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de Valence B, Delaune M, Nguyen Y, Jachiet V, Heiblig M, Jean A, Riescher Tuczkiewicz S, Henneton P, Guilpain P, Schleinitz N, Le Guenno G, Lobbes H, Lacombe V, Ardois S, Lazaro E, Langlois V, Outh R, Vinit J, Martellosio JP, Decker P, Moulinet T, Dieudonné Y, Bigot A, Terriou L, Vlakos A, de Maleprade B, Denis G, Broner J, Kostine M, Humbert S, Lifermann F, Samson M, Pechuzal S, Aouba A, Kosmider O, Dion J, Grosleron S, Bourguiba R, Terrier B, Georgin-Lavialle S, Fain O, Mekinian A, Morgand M, Comont T, Hadjadj J. Serious infections in patients with VEXAS syndrome: data from the French VEXAS registry. Ann Rheum Dis 2024; 83:372-381. [PMID: 38071510 DOI: 10.1136/ard-2023-224819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/07/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an acquired autoinflammatory monogenic disease with a poor prognosis whose determinants are not well understood. We aimed to describe serious infectious complications and their potential risk factors. METHODS Retrospective multicentre study including patients with VEXAS syndrome from the French VEXAS Registry. Episodes of serious infections were described, and their risk factors were analysed using multivariable Cox proportional hazards models. RESULTS Seventy-four patients with 133 serious infections were included. The most common sites of infection were lung (59%), skin (10%) and urinary tract (9%). Microbiological confirmation was obtained in 76%: 52% bacterial, 30% viral, 15% fungal and 3% mycobacterial. Among the pulmonary infections, the main pathogens were SARS-CoV-2 (28%), Legionella pneumophila (21%) and Pneumocystis jirovecii (19%). Sixteen per cent of severe infections occurred without any immunosuppressive treatment and with a daily glucocorticoid dose ≤10 mg. In multivariate analysis, age >75 years (HR (95% CI) 1.81 (1.02 to 3.24)), p.Met41Val mutation (2.29 (1.10 to 5.10)) and arthralgia (2.14 (1.18 to 3.52)) were associated with the risk of serious infections. JAK inhibitors were most associated with serious infections (3.84 (1.89 to 7.81)) compared with biologics and azacitidine. After a median follow-up of 4.4 (2.5-7.7) years, 27 (36%) patients died, including 15 (56%) due to serious infections. CONCLUSION VEXAS syndrome is associated with a high incidence of serious infections, especially in older patients carrying the p.Met41Val mutation and treated with JAK inhibitors. The high frequency of atypical infections, especially in patients without treatment, may indicate an intrinsic immunodeficiency.
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Affiliation(s)
| | - Marion Delaune
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Yann Nguyen
- Médecine interne, Université Paris Cité, Hôpital Beaujon, Clichy, France
| | - Vincent Jachiet
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Mael Heiblig
- Hématologie clinique, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Alexis Jean
- Médecine interne, CHU de Bordeaux, Bordeaux, France
| | | | - Pierrick Henneton
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Philippe Guilpain
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Nicolas Schleinitz
- Médecine interne, Aix-Marseille Universite, Hôpital de la Timone, Marseille, France
| | | | - Hervé Lobbes
- Médecine interne, CHU Estaing, Clermont-Ferrand, France
| | - Valentin Lacombe
- Médecine interne et immunologique clinique, CHU Angers, Angers, France
| | | | | | - Vincent Langlois
- Médecine interne et infectieuse, Hospital Group Le Havre, Le Havre, France
| | - Roderau Outh
- Service de médecine interne et générale, CH Perpignan, Perpignan, France
| | - Julien Vinit
- Médecine interne, Hospital Centre Chalon-sur-Saon, Chalon-sur-Saone, France
| | | | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Yannick Dieudonné
- Immunologie Clinique et Médecine Interne, CHU de Strasbourg, Strasbourg, France
| | | | - Louis Terriou
- Médecine interne - hématologie, CHU Lille, Lille, France
| | - Alexandre Vlakos
- Médecine interne, Haute-Saône Hospital Group Vesoul Site, Vesoul, France
| | | | - Guillaume Denis
- Médecine interne et hématologie, Centre Hospitalier de Rochefort, Rochefort, France
| | | | - Marie Kostine
- Rhumatologie, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Sebastien Humbert
- Hématologie, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | | | - Susann Pechuzal
- Médecine interne-polyvalente, Hôpitaux Drôme Nord, Romans, France
| | | | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Jeremie Dion
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | | | - Rim Bourguiba
- Médecine interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Benjamin Terrier
- Médecine interne, Université Paris Cité, Hospital Cochin, Paris, France
| | | | - Olivier Fain
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Arsène Mekinian
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Marjolaine Morgand
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Thibault Comont
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Jerome Hadjadj
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
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Arnaud L, Costedoat-Chalumeau N, Mathian A, Sailler L, Belot A, Dion J, Morel N, Moulis G. French practical guidelines for the diagnosis and management of relapsing polychondritis. Rev Med Interne 2023:S0248-8663(23)00591-X. [PMID: 37236870 DOI: 10.1016/j.revmed.2023.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Relapsing polychondritis is a rare systemic disease. It usually begins in middle-aged individuals. This diagnosis is mainly suggested in the presence of chondritis, i.e. inflammatory flares on the cartilage, in particular of the ears, nose or respiratory tract, and more rarely in the presence of other manifestations. The formal diagnosis of relapsing polychondritis cannot be established with certainty before the onset of chondritis, which can sometimes occur several years after the first signs. No laboratory test is specific of relapsing polychondritis, the diagnosis is usually based on clinical evidence and the elimination of differential diagnoses. Relapsing polychondritis is a long-lasting and often unpredictable disease, evolving in the form of relapses interspersed with periods of remission that can be very prolonged. Its management is not codified and depends on the nature of the patient's symptoms and association or not with myelodysplasia/vacuoles, E1 enzyme, X linked, autoinflammatory, somatic (VEXAS). Some minor forms can be treated with non-steroidal anti-inflammatory drugs, or a short course of corticosteroids with possibly a background treatment of colchicine. However, the treatment strategy is often based on the lowest possible dosage of corticosteroids combined with background treatment with conventional immunosuppressants (e.g. methotrexate, azathioprine, mycophenolate mofetil, rarely cyclophosphamide) or targeted therapies. Specific strategies are required if relapsing polychondritis is associated with myelodysplasia/VEXAS. Forms limited to the cartilage of the nose or ears have a good prognosis. Involvement of the cartilage of the respiratory tract, cardiovascular involvement, and association with myelodysplasia/VEXAS (more frequent in men over 50years of age) are detrimental to the prognosis of the disease.
