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Biomedical subjects

M A Pistorius

Publications and source records attributed to M A Pistorius.

At least 19 recordsLinked to original sources
PubMed2006

[Heredity and genetic aspects of Raynaud's disease].

The pathophysiology of primary Raynaud's phenomenon (Raynaud's disease) remains uncertain but the transmission of this primary microcirculatory dysregulation seems strongly influenced by genetic factors. For a long time, physicians have found that the hereditary factor plays an important role in the genesis of Raynaud's disease. Familial analysis and twin studies have confirmed the role of an hereditary factor. It seems heterogeneous but pedigree analysis indicates the possibility of an autosomal dominant transmission influenced by sex, in some families, allowing an approach called "reverse genetic" based on linkage analysis. Such an approach has focused on few loci but sequencing of candidate genes for genetic mutations remains negative. Given the supposed heterogeneity of the genetic transmission of Raynaud's disease, diversification of strategies in molecular genetics is suitable with reference to techniques applied to multifactorial heredity.

Female↗
PubMed2004

[Drug addiction and cardiovascular pathologies].

Drug addiction which entails cardiovascular risks unknown or misknown to physicians, currently involves an increasing number of miscellaneous drugs, existing in manifold forms. There appears to be no bounds on the way of intake. All territories of the body may be affected with more or less severity. In young people, the cardiac, coronary, cerebral and peripheral vascular systems are generally involved. Two illicit drugs, cannabis and cocaine, showing a permanent increase in misuse, prevail. This drug addiction comes along with intercurrent pathologies which have their own vascular toxicity, especially HIV infection. Moreover, the advent of new illicit substances emphasizes the complexity of the clinical presentations. These complex situations have a real social and medical impact. We are currently in a phase of permanently increasing risk of cardiovascular complications. The pathophysiological mechanisms involved are intertwined and complicated by the frequent association of polytoxicomania or by the effects excipients added to these drugs: direct vascular toxicity, angeitis, arterial and venous thrombosis. Arsenic, a common component of these drugs, is also found in cigarettes; arsenic toxicity mainly affects the lower limbs. Treatment of these complications is non-specific; the ideal solution being weaning which, unfortunately in this peculiar population of patients, may entail serious complications due to the misuse of substitution products.

Cardiovascular Diseases↗
PubMed2002

[Risk factors for venous thromboembolism in hospitalized patients in internal medicine: case-control study of 150 patients].

BACKGROUND: Risk factors for the thrombo-embolic disease are not yet completely validated in medical setting. Indeed, there is a lack of scientific data concerning their prevalence and their thrombogenic weight. METHODS: We carried out a prospective case-control study in an internal medicine unit where general acute pathologies are recruited. We have included two patients without thrombosis for each patient admitted for a thrombo-embolic event. In all patients, at admission, clinical and biological risk factors for thromboembolism were systematically analysed in a physiopathological and chronological way. RESULTS: 450 patients were included during the 27 months period of the study. Among these patients, 150 were hospitalised for a deep venous thrombosis of the leg or/and a pulmonary embolism. Height risk factors have demonstrated their high thrombogenic potential: paralysis of the legs (OR = 13; 95% CI: 1.4 to 5.1), post-thrombotic syndromes (OR = 13; CI: 1.7 to 4.3), extrinsic compressions (OR = 8; CI: 1.3 to 5.4), pregnancy (OR = 6; CI: 1.2 to 6), malignancy occurred one year before (OR = 4; CI: 1.1 to 6.7), personal history of deep vein thrombosis (OR = 3; CI: 1.6 to 4.5), varicosity (OR = 2.5; CI: 1.2 to 6.1) and venous insufficiency (OR = 1.7; CI: 1 to 7.4). Four parameters, generally considered as risk factors, didn't prove here their pathogenic power: the age over 60, obesity (BMI > 27), bedrest and the presence of an on-going malignancy. CONCLUSIONS: Only risk factors with high thrombogenic power (as paralysis or extrinsic compression for example) could be identified by this kind of study performed in polypathological patients. In this particular population, usually recognised risk factors as age, obesity and bedrest are not determinant parameters for the thomboembolic risk evaluation.

