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Siddiqi T, Coutre S, McKinney M, Barr PM, Rogers K, Mokatrin A, Valentino R, Szoke A, Deshpande S, Zhu A, Arango-Hisijara I, Osei-Bonsu K, Wang M, O’Brien S. Characterization of low-grade arthralgia, myalgia, and musculoskeletal pain with ibrutinib therapy: pooled analysis of clinical trials in patients with chronic lymphocytic leukemia and mantle cell lymphoma. Leuk Lymphoma 2022; 63:1580-1588. [DOI: 10.1080/10428194.2022.2038372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tanya Siddiqi
- City of Hope National Medical Center, Duarte, CA, USA
| | - Steven Coutre
- Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Ahmad Mokatrin
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA, USA
| | - Rudy Valentino
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA, USA
| | - Anita Szoke
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA, USA
| | | | | | | | - Kojo Osei-Bonsu
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA, USA
| | - Michael Wang
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Susan O’Brien
- UC Irvine, Chao Family Comprehensive Cancer Center, Irvine, CA, USA
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Masri Sidani E, Valentino R, Desbois-Nogard N, Le Govic Y. Épidémiologie des candidémies en réanimation dans un CHU d’Outremer entre 2001 et 2019. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.332] [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: 12/01/2022]
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Bonnan M, Valentino R, Debeugny S, Merle H, Fergé JL, Mehdaoui H, Cabre P. Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders. J Neurol Neurosurg Psychiatry 2018; 89:346-351. [PMID: 29030418 DOI: 10.1136/jnnp-2017-316286] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [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: 04/19/2017] [Revised: 08/31/2017] [Accepted: 10/02/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Severe attacks of neuromyelitis optica spectrum disorder (NMO-SD) are improved by plasma exchange (PLEX) given as an adjunctive therapy. Initial studies failed to demonstrate a delay of PLEX treatment influenced clinical outcome; however PLEX was always used late. We examine the clinical consequences of delay in PLEX initiation on severe optic neuritis and spinal cord attacks in NMO-SD. METHODS All of our patients who suffered attacks of NMO-SD, treated in our centre by PLEX, were retrospectively considered for inclusion. Primary outcome was defined as complete improvement. Secondary poor/good outcomes were respectively defined to be the higher/lower third of Delta-Expanded Disability Status Scale (EDSS) (late minus baseline EDSS). Delays from clinical onset to PLEX initiation were categorised for multivariate analysis. RESULTS Of the 60 patients included, NMO-SD criteria (2015) were fulfilled in 92%. One hundred and fifteen attacks were included and received PLEX with a median of 7 days (0-54) after clinical onset. The probability to regain complete improvement continuously decreased from 50% for PLEX given at day 0 to 1%-5% after day 20. Through multivariate analysis, the baseline impairment and PLEX delay were associated with the probability to complete improvement (OR 5.3; 95% CI 1.8 to 15.9). Reducing the PLEX delay also influenced the good secondary outcome but not the poor secondary outcome. CONCLUSIONS These results confirm an improved clinical benefit of early initiation of PLEX during severe attacks of NMO-SD. Perceiving PLEX as a rescue therapy only after steroid failure could be deleterious.
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Affiliation(s)
- Mickael Bonnan
- Service de neurologie, Centre Hospitalier de Pau, Pau, France
| | - Rudy Valentino
- Réanimation médicale, Hopital Pierre Zobda-Quitman, Fort-de-France, Martinique
| | - Stéphane Debeugny
- Unité de Recherche Clinique, Centre Hospitalier de Pau, Pau, Aquitaine-Limousin-Poitou, France
| | - Harold Merle
- Service d'ophtalmologie, Hopital Pierre Zobda-Quitman, Fort-de-France, Martinique
| | - Jean-Louis Fergé
- Réanimation médicale, Hopital Pierre Zobda-Quitman, Fort-de-France, Martinique
| | - Hossein Mehdaoui
- Réanimation médicale, Hopital Pierre Zobda-Quitman, Fort-de-France, Martinique
| | - Philippe Cabre
- Service de Neurologie, Hopital Pierre Zobda-Quitman, Fort-de-France, Martinique
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Bellance R, Valentino R, Sanchez B, Labrada-Blanco O, Manere L, Andoni Urtizberea J, Sarrazin E. [Episodes of recurrent pneumothorax in a patient with collagen VI-related congenital muscular dystrophy]. Med Sci (Paris) 2017; 33 Hors série n°1:27-29. [PMID: 29139382 DOI: 10.1051/medsci/201733s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rémi Bellance
- Hôpital Pierre-Zobda-Quitman, CHU de Martinique, Fort-de-France, Martinique, France
| | - Rudy Valentino
- Hôpital Pierre-Zobda-Quitman, CHU de Martinique, Fort-de-France, Martinique, France
| | - Bruno Sanchez
- Hôpital Pierre-Zobda-Quitman, CHU de Martinique, Fort-de-France, Martinique, France
| | | | - Linda Manere
- Hôpital Pierre-Zobda-Quitman, CHU de Martinique, Fort-de-France, Martinique, France
| | - J Andoni Urtizberea
- Hôpital Marin de Hendaye, Centre de Compétence, et FILNEMUS, Marseille, France
| | - Elisabeth Sarrazin
- Hôpital Pierre-Zobda-Quitman, CHU de Martinique, Fort-de-France, Martinique, France
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Brown JR, Moslehi J, O'Brien S, Ghia P, Hillmen P, Cymbalista F, Shanafelt TD, Fraser G, Rule S, Kipps TJ, Coutre S, Dilhuydy MS, Cramer P, Tedeschi A, Jaeger U, Dreyling M, Byrd JC, Howes A, Todd M, Vermeulen J, James DF, Clow F, Styles L, Valentino R, Wildgust M, Mahler M, Burger JA. Characterization of atrial fibrillation adverse events reported in ibrutinib randomized controlled registration trials. Haematologica 2017; 102:1796-1805. [PMID: 28751558 PMCID: PMC5622864 DOI: 10.3324/haematol.2017.171041] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 12/22/2022] Open
Abstract
The first-in-class Bruton's tyrosine kinase inhibitor ibrutinib has proven clinical benefit in B-cell malignancies; however, atrial fibrillation (AF) has been reported in 6-16% of ibrutinib patients. We pooled data from 1505 chronic lymphocytic leukemia and mantle cell lymphoma patients enrolled in four large, randomized, controlled studies to characterize AF with ibrutinib and its management. AF incidence was 6.5% [95% Confidence Interval (CI): 4.8, 8.5] for ibrutinib at 16.6-months versus 1.6% (95%CI: 0.8, 2.8) for comparator and 10.4% (95%CI: 8.4, 12.9) at the 36-month follow up; estimated cumulative incidence: 13.8% (95%CI: 11.2, 16.8). Ibrutinib treatment, prior history of AF and age 65 years or over were independent risk factors for AF. Multiple AF events were more common with ibrutinib (44.9%; comparator, 16.7%) among patients with AF. Most (85.7%) patients with AF did not discontinue ibrutinib, and more than half received common anticoagulant/antiplatelet medications on study. Low-grade bleeds were more frequent with ibrutinib, but serious bleeds were uncommon (ibrutinib, 2.9%; comparator, 2.0%). Although the AF rate among older non-trial patients with comorbidities is likely underestimated by this dataset, these results suggest that AF among clinical trial patients is generally manageable without ibrutinib discontinuation (clinicaltrials.gov identifier: 01578707, 01722487, 01611090, 01646021).
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Affiliation(s)
| | - Javid Moslehi
- Division of Cardiovascular Medicine and Cardio-Oncology Program Vanderbilt School of Medicine, Nashville, TN, USA
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Peter Hillmen
- CA Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds, UK
| | | | | | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Simon Rule
- Department of Haematology, Plymouth University Medical School, Plymouth, UK
| | | | - Steven Coutre
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, USA
| | | | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, University of Cologne, Germany
| | | | | | - Martin Dreyling
- Department of Medicine III, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Germany
| | - John C Byrd
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
| | - Michael Todd
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | | | | | | | | | - Mark Wildgust
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | - Jan A Burger
- Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Rozé B, Najioullah F, Ferge J, Apetse K, Brouste Y, Cesaire R, Leparc-Goffart I, Valentino R, Signate A, Cabié A. Syndromes de Guillain-Barré associés au virus Zika, une étude prospective dans la Caraïbe. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.147] [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: 12/01/2022]
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Riccitiello F, Valentino R, Telesca D, Ruggiero S, Riccitiello A, Sivero L. Prevalenza di erosioni dentali e lesioni esofagee in pazienti affetti da malattia da reflusso gastroesofageo. Dental Cadmos 2017. [DOI: 10.19256/d.cadmos.03.2017.08] [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: 11/20/2022]
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Valentino R, D'Esposito V, Ariemma F, Cimmino I, Beguinot F, Formisano P. Bisphenol A environmental exposure and the detrimental effects on human metabolic health: is it necessary to revise the risk assessment in vulnerable population? J Endocrinol Invest 2016; 39:259-63. [PMID: 26105974 PMCID: PMC4761008 DOI: 10.1007/s40618-015-0336-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
In the last decades, many reports have focused the attention on deleterious effects of novel environmental chemical compounds, including bisphenol A (BPA), on human health. BPA, a common and widely chemical contaminant acting as endocrine disruptor, accumulates in adipose tissue and may affect adipocyte metabolic and inflammatory functions. BPA, at low chronic doses, is now considered as an obesogen compound, and might contribute to the rise of metabolic syndrome, visceral adiposity and diabetes epidemics. The BPA worldwide presence in the environment is responsible for chronic exposure during vulnerable periods, such as foetal and neonatal life. The BPA source of contamination can occur via food, beverage, wastewater, air, dust and soil. BPA, as lipophilic compound, may accumulate into the adipose tissue already during foetal life and may affect adulthood health, through adverse effects on the growth and development of organs and tissues. Thus, based on several studies, it would be crucial to consider further actions aimed to refine risk assessment at least in vulnerable population, such as foetuses, infants and young children, to prevent metabolic diseases and obesity.
