection of the bacterium by culture and PCR. We report, for the first time, the immunodetection of T. whipplei in a surgically removed arterial embolus. Pathological and immunohistologic analyses may contribute to the diagnosis of Whipple endocarditis.

Adult↗

PubMed2004

Preconditioning delays Ca2+-induced mitochondrial permeability transition.

OBJECTIVE: We investigated whether ischemic preconditioning (PC) may modify mitochondrial permeability transition (MPT) pore opening. METHODS: In protocol 1, New Zealand White rabbits underwent either no intervention (sham group) or 10 min of ischemia followed by 5 min of reperfusion, preceded (PC) or not (C; control) by one episode of 5 min of ischemia and 5 min of reperfusion. Rabbits were pretreated by either saline or the MPT pore inhibitor cyclosporin A (CsA), or its non-immunosuppressive derivative Cs29 (10 mg/kg, IV bolus). Hearts were harvested and mitochondria isolated for further assessment of Ca(2+)-induced MPT using a Ca(2+)-sensitive micro-electrode. In protocol 2, C and PC hearts underwent 30 min of ischemia and 4 h of reperfusion. They were pretreated either by saline, CsA or Cs29, as in protocol 1. Infarct size was assessed by triphenyltetrazolium, and apoptosis by TUNEL staining. RESULTS: In protocol 1, the Ca(2+) overload required to induce MPT pore opening was significantly higher in PC than in C hearts. CsA and Cs29 significantly increased the Ca(2+) overload required for MPT pore opening. In protocol 2, mean infarct size averaged 25% of the risk region in CsA/Cs29 treated hearts versus 15% in PC and 55% in controls (P<0.05 vs. C, P=ns vs. PC). Cardiomyocyte apoptosis was significantly reduced by PC and cyclosporin treatment with a mean apoptotic index of less than 2% in either group versus more than 11% in controls. CONCLUSION: This suggests that delayed opening of MPT pore may play a major role in ischemic PC.

Animals↗

PubMed2004

Endobronchial variant of sclerosing hemangioma of the lung: histological and cytological features on endobronchial material.

We report two cases of a rare presentation of pulmonary sclerosing hemangioma as an endobronchial polyp resulting in clinical symptoms of bronchial obstruction. We describe the histological and cytological description of this entity based on material obtained during bronchoscopic examination. In both cases, bronchoscopy revealed a polypoid mass protruding into the left lower lobar bronchus, with a smooth and hemorrhagic surface, reminiscent of a carcinoid tumor. On bronchial washing in case 1, numerous small round cells were seen with uniform nuclei and inconspicuous nucleoli, arranged in clusters with a pavement-type pattern and papillary configuration. The presence of a few reactive pneumocytes gives a dual cell proliferation, in a background of numerous foamy macrophages. Although the four architectural patterns of sclerosing hemangioma were present in the resected tumors, the papillary and solid patterns predominated in the endobronchial component of the tumors and these were seen on the bronchial biopsies. Recognition of the papillary pattern, the typical round cells coexpressing thyroid transcription factor-1 and epithelial membrane antigen without cytokeratin immunoreactivity, are helpful clues for the diagnosis on bronchial biopsy. Finally, hopefully awareness by clinicians and pathologists that sclerosing hemangioma can present as an endobronchial mass will facilitate diagnosis when this rare event occurs.

Adult↗

PubMed2003

Molecular diagnosis of infective endocarditis by PCR amplification and direct sequencing of DNA from valve tissue.

We used broad-range eubacterial PCR amplification followed by direct sequencing to identify microbial pathogens in heart valve material from 29 patients with histologically confirmed infective endocarditis and 23 patients free of infective endocarditis. Microorganisms cultured by conventional techniques matched those identified by PCR in 21 cases. PCR alone identified the causative agent in three cases (Streptococcus bovis, Staphylococcus cohnii, and Coxiella burnetii), allowing better patient management. PCR corrected the initial bacteriological diagnosis in three cases (Streptococcus bovis, Streptococcus mutans, and Bartonella henselae). Among the 29 cases of histologically confirmed infective endocarditis, PCR findings were positive in 27 cases and were consistent with the bacterial morphology seen at Gram staining (26 cases) or with the results obtained by immunohistologic analysis with an anti-C. burnetii monoclonal antibody (one case). In two other cases of histologically confirmed infective endocarditis, PCR remained negative in a blood culture-negative case for which no bacteria were seen at histological analysis and in one case with visualization of cocci and blood cultures positive for Enterococcus faecalis. Ten clinical diagnoses of possible infective endocarditis were ruled out by histopathological analysis of the valves and subsequently by PCR. PCR was negative in 13 of the 14 patients in whom infective endocarditis was rejected on clinical grounds; the other patient was found to have Coxiella burnetii infective endocarditis on the basis of PCR and histopathological analysis and was subsequently included in the group of 29 definite cases. In total, PCR contributed to the diagnosis and management of infective endocarditis in 6 of 29 (20%) cases.

DNA, Bacterial↗