Acute Disease↗
PubMed2001

Popliteal artery thrombosis secondary to exostosis of the tibia.

This report describes an exceptional case of popliteal artery thrombosis secondary to exostosis of the superior extremity of the superior tibia in a young adult. Correct diagnosis was made during re-operation for recurrent thrombosis. Surgical treatment consisted of resection of the bony tumor and venous bypass to reestablish arterial continuity. Femoropopliteal vascular complications of exostosis are rare, with most cases involving arterial aneurysms or false aneurysms. Differential diagnosis in our young patient took into account the other causes of popliteal thrombosis: entrapped popliteal artery, adventitious cyst, fibrodysplasia, and juvenile arteriopathy. In patients with major functional disability, operative treatment is recommended to remove the bony abnormality and repair the arterial lesion.

Adolescent↗
PubMed2001

[Risk factors and incidence of venous thromboembolic disease in internal medicine: prospective descriptive study on 947 hospitalized patients].

PURPOSE: The thromboembolic risk is difficult to evaluate in medical inpatients because of the multiplicity of risk factors. The lack of scientific data leads to a certain empiricism in selection of patients who need a preventive treatment. METHODS: All patients hospitalised in an internal medicine department were included during 34 months. The pathogenic mechanism of risk factors (venous stasis or hypercoagulability) was analysed as well as their progress (transient or permanent risk factors) and their pathogenic weight (major risk factor or not). Three levels of embolic risk (high, intermediate, low) were identified. A preventive treatment was initiated only for patients at high or intermediate risk. A clinical screening for thromboembolic events was performed daily. Therefore, we have excluded patients who needed a hypocoagulant treatment. RESULTS: Nine hundred and forty-seven patients were included. Age (over 60) was the most frequent permanent risk factor (70%). Bed rest was the most frequent transient risk factor responsible for venous stasis. Fifty percent of patients had a transient and permanent risk factor and needed a preventive treatment according to our selection criteria. The incidence of thromboembolic events was 0.4% in the high-risk treated group and 0.2% in the low-risk non-treated group. CONCLUSIONS: Venous stasis factors are the more frequent risk factor in internal medicine, perhaps because of the increasing number of geriatric patients. The incidence of thromboembolic disease is low in high-risk inpatients when a preventive treatment is performed.

Aged↗
PubMed2001

[Acrocyanosis: changing concepts and nosological limitations].

Acrocyanosis is undoubtedly the most commonplace acrosyndrome, both in terms of pathogenesis and prognosis. Patients experience functional impairment and an esthetic prejudice that must not be neglected. Adopting the nosological classifications described for Raynaud's syndrome, primary acrocyanosis must be distinguished from exceptional secondary phenomena that have a radically different clinical course. Primary acrocyanosis is generally observed in a young woman who appears thin or has recently lost weight. No paroxysmal episode (syncope, cyanosis, suspicious event involving the fingers) is found. The physical examination is negative and no complementary explorations are needed. Current pathophysiological hypotheses remain insufficient but suggest that vasospasticity rather than hemorheology is involved. The hypothesis that a thermoregulation disorder could be associated with weight loss deserves further study. Symptomatic care relies on dietary and hygiene counseling, emphasizing the importance of warm clothing. The psychological element must also be considered even in the most common forms.

Adult↗
PubMed2000

[Rationalization of risk factors for venous thromboembolism in medical inpatients. A prospective study].