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Affiliation(s)
- L Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Auto-Immunes Est Sud-Ouest (RESO), Strasbourg, France.
| | - N Costedoat-Chalumeau
- Department of Internal Medicine, Île-de-France Rare Autoimmune and Systemic Diseases Reference Centre, hôpital Cochin, Paris, France; University of Paris Cité, Paris, France; Inserm U1153, Centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), Paris, France
| | - A Mathian
- Service de médecine interne 2, Institut E3M, Inserm UMRS, Centre d'immunologie et des maladies infectieuses (CIMI-Paris)groupement hospitalier Pitié-Salpêtrière, Centre de référence du lupus, syndrome des anticorps antiphospholipides et autres maladies auto-immunes rares, Assistance publique-Hôpitaux de Paris, Paris, France
| | - L Sailler
- Internal Medicine Department URM Pavilion C.I.C. 1436 - module plurithématique adulte, hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - A Belot
- Department of Paediatric Nephrology-Rheumatology-Dermatology, Mère-enfant Hospital, hospices civils de Lyon, Lyon, France
| | - J Dion
- Department of Internal Medicine, Île-de-France Rare Autoimmune and Systemic Diseases Reference Centre, hôpital Cochin, Paris, France; University of Paris Cité, Paris, France; Inserm U1153, Centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), Paris, France
| | - N Morel
- Department of Internal Medicine, Île-de-France Rare Autoimmune and Systemic Diseases Reference Centre, hôpital Cochin, Paris, France; University of Paris Cité, Paris, France; Inserm U1153, Centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), Paris, France
| | - G Moulis
- Internal Medicine Department URM Pavilion C.I.C. 1436 - module plurithématique adulte, hôpital Purpan, CHU de Toulouse, Toulouse, France
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Zadro Y, Cougoul P, Dion J, Moulis G, Lusque A, Thomazeau J, Zordan J, Gauthier M, Ysebaert L, Comont T. Traitement du PTI et de l’AHAI associés aux hémopathies lymphoïdes B indolentes : faut-il traiter le clone ? Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Larrauffie A, Syrykh C, Tavitian S, Comont T, Dion J. Activated PI3 Kinase Delta Syndrome Revealed by Vasculitis and Disseminated Toxoplasmosis. J Clin Immunol 2022; 42:688-690. [PMID: 35022947 DOI: 10.1007/s10875-021-01186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Aurore Larrauffie
- Department of Internal Medicine and Clinical Immunopathology - IUCT-Oncopole, Centre Hospitalier Universitaire de Toulouse, 1, avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Charlotte Syrykh
- Department of Pathology - IUCT-Oncopole, Centre Hospitalier Universitaire de Toulouse, 1, avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Suzanne Tavitian
- Department of Hematology - IUCT-Oncopole, Centre Hospitalier Universitaire de Toulouse, 1, avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Thibault Comont
- Department of Internal Medicine and Clinical Immunopathology - IUCT-Oncopole, Centre Hospitalier Universitaire de Toulouse, 1, avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Jeremie Dion
- Department of Internal Medicine and Clinical Immunopathology - IUCT-Oncopole, Centre Hospitalier Universitaire de Toulouse, 1, avenue Irène-Joliot-Curie, 31059, Toulouse, France.
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Comont T, Heiblig M, Riviere E, Terriou L, Rossignol J, Bouscary D, Rieu V, Le Guenno G, Mathian A, Aouba A, Vinit J, Dion J, Kosmider O, Terrier B, Georgin-Lavialle S, Fenaux P, Mekinian A. Utilisation de l’azacitidine dans le VEXAS chez des patients porteurs d’un syndrome myélodysplasique : données du registre Français VEXAS. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Comont T, Dion J, Baroudjian B, Ezine E, Careira C, Anderle A, Apalla Z, Freites-Martinez A, Meyer N, Sibaud V. Sarcoïdose induite par les inhibiteurs de BRAF-MEK : série rétrospective européenne. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Comont T, Heiblig M, Rivière E, Terriou L, Rossignol J, Bouscary D, Rieu V, Le Guenno G, Mathian A, Aouba A, Vinit J, Dion J, Kosmider O, Terrier B, Georgin-Lavialle S, Fenaux P, Mekinian A. Azacitidine for patients with Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic syndrome (VEXAS) and myelodysplastic syndrome: data from the French VEXAS registry. Br J Haematol 2021; 196:969-974. [PMID: 34651299 DOI: 10.1111/bjh.17893] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
Azacitidine can be effective in myelodysplastic syndromes (MDS) associated with inflammatory/autoimmune diseases. Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic syndrome (VEXAS) is a new monogenic autoinflammatory syndrome caused by somatic ubiquitin-like modifier-activating enzyme 1 (UBA1) mutation, often associated with MDS, whose treatment is difficult and not yet codified. Based on a French nationwide registry of 116 patients with VEXAS, we report the efficacy and safety of azacitidine treatment in 11 patients with VEXAS with MDS. Clinical response of VEXAS to azacitidine was achieved in five patients (46%), during 6, 8+, 12, 21, 27+ months respectively, suggesting that azacitidine can be effective in selected patients with VEXAS and associated MDS.
