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Biomedical subjects

R Bernheim

Publications and source records attributed to R Bernheim.

At least 19 recordsLinked to original sources
PubMed1988

[Idiopathic lung fibrosis].

Idiopathic pulmonary fibrosis (IPF), also called interstitial pneumonia or fibrosing alveolitis, is a progressive interstitial lung disease of unknown origin. Two distinct forms are known which differ in course, morphologic features and cytological findings in bronchoalveolar lavage: a cellular "desquamative interstitial pneumonia" and a hypocellular and more fibrotic "usual interstitial pneumonia". The two types appear to represent different stages of the same disease. The clinical findings in IPF are dyspnoea, unproductive cough, clubbing and rales. Pulmonary function tests reveal restriction, reduced diffusion capacity and hypoxaemia during exercise. Chest X-rays show localized linear or nodular densities usually accentuated at the lung bases; in 10% of patients with IPF, chest radiography is normal. To assess the inflammatory process bronchoalveolar lavage and transbronchial or open lung biopsy have proven necessary. Before beginning treatment the activity of the inflammatory process and degree of lung function impairment should be established. Therapy of IPF is unspecific and its aim is to suppress alveolitis and the fibrotic process. Corticosteroids are the initial therapy. If there is no improvement after two months, immunosuppressive agents are added. Regular clinical and functional follow-up is required. Course and prognosis vary in different forms of IPF. Without treatment, median survival in the cellular form is over 10 years and in the hypocellular form between 3.2 and 5.6 years. Only 12-30% of patients respond to antiinflammatory treatment.

Adrenal Cortex Hormones↗
PubMed1985

[Insulinoma: diagnostic elements. 13 cases].

The mean age of the 13 patients studied (9 women, 7 men) was 50.5 +/- 15.7 years. The disease was discovered on account of malaise (3 cases), behavioural disorders (4 cases), coma (3 cases), syncope (1 case) or right hemiparesis (1 case) or in the course of systematic examination (1 case). Eleven patients consulted for evaluation of hypoglycaemia and 2 for behavioural disorders. The history was characteristic, with malaise, loss of consciousness, severe neurological disorders (seizures, hemiparesis, hemiplegia or coma) and psychiatric disorders. These symptoms typically occurred in the morning before breakfast or between meals in 9 patients, and atypically at any point of time or after meals in 4 patients. Their hypoglycaemic nature was demonstrated by blood glucose determination in 11/13 cases and by response to ingestion of sugar in 12/13 cases. The mean period elapsed between the initial symptoms and the final diagnosis was 20.3 +/- 17.3 months. Inappropriate insulin secretion was elicited a.m. before breakfast, during Conn's diet or fasting test, or by calculating the blood insulin/glucose ratio or Turner's coefficient. Prior to surgery, the insulinoma was located by ultrasonography in 3/8 cases, by computerized tomography in 2/6 cases, by selective arteriography in 6/11 cases, and by phlebography with spleno-portal catheterization and staged sampling for insulin and C-peptide assays in 8/9 cases. Histological examination after surgery (11 cases) or necropsy (1 case) showed an adenoma without evidence of malignancy.

Adenoma, Islet Cell↗
PubMed1985

[Current aspect of Sheehan's syndrome. 20 cases].

The 20 women investigated were 22 to 59 years old (average 35.9 +/- 2.3 years) when the diagnosis of Sheehan's syndrome was confirmed. Fourteen had had previous pregnancies, 6 were primiparas; average parity was 4. The patients were delivered in hospital, in France, in 14 cases, and abroad (Algeria, Portugal) at home in 6 cases. A history of severe haemorrhage during delivery was recorded in all but 2 cases. This was serious enough to warrant hysterectomy in 2 cases. Agalactia and amenorrhea were observed in all but 1 case in the immediate post-partum period. Transient polyuria and polydipsia occurred in 3 patients. In the months following birth, most women lead restricted lives; they were apathetic, asthenic and indifferent. The diagnosis was established under three different circumstances: in the majority (15/20) on clinical grounds, in 3 cases after acute adrenal failure, in 2 cases, fortuitously. Clinical examination showed signs of global anterior hypophyseal insufficiency involving thyroid, adrenal and gonad stimulating hormones in 14 cases; in 6 cases, the pituitary failure was dissociated. Corticotrophin, somatotropin and prolactin deficiencies were observed in all patients; gonadotrophin (17/20) and thyrotrophin (16/20) deficiencies were common. The diagnosis was confirmed less than 1 month (2 cases) to over 12 years (7 cases) after obstetric haemorrhage (average 6.9 +/- 1.9 years). No correlation was observed between the severity of the syndrome and this time interval. The short term outcome was favourable with return of menstruation and even pregnancy in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[Results of surgical treatment of Basedow's disease].

Diffuse hyperthyroidism occurred in 88 patients (82 women and 6 men), aged 14 to 74 years, and was due to Graves disease in 65 cases and heteromultinodular goiter in 23 cases. After medical preparation, the surgical procedure was subtotal thyroidectomy for Graves disease and total unilateral with partial controlateral lobectomy for heteromultinodular goiter. The immediate postoperative course was uneventful except for two transient acute episodes of thyrotoxicosis. One to eight years after surgery, 53 patients are euthyroid, 34 are hypothyroid and one has recurrent hyperthyroidism. A TRH test was done in each of the 53 euthyroid patients. Three kinds of responses were demonstrated: a normal response in 22 cases, evidencing true euthyroidism; an excessive response in 24 cases, reflecting partial compensated hypothyroidism; an insufficient response in 7 cases.

