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PubMed2006

[Pseudo-tumoral hepatic tuberculosis developing into a multinodular form despite treatment].

Localized macronodular tuberculosis of the liver is rare. In this location antituberculosis therapy results in a favorable clinical evolution in 100% of cases. We report a pseudo-tumoral form of this condition with no specific clinical, biological or radiological data. After ultrasound guided needle aspiration cytology suggesting metastasis, the correct diagnosis was obtained on liver biopsy after laparotomy. After what was probably inadequate therapy, the enlargement of several hepatic and splenic macronodules was observed. After two years and eight months, the clinical condition of the patient was good but radiological features remained. The risk of diagnostic errors and the therapeutic difficulties in the zones where the incidence of tuberculosis is low should be noted.

Antitubercular Agents↗

PubMed2002

Capillary electrophoresis with (R)-(--)-N-(3,5-dinitrobenzoyl)-alpha-phenylglycine as chiral selector for separation of albendazole sulfoxide enantiomers and their analysis in human plasma.

The electrokinetic separation and analysis of the enantiomers of albendazole sulfoxide (ABZSO), a sulfoxide with a sulfur stereogenic center hepatically formed during therapy with the anthelmintic drug albendazole (ABZ), is reported. Using aqueous or nonaqueous alkaline background electrolytes, ABZSO enantiomers cannot be separated via single use of common neutral cyclodextrins and negatively charged carboxymethyl-beta-cyclodextrin. With the Pirkle-type (R)-(-)-N-(3,5-dinitrobenzoyl)-alpha-phenylglycine ((R)-DNBPG) chiral selector, however, ABZSO enantiomers do separate within a borate background electrolyte of pH 9.0-9.5 and can be detected by UV absorbance at 295 nm. Having untreated fused-silica capillaries and 50 mM (R)-DNBPG, enantiomeric resolution is dependent on capillary i.d., capillary length and operational temperature. Optimized separation is obtained for pH 9.25 and the lowest temperature setting. Preliminary data indicate that the same approach could be employed for analysis of the enantiomers of oxfenbendazole, a chiral anthelmintic sulfoxide employed in veterinary pharmacotherapy. Analysis of plasma extracts of patients under ABZ pharmacotherapy confirmed the known enantioselectivity in the sulfoxidation of ABZ with the (+)-ABZSO being the predominant enantiomer in blood. Commencing with 2 ml of plasma, enantiomers present at >1 microg/ml could be detected only, a limitation which is based upon the strong absorbance of the chiral selector. (R)-DNBPG and ABZSO are negatively charged at pH 9.0-9.5, which prevents the application of a partial filling technique. The mobility of (R)-DNBPG is significantly larger compared to that of ABZSO. A migrating plug-plug approach based upon a plug of (R)-DNBPG migrating across the sample plug in an electroosmosis free environment obtained via a dynamic coating produced by spermine is shown to provide chiral resolution but not increased sensitivity.

Albendazole↗

PubMed2003

[Aetiologies of lithium overdose: 10-year experience of Marseille poison centre].

OBJECTIVE: Lithium is used for control of bipolar disorders. In order to precise the different circumstances at the origin of poisonings, the authors present the cases of lithium intoxication observed in the Marseille poison centre between January 1991 and December 2000. STUDY DESIGN: Retrospective study. METHODS: Three hundred and four cases were observed during the studied period (1 patient a case), concerning 6 different circumstances. For 3 of them, the symptoms were mild: accidental ingestion with children (13 cases); mistakes on the quantities of ingested tablets (43 cases); elevation of lithium blood level due to diuretic therapy (8 cases). For 2 other circumstances, the clinical signs were more severe: treated patients who developed renal failure (15 cases, 6 patients managed in intensive care unit [ICU], 1 death) or dehydration (35 cases, 8 patients treated in ICU and 1 death). Finally, the most severe cases were collected with suicide attempts. Fifty-six percent of the patients were managed in ICU, 5% needed haemodialysis, 10% had cardiac (repolarization disturbances) or neurological (seizures) complications, 2% died. CONCLUSION: The severity of lithium poisonings depends of the circumstances. Ingestion of high quantities of sustained released tablets is the most dangerous situation. Accidental ingestion, even with children, must be considered as less severe situations.

Accidents↗

PubMed2002

(+)-Catechin inhibits platelet hyperactivity induced by an acute iron load in vivo.

