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S Bonin-Guillaume

Publications and source records attributed to S Bonin-Guillaume.

12 recordsLinked to original sources

[Necrotic myocarditis in acute eosinophilic lymphoblastic leukaemia].

INTRODUCTION: Hypereosinophilia can cause severe cardiac complications. The association between an acute lymphoblastic leukemia and hypereosinophilia was rare. We report a case of a 29-year-old man who presented a heart failure secondary to necrotic myocarditis related to an acute eosinophilic lymphoblastic leukaemia. EXEGESIS: The patient developed a heart failure and secondary a cardio-embolic stroke, due to a large mobile left ventricle thrombosis. His peripheral blood showed a total white count of 28,500 leucocytes/mm3 with 18,800 eosinophils/mm3. The myelogram cytology showed precursor B-cell acute lymphoblastic leukaemia with hypereosinophilia. CONCLUSION: The possibility of the rapid emergence of cardiac lesions in hypereosinophilic syndromes warrants very close physician vigilance. An Echocardiography and MRI performed at the early stage and in the follow-up allow to detect and to manage these cardiac disorders.

Acute Disease↗

[Is pure red cell aplasia a new extra digestive manifestation of celiac disease?].

INTRODUCTION: Celiac disease is an autoimmune enteropathy that appears on a predisposed genetic background. Its clinical presentation has been extended those last years by varied extradigestive manifestations. EXEGESIS: This is a case report of a twenty-year-old woman who presented simultaneously a celiac disease and pure red cell aplasia. The IgA and IgG antigliadin antibodies as well as antinuclear, anti-DNA, anti-SSA and anti-SSB antibodies were detected, without any clinical symptom supporting the diagnosis of systemic lupus erythematosus or Sjögren syndrome. Thoracic CT-scan reveals a thymus enlargement and biopsy concludes to thymus hyperplasia at histological examination. Pure red cell aplasia regressed after gluten-free diet, corticoid therapy and thymectomy. CONCLUSION: This observation, added to the three others paediatric cases previously published in the literature concern an uncommon association between pure red cell aplasia and celiac disease. However, they are not enough to conclude to a direct link between these two disorders. Pure red cell aplasia could represent un new dysimmune manifestation occurring in celiac disease, but this will need to be confirmed with others cases.

Adrenal Cortex Hormones↗

Insulinemia and leptinemia in geriatric patients: markers of the metabolic syndrome or of undernutrition?

The metabolic syndrome (MS) describes a cluster of metabolic disturbances including type 2 diabetes and/or insulin resistance, hypertension, dyslipidemia and obesity, which predict a high risk of cardiovascular disorders. The associated hyperinsulinemia and hyperleptinemia may contribute to the cardiovascular risk. However, the operational value of the MS in elderly patients is questionable. We therefore investigated the prevalence and significance of the MS in geriatric care. In a survey of 98 consecutive admissions of diabetic patients, <40% had a MS; this is a low value compared to younger diabetic adults, due to a low prevalence of obesity and dyslipidemia. We found a high prevalence of low BMI (<20 kg/m2), hypoalbuminemia and low total cholesterol levels, suggesting that the MS may be modified by undernutrition. The interplay between the MS and undernutrition was further studied in 30 non-diabetic patients. Both leptinemia and insulin resistance indexes (HOMA-IR and QUICKI) were strongly associated with BMI and body fat (measured by Bioelectrical impedance Analysis). BMI, leptinemia and insulin resistance indexes were associated with the Mini Nutritional Assessment (MNA) score. Thus, undernutrition is associated with low leptin and insulin levels and may obscure the association of these parameters with cardiovascular risk. In conclusion, the MS has a low prevalence in our population of elderly diabetic patients, and is of questionable prognostic value. It can be oveshadowed by undernutrition, which is associated with low body weight, leptinemia and insulin resistance indexes. Prevention of undernutrition and/or adjustment to its consequences should receive higher priority in the care of elderly diabetic patients.

Aged↗

[Psychometric evaluation of depression in the elderly subject: which instruments? What are the future perspectives?].

Depression in the elderly is frequent but often unknown (in 30 to 50% of the cases) because of difficulties in detecting or diagnosing it. This is due to the clinical features and prognosis of depression in this kind of population but also to the non-existence of specific diagnostic tests. Most of the authors consider that the most useful diagnostic tests are screening assessments. Some are rating scales that have been validated in general population then secondarily in the elderly: Hamilton Rating Depression Scale (HDRS), Montgomery & Asberg Depression Rating Scale (MADRS), Zung Self Rating Depression Scale (Zung SDS), Beck Depression Inventory (BDI) or Center for Epidemiological Studies Depression Scale (CES-D). They usually involve biases linked to age and more particularly to somatic items; and the educational level required to answer is too high for this population. However, the MADRS is still interesting for measuring change under treatment and the CES-D for detection of depressive elderly. On the other hand, some screening scales are specific of depression in the elderly. The most commonly used is the GDS (Geriatric Depression Scale) with 30 items. Some points have been discussed to increase the achievement of these methods. For example, inventories are better than interviews and should be integrated into semi-standardized interviews which do not last more than 30 minutes. The quotation 'yes' or 'no' is preferable. The instrument have to be short but have to contain specific items for depression in the elderly. Several short forms are already validated or in progress such as GDS with 15 items and, recently, with 4 items, BASDEC, short Zung IDS, BDI with 13 items and DGDS. However, these screening scales loose a part of their validity in the moderate or severe demented elderly. Few instruments can screen depression in a demented population although depression and dementia syndromes are frequently associated. Some of the inventories used are not specific: they evaluate the general psychopathology in the elderly and contains subscales which screen depression or organic brain disease. Thus, GMS-AGECAT Package, CAMDEX, CARPER, BAS are often used by the Anglo-Saxons. At present, only one specific instrument has been validated: the Cornell Scale for Depression in Dementia. Recently, new screening instruments have been put forward: Dementia Mood Assessment Scale and Canberra Interview for the elderly which seem interesting but need further studies.

Aged↗