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Affiliation(s)
- R Valentino
- Institute of Experimental Endocrinology and Oncology (IEOS), National Council of Research (CNR) IEOS-CNR, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy.
| | - V D'Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
| | - F Ariemma
- Department of Translational Medical Sciences, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
| | - I Cimmino
- Department of Translational Medical Sciences, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
| | - F Beguinot
- Institute of Experimental Endocrinology and Oncology (IEOS), National Council of Research (CNR) IEOS-CNR, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
- Department of Translational Medical Sciences, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
| | - P Formisano
- Institute of Experimental Endocrinology and Oncology (IEOS), National Council of Research (CNR) IEOS-CNR, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
- Department of Translational Medical Sciences, Federico II University of Naples, via Pansini, 5, 80131, Naples, Italy
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Thiery G, Crosby L, Perreau C, Madeux B, Cossic J, Armand C, Herrmann-Storcke C, Najioullah F, Valentino R. Critically ill patients with chikungunya virus infection during the carribean outbreak 2013 - 2014. Intensive Care Med Exp 2015. [PMCID: PMC4798370 DOI: 10.1186/2197-425x-3-s1-a348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Esposito C, Villa L, Grosjean F, Mangione F, Esposito V, Castoldi F, Serpieri N, Arra M, Pertile E, Maggi N, Valentino R, Dal Canton A. Rapamycin reduces proteinuria and renal damage in the rat remnant kidney model. Transplant Proc 2014; 41:1370-1. [PMID: 19460562 DOI: 10.1016/j.transproceed.2009.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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
Rapamycin is an immunosuppressive drug used to prevent acute allograft rejection in solid organ transplantation. It shows less nephrotoxicity than calcineurin inhibitors. We evaluated the effect of rapamycin in rats undergoing 5/6 nephrectomy, a model of proteinuric and progressive renal failure. Fourteen days after surgery rats were randomized either to receive rapamycin or to remain untreated (control). Rats were humanely killed on day 91; serum creatinine, creatinine clearance, and proteinuria were assessed. Renal sections were stained with periodic acid-Schiff to evaluate glomerular volume (Gv), glomerulosclerosis (GS) and tubulointerstitial damage (TIS); we evaluated GS and TIS by Sirius red staining (SR). Epithelial-to-mesenchymal transition (EMT) was assessed by immunohistochemistry. Rapamycin affected neither serum creatinine nor creatinine clearance; it reduced Gv (controls, 5.9 +/- 3.1 x 10(6); rapamycin, 1.3 +/- 0.7 x 10(6) microm(3)) and proteinuria (control, 349 +/- 146; rapamycin, 56 +/- 27 mg/24 h; P < .05); rapamycin ameliorated GS (control, 78 +/- 7; rapamycin, 36 +/- 7%; P < .05; SR: control, 13.2 +/- 3.5; rapamycin, 3.8 +/- 1.0%; P < .05), and TIS (control, 3.25 +/- 0.5; rapamycin, 1.0 +/- 0.1; P < .05; SR: control, 29 +/- 3; rapamycin, 11 +/- 3%; P < .05). Rapamycin reduced alphaSMA (control, 3.25 +/- 0.5; rapamycin, 1.0 +/- 0.1; P < .05), VIM (control, 3.5 +/- 0.6; rapamycin, 1.0 +/- 1.4; P < .05), and CD68(+) cells infiltration (control, 110 +/- 43; rapamycin, 24 +/- 1 cells; P < .05). Rapamycin slows the progression of renal damage in the rat remnant kidney and may represent a novel approach to the treatment of chronic kidney disease.
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Affiliation(s)
- C Esposito
- Unit of Nephrology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Passaretti F, Tia M, D'Esposito V, De Pascale M, Del Corso M, Sepulveres R, Liguoro D, Valentino R, Beguinot F, Formisano P, Sammartino G. Growth-promoting action and growth factor release by different platelet derivatives. Platelets 2013; 25:252-6. [PMID: 23855408 DOI: 10.3109/09537104.2013.809060] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Platelet derivatives are commonly used in wound healing and tissue regeneration. Different procedures of platelet preparation may differentially affect growth factor release and cell growth. Preparation of platelet-rich fibrin (PRF) is accompanied by release of growth factors, including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGFβ1), and several cytokines. When compared with the standard procedure for platelet-rich plasma (PRP), PRF released 2-fold less PDGF, but >15-fold and >2-fold VEGF and TGFβ1, respectively. Also, the release of several cytokines (IL-4, IL-6, IL-8, IL-10, IFNγ, MIP-1α, MIP-1β and TNFα) was significantly increased in PRF-conditioned medium (CM), compared to PRP-CM. Incubation of both human skin fibroblasts and human umbilical vein endothelial cells (HUVECs) with PRF-derived membrane (mPRF) or with PRF-CM enhanced cell proliferation by >2-fold (p<0.05). Interestingly, PRP elicited fibroblast growth at a higher extent compared to PRF. At variance, PRF effect on HUVEC growth was significantly greater than that of PRP, consistent with a higher concentration of VEGF in the PRF-CM. Thus, the procedure of PRP preparation leads to a larger release of PDGF, as a possible result of platelet degranulation, while PRF enhances the release of proangiogenic factors.
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Affiliation(s)
- F Passaretti
- Department of Translational Medical Sciences, Federico II University of Naples , Naples , Italy
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12
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Tarantino G, Di Somma C, Pizza G, Brancato V, Nedi V, Valentino R, Orio F, Pivonello C, Colao A, Savastano S. Polycystic Ovary Syndrome and Hepatic Steatosis: Could Low-Grade Chronic Inflammation Be Mediated by the Spleen? EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is characterized by an extreme variety of phenotypes and controversial metabolic implications. Hepatic Steatosis (HS) and low-grade chronic inflammation (LGCI) might be common findings in PCOS. We conducted a cross-sectional study to evaluate the LGCI and HS in young women with PCOS according to their Body Mass index (BMI), Insulin Resistance (IR), and PCOS phenotypes. Sixty young premenopausal PCOS women and 20 age-matched controls participated. Primary outcome measures were the presence/severity of HS; LGCI index evaluated as spleen longitudinal diameter (SLD) by UltraSound, C-Reactive Protein (CRP) and Interleukin (IL)-6 levels; BMI and the Homeostasis Model Assessment (HoMA) of IR. The second outcome measures were testosterone, Sex Hormone-Binding Globulin (SHBG) levels, and Free Androgen Index (FAI). The presence of HS and LGCI was not significantly different between NW and O/O patients, while there were significant differences particularly when the PCOS-women were grouped according to IR or to PCOS phenotypes. At multiple regression adjusted for BMI, HoMA-IR and the spleen size were the major determinants of the severity of HS (β= 0.36, p=0.007, and β= 0.28, p=0.034, respectively). At multiple regression SLD represented the unique predictor of FAI (β=0.32; p=0.018). In young women with PCOS, HS was detected independently from obesity and was well predicted not only by IR but also by spleen size, with variable expression of the liver-spleen axis across the different PCOS subtypes. A possible role of the spleen in determining LGCI also in women with PCOS is emphasized.
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Affiliation(s)
- G. Tarantino
- Department of Clinical and Experimental Medicine, University Federico II of Naples, Italy
| | | | - G. Pizza
- Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, Italy
| | - V. Brancato
- Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, Italy
| | - V. Nedi
- Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, Italy
| | - R. Valentino
- C.N.R. Institute of Experimental Endocrinology and Oncology ‘G. Salvatore’, Naples, Italy
| | - F. Orio
- Department of Endocrinology, Parthenope University, Naples, Italy
| | - C. Pivonello
- Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, Italy
| | - A. Colao
- Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, Italy
| | - S. Savastano
- Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, Italy
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Morotti M, Buccelli E, Valentino R, Venturini P, Ferrero S. M054 PROGESTOGEN-ONLY CONTRACEPTIVE PILL COMPARED WITH COMBINED ORAL CONTRACEPTIVE IN THE TREATMENT OF PAIN SYMPTOMS CAUSED BY ENDOMETRIOSIS IN PATIENTS WITH MIGRAINE WITHOUT AURA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61248-x] [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: 11/24/2022]
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Horovitz A, El ZI, Valentino R, Medhaoui H, Inamo J. How an Ebstein-Barr virus may induce acute fulminant myocarditis in a young immunocompetent adult: a case report. W INDIAN MED J 2012; 61:640-642. [PMID: 23441362] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- A Horovitz
- Service de Cardiologie, Centre Hospitalier Universitaire de Fort de France, Martinique.
