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Jaulhac B, Saunier A, Caumes E, Bouiller K, Gehanno JF, Rabaud C, Perrot S, Eldin C, de Broucker T, Roblot F, Toubiana J, Sellal F, Vuillemet F, Sordet C, Fantin B, Lina G, Sobas C, Gocko X, Figoni J, Chirouze C, Hansmann Y, Hentgen V, Cathebras P, Dieudonné M, Picone O, Bodaghi B, Gangneux JP, Degeilh B, Partouche H, Lenormand C, Sotto A, Raffetin A, Monsuez JJ, Michel C, Boulanger N, Lemogne C, Tattevin P. Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis. Med Mal Infect 2019; 49:335-346. [PMID: 31155367 DOI: 10.1016/j.medmal.2019.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022]
Abstract
The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.
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Affiliation(s)
- B Jaulhac
- Laboratoire de bactériologie et cnr des Borrelia, faculté de médecine et centre hospitalo-universitaire, 67000 Strasbourg, France
| | - A Saunier
- Médecine interne et maladies infectieuses, centre hospitalier, 24750 Périgueux, France
| | - E Caumes
- Maladies infectieuses et tropicales, hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - K Bouiller
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, UMR CNRS 6249 Université Bourgogne Franche Comté, 25000 Besançon, France
| | - J F Gehanno
- Médecine du travail, centre hospitalo-universitaire, 76000 Rouen, France
| | - C Rabaud
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, 54100 Nancy, France
| | - S Perrot
- Centre d'étude et de traitement de la douleur, hôpital Cochin, 75014 Paris, France
| | - C Eldin
- Maladies infectieuses et tropicales, ihu méditerranée infection, centre hospitalo-universitaire Timone, 13000 Marseille, France
| | - T de Broucker
- Neurologie, hôpital Delafontaine, 92300 Saint-Denis, France
| | - F Roblot
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, inserm U1070, 86000 Poitiers, France
| | - J Toubiana
- Service de pédiatrie générale et maladies infectieuses, hôpital Necker-Enfants Malades, AP-HP, 75014 Paris, France
| | - F Sellal
- Département de neurologie, hôpitaux civil, 68000 Colmar, France
| | - F Vuillemet
- Département de neurologie, hôpitaux civil, 68000 Colmar, France
| | - C Sordet
- Rhumatologie, centre hospitalo-universitaire, 67000 Strasbourg, France
| | - B Fantin
- Médecine interne, hôpital Beaujon, université Paris Diderot, Inserm UMR 1137 IAME, 92110 Clichy, France
| | - G Lina
- Microbiologie, centre hospitalo-universitaire, 69000 Lyon, France
| | - C Sobas
- Microbiologie, centre hospitalo-universitaire, 69000 Lyon, France
| | - X Gocko
- Département de médecine générale, faculté de médecine, 42000 Saint-Etienne, France
| | - J Figoni
- Maladies Infectieuses et tropicales, hôpital Avicenne, 93022 Bobigny, France; Santé publique France, 94410 St Maurice, France
| | - C Chirouze
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, UMR CNRS 6249 Université Bourgogne Franche Comté, 25000 Besançon, France
| | - Y Hansmann
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, 67000 Strasbourg, France
| | - V Hentgen
- Pédiatrie, centre hospitalier, 78000 Versailles, France
| | - P Cathebras
- Médecine interne, hôpital Nord, centre hospitalo-universitaire, 42000 Saint-Etienne, France
| | - M Dieudonné
- Centre Max Weber, CNRS, Université Lyon 2, 69000 Lyon, France
| | - O Picone
- Maternité Louis Mourier, 92700 Colombes, France
| | - B Bodaghi
- Ophtalmologie, hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - J P Gangneux
- Laboratoire de parasitologie-Mycologie, UMR_S 1085 Irset université Rennes1-Inserm-EHESP, centre hospitalo-universitaire, 35000 Rennes, France
| | - B Degeilh
- Laboratoire de parasitologie-Mycologie, UMR_S 1085 Irset université Rennes1-Inserm-EHESP, centre hospitalo-universitaire, 35000 Rennes, France
| | - H Partouche
- Cabinet de médecine générale, Saint-Ouen, département de médecine Générale, faculté de médecine. université Paris Descartes, 93400 Paris, France
| | - C Lenormand
- Dermatologie, hôpitaux universitaires de Strasbourg et faculté de médecine, université de Strasbourg, 67000 Strasbourg, France
| | - A Sotto
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, 30000 Nîmes, France
| | - A Raffetin
- Maladies infectieuses et tropicales, centre hospitalier intercommunal, 94190 Villeneuve-St-Georges, France
| | - J J Monsuez
- Cardiologie, hôpital René Muret, 93270 Sevran, France
| | - C Michel
- Médecine générale, 67000 Strasbourg, France
| | - N Boulanger
- Médecine interne, hôpital Beaujon, université Paris Diderot, Inserm UMR 1137 IAME, 92110 Clichy, France
| | - C Lemogne
- Psychiatrie, hôpital européen Georges-Pompidou, AP-HP.5, Inserm U1266; Université Paris Descartes, 75015 Paris, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, centre hospitalo-universitaire, 35033 Rennes, France.