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Affiliation(s)
- Thibault Comont
- Department of Internal Medicine, IUCT-Oncopole, University Hospital of Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Mael Heiblig
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Université Lyon Sud, Pierre Bénite, France
| | - Etienne Rivière
- Department of Internal Medicine, University of Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - Louis Terriou
- Department of Internal Medicine and Clinical Immunology, University of Lille, CHU Lille, Lille, France
| | - Julien Rossignol
- French Reference Center for Mastocytosis (CEREMAST), Hôpital Necker, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Didier Bouscary
- Departement of Hematology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Virginie Rieu
- Department of Internal Medicine, University Hospital Estaing, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, University Hospital Estaing, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexis Mathian
- Department of Internal Medicine, Pitie-Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Achille Aouba
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, Université de Caen, Caen, France
| | - Julien Vinit
- Department of Internal Medicine, CHWM, Chalon-sur-Saône, France
| | - Jeremie Dion
- Department of Internal Medicine, IUCT-Oncopole, University Hospital of Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Olivier Kosmider
- Hematology laboratory, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris (AP-HP), Tenon Hospital, National reference center for autoinflammatory diseases and AA amyloidosis (CEREMAIA), Sorbonne University, Université de Paris, Paris, France
| | - Pierre Fenaux
- Department of Hematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Sorbonne University, Paris, France
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Sorin B, Samson M, Durel C, Diot E, Guichard I, Grados A, Limal N, Régent A, Cohen P, Dion J, Legendre P, Le Guern V, Mouthon L, Guillevin L, Terrier B. Étude de l’association rituximab et methotrexate dans les vascularites associées aux ANCA. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rieu JB, El Kassir A, Largeaud L, Dion J, Comont T, Mansat-De Mas V. Characteristic vacuolisation of granulocytic and erythroid precursors associated with VEXAS syndrome. Br J Haematol 2021; 194:8. [PMID: 33651376 DOI: 10.1111/bjh.17381] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jean-Baptiste Rieu
- Haematology Laboratory Medicine, Cancer University Institute of Toulouse - Oncopole, Toulouse, France
| | - Ali El Kassir
- Haematology Laboratory Medicine, Cancer University Institute of Toulouse - Oncopole, Toulouse, France
| | - Laetitia Largeaud
- Haematology Laboratory Medicine, Cancer University Institute of Toulouse - Oncopole, Toulouse, France
| | - Jeremie Dion
- Department of Internal Medicine, Cancer University Institute of Toulouse - Oncopole, Toulouse, France
| | - Thibault Comont
- Department of Internal Medicine, Cancer University Institute of Toulouse - Oncopole, Toulouse, France
| | - Veronique Mansat-De Mas
- Haematology Laboratory Medicine, Cancer University Institute of Toulouse - Oncopole, Toulouse, France
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Catano J, Uzunhan Y, Paule R, Dion J, Régent A, Legendre P, Cohen P, Puéchal X, Le Guern V, Mouthon L, Lorut C, Lacroix C, Périé S, Terrier B. Spectre étiologique des sténoses sous-glottiques dans les maladies dysimmunitaires. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marcombes C, Lafont E, Jullien V, Flamarion E, Dion J, Costedoat-Chalumeau N, Pouchot J, Arlet JB. [Sickle cell trait complications: A case series of 6 patients]. Rev Med Interne 2020; 41:583-590. [PMID: 32768266 DOI: 10.1016/j.revmed.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with sickle cell trait (SCT) are commonly considered as asymptomatic carriers. However, some clinical manifestations may occur. METHODS Here we present a retrospective descriptive study about SCT subjects with at least one complication diagnosed in a sickle cell disease referral center, in Paris, between 2008 and 2019. We also performed a literature review on the complications of SCT subjects. RESULTS Six patients (between 19 and 65 years old) were included. SCT was already known only for 4 of them at the time of the complication. Four patients presented with a splenic infarct after a stay in high altitude or a plane trip, one of them was associated with papillary necrosis; one patient had isolated papillary necrosis, and the last one had splenic sequestration. These complications happened for most of them after exposure to an unusual situation of hypoxia or deshydratation. Five out of 6 patients had a marked elevated C reactive protein. CONCLUSION SCT may cause acute ischemic complications in a context of prolonged hypoxia or dehydration. The most commonly reported are the splenic infarct and the renal papillary necrosis. A study of hemoglobin should be considered in these clinical situations in patients with compatible ethnic origin.
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Affiliation(s)
- C Marcombes
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Lafont
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - V Jullien
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Flamarion
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - J Dion
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - N Costedoat-Chalumeau
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France; Département de médecine interne, Hôpital Cochin (AP-HP), rue Saint Jacques, 75014 Paris, France
| | - J Pouchot
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - J B Arlet
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France.
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Lenfant T, Dion J, Maisonobe T, Costedoat-Chalumeau N. [A rare cause of impaired general condition: Muscular and cardiac toxicity of antimalarials]. Rev Med Interne 2020; 41:335-338. [PMID: 32334861 DOI: 10.1016/j.revmed.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION This case report signifies the need to systemically assess antimalarial toxicity in those undergoing long-term treatment. CASE REPORT A 59-year-old man with a history of ischemic-labeled heart disease revealed by conduction disorders and cutaneous lupus treated initially with hydroxychloroquine followed by chloroquine consulted for asthenia and weight loss. Clinically, he had a muscular atrophy, a motor deficit, and an abolition of the osteo-tendinous reflexes in the lower limbs. Adverse drug effects of the antimalarial therapy were suspected-specifically, muscular and cardiac toxicity. The diagnosis was confirmed with a muscle biopsy, which showed typical and florid vacuolar myopathy. Cessation of the drug resulted in a slow regression of symptoms. CONCLUSION Cardiac and muscular toxicity related to antimalarials are rare and sometimes fatal; thus, they must be systematically assessed in a patient with several years of exposure. A muscle biopsy could be sufficient to allow for the diagnosis.
