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Biomedical subjects

J Bastard

Publications and source records attributed to J Bastard.

At least 19 recordsLinked to original sources

Effect of prior exposure to Chlamydia pneumoniae, Helicobacter pylori, or cytomegalovirus on the degree of inflammation and one-year prognosis of patients with unstable angina pectoris or non-Q-wave acute myocardial infarction.

Inflammation and chronic infections may be important features in the pathogenesis of acute coronary syndromes. We describe 6 systemic markers of inflammation in patients with unstable angina or non-Q-wave myocardial infarction and the relations between these markers, seropositivity to chronic infections, and prognosis. C-reactive protein (CRP), serum amyloid A protein (SAA), fibrinogen, interleukin-6 (IL-6), neopterin, procalcitonin, and serum antibody levels to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus were measured on admission and 48 hours later. One-year clinical follow-up was performed. Plasma levels of acute phase reactants were all elevated on admission and increased further at 48 hours: CRP from 10.1 +/- 2.1 mg/L at baseline to 26.6 +/- 5.1 mg/L at 48 hours (p <0.001); SAA from 27.3 +/- 8.5 to 93.1 +/- 23.2 mg/dl (p <0.005); fibrinogen from 3.2 +/- 0.1 to 3.8 +/- 0.1 g/L (p <0.0001); whereas initial high levels of IL-6 tended also to increase from 9.8 +/- 2 to 15.3 +/- 3.1 pg/ml (p = NS). In contrast, neopterin and procalcitonin remained unchanged. We found no association between levels of each inflammatory marker and the serologic status. Furthermore, levels of inflammatory proteins in patients seronegative to all 3 agents were comparable to those of patients seropositive to 2 or 3 infectious agents. The composite end points of death, myocardial infarction, recurrent angina, or revascularization at 1-year follow-up did not differ according to the serologic status. Thus, in patients with acute coronary syndromes, the acute phase proteins increased over the first 2 days of hospitalization. This initial inflammatory reaction as well as the 1-year clinical outcome did not differ according to the initial serologic status of Chlamydia pneumoniae, Helicobacter pylori, or cytomegalovirus.

Acute-Phase Proteins↗

[Management of transient ischemic cerebral attacks (author's transl)].

Practitioners should be familiar with the description of transient ischemic attacks (TIA) as 40% are followed more or less rapidly by a stroke. Analysis of the natural history of TIA shows that patients die twice as often from cardiac manifestations of atheroma than from cerebral lesions. This demonstrates the significance of diagnosis and treatment of risk factors. Patients are at increased risk of stroke during the six to twelve months following TIA. Anticoagulants and inhibitors of platelet aggregation seem to reduce this risk. Carotid surgery is indicated only for localized vascular lesions; in other cases surgery increases morbidity. Doppler examination is the best means of detecting cases which need emergency surgical treatment.

Anticoagulants↗

[Morvan's fibrillary chorea].

Two cases of Morvan's chorea are reported. One of the patients presented the characteristic of having had two attacks, the first after organic mercury preparations, and the second after gold salts for inflammatory rheumatism. The second case had facial fibrillations only, and this was followed by a regressive polyradiculoneuritis one month later. This latter case raises certain diagnostic problems. The existence of a particular type of immuno-allergic tendency could be validly related to a triggering effect of various etiological agents (metals such as mercury or gold salts, or infective agents). The absence of hypotonia, and a regressive course appear to be the characteristics that distinguish fibrillary chorea from the continuous activity syndrome of the muscle fibers described by Isaacs.

Aged↗

[Piribedil, dopaminergic agonist. Prolonged clinical and electrophysiological study in 60 parkinsonian patients (author's transl)].

Sixty cases of Parkinson's disease were treated with piribedil alone (dose : 274 mg/day, duration : 20,4 months). The overall clinical improvement, confirmed by recordings of tremor and EMG, was 34%, tremor being improved of 59%. Before treatment, an intravenous test does of piribedil with recording made it possible to predict the effectiveness of oral treatment. Side-effects (vasomotor, digestive, psychiatric) were moderate. Orthostatic hypotension, dyskinesia and fluctuations were exceptional. The basic indication for piribedil lies in forms of recent onset in which tremor predominates, patients in whom L-dopa is contraindicated and a certain number in whom the latter has failed (tremor, fluctuating action).

Administration, Oral↗

[Polygraphic recording of tremor and of hypertonic phenomena. Application to the action of various drugs].

The recording technique described makes possible the detailed analysis of hypertonia and tremor in Parkinson's disease, as well as the action of different drugs. It may contribute to the understanding of the physiopathological basis of these motor disturbances and the mode of action of anti-parkinsonian drugs. It also represents a reliable method of repeated observation, independent of subjective factors, in the evaluation of the long-term effectiveness of a medication. We were particularly concerned with the evaluation and comparison of the effect of different drugs in the course of a short study, involving the administration of a single dose of the medications used. In this way were studied: Apomorphine, given sub-cutaneously in non-emetic doses, which decreases in a constant and spectacular fashion both tremor and hypertonia ; Piribedil (1-3 mg IV) ; L-Dopa (100 mg IV) ; Ro-080576/007 F in a dose of one capsule containing 200 mg of L-Dopa and 50 mg of L-dopa-decarboxylase inhibitor. The effect of these various medications was invariable greater than that of a placebo and lasted much longer. With these doses, and under the special experimental conditions of this study, Piribedil was better tolerated and in general more active than L-dopa, in particular in relation to tremor. The action observed in the course of this short study prior to treatment might, to a certain extent, make it possible to predict the effect of long-term treatment.

Antiparkinson Agents↗

[Myoclonic encephalopathy due to bismuth following colectomy. Apropos of a case].

Bismuth encephalopathy mainly affects chronic constipation sufferers. The case described, which is practically identical, should be considered (in the absence of constipation) within the context of resection for cancer. The responsibility of bismuth, suggested in five similar cases by Burns and colleagues, is here confirmed by the blood, C.S.F. and urine levels. The mechanism of encephalopathy and the possibility of a failure to eliminate bismuth affecting these levels are discussed.

Behavior↗

[A familial case of thoracic outlet syndrome. Clinical, radiological study with treatment (author's transl)].

The authors report the clinical and radiological study and the treatment of a fifteen members family (the two parents and their thirteen children) affected with a thoracic outlet syndrome secondary to a cervical rib and or an apophysomegaly of the seventh cervical vertebra. On the fifteen people considered, the father being deceased has not been examined but has an evocative clinical history. The mother has a clinical impairment with a late beginning and no radiological sign. Twelve children have clinical and radiological signs, one has radiological without clinical signs. Three children underwent a surgical treatment, the others only medical treatment. There is no satisfactory correlation between the clinical features and electrical investigations (electromyography, nerve conduction studies) and radiological examinations. The semiology is vascular, neurologic or mixt. Roos test seems more reliable than that of Adson, Calb and Roth, and Saunders. Eight grand-children out of fourty have been examined. Five have clinical and radiological signs, three have casual radiological signs. The radiological impairment of this family contrasts with the normal frequency of cervical anomalies in the population which is 0,12 to 1%. The family impairment of the thoracic outlet syndrome is rarely reported.

Adult↗