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Gillebert TC, Brooks N, Fontes-Carvalho R, Fras Z, Gueret P, Lopez-Sendon J, Salvador MJ, van den Brink RBA, Smiseth OA, Griebenow R, Kearney P, Vahanian A, Bauersachs J, Bax J, Burri H, Caforio ALP, Calvo F, Charron P, Ertl G, Flachskampf F, Giannuzzi P, Gibbs S, Goncalves L, Gonzalez-Juanatey JR, Hall J, Herpin D, Iaccarino G, Iung B, Kitsiou A, Lancellotti P, McDonough T, Monsuez JJ, Nunez IJ, Plein S, Porta-Sanchez A, Priori S, Price S, Regitz-Zagrosek V, Reiner Z, Ruilope LM, Schmid JP, Sirnes PA, Sousa-Ouva M, Stepinska J, Szymanski C, Taggart D, Tendera M, Tokgozoglu L, Trindade P, Zeppenfeld K, Joubert L, Carrera C. ESC Core Curriculum for the General Cardiologist (2013). Eur Heart J 2013; 34:2381-411. [DOI: 10.1093/eurheartj/eht234] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Monsuez JJ. [Specific cyclo-oxygenase-2 inhibitors in cardiovascular pathology]. Arch Mal Coeur Vaiss 2004; 97:632-40. [PMID: 15283037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Cyclo-oxygenase catalyses the conversion of arachidonic acid and O2 into prostaglandins. Its two isoenzymes, COX-1 and COX-2, have different functions. COX-1 is expressed in constituent form in most tissues where it controls the production of arachidonic acid metabolites which maintain the physiological tissue integrity. By contrast, COX-2 is only induced in response to inflammatory stimuli, resulting in the production of inflammation mediating prostaglandins. Conventional non-steroidal anti-inflammatories inhibit both enzymes in a non-specific manner. The recent development of specific COX-2 inhibitors, which retain the same anti-inflammatory efficacy but do not have the gastric side effects of conventional treatment related to COX-1 inhibition, gives them a greater safety margin. However, coronary events are observed in patients treated with COX-2 inhibitors. This risk, seemingly confirmed at least at higher dosages, has been attributed to a disequilibrium in the balance of thromboxane A2/prostacyclin (TxA2/PGI2) which they induce. Paradoxically, COX-2 inhibitors also have several favorable effects on atheromatous plaque progression and its inflammatory component, not only in vitro but also therapeutically, including situations where platelet activation and arterial thrombosis are predominant, such as in acute coronary syndrome. The salt retention induced by COX-2 inhibitors could also be the origin of an increase in blood pressure, and in susceptible subjects it could provoke cardiac decompensation. These multiple cardiovascular risks tinge the safety profile of COX-2 inhibitors, especially in elderly subjects and those with multiple pathology, for whom extra surveillance is required.
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Affiliation(s)
- J J Monsuez
- Service de médecine interne, hôpital Paul Brousse, Villejuif
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Monsuez JJ. [Mediators of reactive hyperemia]. Arch Mal Coeur Vaiss 2001; 94:591-9. [PMID: 11480157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Reactive hyperemia is a protective adaptive phenomenon, which quickly restores blood flow distal to a transient arterial occlusion. It involves the vascular tone regulation mechanisms of the ischaemic distal territory as a whole, but also its proximal control (flow-mediated dilation). The resulting vasodilatation differs from one vascular bed to another, and also between the large proximal arteries and the distal arterioles in the microcirculation. Thus, although both are elicited by a similar transient occlusion of brachial blood flow, non-invasive investigation of reactive hyperemia in the humeral circulation differs from assessment of endothelial function with the flow-mediated arterial dilation. Indeed, whereas nitric oxide (NO) plays the key-role in the later, several mediators are involved in the former, including myogenic and metabolic factors, prostaglandins, K + ATP channels, adenosine and NO which is only one of the many components of this complex regulation mechanism.
