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P de Faucal

Publications and source records attributed to P de Faucal.

18 recordsLinked to original sources
PubMed2006

[Empirical treatment of granulomatous hepatitis of unknown origin: practice investigation in the French National Society of Internal Medicine].

PURPOSES: Ten to fifteen percent of granulomatous hepatitis are idiopathic. If symptoms like prolonged fever are present, empirical treatment is discussed. The goal of this study is to describe the empirical treatment proposed in this situation by French specialists of internal medicine. METHODS: We conducted a practice investigation among the French national society of internal medicine (SNFMI), using an anonymous questionnaire that related a case of idiopathic granulomatous hepatitis. This questionnaire was proposed to all French internists present at the SNFMI congress in June and December 2004. French specialists of internal medicine had to answer if they would prescribe an empirical treatment and if so, to specify this treatment. RESULTS: Thirty-six French specialists of internal medicine answered to the questionnaire. In the proposed situation, 89% of them initiate an empirical treatment. In 18/36 cases (50%), a first-line anti-tuberculosis empirical treatment is proposed (quadritherapy in 11 cases). In 7 cases (19%), an empirical treatment with prednisone, 0.4 mg/kg/d (N=1) and 1 mg/kg/d (N=6), would be prescribed. Seven internists (19%) would prescribe an empirical treatment with cyclins at the dose of 100 to 400 mg/d. Median duration of the empirical treatment would be 28 days (range: 8-252d). The evaluation parameters mentionned are: fever (69%), weight (59%), seric level of C-reactive protein (59%), and liver biology (53%). In case of failure of first-line empirical treatments, 69% of all questionned internists prescribe a second-line treatments: prednisone at the dose of 0.4 to 2 mg/kg/d (72%), anti-tuberculosis treatments (16%), cyclins 200 mg/d (12%), with a median duration of 28 days. Seven internists (19%) propose to combine two empirical treatments. DISCUSSION: Faced with a problem of idiopathic granulomatous hepatitis, French internists questionned propose four therapeutics options: no treatment, anti-tuberculosis treatment, cyclins or steroids treatment. First-line anti-tuberculosis treatment is a coherent proposition regarding to the high prevalence of tuberculosis. There are only few data available concerning empirical treatment with steroids or cyclins. Specific proposition of such empirical treatments should be defined. CONCLUSIONS: The management of idiopathic granulomatous hepatitis is difficult. Our study shows that therapeutics practices of French internists are heterogenous. The main proposition consists in a first-line anti-tuberculosis empirical treatment, that has to be evaluated after four weeks, and switched with steroids (prednisone, 1 mg/Kg/d) in case of failure. This study is not an expert proposition but contributes to suggest clinical practice guidelines for a rare, complex, heterogenous, and typically internist situation.

Adrenal Cortex Hormones↗
PubMed1995

Angiomagnetic resonance imaging of iliofemorocaval venous thrombosis.

Although magnetic resonance imaging has been proposed for the diagnosis of deep venous thrombosis (DVT), its role in diagnostic strategy remains to be defined. We compared prospectively magnetic resonance angiography (MRA) with two-dimensional time-of-flight with contrast venography (CV) and colour duplex sonography (CDS) in 25 patients with DVT of the pelvis confirmed by CV. All patients were examined by CV (gold standard) and MRA and 17 by CDS. These studies were compared for DVT diagnosis in the pelvis and inferior vena cava and analysis of thrombotic spread. MRA was positive in 25 patients whose DVT was diagnosed by CV (100% sensitivity). MRA sensitivity and negative predictive value were 100%, specificity 98.5% and positive predictive value 97.5% for the diagnosis of thrombosis at each anatomic level. There were discrepancies between MRA and CV (2 false-positive results for 2 venous segments) and between CDS and CV (2 false-positive and 3 false-negative results). CV was uninterpretable for 8.8% of segments and CDS was often technically limited to the pelvic level, whereas all venous segments explored were analysable in MRA. MRA gave excellent results for positive diagnosis and DVT spread. MRA is a potentially valuable technique for assessing iliofemorocaval venous thrombosis.

Adult↗
PubMed1994

[Importance of the Allen test in the diagnosis of distal arteriopathy in Raynaud's phenomenon. Prospective study on a continuous series of 576 patients].

