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H Lévesque

Publications and source records attributed to H Lévesque.

At least 19 recordsLinked to original sources
PubMed2006

Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study.

BACKGROUND: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m(-2) < BMI < or = 30 kg m(-2)) or obesity (BMI >30 kg m(-2)) and VTE risk has not been investigated. METHODS: We carried a multicenter case-control study of VTE among postmenopausal women aged 45-70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. RESULTS: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7-3.7] for overweight and 3.9 (95% CI: 2.2-6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6-7.7 and OR = 1.1; 95% CI: 0.7-1.7, respectively). Compared with non-users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5-30.2 and OR = 20.6; 95% CI: 4.8-88.1, respectively). However, transdermal users with increased BMI had similar risk as non-users with increased BMI (OR = 2.9; 95% CI: 1.5-5.8 and OR = 2.7; 95% CI: 1.7-4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1-14.1 and OR = 4.0; 95% CI: 2.1-7.8 respectively for obesity). CONCLUSIONS: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.

Administration, Cutaneous↗
PubMed2005

[Spontaneous splenic hematoma: trauma injury or drug reaction or both?].

INTRODUCTION: Spontaneous splenic hematomas are uncommon and frequently associated with infectious, hematologic, or neoplastic diseases. Presentation is typically acute but progressive forms have been described. CASE: We report the case of a 45-year-old man consulting for abdominal pain that was found to be due to a spontaneous splenic hematoma. No recent injuries, infections, or hematologic, neoplastic or gastrointestinal diseases were found, but the patient had had a minor injury 9 months earlier and had been treated with selective serotonin reuptake inhibitors (venlafaxine) for the past year. This history suggested that the drug might play a role. DISCUSSION: Although the likely cause of this splenic hematoma appears to be a minor injury 9 months before the onset of pain, we cannot rule out the possibility that selective serotonin reuptake inhibitor treatment was a predisposing factor.

Abdominal Pain↗
PubMed2005

[Tuberculosis peritonitis: an always present disease. About 4 new cases].

INTRODUCTION: Tuberculous peritonitis, a major problem in developing country, occurs preferentially in immigrant population and in patients with acquired immune deficiency syndrome (AIDS). Although rare in France, it did not disappear and epidemiological, clinical and therapeutic approach deserve to be reminded. EXEGESIS: We reported 4 patients (immigrants in two cases), occurred in caucasian and African persons (one with AIDS). Disease was characterized by fever, abdominal pain, anorexia, weight loss and ascites. Biological and radiological were unconclusive. Cell count analysis from ascitic fluid show a lymphocytic predominance with negative direct smear for Ziehl-Neelsen strain. Tuberculous peritonitis was established with combined visual and histological diagnosic laparoscopic examination. CONCLUSION: These observations have the interest to underline that tuberculous peritonitis must be evoked in case of lymphocytic ascitis. We believe an aggressive diagnostic approach, particulary with peritoneal biopsy, is warranted for the diagnosis of tuberculous peritonitis. Validity of PCR amplification is ascitic fluid still needs to be established.

Adult↗
PubMed2004

[Auto-immune manifestations in Non-Hodgkin's lymphoma].

PURPOSE: A wide spectrum of auto-immune manifestations is frequently reported in non-Hodgkin's lymphoma (NHL). The purpose of the review is to describe the immune manifestations observed in NHL, according to their histological subtype and to discuss the current physiopathological hypothesis with their therapeutic relevance. CURRENT KNOWLEDGE AND KEY POINTS: Most of the organs can be targeted by an immune process due to the lymphoproliferative disease: they include skin diseases (paraneoplastic pemphigus, vasculitis, urticaria, acrosyndromes), peripheral and central nervous system involvement (polyneuropathy, multifocal neuropathy), haematological manifestations (immune cytopenia, acquired bleeding disorders), rheumatologic diseases (arthritis, systemic vasculitis, myositis) and renal lesion (cryoglobulinemia, glomerulopathies). A higher prevalence of autoantibodies, such as antinuclear antibodies, Antiphospholipid antibodies, or endomysium antibodies, is observed in NHL but usually without clinical manifestations. In B-cell NHL, clinical and biological immune manifestations are more frequently observed in indolent lymphoma than in aggressive NHL. In T-cell NHL, immune manifestations are frequent and polymorphous, preceding usually the diagnosis of lymphoma. The prognosis value of the immune manifestations in NHL is unclear. Immune manifestations can be also be related to the treatment procedure, including fludarabine, Interferon, autograft or Rituximab. The physiopathology of the immune manifestations may involve auto-antibodies production by natural CD5+ autoreactive B-cell from which is issue the proliferation, a lost of immune tolerance, an abnormality in the Fas/Fas Ligand pathway or a chronic antigenic stimulation. FUTURE PROSPECTS AND PROJECTS: As observed in T-cell lymphoma cases, immunosuppressive treatment can control both immune manifestations and lymphoproliferation, suggesting that lymphoma and auto-immunity may be the two aspects of the same process. The monoclonal antibody anti-CD20 (rituximab), able to suppress the tumoral cells and change the B-cell repertoire is the most promising treatment to cure immune disorders related to NHL. So far, rituximab has been successfully used in mixed cryoglobulinemia and cold agglutinins secondary to NHL.

Antibodies, Antinuclear↗
PubMed2004

[Venous tromboembolic treatment in patients with cancer].

PURPOSE: Venous tromboembolic treatment in patients with cancer can be a clinical dilemma. Comorbid conditions, significant risk of recurrence of bleeding associated with warfarin, difficult venous access, are some of the factors that often complicate anticoagulants therapy in patients with cancer. EXEGESIS: Low molecular weight heparin has replaced unfractionated heparin as the first line treatment in the majority of patients with venous thromboembolism and cancer, in hospital or safely at home. Recent trial demonstrated that long-term low molecular weight heparin administrated over a 6-month period reduced the rate of recurrence venous thromboembolism with non increase in bleeding compared with oral anticoagulant therapy. Placement of an inferior vena caval filter should be reserved for patients with active or very high risk of bleeding, but oncologist should consider these sobering results in such patients. Whether anticoagulants might also improve cancer survival rates independent of their effect on thromboembolism deserves further investigation. PERSPECTIVE: In future, new antithrombotic agents such as oral direct thrombin or long-acting synthetic factor Xa inhibitor may be useful in these patients.

Humans↗