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Affiliation(s)
- J J Monsuez
- Service de médecine interne, hôpital Paul-Brousse, 12-14, avenue Paul-Vaillant-Couturier, F-94804 Villejuif
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Monsuez JJ, Dufaux J, Vittecoq D, Flaud P, Vicaut E. Hemorheology in asymptomatic HIV-infected patients. Clin Hemorheol Microcirc 2001; 23:59-66. [PMID: 11214714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Although cardiac and vascular complications have been recognized among patients infected with the Human Immunodeficiency Virus-1 (HIV-1), their vascular biology and rheology have not been studied. Rheology of red blood cells (RBC) was assessed with an erythroaggregometer in 22 HIV-1 infected asymptomatic patients (pts) and 17 healthy HIV negative controls (C). All participants were normotensive, nondiabetics, had normal lipid levels and had an hematocrit ranging from 37 to 44% and hemoglobin levels > or = 12 g/100 ml. Patients had a shorter RBC aggregation characteristic time than controls (1.49 +/- 0.17 vs. 2.04 +/- 0.41 s, p = 0.001) and an increased disaggregation shear rate (166 +/- 34.9 vs. 122 +/- 25.4 s(-1), p = 0.001). This hyperaggregation tendancy was associated with increased gamma-globulin (18.3 +/- 3.3 vs. 13.7 +/- 1.9 g/l, p = 0.01) and fibrinogen (3.52 +/- 0.57 vs 3.03 +/- 0.48 g/l, p = 0.003) levels and with an increased erythrocyte sedimentation rate (ESR) (25 +/- 14.3 vs. 12.3 +/- 7.5 mm, p = 0.02). Even in patients with ESRs ranging within normal values (< or = 20 mm), the aggregation characteristic time was found lower in patients than in controls (p = 0.004). There was no correlation between these rheological changes and the CD4+ T-cell count. The 17 patients receiving an antiviral therapy had lower CD4+ T-cell counts than their 5 untreated counterparts (244.7 +/- 167 vs. 410 +/- 106/mm3, p = 0.025), and a higher disaggregation shear rate (177.4 +/- 38.2 vs. 127 +/- 25.4, p = 0.01). Thus, an impairment of rheological characteristics is observed in asymptomatic HIV-I infected patients in association with changes in plasma proteins.
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, H pital Paul Brousse, Villejuif, France.
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Abstract
BACKGROUND Given that several pathology-based studies reported some degree of coronary and arterial vasculopathy in HIV-infected patients, we investigated whether abnormal vascular reactivity may also be found in these patients. METHODS Vascular reactivity was assessed noninvasively using finger-skin blood-flow monitoring by laser-Doppler flow measurement in 10 HIV-infected-patients (mean CD4 T-cell count, 350+/-84 cells/mm3) with cardiac symptoms (previous myocardial infarction or left-ventricular dysfunction) and/or HIV-related protease inhibitor-induced hyperlipemia (group 1, symptomatic), 19 HIV-infected patients free of cardiac disease, hyperlipemia, and previous opportunistic infections (mean CD4 T-cell count, 333+/-175 cells/mm3; group 2, asymptomatic), and 19 healthy control subjects (group 3). Laser-Doppler flow was measured at baseline, during postocclusive hyperemic response following transient interruption of brachial blood flow (reactive hyperemia), during transcutaneous delivery of acetylcholine (Ach) using iontophoresis (endothelium-dependent dilation) and after sublingual nitroglycerin administration (endothelium-independent dilation). RESULTS During reactive hyperemia, the absolute increase in flow was found to be lower in asymptomatic HIV-infected patients than in controls (median values [25th-75th percentile]: asymptomatic: 300 [200-400]; versus controls: 600 [400-750] arbitrary units [AU]; p< or =.0001). This abnormality was more pronounced in symptomatic patients (100 [100-200]; p< or =.0001). There was also a reduced peak/baseline flow ratio (symptomatic: 1.14 [1.1-1.2]; asymptomatic: 1.40 [1.25-1.5]; versus controls: 1.83 [1.6-2.2]; p<.0001 for both comparisons) and a reduced hyperemic response, as assessed by the curve of area under the flow versus time from deflation to the end of the hyperemic response (symptomatic: 1850 [1100-2225]; asymptomatic: 6000 [2850-7950]; versus controls: 23,735 [16,000-31, 800] AU x sec; p<.0001 for both comparisons). Although there was no statistically significant difference in acetylcholine (Ach)-induced increases in flow between asymptomatic HIV patients and controls (peak/baseline flow ratio: 6 [4.4-10] versus 5.3 [4-8]; p =.47), a trend to lower values was seen in symptomatic patients (4.4 [1.2-5]; p =.06). Administration of 0.4 mg sublingual nitroglycerin resulted in increases in flow without statistically significant difference between patients and controls: peak/baseline flow ratio for symptomatic: 2.4 [1.9-2.7]; asymptomatic: 2.1 [1.75-2.34] versus controls: 1.97 [1.8-2.4]; p =.2 and.83, respectively). CONCLUSIONS Postischemic reactive hyperemia is reduced in HIV-infected patients. In addition, there was is trend for a reduced response to Ach only in those with cardiac disease and/or hyperlipemia.
