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Vaksmann G, Bouzguenda I, Guillaume MP, Gras P, Silvestri V, Richard A. Mitral annular disjunction and Pickelhaube sign in children with mitral valve prolapse: A prospective cohort study. Arch Cardiovasc Dis 2023:S1875-2136(23)00168-7. [PMID: 37775440 DOI: 10.1016/j.acvd.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Mitral annular disjunction (MAD) and the Pickelhaube sign are identified as risk factors for malignant ventricular arrhythmias (VAs) and sudden cardiac death in adults with mitral valve prolapse (MVP); their prevalence and consequences in children have never been studied. OBJECTIVES To determine the proportion of MAD in children with MVP, and its potential link with VAs. METHODS A cohort of 49 consecutive children (mean age 12.8±3.0 years; 33 females) with MVP and comprehensive clinical arrhythmia (24-hour monitoring) and Doppler echocardiographic characterization, including pulsed-wave tissue Doppler (PWTD) of the lateral mitral annulus, was identified. The relationship between clinical and echocardiographic data and presence of VAs was studied. RESULTS MAD was common (n=25; 51%). Only five patients had significant VAs (Lown grade>2) characterized by polymorphic premature ventricular contractions or couplets. MAD was not associated with VAs on 24-hour Holter monitoring, but an association was found between VAs and spiked high-velocity midsystolic signal>16cm/s on PWTD (Pickelhaube sign) (P=0.004), myxomatous mitral valve (P=0.004) and left ventricular dilatation (P=0.01). T-wave inversion in inferolateral leads on electrocardiogram was more frequent in patients with versus without the Pickelhaube sign (P=0.03). No difference was found between patients with or without MAD regarding sex, history of palpitation, severity of mitral regurgitation, aortic root diameter and incidence of connective tissue disorders. Myocardial fibrosis was detected in two of three patients who underwent a complementary cardiac magnetic resonance examination. CONCLUSIONS MAD is common in children with MVP; its presence was not associated with significant VAs on 24-hour Holter monitoring, but the Pickelhaube sign and presence of myxomatous mitral valve may help to detect patients prone to significant VAs. Myocardial fibrosis can be detected by cardiac magnetic resonance in children with significant VAs.
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Affiliation(s)
- Guy Vaksmann
- Hôpital privé de La Louvière, 69, rue de La Louvière, 59000 Lille, France.
| | - Ivan Bouzguenda
- Hôpital privé de La Louvière, 69, rue de La Louvière, 59000 Lille, France
| | | | - Pauline Gras
- Hôpital privé de La Louvière, 69, rue de La Louvière, 59000 Lille, France
| | | | - Adélaïde Richard
- Hôpital privé de La Louvière, 69, rue de La Louvière, 59000 Lille, France
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Billotte M, Deken V, Joriot S, Vaksmann G, Richard A, Bouzguenda I, Godart F, Baudelet JB, Rakza T, Nguyen The Tich S, Guillaume MP. Screening for neurodevelopmental disorders in children with congenital heart disease. Eur J Pediatr 2021; 180:1157-1167. [PMID: 33119792 DOI: 10.1007/s00431-020-03850-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022]
Abstract
The aim of this study was to evaluate the frequency of neurodevelopmental disorders (NDD) in children with significant congenital heart disease (CHD) and to determine associated factors to NDD and frequency of follow-up in developmental therapies. Two hundred and ten children with significant CHD aged from 6 to 66 months were enrolled over a period of six months. The Ages & Stages Questionnaire Third Edition in French (ASQ-3) was used to assess neurodevelopmental domains. NDD were defined if cut-off scores were ≤ - 1SD. - 1SD corresponded to "Monitor" range: children with minor or emerging disorders; - 2SD corresponded to "Refer" range: children exhibiting neurodevelopmental delays. Forty children were in "Monitor" range and 86 in "Refer" range. NDD rate was 60.0% (n = 126, 95% CI, 53.4 to 66.6%). There was no difference regarding CHD severity (p = 0.99). Only the presence of non-cardiac disease (OR = 2.14; 95% CI, 1.11 to 4.20) was associated with NDD. Forty-six children with NDD had no developmental follow-up (among them 21 were in "Refer" range (10%)) despite this being available.Conclusion: Children with significant CHD are at risk for NDD regardless of CHD severity. Systematic and early monitoring in a specific care program is required. Barriers that prevent access of care must be identified.Trial registration: Neurodevelopmental Disorders in Children With Congenital Heart Disease. NeuroDis-CHD. NCT03360370. https://clinicaltrials.gov/ct2/show/NCT03360370 What is Known: • Children with CHD are at risk for neurodevelopmental disorders and behavioural problems impacting their social adaptation, academic achievements and quality of personal and family life even in adulthood. What is New: • Children with CHD are at risk for neurodevelopmental disorders regardless of the complexity of the CHD. • Even with the availability of appropriate developmental services, children with CHD are not correctly followed, highlighting the need of a specific program of care for a better outcome. Local barriers that prevent access of care of those children must be identified.
