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Biomedical subjects

Véronique Loustaud-Ratti

Publications and source records attributed to Véronique Loustaud-Ratti.

10 recordsLinked to original sources
PubMed2003

Antiviral effect of ribavirin in early non-responders to interferon monotherapy assessed by kinetics of hepatitis C virus RNA and hepatitis C virus core antigen.

BACKGROUND/AIMS: To evaluate the efficacy of ribavirin, given in second intention in non-responders to interferon alone, by studying viral kinetics. METHODS: We conducted a trial including 203 patients with chronic hepatitis C, naïve of treatment. Patients were treated with interferon three times a week with or without ribavirin and amantadine according to response. Viral kinetics were assessed by serial measurements of HCV RNA (bDNA 3.0 and Monitor 2.0) and a new assay, trak-C, able to quantify total Hepatitis C virus (HCV) core antigen. RESULTS: A significant initial drop in HCV RNA or HCV core antigen, under interferon alone, was associated with response to therapy, -4.85+/-1.33 log for HCV RNA in sustained responders versus -1.86+/-1.53 log for others groups, P<0.001. In patients receiving ribavirin in second intention, we also observed a similar drop in HCV RNA and HCV core antigen, predictive of sustained response, -2.67+/-1.26 log for HCV RNA in sustained responders versus -0.44+/-0.49 log in non-responders, P<0.001. CONCLUSIONS: Ribavirin has probably an additional antiviral effect in interferon treated patients. Kinetics of HCV RNA and HCV core antigen under treatment are highly predictive of a sustained virological response.

Adult↗
PubMed2003

Silent, or masked, giant cell arteritis is associated with a strong inflammatory response and a benign short term course.

OBJECTIVE: To determine the frequency, characteristics, and short term outcome of patients who have biopsy-proven giant cell arteritis (GCA) but no local symptoms that can be attributed to vasculitis inflammation [silent temporal arteritis (TA)] throughout the pretreatment course of the disease or an observational period lasting at least 2 months. METHODS: Of 175 consecutive patients with biopsy-proven GCA, 130 had typical cranial arteritis, 21 had silent vasculitis, and the remaining 24 had either discrete cranial symptoms (19 cases) or isolated extracranial vasculitis (5 cases). We sought to determine which of 15 pretreatment characteristics were associated with silent TA, as compared with typical cranial arteritis, and assessed the short term outcome in these patients. RESULTS: Of 21 patients with silent GCA, 14 met criteria for fever of unknown origin. Aside from their different clinical presentation, this population was characterized by a longer delay in diagnosis (p = 0.003), a higher mean erythrocyte sedimentation rate (p = 0.002), higher C-reactive protein (p = 0.002), and lower levels of albumin (p = 0.01) and hemoglobin (p < 0.0001). Permanent visual loss, which occurred in 24 patients (13.7%), exclusively involved those presenting with symptoms and/or signs suggesting cranial arteritis, especially those with frank cranial arteritis. This complication was associated negatively with the delay in diagnosis (p = 0.01), and marginally with the number of symptoms and/or signs suggesting cranial arteritis recorded in each patient (p = 0.07). Oral prednisone at a mean daily dose of 0.7 mg/kg resulted in satisfactory control of silent TA within 4 weeks in all patients but one, and could subsequently be safely tapered by half in a mean delay of 38 +/- 23 days. No differences were observed between patients with silent TA and other forms of the disease regarding the mean prednisone dose at 3 month followup (18.2 +/- 4.5 vs 20.9 +/- 5.9 mg/day) and 6 month followup (14 +/- 4.4 vs 15.6 +/- 6 mg/day ). CONCLUSION: Silent TA may represent a distinct subset of giant cell arteritis, marked by a protracted inflammatory response and a relatively benign short term outcome, excellent response to corticosteroids, and no visual ischemic events, despite the long period of exposure to this complication before appropriate treatment.

Acute Disease↗
PubMed2002

[Management of intermittent fever in the adult].

Episodic fever is a difficult diagnostic challenge, more enigmatic than prolonged fever of unknown origin. Patients are younger, and have longer history of fever before admission. Despite the use of extensive diagnostic procedures 50% of the cases remain undiagnosed. A meticulous physical examination and history remains an important tool for registering potentially diagnostic clues useable in the diagnostic process. In the absence of clues, a staged diagnostic protocol can be used to search elements contributing to the diagnosis (laboratory investigations including chest X-ray and ultrasonography of upper abdomen, imaging techniques, endoscopies and histologic investigations. When diagnosis is not established and patient deteriorate, empiric therapeutic trial is started to presumptive diagnoses. If not, patient must be carefully followed as an out patient basis and symptomatically treated, periodic reassessment will in time reveal the development of overt disease.

Adult↗
PubMed2002

Routine vs extensive malignancy search for adult dermatomyositis and polymyositis: a study of 40 patients.

OBJECTIVE: To identify potential risk factors and the yield of routine screens for early detection of malignancy associated with dermatomyositis (DM) and polymyositis (PM). DESIGN: Retrospective study of malignancies in all patients with DM or PM followed up between the years 1981 and 2000 and a review of the relationship of DM and PM to malignancy, the usefulness of various tests or examinations for malignancy search, and the patients' course. SETTING: Departments of internal medicine and dermatology in a teaching hospital. PATIENTS: Forty consecutive adult patients with DM (33 cases) or PM (7 cases). MAIN OUTCOME MEASURES: (1) Rate of false-negative results of routine workup and yield (percentage of positive results) of blind malignancy search and (2) comparison of 16 characteristics in patients with malignancy vs those without. RESULTS: Malignancy occurred in 16 patients: 13 with DM and 3 with PM. In all cases, the diagnosis of malignancy was made concurrently with or shortly after the diagnosis of DM or PM. Factors associated with malignancy were recruitment in the internal medicine department (P =.02), constitutional symptoms (P<.01), a rapid onset of DM or PM (P =.02), the lack of Raynaud phenomenon (P<.01), and a higher mean erythrocyte sedimentation rate (P<.01) and creatine kinase level (P<.01). Initial routine search failed to discover 4 malignancies, 3 of which were discovered at an advanced stage by more extensive investigations. The positive result yield of blind malignancy search was only 13% (11 of 87), but reached 28% (5 of 18) for blind abdominal-pelvic and thoracic computed tomographic scans. CONCLUSION: Extensive search for malignancy, particularly computed tomographic scans, may be warranted in at least a subset of patients with DM or PM and risk factors of malignancy.

Adult↗