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[Changes in nutritional status at the initial phase of treatment of cancers and malignant hemopathies].

Changes in nutritional status at the initial phase of treatment of cancers and malignant blood diseases were evaluated in 32 male patients (mean age 58 +/- 18 years) examined during three 4-day stays in hospital (T0, T1, T2) at 2 months' interval. On the first day of each stay the following parameters were measured: food intake (kcal/day), weight (kg), squared height (m), fat mass (kg) obtained by measuring 4 skin folds and using Durnin's tables, brachial muscle area (cm2) and total skeletal muscle mass (kg) calculated from Heymsfield's equations. On the third and fourth days, after 48 hours of meat-free and fish-free diet, 3-methylhistidine (mmol/g creatininuria) and creatinine (mg) were measured in urine, and the urinary creatinine/height ratio (mg/cm/day) was calculated. Full anthropomorphic measurements were performed on 19/32 patients and complete measurements of 3-methylhistidine and the urinary creatinine/height ratio in 9/32 patients. Subsequent examinations revealed a decrease in brachial muscle area, total skeletal muscle mass and urinary creatinine/height ratio which, together with an increase in baseline 3-methylhistidine, confirmed the loss of muscle mass. Mean losses of muscle and fat were 6 p. 100 between T1 and T0 and 7 p. 100 between T2 and T0 for the muscle mass, and 9 p. 100 between T2 and T0 for the fat mass. These losses of body mass occurred very early, with significant differences between T1 and T0 and between T2 and T0. They suggest that protein-calorie malnutrition develops at a very early stage in patients treated for cancer or malignant blood disease.

Adult↗
PubMed1997

[Dilated cardiomyopathy and selenium deficiency in AIDS. Apropos of a case].

Cardiac-related death of HIV-positive patients is not rare. The etiology of AIDS-associated dilated cardiomyopathies often remains unknown, even at autopsy. We report an observation associated to a severe deficit in selenium. The patient had been diagnosed as HIV-positive 2 years before. He presented Pneumocystis carinii pneumonia then Cryptococcus meningitis. Two months later he was hospitalized for pancreatitis and cachexia. He presented global heart failure that lead to death. No microorganism was found in myocardium at autopsy but plasma selenium was dramatically decreased (24 micrograms/L). The deficit in selenium has been associated to a dilated cardiomyopathy in non-AIDS patients. HIV-positive patients have an early decrease in plasma selenium, this concentration is dramatically decreased in malnourished patients. Selenium deficit might be the cause of some of the AIDS-related dilated cardiomyopathies and selenium supplementation might be useful in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Assay of plasma thrombomodulin in systemic diseases].

Membrane thrombomodulin (TM) is a very efficient natural anti-thrombin glycoprotein with anticoagulant properties expressed on endothelial cell surface. Circulating plasmatic thrombomodulin (TMp) detected by enzyme immunoassay in plasma is considered as a cell marker of endothelial injury. The TMp levels are increased in many conditions (diabetes mellitus, atheromatous disease...). In cases of collagen vascular diseases, where vascular endothelium damage is suspected, TMp is increased particularly in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). It is noteworthy that the TMp level is correlated with disease activity. Since TMp is a non specific marker of endothelial damage, it may be of interest as a useful marker for the supervision of these diseases. Further studies are needed on larger series. TMp level change during spontaneous evolution or under treatment will help determine wether TMp is a predictor and prognostic marker of these systemic diseases.

Acute Disease↗
PubMed1998

[Familial autoimmune hepatitis and C4 deficiency].

INTRODUCTION: Familial auto-immune hepatitis is unusual. We report a case in which hepatitis was associated with a deficiency in the C4 component of the complement. EXEGESIS: Type 1 auto-immune hepatitis A was diagnosed in a 38-year-old woman presenting with systemic lupus erythematosus. Her daughter had to undergo a splenectomy for immunologic thrombocytopenic purpura when she was 9 years old. When she turned 13, she further developed type 1 autoimmune hepatitis. During follow-up (4 and 8 years, respectively), both patients had a mild deficiency in C4. CONCLUSION: C4 deficiency is not only frequently observed in relatives of patients with auto-immune hepatitis, but also in familial systemic lupus. This abnormality may have had a crucial pathogenic role in these two patients.

Adolescent↗
PubMed1998

[Deep venous thrombosis in an adult with varicella].

INTRODUCTION: Some viral infections are associated with deep venous thrombosis. We report a case of deep venous thrombosis in an adult with varicella. He had neither known predisposing factors for thrombosis nor thrombophilia. EXEGESIS: Transient significant level of antiphospholipid antibodies and lupus circulating anticoagulant were observed. There was no evidence of thrombophilia. Deep venous thrombosis has been mostly associated with varicella in children. A transient protein S deficiency was present in almost all cases, though it was sometimes related to an anti-protein S antibody. This association is exceptional in adults. Some viruses such as herpesvirus and HIV are responsible for endothelium dysfunction, but this is still unclear in the case of varicella-zoster virus. CONCLUSION: In our observation, endothelium activation or antiphospholipid antibodies might be responsible for thrombosis.

