376
|
Marie I, Lévesque H, Ducrotté P, Courtois H. [Involvement of the small intestine in systemic scleroderma]. Rev Med Interne 1999; 20:504-13. [PMID: 10422142 DOI: 10.1016/s0248-8663(99)80085-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Though impairment of the gastrointestinal tract is commonly encountered in patients with systemic sclerosis, the most frequent abnormalities are esophageal and anorectal disorders. Involvement of the small intestine is also common, reaching a 40-80% prevalence. It often leads to life-threatening complications. CURRENT KNOWLEDGE AND KEY POINTS The occurrence of small intestine impairment and its potential relationships with other organ impairment is still unknown. However, it rarely indicates the existence of the disease (10%) which remains asymptomatic for a long period. As clinical symptoms are non-specific and radiological tests (upper intestinal tract barium meal, gastrointestinal transit times of radiolabeled meal, computerized tomography scan) not sensitive enough to detect the symptoms, diagnosis of small intestine impairment is delayed, i.e., when severe complications such as malabsorption or pseudo-obstruction are present. The physiopathology of small intestine disorders is still unclear, leading to both collagenous fibrosis and atrophy of muscle fibers. As well, its treatment is difficult. FUTURE PROSPECTS AND PROJECTS Knowledge of the mechanisms at the origin of small intestine impairment in the course of systemic sclerosis is important for the development of efficacious therapies. Manometry of the small intestine would be a useful tool to assess the various motor abnormalities that may occur in patients presenting with systemic sclerosis associated with either malabsorption or pseudo-obstruction. It would also provide a useful test in selecting patients whose treatment require somatostatin analogs.
Collapse
|
377
|
Cailleux N, Marie I, Perrier G, Primard E, Lecomte F, Plissonnier D, Lévesque H, Courtois H. Lombalgies fébriles: penser au pseudo-anévrysme. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
378
|
Capet C, Jégo A, Denis P, Marie I, Levesque H, Doucet J, Courtois H, Chassagne P, Bercoff E. L'altération cognitive au cours de l'hypothyroïdie est-elle réversible avec le traitement substitutif? Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
379
|
Marie I. Caractéristiques de la maladie de horton en fonction de sa localisation aux artères cérébrales ou aux gros troncs artériels. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
380
|
Marie I, Hachulla E, Levesque H, Reumont G, Cailleux N, Hatron P, Devulder B, Courtois H. Intérêt des immunoglobulines polyvalentes dans les atteintes œsophagiennes sévères au cours des myopathies inflammatoires idiopathiques. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
381
|
Lévesque H, Marie I. [Infection and vascular purpura]. JOURNAL DES MALADIES VASCULAIRES 1999; 24:177-82. [PMID: 10467526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Palpable purpura is the hallmark of cutaneous vasculitis. Small-vessel vasculitis is a common vasculitis manifestation associated with acute or chronic infection. It is also characteristic of a systemic disease whether infectious or not. The pathogenic mechanisms appear to be complex: immune complex formation, vessel damage or altered vessel function mediated directly by infectious agents, humoral or cellular immunologic response. It is also a reaction to mixed cryoglobulinemia. Diagnosis of cutaneous vasculitis is simple (palpable purpuric eruption, nodules, vesiculobullous lesions, ulcerations), but etiological investigation is often difficult because the infectious origin is only rarely demonstrated. This type of purpura occurs in bacterial endocarditis and therefore blood cultures must be performed in any febrile patient particularly in the presence of a cardiac murmur. In fact the viral, parasitic or bacterial infectious origin is demonstrated in less than 30% of the cases of leucocytoclastic vasculitis. While focal sepsis is often found and its eradication should be followed-up, its role has not been proven particularly as antibiotics alone themselves can cause hypersensitivity vasculitis. Finally, mention must be made of virus induced vasculitis (B and C hepatitis, cytomegalovirus, parvovirus), antiviral treatment which permits better control of vasculitis.