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, Hôpital Paul Brousse, Villejuif, France.
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Monsuez JJ, Gallet B, Escaut L, Vayre F, Charniot JC, Pulik M, Merad M, Minozzi C, Slama M, Weber S, Vittecoq D. Clinical outcome after coronary events in patients treated with HIV-protease inhibitors. Eur Heart J 2000; 21:2079-80. [PMID: 11102259 DOI: 10.1053/euhj.2000.2264] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Sellier P, Monsuez JJ, Evans J, Minozzi C, Passeron J, Vittecoq D, Dussaix E, Carcelain G, Lacroix-Jousselin C. Human immunodeficiency virus-associated polymyositis during immune restoration with combination antiretroviral therapy. Am J Med 2000; 109:510-12. [PMID: 11184772 DOI: 10.1016/s0002-9343(00)00562-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Monsuez JJ, Gallet B, Escaut L, Vayre F, Pulik M, Charniot JC, Merad M, Slama M, Weber S, Vittecoq D. [Cardiac side effects of anti-HIV agents]. Arch Mal Coeur Vaiss 2000; 93:835-40. [PMID: 10975035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Both nature and prognosis of cardiac complications occurring in patients infected by the Human Immunodeficiency Virus-1 (HIV-1) have changed considerably since the introduction of highly acive and anti-retroviral triple therapy ("HART"). Opportunist cardiac infections have thus been displaced and side effects of drugs now occupy the primary aetiological role. Torsades de pointe may be exceptionally triggered by anti-infectious agents such as pentacarinat or trimethoprime-sulfamethoxazole, as are those induced by the association of ketoconazole and terfenadine or cisapride, the dangers of which are well known and the prevention more effective, especially with the association with HIV antiproteases which inhibit the cytochrome P450. The diagnosis of iatrogenic myocardial dysfunction is more difficult, except when it occurs acutely as with phosphonoformate (Foscarnet), or interleukine-2. Progressive cardiomyopathy caused by -interferon and dideoxynucleosides (zidovudine, didanosine and zalcitabine), reversible on withdrawal of the drug responsible in half the cases, should be distinguished from those due to the HIV itself (therapeutic relay) or to another associated cause (alcohol, coronary artery disease). The coronary complications of diseases treated by antiproteases usually occur in smokers whose cholesterol and triglyceride levels are rapidly increased with HAART. In a series of 9 patients (amongst 700 treated with the antiproteases), after the acute phase of myocardial infarction during which the interventional approach is often preferred, the medium-term prognosis is relatively good, on condition that the patients correct the hyperlipidaemia and give up smoking.
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Affiliation(s)
- J J Monsuez
- Service de médecine interne, hôpital Paul-Brousse, Villejuif
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Sellier P, Monsuez JJ, Lacroix C, Feray C, Evans J, Minozzi C, Vayre F, Del Giudice P, Feuilhade M, Pinel C, Vittecoq D, Passeron J. Recurrent subcutaneous infection due to Scopulariopsis brevicaulis in a liver transplant recipient. Clin Infect Dis 2000; 30:820-3. [PMID: 10816153 DOI: 10.1086/313764] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of recurrent Scopulariopsis brevicaulis subcutaneous infection, which occurred 6 years after the patient underwent liver transplantation. Combined surgery and long-term oral therapy with terbinafine resulted in a favorable outcome, although this is not the rule in the previously reported S. brevicaulis infections in immunocompromised patients.
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Affiliation(s)
- P Sellier
- Service de Médecine Interne, Hôpital Paul Brousse, Villejuif, France.