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Affiliation(s)
- Morgane Billotte
- Department of Paediatric Cardiology, University Hospital of Lille, Lille, France
| | - Valérie Deken
- EA 2694 Public Health Epidemiology and Quality of Care, University of Lille, University Hospital of Lille, Lille, France
| | - Sylvie Joriot
- Department of Paediatric Neurology, University Hospital of Lille, Lille, France
| | - Guy Vaksmann
- Department of Paediatric Cardiology, Hôpital privé La Louvière, 59700, Lille, France
| | - Adélaïde Richard
- Department of Paediatric Cardiology, Hôpital privé La Louvière, 59700, Lille, France
| | - Ivan Bouzguenda
- Department of Paediatric Cardiology, Hôpital privé La Louvière, 59700, Lille, France
| | - François Godart
- Department of Paediatric Cardiology, University Hospital of Lille, Lille, France
| | - Jean-Benoit Baudelet
- Department of Paediatric Cardiology, University Hospital of Lille, Lille, France
| | - Thameur Rakza
- Department of Paediatric Cardiology, University Hospital of Lille, Lille, France
| | | | - Marie-Paule Guillaume
- Department of Paediatric Cardiology, University Hospital of Lille, Lille, France. .,Department of Paediatric Cardiology, Hôpital privé La Louvière, 59700, Lille, France.
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Billotte M, Deken V, Joriot S, Baudelet JB, Richard A, Bouzguenda I, Vaksmann G, Godart F, Rakza T, Tich SNT, Guillaume MP. Screening for neurodevelopmental disorders in children with congenital heart disease. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.06.002] [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: 10/26/2022]
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Domanski O, Houeijeh A, Guillaume MP, Baudelet JB, Matran R, Montaigne D, Godart F. Shunt fraction in Fontan patients: Insights of cardiopulmonary exercise testing. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.06.030] [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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Godart F, Houeijeh A, Domanski O, Guillaume MP, Brard M, Lucron H. Is the new Occlutech duct occluder an appropriate device for transcatheter closure of patent ductus arteriosus? Int J Cardiol 2018; 261:54-57. [DOI: 10.1016/j.ijcard.2018.03.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022]
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Domanski O, Gras P, Houeijeh A, Guillaume MP, Recher M, Bonnet M, Godart F. Quality of life evaluated in a french center regarding anticoagulation control in a pediatric population with self-testing of the International Normalised Ratio. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30906-0] [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: 10/18/2022]
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Houeijeh A, Marie Brevière G, Guillaume MP, Storme L, Godart F. 0377: Atrial septostomy in very low birth weight infants. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71783-0] [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: 11/16/2022]
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Mboyo A, Khadir SK, Guillaume MP, Massicot R, Flurin V, Lalioui A, Zamfir C, Chevé MT. An exceptional cause of duodenal obstruction detected antenatally: A compressive preduodenal portal vein. Journal of Pediatric Surgery Case Reports 2013. [DOI: 10.1016/j.epsc.2013.09.011] [Citation(s) in RCA: 4] [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] [Indexed: 11/25/2022] Open
