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Biomedical subjects

Simon Carette

Publications and source records attributed to Simon Carette.

8 recordsLinked to original sources
PubMed2006

Azathioprine induced acute interstitial nephritis as the cause of rapidly progressive renal failure in a patient with Wegener's granulomatosis.

Wegener's granulomatosis (WG) is a primary systemic vasculitis involving predominantly the upper and lower respiratory tracts and the kidneys. Few diseases can cause deterioration of renal function and progression to renal failure as rapidly as WG. We describe a woman with WG who developed rapid progression to renal failure within 10 days of starting azathioprine prescribed as maintenance therapy for vasculitis. Her renal biopsy showed acute tubulointerstitial nephritis and no active glomerulonephritis. This case illustrates the importance of the history and urine sediment in differentiating drug hypersensitivity from rapidly progressive glomerulonephritis in patients with WG.

Acute Disease↗
PubMed2006

Scleroderma: health services utilization from patients' perspective.

OBJECTIVE: To evaluate utilization of the health care system by patients with scleroderma by determining which physicians are diagnosing and following patients, what tests are being used, and what is the time to diagnosis, as measured over the past 3 decades. METHODS: A self-administered questionnaire (available in English and French) was mailed up to twice to 1,437 members of 12 provincial chapters of the Scleroderma Society of Canada. RESULTS: The overall response rate was 63%. Eighty-nine percent of respondents were female. Sixty percent were between the ages of 30 and 59 years. Forty-three percent were diagnosed by a rheumatologist. Among patients with diffuse disease, 90% have been followed by a rheumatologist; however just over half of patients have seen a gastroenterologist (54%), cardiologist (51%), respirologist (67%), and less than half have seen a dermatologist (42%), nephrologist (13%), physiotherapist (46%), or occupational therapist (34%). The mean time to diagnosis over the last 3 decades is 2.4 years. At diagnosis less than 50% of patients had an electrocardiogram, echocardiogram, gastroscopy, thorax CT, or skin thickness measurements, whereas over 50% of patients had a chest radiograph and pulmonary function testing. CONCLUSION: Less than half of patients were diagnosed by a rheumatologist, and time to diagnosis from onset of symptoms has remained unchanged over the last 3 decades. Despite their complex, multisystemic disease, less than 50% of patients see sub-specialists or had baseline screening tests for organ involvement of their systemic sclerosis. Further research is needed on health services utilization and on determinants of access to care by patients with scleroderma.

Adult↗
PubMed2005

Disseminated pyomyositis mimicking idiopathic inflammatory myopathy.

Although pyomyositis is uncommon in North America, it may be difficult to distinguish clinically from inflammatory myositis. We describe 2 cases of infectious myositis that were initially diagnosed as inflammatory myositis. As illustrated by these cases, infectious myositis is often a challenging diagnosis and requires a high degree of suspicion.

Adult↗
PubMed2003

Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial.

OBJECTIVE: To compare the efficacy of a single intraarticular corticosteroid injection, a supervised physiotherapy program, a combination of the two, and placebo in the treatment of adhesive capsulitis of the shoulder. METHODS: Ninety-three subjects with adhesive capsulitis of <1 year's duration were randomized to 1 of 4 treatment groups: group 1, corticosteroid injection (triamcinolone hexacetonide 40 mg) performed under fluoroscopic guidance followed by 12 sessions of supervised physiotherapy; group 2, corticosteroid injection alone; group 3, saline injection followed by supervised physiotherapy; or group 4, saline injection alone (placebo group). All subjects were taught a simple home exercise program. Subjects were reassessed after 6 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was improvement in the Shoulder Pain and Disability Index (SPADI) score. RESULTS: At 6 weeks, the total SPADI scores had improved significantly more in groups 1 and 2 compared with groups 3 and 4 (P = 0.0004). The total range of active and passive motion increased in all groups, with group 1 having significantly greater improvement than the other 3 groups. At 3 months, groups 1 and 2 still showed significantly greater improvement in SPADI scores than group 4. There was no difference between groups 3 and 4 at any of the followup assessments except for greater improvement in the range of shoulder flexion in group 3 at 3 months. At 12 months, all groups had improved to a similar degree with respect to all outcome measures. CONCLUSION: A single intraarticular injection of corticosteroid administered under fluoroscopy combined with a simple home exercise program is effective in improving shoulder pain and disability in patients with adhesive capsulitis. Adding supervised physiotherapy provides faster improvement in shoulder range of motion. When used alone, supervised physiotherapy is of limited efficacy in the management of adhesive capsulitis.

Bursitis↗
PubMedDate not supplied

Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review.

The authors conducted a systematic review to assess the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of calcific and noncalcific tendonitis of the rotator cuff. Conservative treatment for rotator cuff tendonitis includes physiotherapy, nonsteroidal antiinflammatory drugs, and corticosteroid injections. If symptoms persist with conservative treatment, surgery is often considered. Extracorporeal shock wave therapy has been suggested as a treatment alternative for chronic rotator cuff tendonitis, which may decrease the need for surgery. Articles for this review were identified by electronically searching Medline, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), and Evidence Based Medicine (EBM) and hand-screening references. Two reviewers selected the trials that met the inclusion criteria, extracted the data, and assessed the methodological quality of the selected trials. Finally, the strength of scientific evidence was appraised. Evidence was classified as strong, moderate, limited, or conflicting. Sixteen trials met the inclusion criteria. There were only five randomized, controlled trials and all involved chronic (>/=3 months) conditions, three for calcific tendonitis and two for noncalcific tendonitis. For randomized, controlled trials, two (40%) were of high quality, one (33%) for calcific tendonitis and one (50%) for noncalcific tendonitis. The 11 nonrandomized trials included nine that involved calcific tendonitis and two that involved both calcific and noncalcific tendonitis. Common problem areas were sample size, randomization, blinding, treatment provider bias, and outcome measures. There is moderate evidence that high-energy ESWT is effective in treating chronic calcific rotator cuff tendonitis when the shock waves are focused at the calcified deposit. There is moderate evidence that low-energy ESWT is not effective for treating chronic noncalcific rotator cuff tendonitis, although this conclusion is based on only one high-quality study, which was underpowered. High-quality randomized, controlled trials are needed with larger sample sizes, better randomization and blinding, and better outcome measures.

Calcinosis↗