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Affiliation(s)
- T Lenfant
- Service de médecine interne pôle médecine, centre de référence maladies auto-immunes et systémiques rares, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - J Dion
- Service de médecine interne pôle médecine, centre de référence maladies auto-immunes et systémiques rares, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - T Maisonobe
- Département de neuropathologie, neurophysiologie clinique, CHU Pitié-Salpêtrière, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - N Costedoat-Chalumeau
- Service de médecine interne pôle médecine, centre de référence maladies auto-immunes et systémiques rares, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France.
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Tieu A, Chaigne B, Dunogué B, Dion J, Regent A, Legendre P, Terrier B, Costedoat-Chalumeau N, Le Jeunne C, Mouthon L. Anticorps versus phénotype dans la sclérodermie systémique : une étude de cas-témoins. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Madaelil TP, Grossberg JA, Howard BM, Cawley CM, Dion J, Nogueira RG, Haussen DC, Tong FC. Aneurysm Remnants after Flow Diversion: Clinical and Angiographic Outcomes. AJNR Am J Neuroradiol 2019; 40:694-698. [PMID: 30846433 DOI: 10.3174/ajnr.a6010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion is an established method to treat complex intracranial aneurysms. The natural history of flow-diversion treatment failure resulting in aneurysm remnants is not well-defined. We aimed to delineate the clinical and angiographic features of this entity. MATERIALS AND METHODS Review of a prospectively maintained Pipeline Embolization Device data base from inception to October 2017 was performed for aneurysms that demonstrated residual filling on follow-up imaging. Procedural and follow-up clinical details were recorded. Independent, blinded, angiographic assessment of occlusion was performed on the basis of the O'Kelly-Marotta scale. Aggregated outcomes were analyzed using the Fisher exact and Mann-Whitney U tests for categoric and continuous variables, respectively (statistical significance, α = .05). RESULTS During the study period, 283 sequential patients were treated; 87% (246/283) were women. The median patient age was 55 years (interquartile range, 47-65 years). Six-month follow-up imaging was available in 83.7% (237/283) of patients, which showed 62.4% (148/237) complete occlusion (class D, O'Kelly-Marotta grading scale). Adjunctive coiling (P = .06), on-label Pipeline Embolization Device use (P = .04), and multiple device constructs (P = .02) had higher rates of complete occlusion at 6 months. Aneurysm remnants were identified in 25 cases on long-term follow-up imaging (median, 16 months; interquartile range, 12-24 months). No patient with an aneurysm remnant after flow diversion presented with delayed rupture or other clinical sequelae, with a median clinical follow-up of 31 months (interquartile range, 23-33 months). CONCLUSIONS Aneurysm remnants after flow diversion are infrequent with minimal clinical impact. When appropriate, the presence of overlapping devices and possibly adjunctive coiling may result in higher rates of complete occlusion.
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Affiliation(s)
- T P Madaelil
- From the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
| | - J A Grossberg
- From the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
| | - B M Howard
- From the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
| | - C M Cawley
- From the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
| | - J Dion
- MicroVention (J.D.), Aliso Viejo, California
| | - R G Nogueira
- Marcus Stroke and Neuroscience Center (R.G.N., D.C.H.), Departments of Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia
| | - D C Haussen
- Marcus Stroke and Neuroscience Center (R.G.N., D.C.H.), Departments of Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia
| | - F C Tong
- From the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
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Dion J, Leroux G, Mouthon L, Piette JC, Costedoat-Chalumeau N. Polychondrite atrophiante : actualités en 2017. Rev Med Interne 2018; 39:400-407. [DOI: 10.1016/j.revmed.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/25/2017] [Indexed: 01/16/2023]
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16
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Stacey WM, Van Rooijen W, Bates T, Colvin E, Dion J, Feener J, Gayton E, Gibbs D, Grennor C, Head J, Hope F, Ireland J, Johnson A, Jones B, Mejias N, Myers C, Schmitz A, Sommer C, Sumner T, Tschaepe L. A TRU-Zr Metal-Fuel Sodium-Cooled Fast Subcritical Advanced Burner Reactor. NUCL TECHNOL 2017. [DOI: 10.13182/nt08-a3933] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- W. M. Stacey
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - W. Van Rooijen
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - T. Bates
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - E. Colvin
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - J. Dion
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - J. Feener
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - E. Gayton
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - D. Gibbs
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - C. Grennor
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - J. Head
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - F. Hope
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - J. Ireland
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - A. Johnson
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - B. Jones
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - N. Mejias
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - C. Myers
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - A. Schmitz
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - C. Sommer
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - T. Sumner
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
| | - L. Tschaepe
- Georgia Institute of Technology Nuclear and Radiological Engineering Program, Atlanta, Georgia 30332-0425
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Simard C, Cloutier M, Jobin C, Dion J, Fournier D, Néron S. Implementing a routine flow cytometry assay for nucleated red blood cell counts in cord blood units. Int J Lab Hematol 2016; 38:600-609. [PMID: 27545617 DOI: 10.1111/ijlh.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/19/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION As required by standards organizations, Héma-Québec Cord Blood Bank performs enumeration of nucleated red blood cells (NRBCs) in cord blood units (CBUs). This study presents the validation and implementation approaches developed to transfer the routine NRBC enumeration from the manual blood film method to a flow cytometric assay. METHODS The flow cytometry method was adapted from Tsuji (Cytometry, 37, 1999, 291). This assay was validated to assess the specificity, detection limit, repeatability, and reproducibility of the method, including interoperator and interlaboratory testing. Finally, postimplementation follow-up and adjustments were performed for CBU over a 7-month period. RESULTS Blood film and flow cytometry NRBC enumerations showed a strong correlation (n = 40; Pearson's r correlation = 0.90). Validation was successful as exemplified by the correlation in interlaboratory testing (n = 30; r = 0.98). During implementation, our routine laboratory analyses revealed that CBU with low NRBC content (≤2%), representing 26% of all CBU tested, resulted in 15% of repeated reading and/or staining and was the principal source of nonconformity. Small adjustments in the standard operating procedures (SOPs), including a fixed 200-event setting in the NRBC gate for the second reading of the replicates, have completely solved this issue. CONCLUSION Flow cytometric NRBC enumerations, now implemented in Héma-Québec Public Cord Blood Bank, is an improvement in the efficiency of our operations by integrating the count for NRBC into our flow cytometry platform.