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Mesquita M, Guillaume MP, Standaert M, Rossez N, Vereerstraeten P, Dratwa M. Prognosis of HIV infected sub-Saharan patients on renal replacement therapy (RRT) in Brussels, Belgium: a single centre retrospective pilot study and review of the literature. Acta Clin Belg 2013; 68:92-6. [PMID: 23967715 DOI: 10.2143/acb.3199] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few data exist documenting the survival experience of immigrated sub-Saharan patients infected by the human immunodeficiency virus (HIV) on renal replacement therapy (RRT). METHODS This retrospective single centre pilot study includes 105 consecutive patients of sub-Saharan origin who started RRT in our unit, between January 1986 and April 2010. The aim was to analyse the characteristics and the survival rate on RRT of these patients. RESULTS Out of 105 patients 81/105 (77%) were HIV-negative and 24/105(23%) were HIV-positive. HIV-positive patients were younger than HIV-negative patients and they were more often treated with peritoneal dialysis (PD) (21/24) than with haemodialysis (HD). Dialysis peritonitis was equally distributed between HIV-positive and HIV-negative patients. Because of opportunistic infections, duration of hospitalisation was longer for HIV-positive than for HIV-negative patients. In PD-treated patients, the number of hospitalisations tended to be greater in patients who experienced at least one peritonitis episode and the duration of hospitalisation also tended to be longer. The survival rate was better in patients younger than 50 years and in patients on HD, but was similar for both positive and negative HIV patients. CONCLUSIONS To the best of our knowledge, these are the first data concerning patients who have emigrated from sub-Saharan Africa to Belgium, and who are on RTT. Their survival rate is better if they are younger than 50 years and on HD. As the majority of HIV patients were treated by PD in our center, a conclusion regarding survival on different dialysis modalities is not possible for this group of patients. Survival rates were similar for HIV-positive and HIV-negative patients despite longer duration of hospisalization for HIV-positive patients.
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Affiliation(s)
- M Mesquita
- Nephrology and Dialysis Clinic, CHU-Brugmann, Belgium.
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Abstract
We describe a case of recurrent haemophagocytic syndrome (HS) in an HIV-infected patient.The first episode was associated with active human herpesvirus 8 infection and progressive Kaposi's sarcoma which was successfully treated with splenectomy, foscarnet and chemotherapy. The second episode was triggered by a Clostridium difficile colitis and resolved completely after treatment with metronidazole only. Recurrent HS has rarely been described in adult patients out of the setting of relapsing malignancy or autoimmune disease.The chronic immune dysregulation and suppression due to HIV-infection may predispose our patient to development of associated HS. Prognosis of HS remains poor, especially in HIV-infected patients. Rapidly unmasking the causative factor and timely instauration of adequate treatment are critical and may improve outcome.
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Affiliation(s)
- I Ramon
- Service de médicine interne, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgique.
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Guillaume MP, Karmali R, Corazza F, Duchateau J. HIV-patients discrimination according to phenotype and functional assay of T-cells subsets. Retrovirology 2010. [PMCID: PMC3316033 DOI: 10.1186/1742-4690-7-s1-p26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mesquita M, Libertalis M, Bakoto ES, Vandenhoute K, Damry N, Guillaume MP. Late diagnosis of extra-pulmonary tuberculosis leads to irreversible kidney failure in a non-immunocompromised patient. Int Urol Nephrol 2009; 42:227-32. [PMID: 19533407 DOI: 10.1007/s11255-009-9587-0] [Citation(s) in RCA: 3] [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] [Received: 01/31/2009] [Accepted: 05/11/2009] [Indexed: 11/26/2022]
Abstract
We report a case of extra pulmonary tuberculosis with multiple localizations including bone and kidney in a 21-year-old Pakistani immigrant living in Belgium. Late diagnosis of tuberculosis may lead to end stage renal disease and dialysis. Countries with low prevalence of tuberculosis should be vigilant towards high risk groups for tuberculosis because this preventable and curable disease may lead to devastating complications when diagnosed late.
