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Biomedical subjects

H Lioté

Publications and source records attributed to H Lioté.

18 recordsLinked to original sources
PubMed2004

[Etiological work-up for bronchectasia in adults].

Search for an etiology of bronchiectasis consists in identifying constitutional or acquired defense mechanisms of the respiratory mucosa. The question is timely because causes change. In developing countries, presumed sequelae of infection account for about 30% of the cases despite vaccination campaigns, control of endemic tuberculosis, and widespread use of antibiotics. Genetic diseases account for 20% of the causes when identified by high-performance prospective diagnostic tests (CFTR mutation). Computed tomography enables the identification of frequent associations between bronchiectasis and rheumatoid disease or ulcerative colitis. Recent diseases such as HIV infection or GVHD can also lead to bronchiectasis. Nevertheless, the cause remains unknown in 30-50% of patients. After a detailed analysis of the clinical presentation and diagnostic criteria specific for each etiology, we propose a two-phase diagnostic procedure. The first step, used for all patients (careful history taking, physical examination, imaging, bronchofibroscopy, limited blood tests) enables detecting localized bronchial obstacles and obvious etiologies (situs inversus of primary ciliary dyskinesia, known systemic disease, HIV...). If the first step is negative, the second phase is oriented by the clinical context. Sequelae of infection (tuberculosis...) in older subjects or migrants, a genetic cause in younger subjects, particularly if there is a familial history and/or infertility, a systemic disease or allergic bronchopulmonary aspergillosis if there is an extra-respiratory context. This etiological search should help improve patient management and provide a better prognosis and prevention of bronchiectasis.

Bronchiectasis↗
PubMed2004

[Respiratory complications of new treatments for rheumatoid arthritis].

INTRODUCTION: Treatment of rheumatoid arthritis (RA) has changed with the release of more efficient disease-modifying anti-inflammatory drugs (DMARDs) and biologicals, such as methotrexate, leflunomide and TNF blockers, respectively. However they are prone to trigger potential pulmonary side effects. STATE OF KNOWLEDGES: Diffuse interstitial pneumonitis with alveolar lymphocytosis are induced by methotrexate. This drug increases also the risk of opportunistic infections (Pneumocyctis carinii) and of delayed lymphomas. Many intracellular bacterial infections, about 80 cases of diffuse pneumonitis, and rare vasculitis are attributable to leflunomide. PERSPECTIVES: The TNF blocking agents (infliximab, etanercept and adalimumab) trigger immunization and consequently, rare type I and III hypersensitivity pneumonitis, serological lupus-like reactions usually without any clinical manifestations. Indeed the risk of infection with intracellular agents remains the first concern. Several hundreds of cases of pulmonary and non pulmonary tuberculosis (TB) have been described. They present as disseminated forms, with pulmonary manifestations present in half cases; of note, other sites are atypical, namely meningitis, lymph node, and digestive involvement. Pathological diagnosis can be difficult since granulomas are sparse or absent. Therefore TB can be lethal because of delayed diagnosis and treatment. CONCLUSION: To prevent this major risk when using TNF blockers, the French agency AFFSAPS recommends to screen and treat susceptible patients such as latent tuberculosis. Specifically, antituberculous drugs have to be started three weeks before anti-TNF agents. During biological therapy, physicians must regularly look for usual and unusual symptoms of TB. When TB is diagnosed, anti -TNF agents have to be discontinued, probably definitively, and appropriate antituberculosis treatment started in order to achieve an uneventful course.

Antirheumatic Agents↗
PubMed2001

[Prophylactic prescription of low-molecular-weight heparin in the non-surgical setting: impact of recommendations].

OBJECTIVE: Low-molecular-weight heparins (LMWH) had official approval for use for venous thromboembolism prophylaxis only for surgery patients when this survey was conducted, but were nevertheless often used in non-surgery patients. We conducted this "before and after" survey from May 1998 to April 1999 to assess the impact of the recommendations implemented in the beginning of 1999. METHODS: Data on the use of LMWH were collected on three different days within a three week interval in all non-surgery departments at the Tenon hospital before distribution of expert recommendations early in 1999. Published in La Presse Médicale in January 2000, these recommendations issued from an external panel of 43 experts who were contacted to establish a consensus opinion using the Delphi method. Data were again collected on three different days after implementation of the recommendations. Implementation was based on a patient-specific prescription order form requested by the hospital pharmacy for delivery to the department. RESULTS: Data were collected for 121 prescriptions prior to the recommendations and for 158 after. Sex-ratio, mean age and percentage of LMWH prescriptions did not differ significantly between the two periods. There was a lower number of non-appropriate prescriptions after implementation of the recommendations from 54.5% to 35.4% (p = 0.01) with better conformity for recommendation A (high-risk patients) (36% versus 43%, NS) and for recommendation B (= 2 risk situations or = 1 risk situation and = 2 aggravating factors) (10% versus 22%, p = 0.01). Better conformity of LMWH prescriptions in oncology and radiotherapy departments partially explained this general improvement, but the difference remained significant when excluding these two departments (p = 0.04). CONCLUSION: This study shows that physician compliance with recognized expert recommendations can improve their implementation. This procedure is now in general use in the Tenon hospital.

