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H Mosnier-Pudar

Publications and source records attributed to H Mosnier-Pudar.

11 recordsLinked to original sources
PubMed2005

Advantages to using capillary blood beta-hydroxybutyrate determination for the detection and treatment of diabetic ketosis.

Ketone body determination is indicated in all diabetic patients when the risk of ketotic decompensation exists. New methods of screening for ketosis, in particular capillary blood ketone body determination, provide analytical, technical and clinical advantages compared to the conventional ketonuria. It is proposed that a diabetic patient with hyperglycaemia (capillary blood glucose > 2.50 g.l(-1)) and capillary blood ketone bodies exceeding 0.5 mmol.l(-1) requires therapeutic management. For values greater than 3 mmol.l(-1) or in case of more serious clinical symptoms, hospitalisation is indicated, considering the high probability of ketoacidotic decompensation. The advantages of capillary blood ketone body determination including easy use, and rapid and objective results may improve management of the diabetic patient, especially in emergency situations. However, prescription by a physician of capillary blood ketone body determination should be offered to targeted populations that have a high risk of ketoacidotic decompensation, after providing education to patients that is above all aimed at preventing this metabolic complication. In this context of determining ketone bodies in capillary blood, the term "capillary blood ketone bodies" is therefore preferable to the term "capillary blood beta-hydroxybutyrate determination". Indeed, it appears more appropriate, simple, descriptive and significant both for health-care staff and for patients.

3-Hydroxybutyric Acid↗
PubMed2003

[Indications and modalities of assisted reproductive techniques in infertile women with cystic fibrosis].

OBJECTIVE: To treat cystic fibrosis women who failed to conceive. PATIENTS AND METHODS: Multidisciplinary coordinated approach in 20 infertile women affected with cystic fibrosis. Advisability of pregnancy was based on the assessment of pulmonary and nutritional status, risks of maternal health deterioration, infertility factors, risk of cystic fibrosis in the offspring. Assisted reproductive techniques in moderately affected women are described. RESULTS: Three patients requested only information, three were discouraged, two are still evaluated, 12 were treated and three delivered healthy children. The pulmonary status of each patient remained unchanged 36 months after delivery, and all three children remain healthy. DISCUSSION AND CONCLUSION: Assisted reproductive techniques are an option in moderately affected infertile cystic fibrosis women. Advisability and management of pregnancy should be provided by a coordinated team of healthcare professionals with knowledge and experience in cystic fibrosis.

Adult↗
PubMed2000

[Metabolic complications associated with use of protease inhibitors].

The potency of highly active antiretroviral therapy, including protease inhibitors have led to declining morbidity and mortality in patients with HIV infection. However the use of protease inhibitors is associated with onset of morphologic and metabolic disorders. A syndrome of lipodystrophy has been described. It is characterized by fast wasting of the face and limbs, and a central adiposity, breast hypertrophy and buffalo neck. The prevalence of lipodystrophy in patients treated with protease inhibition is about 60%. The principal metabolic disorders are lipid abnormalities, principally hypertriglyceridemia. New onset of diabetes mellitus is less frequent. The pathogenesis of these abnormalities unknown. Insulin resistance seems to be a common feature of protease inhibitor associated metabolic an morphologic side-effects.

Diabetes Mellitus↗
PubMed2000

[Diagnosis and treatment of diabetes in adult patients with cystic fibrosis].

As their life expectancy has improved, patients with cystic fibrosis have experienced an increasing incidence of diabetes. Diabetes mellitus is characterized by improved and delayed insulin secretion, normal insulin sensitivity, and it is most often accompanied by exocrine pancreatic insufficiency. The development of diabetes mellitus is insidious and symptomless, and the overall cystic fibrosis status deteriorate for years prior to the diagnosis of diabetes. Since insulin therapy seems to revert deterioration for years of clinical status, and since late diabetic complications may develop, diabetes mellitus in cystic fibrosis should be identified by screening with an OGTT from the age of 15 years, and treated with insulin from the time of diagnosis of diabetes.

Adolescent↗
PubMed1998

[Adrenal incidentalomas].

Since the early 1980s, incidentally discovered adrenal masses have become a common clinical problem as a result of the more widespread use of abdominal imaging procedures. Once identified, an adrenal lesion must be characterized as to its functional status and malignant potential. The evaluation of these masses include clinical, hormonal, radiological and scintigraphic data. Optimal treatment of these patients require an agreement between endocrinologist, radiologist and surgeon. The presence of an hypersecretion will prompt a surgical intervention. In the vast majority of cases, the mass will be hormonally nonhypersecretory. Than the possibility of primary or metastatic malignancy must be excluded. The arguments for benign nonhypersecretory mass are mainly a enhanced CT attenuation coefficient of 0 HU or less, a small size (< or = 3 cm of diameter), typical feature of benign mass on CT scan. In the presence of those features non further investigation are necessary, and a reevaluation will be done regularly. We recommended surgery for adrenals at high risk of malignancy: 1. CT attenuation coefficient of more than 10 HU; 2. large (> 5 cm) diameter or increase in size at any reevaluation; 3. picture of intratumoral necrosis, hemorrhage or irregular margins.

Adenoma↗
PubMed1996

[Cushing's disease].