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Esposito C, Valentino R, Villa L, Serpieri N, Mangione F, Grosjean F, Esposito V, Castoldi F, Sileno G, Montagna F, Maggi N, Torreggiani M, Marchi G, Dal Canton A. Effects of sirolimus on human mesangial cells. Transplant Proc 2010; 42:1344-6. [PMID: 20534297 DOI: 10.1016/j.transproceed.2010.03.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mesangial cell (MC) proliferation and production of extracellular matrix or loss of MC are both central findings in a number of renal proteinuric diseases. However, the role of MC as components of the glomerular filtration barrier and whether MC alterations induce changes in the glomerular filtration barrier leading to proteinuria are still matters of debate. The effects of Sirolimus (SRL) in proteinuric nephropathies is controversial: some papers have indicated a reduction and others, an increase in proteinuria after sirolimus treatment. Considering the pivotal role of MC in the pathogenesis of many chronic nephropathies, we evaluated the effect of SRL on cultured human MC. We treated primary human MC cultures with SRL, or platelet-derived growth factor (PDGF) or SRL + PDGF, or dimethylsulfoxide, the SRL vehicle, as a control. PDGF was used to activate MC. After 48 hours treatment, MC showed a significant growth increase that was significantly reduced by SRL (P < .01). Apoptosis, determined by the TUNEL assay and flow cytometry, was not modified by the treatments at 24 hours. SRL treatment increased significantly the number of alpha-smooth muscle actin-positive cells compared with controls (P < .05). Cells treated with SRL and SRL + PDGF showed significant changes in morphology with increased mean cell surface, perimeter, and maximum diameter (P < .01) but not protein content. Furthermore, MC treated with SRL showed decreased migration through polycarbonate membranes. The changes induced by SRL may help to explain some of the in vivo effects observed in SRL-treated patients.
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Affiliation(s)
- C Esposito
- Unit of Nephrology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Savastano S, Valentino R, Pizza G, De Rosa A, Orio F, Passaretti F, Formisano P, Lombardi G, Beguinot F, Colao A. Preliminary data on effects of metformin on PED/PEA-15 cellular levels in obese women with polycystic ovary syndrome. J Endocrinol Invest 2010; 33:446-50. [PMID: 20671408 DOI: 10.1007/bf03346622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The cellular abundance of the phosphoprotein enriched in diabetes (PED/PEA-15), a 15 kDa protein related to insulin resistance (IR), is increased in women with polycystic ovary syndrome (PCOS). AIM To investigate whether metformin (MET) has additive effects on PED/PEA-15 protein levels. MATERIAL/SUBJECTS AND METHODS This is an open label, prospective clinical study over 6 months. Ten hyperandrogenic obese PCOS women [age: 24.6+/-1.6 yr; body mass index (BMI): 30.7+/-1.2 kg/m(2)] were treated with MET (1250 mg/day). Ten age- and BMI-matched normo-androgenic women were used as controls. Outcome measures are: PED/PEA-15 protein levels, fasting plasma glucose and insulin (FPI), reciprocal index of homeostasis model assessment of insulin resistance (1/HOMA-IR); quantitative insulin sensitivity check index (QUICKI); wholebody insulin sensitivity index (ISI); SHBG; total testosterone; free androgen index (FAI). RESULTS At baseline FPI and PED/PEA- 15 protein levels were higher, while 1/HOMA-IR, QUICKI, and ISI were lower (p<0.001) in MET group than in controls. After treatment, independently of body weight and hyperandrogenism, FPI, and PED/PEA-15 protein levels decreased (p=0.001 and 0.004, respectively), while, 1/HOMA-IR, QUICKI, and ISI increased (p<0.001). PED/PEA-15 protein levels correlated significantly with ISI either before (r=0.636; p=0.048), and after treatment (r=0.758; p=0.011). CONCLUSIONS PED/PEA-15 protein levels reduced after a short course of treatment with MET in a group hyperandrogenic obese PCOS women. This effect was independent of body weight and hyperandrogenism, and correlated with ISI, thus adding a further benefit to obese PCOS women.
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Affiliation(s)
- S Savastano
- Division of Endocrinology, Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples, via S. Pansini 5, 80131 Naples, Italy.
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Mehdaoui H, Allart L, Sarrazin B, Valentino R, Balestrat E, Ravaux P. Impact of thiopental use on cerebral perfusion pressure in severe brain trauma: an example of caregivers' adaptation. Crit Care 2010. [PMCID: PMC2933975 DOI: 10.1186/cc8677] [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: 11/10/2022] Open
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18
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Oriente F, Iovino S, Cassese A, Romano C, Miele C, Troncone G, Balletta M, Perfetti A, Santulli G, Iaccarino G, Valentino R, Beguinot F, Formisano P. Overproduction of phosphoprotein enriched in diabetes (PED) induces mesangial expansion and upregulates protein kinase C-beta activity and TGF-beta1 expression. Diabetologia 2009; 52:2642-52. [PMID: 19789852 DOI: 10.1007/s00125-009-1528-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 08/05/2009] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Overproduction of phosphoprotein enriched in diabetes (PED, also known as phosphoprotein enriched in astrocytes-15 [PEA-15]) is a common feature of type 2 diabetes and impairs insulin action in cultured cells and in mice. Nevertheless, the potential role of PED in diabetic complications is still unknown. METHODS We studied the effect of PED overproduction and depletion on kidney function in animal and cellular models. RESULTS Transgenic mice overexpressing PED (PEDTg) featured age-dependent increases of plasma creatinine levels and urinary volume, accompanied by expansion of the mesangial area, compared with wild-type littermates. Serum and kidney levels of TGF-beta1 were also higher in 6- and 9-month-old PEDTg. Overexpression of PED in human kidney 2 cells significantly increased TGF-beta1 levels, SMAD family members (SMAD)2/3 phosphorylation and fibronectin production. Opposite results were obtained following genetic silencing of PED in human kidney 2 cells by antisense oligonucleotides. Inhibition of phospholipase D and protein kinase C-beta by 2-butanol and LY373196 respectively reduced TGF-beta1, SMAD2/3 phosphorylation and fibronectin production. Moreover, inhibition of TGF-beta1 receptor activity and SMAD2/3 production by SB431542 and antisense oligonucleotides respectively reduced fibronectin secretion by about 50%. TGF-beta1 circulating levels were significantly reduced in Ped knockout mice and positively correlated with PED content in peripheral blood leucocytes of type 2 diabetic patients. CONCLUSIONS/INTERPRETATION These data indicate that PED regulates fibronectin production via phospholipase D/protein kinase C-beta and TGF-beta1/SMAD pathways in kidney cells. Raised PED levels may therefore contribute to the abnormal accumulation of extracellular matrix and renal dysfunction in diabetes.
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MESH Headings
- Actins/genetics
- Animals
- Astrocytes/metabolism
- Blood Pressure
- DNA Primers
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Nephropathies/epidemiology
- Fatty Acids, Nonesterified/blood
- Fibronectins/genetics
- Gene Expression Regulation
- Heart Rate
- Humans
- Insulin/blood
- Kidney/physiology
- Kidney Failure, Chronic/etiology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Phenotype
- Phosphoproteins/biosynthesis
- Phosphoproteins/genetics
- Protein Kinase C/genetics
- Protein Kinase C beta
- Reverse Transcriptase Polymerase Chain Reaction
- Smad2 Protein/genetics
- Transforming Growth Factor beta1/genetics
- Up-Regulation
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Affiliation(s)
- F Oriente
- Department of Cellular and Molecular Biology and Pathology, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
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19
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Bonnan M, Valentino R, Olindo S, Mehdaoui H, Smadja D, Cabre P. Plasma exchange in severe spinal attacks associated with neuromyelitis optica spectrum disorder. Mult Scler 2009; 15:487-92. [PMID: 19324982 DOI: 10.1177/1352458508100837] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Plasma exchange (PE) is increasingly undertaken in diseases involving humoral factors and is proven to be beneficial in acute demyelinating diseases. Spinal attacks in relapsing neuromyelitis optica (NMO) and in extensive transverse myelitis (ETM) – a truncated form of NMO with spinal involvement – are usually devastating. Objective We retrospectively studied the outcome of PE-treated versus steroid-only treated spinal attacks in relapsing NMO and ETM. Methods We included 96 severe spinal attacks in 43 Afro-Caribbean patients. PE was given as an add-on therapy in 29 attacks. Expanded disability status score (EDSS) was obtained before attack, during the acute and residual stage. We defined the ΔEDSS as the rise from basal to residual EDSS. Results The ΔEDSS was found to be lower in the PE-treated group (1.2 ± 1.6 vs 2.6 ± 2.3; P < 0.01). A low basal impairment is associated with a better outcome. Improvement was obtained in both NMO-IgG negative and positive NMO attacks. Minor adverse events manifested in seven PE sessions (24%). Conclusion PE appears to be a safe add-on therapy that may be employed early in severe spinal attacks in the NMO spectrum disorders in order to maximize improvement rate. PE efficiency is independent of NMO-IgG positivity.