Adult↗
PubMed1999

[Secondary aortoduodenal fistulas: report of 7 cases].

PURPOSE: Aortoduodenal fistulas are the most frequent aortoenteric fistulas. They may be primary (occurring after aneurysms of the native aorta) or secondary (occurring after aortic prosthesis). Aortoduodenal fistulas are a rare complication of aortic prostheses. They may be caused by prosthesis infection or due to inadequate prosthesis. METHODS: We report seven observations that emphasize issues pertaining to either diagnosis or therapy. RESULTS: The delay of occurrence is variable, with a mean of 3 years as reported in the literature. Clinical picture includes upper digestive tract hemorrhage, sometimes fever, abdominal pain or mass. Though difficult, diagnosis can be achieved through gastric endoscopy or CT-scan. Additional diagnostic procedures are often not useful and should not be numerous. Surgical procedures help guide the diagnosis and constitute the main part of the treatment with suture of the duodenum and vascular prosthesis. According to previous works, our observations including prolonged follow-up of the patients suggest that the best vascular treatment is extra-anatomic axillo-bifemoral bypass, while simple suture and prosthesis replacement lead to poor results. CONCLUSION: Mortality related to aortodigestive fistulas is high (five out of seven patients in the present study) and requires prevention, including more particularly delicate surgery and antibiotic therapy in case of any episode of infection. Aortoduodenal fistulas must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained fever.

Aged↗
PubMed2005

[Subacute ischemia of the lower limb revealing hyperhomocysteinemia in a young woman].

A 51-year-old woman had no known cardiovascular risk factor. She presented with bilateral calf intermittent claudication from February. She was hospitalized in August for acute right leg ischemia without loss of sensorymotor functions, following angiography by one week. She had an occlusion of both superficial femoral arteries and abdominal aorta thrombus, plausible source for embolism. Her condition quickly improved with heparin and iloprost infusion. Since the aortic thrombus was removed on ultrasound, aortic surgery was not performed at this time. Investigations showed hyperhomocysteinemia (25 microg/L after overnight fasting and 115 after methionin load) and decrease in folic acid. This report highlights the occurrence of severe arterial disease in young women with high serum homocysteine levels.

Aorta, Abdominal↗
PubMed2005

[Optimizing history taking for evaluating the risk of venous thromboembolism: the OPTIMEV study].

UNLABELLED: Venous thromboembolism (VTE) is a frequent disease and remains a major cause of mortality and morbidity among our patients. During the 20 past years, clinical description, diagnostic tools, and treatment have changed dramatically. Most published data describing risk factors for VTE no longer apply to the patients seen in daily practice. We present here the rationale, aims, and methodology of the OPTIMEV Study (OPTimisation de l'Interrogatoire pour la Maladie thromboEmbolique Veineuse). RATIONALE: Risk factors for VTE are numerous, complex and interactions between them and their clinical importance is difficult to measure (table I). For example, odds ratios for VTE recurrence vary greatly across longitudinal studies. We searched the National Library of Medecine (PubMed) and the Amedeo website using the following keywords: "venous thromboembolism", "pulmonary embolism", "deep vein thrombosis", "risk factors". We selected 84 relevant articles published between 1972 and 2005. Based on this literature analysis, we identified the following major risk factors: VTE recurrence, surgery, cancer, immobilization, age, biological factors. For these factors, data are lacking and some questions are proposed. OBJECTIVES: The broad objective of the study is to better evaluate clinical risk factors that fit today's practice against VTE. Specific aims are: 1) to determine whether risk factors are different between proximal and distal deep vein thrombosis (DVT); 2) to develop and prospectively validate a new prediction rule for outpatients. The primary hypothesis is that careful assessment of VTE recurrence, adequate surgical thromboprophylaxis, cancer staging, and varicose vein stratification according to the CEAP classification, is mandatory for accurate evaluation of thromboembolic disease risk. METHODS: We conducted a multicenter, prospective, cohort study of 10000 patients. Enrollees are inpatients and outpatients presenting with a clinical suspicion of VTE in Emergency Departments and outpatient clinics in France. 4173 patients have been enrolled at this time (Figure 2). All eligible patients are enrolled during a selected period of time through different seasons. Data are collected by physicians in charge of the patients using an electronic case recording form. Collected data include baseline characteristics, risk factors, results of diagnostic investigations. Outcome measures obtained through telephone interview at 3 and 12 months include cancer diagnosis, VTE recurrence, haemorrhagic events, treatments, death. Univariate and multivariate analysis will be performed using multilevel logistic regression. The study organization is performed by the Centre d'Investigation Clinique de Grenoble and is sponsored by the French Society of Vascular Medicine. First results, to be published in 2006, will allow development of new prediction rules for VTE diagnosis.