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Affiliation(s)
- C Simard
- Recherche et Développement, Héma-Québec, Québec, QC, Canada
| | - M Cloutier
- Recherche et Développement, Héma-Québec, Québec, QC, Canada
| | - C Jobin
- Recherche et Développement, Héma-Québec, Québec, QC, Canada
| | - J Dion
- Qualité et affaires réglementaires, Héma-Québec, Québec, QC, Canada
| | - D Fournier
- Cord Blood Bank, Héma-Québec, Saint-Laurent, QC, Canada
| | - S Néron
- Recherche et Développement, Héma-Québec, Québec, QC, Canada
- Biochimie, Microbiologie et Bio-informatique, Faculté des sciences et de génie, Université Laval, Québec, QC, Canada
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Dion J, London J, Chaigne B, Dumoitier N, Lofek S, Dunogué B, Cohen P, Groh M, Le Jeunne C, Guillevin L, Mouthon L, Terrier B. Caractéristiques phénotypiques et fonctionnelles des sous-populations lymphocytaires au cours de la granulomatose éosinophilique avec polyangéite. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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London J, Dumoitier N, Lofek S, Dion J, Chaigne B, Cohen P, Le Jeunne C, Varin-Blank N, Guillevin L, Terrier B, Mouthon L. Analyse phénotypique et fonctionnelle des sous-populations lymphocytaires au cours de la granulomatose avec polyangéite. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Chaigne B, Dion J, Guillevin L, Mouthon L, Terrier B. Physiopathologie de la granulomatose éosinophilique avec polyangéite (Churg-Strauss). Rev Med Interne 2016; 37:337-42. [DOI: 10.1016/j.revmed.2015.10.339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/20/2015] [Indexed: 01/13/2023]
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Affiliation(s)
- J. Côté
- Corresponding author. Lallemand Bio-Ingredients, 1620 Prefontaine, Montreal, QC H1W 2N8, Canada
- Lallemand Bio-Ingredients, Montreal, QC, Canada
| | - J. Dion
- L.V. Lomas Limited, Montreal, QC, Canada
| | - P. Burguière
- Lallemand Health Solutions, Montreal, QC, Canada
| | - L. Casavant
- Lallemand Baking Solutions, Montreal, QC, Canada
| | - J. Van Eijk
- Lallemand Baking Solutions, Montreal, QC, Canada
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Case D, Dion J, Wojno T, Tong F. O-014 A new application of MRI fusion in angiographic percutaneous intervention for pediatric orbital lesions: Abstract O-014 Figure 1. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455a.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Hui F, Cawley M, Dion J, Rasmussen P, Moskowitz S, Toth G, Hussain S, Schuette J, Spiotta A, Tong F. P-017 Intermediate catheters: experience, cost and complication rates at two high volume centers. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Hui F, Schuette A, Spiotta A, Lieber M, Moskowitz S, Dion J, Tong F, Barrow D, Cawley M. O-027 Antithrombotic states and outcomes in patients with aneurysmal subarachnoid hemorrhage. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Hui F, Tong F, Schuette J, Dion J, Cawley M. O-017 Does intraprocedural rupture of anterior communicating artery aneurysms matter? A retrospective comparison of endovascular and microsurgical approaches. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Moskowitz S, Hui F, Gupta R, Rasmussen P, Masaryk T, Wahkloo A, Schuette A, Cawley C, Dion J. 008 Initial experience with Deltapaq coils during embolization of cerebral aneurysms. J Neurointerv Surg 2009. [DOI: 10.1136/jnis.2009.000869h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Joseph GJ, Goldstein J, Cloft H, Tong F, Dion J. Endovascular stenting of atherosclerotic stenosis in a basilar artery after unsuccessful angioplasty. AJR Am J Roentgenol 2000; 174:383-5. [PMID: 10658710 DOI: 10.2214/ajr.174.2.1740383] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G J Joseph
- Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, USA
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Guglielmi G, Viñuela F, Duckwiler G, Dion J, Stocker A. High-flow, small-hole arteriovenous fistulas: treatment with electrodetachable coils. AJNR Am J Neuroradiol 1995; 16:325-8. [PMID: 7726080 PMCID: PMC8338335] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We present one case of carotid-cavernous fistula caused by percutaneous treatment of trigeminal neuralgia and one case of vertebrovertebral fistula caused by percutaneous internal jugular vein cannulation. Each fistula had a small arteriovenous communication that prevented the use of detachable balloons. Endovascular transarterial treatment of these two iatrogenic fistulas with electrically detachable platinum coils was performed. Both fistulas were occluded with preservation of the parent artery, and the patients have fully recovered.