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Affiliation(s)
- Maria Mesquita
- Nephrology and Dialysis Clinic, CHU Brugmann, Free University of Brussels, Brussels, Belgium.
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Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious life-threatening complication in peritoneal dialysis patients. At present, there is no evidence-based standard therapy for EPS. Tamoxifen has been used and shown good results in non-HIV peritoneal dialysis patients with EPS. We report a case of a patient with HIV treated with antiretroviral therapy (zidovudine, lamivudine and saquinavir) for several years. He had end-stage renal disease and was treated with continuous ambulatory peritoneal dialysis (CAPD). After 11 years on CAPD, he developed EPS and was treated successfully with tamoxifen in combination with corticosteroids. No adverse effects were observed and no changes were noted in CD4 counts or HIV viral load during this therapy. These findings suggest that tamoxifen can be safely given to HIV patients with peritoneal dialysis-related EPS. Nevertheless, caution is required as tamoxifen could interact with certain antiretroviral agents.
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Affiliation(s)
- M Mesquita
- Department of Internal Medicine and Nephrology-Dialysis Division, Brugmann University Hospital (Free University of Brussels), Brussels, Belgium.
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Guillaume MP. Clusters Differentiation in HIV Patients According to Measurements of T Cells Subpopulations in Whole Blood After In Vitro Activation with Mitogen. Clin Immunol 2007. [DOI: 10.1016/j.clim.2007.03.303] [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: 10/23/2022]
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Abstract
Renal cell carcinoma has a variable clinical course. Size is a prognostic factor correlated with venous invasion, lymph node or distant metastases. These are more often encountered when the size exceeds 10 cm. For 20 years, incidental renal tumours have represented the majority of diagnosed cases, as a result of more common use of imaging techniques. We report a case of renal cell carcinoma of an unusually large size, without metastatic or locally advanced disease. Histology revealed a pT2 clear cell renal cell carcinoma of 31 x 31 x 10 cm, which was totally resected. It is the first case reported of localized conventional renal cell carcinoma reaching such a size.
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Affiliation(s)
- M P Guillaume
- Department of Internal Medecine, Brugmann University Hospital, Free University of Brussels (ULB), Brussels, Belgium
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Abstract
Human parvovirus B19 infection may be responsible for acute and chronic arthropathy. We present the case of a woman, who developed a severe chronic parvovirus B19 infection with persistence of DNA parvovirus B19, which was detected in the serum by polymerase chain reaction (PCR). After intravenous immunoglobulin administration she noted a disappearance of the general symptoms and the virus became undetectable by PCR in the serum. However, 1 month later back pain appeared. Magnetic resonance imaging showed bilateral effusions of the apophyseal joints of the lumbar spine (L4-L5). Spine involvement is rarely described during acute or chronic parvovirus B19 infection. In this case it was not possible to determine whether the facet joint arthropathy was reactive or due to persistent articular infection, or induced by immunoglobulin therapy.