BACKGROUND: In terms of preventive management of venous thromboembolism in medical inpatients, very large differences may be observed. Rationalization of behaviour requires the evaluation of simple and logical parameters, which takes into account both patient safety and economic considerations. AIM: The aim of this study was to evaluate a preventive scheme including the rationalization of the indications and the use of low molecular weight heparin. METHODS EXPERIMENTAL DESIGN: Epidemiologic investigation. SETTING AND PATIENTS: Patients hospitalized in five medical departments in the Hospital Center of Nantes, France. INTERVENTION: The risk of venous thromboembolism was rated as high, intermediate and low. Patients with high or intermediate risk were eligible for prevention therapy (table I). MEASURES: The main criterion was the occurrence during hospital stay of deep or superficial venous thrombosis of the lower limbs, pulmonary embolism, or unexplained sudden death. The screening was based on clinical features double-checked by venous doppler ultrasonography of the lower limbs and/or ventilation-perfusion lung scanning. RESULTS: 24,497 patients were eligible (table II), 15% were considered at risk and treated with Nadroparin, 6% had the same risk profile but were not treated and 14. 7% had low risk and no prevention. No bleeding event was reported. The incidence of venous thromboembolism was 0.75%, 1.7% and 0.14% respectively (p <0.01) (table III). This efficacy does not appear to depend on body weight or the existence of multiple risk factors observed (table IV and V). CONCLUSIONS: This analysis of risk factors separates two populations with rates of incidence dramatically and significantly different. The prevention of venous thromboembolism by fixed dose of low molecular weight heparin remains justified since it reduces the risk of venous thromboembolism by a factor of 2.5.

Adult↗
PubMed1999

[Disclosure of Behcet disease by concomitant dental infection].

BACKGROUND: Behçet's disease can be aggravated by chronic infection. Our case illustrates how the disease can be disclosed during an acute activation of a chronic infectious focus. CASE REPORT: A 40-year-old man had Behçet's syndrome associating fever, bipolar aphtosis, cutaneous pseudo folliculitis, anterior uveitis, and meningitis following an acute episode of a dental infection, with periapical granuloma. Antibiotic therapy was ineffective in calming this first flare-up of Behçet's disease. Corticosteroid and colchicine therapy were effective. DISCUSSION: Clinical and experimental work would implicat buccal streptococcal flora in the pathogenesis of Behçet's disease. Antibiotics offer interesting perspectives but further studies are needed to define their role in the treatment of Behçet's disease.

Adult↗
PubMed1999

[Capillaroscopy and vascular acrosyndromes].

Periungual capillaroscopy is a simple noninvasive exploration contributing to the clinical examination. It is highly contributive to the etiological diagnosis of Raynaud's phenomenon and is the simplest means of detecting scleroderma early. Capillaroscopy has also largely contributed to better understanding of the pathogenesis of vascular disorders encountered in acrosyndromes. Experience has shown however that clinical indications should be more precise and results interpreted with more scientific rigor (J Mal Vasc 1999; 24: 357-362).

Cyanosis↗
PubMed1997

Spontaneous dissection of the celiac artery.

We describe a case of intestinal angina caused by spontaneous dissection of the celiac artery and thrombosis of the superior mesenteric artery. Spontaneous dissection of a visceral artery is an uncommon occurrence that is usually diagnosed after fatal hemorrhage or ischemia. The underlying mechanism is unclear but the frequent association with multiple arterial lesions suggests general arterial disease. In symptomatic forms, surgical reconstruction is mandatory, to treat the lesion and allow definitive histological diagnosis.

Aortic Dissection↗
PubMed1997

[Limitations of the protein profile for diagnostic orientation in initial internal medicine consultation. Prospective study on 76 patients].

Determination of the protein profile of orientation (PPO) is now considered by some authors as a means of improving the diagnosis in internal medicine. The feasibility of systematizing this practice was investigated in 76 outpatients (79 included, three excluded secondarily) seen for pathology of undetermined diagnosis. The 79 patients (mean age: 52 years) underwent the classical biological explorations plus PPO. The physicians were divided into two groups (seniors and assistants). Two complete clinical files were established for each patient, with one difference concerning inflammatory and immunologic data: one file included the minimum number of tests considered necessary by the physician and the other the complete PPO (nine proteins). Each file (with or without PPO) was randomly distributed to one of two physicians in the same group. Each physician filled in a diagnostic evaluation sheet indicating whether there was organic pathology or not, the main diagnosis (inflammatory, neoplastic, infectious or other), the secondary diagnosis and the hypothesis of probability. The relevance of the clinical opinion was analyzed by an internal medicine specialist from outside the department with 40 years of clinical experience. The duration of symptoms before the medical visit was from 3 weeks to 5 years (mean 6 months). A diagnosis of organic pathology was reached for three out of four patients. Sixty-seven patients were seen again after a minimum of 6 months, and nine were lost to follow-up. Diagnostic efficiency was no greater for cases with PPO, which appears to be a biological examination of second intention. We suggest that the term "protein profile of orientation" be replaced by "broad protein profile."

