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Biomedical subjects

H Lévesque

Publications and source records attributed to H Lévesque.

At least 109 records · Page 6Linked to original sources
PubMed1997

[Estrogen therapy and venous thromboembolic disease].

A link between venous thromboembolism and oral contraceptive users is well established. This paper analyzes recent epidemiological studies affecting risk of venous thromboembolism with the use of oral contraceptive or with postmenopausal hormone replacement therapy. Four epidemiological studies showed a two-fold increase of venous thromboembolism with the use of oral contraceptives containing third generation progestins (gestodene and desogesterel, relative to second-generations product (levonorgestrel); relative risk 3.8 per 100,000 women years in non-user women, 16 per 100,000 women years in women using levonorgestrel containing oral contraceptive) and 29 per 100,000 women years in women using gestodene containing oral contraceptive). Third-generation oral contraceptives induce a resistance to the activated protein C of almost the same magnitude as the resistance induced by a mutation in coagulation factor V. Studies with postmenopausal estrogen-replacement therapy show a two-fold risk of venous thromboembolism with estrogen only as well as with combined estrogen-progestagen hormone replacement therapy. However venous thromboembolism risk is very small compared with the cardiovascular and other benefits.

Contraceptives, Oral↗
PubMed1997

[Cost of low molecular weight heparin used in the prevention or therapy of thromboembolic disease].

Low-molecular-weight heparin are widely used for prophylaxis or curative treatment of thromboembolic disease. In France, low molecular weight heparin can only be used for the surgical prophylaxis (general and orthopaedic) of thromboembolic disease, for the initial treatment of deep vein thrombosis and in haemodialysis. In an economic approach we try to assess costing information which takes account of drug acquisition costs but also costs of drug administration and costs of drug therapy failure (failed prophylaxis, bleeding and recurrent thrombosis). At least, it has been argued that low molecular weight heparin may take it possible to discharge patients earlier and even to treat patients at home or as out-patients, thus creating further cost savings.

Cost Control↗
PubMed1997

[Thrombophlebitis and cancer: evaluation of the diagnostic value of abdominal ultrasonography in the acute phase of a deep venous thrombosis. Report of 148 consecutive examinations].

If an association between venous thromboembolism and malignancy is now well established, there is no consensus about the investigations which should be performed to detect occult malignancy after deep vein thrombosis episode. We investigated the usefulness of systematic abdomino-pelvic ultrasonography in 148 consecutive patients older than 40 with deep vein thrombosis and or pulmonary embolism. Ultrasonography was abnormal in 8 patients (5.4%) and detected only 6 cancers. In 5 cases, clinical examination and laboratory tests were sufficient to suggest malignancy. Our results suggest that ultrasonography should not be systematically performed in patients with deep vein thrombosis. Decisions to performed additional diagnostic tests can be based on the finding of the initial clinical examination, that includes medical history, physical examination, routine laboratory tests and chest-x-ray.

Abdomen↗
PubMed1996

[Platelet antiaggregants and atheromatous arteriopathy of the lower limbs].

Antiplatelet therapy (chiefly aspirine alone) greatly reduces the risk of vascular death and vascular events in patients with acute myocardial infarction, past history of myocardial infarction, unstable angina, stroke or transient ischaemic attack, and also in the large categories of patients at increased risk of occlusive vascular diseases. Studies of patients with peripheral arteriopathy demonstrate that antiplatelet therapy significantly reduces the risk of vascular occlusions in patients with intermittent claudication or with saphenous vein grafts or prosthetic implants or angioplasty for lower limb diseases. In trials in high risk patients where patients data were available, antiplatelet therapy produces a similar effect in middle age or old age, in men or women, in diabetic and non-diabetic or in hypertensive or normotensive patients. There is no clear evidence that antiplatelet therapy is indicated in primary prevention. Medium dose aspirin (75-325 mg/d), probably for indefinite continuation, is the most widely tested antiplatelet regimen.

Arterial Occlusive Diseases↗
PubMed1994

Localization and solubilization of hyaluronan and of the hyaluronan-binding protein hyaluronectin in human normal and arteriosclerotic arterial walls.