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Monsuez JJ, Charniot JC. [Cardiac adverse events from non-cardiac drugs]. Ann Cardiol Angeiol (Paris) 1999; 48:447-53. [PMID: 12555343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Prevention of adverse events of non-cardiological medicinal products is essentially based on the knowledge that they exist and quantification of the risk to which the patient is exposed, both in terms of frequency and potential severity.
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Affiliation(s)
- J J Monsuez
- Service de Médecine Interne, Hôpital Paul Brousse, 12, avenue Paul Vaillant Couturier, F 94804 Villejuif
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Abstract
An adult male patient was admitted for a pericardial effusion occurring during a longstanding mesalazine treatment for Crohn's disease. The relation between the drug's administration, symptoms and ECG changes suggests that the pericardial injury was caused by mesalazine. Also, the rapid resolution of clinical signs and ECG changes following the drug withdrawal were in agreement with this hypothesis. Eight months later, the patient remains well and symptom-free, and ECG and echocardiographic control were normal.
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Monsuez JJ, Vittecoq D, Musset L, Alemanni M, Dussaix E, Autran B. Arthralgias and cryoglobulinemia during protease inhibitor therapy in a patient infected with human immunodeficiency virus and hepatitis C virus. Arthritis Rheum 1998; 41:740-3. [PMID: 9550487 DOI: 10.1002/1529-0131(199804)41:4<740::aid-art25>3.0.co;2-m] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present the case of a woman who had a chronic infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). She developed severe polyarthralgias associated with type II mixed cryoglobulinemia during therapy with an HIV-1 protease inhibitor. This therapy resulted in a dramatic increase in her CD4+ T cell count, from 70/mm3 to 567/mm3, which was composed of a high proportion (88%) of naive CD45RA+ CD62L+ cells, together with a recovery of her CD4+ T cell reactivity to antigenic stimulation. This may suggest that rapid recovery of immune competence in the CD4+ T helper subset might participate in the development of immunopathologic events such as this patient's cryoglobulinemia.
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, Hôpital Paul Brousse, Villejuif, France
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, Hôpital Paul Brousse, Paris, France
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, Hôpital Paul Brousse, Villejuif, France
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Adult
- Diagnosis, Differential
- Echocardiography
- Fatal Outcome
- HIV-1/isolation & purification
- Homosexuality, Male
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/therapy
- Male
- Plasma Exchange
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/therapy
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Abstract
Although the use of central venous silicone catheters is widespread, little is known about the incidence of catheter rupture and embolization. Over a three-year period, 3916 silicone catheters were inserted in 3672 patients in the authors' hospital. Catheter or catheter fragments embolism occurred in 4 patients (1.2 embolizations per 1000 patients treated). Inappropriate mechanical deobstruction attempts resulted in 2 embolizations, and hence, these should be avoided. Chest roentgenography failed to detect the small fragments within the heart silhouette in 2 cases. Two-dimensional echocardiography showed the separated catheter fragment in all 4 cases. All four catheter fragments were subsequently removed from the right-heart chambers.
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Affiliation(s)
- J J Monsuez
- Emergency Room and Intensive Care Unit, Hôpital Saint-Louis, Paris, France
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Monsuez JJ, Vittecoq D, Kinney EL. Increased survival of AIDS patients with heart disease within 10 years? Circulation 1996; 94:2312-3. [PMID: 8901697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Monsuez JJ, Mathieu D, Arnoult F, Passeron J. Cutaneous diphtheria in a homeless man. Lancet 1995; 346:649-50. [PMID: 7651047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Monsuez JJ, Fergelot H, Le Gall JR. Homeless in the emergency department. Lancet 1995; 346:55. [PMID: 7603165 DOI: 10.1016/s0140-6736(95)92686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Monsuez JJ, Papon BJ, Lachurié ML, Passeron J. Sudden cardiac death in heart failure: the role of abnormal repolarization. Circulation 1995; 91:1899-900. [PMID: 7882505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Monsuez JJ, Lachurie ML, Passeron J. Improvement of age-related impairment in left ventricular diastolic filling with verapamil in the normal human heart. Circulation 1995; 91:1275-6. [PMID: 7850972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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29
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Abstract
Two patients with eosinophilic endomyocardial disease related to peripheral T-cell lymphomas are reported. Both patients were free of cardiac symptoms at presentation and during follow-up. Routine two dimensional echocardiography revealed bi-apical ventricular obliteration, which was also seen on MR imaging. On the T1-weighted sequence, the thickened endocardium appeared with an isointense signal. Gadolinium DOTA provided an enhanced contrast of the internal part of the left ventricular wall. On T2-weighted sequence, a thin hypointense curvilinear structure drew a dividing line between the internal, endocardial, and the external, myocardial area. Left-ventricular systolic and diastolic functions remained unaltered during subsequent follow-up.
