RESUMO
A link between chronic hepatitis C virus (HCV) infection and low-grade B-cell lymphomas has been suggested by epidemiological studies. Marginal zone lymphomas (MZLs) including splenic lymphomas with villous lymphocytes are among the most frequently reported subgroups in the setting of chronic HCV infection. In this study, we examined the effect of antiviral treatment in eight patients with HCV-associated MZL. We found that five out of eight patients have responded to interferon alpha and ribavirin. In some cases, hematologic responses were correlated to virologic responses. In addition, we report a case of large granular lymphocyte leukemia occurring in association with MZL and HCV, and responding to interferon and ribavirin. We suggest that there is an etiologic link between HCV and antigen-driven lymphoproliferative disorders.
Assuntos
Antivirais/uso terapêutico , Hepacivirus/patogenicidade , Hepatite C/tratamento farmacológico , Linfoma de Células B/virologia , Adulto , Idoso , Quimioterapia Combinada , Feminino , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/complicações , Hepatite C/virologia , Humanos , Interferon-alfa/uso terapêutico , Linfoma de Células B/complicações , Linfoma de Células B/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Ribavirina/uso terapêutico , Resultado do TratamentoAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Inibidores de Ciclo-Oxigenase/efeitos adversos , Doenças do Íleo/induzido quimicamente , Obstrução Intestinal/induzido quimicamente , Sulfonamidas/efeitos adversos , Celecoxib , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Humanos , Isoenzimas/antagonistas & inibidores , Masculino , Proteínas de Membrana , Pessoa de Meia-Idade , Prostaglandina-Endoperóxido Sintases , PirazóisRESUMO
PURPOSE: The aim of the study was to assess the place of cardiac Magnetic Resonance Imaging (MRI) in patients with sarcoidosis with or without cardiac involvement. MATERIALS AND METHODS: Fifty patients with histologically-proven sarcoidosis underwent initial cardiac evaluation including MRI, ECG, holter ECG, echocardiography. Seven of them had cardiac involvement (cardiac insufficiency, auriculo-ventricular block, bundle-branch block). Fiveteen patients had a second evaluation at 10-month follow-up. MRI was classified in three stages, on the base of literature data (stage 1 "granulomatous", stage 2 "exsudative", stage 3 "fibrotic"). RESULTS: A good correlation between the type of the sarcoidosis and MRI was observed: patients with cardiac involvement had all stage 2 MRI; patients with quiescent sarcoidosis had normal or stage 3 MRI; patients without cardiac involvement had all stages on MRI. A good correlation was observed between cardiac MRI abnormalities and evolution of sarcoidosis. Patients under corticoid, with or without cardiac involvement all had regression of MRI lesions and sarcoidosis. In 2 cases, MRI was predictive of clinical cardiac involvement. CONCLUSION: Cardiac MRI is a useful non-invasive method for the early diagnosis and follow-up of cardiac sarcoidosis.
Assuntos
Cardiomiopatias/patologia , Imageamento por Ressonância Magnética , Sarcoidose/complicações , Corticosteroides/uso terapêutico , Adulto , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoidose/tratamento farmacológicoRESUMO
Mycobacterium kansasii most commonly causes a slowly progressive pulmonary disease. Skin and disseminated infections are seen less frequently and only in immunocompromised hosts. To our knowledge, no case of Mycobacterium kansasii infection or skin infection associated with additional organ involvement in an immunocompetent patient has been reported.
Assuntos
Linfadenite/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium kansasii/isolamento & purificação , Dermatopatias Infecciosas/diagnóstico , Idoso , Biópsia , Feminino , Humanos , Imunocompetência , Linfadenite/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Pele/microbiologia , Pele/patologia , Dermatopatias Infecciosas/microbiologiaAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Dapsona/efeitos adversos , Dermatite Herpetiforme/tratamento farmacológico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Febre/induzido quimicamente , Febre/diagnóstico , Adulto , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Hipersensibilidade a Drogas/tratamento farmacológico , Feminino , Febre/tratamento farmacológico , Humanos , Esteroides , Fatores de Tempo , Índias OcidentaisRESUMO
The aim of this study was to determine the prevalence of venous thromboembolism (VT) in current prophylactic practice with low-molecular-weight heparin (LMWH) among medical inpatients and to analyze associated risk factors for VT. A cross-sectional survey on five given days was conducted in the medical departments of a university hospital. The prevalence of prophylaxis and confirmed VT was measured. Risk markers for receiving high doses of LMWH and for VT under prophylaxis were assessed by logistic regression models. Of 1,194 inpatients, 1.4% suffered VT. The mean proportion of patients with LMWH prophylaxis was 24% (range: 4-64%). The prevalence of VT was higher among inpatients receiving prophylaxis than among those patients not receiving prophylaxis (3.5% vs. 0.7%, p = 0.002). Under prophylaxis, independent risk markers for thrombosis were history of vein thrombosis (odds ratio [OR]: 4.03; confidence interval [95%CI]: 1.04-15.62) and age (OR: 1.08; 95%CI: 1.01-1.15). Two factors were independently associated with the prescription of high doses of LMWH: obesity was positively associated (OR: 7.50; 95%CI: 2.97-18.92; p < 0.0001) and respiratory insufficiency was negatively associated. In medical departments, current prophylaxis practice leads to many patients being given LMWH. LMWH doses and other preventive measures should be adapted in high-risk inpatients.
