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Biomedical subjects

J Jouglard

Publications and source records attributed to J Jouglard.

At least 19 recordsLinked to original sources
PubMed1997

[Occlusion of the central retinal vein after vaccination against viral hepatitis B with recombinant vaccines. 4 cases].

OBJECTIVES: Hepatitis B vaccination has been proven to be effective and well-tolerated. Certain neurological, ocular or systemic complications have, however, been reported to be induced by the vaccine. Clinicians should be aware of exceptional ocular complications. CLINICAL REPORT: Four patients under 50 years of age developed occlusion of the central vein of the retina after vaccination with recombinant hepatitis B vaccine. None of the classical causes of occlusion of the central vein of the retina could be evidenced. DISCUSSION: Several pathophysiological hypotheses have been proposed to explain these ocular manifestations after vaccination: role of immunocomplexes, antigenic cross-reactions, role of immediate hypersensitivity, simulation of a pathogenic lymphocyte repertoire. None of these hypotheses is entirely satisfactory. It is important however to emphasize the need for a complete general evaluation, including an ophthalmological examination in the presence of unexplained ocular manifestations following hepatitis B vaccination.

Adult↗
PubMed1997

Central and peripheral neurotoxic effects of chronic methyl bromide intoxication.

OBJECTIVE: To examine all methyl bromide poisonings reported to the Marseille Poison Centre and to describe more precisely the infrequent cases of chronic, nonacute exposure. DESIGN: Retrospective observational cohort. METHOD: Data retrieval from the French Poison Centres National Data Bank (ARIT) which contains all the cases of poisonings collected by the Marseille Poison Centre (Hot Line observations, Toxicovigilance, Toxicological intensive care unit). All methyl bromide poisonings 1973-1994 were examined to evaluate to frequency of the different circumstances. RESULTS: Of the 89 methyl bromide intoxications studied, there were two cases of chronic exposure: two workers presented with neurological signs of cerebello-vestibular and pyramidal deficits, visual troubles and peripheral neuropathy of the lower limbs at the end of a season of exposure during which no acute incident involved. In one patient, the symptoms improved within five months; in the other, paresthesia were still present two years later and were associated with visual after-effects. CONCLUSION: The incidence of chronic methyl bromide intoxication is low. The risk for chronic exposure or persistent toxic effects may be masked by the severity of the acute toxic effects. The development of peripheral neuropathy immediately after the central neurological signs was noted in our two subjects. A dying back axonopathy may explain this unique chronological evolution.

Adult↗
PubMed1997

[Mass ciguatera poisoning after eating barracuda in Mexico: prognostic and therapeutic implications].

Thirty patients were admitted to the Anti-Poison Center of Marseille, France, on the fifth day of ciguatera fish poisoning due to ingestion of the same barracuda in Mexico. The purpose of this prospective study conducted during management of this group was to identify prognostic factors and evaluate the efficacy of treatment using mannitol. Upon admission severity was individually scored based on clinical findings. Twenty-two patients exhibiting the highest severity scores were immediately treated by infusion of 250 ml of 20% mannitol within one hour. These patients presented low plasma cholinesterase levels. Treatment led to transient improvement mainly with regard to cramping and digestive manifestations. All patients who presented high severity scores upon admission reported persistent manifestations lasting between 1 and 7 months. In 6 of these patients symptoms recurred after ingestion of seafood and/or alcohol. The fact that the extent of clinical symptoms in terms of severity and duration was correlated with the amount of fish ingested confirms that ciguatera poisoning is dose-dependent in man. However cholinesterase levels were not correlated with the severity of clinical manifestations.

Adult↗
PubMed1996

[A wine pitcher, cause of lead poisoning].