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Affiliation(s)
- J J Monsuez
- Department of Haematology, Hôpital Saint Louis, Paris, France
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30
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Monsuez JJ, Fergelot H, Papon BJ, Le Gall JR. Early social intervention in the emergency department. Eur J Med 1993; 2:489-92. [PMID: 8258050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To assess the usefulness of an early medical social intervention conducted by a specially oriented medical social workers stationed in the Emergency Department. METHODS Prospective study during a 2-month reference period, in a 900-bed inner-city teaching hospital that has approximatively 30,000 emergency department visits annually, providing health care facilities for a metropolitan area with a population of 230,000. RESULTS Among 6,000 patients presenting to the emergency department during the study, 72 were found to require social intervention (1.2% of all emergency department visits, 6.85% of admissions to the hospital). Social intervention consisted of telephone calls (89%), correspondence by letters (26.5%), counsel and advice (23.5%), out-hospital intervention (14%) and resulted in: house-keeping help (34.5%) or transferal to nursing homes or nursing hospitals (28%) of elderly patients; aid to homeless and socially disadvantaged people, such as transferal to homing city shelters, clothing supply, etc., allowing extra hospital maintenance (23.5%); regularization of health insurance affiliation (10%); aid in various other social situations (22%). CONCLUSION An early medical social intervention in the emergency department resulted in alternatives to hospital admission for a high proportion of patients (82%).
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Affiliation(s)
- J J Monsuez
- Emergency Room and Intensive Care Unit, Hopital Saint-Louis, Paris, France
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31
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Monsuez JJ, Janier M, Van-Cao AN, Le Gall JR. Absence of enhancement of spontaneous echocardiographic contrast by thrombocytosis in a patient with left ventricular aneurysm, primary thrombocythemia, and von Recklinghausen neurofibromatosis: a case report. Angiology 1993; 44:651-4. [PMID: 8342882 DOI: 10.1177/000331979304400810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A thirty-eight-year-old man with primary thrombocythemia, von Recklinghausen neurofibromatosis, and myocardial-infarction-related left ventricular aneurysm with spontaneous echocardiographic contrast was followed up, suggesting that: 1. Neurofibromatosis may promote silent myocardial infarction or ischemia. Whether involvement of cardiac sensory nerves is a possible underlying mechanism remains nevertheless uncertain. 2. Platelets, whose role in the genesis of spontaneous echocardiographic contrast has been advocated, are probably not involved in this phenomenon, even in large numbers.
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Affiliation(s)
- J J Monsuez
- Intensive Care Unit, Hôpital Saint-Louis, Paris, France
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Monsuez JJ, Deland E, Rabbat A, Bourquelot P, Jacob L, Pages A, Le Gall JR. Constrictive pericarditis developing forty-five years after gunshot wound. J Thorac Cardiovasc Surg 1992; 104:846-8. [PMID: 1513176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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33
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Monsuez JJ, Leleu-Nahmias G, Garrouste M, Frija J, Le Gall JR. Spontaneous echocardiographic contrast as a diagnostic tool for ruptured aneurysms of the aortic arch. J Thorac Cardiovasc Surg 1992; 103:601-3. [PMID: 1545563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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34
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Monsuez JJ, Frija J, Hertz-Pannier L, Miclea JM, Extra JM, Boiron M. Non-Hodgkin's lymphoma with cardiac presentation: evaluation and follow-up with echocardiography and MR imaging. Eur Heart J 1991; 12:464-7. [PMID: 2040331 DOI: 10.1093/oxfordjournals.eurheartj.a059918] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cardiac presentation of non-Hodgkin's lymphoma is rare and usually associated with a short survival. Two cases were documented and followed-up with echocardiography and magnetic resonance imaging (MRI). The tumoral masses were accurately delineated by MRI. A non-delayed diagnosis ensued and, in association with a multiple drug antimitotic therapy, an improved prognosis obtained.