Hyaluronectin (HN), a hyaluronan (hyaluronic acid, HA)-binding glycoprotein isolated from human brain, was studied in normal and atherosclerotic human arteries. It can be detected and assayed in tissue samples by immunohistochemistry. In addition, its high and specific affinity for HA makes it possible to develop specific histological localization of HA using HN as a probe. We tested the presence of HN and HA in human carotid artery samples from adults and newborns. In atheroma-free arterial samples HN was found in the intima, between smooth muscle cells and in the adventitial extracellular matrix. In atherosclerotic lesions, HN was strongly expressed in the diffuse thickened intima and surrounding extracellular microcrystalline calcium deposits, and very little in the lipid core. HA was found in the same locations. The similar localizations of HN and HA shown by immunohistology and demonstration of HN-HA complexes by high pressure liquid chromatography (HPLC) suggest that they are associated in vivo.

Adult↗
PubMed1994

Prevalence and evolution of anticardiolipin antibodies in giant cell arteritis during corticosteroid therapy. A prospective study of 20 consecutive cases.

IgG and IgM anticardiolipin antibodies (aCA) were studied prospectively in 20 consecutive patients (12 females, eight males, mean age 74.6 +/- 14 yr, range 62-86 yr) with giant cell temporal arteritis before and during corticosteroid therapy (days 7, 30, 90 and 180). IgG-aCA were present in 10 out of 20 cases and in nine out of 12 with positive temporal artery biopsy but were not found in 20 paired control subjects. During steroid therapy aCA levels returned to within the normal range in 60% of patients with positive aCA at day 7 and in 80% at day 30. In two cases aCA persisted during the 6-month follow-up despite clinical and biological success. No association was found between aCA and thrombotic events.

Adrenal Cortex Hormones↗
PubMed1994

Endothelins. A potential target for pharmacological intervention in diseases of the elderly.

The existence of vasoconstrictive factors originating from the endothelium was confirmed by the description of endothelin, a 21-amino-acid peptide derived from a series of precursors, preproendothelin and a 38-amino-acid big endothelin. Three isoforms of endothelin, endothelin-1, -2 and -3, and 3 receptors (ETA, ETB and ETC) have been described and cloned. The cellular mode of action of endothelin seems to involve the modulation of intracellular calcium (through inositol trisphosphate, diacylglycerol and phospholipase C) and activation of calcium channels. The effects of endothelin are predominantly on the cardiovascular system. Its major effect is vasoconstriction, both systemic and pulmonary, with additional positive chronotropic and inotropic effects on the heart. It has also been implicated in homeostatic regulation of kidney microcirculation, and has powerful mitogenic effects on fibroblasts and smooth muscle cells. Many additional effects have been described on the endocrine system and on other systems. However, the clinical relevance of such effects is uncertain. Increased plasma endothelin levels have been reported in many diseases, but as yet it is not certain whether they are a cause or a consequence of the pathology. Pathologies most probably related to endothelin dysfunction are the vasospastic diseases, especially vasospasm after subarachnoid haemorrhage. Endothelin could be implicated to a lesser measure in diseases typical of the elderly population, such as hypertension or atherosclerosis. Drugs are being developed which act on endothelin metabolism, the most promising of which appear to be the inhibitors of endothelin converting enzyme and endothelin receptor antagonists. Some already existing drugs, such as calcium channel blockers or angiotensin converting enzyme inhibitors, probably act at least in part by interfering with endothelin metabolism or effects.

Aged↗
PubMed1993

[Remission under treatment of cutaneous xanthomatosis disclosing myeloma: apropos of a case with a three-year course].

We report a case of IgG lambda multiple myeloma with inaugural cutaneous xanthomatosis. A three years follow up showed parallel evolution of xanthomatosis and monoclonal gammapathy during therapy suggesting that the association is not coincidental. A decrease in IDL catabolism could be responsible. The monoclonal gammapathy could react with IDL and disturb the recognition of apolipoprotein E by its hepatic receptor.

Cyclophosphamide↗