From a prospective study concerning 576 patients with Raynaud's phenomenon, the authors studied the results of Allen's clinical test and their etiologic significance. These results were compared to those obtained by the instrumental technique using the Doppler probe to locate and compress radial and ulnar arteries and digital plethysmography to measure the effects of this compression. This instrumental technique makes it possible to investigate hand vascularization when Allen's clinical test is non interpretable or impossible which corresponds to 30% patients. A pathological Allen's test, whether it be clinical or instrumental, rather favors a Raynaud's syndrome (p < 10(-4)). The absence of ulnar vascularization was the abnormality most often noted and was rather found in severe Raynaud's phenomena, the sclerodermatous particularly (p < 10(-4)).

Adult↗
PubMed1994

Plethysmographic cold test for diagnosis and evaluation of the severity of Raynaud's phenomenon. Validation of the method by factorial analysis of correspondences in 541 patients.

The purpose of this study was to analyze the reactivity to cold in a series of 541 patients with Raynaud's phenomenon and to search for possible correlations with the functional severity and the etiologic diagnosis of the acrosyndrome. Digital reactivity to cold was quantified by a plethysmographic cold test performed under standardized conditions, using mercury-strain-gauge plethysmography. The functional severity of Raynaud's phenomenon was assessed by the weekly frequency of attacks during winter. Topographic evaluation of the acrosyndrome sought to determine the possible extension of attacks to the thumb. Factorial Analysis of Correspondences indicated a high correlation between the intensity of reactivity to cold and the frequency of thumb involvement (p = 0.0001) or the weekly frequency of attacks during winter (p < 10(-4)). There was also a close dependence between reactivity to cold and the etiologic diagnosis of the acrosyndrome (p < 10(-4)). Significant correspondences were found between mild or major types of reactivity and primary Raynaud's disease, between very severe reactivity to cold and scleroderma. This study contributes to a clinical validation of the plethysmographic cold test. During Raynaud's phenomenon, it is indicative of clinical severity and can in a certain way guide the etiologic diagnosis, particularly concerning the risk of scleroderma.

Adolescent↗
PubMed1994

[Pelvic phlebitis presenting as paradoxical arterial embolism].

The authors report the case of a 24-year-old woman with paradoxical embolism of the right arm subsequent to childbirth. Patent foramen ovale was diagnosed by right cardiac catheterization and contrast echocardiography. On the basis of clinical, immunoscintigraphic and radiologic data, the pelvic region was the only possible origin of the embolic process. The main interest of this case is that arterial ischemic signs were indicative of an embolic process of pelvic origin diagnosed by scintigraphy using radiolabeled antifibrin antibody.

Adult↗
PubMed1993

[Aortic thrombosis during acute endocarditis caused by Staphylococcus aureus].

The authors report a case of acute bacterial (Staphylococcus aureus) endocarditis in a 70-year-old woman, revealed by a febrile cerebral ischemic accident. Ultrasonography confirmed the presence of a large posterior mitral valve vegetation interfering with left ventricular filling. The sudden onset of complete paraplegia and acute ischemia of the lower limbs suggested thrombosis of the abdominal aorta, which was confirmed by aortography. These features indicated that a vegetation fragment had migrated, obstructing the aortic bifurcation and causing secondary thrombosis. This led in turn to involvement of the medullary arteries and the onset of paraplegia. Unfortunately, acute renal insufficiency and major left heart failure rapidly developed, and the patient died. Autopsy confirmed the diagnosis of aortic thrombosis with involvement of the renal arteries. Multiple visceral infarcts were noted as well as the large mitral vegetation. This case illustrates the potential severity of systemic embolism complicating endocarditis due to Staphylococcus aureus. The accident was remarkable because of the aortic acute occlusion and the association with paraplegia, an unusual neurologic complication.

Acute Disease↗
PubMed1991

[Vascular manifestation of thoracic outlet syndrome. Prospective study of 104 patients].

On the basis of a prospective study of 104 patients, the authors discuss the diagnostic value of the clinical symptoms revealing the thoracic outlet syndrome (TOS), as well as the specificity of the vascular functional exploration carried out to establish the diagnosis. Non-systematized pain and dysesthesia in the upper limb, with a postural or nocturnal onset, and Raynaud's sign are the most frequently observed signs. The "candlestick" maneuver still is the most reliable clinical triggering maneuver. The clinical features and the vascular functional explorations (capillaroscopy and digital plethysmography) allow demonstrating the existence of a true Raynaud's syndrome secondary to the TOS. The results of the arterial Doppler study distinguish the symptomatic and asymptomatic sides in the same patient, though without any correlation with the symptoms observed. The Doppler examination therefore seems to be reliable to demonstrate an anatomical duct, but remains insufficient to establish a causal relationship with the signal symptoms in most cases.