Reactive oxygen species and platelets are thought to be involved in the pathogenesis of cardiovascular disease. Epidemiological data have indicated that high consumption of fruits and vegetables is associated with a lower incidence of vascular events. Polyphenols were proposed to provide such a protection. In the present study performed in rats, we investigated the influence of (+)-catechin (Cat), a polyphenol identified in tea, cocoa, and red wine, on an acute iron load-induced model of platelet hyperactivity. We found that platelet function was significantly enhanced in iron-loaded rats. These changes were associated with impairment of the antioxidative defense including ex vivo free radical-induced hemolysis. Pretreatment with Cat (10 mg/kg, ip, 4 d) normalized biomarkers of antioxidative status and platelet hyperactivity. The benefits of Cat treatment were only observed in iron-loaded animals and not in control animals. In light of the known antioxidant properties of Cat (or its metabolites), we suggest that oxidative injury-induced modification of platelet calcium homeostasis may have explained the iron load-induced platelet hyperactivity. The protective effect of Cat appears to work probably through normalization of the antioxidative status.

Animals↗

PubMed2000

Dietary protein level and origin (casein and highly purified soybean protein) affect hepatic storage, plasma lipid transport, and antioxidative defense status in the rat.

The effects of different proportions (10, 20, and 30%) of dietary casein or highly purified soybean protein on lipid metabolism were studied in growing Wistar rats. Hepatic, plasma and lipoprotein lipid, and protein concentrations, plasma thiobarbituric acid-reactive substance (TBARS) levels, and resistance of red blood cells against free-radical attack were determined after a 4-wk dietary regimen. Compared with the 20% casein diet, the 20% soybean protein diet exhibited similar cholesterolemia but lower plasma triacylglycerol concentrations and very-low-density lipoprotein (VLDL) particle number, as measured by diminished contents of VLDL-triacylglycerol, VLDL-protein, and VLDL-apolipoprotein (Apo) B (B-100 and B-48). The soybean protein diet raised high-density lipoprotein (HDL)(2-3) particle number, as measured by enhanced concentrations of HDL(2-3) cholesterol, HDL-phospholipid, and HDL-ApoA-I. Increasing casein or soybean protein level (from 10 to 30%) in the diet involved higher VLDL-ApoB (B-100 and B-48), indicating an increase in the number of VLDL particles. Feeding the 30% casein or 30% soybean protein diet enhanced LDL-HDL(1) cholesterol contents. Despite similar HDL(2-3)-ApoA-I levels, the 30% casein diet enhanced the HDL(2-3) mass and its cholesterol concentrations. In contrast, feeding either the 10 or 30% soybean protein diet significantly lowered HDL(2-3) cholesterol and ApoA-I levels. These effects on cholesterol distribution in lipoprotein fractions occurred despite unchanged total cholesterol concentrations in plasma. Feeding 20% soybean protein versus 20% casein involved lower plasma TBARS concentrations. Decreasing casein or soybean protein levels in the diet were associated with higher plasma TBARS concentrations and had a lower resistance of red blood cells against free-radical attack. The present study shows that dietary protein level and origin play an important role in lipoprotein metabolism and the antioxidative defense status but do not affect total cholesterol concentrations in plasma.

Animals↗

PubMed2003

Dietary fish protein lowers blood pressure and alters tissue polyunsaturated fatty acid composition in spontaneously hypertensive rats.

OBJECTIVE: To investigate the effect of two types of dietary protein on blood pressure, liver fatty acid desaturation and composition, and urine 6-keto-prostaglandin-F (PGF(1alpha)) level, the metabolite of prostacyclin. METHODS: 5-wk-old spontaneously hypertensive rats were fed 20% casein or purified fish protein. The fat source was 5% ISIO oil, which contains 47.9% (omega-6) and 1.7% (omega-3) total polyunsaturated fatty acids. After 2 mo on the diet, systolic blood pressure was reduced with fish protein compared with casein (189.8 +/- 10.5 versus 220.7 +/- 8.7). RESULTS: Excretion of 6-keto-PGF(1alpha) in urine was negatively correlated with blood pressure. Liver cholesterol and phospholipid concentrations were 1.71- and 1.27-fold lower with fish protein than with casein, respectively. The fish protein diet lowered the 20:4(omega-6) proportion and the ratio of 20:4(omega-6) to 18:2(omega-6) in liver microsomal lipids and phospholipids, which was due to the reduced microsomal Delta6(omega-6) desaturation activity. Dietary protein source did not affect omega-3 fatty acid composition, and this was associated with a similar activation of Delta6(omega-3) desaturation in liver microsomes. CONCLUSIONS: The present data indicated a significant blood pressure-lowering effect caused by fish protein, rather than by casein, that modified the fatty acid composition of liver phospholipids and liver microsomal total lipids.