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Affiliation(s)
- M Bonnan
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - R Valentino
- Réanimation médicale, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - S Olindo
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - H Mehdaoui
- Réanimation médicale, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - D Smadja
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
| | - P Cabre
- Service de neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, Martinique, French West Indies
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20
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Mehdaoui H, Allart L, Valentino R, Elzein I, Meunier C, Sarrazin B, Vilhelm C, Zitouni D, Ravaux P. Severe brain trauma management analysis using a high-rate recording tool: better definition allows better analysis of practice. Crit Care 2009. [PMCID: PMC4083975 DOI: 10.1186/cc7253] [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: 11/25/2022] Open
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21
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Mehdaoui H, Valentino R, Allart L, Zitouni D, Sarrazin B, Meunier C, Elzein I, Tissier S, Ravaux P. Brain trauma care targets analysis using a high-rate recording and computing network. Crit Care 2008. [PMCID: PMC4088492 DOI: 10.1186/cc6342] [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: 11/23/2022] Open
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22
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Mehdaoui H, Sarrazin B, El Zein I, Allart L, Vilhelm C, Guerra S, Zitouni D, Lemdani M, Valentino R, Herbland A, Ravaux P. ISIS program: a new tool for medical research at the bedside in critical care units. Crit Care 2007. [PMCID: PMC4095492 DOI: 10.1186/cc5599] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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23
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Valentino R, Lupoli GA, Raciti GA, Oriente F, Farinaro E, Della Valle E, Salomone M, Riccardi G, Vaccaro O, Donnarumma G, Sesti G, Hribal ML, Cardellini M, Miele C, Formisano P, Beguinot F. The PEA15 gene is overexpressed and related to insulin resistance in healthy first-degree relatives of patients with type 2 diabetes. Diabetologia 2006; 49:3058-66. [PMID: 17021921 DOI: 10.1007/s00125-006-0455-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/27/2006] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS Overexpression of the gene encoding phosphoprotein enriched in astrocytes 15 (PEA15), also known as phosphoprotein enriched in diabetes (PED), causes insulin resistance and diabetes in transgenic mice and has been observed in type 2 diabetic individuals. The aim of this study was to investigate whether PEA15 overexpression occurs in individuals at high risk of diabetes and whether it is associated with specific type 2 diabetes subphenotypes. SUBJECTS AND METHODS We analysed PEA15 expression in euglycaemic first-degree relatives (FDR) of type 2 diabetic subjects. RESULTS The expression of PEA15 in peripheral blood leucocytes (PBLs) paralleled that in fat and skeletal muscle tissues. In PBLs from the FDR, PEA15 expression was two-fold higher than in euglycaemic individuals with no family history of diabetes (control subjects), both at the protein and the mRNA level (p < 0.001). The expression of PEA15 was comparable in FDR and type 2 diabetic subjects and in each group close to one-third of the subjects expressed PEA15 levels more than 2 SD higher than the mean of control subjects. Subjects with IFG with at least one type 2 diabetes-affected FDR also overexpressed PEA15 (p < 0.05). In all the groups analysed, PEA15 expression was independent of sex and unrelated to age, BMI, waist circumference, systolic and diastolic BP, and fasting cholesterol, triacylglycerol and glucose levels. However, in euglycaemic FDR of type 2 diabetic subjects, PEA15 expression was inversely correlated with insulin sensitivity (r = -557, p = 0.01). CONCLUSIONS/INTERPRETATION We conclude that PEA15 overexpression represents a common defect in FDR of patients with type 2 diabetes and is correlated with reduced insulin sensitivity in these individuals.
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Affiliation(s)
- R Valentino
- Department of Cellular and Molecular Biology, University of Naples Federico II, Naples, Italy
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24
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Valentino R, Savastano S, Tommaselli AP, Di Biase S, Calvanese E, Carbone D, Dorato M, Orio F, Lupoli G, Lombardi G. Screening a coastal population in Southern Italy: iodine deficiency and prevalence of goitre, nutritional aspects and cardiovascular risk factors. Nutr Metab Cardiovasc Dis 2004; 14:15-19. [PMID: 15053159 DOI: 10.1016/s0939-4753(04)80042-5] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM To evaluate the prevalence of goitre by means of urinary iodine excretion, palpatory and ultrasonographic thyroid examinations in a heterogeneous population living by the sea. METHODS AND RESULTS We used a special self-administered questionnaire to evaluate thyroid size, iodine intake, eating habits and cardiovascular risk factors in 600 subjects with a mean age of 45 +/- 17 years: 253 men (42.3%) and 347 women (57.7%). Urinary iodine excretion was low (72.1 +/- 15.7 microg/L; median 71.2) and associated with ultrasonographic evidence of an enlarged thyroid (16%) or structural thyroid abnormalities (30%), thus allowing us to define the Salerno Gulf as a mild-moderate area of endemic goitre. All of the subjects ate a Mediterranean diet, with a mean of two portions of fish/week. The cardiovascular risk factors considered were obesity, cigarette smoking, hypertension, hypercholesterolemia, hypertriglyceridemia and diabetes, the prevalences of which were in line with those reported in other studies of similar age-matched populations. CONCLUSIONS The moderate intake of fish and the consumption of a Mediterranean diet did not prevent goitre. Iodine deficiency and subsequent goitre endemia are also present at sea level, probably because of a diet based on local products grown on soil with a low iodine content or possible seawater, soil and air environmental pollution that may interfere with the availability of iodine. The assessment of iodine deficiency should therefore involve the entire population and not only subjects living far from the sea.
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Affiliation(s)
- R Valentino
- Istituto di Endocrinologia ed Oncologia Sperimentale G.Salvatore, Consiglio Nazionale delle Ricerche, Dipartimento di Biologia e Patologia Cellulare e Molecolare, Naples, Italy.
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25
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Mehdaoui H, Pascal-mousselard H, Schott P, Dubois B, Valentino R, Joachim-arnaud D. Crit Care 2004; 8:P208. [DOI: 10.1186/cc2675] [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: 11/10/2022] Open
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26
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Mehdaoui H, Uzan J, Lucien W, Edragas R, Dubois B, Joachim-arnaud D, Valentino R. Crit Care 2004; 8:P309. [DOI: 10.1186/cc2776] [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: 11/10/2022] Open
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27
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Abstract
alpha 1 Adrenergic receptors mediate a variety of physiological responses and have been well studied in the cardiovascular and peripheral nervous system. However, their role in the central nervous system remains ill defined because of the lack of highly specific ligands to the alpha1 receptor subtypes. Here, we have employed gene targeting to elucidate the role of alpha 1d receptors in vivo. In addition to disrupting function, the insertion of the lacZ gene into the alpha 1d receptor locus enabled the specific identification of cells expressing the alpha 1d gene. These cells are localized in the cortex, hippocampus, olfactory bulb, dorsal geniculate and ventral posterolateral nuclei of the thalamus. Behaviorally, the alpha 1d(-/-) mice show normal locomotor activity during the subjective day, or resting phase of their cycle. However, during subjective night, or active phase, wheel-running activity is significantly reduced in mutant mice. Furthermore, these mice show a reduction in exploratory rearing behavior in a novel cage environment. Lastly, alpha 1d(-/-) mice show reduced hyperlocomotion after acute amphetamine administration. Together, these data reveal the functional importance of alpha 1d adrenoceptors in mediating a variety of stimulus-induced changes in locomotor behaviors. While the sensitivity of noradrenergic neurons to environmental stimuli has been well documented, our data demonstrate that at least some of these post-synaptic responses are mediated by alpha 1d adrenergic receptors.
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MESH Headings
- Alleles
- Animals
- Avoidance Learning/drug effects
- Brain/physiology
- Brain Mapping
- Chimera/genetics
- Circadian Rhythm
- Cocaine/pharmacology
- Dextroamphetamine/pharmacology
- Environment
- Exploratory Behavior/drug effects
- Female
- Gene Targeting
- Lac Operon
- Locomotion
- Male
- Maze Learning/drug effects
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Motor Activity/drug effects
- Motor Activity/genetics
- Mutagenesis, Insertional
- Nerve Tissue Proteins/deficiency
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/physiology
- RNA, Messenger/analysis
- Reaction Time/genetics
- Receptors, Adrenergic, alpha-1/deficiency
- Receptors, Adrenergic, alpha-1/genetics
- Receptors, Adrenergic, alpha-1/physiology
- Rotation
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Affiliation(s)
- A Sadalge
- Department of Pharmacology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Savastano S, Valentino R, Belfiore A, De Luca N, de Alteriis A, Orio F, Palomba S, Villani AM, Falconi C, Lupoli G, Lombardi G, Falcone C. Early carotid atherosclerosis in normotensive severe obese premenopausal women with low DHEA(S). J Endocrinol Invest 2003; 26:236-43. [PMID: 12809174 DOI: 10.1007/bf03345163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the direct involvement of hyperinsulinaemia, DHEA and DHEA-S [DHEA(S)] in severe obesity in early carotid atherosclerosis, measured as intima-media thickness (IMT). Seventeen normotensive premenopausal women with very high BMI (43.5 +/- 1.6 kg/m2) were recruited for the study. Six women were also evaluated 12 months after laparoscopic adjustable silicone gastric banding (LASGB). Dietary intake, fasting plasma lipid profile, glycemic and insulinemic response to the OGTT, adrenal secretion, at baseline and after ACTH stimulation test, were measured. IMT, common carotid diameter (CD) and left ventricular mass index (LVMi) were measured by B-mode echotomography. All obese subjects showed higher fasting and stimulated insulin levels, but lower DHEA(S) levels than controls, showing a negative correlation between both fasting and stimulated insulin and DHEA(S), either at baseline or after ACTH testing. IMT was higher (p < 0.05) than controls, with a positive correlation with stimulated insulin (p < 0.05) and a strong negative correlation with DHEA(S) (p < 0.001). In a multiple linear regression analysis, insulin response to OGTT maintained an association with DHEA(S) independent of fasting insulin, while DHEA maintained the association with IMT independent of stimulated insulin (p < 0.0001). In the six patients evaluated 12 months after LASGB, fasting insulin levels decreased, while DHEA(S) levels increased (p < 0.05). In conclusion, an early cardiovascular involvement was detected in this group of severe obese with hyperinsulinaemia and low DHEA(S), even in the absence of other well known CVD risk factors.
