Biomedical subjects
Publications and source records attributed to H Lévesque.
The case of 87-old year woman with necrolytic migratory erythematosus rash without elevated plasma enteroglucagon is discribed. Decreased serum zinc level, response to oral zinc substitution and follow up proved the zinc deficiency.
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In order to assess the prevalence of cardiac involvement in the primary antiphospholipid syndrome (PAS), a syndrome which associates thromboembolism, recurrent abortion, the presence of antiphospholipid antibodies and thrombocytopenia, transthoracic (TTE) and trans-esophageal echocardiography (TEE) was performed in 15 patients, 10 women and 5 men with a mean age of 38.8 +/- 11 years, with the PAS but without systemic lupus erythematosus. The presentation of the PAS was a thrombotic event (6 arterial and 7 venous) in 13 cases, and recurrent abortion in 3 cases. Twelve patients had high anticardiolipin antibody levels (> or = 15 U GPL) and 12 had a raised anti-prothrombinase antibody title. Valvular heart disease was detected in 9 patients (60%) as a valve thickening (> or = 5 mm for the mitral and > or = 3 mm for the aortic valve) or nodule. Mitral regurgitation was observed in 4 cases both on TTE and TEE and was mild in 3 cases and severe in 1 case. Aortic regurgitation was diagnosed in 6 patients, in 3 cases by TTE and in 6 cases by TEE. It was mild in 5 cases and moderate in the other cases. Pericardial effusion was observed in 3 patients (20%), alone in 1 case and associated with valvular disease in the other two cases. No abnormality of left ventricular systolic or diastolic function could be demonstrated. In conclusion, cardiac involvement seems to be common in the PAS, and TEE is a sensitive and accurate method for describing the valvular, especially aortic valve, abnormalities.
Diffuse arterial involvement in temporal arteritis is well known but the intimate mechanisms of vasculopathy is unknown. Recently the presence of anticardiolipin antibodies (aCL) has been recognized in giant cell arteritis. We report two cases of temporal arteritis with diffuse arterial involvement associated with aCL (axillary arteries in the two cases associated with femoral arteries in one). During corticosteroid and anticoagulant therapy, a rapid improvement was noted with regression of upper-limb ischemia. One month later, the aCL were absent. These cases confirm the presence of aCL in giant cell arteritis with diffuse arterial involvement. These antibodies might imply severe vascular damage and could play a role in pathogenesis of the vasculopathy of temporal arteritis. Their presence suggests the necessity of anticoagulant therapy at the beginning of corticosteroid therapy.
Serum cholesterol was measured in all patients admitted to the Department of Internal Medicine over one year. 6.2 percent had hypocholesterolaemia defined as total serum cholesterol level below 4 mmol/l. Comparison with non-hypocholesterolaemic patients showed male predominance and indirect arguments for increased morbidity: longer duration of hospital stay, greater number of rehospitalizations, greater number of associated diseases. In over a quarter of the cases, hypocholesterolaemia was associated with malignant disease. These results should entice physicians to caution when finding a low serum cholesterol level: this could be a marker of associated disease, especially malignant.
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We report the case of a 25 year old man with pituitary carcinoma with Cushing's syndrome. Though the diagnosis was initially proposed, it was only confirmed by the appearance of meningeal and lymphatic metastases. These were secretory, as confirmed by immunocytochemistry and electron microscopy. These tumours are rare, whether they secrete or not, and can be confirmed only by the existence of metastases, most often in the brain or the liver.
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Endothelin (ET) is a novel vasoactive peptide occurring in 3 isoforms (ET1, ET2, ET3) in humans. Derived from vascular endothelium cells, ET arises from a precursor peptide and exerts diverse actions through specific receptors. ET possess a wide spectrum of activities: a potent vasoconstrictor activity but also contraction of nonvascular smooth muscles (air-way, intestinal, urinary) or mitogenic actions, renal and endocrine effects. The physiological and/or physiopathological roles of endothelin is still unclear, but ET may play a part in the genesis of some vascular diseases as atherosclerosis, forms of hypertension or may be implicated in the pathogenesis of vasospasm.
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The role of the endothelium in vascular tone is well established. New physiopathological concepts were brought about by the discovery of endothelium derived vasoactive substances such as the vasodilators prostacyclin and endothelium-derived relaxing factor (EDRF) or the vasocontrictors endothelin and other putative endothelium-derived contracting factors (EDCF). Their discovery led to new therapeutic concepts in vascular, respiratory and infectious diseases. Prostacyclin is a prostaglandin derived from arachidonic acid which has an inhibitor effect on platelet aggregation. It also has a vasodilator effect on vascular smooth muscles cells. Prostacyclin analogues are choice vasculoactive pharmacological agents for patients with thromboangiitis obliterans or severe peripheral vascular disease, whether arteriosclerotic or not. The effect of EDRF is vascular dilatation, predominately in the arteries but also in the veins, including vessels in grafted tissues. EDRF also inhibits platelet aggregation and adhesion. Inversely, the endothelium can also release EDCF which has a vasoconstrictor effect. Endothelin, a recently identified 2429 kD EDCF is active in both arteries and veins and is implicated in physiologic regulation of vasomotricity.
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For curative treatment of deep vein thrombosis, all trials have shown that twice a day low molecular weight heparin were at least as efficacious as unfractionated heparin on clot reduction or stabilisation. Through the unit cost of low molecular weight heparin is higher, the real cost of treatment should take into account not only the cost of the drug, but also the cost of materials used and lab tests as well as the time necessary. We have therefore prospectively compared the operating and overall costs of nadroparin and intravenous heparin treatment of deep vein thrombosis in hospitalised patients (21 with unfractionated heparin and 19 with nadroparin). The results show that low molecular weight heparin is no more expensive than treatment with unfractionated heparin (336 +/- 74.9 F for unfractionated heparin and 344.9 +/- 44.05 F for nadroparin). In addition, using nadroparin rather than heparin saves approximately one hour per patient per week nursing time (42 +/- 7 minutes vs 104.0 +/- 10.7 minutes, p < 0.05). The methodology of this study should be repeated with other low molecular weight heparin and low molecular weight heparin compare not only to standard i.v. heparin, but also to standard SC heparin.
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