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Affiliation(s)
- J J Monsuez
- Department of Haematology, Hôpital Saint-Louis, Paris, France
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35
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Brice P, Tredaniel J, Monsuez JJ, Marolleau JP, Ferme C, Hennequin C, Frija J, Gisselbrecht C, Boiron M. Cardiopulmonary toxicity after three courses of ABVD and mediastinal irradiation in favorable Hodgkin's disease. Ann Oncol 1991; 2 Suppl 2:73-6. [PMID: 1710923 DOI: 10.1007/978-1-4899-7305-4_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The combination of chemotherapy and radiotherapy in Hodgkin's disease has been associated with iatrogenic effects. Forty adult patients were studied to evaluate the early toxicity following three courses of ABVD (cumulative dose of doxorubicin [Adriamycin] 150 mg/m2, and bleomycin 60 mg) and mediastinal irradiation at 40 Gy. Cardiopulmonary toxicity was assessed from six months to three years after completion of irradiation. Of the 40 patients, all of whom were in complete remission from Hodgkin's disease, 6 experienced dyspnea on exertion. In studies related to Cardiac toxicity, the left ventricular ejection fraction ranged from 50 to 77% (mean 63%); 8 patients had a minor pericardial effusion, 4 had valvular calcification, and 6 had minimal cardiac abnormalities. With regard to pulmonary toxicity, CT scan showed a small pleural effusion with pleural thickening in 19 patients and mediastinal or apical fibrosis in 15 patients. The total pulmonary capacity value was low (less than 80%), in 19 patients, and decreased carbon monoxide diffusion capacity (less than 70%) was found in 10 patients. We conclude that early cardiac toxicity was absent despite the use of Adriamycin and mediastinal irradiation. Pulmonary toxicity was present but minor, and it may decrease with the use of smaller fraction sizes for mantle field irradiation.
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Affiliation(s)
- P Brice
- Institut d'hématologie, Hôpital Saint-Louis, Paris, France
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36
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Grange F, Kinney EL, Monsuez JJ, Rybojad M, Derouin F, Khuong MA, Janier M. Successful therapy for Toxoplasma gondii myocarditis in acquired immunodeficiency syndrome. Am Heart J 1990; 120:443-4. [PMID: 2382625 DOI: 10.1016/0002-8703(90)90098-i] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F Grange
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
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Affiliation(s)
- J J Monsuez
- Department of Hematology, Hôpital Saint-Louis, Paris, France
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Abstract
Although the diagnosis of AIDS-associated heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then administration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphotericin B. The response, which included resolution of congestive heart failure, occurred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.
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Abstract
Intracranial mycotic aneurysms (IMA) occur in 1-3% of all infective endocarditis. Although spontaneous resolution was evidenced on serial angiograms in many asymptomatic cases, the prognosis, if they rupture, is reported to be worse and partly contingent on the therapeutic approach. Among 12 patients (six acute and six subacute endocarditis) with ruptured IMA, six were treated surgically and four were treated medically. Two patients died during rupture before any treatment could be started. Six patients had a sudden rupture manifested by coma, less clear consciousness seizures, hemiparesis unilateral mydriasis. CT-Scan showed intracerebral, intraventricular and subarachnoid haemorrhage. Ten angiograms showed 11 IMA. For patients with ruptured IMA, the decision for surgical treatment was made in the presence of deepening coma and extensive mass-lesion on CT-scan (one of six died in the postoperative period). Others received medical treatment (four cases: all survived) and were followed-up with serial angiographies. Of the nine patients who survived, five remained free of any disability 1-4 years later. We suggest that the prognosis of ruptured IMA (25% mortality rate) is not as bad as previously reported if surgery following angiography is performed early in the presence of deepening coma and extensive lesion.
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Monsuez JJ. [Treatment of severe cytomegalovirus infections with DHPG]. Soins 1989:12-5. [PMID: 2554508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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41
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Levy M, Brion N, Cremieux AC, Monsuez JJ. [Antibiotic prophylaxis in cardiac surgery in France]. Pathol Biol (Paris) 1989; 37:472-6. [PMID: 2780104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Prophylactic administration of antibiotics in patients undergoing cardiac surgery is now an established procedure. The interest of a short prophylaxis (less then 48 h), directed mainly against Gram positive cocci has been demonstrated. However, there is no general agreement as to the agent to be used. We thus conducted a survey of the current practice of antibiotic prophylaxis (ABP) by sending a detailed questionnaire to each of the 51 centers performing cardiac surgery in France. 48 replies (94%) were received. Monotherapy was used in 42 centers, with cephalosporins in 41 (cefamandole: 22, cefazolin: 10, cefuroxime: 4, cephalothin: 3, cefotiam: 2) and with minocycline in one center. Six centers used a combination including aminoglycoside. Mean duration of ABP was 1.8 +/- 1.2 d. First dose of antibiotic was given before cardiopulmonary (C-P) bypass intravenously. In 29 centers, AB was injected into the C-P pump. Mean dosage of cephalosporin before surgery was 25 mg/kg and total dosage was 70 mg/kg/24 h. We conclude that cephalosporins are almost exclusively chosen in France contrasting with other european countries such as the United Kingdom where the most used regimen is a combination of penicillinase-resistant penicillin and an aminoglycoside.