Assuntos
Trombose Venosa/tratamento farmacológico , Trombose Venosa/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Coleta de Dados , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente , Prevalência , Análise de Regressão , Fatores de Risco , Tromboembolia/tratamento farmacológico , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Trombose Venosa/etiologiaRESUMO
Aims. - The objectives of the study were to describe the circumstances surrounding the intiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. Design.- In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. Participants.- Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. Findings. - The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72% and 74% of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83% and 85% of cases. Conclusion. - Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.
RESUMO
In Crohn's disease (CD), labeled leukocyte scintigraphy results are highly correlated with radioendoscopic findings and the degree of histologic inflammation. We evaluated the correlation between leukocyte activity measured by two complementary methods. polymorphonuclear leukocyte (PMN)-elastase concentration and leukocyte scintigraphy. In 20 patients with CD, labeled leukocytes, 99m technetium hexamethyl propylene amine oxime (99mTc-HMPAO) scintigraphy, and PMN-elastase concentration were evaluated on the same day. A good correlation was found between PMN-elastase concentrations and the scintigraphic scores (p = 0.005; rs = 0.60; 95% CI, 0.20-0.83). Scintigraphy results were significantly correlated with CD activity index (p = 0.023, rs = 0.50). In four patients, scintigraphic scores and clinical disease activity were not consistent due to the state of PMN leukocyte activation, measured by elastase concentration. In CD, PMN-elastase can provide information about the degree of activation of PMN leukocytes and may explain discrepancy between clinical and scintigraphic indexes.
Assuntos
Doença de Crohn/diagnóstico , Elastase de Leucócito/sangue , Leucócitos/diagnóstico por imagem , Neutrófilos/enzimologia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Exametazima , Adulto , Idoso , Sedimentação Sanguínea , Proteína C-Reativa/análise , Separação Celular , Doença de Crohn/sangue , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/enzimologia , Interpretação Estatística de Dados , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , CintilografiaRESUMO
The aim of this study was to identify relationships between injecting and sexual risk behaviours and hepatitis C virus (HCV) status knowledge in intravenous drug users (IDUs). It was a cross-sectional survey (March 1994-June 1995) in 10 drug abuse treatment or psychosocial centres in Paris, France. We used a structured questionnaire about sexual, injecting, HIV and HCV antibody testing practices and results during the previous 6 months. Six hundred and twelve sexually active IDUs aged 18 or older who were current injecting drug users were interviewed. Of 592 respondent IDUs, 37% did not report consistent HCV testing and 34% reported being HCV-positive. HCV-positive IDUs were older than HCV-negatives and HCV-unknowns. HCV-unknowns and HCV-positives had a lower educational level than HCV-negatives. After adjusting for demographic characteristics and HIV status, the factors associated with being HCV-unknown were not using condoms (OR: 2.9; 95% CI: 1.9-4.6) as well as clean equipment (OR: 1.8; 95% CI: 1.2-3.0). Not using new equipment was negatively associated with being HCV-unknown (OR: 0.4; 95% CI: 0.2-0.6) and with being HCV-positive (OR: 0.5; 95% CI: 0.3-0.8). Our study suggests that particular sexual and injecting risk-behaviours are associated with not knowing HCV status. As HCV-unknown IDUs are likely to be at the risk of transmitting HCV or acquiring other infections. HCV testing should be encouraged and associated with sexual counselling. Special attention should be paid to disinfecting practices for HCV-positives and use of new injecting equipment should be recommended for HCV-negatives.
Assuntos
Infecções por HIV/complicações , Hepatite C/diagnóstico , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/complicações , Adolescente , Adulto , Bissexualidade , Estudos Transversais , Interpretação Estatística de Dados , Feminino , França , Soronegatividade para HIV , Soropositividade para HIV , Hepatite C/transmissão , Heterossexualidade , Homossexualidade , Humanos , Masculino , Trabalho Sexual , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Eccrine sweat gland carcinoma, which belongs to the eccrine sweat gland carcinoma family, is a rare malignancy of the skin with a potential aggressive growth and metastatic spread. EXEGESIS: We report here a case of malignant eccrine poroma arising on the upper leg, with widespread pulmonary metastases. CONCLUSION: A brief synopsis of the pathological and clinical aspects of eccrine sweat gland carcinoma is presented with the currently available therapies.
Assuntos
Acrospiroma/patologia , Carcinoma de Células Escamosas/secundário , Glândulas Écrinas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , PrognósticoRESUMO
AIMS: The objectives of the study were to describe the circumstances surrounding the initiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. DESIGN: In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. PARTICIPANTS: Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. FINDINGS: The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72 % and 74 % of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83 % and 85 % of cases. CONCLUSION: Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.