Aged↗
PubMed2001

The relationship between introduction of American society of clinical oncology guidelines and the use of colony-stimulating factors in clinical practice in a Paris university hospital.

BACKGROUND: Clinical practice guidelines are issued periodically by professional medical societies or committees to assist practitioners in clinical decision making. However, it is unclear whether such guidelines have any lasting impact on clinical practice. OBJECTIVE: The purpose of this study was to assess the impact of the American Society of Clinical Oncology (ASCO) guidelines regarding use of hematopoietic colony-stimulating factors (CSF) on cancer care in a university hospital in Paris. METHODS: The study was performed at Hĵpital Tenon, an 830-bed university hospital in Paris, in 1996 and 1997, both before and after the ASCO guidelines were implemented. The guidelines were first disseminated as a continuing medical education program and then actively implemented using a CSF prescription order form summarizing the guidelines. This form had to be used during the patient consultation and was sent to the Hĵpital Tenon pharmacy for CSF dispensation. Even if CSF use did not comply with the ASCO guidelines, the pharmacy filled the prescription. Seven other university hospitals in Paris, where the ASCO guidelines were not actively implemented, comprised the control group. The main outcome measure was the proportion of prescriptions in compliance with the 1996 update of the ASCO guidelines. Secondary outcome measures were the proportions of prescriptions in compliance with ASCO guidelines regarding primary prophylactic, secondary prophylactic, and therapeutic CSF administration. RESULTS: Before implementation of the ASCO guidelines, CSF use in compliance with the guidelines was 39% (41/105) at the study site and 31% (16/51) at the control sites (P > 0.05). Six months after dissemination and implementation of the guidelines, the proportion of CSF prescriptions complying with ASCO guidelines increased significantly versus baseline (P = 0.003) in the study group, to 61% (50/82). However, even after the guidelines were implemented, compliance with guidelines on primary prophylactic CSF administration did not change significantly versus before implementation in the study group (12% [5/41] before implementation vs 6% [2/33] after implementation; P > 0.05). CONCLUSIONS: The results suggest an association between the active implementation strategy (continuing medical education and CSF prescription reminder form) and physician compliance with the ASCO guidelines. Implementation of the ASCO guidelines appears to have had some impact on medical practice.

Colony-Stimulating Factors↗
PubMed2000

[Prevention of venous thromboembolism in a non-surgical medical ward. Proposed indications for low molecular weight heparin].

OBJECTIVE: The efficiency of venous thromboembolism prophylaxis with low molecular weight heparins (LMWH) has not been established in non surgical patients, so their official preventive use has been limited in France since 1995 to surgery. However, a survey conducted in 5 university hospitals in non surgical patients showed that 21-29% of patients still received a LMWH prescription. It seemed necessary to define the medical conditions for which the practical use of these heparins would be justified. We contacted external experts to obtain a consensus by using the Delphi method. METHODS: The Delphi method, created by the "Rand Corporation" in the USA and used in medicine since the nineteen seventies, is based on a light logistic, with questionnaires been sent by mail with a feed-back report A total of 48 experts were chosen by local staff teams in the 5 hospitals. For the 3 rounds, from March to October 1998, questions were devised by a multicentred staff team. RESULTS: Among the 48 experts contacted, 32 completed the 3 questionnaires, 7 of them did for 2, and 43 did for at least one questionnaire. The experts first defined a list of 12 risk or high risk situations and 11 aggravating factors. For any high risk situation, prescription is justified. For other cases, 2 risk situations are required, or one risk situation with at least 2 aggravating factors, to justify a prescription. If no risk situation is present, prescription is, according to experts, usually not justified. CONCLUSION: The maximal agreement defines the situations in which one use of low molecular weight heparins is proposed to prevent deep venous thrombosis in non surgical inpatients, in most current hospital situations and for more than 24 hours of hospitalization. Clinical trials are needed, to validate their effectiveness and define the optimal dose in these indications. To date, epidemiological studies should be conducted to evaluate the experts proposals by estimating risk factors for deep venous thrombosis.

Double-Blind Method↗
PubMed1990

Adult-onset Still's disease revealed by a pleuropericarditis.

