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M Tubery

Publications and source records attributed to M Tubery.

9 recordsLinked to original sources

[Pulmonary embolism in patients using estrogen-progestagen contraceptives].

OBJECTIVES: The risk of thromboembolism in patients taking estrogen-progestagen oral contraceptive drugs has apparently increased since the introduction of third-generation progestagens (desogestrel, gestodene). We examined the clinical features, risk factors and outcome of pulmonary embolism in this context. PATIENTS AND METHODS: We reviewed 11 cases of thromboembolism in patients on oral contraception and hospitalized in emergency situations in 1995 and 1996 for pulmonary embolism in order to determine the gravity of the thromboembolic event, risk factors and type of drug used. RESULTS: Early clinical signs had preceded the onset of embolism by 2 to 164 days. PaO2 was below 70 mmHg in 4 patients. Diagnosis was achieved with pulmonary scintigraphy (11 cases), spiral CT (3 cases) and angiopneumography (2 cases). Duplex Doppler visualized the phlebitis in 7 patients. Given heparin (with fibrinolysis in 3 cases) then anti-vitamin K, and after withdrawal of the oral contraceptive, outcome was favorable in all cases. There were no recurrences. The nature of the oral contraceptive varied. Five patients were taking third-generation progestagens. In two cases, embolism had occurred following a change from a second-generation to a third-generation progestagen. Family history of phlebitis and/or abnormal laboratory findings were observed in 6 patients: resistance to activated protein C (2 patients), protein C deficiency (2 patients), anticardiolipin (2 patients) and low-titre antinuclear antibodies (2 patients). CONCLUSION: Pulmonary embolism in patients on oral contraceptives persists despite changes in the hormone content of the drugs. Diagnosis is often delayed. Family history of thrombosis or biological risk factors are often found.

Adult↗

[Systemic manifestations of primary Gougerot-Sjögren syndrome. Nature and incidence apropos of 34 cases].

OBJECTIVES: Assess the systemic manifestations observed in patients with primary Sjörgen's syndrome and the correlation between clinical findings and paraclinical data. METHODS: This retrospective study included patients who met the preliminary European criteria established in 1993. RESULTS: Among the 34 patients with primary Sjögren's syndrome (32 women, 2 men, mean age 54.9 years), systemic manifestations were observed as the inaugural sign in 25 (73.5%) and 31 cases (91%) during a mean 43-month follow-up. Clinical signs in 23 patients were: neuropsychiatric disorders including depressive syndromes (n = 17) and peripheral neuropathies (n = 13), joint and muscle disorders (n = 16), Raynaud's phenomenon (n = 8), pulmonary disorders (n = 8), digestive disorders (n = 8) including two cases of chronic autoimmune hepatitis, skin disease (n = 7), and renal (n = 3) and thyroid (n = 8) disorders. Antinuclear antibodies were found in 20 cases and anti-SSA antibodies in 5 associated with anti-SSB in 4. Eight patients had hematologic disorders. There was a correlation between the number of systemic signs (at least 2) and positive Rose-Bengal test (p = 0.045). DISCUSSION: Different systemic manifestations were found at percentages comparable with data in the literature except for Raynaud's syndrome which was less frequent and neurological disorders which were more frequent.

Adolescent↗

[Specific respiratory manifestations associated with hemorrhagic rectocolitis. Analysis of a case and review of the literature].

Respiratory impairments occurring as systemic manifestations of ulcerative colitis are often misinterpreted. We report a case of chronic productive bronchitis associated with ulcerative colitis; symptoms appeared after colectomy. Clinical features distinguished it from common chronic bronchitis: it occurred in a woman without respiratory disease or smoking history, a chronic productive cough without bronchiectasis, negative infectious investigations, severe endoscopic and histologic lesions, and above all remarkable steroid efficacy. Systematic research and early treatment of these manifestations avoids aggravating pulmonary disease, especially secondary bronchiectasis. Though less frequent, other respiratory manifestations of ulcerative colitis have been described, such as asphyxiating tracheal stenosis, pneumonia or interstitial pulmonary diseases, pleurisy or pleuro-pericarditis.

Bronchitis↗

[A fleshy bud...].

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Bronchoscopy↗

[Microscopic polyarteritis].

Microscopic polyarteritis is an idiopathic necrotising vascularitis of the small vessels. Manifestations include diffuse alveolar haemorrhage, segmentary necrotising glomerulonephritis, and a cutaneous, articular, neurological or digestive vascularitis. The absence of a histological granulomas and medium calibre vessel involvement distinguishes Wegener's syndrome from polyarteritis nodulosa. The diagnosis is facilitated when anti-neutrophil cytoplasm antibodies are found in the serum. These auto-antibodies are suspected to be the cause based on clinical and experimental data, although this aetiology has not been confirmed. Corticosteroids, immunosuppressors and plasmapheresis can improve the prognosis of this severe and evolving affection which may be fatal.

Adrenal Cortex Hormones↗

[Preventability of adverse effects in a medical emergency service].

The aim of this prospective pharmacovigilance study was to assess the incidence and the preventability of adverse drug reactions (ADRs) leading to hospital admissions. All patients admitted to the Toulouse University Hospital through the medical admission ward during four non-consecutive weeks were included in the study. Characteristics of patients admitted for a suspected ADR (cases) were compared with those admitted for other reasons (controls). All cases were reviewed by both a pharmacologist and an emergency medicine specialist. Among a total of 671 admissions, 44 ADRs were identified. The incidence of hospital admissions for ADRs was 6.1 per 100 admissions [4.4-8.3]. Cases were exposed to a higher number of drugs (3.6 vs. 1.7; p < 0.001). Some classes of drugs were significantly associated with a higher risk of ADRs: antineoplastic, anti-infectious or musculoskeletal drugs. Haematological, metabolic and electrolytic, liver/gastrointestinal or cutaneous disorders were causes of admissions significantly more frequently related to ADRs. Using Imbs's preventability scale, 65 per cent of ADRs were categorized as 'definitely unpreventable', 26 per cent 'potentially preventable' and 9 per cent 'definitely preventable'. These results underline the frequency of ADRs leading to hospitalization, with 35 per cent which are more than likely preventable. Further studies are needed to validate this preventability scale in order to obtain an easier, more reliable and more reproducible tool.

Drug Therapy↗