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Senet P, Maillard H, Diot E, Lazareth I, Blaise S, Arnault JP, Pistorius MA, Boulon C, Cogrel O, Warzocha U, Rivière S, Malloizel-Delaunay J, Servettaz A, Sassolas B, Viguier M, Monfort JB, Janique S, Vicaut E. Efficacy and Safety of Botulinum Toxin in Adults with Raynaud's Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Arthritis Rheumatol 2023; 75:459-467. [PMID: 36066501 DOI: 10.1002/art.42342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine whether a single session of botulinum toxin type A (BTA) injections into both hands more effectively decreases the frequency of systemic sclerosis-associated Raynaud's phenomenon (SSc-RP) episodes than placebo. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group phase III trial in patients with SSc-RP assessed the effect of 50-unit BTA or placebo injections into the palms of both hands around each neurovascular bundle during 1 session in winter. The primary end point was the between-group difference in the median change in the number of RP episodes from baseline (day 0) to 4 weeks postinjection. Values between the groups were compared with the Wilcoxon rank-sum test. RESULTS The intent-to-treat analysis included 46 BTA-treated patients and 44 placebo recipients. At 4 weeks after assigned treatment injections, the median number of daily RP episodes decreased comparably in the BTA and placebo groups (median change -1 episode/day [interquartile range (IQR) -1.5, 0 episodes/day] and -1 episode/day [IQR -2.5, 0 episodes/day], respectively) (P = 0.77 versus placebo). Moreover, change in Raynaud's Condition Score, quality of life assessed by Health Assessment Questionnaire disability index, and hand function assessed by shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Cochin Hand Function Scale from baseline to follow-up weeks 4, 12, and 24 did not differ significantly between groups. The BTA group experienced transient hand muscle weakness significantly more frequently (P = 0.003). CONCLUSION Neither the primary nor secondary end points were reached, and our results do not support any beneficial effect of palmar BTA injections to treat SSc-RP.
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Affiliation(s)
- Patricia Senet
- Assistance Publique-Hôpitaux de Paris, and Service de Dermatologie, Centre Hospitalier Universitaire Tenon, Groupe Hospitalier Sorbonne Université, Paris, France
| | - Hervé Maillard
- Service de Dermatologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Elisabeth Diot
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Bretonneau-Tours, Tours, France
| | | | - Sophie Blaise
- Université Grenoble Alpes, Inserm, HP2, Grenoble, France
| | - Jean-Philippe Arnault
- Service de Dermatologie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | - Carine Boulon
- Service de Médecine Vasculaire, Centre Hospitalier Universitaire St-André, Bordeaux, France
| | - Olivier Cogrel
- Unité de Dermatologie Interventionnelle, Service de Dermatologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Ursula Warzocha
- Assistance Publique-Hôpitaux de Paris, and Service de Médecine Interne, Centre Hospitalier Universitaire Avicenne, Bobigny, France
| | - Sébastien Rivière
- Assistance Publique-Hôpitaux de Paris, and Service de Médecine Interne, Centre Hospitalier Universitaire Saint-Antoine, Groupe Hospitalier Sorbonne Université, Paris, France
| | | | - Amélie Servettaz
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, Hôpital Robert-Debré, Centre Hospitalier Universitaire, Reims, France
| | - Bruno Sassolas
- Département de Médecine Interne et Pneumologie, Hôpital de la Cavale Blanche, Centre Hospitalier Régional Universitaire, Brest, France
| | - Manuelle Viguier
- Service de Dermatologie-Vénéréologie, Hôpital Robert-Debré, Université Reims Champagne Ardenne, IRMAIC, EA7509, Reims, France
| | - Jean-Benoit Monfort
- Assistance Publique-Hôpitaux de Paris, and Service de Dermatologie, Centre Hospitalier Universitaire Tenon, Groupe Hospitalier Sorbonne Université, Paris, France
| | - Solène Janique
- Assistance Publique-Hôpitaux de Paris, Unité de Recherche Clinique, Centre Hospitalier Universitaire Fernand-Widal, Paris, France
| | - Eric Vicaut
- Assistance Publique-Hôpitaux de Paris, Unité de Recherche Clinique, Centre Hospitalier Universitaire Fernand-Widal, Paris, France