6-Ketoprostaglandin F1 alpha↗

PubMed2003

[Star anise poisoning in infants].

UNLABELLED: Star anise is used as herbal tea, for the treatment of colicky pain in infants. It may cause neurological troubles. CASE REPORTS: We report 2 cases of star anise poisoning in infants before 6 months of age. Star anise herbal tea was given by parents. Tremors or spasms, hypertonia, hyperexcitability with crying, nystagmus, and vomiting were observed. Contamination or adulteration of Chinese star anise (Illicium verum Hook), with Japanese star anise (Illicium religiosum) was proved in one child. CONCLUSION: Confusion or blending between Chinese and Japanese star anise may cause poisoning. Japanese star anise is a neurotoxic plant indeed, because it contains sesquiterpenic lactones. From November 2001, star anise products are theoretically prohibited in France, but they may be still available in some small groceries, or imported by families themselves.

Beverages↗

PubMed1997

[Treatment of acne].

The treatment of acne is based upon simple pathogenic arguments, but needs to be adapted to the type of acne. Patients must always be informed that it is long and difficult and that no significant response will be expected before 2 to 3 months of regular treatment. The authors present the different therapeutic agents and strategies. Isotretinoin should be used only in severe acne after failure of at least 3 months of a well conducted classical treatment and in nodulo-cystic acne; because of its major side effect of teratogenicity its use in adolescent girl's requires pregnancy testings before and during treatment and an effective contraception.

Acne Vulgaris↗

PubMed2003

Synthesis and antioxidant efficiency of a new amphiphilic spin-trap derived from PBN and lipoic acid.

The synthesis of a new amphiphilic antioxidant called PBNLP and derived from both alpha-phenyl-N-tert-butyl nitrone (PBN) and lipoic acid was described. Grafting a lactobionamide moiety onto the aromatic group of the PBN provided the water solubility of this compound. In vitro preliminary biological evaluations of its antioxidant capacity were performed using the KRL biological test based on free radical-induced hemolysis. The PBNLP induces a protection of erythrocytes against exogenous free radicals higher than that measured with lipoic acid or PBN alone or with lipoic acid or PBN derivatives in admixtures.

Antioxidants↗

PubMed2003

Fractalkine/CX3CL1 production by human aortic smooth muscle cells impairs monocyte procoagulant and inflammatory responses.

Expression of membrane-bound CX3CL1, a CX(3)C chemokine, can be strongly induced by inflammatory cytokines in primary endothelial cells, mediating capture and tight adhesion of cells, such as monocytes, that carry the CX(3)CR1 receptor. Here, we measured CX3CL1 mRNA and protein induction by human aortic smooth muscle cells (SMCs), another major component of vessel walls, in response to inflammatory stimuli, and analyzed the effect of membrane-bound CX3CL1 on monocyte adhesion, tissue factor (TF) expression, and tumor necrosis factor-alpha (TNF-alpha) released. In human vascular SMCs, CX3CL1 transcripts were induced after 4h of stimulation with a combination of TNF-alpha and interferon-gamma. Cell-associated and shedded CX3CL1 were measured with a specific ELISA, showing that only 30% of the protein was cleaved from the membrane. Expression of CX3CL1 by SMC increased adhesion of monocytic cells, an effect, which was blocked by soluble CX3CL1. Interestingly, monocyte adhesion to CX3CL1-coated plates partially inhibited lipopolysaccharide-induced TF expression and TNF-alpha release. Thus, CX3CL1, in addition to its adhesive/chemotactic functions, directly promotes monocyte antiinflammatory and antiprocoagulant responses. This could have important implications in clinical settings such as atherosclerosis, in which SMCs and monocytic cells are in close proximity.

Aorta↗

PubMed2004

A cost-minimizing diagnostic methodology for discrimination between neoplastic and non-neoplastic brain lesions: utilizing a genetic algorithm.

