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J Ducobu

Publications and source records attributed to J Ducobu.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Prevention of cardiovascular diseases and patient compliance: limiting factors and proposals].

Despite epidemiological evidence in favour of cardiovascular prevention, many surveys show that only a minority of patients with coronary heart disease are receiving hypolipidemic therapy. The compliance is the neglected issue in preventive cardiology, for many reasons. The patients are reluctant to change their long lasting nutritional and smoking habits. The physicians are more motivated by acute care and are not trained in preventive medicine. Moreover there is too often a lack of interface between specialists and GP. To improve compliance, it is necessary to give clear instructions and tailored regimens. The treatment must be monitored and the follow up organised. Last but not least, the reimbursement of hypolipidemic drugs should be adapted to Evidence Based Medicine.

Cardiovascular Diseases↗
PubMed2000

[Glitazones (thiazolidinedione)].

Insulin resistance is the major defect in type 2 diabetes. Troglitazone is the first of a new class of drugs, the thiazolidinediones (TZD) with insulin sensitising actions. The TZD activate PPAR gamma (Peroxisome Proliferator Activated Receptor gamma). In clinical trials, the TZD decrease plasma glucose, plasma insulin and Hb A1C. Moreover they are synergistic with the glucose lowering drugs (biguanides and sulfonylureas) and with insulin therapy. The TZD also decrease triglycerides and increase HDL cholesterol, while reducing LDL oxidation. Few side effects have been reported but concerns persist about their safety. Hepatic dysfunction is seen in about 2% of the patients receiving troglitazone, leading sometimes to liver failure. This potentially lethal side effect appears to be less frequent with the second generation TZD, rosiglitazone and pioglitazone. Drug interactions, fluid retention, induction of colon polyps are other potential unwanted effects. This new class of drugs could play an important role in diabetes therapy, if clinical trials prove their long term efficacy and safety.

Animals↗
PubMed1999

[Amiodarone and thyroid disorders--prospective study and review of the literature].

A well-known adverse effect of amiodarone is the induction of thyroid dysfunction. The numerous studies evaluating the incidence of amiodarone-induced thyroid dysfunction have given very dissimilar results, because of the variability in the criteria of hyper- and hypothyroidism, on the one hand, and in the iodine intake of the studied population on the other hand. The aim of our study was to evaluate the incidence of amiodarone-induced thyroid dysfunction. One hundred and twelve patients without prior thyroid dysfunction or anterior treatment with amiodarone were included in the study. Thirty-one patients were later excluded from the analysis because of a follow-up duration of less than four months. So our analysis concerned 81 patients (52 men and 29 women), followed for a mean period of 37.3 months. Amiodarone-Induced Thyrotoxicosis (AITT), diagnosed by the association of a low TSH and a high T4 (free and total T4), occurred in 13 patients (16%). Male sex proved to be a statistically significant risk factor of AITT. The normalization of the thyroid tests was obtained by the withdrawal of amiodarone and, for most of the patients, by the addition of thionamides. Amiodarone-Induced Hypothyroidism (AIHT), diagnosed by the elevation of TSH, occurred in 10 patients (12.3%). Female sex proved to be a statistically significant risk factor of AIHT.

Adult↗
PubMed1999

[Atorvastatin (Lipitor)].

Atorvastatin is a second generation synthetic statin, introduced in Belgium in May 1998. Its mechanism of action is similar to that of the other statins, i.e. the inhibition of HMG Co-A reductase, the key enzyme in cholesterol synthesis, which leads to the increase of LDL receptors. The prolonged half-life (20-30 H) of atorvastatin and its active metabolites, induces a prolonged inhibition of HMG Co-A reductase and a reduction of hepatitic apo B production. The biological efficacy of atorvastatin is high: 41 to 61% lowering of LDL depending of the dose. Atorvastatin is indicated in primary hypercholesterolemia, mixed hyperlipidemia and homozygous familial hypercholesterolemia. If necessary, a resin or even a fibrate may be added. The safety profile is good. The most common adverse effects are gastro-intestinal and transient. Liver tests or muscle enzymes are rarely modified. If clinical proof of reduction of CV morbidity and mortality in primary and secondary prevention is obtained, atorvastatin shall represent a major step forward in the treatment of hypercholesterolemia.

Anticholesteremic Agents↗
PubMed1998

[New developments in the treatment of diabetes and hyperlipidemias].

Diabetes mellitus is a still growing disease. New diagnostic criteria lowered the cut off value to 126 mg/dl, in order to detect more rapidly diabetes and its complications. The treatment of diabetes 2 by the classic oral antidiabetic drugs (sulfamides and biguanides) is completed by intestinal glycosidases inhibitors and thiazolidendiones. These last drugs seem very attractive because they decrease insulin resistance in obese, diabetics. Their hepatic side effects must be however under control. Better knowledge of non lipidic effects of statins on the arterial wall and the discovery of the action of fibrates on PPAR (Peroxisome Proliferator Activated Receptors) improved strongly the therapeutic management of hyperlipidemias. Recent intervention studies have demonstrated the necessity to treat vigorously dysipidemias.

Diabetes Mellitus↗
PubMed1997

[Lipoprotein receptors. Old acquaintances and newcomers].

Lipoprotein receptors are plasma membrane proteins of high affinity which interact with circulating lipoprotein particles. The well characterized LDL receptor continues to be analysed and some new findings on its intracellular mechanisms of action have emerged. New lipoprotein receptors have recently been described: the chylomicron remnant receptor or LDL-related protein (LRP), the lipolysis stimulated receptor (LSR), the very low density lipoprotein receptor (VLDLR), the HDL receptor (HDLR) and the scavenger receptor (SR). The molecular details of the receptors will facilitate the development of new therapeutic means to improve receptor-mediated clearance of lipoproteins.