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Le Jeune S, Suhl J, Benainous R, Minvielle F, Purser C, Foudi F, Warzocha U, Dhote R. High prevalence of early asymptomatic venous thromboembolism in anticoagulated COVID-19 patients hospitalized in general wards. J Thromb Thrombolysis 2021; 51:637-641. [PMID: 32812199 PMCID: PMC7433772 DOI: 10.1007/s11239-020-02246-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with coagulation activation and high incidence of venous thromboembolism (VTE) in severe patients despite routine thromboprophylaxis. Conflicting results exist regarding the epidemiology of VTE for unselected anticoagulated COVID-19 patients hospitalized in general wards. The aim of this study was to evaluate the prevalence of asymptomatic deep venous thrombosis (DVT) in unselected patients with COVID-19 recently hospitalized in general wards. We performed a systematic complete doppler ultrasound (CDU) at a median 4 days after admission in 42 consecutive COVID-19 patients hospitalized in general wards of our university hospital, irrespective of D-Dimer level, and retrospectively collected clinical, biological and outcome data from electronic charts. Thromboprophylaxis was systematically applied following a French national proposal. In our population, the prevalence of asymptomatic DVT was 19% (8/42 patients), with distal thrombosis in 7/8 cases and bilateral DVT in 4/8 cases. Symptomatic pulmonary embolism was detected in 4 (9.5%) patients, associated to DVT in one case. Compared to patients without DVT, patients with DVT were older and experienced poorer outcomes. In conclusion, prevalence of asymptomatic DVT is high in the first days of hospitalization of unselected COVID-19 patients in general wards and may be related to poor prognosis. Individualized assessment of thromboprophylaxis and early systematic screening for DVT is warranted in this context.
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Affiliation(s)
- Sylvain Le Jeune
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France.
| | - Jaehyo Suhl
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - Ruben Benainous
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - François Minvielle
- Service des Explorations Fonctionnelles, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Christine Purser
- Service des Explorations Fonctionnelles, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Farid Foudi
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - Ursula Warzocha
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
| | - Robin Dhote
- Service de Médecine Interne, Centre Hospitalo-Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93000, Bobigny, France
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La Rosa A, Elourimi G, Zmuda M, Cucherousset N, Tran Ba S, Warzocha U, Larroche C, Sené T, Héran F, Galatoire O, Dhôte R, Abad S. [Management of orbital inflammatory disorders in internal medicine: New findings resulting from a retrospective study of 31 consecutive patients]. Rev Med Interne 2020; 41:800-808. [PMID: 32861532 DOI: 10.1016/j.revmed.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe a case series of patients investigated in internal medicine for orbital inflammation (OI) since the individualization of the clinical entity of the IgG4-related orbital disease (IgG4 ROD). PATIENTS AND METHODS Thirty four patients were consecutively referred by a specialized center where orbital biopsy was performed when the lesion was surgically accessible. Fourteen patients were excluded in case of missing data or lymphoma, periocular xanthogranuloma or Graves' orbitopathy. Patients with systemic or auto-immune disease according to the international criteria, or presenting with idiopathic orbital inflammation syndrome (IOIS), were included. Knowing the histological similarities between IOIS and IgG4 ROD, immunohistochemical assessment of plasma cells for IgG4 positivity was performed for every patient with available biopsy. Clinical and biological characteristics, treatment and response to treatment of included patients are reported. RESULTS Among 22 included patients, 10 presented with orbital manifestation of a systemic or autoimmune disease including 2 sarcoidosis (9%) and 8 (36%) cases of non specific OI which were reclassified in IgG4 ROD. Finally, IOIS of various clinicopathological presentation was diagnosed for 12 patients including 10 with histological documentation. Whereas relapse and resistance were not found to be related to IgG4 positivity (50% in both IOIS and IgG4 ROD groups), another treatment in addition to corticosteroids was more often necessary in IgG4 ROD patients (50%) than in IOIS patients (25%). CONCLUSION After ruling out auto-immune orbital diseases, especially IgG4 ROD, IOIS should be discussed. Factors conditioning the corticosteroid response are yet to be determined.