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Affiliation(s)
- M P Guillaume
- Department of Internal Medicine, Brugmann Hospital, Free University of Brussels, Brussels, Belgium
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Peretz A, Guillaume MP, Casper-Velu L. Uveitis management: a multidisciplinary approach to assess systemic involvement and side effects of treatments. Acta Clin Belg 2002; 57:142-7. [PMID: 12212355 DOI: 10.1179/acb.2002.030] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Non-infectious uveitis is often associated with systemic diseases severe enough to require corticosteroids (CS) and immunosuppressive drugs, which have potential serious side effects. METHODS 28 patients with non-infectious uveitis were referred by the ophthalmologist. RESULTS A systemic disease was found in 17/28 patients (60%): sarcoidosis in 11, spondylarthropathy in 3, Behcet's disease in 2, Crohn's disease in 1 patient. Eighteen patients received CS, 21 patients received immunosuppressive drugs. Most side effects were due to CS treatment: Cushing's syndrome in 12, cataract in 11, glucose intolerance in 3, gastric ulcus in 1, hypertension in 1, osteoporosis in 17, avascular bone necrosis in 3 patients. Prophylaxis or treatment of corticosteroids induced osteoporosis consists in calcium, 500 mg/day and vitamin D 400 IU in most of them with in addition hormone replacement therapy (n = 8) or bisphosphonates (n = 13). CONCLUSION Sixty percent of patients with severe uveitis had a systemic disease. CS were the most deleterious drugs in spite of bi- or tri-therapy with CS sparing immunosuppressive drugs.
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Affiliation(s)
- A Peretz
- Internal Medicine Department, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Belgique.
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Servais G, Daens S, Guillaume MP, Cumps J, Duchateau J, Peretz A. Diagnostic specificities and sensitivities of anti dsDNA, anti membrane DNA and anti nucleosomes autoantibodies. Scand J Clin Lab Invest Suppl 2002; 235:61-7. [PMID: 11712694] [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: 02/22/2023]
Abstract
The aim of this study is to evaluate, from 369 routine sera of SLE and control patients, the worth of anti double stranded nuclear DNA, anti nucleosomes autoantibodies and anti membrane DNA for the diagnosis of SLE. Cell membrane associated DNA (mDNA) has been described on B lymphocytes and monocytes, but not on T cells. Antibodies to mDNA were identified by an indirect immunofluorescence assay using a B cell line fixed but not permeabilised. At a 1:40 serum dilution, anti mDNA is almost associated with the diagnosis of systemic lupus erythematosus (SLE). Anti mDNA were shown to be different in specificity as compared with anti double stranded nuclear DNA. We compare its characteristics as diagnostic procedure to the conventional anti dsDNA antibody detection and to the recently introduced anti nucleosome antibody test documented as associated with SLE. It appears that the best sensitivity (0.65) and specificity (0.98) is given by the anti mDNA test.
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Affiliation(s)
- G Servais
- Immunology Department, CHU Brugmann-Free University of Brussels, Belgium.
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Abstract
We report a case of multidrug-resistant spinal tuberculosis complicated by epiduritis and paraspinal abscess in a 68-year-old black woman. Multidrug-resistant tuberculous spondylitis is still rare in Belgium. Two others cases were reported from 1992 to 1997. The optimal therapy is not standardized and the mandatory duration of treatment is not known. Clinical presentation, radiological findings, and treatment are presented. The need for prompt diagnosis and optimal therapy is emphasized.