A 35-year-old male nurse hospitalized for recurrent episodes of intolerable abdominal pain was found to have non-hemolytic anemia and saturnism with blood lead level reaching 500 micrograms/l. Search for the source of the lead led to the discovery of an earthenware jug purchased in a Corsica craftsware shop. This jug had been used to hold the patient's daily consumption of wine (estimated at one-half to three-quarters liters per day) in the refrigerator. On the basis of lead release measurements using the method described in the EEC directive 84/500 (maximum tolerated limit for crockery = 4 mg lead/litter contents), it was found that the jug released 216 mg/l and estimated that the patient had ingested 0.8 to 1 mg of soluble lead daily for the past 8 years. The patient was successfully treated with chelator agents. This case of lead poisoning caused by a single earthenware wine jug confirms the need for rigourous governmental directives to control the production and distribution of varnished earthenware.

Adult↗
PubMed1996

[Value of toxicological research in newborn infants of addicted mothers by the study of several samples (urine, meconium, hair)].

BACKGROUND: Urinary detection of prenatal drug exposure in the neonate may give false-negative results. We report our experience on meconium and hair testing, in addition to urine testing in order to improve diagnosis of fetal drug exposure. POPULATION AND METHODS: Thirty-one infants (aged 1-45 days) whose mothers were confirmed (n = 12) or suspected (n = 19) to be drug-addicted were included in the study. One or more specimens of urine, meconium or hair were collected in the 31 infants, two of the specimens in 17 and three in six. Drugs and their metabolites were detected by immunoenzymologic techniques and positive results were confirmed by gas-exchange chromatography. All the mothers and families were interviewed during admission and the information was compared to those provided by medical and social services; the results of laboratory analysis were not known by the investigators at this time of the study. RESULTS: The maternal drug addiction was confirmed after clinical investigation in 18 cases including the 12 cases detected by prenatal interview (group 1), and recused in 13 other cases (group 2). In group 1, nine infants of 12 had a positive urine test (seven opiate, one cocaine, one cannabis), 11 of 11 a positive meconium test (nine opiate, one cocaine, one cannabis), ten of 19 a positive hair test (eight opiate, one cocaine, one cannabis); all infants in this group had at least one positive result. In group 2, all tests were negative except one urine test positive for opiate after cesarean delivery performed under anesthesia including opiate analgesia. CONCLUSIONS: Urine, meconium and hair testing versus urine testing alone increase the sensitivity of laboratory analysis for detection of prenatal drug exposure.

Cannabis↗
PubMed1996

Research into individual predisposition to develop acute rhabdomyolysis attributed to fenoverine.

A xenobiotic, well tolerated by the majority of treated patients, can cause serious complications in patients with individual susceptibility. Based on the hypothesis that such a phenomenon may occur in rare cases of rhabdomyolysis attributed to fenoverine (DCI), we designed a protocol to look for a genetic predisposition. Six patients were included who had previously had an episode of rhabdomyolysis after taking fenoverine. A seventh patient was added, who had only experienced myalgia without cytolysis. All patients were investigated by the following tests: 31-phosphorus nuclear magnetic resonance spectroscopy, histopathological examination of the muscle, muscle contraction tests and biochemical analysis of the muscle. All patients examined proved to have muscle abnormalities. The pathology found varied greatly from patient to patient: mitochondrial myopathy, lipid storage myopathy, sensitivity to malignant hyperthermia or disorders of oxidative metabolism. The probability of finding by chance such rare muscle disorders associated with the equally rare rhabdomyolysis attributed to fenoverine is practically zero. We conclude that there is a cause and effect link between underlying abnormalities and the muscular cytolysis attributed to fenoverine.

Biopsy↗
PubMed1996

[Envenomation by exotic snakes].

Snake bite envenoming in tropical areas affects an estimated one million people according to the World Health Organization. Two studies showed that annual mortality is between 30,000 and 50,000 people. Clinically cobra and viper envenoming are the most well known but several other snakes cause characteristic manifestations allowing species-specific diagnosis. Immuno-enzymatic tests are a useful diagnostic tool that is currently expanding but remains available only in developing countries because of cost. Treatment consists mainly of serotherapy in the most severe cases. Use of purified products and fragments active specifically on toxins and enzymes is both safer and more effective. Heparinotherapy should be used only when indicated by clinical manifestations and hemostasis testing. Management of envenoming must be organized in function of antivenom availabilities in a given region. Future improvements in immuno-enzymatic tests and antivenoms should allow more successful treatment of severe snake bite envenoming.