RATIONAL AND OBJECTIVES: The purpose of this study was to make an improvement in the performance of a logistic regression model in predicting the presence of brain neoplasia with magnetic resonance spectroscopy data by using a new approach for logistic regression coefficient estimation. This new approach, termed cost minimizing (C-min), introduced by one of the authors (Chetty), uses the cost function for prediction outcomes to estimate model coefficients and the prediction decision rule. To do this requires use of a genetic algorithm. MATERIALS AND METHODS: Consecutive patients with suspected brain neoplasms or recurrent neoplasia referred for magnetic resonance spectroscopy were enrolled once a final diagnosis was established by histopathology or clinical course, laboratory data, and serial imaging. For the same magnetic resonance spectroscopy explanatory (input) variables, logistic regression models were constructed with conventional and C-min coefficient estimates, and sensitivity and specificity outcomes were compared at alternative probability threshold levels. RESULTS: The C-min approach dominated the conventional approach in 14 of 18 trials, in that C-min had either fewer of both false negatives and false positives, or it had the same number of one type, and less of the other type of diagnostic error. C-min was always less costly. CONCLUSION: The C-min approach to logistic or other regression model estimation may be a step forward in reducing the cost and, often, the errors of diagnostic (and treatment) processes. However, this new approach must be validated on larger and more varied datasets, and its statistical performance characteristics determined before it can be implemented as a practical clinical tool.

Algorithms↗

PubMed2002

A simple scheme for the design of solvent-suppression pulses.

Excitation sculpting was first introduced as a way to efficiently suppress solvent signals. It requires a pulse sequence that acts as a null pulse at the solvent-resonance frequency and as an inversion pulse everywhere else. In this article, it is shown that such a goal can be achieved starting with "top-hat" inversion shaped pulses such as I-BURP-2 or gaussian cascade G3. The result is a Globally Antisymmetric Selective Pulse, or GASP. Numerical optimization was used to extend the performance of such pulses. Multifrequency signal suppression was shown to be possible through application of successive excitation sculpting modules.

Chromatography↗

PubMed2003

Mechanisms of action of intravenous immunoglobulin in autoimmune and inflammatory diseases.

Therapeutic polyclonal intravenous immunoglobulin (IVIg) consists of normal IgG obtained from the pools of plasma of several thousand healthy blood donors. IVIg is used as substitutive treatment of primary and secondary immunodeficiences. Since the first study of Paul Imbach who demonstrated the beneficial effect in idiopathic thrombocytopenic purpura, IVIg is also used in a number of autoimmune and inflammatory diseases. The immunoregulatory effects of IVIg in autoimmune diseases depend on the interaction of Fc portion of immunoglobulins with Fc receptors and on the selection of lymphocyte repertoires of patients through variable regions of infused immunoglobulins. IVIg modulates the activation and effector functions of B and T lymphocytes, neutralizes pathogenic autoantibodies, interferes with antigen presentation and has a strong anti-inflammatory effect which depends on its interaction with the complement system, cytokines and endothelial cells. The immunomodulatory potential of IVIg in patients is thus a result of a variety of complex mechanisms that act in a synergy.

Autoimmune Diseases↗

PubMed2001

Interindividual variations in beliefs about the placebo effect: a study in 300 rheumatology inpatients and 100 nurses.

PATIENTS AND METHODS: Three hundred patients admitted to a rheumatology department (mean age, 49.2+/-15.5 years) and 100 nurses working in the same teaching hospital (mean age, 36+/-8.6 years) completed a questionnaire on the placebo effect in the treatment of pain. RESULTS: The patients believed that the percentages of subjects who responded occasionally or consistently to a placebo were 32% (+/- 22%) and 21% (+/- 17%), respectively. The figures given by the nurses were only slightly higher: 42% (+/- 23%) and 23% (+/- 17%), respectively. Only 27% of the patients and 58% of the nurses knew that pain could resolve completely under placebo therapy. The mean percentage improvement induced by placebo therapy as compared to the study analgesic was estimated at 21% (+/- 17%) by the patients and 30% (+/- 18%) by the nurses. Only 23% of patients and 24% of nurses knew about nocebo effects. CONCLUSION: These data suggest that during double-blind placebo-controlled trials three-quarters of the placebo arm patients who experience a marked improvement or a nocebo effect may believe they received the active drug. This is likely to reduce the difference between the placebo and active drug groups. Furthermore, most patients and nurses have a negative perception of placebo therapy. It may be useful to include a brief description of placebo and nocebo effects into the patient's information and informed consent documents used in double-blind placebo-controlled trials.