Chylomicrons↗
PubMed1996

Low response to high-dose intravenous immunoglobulin in the treatment of acquired factor VIII inhibitor.

Prednisone is the classic first-line therapy to suppress an acquired factor VIII inhibitor and may achieve complete remission in about 30% of patients. More recently, promising results have been reported with high-dose intravenous immunoglobulin (IVIg). However, after an extensive review of the literature, we found only three complete remissions (12%) among the 26 assessable patients treated by IVIg. These data are in agreement with the low response to IVIg that we experienced in our series of patients. This study suggests that steroids should still be preferred to IVIg, an expansive therapy, to suppress an acquired factor VIII inhibitor.

Adult↗
PubMed1996

Patient with monoclonal gammopathy, thyrotoxicosis, pretibial myxedema and thyroid-associated ophthalmopathy; demonstration of direct binding of autoantibodies to the thyrotropin receptor.

We describe a patient with monoclonal gammopathy who subsequently developed thyrotoxicosis, pretibial myxedema and thyroid-associated ophthalmopathy. The pathogenesis of thyrotoxicosis in Graves' disease is due to the presence of autoantibodies that mimic the action of thyrotropin (TSH), called thyroid-stimulating antibodies (TS-ab); these antibodies may or may not inhibit the binding of TSH to the receptor (thyroid-binding inhibiting immunoglobulin, TBII). The patient's immunoglobulins were TS-ab positive and TBII negative when measured on CHO cells expressing the human TSH receptor. The pathogenetic link between the thyroid, orbit and skin is yet to be established but several candidate shared antigens have been proposed, including the TSH receptor itself. The monoclonal immunoglobulins were in evidence before the symptoms of pretibial myxedema, thyrotoxicosis and ophthalmopathy. In addition, the patient had no autoantibodies to thyroglobulin or thyroperoxidase, which are classic markers of thyroid autoimmunity. This combination led us to postulate that the monoclonal gammopathy could be the cause of all the observed pathology. One method to test this hypothesis would be to show that the monoclonal immunoglobulin is a TS-ab. Various methods were used to separate the monoclonal from the polyclonal components of the patient's serum. Preparative isoelectric focusing enabled us to obtain fractions containing only the monoclonal (as revealed by polyacrylamide gel electrophoresis), which were devoid of TS-ab activity (measured as cAMP accumulation in CHO cells expressing the human TSH receptor in a hypotonic bioassay). Subsequently, different oligoclonal fractions were shown to have varying degrees of TS-ab activity, with one fraction having faint biological activity and able to recognize a recombinant TSH receptor preparation in a Western blot. In conclusion, the monoclonal antibody does not seem to be responsible for the thyrotoxicosis, pretibial myxedema and ophthalmopathy. We confirm previous data showing that TSH receptor antibodies in patients with Graves' disease are heterogeneous in nature and we present the first demonstration of autoantibodies capable of binding the TSH receptor but devoid of TBII activity.

Adult↗
PubMed1993

[Hyperlipidemia and atherosclerosis: epidemiology, biochemistry and therapy].

Cardiovascular diseases cause 40% of deaths in Belgium. The coronary risk is more important in the Southern than in the Northern part of the country, owing probably to different levels of serum cholesterol due to different fat contents of the diet. The features of lipoprotein metabolism are mainly the permanent transfer of apoproteins and the dynamic exchange of neutral lipids. Atherogenic particles include remnants enriched in cholesterol esters and low density lipoproteins (LDL) after their oxidation. New European guidelines insist more on secondary prevention than on primary prevention.

Arteriosclerosis↗
PubMed1992

Doxycycline and hepatotoxicity.

The hepatotoxicity of tetracyclines is well known. If microvesicular steatosis due to a high dose of tetracycline has virtually disappeared, it can also be observed with other drugs belonging to the tetracycline family. To our knowledge, hepatotoxicity induced by doxycycline has never been reported. In our patient, the abrupt onset of hepatic failure, five days after the start of doxycycline and the rapid normalization after the drug was stopped, leads to suspect a causal relationship between doxycycline and liver insufficiency. We must however be careful before concluding, because our patient received also acetylsalicylic acid and paracetamol, two other potential hepatotoxic drugs.

Adult↗
PubMed1990

[LDL receptors].

The low density lipoprotein receptor removes the cholesterol-carrying lipoproteins from blood. When the activity of LDL receptors is reduced, as a result of genetic or acquired abnormalities, LDL increases in blood, resulting in atherosclerosis. Heterozygote familial hypercholesterolemia (one mutant gene) is characterized by a 50% reduction of LDL receptors leading to twofold increases of LDL. In homozygote familial hypercholesterolemia (two mutant genes), there are no active LDL receptors. So very high cholesterol blood levels are observed and severe atherosclerosis ensues. FH heterozygotes can be treated with drugs that stimulate the cells to produce more LDL receptors. Because these are under negative feed-back regulation by intracellular cholesterol, depletion of intracellular cholesterol in the liver through administration of bile acid-binding resins and cholesterol synthesis inhibitors activates the synthesis of LDL receptors. The ingestion of a die rich in cholesterol and saturated fatty acids reduce the LDL receptors in the liver. This may contribute in part to the widespread occurrence of high cholesterol levels and atherosclerosis in western societies.

Anticholesteremic Agents↗