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Affiliation(s)
- G Guglielmi
- Department of Radiological Sciences, University of California at Los Angeles 90024-1721, USA
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Duckwiler G, Dion J. Catheters, embolic agents spark neurointervention. Diagn Imaging (San Franc) 1994; 16:66-72, 102. [PMID: 10147088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Dupuis G, Martel J, Bastin B, Dion J, Payet MD. Microtubules are not an essential component of phytohemagglutinin-dependent signal transduction in Jurkat T lymphocytes. Cell Immunol 1993; 146:38-51. [PMID: 8425229 DOI: 10.1006/cimm.1993.1004] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have used two disruptors of the cytoskeleton microtubular network (colchicine and vinblastine) to investigate the role of microtubules in Phaseolus vulgaris phytohemagglutinin (PHA) signal transduction in Jurkat T cells. Both drugs decreased but did not abolish the PHA-dependent Ca2+ response of Jurkat cells. Neither colchicine nor vinblastine had any major effects on the PHA-dependent turnover of the mono-, di-, tri-, and tetra-substituted phosphorylated derivatives of D-myo-inositol or the cellular distribution of protein kinase C (PKC) activity. However, both microtubule disruptors increased interleukin-2 (IL-2) production. Whereas vinblastine enhanced IL-2 production approximately twofold at all the concentrations tested (0.1, 1.0, and 10 microM), colchicine did so only at a 10 microM concentration. When a combination of PHA and 12-O-tetradecanoyl-13-O-acetyl phorbol (TPA) was used, a small increase in IL-2 production was observed only in the presence of vinblastine (10 microM). In contrast to recent reports that microfilaments may be involved in the regulation of signal transduction, our data suggest that this is not the case for microtubules in PHA-dependent signal transduction in Jurkat T cells.
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Affiliation(s)
- G Dupuis
- Department of Biochemistry, Faculty of Medicine, University of Sherbrooke, Quebec, Canada
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Guglielmi G, Viñuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, Strother C, Graves V, Halbach V, Nichols D. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992; 77:515-24. [PMID: 1527608 DOI: 10.3171/jns.1992.77.4.0515] [Citation(s) in RCA: 401] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm. One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia. A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion. Overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III). It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.
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Affiliation(s)
- G Guglielmi
- Department of Neurological Sciences (Therapeutic Neuroangiography), University of Rome, Italy
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Rauch RA, Vinuela F, Dion J, Duckwiler G, Amos EC, Jordan SE, Martin N, Jensen ME, Bentson J. Preembolization functional evaluation in brain arteriovenous malformations: the ability of superselective Amytal test to predict neurologic dysfunction before embolization. AJNR Am J Neuroradiol 1992; 13:309-14. [PMID: 1595467 PMCID: PMC8331738] [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: 12/27/2022]
Abstract
PURPOSE To describe the incidence of neurologic dysfunction following embolization of supratentorial AVMs, and to correlate findings with results of preembolization Amytal tests. MATERIALS AND METHODS Data from 147 embolizations of supratentorial AVMs following Amytal tests in 30 awake patients were analyzed retrospectively. RESULTS Of five embolizations done after a positive Amytal test, two were followed by neurologic complications. Eighty-two embolizations done as single embolizations immediately after a negative Amytal test were associated with no neurologic complications. The remaining embolizations were parts of multiple series of embolizations, each beginning with an Amytal test and followed by a number of embolizations without catheter movement or repeat Amytal testing. Since any prior embolization in the series might reduce the sump effect of the AVM, embolic agent delivered later in the series could potentially reach functional brain tissue not fully tested by the Amytal test. Therefore, repeat embolizations (not immediately preceded by an Amytal test) were considered separately. In 60 repeat embolizations, six (10%) were associated with some neurologic complication. CONCLUSIONS Repeat Amytal testing might detect the loss of sump effect as the AVM is embolized. We conclude that use of data from superselective Amytal tests adds to the safety of AVM embolizations and that repeat Amytal testing potentially could be valuable when serial embolization of a vessel is planned.
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Affiliation(s)
- R A Rauch
- Department of Radiology, University of California, Los Angeles Medical Center 90024
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35
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Rauch RA, Vinuela F, Dion J, Duckwiler G, Amos EC, Jordan SE, Martin N, Jensen ME, Bentson J, Thibault L. Preembolization functional evaluation in brain arteriovenous malformations: the superselective Amytal test. AJNR Am J Neuroradiol 1992; 13:303-8. [PMID: 1595466 PMCID: PMC8331742] [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: 12/27/2022]
Abstract
PURPOSE To describe our experience with the use of Amytal injected through a superselective catheter prior to planned embolization of cerebral arteriovenous malformations. MATERIALS AND METHODS 109 superselective tests were performed with 30-mg injections of Amytal. All patients were evaluated by both clinical examination and EEG. RESULTS Twenty-three of these tests were positive. There were no prolonged neurologic complications of the Amytal test. We also examined the value of EEG monitoring compared to clinical monitoring during the Amytal test. Of the 23 positive Amytal tests, only 12 showed a change on clinical exam (52%). This meant that almost half of the positive Amytal tests would have been falsely called negative (false negative rate of 10%). There were also three positive Amytal tests with changes on clinical examination without any change on EEG. CONCLUSION The superselective Amytal test can be done safely as part of the interventional neuroradiologic procedure. Clinical and EEG monitoring of the patient are essential.
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Affiliation(s)
- R A Rauch
- Department of Radiology, University of California, Los Angeles Medical Center 90024
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Abstract
Fifteen patients with high-risk intracranial saccular aneurysms were treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage.
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Affiliation(s)
- G Guglielmi
- Department of Neurological Sciences, University of Rome Medical School, Italy
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Guglielmi G, Viñuela F, Dion J, Duckwiler G, Cantore G, Delfini R. Persistent primitive trigeminal artery-cavernous sinus fistulas: report of two cases. Neurosurgery 1990; 27:805-8; discussion 808-9. [PMID: 2259413 DOI: 10.1097/00006123-199011000-00021] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Two cases of persistent primitive trigeminal artery-cavernous sinus fistulas are presented. In one case, the fistula was treated by using a two-balloon tandem technique. This method was accomplished by introducing, inflating, and detaching a silicone balloon into the trigeminal artery, thus preserving the carotid and basilar blood flow. An unusual case of a similar fistula with only contralateral exophthalmos is also reported. The relationship between this type of fistula and the presence of aneurysms on the persistent primitive trigeminal artery and the relationship with traumatic events are discussed.