Adolescent↗
PubMed1980

[Value of high dosage propranolol and per-operative hypothermia in thyroidectomy when conventional preparatory treatment is unsuitable (author's transl)].

Five hyperthyroid patients could be prepared for surgery wit propranolol alone in daily doses of 240 to 400 mg. The drug administered for 3 to 5 days before, and 5 to 15 days after the operation. Following premedication with levopromazine, almost total thyroidectomy was performed under neuroleptanalgesia and moderate hypothermia. The immediate results were satisfactory and free from acute thyrotoxic crisis. On follow-up, 2 to 18 months after surgery 4 patients had clinically and biologically normal thyroid function, and one patient showed evidence of hypothyroidism. For the common forms of the disease the authors use the conventional preparatory treatment. However, they favour a short course of propranolol in high doses either when non-thyroid emergency operations require preliminary treatment of the patient's hyperthyroidism, or when the conventional treatment is ineffective or contra-indicated on account of haematological complications.

Adult↗
PubMed1979

[Thyroid nodule secondary to subacute thyroiditis. 8 cases (author's transl)].

This description of 8 cases of thyroid nodules secondary to subacute thyroiditis serves to emphasise the relative prevalence of the circumscribed forms. These nodules, variable in size, firm and painful, developed after a period of cervical discomfort and pain. A contrast between a raised or normal blood hormone level and a very low uptake of I131 was found in five cases. It was all the more valuable when there was no iodine overload. Scintigraphy showed the nodule to be cold in 6 cases, isofixing in one and hot in one case. An essential diagnostic criterion is the rapidly favourable course: 4 nodules disappeared completely, 3 regressed in less than 6 months and one persisted, justifying excision with histopathological examination since localised thyroiditis of this type may be the presenting feature of a carcinoma.

Adult↗
PubMed1978

Thyroid autoantibody levels during lithium therapy.

The study of the levels of thyroid antibodies was conducted in 58 patients treated with lithium and in 40 subjects who received other psychotropic drugs and who were used as controls. The measure of the antithyroglobulin antibodies were made by passive hemagglutination and that of the antimicrosomal antibodies by indirect immunofluorescence. For the whole control group, the research of the antithyroglobulin antibodies was positive in 3 cases, i.e. 7.5%. For the 58 patients treated with lithium, this research was positive in 11 subjects, i.e. 19%: thus, lithium seems to cause immunological reactions in the thyroid. 5 lithium-treated patients developed a goiter. The antibody determination was positive in only 2 subjects and was negative in the others. The measure of antithyroid antibodies before lithium did not enable us to predict the emergence of thyroid complications. On the contrary, subjects treated with lithium presented signficantly high antibody levels without developing clinical thyroid manifestations.

Autoantibodies↗
PubMed1975

[Assay of serum creatine phosphokinase in primary hypothyroidism. Comparison with other thyroid gland function tests in 32 cases. Value of isoenzyme studies].

Serum-creatine phosphokinase levels were measured in 32 cases of primary hypothyroidism in adults and compared with the results of other thyroid function test. C.P.K. elevation appeared to be almost completely uniform (31 out of 32 cases) and marked, reaching six times the normal value. This elevation is more marked in 18 myxoedematous patients than in 14 with those with hypothyroidism of mixed aetiology. Close correlation does not seem to exist between the elevation of C.P.K. and the lowering of serum thyroxine. The elevation of C.P.K. above the upper limits of normal seemed more constant than lengthening of the achilles reflex time, a rise in serum cholesterol, or a rise in other enzymes of muscular origin, such as the glutampopyruvic and glutamo-oxalocetic transaminases, lactodehydrogenase and hydroxybutyric dehydrogenase. In 8 cases of hypothyroidism, the isoenzymic study of serum C.P.K. by electrophoresis on cellulose acetate confirmed that the molecular structure was of the muscle type MM. The advantage of such a study shows that a structure MB found in the case of myocardial infarction in a patient with hypothyroidism deserves to be stressed.

Adolescent↗
PubMed1975

[Comparative action of carbamazepine and clofibrate in diabetes insipidus. Study of 7 cases].

A study was performed on the effects of carbamazepine and of clofibrate in 7 cases of diabetes insipidus of high origin. In 4 cases the action of the two substances used in association was studied. Carbamazepine, in a dose of 0.60 g/day was effective in all cases with negativisation of free water clearance in 5 out of 7. Clofibrate, in a dose of 1.50 g/day was effective in 4 cases out of 7 with negativation of free water clearance in 2. Both medications act by provoking the secretion of anti-diuretic hormone by the hypothalamic/posterior pituitary centres and are thus only active if a minimal secretion of ADH is still possible. There is no apparent potentialisation of the two substances, which both require a minimal possibility of ADH secretion to be active. There is no diminution in the ADH secretor effect, since both products remain active for as long as they are given, making it possible to observe in 3 out of 7 cases spontaneous cure of the diabetes insipidus, allowing suppression of the treatment.

Adolescent↗
PubMed1975

[Disorders of intra-cardiac conduction and hypothyroidism in adults. A systematic study of 42 cases].

The rate of occurrence of disturbances of intracardiac conduction in association with adult hypothyroidism is not well known. On the basis of routine study of the electrocardiograms of 42 non-treated patients, disturbances of conduction were found in almost one third. Left anterior hemiblock (6/42) and first degree atrioventricular block (5/42) are the commonest. Bifascicular involvement is rare. Neither a trifascicular lesion nor complete AV dissociation were seen. There was no evident effect of hormone therapy on conduction disturbances. Their prognosis is good but they should perhaps be taken into consideration when the indications for beta-blockers are weighed.

Adolescent↗