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Affiliation(s)
- A La Rosa
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Bobigny, France
| | - G Elourimi
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Bobigny, France
| | - M Zmuda
- Fondation Adolphe De Rothschild, Service de Chirurgie OculoPlastique, Paris, France
| | - N Cucherousset
- AP-HP, Hôpital Avicenne, Service d'Anatomopathologie, Bobigny, France
| | - S Tran Ba
- AP-HP, Hôpital Avicenne, Service d'Imagerie, Bobigny, France
| | - U Warzocha
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Bobigny, France
| | - C Larroche
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Bobigny, France
| | - T Sené
- Fondation Adolphe De Rothschild, Service de Médecine Interne, Paris, France
| | - F Héran
- Fondation Adolphe De Rothschild, Service d'Imagerie, Paris, France
| | - O Galatoire
- Fondation Adolphe De Rothschild, Service de Chirurgie OculoPlastique, Paris, France
| | - R Dhôte
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, UMR1125, LI2P, Bobigny, France
| | - S Abad
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, UMR1125, LI2P, Bobigny, France.
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Rodrigues F, Abad S, Elourimi G, Le Jeune S, Mourad JJ, Warzocha U, Larroche C, Boissier MC, Bourgarit-Durand A, Brillet PY, Mekinian A, Soussan M, Dhote R. Thoracic aorta involvement in giant cell arteritis: a case-control analysis of morphological data at diagnosis. Clin Exp Rheumatol 2020; 38:140-143. [PMID: 31376270] [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] [Received: 05/29/2018] [Accepted: 06/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Giant cell arteritis (GCA) is a cause of potentially fatal aortic aneurysms. Descriptive data on thoracic aorta measurements at the beginning of the disease are lacking. We aimed to compare aortic diameters between a recently diagnosed GCA population and an age- and sex-matched control group. METHODS Patients with GCA and with an available thoracic CT concomitant with diagnosis were included. Controls were patients matched for age and sex and hospitalised in the same care centre for pneumonia. The main criteria were the anteroposterior and lateral diameters of the ascending thoracic aorta, which were measured by a blinded evaluator. RESULTS 90 cases and 90 controls were included. Each group comprised 30 males and 60 females for a mean age of 75.1±9 and 75.7±10.1 years old. At the time of GCA diagnosis no difference was found between the two groups (anteroposterior diameter 37.1±5 mm for cases vs. 36.7±5 mm for controls, p=0.6; lateral diameter 36.6±5 mm for cases vs. 35.9±4 mm for controls, p=0.3). Thoracic aorta diameter was not significantly higher in patients with aortitis at diagnosis (n=44) than in cases without aortitis (n=46). CONCLUSIONS Morphologic comparison of thoracic aorta at diagnosis of GCA with an age- and sex-matched control population showed no significant difference. Morphologic evaluation of aorta cannot predict accurately the occurrence of aortic aneurysm. Systematic follow-up according to current recommendations is thus justified.
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Affiliation(s)
- François Rodrigues
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Sébastien Abad
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny; Faculté de Médecine SMBH Université Paris 13, Sorbonne Paris Cité, Bobigny; and Université Paris 13, Sorbonne Paris Cité, UMR1125, LI2P, Bobigny, France
| | - Ghassan Elourimi
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Sylvain Le Jeune
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Jean-Jacques Mourad
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, and Faculté de Médecine SMBH Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Ursula Warzocha
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Claire Larroche
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Marie Christophe Boissier
- Université Paris 13, Sorbonne Paris Cité, UMR1125, LI2P, Bobigny, and Service de Rhumatologie, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Anne Bourgarit-Durand
- Service de Médecine Interne, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, and Faculté de Médecine SMBH Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Pierre Yves Brillet
- Service de Radiologie, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Arsene Mekinian
- Service de Médecine Interne, Inflammation- Immunopathology-Biotherapy Department (DHU i2B), AP-HP, Hôpital Saint-Antoine, Faculté de Médecine Sorbonne Université, Paris, France
| | - Michael Soussan
- Service de Médecine Nucléaire, AP-HP, Hôpital Universitaire Seine Saint Denis, Bobigny, France
| | - Robin Dhote
- Service de Médecine Interne, AP-HP, Hôpital Univ. Seine Saint Denis, Bobigny; Faculté de Médecine SMBH Université Paris 13, Sorbonne Paris Cité, Bobigny; and Université Paris 13, Sorbonne Paris Cité, UMR1125, LI2P, Bobigny, France.