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Affiliation(s)
- G Guglielmi
- Department of Neurological Sciences, School of Medicine, University of Rome, Italy
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38
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Martin NA, Bentson J, Viñuela F, Hieshima G, Reicher M, Black K, Dion J, Becker D. Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 1990; 73:526-33. [PMID: 2398382 DOI: 10.3171/jns.1990.73.4.0526] [Citation(s) in RCA: 123] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Intraoperative digital subtraction angiography using commercially available equipment was employed to confirm the precision of the surgical result in 105 procedures for intracranial aneurysms or arteriovenous malformations (AVM's). Transfemoral selective arterial catheterization was performed in most of these cases. A radiolucent operating table was used in all cases, and a radiolucent head-holder in most. In five of the 57 aneurysm procedures, clip repositioning was required after intraoperative angiography demonstrated an inadequate result. In five of the 48 AVM procedures, intraoperative angiography demonstrated residual AVM nidus which was then located and resected. In two cases intraoperative angiography failed to identify residual filling of an aneurysm which was seen later on postoperative angiography, and in one case the intraoperative study failed to demonstrate a tiny residual fragment of AVM which was seen on conventional postoperative angiography. Two complications resulted from intraoperative angiography: one patient developed aphasia from cerebral embolization and one patient developed leg ischemia from femoral artery thrombosis. This technique appears to be of particular value in the treatment of complex intracranial aneurysms and vascular malformations.
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Affiliation(s)
- N A Martin
- Division of Neurosurgery, University of California School of Medicine, Los Angeles
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39
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Abstract
The MR appearance of acute subarachnoid hemorrhage experimentally produced in Macaca monkeys and observed in patients with clinically documented acute subarachnoid hemorrhage is presented. Subarachnoid hemorrhages were produced in two Macaca Nemestrema monkeys using the technique of Frazee. CT and MR imaging were performed immediately after the procedure and at frequent intervals up to two week post hemorrhage. MR including T1 and T2 weighted multiplanar spin echo images were obtained. The imaging studies were compared with clinical evaluations and pathological specimens of all animals. Findings in the experimental animals are correlated with those observed in patients with clinically documented subarachnoid hemorrhage. The results show that acute subarachnoid hemorrhage (SAH) can be detected with MRI as isointense signal replacing normally black CSF spaces on T1 weighted images. Signal changes most likely relate to protein water binding associated with the clotting mechanism rather than oxidative denaturation of hemoglobin. Imaging performed experimentally and clinically beyond four days, however, showed a marked increase in signal intensity on T1 weighted images which probably does result from methemoglobin formation within the clot matrix. Although CT remains the gold standard in detecting acute SAH, MR does provide some sensitivity to its presence.
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Affiliation(s)
- E Spickler
- Department of Radiological Sciences, UCLA School of Medicine 90024
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Duckwiler G, Dion J, Vinuela F, Jabour B, Martin N, Bentson J. Intravascular microcatheter pressure monitoring: experimental results and early clinical evaluation. AJNR Am J Neuroradiol 1990; 11:169-75. [PMID: 2105600 PMCID: PMC8332501] [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: 12/30/2022]
Abstract
With the use of Tracker and Balt microcatheter systems, intravascular pressure measurements were obtained in an experimental animal model, establishing the reliability of mean blood pressure measurements from these microcatheter systems. In the experimental model, selective occlusion of branches of the external carotid artery with simultaneous pressure measurements showed significant and reproducible changes in intravascular pressures. Also, pharmacologic manipulation of the blood pressure with simultaneous microcatheter and 6-French catheter recordings demonstrated an accurate and linear response of the microcatheter systems to mean blood pressure as it varied from 30 to 130 mm Hg. Preliminary results in humans with vascular malformations yielded similar results. We studied two cases of brain arteriovenous malformations (AVMs), one sigmoid-transverse sinus dural AVM, and one brain arteriovenous fistula (AVF). In these four cases the pressure dropped substantially, approaching the level of the shunt. In the case of the brain AVF, pressures rose in the same vessel after embolization. In the case of the dural AVM, correlation of the venous pouch pressures and the angiographic appearance indicated that shunting was no longer present when the venous and arterial pressures equalized. This system can be of substantial benefit in the evaluation and therapy of these lesions, and may increase our understanding of the physiology of vascular malformations.
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Affiliation(s)
- G Duckwiler
- Department of Radiological Sciences, University of California, Los Angeles 90024
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41
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Lylyk P, Viñuela F, Vinters HV, Dion J, Bentson J, Duckwiler G, Lin T. Use of a new mixture for embolization of intracranial vascular malformations. Preliminary experimental experience. Neuroradiology 1990; 32:304-10. [PMID: 2234390 DOI: 10.1007/bf00593050] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [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: 12/30/2022]
Abstract
The internal carotid artery system in swine has a special anatomic configuration similar to a brain "arterial-arterial malformation." The internal carotid artery breaks up into a multitude of fine channels (rete mirabile) situated at the base of the skull on the side of the hypophysis. This anatomic arterial model was used to analyze acute and chronic angiographic and histological changes after occlusion of the rete mirabile with I) avitene, II) avitene, and 50% ethanol, III) avitene, 30% ethanol and Polyvinyl alcohol, IV) avitene 50% ethanol and Polyvinyl alcohol, V) IBCA and VI) silk. Histopathological changes observed in the rete mirabile six weeks following occlusion demonstrated that a mixture of avitene, 30% ethanol and Polyvinyl alcohol and IBCA produced the best anatomic results. Embolization with avitene, PVA and ethanol induced a more bland histological reaction than the one observed with IBCA. Preliminary clinical experience with this mixture is reassuring in those cases in which the AVM was surgically resected. The partially thrombosed AVM was easily depressed and compressed by the neurosurgeon allowing for satisfactory hemostasis in and around the nidus of the AVM.