Assuntos
Heroína , Entorpecentes , Abuso de Substâncias por Via Intravenosa , Adolescente , Adulto , Estudos Transversais , Interpretação Estatística de Dados , Feminino , Infecções por HIV/transmissão , Hepatite C/transmissão , Humanos , Masculino , Assunção de Riscos , Parceiros Sexuais , Abuso de Substâncias por Via Intravenosa/psicologia , Inquéritos e QuestionáriosRESUMO
The aim of this study was to report the clinical, serological and epidemiological features of a homogeneous cohort of patients with various forms of Lyme borreliosis, based on recent European case-definition guidelines. Complete clinical and epidemiological reports were requested from the patients' physicians for case definition. Enzyme immunoassay IgG and IgM screening tests were performed. A total of 170 patients (141 adults and 29 children) with the following forms of Lyme borreliosis were included between 1989 and 1997: erythema migrans alone (n = 38), early neuroborreliosis (n = 76), arthritis (n = 34), acrodermatitis chronica atrophicans (n = 12), carditis (n = 2), lymphocytoma (n = 3), chronic neuroborreliosis (n = 2), and miscellaneous disorders (n = 3). On the basis of the occurrence and course of the full spectrum of complicated forms of Lyme borreliosis, the specificity of the clinical and biological presentation of the complicated forms (age, ratio of children/adults, sex ratio, incubation period, time to diagnosis, and serological profiles) was demonstrated, as was the absence of overlap between the clinical presentations. Using these data, an alternative scheme for the natural history of Lyme borreliosis is suggested.
Assuntos
Anticorpos Antibacterianos/sangue , Grupo Borrelia Burgdorferi/imunologia , Doença de Lyme , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Técnicas Imunoenzimáticas , Doença de Lyme/complicações , Doença de Lyme/epidemiologia , Doença de Lyme/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paris/epidemiologiaRESUMO
An 80-year-old man was admitted with recurrent asphyxiating pleurisy, first attributed to heart failure. During the recurrent episodes, the patient presented fever, signs of inflammation, no signs of heart failure, and subnormal cardiac function, prompting further investigations which disclosed that the patient was a homozygous carrier of the severe type of periodic disease mutation. The patient's age at symptom onset and the clinical features of this case of periodic disease are exceptional. These points emphasize the usefulness of available genetic tests in difficult diagnostic cases. It also reflects current difficulties in trying to establish correlations between genotype and phenotype in periodic disease.
Assuntos
Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/diagnóstico , Pleurisia/etiologia , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Febre Familiar do Mediterrâneo/genética , Feminino , Triagem de Portadores Genéticos , Testes Genéticos , Genótipo , Heterozigoto , Homozigoto , Humanos , Mutação/genética , Fenótipo , Pleurisia/diagnóstico por imagem , Radiografia , RecidivaRESUMO
We report the first case of recurrent hepatitis secondary to a pituitary macroadenoma in a 55-year old man. Liver ischemia is thought to be the main consequence of episodes of acute adrenal insufficiency. Sudden acute adrenal insufficiency was due to enlargement of the sella content secondary to several microhemorrhages in the macroadenoma.
Assuntos
Adenoma/complicações , Hepatite/etiologia , Isquemia/etiologia , Fígado/irrigação sanguínea , Neoplasias Hipofisárias/complicações , Doença Aguda , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Transaminases/sangueRESUMO
INTRODUCTION: The authors report the case of a patient who presented for 4 years recurrent anterior uveitis accompanied by asymptomatic tuberculous mediastinal lymphadenitis. EXEGESIS: CT scan of the chest showed the existence of mediastinal lymphadenopathy (< 1 cm). Mediastinoscopy with biopsy of the right laterotracheal lymph node was performed. The culture was positive for Mycobacterium tuberculosis, thus permitting the diagnosis of tuberculosis. CONCLUSION: This case report stresses the advantage of extensive etiological assessment when faced with unexplained uveitis; particularly it emphasizes the importance of investigating potential tuberculosis. The existence of granulomatous uveitis, a positive skin test, the ethnic origin, and mostly results of chest CT scan, were the rationale for the use of mediastinoscopy with lymph node biopsy to help guide diagnosis.
Assuntos
Doenças do Mediastino/diagnóstico , Mediastinoscopia , Tuberculose dos Linfonodos/diagnóstico , Uveíte/microbiologia , Adulto , Feminino , Humanos , Doenças do Mediastino/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Recidiva , Tuberculose dos Linfonodos/microbiologia , Uveíte/etiologiaRESUMO
Turner's syndrome is an ovarian dysgenesis (karyotype 45 X0) characterized by sexual infantilism and multiple malformations. Liver enzyme anomalies are often observed, but the underlying pathogenic mechanism remains unknown. Nodular regenerative hyperplasia of the liver is associated with another disease in about 80% of cases. However, these two diseases have only been reported together in one woman. We describe here a second case of this association "Turner's syndrome and nodular regenerative hyperplasia". We think that women with Turner's syndrome should benefit from screening for nodular regenerative hyperplasia by searching for elevated liver enzymes. This easily applicable screening protocol would provide early diagnostic of nodular regenerative hyperplasia and allow early and effective treatment of portal hypertension. Moreover, this approach would improve our knowledge of this association.