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Benainous R, Bret J, Lusina D, Larroche C, Le Jeune S, Boubaya M, Abad S, Warzocha U, Bloch-Queyrat C, Cymbalista F, Dhôte R. Intérêt du dosage de la teneur en hémoglobine des réticulocytes (Ret-hb) au cours des anémies. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toth H, Costes Y, Happe F, Benainous R, Abad S, Warzocha U, Dhôte R. Une forme pathognomonique de sarcoïdose en imagerie par TEP-TDM : l’aspect snow leopard. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Benainous R, Elourimi G, Abad S, Mazoyer E, Warzocha U, Baron S, Le Jeune S, Lopez-Sublet M, Giroux-Leprieur B, Larroche C, Mourad J, Dhôte R. Évaluation de la morbi-mortalité à deux ans des patients traités pour une fibrillation auriculaire non valvulaire après une hospitalisation pour surdosage en anticoagulants. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.392] [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: 11/27/2022]
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Elourimi G, Soussan M, Warzocha U, Bugaud H, Dhôte R, Abad S. Efficacy of tocilizumab highlighted by FDG-PET/CT in a patient with relapsing polychondritis-associated aortitis. Rheumatol Int 2017; 37:1931-1935. [PMID: 28965131 DOI: 10.1007/s00296-017-3832-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/21/2017] [Indexed: 01/15/2023]
Abstract
Relapsing polychondritis (RP) is a rare systemic inflammatory disease primarily affecting the ears, nose and tracheobronchial tree cartilage, but also the cardiovascular system. Cardiovascular complications are the second cause of mortality in RP. We report the case of a woman with a corticosteroid-resistant RP-associated aortitis, who was successfully treated with tocilizumab (TCZ). The FDG-PET/CT was a useful tool for diagnosing aortitis and assessing the effect of biotherapy. We conducted a systematic literature review confirming this is the first case of rapid and sustained remission in a patient with corticosteroid-resistant RP-associated aortitis after TCZ treatment administered as a first-line immunotherapy. However, further studies are needed to confirm the beneficial effect of TCZ used in this life-threatening condition.
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Affiliation(s)
- Ghassan Elourimi
- Assistance Publique- Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, 125 Route de Stalingrad, 93009, Bobigny Cedex 9, France
| | - Michael Soussan
- AP-HP, Hôpital Avicenne, Service de Médecine Nucléaire, Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, Bobigny, France
| | - Ursula Warzocha
- Assistance Publique- Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, 125 Route de Stalingrad, 93009, Bobigny Cedex 9, France
| | - Hélène Bugaud
- Assistance Publique- Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, 125 Route de Stalingrad, 93009, Bobigny Cedex 9, France
| | - Robin Dhôte
- Assistance Publique- Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, 125 Route de Stalingrad, 93009, Bobigny Cedex 9, France
| | - Sébastien Abad
- Assistance Publique- Hôpitaux de Paris (AP-HP), Hôpital Avicenne, Service de Médecine Interne, Université Paris 13, Sorbonne Paris Cité, Faculté de Médecine SMBH, 125 Route de Stalingrad, 93009, Bobigny Cedex 9, France.
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Rodrigues F, Elourimi G, Le Jeune S, Abad S, Larroche C, Saidenberg N, Soussan M, Warzocha U, Brillet P, Boissier M, Mourad J, Dhôte R. Atteinte aortique thoracique au cours de l’artérite temporale. Analyse cas-témoins des données morphologiques au diagnostic. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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London J, Martin A, Soussan M, Badelon I, Gille T, Uzunhan Y, Giroux-Leprieur B, Warzocha U, Régent A, Galatoire O, Dhote R, Abad S. Adult Onset Asthma and Periocular Xanthogranuloma (AAPOX), a Rare Entity With a Strong Link to IgG4-Related Disease: An Observational Case Report Study. Medicine (Baltimore) 2015; 94:e1916. [PMID: 26512617 PMCID: PMC4985430 DOI: 10.1097/md.0000000000001916] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Adult onset asthma and periocular xanthogranuloma (AAPOX) is a rare non-Langerhans histiocytosis characterized histopathologically by a periocular infiltration of foamy histiocytes and Touton giant cells. Benign hyperplasia with plasma cell infiltration is classically described in eyelids or lymph nodes of AAPOX patients. It is also a characteristic feature of IgG4-related disease (IgG4-RD), a new entity defined by an IgG4-bearing plasma cell infiltration of organs.To determine if AAPOX syndrome shares clinical, biological, and histopathological characteristics with IgG4-RD, we used the comprehensive clinical diagnostic criteria for IgG4-RD in a retrospective case series of three consecutive patients with histologically-proven AAPOX. Patients who were diagnosed with AAPOX at a French academic referral center for orbital inflammation between November 1996 and March 2013 were enrolled. Biopsies from ocular adnexa or other organs were systematically reexamined. For each patient, clinical and serological data, radiologic findings, and treatment were retrospectively analyzed.Two AAPOX patients fulfilled all of the diagnostic criteria for a definite IgG4-RD. One patient who lacked the serological criteria fulfilled the criteria of a probable IgG4-RD.These 3 cases of AAPOX patients fulfilled the IgG4-RD comprehensive clinical diagnostic criteria. To our knowledge, this is the first observational case report study to clearly show a strong relationship between IgG4-RD and AAPOX syndrome.