Adult↗

PubMed2001

Pseudallescheria boydii knee arthritis in a young immunocompetent adult two years after a compound patellar fracture.

Pseudallescheria boydii arthritis of the knee developed in a 32-year-old immunocompetent man 2 years after a compound patellar fracture contaminated with soil. No other potential portal of entry was identified, suggesting that the fungus remained latent for 2 years. Pseudallescheria arthritis often occurs after a prolonged latency period, causing minimal symptoms that contrast with the frequently severe radiological changes. Although this organism often shows limited sensitivity to most antifungal agents, our patient achieved a full recovery after surgical synovectomy and 6 months of itraconazole therapy (400 mg/ d). This case illustrates the importance of testing for fungi in patients with torpid arthritis, particularly when mild clinical symptoms contrast with severe bone and joint destruction.

Adult↗

PubMed2002

Hypercalcemia in a patient with tuberculous adrenal insufficiency.

OBJECTIVES: To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency. CASE REPORT: Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given. CONCLUSION: The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. Hyperparathyroidism was ruled out in our patient. Adrenal insufficiency should be considered in some patients with hypercalcemia.

Adrenal Insufficiency↗

PubMed2002

Clinical and functional status in 88 rheumatoid arthritis patients followed for 15 years or more by office-based (n = 41) or hospital-based (n = 47) physicians.

OBJECTIVE: To determine the very long-term clinical and functional outcomes in rheumatoid arthritis (RA) patients followed by office-based or hospital-based physicians. PATIENTS AND METHODS: A questionnaire including items on clinical outcomes (active disease, remission, burn-out) and the Health Assessment Questionnaire (HAQ) was mailed to 122 patients with RA of at least 15 years' duration; 61 were followed by office-based physicians and 61 by hospital-based physicians. In the 88 (72%) respondents, mean age was 63 +/- 13 years and mean disease duration was 20.1 +/- 8.7 years. RESULTS; None of the patients experienced burn-out of their disease, and only six (7%) met Pinals' remission criteria. However, 23 (26%) reported a current subjective remission with a mean duration of 8.5 +/- 5.9 months. Although the mean pain score in the 88 patients was 4.1 +/- 2.3, only 50 (56%) patients reported a physician visit during the last 6 months. HAQ scores varied widely, the mean being 1.11 +/- 0.84. Forty (46%) patients had a history of arthroplasty (knee or hip in 29 (33%)). Of the 34 nonrespondents, seven had died (at a mean age of 74 years), and in four of these seven the cause of death was infection or immobility-related complications; in the 27 survivors, disease activity was considered minimal by the physicians or patients, 11 (41%) patients believed they were in remission, and mean time since the last physician visit was 3.9 years. Conclusion. Although burn-out within 20 years of RA onset seems exceedingly rare, clinical activity is milder than in early RA; over one-fourth of our patients believed they were in remission and over one half had not seen a physician during the last 6 months. Functional outcomes varied widely across patients but were acceptable overall, a result that is partly ascribable to the favorable effects of surgery. No differences in functional outcomes were found between patients followed by office-based physicians and those followed by hospital-based physicians.

Arthritis, Rheumatoid↗

PubMed2005

Professions, generations and reproductive dynamics of a French Alpine population (16th-20th centuries).

As part of a survey of the biological history of Alpine populations, the lineages of all the families of the Vallouise valley (a French 'department' of the Hautes Alpes) have been reconstructed over several centuries. The genealogies have been included in a computerized population record, known as 'Vallouise in the Briançon area (14th-20th centuries)', using the French-Canadian programme Analypop. Most of the professions of the family heads were included in the files. In this study, various profession groups were identified and their descents determined over successive generations. In this mountain area, where over 92% of marriages took place among relatives during the 19th century, the profession groups modulated their descents according to chosen strategies, sometimes with considerable differences among groups but with a remarkable consistency of behaviour. Moreover, there was weak interpenetration in the descents of each profession at both the 2nd and 3rd generations.

Catchment Area, Health↗