Collapse
|
382
|
Kadri N, Chassagne P, Capet C, Jégo A, Bénichou J, Marie I, Héron F, Lévesque H, Courtois H, Doucet J, Bercoff E. Syncope du sujet âgé: l'interrogatoire du malade et de son entourage est-il concordant? Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
383
|
Marie I, Héron F, Lecomte F, Levesque H, Courtois H. Pyomyosites: à propos de deux observations chez des patients immunocompétents. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
384
|
Cailleux N, Marie I, Lecomte F, Peillon C, Lévesque H, Courtois H. L'ischémie digitale: une affaire d'internistes. À propos de 96 observations. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80217-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
385
|
Marie I, Hatron PY, Levesque H, Hachulla E, Hellot MF, Michon-Pasturel U, Courtois H, Devulder B. Influence of age on characteristics of polymyositis and dermatomyositis in adults. Medicine (Baltimore) 1999; 78:139-47. [PMID: 10352646 DOI: 10.1097/00005792-199905000-00001] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In a retrospective study of 79 consecutive patients, we evaluated characteristics of polymyositis (PM) and dermatomyositis (DM) and compared clinical presentation, biochemical findings, histologic changes, evolution, complications, and mortality rate of elderly patients (aged > or = 65 yr) and younger patients (aged < or = 64 yr) at the onset of PM/DM. We found a high prevalence of PM/DM in elderly patients: 23 patients (29%) were aged 65 years or over. We also found that esophageal involvement (34.8% versus 16.1%, respectively) and bacterial pneumonia related to both ventilatory insufficiency and esophageal impairment (21.7% versus 5.4%, respectively) were more common in elderly patients compared with younger patients, resulting in increased morbidity and mortality rates. Moreover, malignancy frequency was higher in elderly patients compared with younger patients (47.8% versus 9.1%, respectively, p = 0.0001), particularly patients with DM (10/11). Fifty percent of malignancies were colon malignancies in elderly patients. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and ferritin levels were also higher in the elderly patient group compared with the younger group, and the presence of serum hypoprotidemia, hypoalbuminemia, and anemia was more frequent. Finally, PM/DM complete remission was less frequent (13.6% versus 41.1%) and the mortality rate (47.8% versus 7.3%) was higher in elderly patients than in younger patients. The main causes of death in elderly patients were bacterial pneumonia, due to ventilatory insufficiency and esophageal impairment, and malignancies. Our findings therefore indicate that PM/DM-related esophageal and lung involvement should be systematically searched for in elderly patients. Esophageal manometry and pulmonary function tests should become an integral part of initial evaluation in elderly patients for early detection of impairment. Moreover, as we observed a marked overrepresentation of colon cancer in elderly patients with DM, we suggest that the search for malignancies in elderly patients with DM should include lower gastrointestinal tract investigations.
Collapse
|
386
|
Blot E, Marie I, Delastre O, Cailleux N, Pouillart P, Lévesque H, Courtois H. [Thrombotic microangiopathy associated with cancer is an oncologic emergency: a case report]. Rev Med Interne 1999; 20:448-9. [PMID: 10365422 DOI: 10.1016/s0248-8663(99)83103-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
387
|
Boyer A, Marie I, Primard E, Cailleux N, Lévesque H, Courtois H. [Osteo-neuro-meningeal-lumbosacral involvement in Marfan syndrome. Report of a case]. JOURNAL DES MALADIES VASCULAIRES 1999; 24:139-42. [PMID: 10399648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Marfan syndrome is an hereditary condition which primarily affects conjunctive tissue with predominant vascular lesions, aortic insufficiency and aortic dissection which condition vital prognosis. Until further progress is made in the genetic determination of the disease, the diagnosis is currently based on the association of clinical criteria, which enables multidisciplinary management. This approach should lead to specific medical and surgical treatment--which may reduce Marfan morbidity and mortality. We report the case of a 45 year-old patient with suspected Marfan syndrome during adolescence. The presence of a cardiovascular lesion and a recently reported abnormality i.e. a sacral erosion by a dural ectasia, enabled us to confirm the diagnosis. We reviewed the current criteria in Marfan diagnosis and their specific management.