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Affiliation(s)
- Jonathan London
- From the Department of Internal Medicine, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 13, Sorbonne Paris Cité, Bobigny, France (BGL, UW, RD, SA); Department of pathology, Hôpital Avicenne, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bobigny, France (AM); Department of Nuclear Medicine, Hôpital Avicenne, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bobigny, France (MS); Department of Ophthalmology, Hôpital Avicenne, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bobigny, France (IB); Department of Oculoplastic Surgery, Fondation Adolphe de Rothschild, Paris, France (OG); Department of Pneumology, Hôpital Avicenne, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bobigny, France (TG, YU); Department of Internal Medicine, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France (JL, AR)
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Dumas M, Warzocha U, Schischmanoff PO, Guyot A, Safa G, Prost-Squarcioni C, Lévy A, Roulot D, Laroche L, Caux F. Syndrome de Dorfman-Chanarin : analyse d’une série de 10 patients. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.327] [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: 11/29/2022]
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Zumelzu C, Flageul B, Warzocha U, Caux F, Laroche L. Hypertrophie des plexus cervicaux prise à tort pour une thrombose jugulaire externe, au cours d’une maladie de Hansen. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.495] [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: 11/27/2022]
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13
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Gallais-Serezal I, Chauchard M, Warzocha U, Larroche C, Abad S, Martin A, Dhôte R, Le Jeune S. Prévalence du syndrome d’hyperIgG4 au cours de la fibrose rétropéritonéale idiopathique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lopez Sublet M, Warzocha U, Le Jeune S, Abad S, Larroche C, Roulot D, Dhote R. Un morphotype marphanoïde. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.192] [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: 11/29/2022]
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Verin A, Uzunhan Y, Brillet P, Larroche C, Warzocha U, Abad S, Valeyre D, Brauner M, Dhote R. Atteinte respiratoire au cours du syndrome de Gougerot-Sjogren : analyse systématique des données TDM. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Luong Nguyen LB, Warzocha U, Brillet PY, Abad S, Larroche C, Amar L, Frachet B, Dhote R. [Vascular involvement in Cogan's syndrome. A case report]. ACTA ACUST UNITED AC 2011; 37:19-21. [PMID: 22197586 DOI: 10.1016/j.jmv.2011.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 11/02/2011] [Indexed: 11/25/2022]
Abstract
Vascular manifestations of Cogan's syndrome are rarely reported. We report the case of a young woman followed for typical Cogan's disease. Serious vascular involvement was found only during work-up for arterial hypertension. This case highlights potentially asymptomatic nature of extensive vasculitis affecting large and medium-sized vessels in Cogan's disease. Careful screening is required to prevent life-threatening complications.