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Affiliation(s)
- M Levy
- Groupe de Recherche et d'Etudes Scientifiques, Paris
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42
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Rouffy J, Chanu B, Bakir R, Goy-Loeper J, Djian F, Monsuez JJ, Gomberg R, Laval-Jeantet M. Changes in lipid and lipoprotein levels and Achilles tendon diameters and indices in familial hypercholesterolaemic patients with tendinous xanthomatosis treated by diet and bezafibrate for 2 years. Curr Med Res Opin 1988; 11:123-32. [PMID: 3219880 DOI: 10.1185/03007998809110455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Thirteen young adult patients suffering from heterozygotic familial hypercholesterolaemia with tendinous xanthomatosis, previously treated with a suitable special diet, were studied to assess the effect of bezafibrate, given for 2 years at a dose of 800 mg/day, on plasma lipid and lipoprotein levels and on changes in size of the Achilles tendon xanthomas. Measurements were made before and at intervals during treatment, the tendinous xanthomas being measured by an echographic procedure to give data on antero-posterior and lateral diameters, thus enabling an Achilles tendon index to be defined. The results confirm the hypolipidaemic activity of bezafibrate, changes in the levels of total cholesterol, triglycerides, lipids and lipoproteins (LDL, VLDL and HDL) being similar in direction and magnitude to those reported previously. A significant regression in the size of the Achilles tendon xanthomas was observed in 11 of the 13 patients, and the regression in the Achilles tendon index correlated significantly with a favourable change in the ratio HDL/LDL + VLDL. It is suggested that, as a result of this objective observation, a favourable effect of bezafibrate treatment would possibly be seen on the anatomical atheromatous lesions which are usual in this type of hyperlipidaemia.
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Affiliation(s)
- J Rouffy
- Department of Internal Medicine and Vascular Pathology, Hôpital Saint-Louis, Paris, France
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44
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Vilmer E, Vittecoq D, Autran B, Rozenbaum W, Dormont D, Rabian C, Bourhis JH, Monsuez JJ, Benbunan M, Gluckman E. Is lymphocyte transfer a promising therapeutic approach towards AIDS? Ann Inst Pasteur Immunol 1987; 138:269-73. [PMID: 3300702 DOI: 10.1016/s0769-2625(87)80078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Monsuez JJ, Drobinski G, Verdière C, Chollet D, Grosgogeat Y. [Prospective study of the prevalence of coronary involvement in isolated aortic stenosis]. Ann Cardiol Angeiol (Paris) 1985; 34:65-9. [PMID: 3985555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
From 1980 to 1982, 148 consecutive patients with isolated aortic stenosis (AS) were studied prospectively with coronary angiography. Significant coronary artery disease was discovered in 27 patients (18.4 percent of cases), with involvement of the left main coronary artery 4 times (15 percent of cases), three-vessel involvement 10 times (37 percent of cases), two-vessel involvement 8 times (30 percent of cases), and single-vessel involvement 9 times (33 percent of cases). Clinical information such as age, sex, the existence of angina (present in 81 out of 148 patients, or 54.7 percent of cases), or electrocardiographic findings could not accurately predict coronary artery involvement except for the previous history of a myocardial infarction. Five patients with coronary artery lesions had no manifestations of angina, comprising 18.5 percent of patients with coronary artery disease, 3.4 percent of the entire group of 148 patients with AS, and 7 percent of patients without angina. This study's originality resides in the fact that it is a prospective study which demonstrates that coronary artery lesions associated with AS can often be severe and can not be predicted without coronary angiography. No other examination can reliably identify the association of these two conditions, making coronary angiography a routine part of the preoperative evaluation of AS if these lesions are to be discovered.
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Wyler Y, Grand J, Monsuez JJ, Breuzard J, Corone P. [Carotid and femoral mechanographical tracings. Their value in the diagnosis and postoperative surveillance of coarctations]. Arch Mal Coeur Vaiss 1980; 73:1111-5. [PMID: 6776930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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