Age Factors↗
PubMed2003

Three dimensional texture analysis in MRI: a preliminary evaluation in gliomas.

The discrimination of tumor boundaries from normal tissue, as well as the evaluation of tissue heterogeneity and tumor grading often continue to pose a challenge in MRI. Although yielding promising results in various fields of medical imaging, two- dimensional (2D) texture analysis in MRI has, until now, demonstrated a lack of specificity in brain tumor classification. A new three-dimensional (3D) approach using Cooccurrence Matrix analysis is proposed to increase the sensitivity and specificity of brain tumor characterization. A preliminary comparative evaluation of 2D and 3D texture analysis was performed on T(1)-weighted MRI of seven gliomas for characterization of solid tumor, necrosis, edema and surrounding white matter. With 3D compared to 2D method, a better discrimination is obtained between necrosis and solid tumor as well as between edema and solid tumor. Using both methods, peritumoral white matter overlaps with edema, but is completely separated from far homo-lateral matter. This latter shows a complete overlapping with contra-lateral matter. The 3D texture analysis approach could provide a new tool for tumor grading and treatment follow-up, as well as for surgery or radiation therapy planning.

Brain Neoplasms↗
PubMed2003

MRI texture analysis on texture test objects, normal brain and intracranial tumors.

Texture analysis was performed in three different MRI units on T1 and T2-weighted MR images from 10 healthy volunteers and 63 patients with histologically confirmed intracranial tumors. The goal of this study was a multicenter evaluation of the usefulness of this quantitative approach for the characterization of healthy and pathologic human brain tissues (white matter, gray matter, cerebrospinal fluid, tumors and edema). Each selected brain region of interest was characterized with both its mean gray level values and several texture parameters. Multivariate statistical analyses were then applied in order to discriminate each brain tissue type represented by its own set of texture parameters. Texture analysis was previously performed on test objects to evaluate the method dependence on acquisition parameters and consequently the interest of a multicenter evaluation. Even obtained on different sites with their own acquisition routine protocol, MR brain images contain textural features that can reveal discriminant factors for tissue classification and image segmentation. It can also offer additional information in case of undetermined diagnosis or to develop a more accurate tumor grading.

Adult↗
PubMed2005

[Therapeutic intensification and autologous stem cell transplantation in autoimmune diseases].

THE PATHOPHYSIOLOGY of most autoimmune diseases is often poorly understood. EXPERIMENTAL CONSIDERATIONS and clinical experience suggest that high doses immunoablation followed by stem cell transplantation is a therapeutic option to consider for certain severe autoimmune disorders. THE CONCEPT OF RESTORING NORMAL IMMUNE REACTIVITY must in part br true since current results of 466 transplants (445 autologous, 21 allogeneic) patients suffering from various autoimmune diseases show a beneficial outcome in approximately 2/3 of the patients. TO IMPROVE THE EFFICACY AND SAFETY OF SUCH AN AGGRESSIVE PROCEDURE in patients with potentially affected vital organs by the underlying autoimmune disease, it is especially important to follow international consensus guidelines and to centrally collect clinical data for in depth analysis in the EBMT International Stem Cell Project for Autoimmune Disease in Basel, Switzerland. PHASE III STUDIES ARE RUNNING FOR SYSTEMIC SCLEROSIS (Astis, Autologous Stem cell Transplantation International Rheumatoid Arthritis Trial) started in 2003. A STUDY PROJECT IS PLANNED FOR MULTIPLE SCLEROSIS (Astims, Autologous Stem cell Transplantation International Multiple Sclerosis).

Adolescent↗
PubMed2002

Stability of worry content in GAD patients: a descriptive study.

The stability of worry content was investigated in a sample of 27 individuals diagnosed with Generalized Anxiety Disorder. During an initial evaluation, participants were asked to describe the content of their current worries, and the examining psychiatrist rated the frequency and intensity of these topics. During the following year, the investigators interviewed the participants on a monthly basis assessing the intensity and frequency of original worries, intensity and frequency of new worries, overall worry level, and general anxiety level. Analysis of this longitudinal data indicated level of overall worry and anxiety remained fairly stable over a 12-month period. Although the intensity and frequency of original worries decreased over time, few original worry topics completely remitted. In fact, at the end of the 12-month monitoring period, worry content identified at baseline continued to account for over 65% of the overall worry variance. Most participants did identify new worry topics during the course of the 12-month period, and the frequency and intensity of the new worries were comparable to the decrease in frequency and intensity of the original worries.

Activities of Daily Living↗