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Affiliation(s)
- S Cherifi
- Department of Internal Medicine, Brugmann University Hospital, Free University of Brussels, Belgium
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Guillaume MP, Brandelet B, Peretz A. Unusual high frequency of multifocal lesions of osteonecrosis in a young patient with systemic lupus erythematosus. Br J Rheumatol 1998; 37:1248-9. [PMID: 9851281 DOI: 10.1093/rheumatology/37.11.1248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Servais G, Guillaume MP, Dumarey N, Duchateau J. Evidence of autoantibodies to cell membrane associated DNA (cultured lymphocytes): a new specific marker for rapid identification of systemic lupus erythematosus. Ann Rheum Dis 1998; 57:606-13. [PMID: 9893572 PMCID: PMC1752489 DOI: 10.1136/ard.57.10.606] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/03/2022]
Abstract
OBJECTIVE Autoantibodies to cell membrane associated DNA are described in systemic lupus erythematosus (SLE). The specificity of these antibodies differ from antibodies to nuclear DNA. METHODS Using indirect immunofluorescence, a specific IgG was detected giving a characteristic pattern of continuous peripheral membrane fluorescence on cultured B-lymphocytes. RESULTS This pattern was observed in 53 of 80 serum samples of SLE patients but absent in the serum samples of the control populations: 15 rheumatoid arthritis, 38 ankylosing spondylarthritis, 17 non-inflammatory osteopenic patients, and 224 blood donors. In 34 Sjögren syndrome's patients one only showed a positive test. The cmDNA specificity of these antibodies was confirmed by pattern extinction with DNAse but not RNase or protease pre-treatment of the cells. IgG to cmDNA, separated by absorption/elution from purified cmDNA immobilised on DEAE-nitrocellulose reproduced the immunofluorescence pattern pictures. Extensive serum depletion of anti-double strand or single strand DNA antibodies by absorption to cellulose bound ds- or ss-DNA affected marginally the pericellular fluorescence revealing some minor cross reactivity with nuclear DNA. Moreover, in SLE patients without detectable antibody to ds-DNA, pericellular fluorescence could be visible. CONCLUSION This novel rapid immunofluorescence method may serve as an identification test of SLE patients. Given its positive (97.1%) and negative (92.9%) predictive value, sensitivity (66%) and specificity (99.5%), it improves on other diagnostic tests such as the detection of antibodies to Sm.
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Affiliation(s)
- G Servais
- Department of Immunology, Centres Hospitaliers Universitaires Brugmann-Huderf, Brussels, Belgium
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Baraké H, Guillaume MP, Mendes da Costa P. [Conservative surgical treatment of a spontaneous splenic rupture during infectious mononucleosis. Report of a case and review of the [Conservative surgical treatment of a spontaneous splenic rupture during infectious mononucleosis. Case report and literature review]. Rev Med Brux 1997; 18:381-4. [PMID: 9481158] [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: 02/06/2023]
Abstract
A spontaneous splenic rupture occurred in a 31 year old patient suffering from infectious mononucleosis. An echography and an abdominal CT Scan revealed a rupture of the inferior pole of the spleen with a hemoperitoneum. A conservative surgical treatment was performed. Postoperative course was uneventful. This case-report draws the attention to the possibility of a conservative surgical treatment of a splenic rupture in the course of infectious mononucleosis. This attitude avoids the complications of splenectomy.
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Affiliation(s)
- H Baraké
- Service de Chirurgie Digestive, C.H.U. Brugmann, Bruxelles
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Supiot F, Guillaume MP, Hermanus N, Telerman-Toppet N, Karmali R. Toxoplasma encephalitis in a HIV patient: unusual involvement of the corpus callosum. Clin Neurol Neurosurg 1997; 99:287-90. [PMID: 9491308 DOI: 10.1016/s0303-8467(97)00101-7] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with acquired immuno-deficiency syndrome, the differential diagnosis between primary brain lymphoma and toxoplasma encephalitis is not radiologically always straightforward, especially in the presence of a solitary cerebral lesion. In this context, involvement of the corpus callosum is almost exclusively associated with primary brain lymphoma. We describe here an HIV-infected patient who presented with a single and large cerebral lesion affecting the corpus callosum, suggestive of primary brain lymphoma on MRI-scan but who nonetheless responded clinically and radiologically to an anti-toxoplasma drug trial confirming the diagnosis of toxoplasma encephalitis.