Collapse
|
388
|
Marie I, Levesque H, Cailleux N, Lepretre S, Duval C, Tilly H, Courtois H. An uncommon association: Sjögren's syndrome and autoimmune myelofibrosis. Rheumatology (Oxford) 1999; 38:370-1. [PMID: 10378716 DOI: 10.1093/rheumatology/38.4.370] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
389
|
Marie I, Lecomte F, Levesque H, Janvresse C, Kerleau JM, Cailleux N, Courtois H. Löfgren's syndrome as the first manifestation of acute infection due to Chlamydia pneumoniae: a prospective study. Clin Infect Dis 1999; 28:691-2. [PMID: 10194106 DOI: 10.1086/517223] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
390
|
Cailleux N, Marie I, Jeanton M, Lecomte F, Lévesque H, Courtois H. [Are antiphospholipid antibodies thrombogenic in the course of human immunodeficiency virus infection?]. JOURNAL DES MALADIES VASCULAIRES 1999; 24:53-6. [PMID: 10192038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lupus-like anticoagulant is commonly encountered in human immunodeficiency virus infection although thromboembolic manifestations are rare in HIV patients. We report the case of an HIV patient who developed gangrene of both forefeet associated with anticardiolipin antibodies. A 42-year-old woman had a 12-year history of HIV infection (stage B2). She presented with painful gangrene involving the forefeet of 4-day duration. Doppler ultrasonography, electromyography and nailfold capillaroscopy were normal. Skin biopsy revealed intracapillary thrombi and severe necrosis within the hypodermis; there was no evidence of vasculitis. Laboratory findings showed a marked inflammatory syndrome and the presence of anticardiolipin antibodies (IgG: 22 GPL U/ml). Several cutaneous manifestations are known to be associated with antiphospholipid syndrome, such as livedo reticularis, ulcers and gangrene of the extremities. Skin biopsy often shows noninflammatory thrombosis of small vessels within the dermis. Microcirculation damages have also been described in HIV infection, mainly vasculitis. In the present case report, the absence of both vasculitis and other causes suggest that anticardiolipin could be the culprit. But, it is possible that painful gangrene of the forefeet was secondary to HIV infection.
Collapse
|
391
|
Lévesque H, Marie I. [CREST or CREIST syndrome?]. JOURNAL DES MALADIES VASCULAIRES 1999; 24:7-9. [PMID: 10192029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
392
|
André M, Aumaître O, Piette J, Francès C, Wechsler B, Kémény J, Baty V, Grosbois B, Hausfater P, Joly C, Marie I, Solal Celigny P, Veit V, Verrot D. Épidémiologie des abcès aseptiques d’organes profonds. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
393
|
Lecomte F, Nouvellon M, Hudak N, Cailleux N, Marie I, Ozenne G, Kerleau J, Heron F, Chiffard D, Lemeland J, Levesque H, Courtois H. Infection et colonisation à Staphylococcus aureus méthicilline-résistant des ulcères d’origine ischémique. Étude prospective de 160 patients consécutifs. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
394
|
Cailleux N, Marie I, Lecomte F, Primard E, Lévesque H, Courtois H. Diversité étiologique des thromboses veineuses jugulaires internes. À propos de dix observations. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
395
|
Lecomte F, Cailleux N, Marie I, Lévesque H, Courtois H. [Recurrent febrile organomegaly]. Rev Med Interne 1998; 19 Suppl 2:301s-302s. [PMID: 9775100 DOI: 10.1016/s0248-8663(98)80851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
396
|
Marie I, Boyer A, Heron F, Joly P, Levesque H, Thomine E, Courtois H. Focal aseptic osteitis underlying neutrophilic dermatosis. Br J Dermatol 1998; 139:744-5. [PMID: 9892926 DOI: 10.1046/j.1365-2133.1998.02482.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
397
|
Marie I, Levesque H, Cailleux N, Courtois H, Mihout B, Iasci L. Diplopia as the first manifestation of relapsing polychondritis. Ann Rheum Dis 1998; 57:634-5. [PMID: 9893578 PMCID: PMC1752480 DOI: 10.1136/ard.57.10.634a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
398
|