Animals↗
PubMed1995

[Bradycardia during treatments of weight loss].

Sinus bradycardia was observed in 10 adolescents participating in a weight loss diet conducted in a health centre. The precise cause was assessed. The subject's age ranged from 10 to 15 years and weight loss ranged from 8 to 24 kg over a period ranging from 8 to 23 weeks. None of the subjects had taken drugs with a bradycardic effect and search for toxic agents in the blood and urine was negative in all cases. Infection was suggested since 8 of the 10 adolescents had a rhinopharyngitis a few weeks before the discovery of bradycardia. This cause was not retained due to the lack of any signs of infection or inflammation and negative virus serology. Nutritional status was therefore retained as the most likely cause in these adolescents who were eating a diet containing < or = 1350 kcal/day. This hypothesis was supported by the results of work reported in 1970 showing arrhythmia in very low calorie diets. The effect is essentially related to the biological value of proteins in the diet, its duration and the initial weight of the subjects. In addition bradycardia is frequently seen in subjects taking hypocaloric diets or with anorexia nervosa and should be considered as an adaptation to hypometabolism rather than a true heart disorder. Thus the biological value of the proteins and the mineral status should be taken into consideration during the course of low calorie diets, even though bradycardia is frequent and does not require a specific treatment. Therefore heart rate and decreasing rate of weight loss should be carefully followed during the course of low calorie diets.

Adolescent↗
PubMed1994

[Latrodectism in southern France. A series of cases from the poisoning center of Marseille].

OBJECTIVES: Black widows, which belong to the genus Latrodectus, are particularly dangerous spiders. The clinical syndrome caused by their bite is known as latrodectism. In Provence and in Corsica, there is a locally-found species, Latrodectus mactans tredecimguttatus called "malmignate". A series of 30 cases were collected by the Marseille Poison centre between 1973 and 1993 inclusive. RESULTS: The cases of poisoning involved patients bitten in the summer, mostly in Corsica (only 5 of the cases were from Provence) in rural areas. The symptoms were generally widespread pain and muscle contractions, sometimes associated with neurosomatic symptoms, such as increased sweating, or alterations in the blood pressure or body temperature. On the other hand, local signs remained benign or were absent, this sometimes causing confusion with the diagnosis: in 5 of the cases were surprisingly severe, the outcome of the poisoning was always favourable, using symptomatic treatment including infusions of calcium salts, which combat the effects of toxins (disturbance of presynaptic ion exchange).

Animals↗
PubMed1994

[Latrodectism in Madagascar].

Data concerning lactrodectism in Madagascar is scarce. Two spider species of the Latrodectus genus are found on the Grand Isle: the black widow Latrodectus mactans mena vody and the brown widow Latrodectus geometricus. From March 1991 through July 1992, 10 cases of envenomation by these spiders were treated in the Intensive Care Unit of Antananarivo Hospital. Symptomatology was remarkable with regard to severity (one fatality due to cardiovascular failure, one gangrene of the foot) as well as clinical manifestations (immediate local pain, kidney dysfunction, arterial hypertension). In two cases, the spider was captured and identified. Both were female brown widows (Latrodectus geometricus), which might explain the differences observed in comparison with the classic features of latrodectism that have been established from American and European black widow bites. Since antivenom was unavailable, only symptomatic treatment was administered, including intravenous calcium that proved effective for pain relief.

Adult↗
PubMed1993

[Iatrogenic axonal neuropathy and erythroderma induced by piroxicam. Manifestations of hypersensitivity?].

A case of peripheral neuropathy following treatment with piroxicam is reported. The patient developed muscle pain and asymmetrical sensory distal neuropathy of the lower limbs a few months after the onset of the treatment. Piroxicam was withdrawn and full recovery was achieved within one year. The simultaneous appearance in the same patient of erythroderma with microvasculitis on nerve and skin biopsies suggests a common type III hypersensitivity mechanism in the pathogenesis of these two side-effects of piroxicam.

Aged↗