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Affiliation(s)
- L-B Luong Nguyen
- Service de Médecine Interne, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris-13, 125, rue de Stalingrad, 93000 Bobigny, France
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17
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Roulot D, Costes JL, Buyck JF, Warzocha U, Gambier N, Czernichow S, Le Clesiau H, Beaugrand M. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut 2011; 60:977-84. [PMID: 21068129 DOI: 10.1136/gut.2010.221382] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver stiffness measurement (LSM) has been used to measure fibrosis in patients with various types of chronic liver diseases. However, its usefulness as a screening procedure in apparently healthy people had not been evaluated to date. METHODS 1358 subjects >45 years old from a general population attending for a medical check-up were consecutively enrolled in the study. All subjects were submitted to medical examination and laboratory tests in addition to LSM, performed on the same day by a single operator. Subjects with LSM values >8 kPa were referred to a liver unit for further investigations. RESULTS 168 subjects were not considered for analysis due to missing data (n=23), LSM failure (n=51) or unreliable LSM values (n=94). Among the 1190 remaining subjects, 89 (7.5%) had LSM >8 kPa including nine patients with LSM >13 kPa. Despite the fact that normal liver tests were observed in 43% of them (38 out of 89), a specific cause of chronic liver disease was found in all cases. Non-alcoholic fatty liver disease (NAFLD) was the likely cause of chronic liver disease in 52 patients, alcoholic liver disease (ALD) in 20, and both causes were associated in seven additional patients. Hepatitis C virus and hepatitis B virus chronic hepatitis was documented in five and four cases, respectively, and primary biliary cirrhosis in one. Liver biopsy was obtained for 27 patients, including the nine patients with LSM >13 kPa, who were diagnosed with liver cirrhosis due to ALD (n=5), chronic hepatitis C (n=3) or chronic hepatitis B (n=1). The 18 remaining biopsies showed liver fibrosis in all cases except one (isolated steatosis), with ALD and NAFLD being present in six and eight cases, respectively. CONCLUSION LSM proved to be a useful and specific procedure to screen for cirrhosis in the general population and to detect undiagnosed chronic liver disease in apparently healthy subjects.
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Pagnoux C, Le Guern V, Goffinet F, Diot E, Limal N, Pannier E, Warzocha U, Tsatsaris V, Dhote R, Karras A, Cohen P, Damade R, Mouthon L, Guillevin L. Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies. Rheumatology (Oxford) 2010; 50:953-61. [PMID: 21183452 DOI: 10.1093/rheumatology/keq421] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe pregnancies of women with systemic necrotizing vasculitides (SNVs), i.e. PAN, WG, Churg-Strauss syndrome (CSS) or microscopic polyangiitis (MPA), followed over the past 15 years at four French centres. METHODS Retrospective analysis of women whose SNV appeared during pregnancy or who became pregnant after SNV diagnosis. RESULTS Among the 12 women identified, one experienced rupture of pancreatic artery microaneurysms at 27 weeks revealing PAN, leading to surgical haemostasis and caesarean delivery. Eleven others started 19 pregnancies after SNV diagnosis (8 in four WG, 6 in three CSS, 1 each in three PAN and 2 in one MPA); 14 conceived during vasculitis remission. Two ended in first-trimester abortions, four miscarried; the remaining 13 pregnancies yielded 14 live newborns (1 twin pregnancy), with 7 pre-term births. Life-threatening complications occurred during 3 of these latter 13 pregnancies and required caesarean delivery. The twin pregnancy (in a CSS patient with initial vasculitis-related cardiac involvement, but in remission at conception) was complicated by transient maternal cardiac failure at 32 weeks. One WG patient with vasculitis-related renal damage developed thrombotic microangiopathy-associated renal impairment at 32 weeks, and another WG patient had severe pneumonia at 37 weeks. Other pregnancies were uneventful or with minor vasculitis manifestations. CONCLUSION Pregnant SNV patients should be monitored closely, because miscarriages and pre-term births are not uncommon. Pregnancy does not seem to have a major impact on vasculitis activity. However, life-threatening manifestations can occur, especially in patients with vasculitis-related cardiac or renal damage.
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Affiliation(s)
- Christian Pagnoux
- Department of Internal Medicine, National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Université Paris Descartes, Hôpital Cochin, 27 rue du faubourg Saint-Jacques, 75679 Paris Cedex 14, France.
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19
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Dollat M, Gambier N, Warzocha U, Naggara N, Nunes H, Abad S, Dhôte R. Hématome épidural spontané au cours du lupus érythémateux systémique. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.236] [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: 11/26/2022]
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20
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Gambier N, Warzocha U, Dhôte R, Roulot D. Traitement par Ribavirine d’une cirrhose virale E chez un patient non immunodéprimé. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Briand A, Nguyen T, Gambier N, Abad S, Larroche C, Warzocha U, Dhôte R. Premier cas français de tuberculose au cours d’un traitement par tocilizumab. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Abad S, Adelon I, Warzocha U, London J, Gambier N, Larroche C, Morax S, Dhôte R. Prise en charge de l’inflammation orbitaire en médecine interne : à propos d’une série de 38 patients consécutifs. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause, most frequently diagnosed in young Asian women. The authors present an atypical initial presentation of Takayasu disease with bilateral loss of vision in a young Haitian man. METHODS Case report. RESULTS The presenting feature was bilateral loss of vision, a result of malignant hypertensive retinopathy and choroidopathy. Systemic evaluation disclosed inflammatory signs and renal artery obstruction which caused the malignant hypertension. CONCLUSION This case, involving an unusual presentation of Takayasu disease, illustrates how a malignant hypertensive retinopathy and choroidopathy led to the ultimate diagnosis of Takayasu disease.