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Affiliation(s)
- P Lylyk
- Department of Radiological Sciences (Neuroradiology), UCLA
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Tessler FN, Dion J, Viñuela F, Perrella RR, Duckwiler G, Hall T, Boechat MI, Grant EG. Cranial arteriovenous malformations in neonates: color Doppler imaging with angiographic correlation. AJR Am J Roentgenol 1989; 153:1027-30. [PMID: 2678994 DOI: 10.2214/ajr.153.5.1027] [Citation(s) in RCA: 26] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Five neonates with cranial arteriovenous malformations were studied with color Doppler sonography. Excellent correlation was found between sonography and subsequent angiography. In three patients with vein of Galen aneurysms, sonography showed a cystic structure with rapid or swirling flow. Careful adjustment of the color Doppler system was required to demonstrate flow in another patient with a dural arteriovenous malformation. An arteriovenous fistula in a fifth patient appeared as an area of increased flow. Arterial feeders and major draining veins were visualized in all five patients. Color Doppler imaging also was used to assess the effect of embolic or operative therapy in three of the patients. We conclude that color Doppler sonography is able reliably to characterize flow patterns in neonatal cranial arteriovenous malformations. Color Doppler imaging also is helpful in assessing flow after embolic or surgical therapy.
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Affiliation(s)
- F N Tessler
- Department of Radiological Sciences, University of California, Los Angeles, School of Medicine 90024-1721
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Affiliation(s)
- F Viñuela
- Department of Radiological Sciences, University of California, Los Angeles, Medical Center 90024-1721
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Abstract
Aspiration biopsy guided with computed tomography (CT) has long been a valuable tool in the evaluation of head and neck disease. The ability to obtain diagnoses without the need for surgery has had a significant effect on patient treatment. Magnetic resonance (MR) imaging is now rapidly replacing CT as the primary imaging study for many head and neck diseases. The standard stainless steel needles used for CT-guided biopsy are unsuitable for MR-guided biopsy because significant ferromagnetic artifacts obscure the underlying anatomy. A new needle has recently been designed specifically for use with MR imaging. This needle has far less magnetic susceptibility and therefore does not cause significant image distortion. The authors describe the use of this needle in MR-guided aspiration biopsy of a variety of lesions in the head and neck.
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Affiliation(s)
- G Duckwiler
- Department of Radiological Sciences, UCLA School of Medicine 90024
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Peoples JR, Herbosa EG, Dion J. Management of internal maxillary artery hemorrhage from temporomandibular joint surgery via selective embolization. J Oral Maxillofac Surg 1988; 46:1005-7. [PMID: 3183800 DOI: 10.1016/0278-2391(88)90340-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J R Peoples
- University of California Los Angeles Medical Center
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Johnson WC, Sentissi JM, Baldwin D, Hamilton J, Dion J. Treatment of claudication with pentoxifylline: are benefits related to improvement in viscosity? J Vasc Surg 1987; 6:211-6. [PMID: 3625877 DOI: 10.1067/mva.1987.avs0060211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Forty-five patients with short-distance claudication were treated with pentoxifylline. The initial claudication distance increased significantly (32.5 m, p = 0.02) and the absolute claudication distance (ACD) increased significantly (49.5 m, p = 0.001) while the patients were receiving pentoxifylline. Patients with initial elevated viscosity levels were more likely to have decreased viscosity with pentoxifylline than were patients with normal viscosity levels (p = 0.01). No significant improvement in ACD or viscosity was noted in 51% of patients. Both ACD and viscosity improved in 15% of patients, viscosity improved without improvement in ACD in 9%, and ACD improved without improvement in viscosity in 25%.
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Cousineau G, Dion J, Lemire P. Traumatic subarachnoid-mediastinal fistula mimicking a ruptured aorta. Can J Surg 1983; 26:63-4. [PMID: 6821765] [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: 01/22/2023] Open
Abstract
A 35-year-old man, injured in an automobile accident was found to have a subarachnoid-mediastinal fistula that mimicked a ruptured aorta. Of 16 reported cases of traumatic subarachnoid-mediastinal fistula, this is only the third in which the fistulous communication was with the extrapleural space only. The possibility of subarachnoid-mediastinal fistula, although rare, should be entertained in injuries to the thoracocervical spine when neurologic symptoms are present.
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Ménard HA, Dion J, Richard C. [Antinuclear antibodies and PHA response in rheumatoid arthritis]. Ann Immunol (Paris) 1977; 128:295-6. [PMID: 300600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We have studied the in vitro PHA response of two groups of rheumatoid arthritis patients differing only in the presence or absence of antinuclear antibodies. The response was depressed in positive patients and normal in negative patients. Differences in peripheral blood mononuclear cell sub-populations or lymphocytotoxic antibodies do not seem to explain this observation. Simple antinuclear antibody screening could serve as a simple method to identify a sub-group of immunodepressed rheumatoid patients as potential candidates for immunostimulating therapy.
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Ménard HA, Dion J. Is local antigen persistence responsible for the chronicity of the experimental immune arthritis of the rabbit. Experientia 1976; 32:1474-5. [PMID: 992004 DOI: 10.1007/bf01937443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Menard HA, Dion J. Experimental immune arthritis: host factors. J Rheumatol 1975; 2:373-83. [PMID: 1206669] [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: 12/26/2022]
Abstract
An experimental chronic mono-arthritis was induced in rabbits using adjuvants and bovine serum albumin. The results suggest that unidentified host factors (possibly genetic) influence the induction of delayed hypersensitivity to the antigen. The data further show a clear correlation between systemic cell mediated immunity and chronic synovitis. When this condition is absent, there is a poor correlation between the humoral response and the arthritis. The results make difficult the interpretation of local immune complex deposition as the sole, chronic phlogistic stimulus. (J Rheumatol 2: 373-383, 1975).
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