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Affiliation(s)
- F Supiot
- Department of Neurology, Brugmann Hospital, Free University of Brussels (ULB), Belgium
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Affiliation(s)
- M P Guillaume
- Department of Internal Medicine, Hôpital Universitaire Brugmann, Université Libre de Bruxelles, Belgium
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Guillaume MP, De Prez C, Cogan E. Subacute mitochondrial liver disease in a patient with AIDS: possible relationship to prolonged fluconazole administration. Am J Gastroenterol 1996; 91:165-8. [PMID: 8561126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Azole-derived antifungal medications are particularly involved in drug-induced hepatic injury encountered in patients with AIDS. Fluconazole may induce multiple hepatic abnormalities usually characterized by asymptomatic and reversible mild hepatic necrosis. We here describe severe subacute liver damage occurring in a patient with AIDS who was receiving fluconazole maintenance therapy for a cryptococcosis. Hepatotoxicity was essentially characterized by mixed cytolytic and cholestatic liver tests abnormalities which improved after fluconazole discontinuation and worsened on fluconazole rechallenge. Optical microscopy demonstrated nonspecific abnormalities including granular aspect of the cytoplasm of the hepatocytes. In contrast, analysis of electron microscopy revealed unusual unreported features characterized by giant mitochondria with paracrystalline inclusions and enlarged smooth endoplasmic reticulum. All microscopic abnormalities were reversed after discontinuation of fluconazole. We suggest that persistent increased hepatic enzymes in HIV-infected patient taking fluconazole should prompt suspension of the treatment. Prospective studies are needed to determine whether careful monitoring of hepatic tests should be recommended in AIDS patients on prolonged fluconazole maintenance therapy.
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Affiliation(s)
- M P Guillaume
- Department of Internal Medicine, Hôpital Universitaire Brugmann, Belgium
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Guillaume MP, Van Beers D, Delforge ML, Devriendt J, Cogan E. Primary human immunodeficiency virus infection presenting as myopericarditis and rhabdomyolysis. Clin Infect Dis 1995; 21:451-2. [PMID: 8562768 DOI: 10.1093/clinids/21.2.451] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Noseda A, Schoonjans J, Carioni M, Guillaume MP, Prigogine T, Douat N. [Induced expectoration or endoscopic samples in case of bronchopulmonary infection?]. Rev Med Brux 1994; 15:132-6. [PMID: 8066358] [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: 01/28/2023]
Abstract
The aim of this study was to compare induced sputum versus bronchoscopy in a non selected population. An induced sputum and a bronchoscopy with aspiration of secretions and bronchoalveolar lavage (BAL) were proposed to 30 patients with suspected lower respiratory tract infection, including 14 subjects with AIDS. Induced sputum failed in 3 patients, while endoscopy could not be performed (contra-indication, refusal or failure due to lack of cooperation) in 7 patients; a technical failure for BAL was observed in 3/23 cases. Contamination by oral germs was significantly less frequent with BAL (4/20) than with aspiration (15/23) or induced sputum (17/27). A relevant pathogen was cultured from induced sputum in 7/27 cases (3 mycobacteria, 4 usual pathogens) from aspiration in 3/23 cases (one mycobacterium, 2 usual pathogens) and from BAL in 4/20 cases (one mycobacterium, 3 usual pathogens). These results suggest that induced sputum is a promising method when difficulties in performing bronchoscopy are expected (severe respiratory insufficiency, psychiatric disease, lack of cooperation).
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Affiliation(s)
- A Noseda
- Cliniques de Pneumologie, Hôpital Brugmann, Bruxelles
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Abstract
Abscesses of the psoas muscle are due to a hematogenous dissemination, to the spread of infection from adjacent intestinal structures, to osteomyelitis of the spine or to tuberculous infection of a disc space. In contrast, psoas abscesses related to the urological tract have only been described on exception. The present report focuses on a right psoas abscess which developed 27 years after a nephrectomy. The infectious process resulted from the spread of an acute vesical infection through the residual ureter. Analysis of 4 other cases reported in the literature allows us to delineate the clinical features of psoas abscesses of urological origin.
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Affiliation(s)
- M P Guillaume
- Department of Internal Medicine, Brugmann University Hospital, Free University of Brussels (ULB), Belgium
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