Adolescent↗
PubMed1990

[Methods for studying vasodilator agents in Raynaud's phenomenon].

Raynaud's phenomenon is usually a benign acrosyndrome which few of the currently available therapies improve significantly. This makes the evaluation of the efficacy of vasodilators very difficult, especially as there are no standardised complementary investigations to quantify their effects. Assessment is based essentially on careful interrogation and the use of an analogical scale remains the method of reference. The multiplicity of factors inducing the acrosyndrome necessitates cross-over trials versus placebo over sufficiently long periods of observation (if possible, one month). As regards follow-up and objective evaluation, reactivity to cold is a promising method providing the tests can be standardised with respect to methodology and expression of results.

Drug Evaluation↗
PubMed1990

[Non-invasive diagnosis of phlebothrombosis of the limbs. Prospective evaluation of mercury gauge plethysmography associated with ultrasonic Doppler].

Associated ultrasonic Doppler study (D) and plethysmography (P) were evaluated as compared to phlebography in diagnosis of venous thrombosis of the lower limbs (TVP). Probes (5 and 7.5 MHz respectively) were used in D for examination of proximal and calf veins. Plethysmography using a mercury ring gauge (Perivein, ETNA) was considered pathologic if filling volume was less than 1.5 vol% and/or emptying volume less than 40 ml/min/100 ml. One hundred and four patients hospitalized in an internal medicine department for suspected deep venous thrombosis were studied, including 97 for whom phlebography interpretation was unmistakable: 11 calf vein, 28 collector trunk and 42 total limb involvement TVP. In these localizations, D sensitivity was respectively 55, 72 and 100% (mean 85.5%) and that of P 63.5, 68 and 88% (mean 77.7%); association of D or P improved sensitivity: 82, 82 and 100% (mean 91.5%). Specificity was 86.6% for D, a poor 62.5% for P and 93.5% for associated D and P. The results are comparable to those in the literature but disappointing for diagnosis of isolated calf vein TVP. False-negatives in both D and P were due to strong collateral circulation or limited thrombus extension.

Adolescent↗
PubMed1990

[Clinical hemorheologic study of 65 inflammatory syndromes explored using standard biologic examination and total blood filtration test].

The hemorrheologic impact of an inflammatory syndrome was investigated in a prospective biological study of 65 patients by using an erythrocyte filtration test on total blood. Impact was assessed by a statistical study of correlations between relative filtration time (RFT), inflammation-reactive proteins (IRP) and the different parameters of the hemogram. A stepwise multiple regression test (SMRT) indicated the dominant role of fibrinogen in determining acceleration of the sedimentation rate (p less than 10(-3) and lengthening of RFT (p less than 10(-3). Moreover, RFT appeared to be very significantly correlated with polymorphonuclears (R = 0.55; p less than 10(-3] hematocrit as measured by the centrifugation technique (R = 0.34; p = 0.005) and corpuscular concentration in hemoglobin (CCHM) (R = 0.30; p = 0.01). A chart predictive of microcirculatory risk was deduced from the study based on fibrinogen values and hematocrit. However, the relatively low rate of reduction in the total variance observed during SMRT suggests the quite relative role of the studied parameters in erythrocyte filtration disturbances during an inflammatory syndrome.

Blood Sedimentation↗
PubMed1986

A quantitative test for measuring reactivity to cold by the digital plethysmograph technique: application to 66 control subjects and 65 patients with Raynaud's phenomenon.

The authors have developed a vascular reactivity test to cold using the digital plethysmograph technique with a mercury strain gauge. Three types of arterial reactivity were determined: local reactivity after immersion of the hand in 11 degrees C water, general reactivity after thorax ventilation, and cumulative reactivity associating both of these cooling modes. The method is based on measurement of the digital plethysmographic signal expressed as a ratio of a reference warm amplitude obtained after immersion of the hand in 45 degrees C water for 3 min. The method was tested and perfected in 66 control subjects before being applied to 65 patients with Raynaud's disease. Significant differences were noted between these 2 groups, especially in cumulative reactivity (p less than 10(-9)), which led to numerical expression of results in 5 types of increasingly important reactivity. It would appear that the test has diagnostic and prognostic value in the exploration of vascular acrosyndromes and their therapeutic follow-up.