Marie I, Levesque H, Ducrotté P, Denis P, Benichou J, Hellot MF, Cailleux N, Le Loët X, Joly P, Lauret P, Courtois H. Manometry of the upper intestinal tract in patients with systemic sclerosis: a prospective study. ARTHRITIS AND RHEUMATISM 1998; 41:1874-83. [PMID: 9778230 DOI: 10.1002/1529-0131(199810)41:10<1874::aid-art21>3.0.co;2-t] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess both the prevalence and the characteristics of motor disorders of the small bowel in patients with systemic sclerosis (SSc) and to investigate for an association between clinical manifestations in the upper intestinal tract, capillaroscopic features, esophageal motor impairment, and manometric evidence of motor disturbances. METHODS Fasting and postprandial motor activity of the upper intestinal tract was studied in 17 consecutive patients with SSc (6 with and 11 without clinical manifestations of small bowel involvement) and 17 age- and sex-matched healthy control subjects. RESULTS The prevalence of manometric evidence of intestinal involvement was as high as 88% in the SSc patients; normal motor activity was present in only 2 patients. The median values for duodenal and jejunal interdigestive phase III migrating motor complex duration, amplitude, and velocity and the postprandial motility index were therefore lower in SSc patients compared with controls. Our manometric findings indicated that there are both neuropathic and myopathic stages of upper intestinal tract dysfunction in SSc. Furthermore, no association could be found between the severity of the intestinal manometric abnormalities and clinical presentation, SSc subsets, disease score, capillaroscopic findings, or esophageal manometric impairment. CONCLUSION We suggest that manometry of the upper intestinal tract may be useful in SSc patients with clinical manifestations in the small bowel (i.e., malabsorption syndrome or pseudoobstruction) in that it can be used to accurately evaluate both the nature and the severity of motor disturbances. Furthermore, this procedure can be used to assist in the selection of patients who may require octreotide therapy.
Collapse
|
399
|
Marie I, Héron F, Lévesque H, François A, Kerleau JM, Courtois H. [Autoimmune cholangitis: a rare and ignored cause of cholestatic hepatitis]. Rev Med Interne 1998; 19:579-80. [PMID: 9775077 DOI: 10.1016/s0248-8663(99)80029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
400
|
Trivalle C, Chassagne P, Bouaniche M, Landrin I, Marie I, Kadri N, Menard JF, Lemeland JF, Doucet J, Bercoff E. Nosocomial febrile illness in the elderly: frequency, causes, and risk factors. ARCHIVES OF INTERNAL MEDICINE 1998; 158:1560-5. [PMID: 9679797 DOI: 10.1001/archinte.158.14.1560] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although nosocomial febrile illness (NFI) is common in hospitalized patients, it has been less extensively studied in the elderly. OBJECTIVE To determine the frequency, causes, and risk factors of NFI in elderly inpatients. METHODS This prospective study involved 608 patients (> or = 65 years of age) admitted in an acute geriatric unit. Investigators followed this cohort until 1 of the following events occurred: development of NFI, discharge from the geriatric unit, or death. The cause of NFI was classified into 3 groups: infectious, noninfectious, and no apparent diagnosis. We systematically studied 17 comorbid conditions, 6 drugs, and 7 invasive procedures. For comparison, the patients were stratified into 2 groups: patients with NFI and patients without NFI. RESULTS Sixty-six patients (10.9%) with NFI were identified. They were compared with the remaining 542 patients without NFI. In 49 patients (74%) with NFI, the cause was infectious; in 9 (13.5%), it was noninfectious; and in 8 (12.5%), there was no apparent cause. After multivariate analysis, only fecal incontinence (odds ratio [OR], 5.54; 95% confidence interval [CI], 2.13-14.5), congestive heart failure (OR, 2.97; 95% CI, 1.53-5.76), and pressure ulcers (OR, 2.93; 95% CI, 1.19-7.17) were independent risk factors for NFI. The number of invasive procedures preceding the febrile episode was a significant predictor of infection (OR, 3.68; 95% CI, 1.14-9.21). CONCLUSIONS Nosocomial febrile illness is a common event in elderly hospitalized patients. In 74% of the patients with NFI, an infection is found. Measures to decrease infectious NFI in the elderly require a reduction in the number of invasive procedures.
Collapse
|