Biomedical subjects
Jean-Louis Schlienger
Publications and source records attributed to Jean-Louis Schlienger.
[Homocysteine and alcohol consumption. An ambiguous relationship and a new paradox].
HOMOCYSTEINEMIA AND ITS VARIATIONS: The increase in plasma concentrations of homocysteine (Hcy) is a factor of cardiovascular risk. Its determinants are multifactorial, genetic and environmental. Out of the ingestion of dietary supplements containing vitamin B6, folates and B12, other substances such as coffee or alcohol contribute in the increase in Hcy. THE EFFECTS OF ALCOHOL: The alcohol-Hcy interaction is complex and ambiguous. Although chronic alcoholism clearly increases Hcy concentration, the effects of moderate and regular consumption of alcohol are debated in epidemiological studies. Following adjustment of various parameters, it is now admitted that alcohol moderately increases Hcy levels. This is paradoxical since the coronary protective effects of alcoholic beverages has been well established. THE PARTICULAR CASE OF BEER: However, a negative correlation between Hcy and alcoholic beverages has been described in some studies, more especially in beer-drinkers. The hypothesis of a reduction in Hcy induced by the beer contents has been described in an interventional study. The vitamins contained in beer, particularly B6, may well be at the origin of this beneficial effect.
Actigraphic assessment of the circadian rest-activity rhythm in elderly patients hospitalized in an acute care unit.
Hospitalization for acute illness is a major risk factor of rest-activity rhythm disturbance among elderly subjects. The rest-activity rhythm is disturbed by the acute illness, aging and hospital environment. The purpose of this study is to assess the rest-activity rhythm and light exposure (using a wrist worn actigraph) of 10 patients (mean age 81 years, seven females) admitted on an acute care unit, suffering from cardiac, respiratory or renal acute disease. A non-parametric method was used to analyze activity data. With an improvement of the underlying diseases, the mean relative amplitude of rhythm increased from 0.31 +/- 0.19 for the first 5-day period after admission to 0.54 +/- 0.21 for the second period before discharge (P < 0.05). The amount of time at night spent above a lighting threshold of 50 lux decreased from 31.4 to 12.3 min between the two periods. The rhythm of elderly subjects hospitalized in the acute care unit is severely altered during the initial period and is progressively resynchronized following clinical improvement. Under the acute underlying disease and/or aging, environmental conditions (light, noise) should be considered to maintain regular rest-activity rhythm.
[Should precocious hyperthyroidism be treated early?].
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Food-cobalamin malabsorption in the elderly.
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Effects of thyroid-stimulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular nonpalpable changes: a randomized, double-blind, placebo-controlled trial by the French Thyroid Research Group.
The efficacy of suppressing TSH secretion with levothyroxine (L-T(4)) in reducing solitary thyroid nodule growth is still controversial. In this prospective multicenter, randomized, double-blind, placebo-controlled trial, 123 patients with a single palpable benign nodule were included and randomly allocated to an 18-month treatment with L-T(4) or placebo. Individual dose was adjusted to allow a serum TSH level below 0.3 mIU/liter. Clinical and ultrasonographic nodule characteristics were assessed before treatment and 3, 6, 12, and 18 months thereafter. The largest mean nodule size assessed on palpation and largest volume, assessed by ultrasonography, decreased in the L-T(4) group and increased slightly in the placebo group [size, -3.5 +/- 7 mm vs. +0.5 +/- 6 mm (P = 0.006); volume, -0.36 +/- 1.71 ml vs. +0.62 +/- 3.67 ml (P = 0.01), respectively]. The proportion of clinically relevant volume reduction (> or =50%) rose significantly in the L-T(4) group [26.6% vs. 16.9% (P = 0.04)]. The proportion of patients with a reduced number of infraclinical additional nodules was significantly higher in the L-T(4) group [9.4% vs. 0 (P = 0.04)]. It is concluded from this study that suppressive L-T(4) therapy is effective in reducing solitary thyroid nodule volume and improving infraclinical extranodular changes.
[Vitamin B12 deficiency-induced moderate hyperhomocysteinemia and venous thromboembolism].
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[Biermer's anemia corrected by oral vitamin B12].
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Retrospective monocentric study of 17 patients with adult Still's disease, with special focus on liver abnormalities.
BACKGROUND/AIMS: Adult Still's disease is one of the febrile disorders of unknown etiology, characterized by high fever, transient cutaneous rash and leukocytosis. Liver dysfunction in adult Still's disease has been described in some case reports. The objective of this study was to analyze the pattern and the frequency of liver abnormalities in a monocenter series of adult Still's disease patients. METHODOLOGY: Data of 17 patients with adult Still's disease (fulfilling Yamaguchi's diagnostic criteria) were retrospectively reviewed. These patients were followed in an Internal Medicine Department over a period of 7 years. RESULTS: The median age was 27 years with a sex ratio M/F of 1.4. Fever was present in 100% of the cases and hepatomegaly occurred in 47% of the cases. Abnormalities in liver biochemistry, apparent in 76% of the subjects were characterized from moderate (elevation of transaminases between 2 and 5 N) (65%) to severe cytolysis (level of transaminases > 5 N) (12%), cholestasis (elevation of gamma GT and/or PAL) (65%), and increase in the level of LDH (35%). All of these symptoms disappeared either spontaneously or under treatment (83%), within a median period of 18 days. CONCLUSIONS: This study confirms the high frequency of liver dysfunction in adult Still's disease patients. Although it is moderate and asymptomatic in most cases, severe cytolytic hepatitis has been described. This study especially puts forward the need for exploring the possibility of adult Still's disease in the presence of a fever and hepatic cytolysis.