Patients with Cushing's disease usually present typical clinical and biological features easily leading to the diagnosis. However very atypical presentations of the disease do exist especially in the intermittent forms and several investigations are often necessary to detect pituitary microadenoma wich sometimes is inconspicuous. The course of the disease can be serious and might responsible of definitive sequellas wich can threaten patient's life. Therefore rapid treatment is recommended. Pituitary surgery should be considered as the major therapeutic approach; however, in severe cases or when pituitary-directed treatments or OP'DDD have failed, total bilateral adrenalectomy should be proposed.

Adenoma, Basophil↗
PubMed1995

Long-distance and long-term follow-up of a patient with intermittent Cushing's disease by salivary cortisol measurements.

Salivary cortisol is an excellent indicator of the plasma free cortisol concentration in normal and pathological situations. We took advantage of its ease of sampling, allowing multiple collections at home, to follow the course of a patient with Cushing's disease living in North Africa. This 48-year-old woman presented with a clinically moderate hypercortisolism caused by a large basophilic pituitary adenoma. Bilateral extension to the cavernous sinuses precluded surgical therapy. She went into spontaneous remission based on clinical signs as well as biochemical findings. During the following 2 years she demonstrated intermittent relapses that were treated by radiotherapy (50 Gy), followed by ketoconazole and then o-paraprime-dichloro-diphenyl-dichloroethane (Op'DDD). After a prolonged clinical remission, Cushing's syndrome again became active. Bromocriptine was started without effect and a new treatment with Op'DDD was began. Evaluation and follow-up were performed during hospitalizations and mainly through the measurements of salivary cortisol in more than 100 samples sent from North Africa by air mail to our department in Paris. Thus we were able to demonstrate intermittent overproduction of cortisol before any treatment, with periods of normal and even low values, and to follow the efficacy of therapy and to detect the relapses. We conclude that measurement of salivary cortisol is a valuable tool in difficult clinical situations such as intermittent hypercortisolism and remoteness between the patient and hospital.

Africa, Northern↗
PubMed1992

[Bilateral adrenal tumoral formation. Regressive spontaneous evolution].

A case of bilateral adrenal tumoral formation associated with Addison's disease is reported, and the possible cause of this association is discussed. The short-term deleterious course of metastatic malignancies, hemopathies or severe infections when left without specific treatment, and the long-term course of our patient's tumoral pathology excluded these diagnoses. The spontaneous regression of a bilateral pseudotumoral mass was suggestive of 2 causes: haematoma or tuberculosis. Haematoma was unlikely in the absence of causal factors, and this, combined with the slow regression of the adrenals, made tuberculosis the most probable diagnosis. The few similar cases found in the literature are reviewed.

Addison Disease↗
PubMed1991

[Effects of deprivation and replacement by percutaneous 17 beta estradiol and oral progesterone on blood pressure and metabolic parameters in menopause patients with non-insulin-dependent diabetes].

The main purpose of this randomized controlled study was to assess the effects of postmenopausal estrogen replacement therapy on blood pressure (BP) and plasma renin substrate (PRS) in non insulin-dependent diabetic patients (DNID). We randomized 32 postmenopausal DNID (mean age: 55.3 +/- 4.2 years) into two groups: 16 women were untreated, and 16 received percutaneous estradiol (E2) 17 beta and natural progesterone for 6 months. Systolic (SBP) and diastolic (DBP) blood pressure were monitored by an automatic device at inclusion and on the 1st, 3rd and 6th months of therapy. Treatment efficacy was proven by significant E2 plasma increase to 92.2 +/- 13.4 pg/ml in the treated group, which is a sufficient level for preventing postmenopausal osteoporosis. No significant inter or or intra-individual variation in SBP or DBP was observed in either group. The same stability was noted for plasma renin substrate. No significant difference was noted between the two groups in terms of body weight, fructosamine and glycosylated hemoglobin A1c after 1, 3 and 6 months. There was also no change in plasma levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins A1 and B. All the patients who received replacement therapy wished to continue treatment. We conclude that the association of percutaneous E2 17 beta and natural progesterone had no deleterious effects, in diabetic patients, on BP, carbohydrate and lipoprotein metabolism. Thus this postmenopausal replacement therapy appears preferable in this vascular high risk population, particularly since estrogens via the parenteral route may have an antiatherogenic effect by direct action on the vessel walls.

Administration, Cutaneous↗
PubMedDate not supplied

[Riedel's thyroiditis and lymphoma. Diagnostic difficulties].

Two cases of Riedel's thyroiditis demonstrated the difficulties encountered in diagnosis. In the first case, subtotal thyroidectomy was performed due to compressive goiter. The intraoperative macroscopic aspect suggested Riedel's thyroiditis. The pathology report also discussed the diagnosis, despite a major lymphoid component, as dense fibrosis had multilated the thyroid parenchyma. Subsequent clinical course led to the diagnosis of lymphoma. The clinical presentation in the second case was classical with rapid increase in size of a hard thyroid gland. Histology was however atypical showing calcifications and liquid cysts within the fibrous thyroid tissue. The initial signs of Riedel's thyroiditis, a very rare disease, usually suggest neoplasia: ligneous compressive goiter with deep adherences. Histologically, there is invasive fibrous thyroiditis with highly suggestive occlusive phlebitis in certain cases. The origin of the disease remains obscure. The differential diagnosis between a sclerosing form and lymphoma is particularly important for therapeutic management.

Aged↗