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Affiliation(s)
- S Savastano
- Department of Molecular and Clinical Endocrinology and Oncology, University "Federico II" Medical School, Naples, Italy.
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Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Cardinaud JP, Guenard H. [Non-invasive ventilation in immunosuppressed patients]. Rev Mal Respir 2003; 20:68-76. [PMID: 12709636] [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: 03/02/2023]
Abstract
INTRODUCTION In immunosuppressed patients with acute respiratory insufficiency (ARI) mechanical ventilation is associated with a high mortality. Therefore, in this situation, avoidance of intubation could be an important objective. However, experience of non-invasive ventilation (NIV) in the immunosuppressed remains limited. STATE OF ART The first descriptive studies have shown that NIV could be an alternative to intubation, particularly in patients with malignant haematological disorders. In a prospective randomised controlled study Antonelli et al. showed that the use of NIV significantly improved the prognosis of patients with ARI following organ transplantation. We have carried out a prospective randomised controlled trial in 52 immunosuppressed patients to determine whether NIV improved the prognosis in patients admitted to intensive care with pulmonary infiltrates, fever and ARI. The use of NIV was associated with significant reductions in the intubation rate, serious complications and ICU and hospital mortality. PERSPECTIVES Further studies are needed in order to better define the patients susceptible to benefit from NIV, and to establish variables predictive of the success or the failure of the method. CONCLUSIONS NIV leads to an improvement in the prognosis of some immunosuppressed patients admitted to intensive care.
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Affiliation(s)
- G Hilbert
- Département de Réanimation Médicale, CHU Bordeaux, Bordeaux, France
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30
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Moiton MP, Bijou F, Vargas F, Valentino R, Gruson D, Hilbert G, Bénissan G, Cardinaud JP. [Association of type 1 neurofibromatosis and primary hyperparathyroidism]. Presse Med 2002; 31:1604-5. [PMID: 12426977] [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: 02/27/2023] Open
Abstract
INTRODUCTION The combination of neurofibromatosis type I with hyperparathyroidism is classical but rare. OBSERVATION Our report is on the original observation of a patient affected with Von Recklinghausen's disease complicated by chronic restrictive breathing deficiency. After an intense breathing decompensation and a spreading convulsive attack, hyperparathyroidism was diagnosed. DISCUSSION The similarity of the bone lesions seen in type I neurofibromatosis and in hyperparathyroidism strongly suggests a genetic link between these two pathologies. Hence, hyperparathyroidism should be searched for in all patients affected with Von Recklinghausen's disease, since the adjustment of hypercalcemia can lead to partial reversibility of the bone abnormalities.
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Affiliation(s)
- M P Moiton
- Service de rhumatologie, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000 Bordeaux.
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Valentino R, Savastano S, Tommaselli AP, D'Amore G, Dorato M, Lombardi G. The influence of intense ballet training on trabecular bone mass, hormone status, and gonadotropin structure in young women. J Clin Endocrinol Metab 2001; 86:4674-8. [PMID: 11600524 DOI: 10.1210/jcem.86.10.7908] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A cross-sectional study on young dancers and exdancers was performed to evaluate the effects of intense weight-bearing exercise and dietary restriction, started during puberty, on bone mineral density (BMD), menarche age, menstrual function, and gonadotropin structure. Twenty current dancers (group 1) and 9 exdancers (group 2) were compared with a control group of 30 age-matched, regularly cycling women. Body weight, body mass index, total daily caloric intake, and nutritional markers were significantly lower (P < 0.05) in groups 1 and 2 than in controls. Using Quantitative Computed Tomography for the BMD evaluation, 12 dancers and 5 exdancers had Z-scores less than 2.5 SD below the mean of the controls; whereas, in 6 dancers and in 2 exdancers, BMD was between 1 and 2.5 SD. Groups 1 and 2 had a delay of menarche, which correlated positively with years of dance before menarche (r = 0.8; P < 0.001). Dancers had low levels and altered structure of circulating gonadotropins, which improved after GnRH stimulation. In conclusion, ballet training performed by dancers during puberty, dietary restriction, and low body mass index can all be associated with reduction in BMD and altered gonadotropin isoforms, with subsequent delay of menarche, menstrual dysfunctions, and insufficient peak bone mass. A longitudinal study must be conducted to confirm the persistence of low lumbar spine bone density in adult age.
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Affiliation(s)
- R Valentino
- Consiglio Nazionale delle Richerche, Experimental Endocrinology and Oncology Center (CEOS), Department of Cellular and Molecular Biology and Pathology, Federico II University Medical School, Via Pansini, 5, 80131 Naples, Italy.
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33
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Rossi R, Tauchmanovà L, Luciano A, Valentino R, Savastano S, Battista C, Di Martino M, Lombardi G. Functional hyperandrogenism detected by corticotropin and GnRH-analogue stimulation tests in women affected by apparently idiopathic hirsutism. J Endocrinol Invest 2001; 24:491-8. [PMID: 11508782 DOI: 10.1007/bf03343881] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The etiologic diagnosis of hirsutism is often difficult. Previous studies have reported normal basal androgen and SHBG concentrations in 33-50% of hirsute women, suggesting the presence of an "idiopathic" form of hirsutism as the most frequent cause of this problem. The recent use of GnRH-analogues together with the corticotropin stimulation test allows better understanding of whether the cause of hirsutism is androgen excess and, if so, whether the origin of the latter is ovarian, adrenal or both. The present study evaluated adrenal and ovarian function in 48 young hirsute women as well as in 78 normal women matched for body mass index and age, who acted as control group. To determine ovarian function, a single 100-microg dose of GnRH analogue triptorelin was injected s.c.; thereafter, gonadotropins, 17-hydroxyprogesterone (17-OHP), delta4-androstenedione (delta4), total testosterone (T) and estradiol were determined. To better understand the adrenal function, 250 microg of 1,24 ACTH were administrated as i.v. infusion for 5 h, and plasma cortisol (F), 17-OHP, A4, DHEAS, T, 11-desossicortisol were measured. The combined use of these two stimulation tests was able to detect mild to moderate abnormalities in the steroidogenesis of ovaries alone (23%), adrenals alone (16.6%), or both (35.4%) in most hirsute women (75%) with otherwise normal baseline androgen concentrations. In particular, patients showed significantly increased responses of 17-OHP, delta4, total T, 11-desossicortisol, and F to 1,24-ACTH administration. Moreover, they also had significantly higher 17-OHP and T responses to triptorelin. In conclusion, milder forms of functional ovarian and/or adrenal hyperandrogenism, similar to those found in clearly hyperandrogenic women, were observed and could be an underlying mechanism of idiopathic hirsutism.
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Affiliation(s)
- R Rossi
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy.
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Hilbert G, Vargas F, Valentino R, Gruson D, Chene G, Bébéar C, Gbikpi-Benissan G, Cardinaud JP. Comparison of B-mode ultrasound and computed tomography in the diagnosis of maxillary sinusitis in mechanically ventilated patients. Crit Care Med 2001; 29:1337-42. [PMID: 11445682 DOI: 10.1097/00003246-200107000-00007] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 11/25/2022]
Abstract
OBJECTIVE To compare B-mode ultrasound with sinus computed tomograph (CT) scan in the diagnosis of sinusitis in intubated patients undergoing mechanical ventilation. DESIGN Prospective, clinical investigation. SETTING Medical intensive care unit of a university hospital. PATIENTS Fifty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of paranasal sinusitis with purulent nasal discharge. INTERVENTIONS One hundred paranasal sinuses were examined. A paranasal CT scan and a B-mode ultrasound were performed the same day. Radiologic maxillary sinusitis (RMS) was defined as complete opacification of the sinus or as the presence of an air-fluid level. Absence of RMS was defined as normal sinus or as the presence of mucosal thickening. Important RMS was defined by total opacity or air-fluid level larger than half of the sinus area. Moderate RMS was defined by air-fluid level inferior than half of the sinus area. For ultrasonographic procedure, the image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: 1) a moderate lesion was defined as the visualization only of the hyperechogenic posterior wall of the sinus; 2) an important lesion was defined as the hyperechogenic visualization of posterior wall and the extension by the internal wall of the sinus outlining the hypoechogenic sinus cavity. MEASUREMENTS AND MAIN RESULTS Sensibility, specificity, positive predictive value, and negative predictive value of B-mode ultrasound compared with CT were, respectively: 100% (95% confidence intervals [95% CI] = 94.9-100.0), 96.7% (95% CI = 82.8-99.9), 98.6% (95% CI = 92.4-99.9), and 100% (95% CI = 88.1-100). The concordance between a moderate B-mode ultrasound lesion and a moderate RMS on CT, and between an important B-mode ultrasound lesion and an important RMS on CT, assessed using kappa statistics was 93%. The concordance between B-mode ultrasound's results and CT's results assessed using weighted kappa statistics was 97%. CONCLUSION B-mode ultrasound may be proposed first-line in a ventilated patient with suspicion of maxillary sinusitis.