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Affiliation(s)
- Charlotte Rohart
- From the Departments of *Ophthalmology and †Internal Medicine, Hospital Avicenne, Assistance Publique des Hôpitaux de Paris, Bobigny, France
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Gambier N, Abad S, Warzocha U, Roulot D, Ziol M, Valeyre D, Dhôte R. Atteinte hépatique de la sarcoïdose : une série de 43 cas. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.127] [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: 11/26/2022]
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25
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Abad S, Miquel T, Badelon I, Larroche C, Warzocha U, Morax S, Gambier N, Dhôte R. Efficacité de l’infliximab au cours de l’inflammation orbitaire idiopathique : une alternative aux agents épargneurs de cortisone conventionnels. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.322] [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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26
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Abad S, Badelon I, Warzocha U, Larroche C, Morax S, Dhote R. Xanthogranulomatose de l'orbite et des annexes chez l'adulte: À propos de deux patients et revue de la littérature. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Warzocha U, Larroche C, Abad S, Buffet S, Frachet B, Dhôte R. Syndrome de Cogan et atteinte vasculaire. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Girard P, Christidis C, Cosserat J, Dibie A, Knani L, Moulinié J, Prapotnich D, Stern J, Valensi P, Warzocha U. 17 - Le traitement anticoagulant « réel » à l’hôpital : enquête prospective un jour donné. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Increased pulse pressure (PP), an independent predictor of cardiovascular risk, may be quantified on the basis of the prevalence of isolated systolic hypertension (ISH) in the population at large. The purpose of this study was to estimate the prevalence of ISH and its relation to age and drug therapy in a large group of outpatient hypertensive subjects in France. Between March and December 1999, 2975 French general practitioners included 17 716 consecutive patients with uncontrolled hypertension (systolic blood pressure [SBP] >140 mm Hg and/or diastolic blood pressure [DBP] >90 mm Hg), either treated or not treated. They were asked to complete a questionnaire concerning associated cardiovascular risk factors and ongoing antihypertensive therapy. Subjects were classified according to 5 age ranges (from 18 to 103 years). In each age range, SBP, DBP, mean blood pressure, and PP were significantly lower (P<0.001) in treated subjects than in untreated subjects, with the exception of PP in subjects >75 years. The latter finding resulted from a significant increase of SBP and PP with age, together with a significant lowering of DBP with age, irrespective of drug treatment. Subsequently, the prevalence of ISH increased with age from 20.4% to 35.2% in men and women. In any given age range, drug therapy for hypertension is associated with marginally lower values of PP. In the studied populations, the increase of PP with age is independent of gender and of the presence of antihypertensive drug treatment, leading to an increased prevalence of ISH and a subsequent increase of cardiovascular risk with age.
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Affiliation(s)
- J J Mourad
- Department of Internal Medicine, St Michel Hospital, Paris, France
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Bellier S, Beuzelin C, Warzocha U, Guedj A, Mourad JJ. [The king touches you, but God heals you]. Rev Med Interne 2001; 22:668-9. [PMID: 11508162 DOI: 10.1016/s0248-8663(01)00410-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S Bellier
- Service de médecine interne, hôpital Saint-Michel, 33, rue Olivier-de-Serres, 75015 Paris, France
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Warzocha U, Borie-Cavrois MF, Mourad JJ. [A troublesome foot]. Rev Med Interne 2001; 22:587-8. [PMID: 11433570 DOI: 10.1016/s0248-8663(01)00397-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- U Warzocha
- Service de Médecine interne, hôpital Saint-Michel, 33, rue Olivier-de-Serres, 75015 Paris, France
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32
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Warzocha U, Djebali D, Meune E, Guedj A, Mourad JJ. [A neglected tumor. A pleomorphic adenoma of the right parotid gland]. Rev Med Interne 2001; 22:485-6. [PMID: 11402521 DOI: 10.1016/s0248-8663(01)00380-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- U Warzocha
- Service de médecine interne, hôpital Saint-Michel, 33, rue Olivier-de-Serres, 75015, Paris, France
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