Adult↗
PubMed1986

[Finger plethysmography for studying the blood rheological and hemodynamic components of an acrosyndrome].

Digital plethysmography allows investigation of maximum digital pulse (M.D.P.) after immersion of hands at 45 degrees C over three minutes. It is correlated with digital arterial blood flow. Reactivity to cold is determined from the ratio M.D.P./digital pulse after local and body cooling over 3 minutes. Tests were performed on 65 controls, 69 patients with idiopathic Raynaud's syndrome, 12 with scleroderma, 10 with digital arteritis and 15 with Raynaud's phenomenon secondary to hemorheologic affections. Maximum digital pulse was significantly decreased in patients with digital arteritis and scleroderma. The M.D.P. was normal in controls and patients with idiopathic Raynaud's syndrome, and was significantly increased in patients with a rheologic Raynaud's phenomenon. Digital artery reactivity differentiates the populations studied: it was maximum in patients with scleroderma, moderate in controls and patients with isolated digital arteritis and marked in patients with idiopathic Raynaud's disease and those with rheologic Raynaud's phenomena.

Adult↗
PubMed1986

[Evaluation of digital venous reactivity to cold by plethysmographic measurement of compliance to cold and hot. Application of the method to 80 patients with Raynaud's phenomena and 36 controls].

A method is described for measuring digital venous compliance to cold by venous occlusion plethysmography (Perivein-Janssen apparatus). Determinations are made firstly to heat during immersion of the hand at 45 degrees C and then to cold during its immersion at 11 degrees C. In each case compliance is measured directly from a curve derived from successive venous occlusions of 1 mm Hg up to 120 mm Hg and by a standardized rate of recording. For pressures between 30 and 80 mm Hg a tracing is obtained that is assimilable to a linear slope from which compliance is calculated from the ratio delta P/delta V expressed as percentage variation of volume per cm Hg. The method was applied to 36 control subjects (19 men and 17 women) and 80 cases of Raynaud's phenomenon. Comparison of findings showed a significantly more marked fall in compliance to cold between: the female and male control subjects (p less than 10(-2)) the group of men with Raynaud's syndrome and male control subjects (p less than 10(-3)), the group with Raynaud's syndrome and Raynaud's disease (p less than 0.05). The findings suggest a possible pathogenic role of venospasm from cold in the determination of the syncopal phase of Raynaud's phenomenon and with respect to its predominance in members of the female sex.

Adult↗
PubMedDate not supplied

Impaired IL2 production by lymphocytes of patients with systemic lupus erythematosus.

The aim of this study was to define as possible abnormality of interleukin 2 (IL2) production by PHA-stimulated peripheral blood lymphocytes (PBL) in systemic lupus erythematosus (SLE). Thirty-four SLE PBL samples were stimulated to produce IL2 and compared with PBL from healthy (age- and sex-matched) controls. A significant defect in IL2 production was observed in SLE patients. This defect was not restricted to corticosteroid-treated patients and was not correlated with the presence of lymphotoxic antibodies or with clinical disease activity. Although 5-day responsiveness to phytohaemagglutinin (PHA) decreased in SLE, the SLE PHA-blasts responded as well as control blasts to semipurified IL2, suggesting that the receptor for IL2 was normally expressed on SLE blasts. In 9 cases, the effect of addition of indomethacin (2 micrograms/ml) or of an optimal amount of IL1 on PHA-induced IL2 production was studied. Indomethacin increased (22%) the IL2 yield of healthy individual PBL. In SLE, indomethacin (but not IL1) was able to completely restore (41% increase) the IL2 production of lectin-stimulated PBL (P less than 0.01). These data suggest that, in SLE, the inhibition of IL2 production is mediated by prostaglandin, possibly produced by monocytes.

Adolescent↗
PubMedDate not supplied

Experimental venous thrombosis: what animal model?

A new experimental venous thrombosis model is described and its role relative to other models is defined. Previous models are not satisfactory for all types of investigation. Opposite, present model based on the three classic thrombogenic factors is suitable for venous scintigraphy and evaluation of different forms of therapy for venous thrombosis of the limbs. So this model permits research on diagnosis and therapy of thromboembolic disease.

Animals↗