Adult↗
PubMed1997

[Venous thrombosis of the legs and cancer. Evaluation of risk factors of venous thrombosis in the medical environment].

In medical patients, risk factors of leg venous thrombosis are not well evaluated. Cancer is considered as an important one. The aim of this study was to evaluate the role of intrinsic thrombotic risk (tumor hypercoagulable state) and external thrombotic risk (associate factors). We have made a prospective analysis of thrombotic venous risk factors in two medical populations with leg venous thrombosis: patients with cancer and patients without cancer. Risk of thrombosis depends on the thrombogenic importance of the risk factor and its chronicity or not. We assessed cancer and thromboembolic disease at the time of diagnosis and during a median follow up of 125.2 days. We included 31 consecutive cases of cancer (21 men, 10 women, mean age 63.8 years), and 50 consecutive cases of non cancer patients (32 men, 18 women, mean age 65.5 years), these two populations were not different. The classic risk factors of venous thrombosis were not frequent in cancer patient. Analysis of thrombotic risk showed that 61% of cancer patient group had venous thrombosis without classic thrombotic risk, as compared to 32% in non cancer patient group, showing the direct role of cancer in thrombosis (p < 0.01). The cancer was often aggressive and metastatic adenocarcinoma of various origins. The effect of chemotherapy is not clear, only hormonotherapy seemed to be responsible in two cases. Cancer hypercoagulability, defined by clinical characteristics, is a real risk factor of venous thrombosis but of low frequency. Indeed, the incidence of venous thrombosis in oncologic unit is rare (0.4%). Finally, thromboembolic disease in cancer patients is not different than in no cancer patients, Trousseau's syndrome is unfrequent. Prognosis is poor (40% death with 44.5 days of median survival), and antithrombotic therapy complications are frequent (bleeding 16%, oral anticoagulants resistance 20%).

Aged↗
PubMed1995

Incidence of thoracic outlet syndrome on the epidemiology and clinical presentation of apparently primary Raynaud's phenomenon. A prospective study in 570 patients.

In the absence of established criteria enabling a Raynaud's phenomenon to be related to a thoracic outlet syndrome, the authors attempted to assess whether the presence of objective clinical features of thoracic outlet might modify the epidemiology or the clinical presentation of Raynaud's phenomenon (RP). From a population of 570 RP, 263 RP with primary feature were selected according to classical clinical, biological and capillaroscopy criteria. Within this group, apparently primary RP without any objective sign of thoracic outlet were compared with those presenting objective signs of thoracic outlet (ie positive "candlestick manoeuvre", abnormal dynamic Doppler examination). The two groups were compared according to epidemiologic (family history of RP, age of onset, sex), clinical (digital topography of attacks, asymmetry of RP, functional severity, course during summer, circumstances of occurrence) and investigational data (digital plethysmographic cold test). No significant differences were found between apparently primary RP with signs of thoracic outlet and those without signs of thoracic outlet as concerns the parameters usually distinguishing Raynaud's syndrome from Raynaud's disease (family history of vasospasm, sex, asymmetry of RP, thumb involvement, digital vascular reactivity to cold). On the other hand, significant differences are noted for the following parameters: age of onset (p = 0.005), course during summer (p = 0.031), circumstances of occurrence (p = 0.0007), digital topography of attacks (p = 0.004), functional severity (p = 0.044), plethysmographic basal reactivity (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1995

[Diagnostic importance of digital topographic assessment of Raynaud's phenomenon. A prospective study of a population of 522 patients].