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Affiliation(s)
- G Hilbert
- Medical Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
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Abstract
An increased frequency of reproductive endocrine disorders has been reported in women with epilepsy. A possible role of the seizure disorder or, alternatively, of the use of antiepileptic drugs (AEDs) has been suggested as the pathogenic mechanism. The aim of the present study was to assess the frequency of reproductive endocrine disorders in a series of women with epilepsy, examining the possible relationships of these disturbances with different epilepsy syndromes and AED treatment. Fifty epileptic women, all of reproductive age and none pubertal, pregnant, or lactating, were submitted to clinical endocrinological evaluation, hormonal assessment, and ovarian ultrasonography. Subjects with abnormal findings in this preliminary study underwent additional evaluations. Reproductive endocrine disorders were diagnosed in 16 (32%), consisting of polycystic ovary syndrome in 13, hypothalamic amenorrhea in 2, and luteal phase deficiency in 1. There was no significant association of these disturbances with epilepsy type or AED treatment. Patients with reproductive endocrine disorders often showed delayed ovulation with shortened luteal phase. The results of this study suggest that the prevalence of disordered ovulation, in particular polycystic ovary syndrome, is increased in epilepsy, independent of antiepileptic medications or type of seizure disorder.
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Affiliation(s)
- L Bilo
- Epilepsy Center, Department of Neurosciences, Federico II University, 80131 Naples, Italy.
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Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001; 344:481-7. [PMID: 11172189 DOI: 10.1056/nejm200102153440703] [Citation(s) in RCA: 622] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Avoiding intubation is a major goal in the management of respiratory failure, particularly in immunosuppressed patients. Nevertheless, there are only limited data on the efficacy of noninvasive ventilation in these high-risk patients. METHODS We conducted a prospective, randomized trial of intermittent noninvasive ventilation, as compared with standard treatment with supplemental oxygen and no ventilatory support, in 52 immunosuppressed patients with pulmonary infiltrates, fever, and an early stage of hypoxemic acute respiratory failure. Periods of noninvasive ventilation delivered through a face mask were alternated every three hours with periods of spontaneous breathing with supplemental oxygen. The ventilation periods lasted at least 45 minutes. Decisions to intubate were made according to standard, predetermined criteria. RESULTS The base-line characteristics of the two groups were similar; each group of 26 patients included 15 patients with hematologic cancer and neutropenia. Fewer patients in the noninvasive-ventilation group than in the standard-treatment group required endotracheal intubation (12 vs. 20, P=0.03), had serious complications (13 vs. 21, P=0.02), died in the intensive care unit (10 vs. 18, P=0.03), or died in the hospital (13 vs. 21, P=0.02). CONCLUSIONS In selected immunosuppressed patients with pneumonitis and acute respiratory failure, early initiation of noninvasive ventilation is associated with significant reductions in the rates of endotracheal intubation and serious complications and an improved likelihood of survival to hospital discharge.
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Affiliation(s)
- G Hilbert
- Division of Medical Intensive Care, University Hospital, Bordeaux, France.
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Hilbert G, Gruson D, Vargas F, Valentino R, Favier JC, Portel L, Gbikpi-Benissan G, Cardinaud JP. Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients. Crit Care Med 2001; 29:249-55. [PMID: 11246301 DOI: 10.1097/00003246-200102000-00004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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: 11/26/2022]
Abstract
OBJECTIVE Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) are major tools in the diagnosis of pulmonary complications in immunocompromised patients. Nevertheless, severe hypoxemia is an accepted contraindication to FOB in nonintubated patients. The purpose of this study was to evaluate the feasibility and safety of laryngeal mask airway (LMA)-supported FOB with BAL in immunosuppressed patients with suspected pneumonia and severe hypoxemia. DESIGN Prospective, clinical investigation. SETTING Medical intensive care unit of a university hospital. PATIENTS Forty-six immunosuppressed patients admitted to our intensive care unit with suspected pneumonia and Pao2/Fio2 < or = 125. INTERVENTIONS After the administration of 0.3 mg x kg(-1) of etomidate, the patients were ventilated manually while receiving 1.0 Fio2. After the administration of 2.5 mg x kg(-1) of propofol, followed by an infusion of 9.1 +/- 2.3 mg x kg(-1) x hr(-1) of propofol, the LMA (size 3 or 4) was placed and connected to a bag-valve unit to allow manual ventilation with 1.0 Fio2. The FOB was introduced through a T-adapter attached to the LMA, and BAL was carried out with 150 mL of sterile 0.9% saline solution by sequential instillation and aspiration of 50-mL aliquots. MEASUREMENTS AND MAIN RESULTS Three patients developed transient laryngospasm during passage of the bronchoscope via the LMA, which resolved with deepening of anesthesia. Changes in mean blood pressure, heart rate, Pao2/Fio2, and Paco2 values induced by the procedure did not reach significance. Seven patients (15%) presented hypotension (mean blood pressure, <60 mm Hg) maintained for 120 +/- 40 secs, which required plasma expanders in three cases. Oxygen desaturation to <90% occurred in six patients (13%) during BAL. Nevertheless, the lowest Sao2 during the procedure was significantly higher than the initial Sao2 (94% +/- 4% vs. 90% +/- 2%). No patient required tracheal intubation during the 8 hrs after the procedure. BAL had an overall diagnostic yield of 65%. Because of the results obtained by using the BAL analysis, treatment was modified in 33 (72%) cases. CONCLUSION Application of the LMA appears to be a safe and effective alternative to intubation for accomplishing FOB with BAL in immunosuppressed patients with suspected pneumonia and severe hypoxemia.
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Affiliation(s)
- G Hilbert
- Medical Intensive Care Unit, Pellegrin Hospital, Bordeaux, France
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Gruson D, Hilbert G, Vargas F, Valentino R, Pigneux A, Gbikpi-Benissan G. Usefulness of computed tomography for early detection of pneumonia in leukopenic patients. Intensive Care Med 2001; 27:444. [PMID: 11396293 DOI: 10.1007/s001340000826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vargas F, Hilbert G, Valentino R, Gruson D, L'Hostis H, Gbikpi-Benissan G, Cardinaud JP. An idiopathic total gastric necrosis. Intensive Care Med 2001; 27:331-2. [PMID: 11280667 DOI: 10.1007/s001340000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hilbert G, Gruson D, Vargas F, Valentino R, Portel L, Gbikpi-Benissan G, Cardinaud JP. Noninvasive ventilation for acute respiratory failure. Quite low time consumption for nurses. Eur Respir J 2000; 16:710-6. [PMID: 11106217 DOI: 10.1034/j.1399-3003.2000.16d24.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/23/2022]
Abstract
Methods of noninvasive pressure support ventilation (NIPSV) are not always easy to apply in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). The assistance time spent by nurses in relation to ventilatory time was prospectively studied, when NIPSV was used, in a sequential mode, in COPD patients with either acute exacerbations (58 patients, group I) or postextubation hypercapnic respiratory insufficiency (42 patients, group II) in a medical intensive care unit. During the first 24 h after enrolment, NIPSV was used for 6.7+/-3.2 h (mean+/-SD) in group I and 5.6+/-3.1 h in group II; the duration of NIPSV sessions and the nurse time consumption per session were respectively 47+/-12 and 11+/-7 min in group 1, and 46+/-12 and 11+/-6 min in group II. After the first 24 h of the study, the duration of NIPSV was 4.7+/-3.2 h x day(-1) in group I and 4.9+/-3.5 h x day(-1) in group II, and the nurse time consumption dropped significantly: the duration of NIPSV sessions and the nurse time consumption per session were respectively 44+/-10 and 7+/-4 min in group I, and 47+/-14 and 7+/-3 min in group II. Between the first 24 h and the subsequent period of 24 h, the nursing time dropped significantly (98 versus 59 min in group I (p<0.05), and 85 versus 52 min in group II (p<0.05)). There was no difference in the duration of NIPSV sessions, or in the overall assistance time per session, between the two groups of patients. In conclusion, the study seems to favour a quite low assistance time spent by nurses in relation to ventilatory time when noninvasive pressure support ventilation is used in chronic obstructive pulmonary disease patients with either acute exacerbations or postextubation hypercapnic respiratory insufficiency.