We report a case of adult-onset Still's disease (AOSD) revealed by pleuropericardial manifestations. A 40 yr old black woman was admitted for flu-like syndrome with pharyngitis, hectic fever, polymorphonuclear hyperleucocytosis and pleuropericarditis. The diagnosis of AOSD was supported by 3 major and 3 minor criteria after exclusion of infectious, haematological and connective tissue diseases. Pulmonary involvement is infrequent in AOSD, and consists of transient pulmonary infiltrates and chronic restrictive pattern. However, pleuritis, like pericarditis, is present in 25% of cases. Initial onset of pleuritis, associated with fever and hyperleucocytosis preceding articular manifestations could be responsible for a delay in diagnosis and a subsequent worsening in the prognosis of the disease. A rapid improvement is usually observed under nonsteroidal anti-inflammatory drug or corticosteroid treatment.

Adult↗
PubMed1989

Role of mucus and cilia in nasal mucociliary clearance in healthy subjects.

Large interindividual variations of nasal mucocilliary clearance across healthy subjects have been previously described. The aim of this study was to evaluate the respective role of the nasal mucus quality and ciliary activity in determining nasal mucociliary clearance and to study changes in these variables across time and with environmental conditions. In 20 healthy nonsmoking volunteers, the in vivo nasal mucociliary clearance was measured with the saccharin test. Then, nasal mucus and ciliated cells were collected. The in vitro ciliary beat frequency of the nasal cells was evaluated by a photometric analysis. The in vitro nasal mucus transport rate was evaluated by use of the frog depleted-palate model. The nasal mucociliary transport time (NMTT) of saccharin was greater than 30 min in seven subjects and was 13.6 +/- 6.1 min (mean +/- SD) in the remaining 13 subjects. NMTT was correlated to the in vitro transport rate of the nasal mucus (r = -0.75, p less than 0.001), but not to the ciliary beating frequency or to ambient temperature, relative humidity, or air pollution indices measured. Moreover, large intraindividual variations of NMTT, measured on two occasions 4 to 8 wk apart, were found to be significantly correlated with changes in mucus transport rate (r = -0.60, p less than 0.05).

Adult↗
PubMed1989

[Protein-poor pleurisy and mesothelioma. Apropos of 2 cases].

We report two cases of protein poor pleural effusions secondary to malignant mesothelioma which were proven histologically. In the absence of any extra pulmonary cause, in particular cardiac, the associated investigations carried out led to the exclusion of either a chylothorax or a mechanical effusion due to atelectasis. Pulmonary venous obstruction by the mesothelial masses which had developed on the mediastinal pleura were shown in the two cases. The high pressure in the pulmonary capillaries which resulted could be the origin of the low level of protein observed in the pleural fluid.

Aged↗
PubMed1989

[Acute, reversible, interstitial pneumopathy induced by melphalan].

A case of acute interstitial pneumonia with hypoxaemia is described; this occurred after the cessation of cortico steroids in a patient suffering from myeloma treated with melphalan. The absence of any microbes and the lymphocytosis in the bronchoalveolar lavage and the rapid and favourable improvement on cortico steroids led to a diagnosis of melphalan induced pneumonia. This acute form is probably due to a hypersensitivity mechanism and should be distinguished from the majority of cases of sub-acute fibrosing pneumonitis due to melphalan which have been published before. Urgent treatment with glucocorticoids is justified as well as the immediate and final cessation of the medication responsible, because it is this which will affect prognosis.

Acute Disease↗
PubMed1988

[Thoracic metastases of ependymoma. Apropos of a case and review of the literature].

A 27-year old woman with occipital ependymoma treated by surgery and radiotherapy for multiple recurrences developed a right lymphocytic pleural effusion. After 3 inconclusive needle biopsies of the pleura, pleurectomy was performed. Pathological examination with a specific immunohistochemical marker provided a diagnosis of pleuro-pulmonary metastases from the ependymoma. This rare case of extraneuraxial metastasis from a cerebral ependymoma is discussed in the light of published data. Its originality lies in that a positive diagnosis of pleural metastases was obtained with an immunohistochemical marker, the gliofibrillary antiprotein serum (anti-GFAP) specific of glial tissue.

Adult↗
PubMed1988

[Pulmonary aspergilloma appearing early].

A 62-year old smoker and alcoholic woman with chronic obstructive lung disease was admitted for suppurative pneumonia with cavitation and developed an intracavitary aspergilloma less than 2 months after the first signs of pneumonia. In view of the short time elapsed between the aspergilloma and the onset of suppurative pneumonia, 2 possibilities are discussed: either an aspergilloma developed unusually early in the cavity of a recent pulmonary abscess, or the patient had a chronic necrotizing pulmonary aspergillosis diagnosed at an early stage, which would account for all the manifestations observed.

Aspergillosis↗