From a prospective study of 552 Raynaud's phenomena, the authors have analyzed the relationships between digital topography of the attacks, etiologic diagnosis and type of hand vascularization. Five topographic subsets were differentiated: median (one of the three median fingers), ulnar (the 2 or 3 last fingers), radial (the 2 or 3 first fingers), all fingers excluding thumb, all fingers including thumb. The respective role of radial and ulnar arteries in hand vascularization was assessed by Allen's test. It has been found 33% Raynaud's phenomena with involvement of all fingers excluding thumb, 31% with median topography, 29% with involvement of all fingers including thumb and 7% with ulnar or radial topography. Unilaterally (9% Raynaud's phenomena) preferentially points out a syndrome with neurological origin essentially (ulnar or carpal tunnels and thoracic outlet syndromes). Factorial Analysis of Correspondences has been used to study the topographic repartition of the attacks according to etiology: homogeneous involvement of all fingers including severe involvement of thumb has to evoke the diagnosis of scleroderma, whereas involvement of the median fingers, of all fingers excluding thumb or with a mild involvement of thumb is still consistent with primary Raynaud's disease. Strictly lateral topography (ulnar, radial) suggests the diagnosis of Raynaud's syndrome of neurological cause essentially. It has not been found any correlation between digital topography of Raynaud's phenomenon and type of hand vascularization; this can probably be explained by the clear preponderance of neurological etiologies as compared to vascular ones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Inguinal mastocytosis with histiocytic infiltrate].

INTRODUCTION: The diagnosis of mastocytosis is usually not difficult in cases with typical skin lesions. Intertrigo is exceptional. CASE REPORT: An 83-year-old patient developed inguinal intertrigo bilaterally. The lesions contained maculopapulous elements without Darier's sign. The histology examination revealed a mixed mast cell infiltration predominated by histiocytes. The ultrastructure confirmed the diagnosis of cutaneous mastocytosis. No extension was observed. DISCUSSION: Skin folds are rarely involved in infiltrating diffuse mastocytosis. Two cases have been reported in the literature including one doubtful case. Mastocytosis should thus be included in the possible diagnoses in patients with macupopapulous intertrigo. In addition, the mastocytic and histiocytic polymorphism observed here is rare.

Aged↗
PubMed1994

Primary Raynaud's phenomenon. Age of onset and pathogenesis in a prospective study of 424 patients.

Many authors consider that late onset is a suspect criterion for differentiating primary Raynaud's phenomenon (Raynaud's disease, RD) from Raynaud's syndrome (RS). However, many cases of late-onset Raynaud's phenomenon in patients over forty years of age remain without etiologic diagnosis and therefore deserve the designation "late-onset RD." One hundred and ninety-four patients with RD (143 women, 51 men) were selected among 424 patients with Raynaud's phenomenon, according to Allen and Brown's criteria with negative serologic investigations and normal capillaroscopy. The purpose of the study was to consider the possible discriminant value of age of onset in distinguishing between RD and RS. The following epidemiologic features were studied: age of onset, sex, family history of Raynaud's phenomenon and migraine, and smoking and working habits. Microcirculation was assessed by capillaroscopy and strain-gauge plethysmography. Maximal digital flow at 45 degrees C and reactivity to cold were determined for each patient. Results were related to age of onset. The existence of true cases of late-onset RD in patients over forty years of age was confirmed (prevalence 27%), showing a correlation with a family history of Raynaud's phenomenon inferior to that found in early-onset cases (p < 0.0001). Microcirculation studies generally indicated a strong correlation between reactivity to cold, familial RD, and early onset, whereas no correlation was found with migraine or smoking. Nor was there any clinical or plethysmographic evidence for arteritis as a possible pathogenetic factor in late-onset RD. These results indicate that late-onset RD is a valid designation and that its pathogenesis seems less dependent on genetic sensitivity to cold than that of early-onset cases. In the absence of underlying arteritis, neurovascular dysfunction or a hemorheologic mechanism may be suggested as plausible causes of late-onset RD.

Adult↗