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Affiliation(s)
- G Hilbert
- Medical Intensive Care Unit, Pellegrin Hospital, Bordeaux, France
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Gruson D, Hilbert G, Vargas F, Valentino R, Bebear C, Allery A, Bebear C, Gbikpi-Benissan G, Cardinaud JP. Rotation and restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria. Am J Respir Crit Care Med 2000; 162:837-43. [PMID: 10988092 DOI: 10.1164/ajrccm.162.3.9905050] [Citation(s) in RCA: 248] [Impact Index Per Article: 10.3] [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: 12/31/2022] Open
Abstract
To test the hypothesis that a new program of antibiotic strategy control can minimize the incidence of ventilator-associated pneumonia (VAP) caused by potentially antibiotic-resistant microorganisms, we performed a prospective before-after study in 3, 455 patients admitted to a single intensive care unit over a 4-yr period. Regarding the bacterial ecology and the increasing antimicrobial resistance in our medical intensive care unit (MICU), we decided to vary our choice of empiric and therapeutic antibiotic treatment, with a supervised rotation, and a restricted use of ceftazidime and ciprofloxacin, which were widely prescribed before this scheduled change. For all patients, VAP was diagnosed based on the results of quantitative culture of bronchoalveolar lavage specimens (>/= 10(4) cfu/ml). We studied 1,044 and 1,022 patients requiring more than 48 h of mechanical ventilation (MV), respectively, in the before-period (2 yr: 1995-1996) and the after-period (2 yr: 1997-1998). We observed a decrease from 231 consecutive episodes of VAP in the before-period to 161 episodes of VAP in the after-period (p < 0.01), particularly for VAP occurring before 7 d of MV. The total number of potentially antibiotic-resistant gram-negative bacilli responsible for VAP such as Pseudomonas aeruginosa, Burkholderia cepacia, Steno-trophomonas maltophilia, and Acinetobacter baumanii decreased from 140 to 79 isolated bacilli. The susceptibilities of these bacteria to the antibiotics regimen increased significantly, especially for P. aeruginosa and B. cepacia. The percentage of methicillin-sensitive Staphylococcus aureus increased significantly from 40% to 60% of S. aureus responsible for VAP. These results suggest that a new strategy of antibiotics use could be an efficient means to reduce the incidence of VAP caused by antibiotic-resistant bacteria. Nevertheless, further studies are needed to validate these data.
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Affiliation(s)
- D Gruson
- Pulmonary and Critical Care Division and Department of Bacteriology, University Hospital of Bordeaux, Bordeaux, France
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Hilbert G, Gruson D, Vargas F, Valentino R, Chene G, Boiron JM, Pigneux A, Reiffers J, Gbikpi-Benissan G, Cardinaud JP. Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission. Crit Care Med 2000; 28:3185-90. [PMID: 11008980 DOI: 10.1097/00003246-200009000-00012] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [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: 11/27/2022]
Abstract
OBJECTIVE To evaluate the tolerance and the efficacy of noninvasive continuous positive airway pressure (CPAP) in severe acute respiratory failure occurring in intensive care unit (ICU) neutropenic patients with hematologic malignancies, and to establish predictive variables of efficacy of this method. DESIGN Prospective study over a 5-yr period. SETTING Hematologic and medical intensive care unit of a teaching hospital. METHODS Among 129 neutropenic patients admitted to the ICU, 64 patients presented with febrile acute hypoxemic normocapnic respiratory failure (PaO2/FIO2 ratio <200) and were enrolled. In addition to standard therapy, patients received CPAP with a facial mask. The initial settings of the CPAP were 6 cm H2O positive end-expiratory pressure and FIO2 0.8 (80%). Physiologic measurements were performed at the end of 45 mins of ventilation with first adjustments. CPAP was used with a sequential mode (45 mins/3 hrs). CPAP was efficient if intubation was avoided. RESULTS The setting of CPAP, after adjustments, was as follows: positive end-expiratory pressure 7 +/- 1 cm H2O and FIO2 0.7 +/- 0.1 (70% +/- 10%). For the 64 patients, CPAP was administered for a total of 6 +/- 2 hrs during the first 24 hrs. The mean duration of CPAP was 7 +/- 3 days. A reduction in respiratory rate to less than 25 breaths/min was achieved in 53% of patients. PaO2/FIO2 ratio increased from 128 +/- 32 to 218 +/- 28. CPAP was successful in avoiding endotracheal intubation in 16/64 patients. A total of 16 responders and four nonresponders survived. Hepatic failure was a criterion indicating the failure of CPAP: 1/16 vs. 26/48 (p = .001). In multivariate analysis, two variables were predictive of failure of CPAP: Simplified Acute Physiology Score II (58 +/- 14 vs. 41 +/- 11) and a hepatic failure at the entry into the study. CONCLUSION CPAP was efficient in 25% of cases. All the responders survived. This noninvasive method was used as a way to avoid mechanical ventilation, which is well correlated with a poor prognosis in neutropenic ICU patients. Further controlled studies are needed to confirm the efficacy of noninvasive CPAP and to evaluate the most appropriate selection of immunocompromised patients.
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Affiliation(s)
- G Hilbert
- Medical Intensive Care Unit, University Hospital, Bordeaux, France
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Gruson D, Hilbert G, Vargas F, Valentino R, Chene G, Boiron JM, Reiffers J, Gbikpi-Benissan G, Cardinaud JP. Impact of colony-stimulating factor therapy on clinical outcome and frequency rate of nosocomial infections in intensive care unit neutropenic patients. Crit Care Med 2000; 28:3155-60. [PMID: 11008974 DOI: 10.1097/00003246-200009000-00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
OBJECTIVES To determine whether the use of recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim) reduces the mortality rate and the frequency rate of nosocomial infections in neutropenic patients requiring intensive care unit (ICU) admission. DESIGN Retrospective consecutive case series analysis. SETTING Medical ICU of a teaching hospital. PATIENTS We compared two groups of patients, according to whether or not they received G-CSF. In the ICU, 28 leukopenic patients received filgrastim (5 microg of body weight per day intravenously). In all these patients, G-CSF was continued until recovery from leukopenia, defined as a leukocyte count >1,000/mm3. A total of 33 ICU leukopenic patients did not receive G-CSF. End points included leukocyte count, bone marrow recovery, frequency of ICU nosocomial infections (pneumonia, urinary tract, and catheter-related infections), and mortality rate. MEASUREMENTS AND MAIN RESULTS There were no differences in number of patients who recovered from leukopenia or in whom blood leukocyte count increased. Nosocomial infections occurred in the same percentage in both groups. The percentage of patients who died was identical in both groups. The percentage of patients with and without filgrastim therapy who recovered from leukopenia but died, was 86% and 78%, respectively. CONCLUSION In the ICU, clinical outcome of neutropenic patients was not changed by G-CSF therapy. It is possible that G-CSF therapy may not be helpful in improving the ICU clinical outcome of neutropenic patients. Additional controlled studies designed to address this question are warranted.
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Affiliation(s)
- D Gruson
- Medical Intensive Care Unit, University Hospital of Bordeaux, France
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Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, Allery A, Pigneux A, Gbikpi-Benissan G, Cardinaud JP. Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates. Crit Care Med 2000; 28:2224-30. [PMID: 10921544 DOI: 10.1097/00003246-200007000-00007] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [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: 02/02/2023]
Abstract
OBJECTIVE To analyze the impact of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on guiding the treatment and intensive care unit (ICU) clinical outcome in neutropenic patients with pulmonary infiltrates admitted to the ICU. DESIGN Prospective collection of data. SETTING Medical ICU in a teaching hospital. PATIENTS During a 6-yr period, we analyzed the results of 93 fiberoptic bronchoscopies plus BALs performed in 93 consecutive neutropenic ICU patients. We separated the patients into two groups according to the cause of neutropenia (high-dose chemotherapy [n = 41] or stem cell transplantation [SCT; n = 52]). RESULTS Of the 93 BALs, 53 were performed to evaluate diffuse infiltrates and 42 were performed on mechanically ventilated patients. Forty-nine percent of BALs (46 patients) were diagnostic, with a significantly better yield in ICU patients with high-dose chemotherapy-induced neutropenia (26 of 41 BALs). The number of cases of proven infectious pneumonia was significantly higher in this group of ICU neutropenic patients. In patients who underwent SCT, diffuse infiltrates were statistically correlated with a negative result of BAL. Twenty-six patients who underwent diagnostic BALs changed therapy. Sixteen complications (17%) occurred with only two intubations. The overall mortality rate in the ICU and the mortality rate in mechanically ventilated neutropenic patients were 71% and 93%, respectively. In neutropenic patients who underwent SCT, the mortality rate was statistically higher in patients in whom no diagnosis was established. Patients who had a diagnostic BAL that changed therapy did not have an increased probability of survival compared with patients who had a BAL that did not change therapy. CONCLUSIONS The use of routine diagnostic BAL in ICU neutropenic patients with pulmonary infiltrates is difficult to establish, even if BAL is helpful in the management of these critically ill patients. BAL in our ICU neutropenic patient population had an acceptable overall diagnostic yield (49%), which was higher in ICU patients with chemotherapy-induced neutropenia. Nevertheless, in the ICU, if BAL had a low complication rate, it had infrequently led to changed treatment and was not associated with improved patient survival.
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Affiliation(s)
- D Gruson
- Division of Medical Intensive Care, University Hospital, Bordeaux, France
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Vargas F, Hilbert G, Gruson D, Valentino R, Gbikpi-Benissan G, Cardinaud JP. Fulminant Guillain-Barré syndrome mimicking cerebral death: case report and literature review. Intensive Care Med 2000; 26:623-7. [PMID: 10923739 DOI: 10.1007/s001340051213] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [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: 10/27/2022]
Abstract
A 45-year-old woman was admitted to the intensive care unit (ICU) for respiratory arrest. One day prior to admission, she had been nauseated and in a state of total exhaustion. On the night of admission she was unresponsive and developed gasping respiration. The patient was comatose with absent brainstem reflexes and appeared brain dead. Blood chemistry findings and brain magnetic resonance imaging were normal. Electroencephalogram revealed an alpha rhythmical activity unresponsive to painful or visual stimuli. The cerebrospinal fluid showed an albuminocytological dissociation. Guillain-Barré syndrome (GBS) was suspected. The electrophysiological evaluation revealed an inexcitability of all nerves. The pathological findings of the sural nerve biopsy indicated an axonal degeneration secondary to severe demyelination. GBS can very rarely present with coma and absent brainstem reflexes. This case illustrates the importance of electrophysiological tests and laboratory and imaging studies in patients with suspected brain death where a cause is not clearly determined.
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Affiliation(s)
- F Vargas
- Medical Intensive Care Unit B, Pellegrin Hospital, Bordeaux, France.
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Valentino R, Savastano S, Tommaselli AP, Dorato M, Scarpitta MT, Calvanese E, Del Puente A, Lombardi G. Female pseudohermaphroditism and inefficient peak bone mass in an untreated subject affected by 21-hydroxylase congenital adrenal hyperplasia. J Endocrinol Invest 2000; 23:317-20. [PMID: 10882150 DOI: 10.1007/bf03343729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Here we describe a subject with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-CAH), in its classical virilizing form, who presented at birth ambiguous genitalia and subsequently was assigned by the parents as male. At the age of 8 years, he underwent a two-step surgical correction of hypospadia and at 22 years old, uterus and ovaries were removed and a bilateral testicular prothesis was surgically placed in scrotum. He refused any chronic glucocorticoid therapy, that was given only acutely to prevent adrenal crises during stress, trauma surgery or severe illness. The patient is now 38 years old, he is genotypically female but phenotypically male, with high endogenous levels of androgen, all of adrenal origin, and with an apparent male sexual life. He had severe osteopenia, probably due to the lack of estrogen/androgen-induced increase in bone mineral density, although periferal estrogen conversion was normal. His skeletal mass, in fact, normally acquired during adolescence and early adult life, could in this case be inefficient, for the precocious pseudopuberty, that caused an inefficient peak bone mass in adolescence period.
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Affiliation(s)
- R Valentino
- CNR, Experimental Endocrinology and Oncology Center (CEOS), Department of Cellular and Molecular Biology and Pathology, Medical School, University Federico II, Naples, Italy
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Savastano S, Cannavale V, Valentino R, Tommaselli AP, Rossi R, Luciano A, Tauchmanovà L, Mariano A, Mazzitelli L, Macchia V, Lombardi G. AlphaANP, AVP, and pituitary-thyroid axis in patients with congestive heart failure and acute respiratory failure. J Endocrinol Invest 1999; 22:766-71. [PMID: 10614526 DOI: 10.1007/bf03343642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The pituitary-thyroid axis and neurohumoral activation indexes were simultaneously investigated in 16 in-patients hospitalized for cardiac heart failure (CHF), New York Heart Association (NYHA), class II-IV, and Killip clinical scale, class II-III, to evaluate their relationship with CHF morbidity and the relative prognostic value. At entry the patients were divided into two subgroups (A and B), according to the severity of CHF. Patients were further classified into two subgroups, according to the subsequent clinical course (C, poor outcome and D, improved clinical course). Blood samples were obtained every day for the radioimmunoassay measurement of plasma alpha-atrial natriuretic peptide (alphaANP), arginine vasopressin (AVP), and thyroid hormones, and the results were compared with those of 12 control subjects. At admission, alphaANP and 3,3',5'-triiodothyronine (rT3) values were higher, while 3,3',5-triiodothyronine (T3) to rT3 (T3/rT3) ratio was lower in subgroups A and B than in controls (p<0.001), respectively, and in C than in D (p<0.001), respectively, according to the prognosis. Conversely, no differences in other thyroid indexes, nor a significant correlation between alphaANP and either rT3 or T3/rT3 ratio were present in any of the subgroups. AVP plasma levels in subgroup A were not statistically different from those of controls, whereas they were significantly decreased in subgroups B and C (p<0.05) and D (p<0.001). In conclusion, these results indicate that in CHF the pituitary-thyroid axis is not altered, that alphaANP and T3/rT3 ratio are non-invasive and reliable predictors of severity and prognosis, while AVP might be affected by the different pathological processes leading to CHF or by the concomitant use of drugs.
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Affiliation(s)
- S Savastano
- Cattedra di Endocrinologia, Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica, Napoli, Italy
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Valentino R, Savastano S, Tommaselli AP, Dorato M, Scarpitta MT, Gigante M, Micillo M, Paparo F, Petrone E, Lombardi G, Troncone R. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm Res 1999; 51:124-7. [PMID: 10461017 DOI: 10.1159/000023344] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The occurrence of autoimmune thyroid disorders among patients with coeliac disease (CD) is well documented, but the exact prevalence of CD among patients with autoimmune thyroid diseases (ATD) is as yet unclear. We screened 150 newly diagnosed patients with ATD by serum endomysial antibody detection (EmA). In 5 subjects (3.3%) EmA positivity was found; all underwent jejunal biopsy. On gluten-free diet an excellent clinical and histological response was recorded with an improvement of hypothyroidism and reduction of the thyroxine dosage. Our data suggest a significant high prevalence (3.3%) of CD in patients with ATD, in particular with Hashimoto's thyroiditis.
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Affiliation(s)
- R Valentino
- CNR, Experimental Endocrinology and Oncology Center (CEOS), Department of Cellular and Molecular Biology and Pathology, University Federico II, Naples, Italy
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Valentino R, Tommaselli AP, Savastano S, Scarpitta MT, Dorato M, Luciano A, Calvanese E, Lombardi G. Dysregulation of adrenal 11 beta-hydroxylase activity in hypertensive subjects: usefulness of the ACTH 1-17 stimulation test. Nutr Metab Cardiovasc Dis 1999; 9:192-195. [PMID: 10614061] [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: 02/15/2023]
Abstract
BACKGROUND AND AIM The aim of this study was to determine the validity of our previous hypothesis of adrenal 11 beta-hydroxylase (11-OH) dysregulation in "essential" low-renin hypertension. METHODS AND RESULTS A comparison was made between 30 hypertensive patients and 30 age-matched controls (NC) in basal conditions and after ACTH stimulation (ACTH 1-17) test. The 11-deoxycortisol (S) and deoxycorticosterone (DOC) integrated areas under the curve (AUCs) of stimulus were significantly higher in the hypertensives (p < 0.001) and pointed to adrenal 11-OH dysregulation. CONCLUSIONS The ACTH 1-17 test detects impairment of 11-OH activity of probable genetic origin. The relative mineralocorticoid excess thus provoked could be an additional cause of "essential" low-renin hypertension.
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Affiliation(s)
- R Valentino
- Centro di Endocrinologia ed Oncologia Sperimentale (CEOS) del CNR Dipartimento di Biologia e Patologia Cellulare e Molecolare, Università degli Studi Federico II, Naples, Italy
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Valentino R, Savastano S, Tommaselli AP, Dorato M, Scarpitta MT, Gigante M, Lombardi G, Troncone R. Unusual association of thyroiditis, Addison's disease, ovarian failure and celiac disease in a young woman. J Endocrinol Invest 1999; 22:390-4. [PMID: 10401714 DOI: 10.1007/bf03343578] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The coexistence of autoimmune endocrine diseases, particularly autoimmune thyroid disease and celiac disease (CD), has recently been reported. We here present a 23-year-old woman with a diagnosis of hypothyroidism due to Hashimoto's thyroiditis, autoimmune Addison's disease, and kariotypically normal spontaneous premature ovarian failure. Considering the close association between autoimmune diseases and CD, we decided to search for IgA anti-endomysium antibodies (EmA) in the serum. The positivity of EmA and the presence of total villous atrophy at jejunal biopsy allowed the diagnosis of CD. On a gluten-free diet the patient showed a marked clinical improvement accompanied, over a 3-month period, by a progressive decrease in the need for thyroid and adrenal replacement therapies. After 6 months, serum EmA became negative and after 12 months a new jejunal biopsy showed complete mucosal recovery. After 18 months on gluten-free diet, the anti-thyroid antibodies titre decreased significantly, and we could discontinue thyroid substitutive therapy. This case emphasizes the association between autoimmune polyglandular disease and CD; the precocious identification of these cases is clinically relevant not only for the high risk of complications (e.g. lymphoma) inherent to untreated CD, but also because CD is one of the causes for the failure of substitute hormonal therapy in patients with autoimmune thyroid disease.
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Affiliation(s)
- R Valentino
- Centro di Endocrinologia e Oncologia Sperimentale del CNR, Dipartimento di Biologia e Patologia Cellulare e Molecolare L. Califano, Italy
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