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Tijeras-Raballand A, De Gramont A, Chiron M, Bachet J, André T, Auby D, Desramé J, Baba-Ahmed N, Lecaille C, Lebrun V, Louvet C, Tournigand C, Benner S, Attia M, De Gramont A, Bonnetain F, Chibaudel B. Impact of circulating biomarkers in patients with metastatic colorectal cancer treated with first-line FOLFOX-aflibercept therapy. Results of the GERCOR VELVET Phase II study. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33036-2] [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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2
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Tournigand C, Malka D, Desramé J. [45th Congress of the American Society of Clinical Oncology (ASCO) Orlando, May 30th-June 2nd 2009]. ACTA ACUST UNITED AC 2009; 146:311-5. [PMID: 19682684 DOI: 10.1016/j.jchir.2009.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Tournigand
- Service d'oncologie, hôpital Saint-Antoine, 184, rue du Faubourg-St-Antoine, Paris, France.
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Béchade D, Blondon H, Sekkach Y, Desramé J, Algayres JP. [Review of the association between obesity and gastroesophageal reflux and its complications]. ACTA ACUST UNITED AC 2009; 33:155-66. [PMID: 19250782 DOI: 10.1016/j.gcb.2008.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 12/02/2008] [Accepted: 12/02/2008] [Indexed: 12/20/2022]
Abstract
Esophageal adenocarcinoma and its precursor Barrett's esophagus are increasing in incidence in western populations. Gastroesophageal reflux and high body mass index (BMI) are known risk factors. Studies about Barrett's esophagus in obese patients have emphasised the role of central adiposity as a stronger risk factor than BMI in the development of specialized intestinal metaplasia and subsequently esophagus adenocarcinoma. The proinflammatory impact of adipocytokines of the abdominal fat associated with the metabolic syndrome is also relevant. Except cardiovascular diseases, type 2 diabetes and non alcoholic steatohepatitis, abdominal obesity and metabolic syndrome are responsible of an increase of prevalence of esophageal adenocarcinoma, but also other cancer sites. In this review, we study the up to date main epidemiologic and physiopathologic data concerning this association that could be important in future for a preventive action in obese patients, especially when metabolic syndrome is present.
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Affiliation(s)
- D Béchade
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Sekkach Y, Carmoi T, Lebreton Y, Lecoules S, Billhot M, Blondon H, Desramé J, Béchade D, Algayres JP. [Cholangiocarcinoma and humoral hypercalcemia of malignancy]. Gastroenterol Clin Biol 2009; 33:85-87. [PMID: 19124210 DOI: 10.1016/j.gcb.2008.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 10/17/2008] [Accepted: 11/03/2008] [Indexed: 05/27/2023]
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Bonnefoy S, Béchade D, Bertocchi C, Blondon H, Desramé J, Algayres JP. [Sporadic colonic juvenile polyps in adults]. ACTA ACUST UNITED AC 2008; 33:88-91. [PMID: 18603394 DOI: 10.1016/j.gcb.2008.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 03/30/2008] [Accepted: 05/09/2008] [Indexed: 11/18/2022]
Abstract
Sporadic colonic juvenile polyps are uncommon in adults. We report three cases for which clinical manifestations were presence of occult blood in the stool, rectal bleeding or chronic diarrhea. Two of these polyps occurred in the caecum which is an uncommon localisation. Endoscopic characteristics of these polyps were indistinguishable from adenomas. Endoscopic resection was complicated in one case by bleeding.
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Affiliation(s)
- S Bonnefoy
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
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Banal F, Lecoules S, Carmoi T, Thomas L, Bonnefoy S, Béchade D, Desramé J, Algayres JP. [Acute renal insufficiency after flurbiprofen treatment in a patient treated with angiotensin converting enzyme inhibitor]. Rev Med Interne 2008; 29:593-5. [PMID: 18280012 DOI: 10.1016/j.revmed.2007.12.014] [Citation(s) in RCA: 1] [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] [Received: 08/10/2007] [Revised: 12/18/2007] [Accepted: 12/27/2007] [Indexed: 11/15/2022]
Abstract
We report a case of acute renal insufficiency in a 77 year-old patient who took flurbiprofen as antiplatelet therapy. This is an important observation because it illustrates the potential risk of acute renal insufficiency, when using flurbiprofen before invasive medical examination or surgery in patients receiving long-term treatment with angiotensin converting enzyme inhibitors or angiotensin II inhibitors. This risk is probably underestimated in usual clinical practice.
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Affiliation(s)
- F Banal
- Service de médecine interne, hôpital d'instruction des armées du Val-de-Grâce, Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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Le Berre JP, Desramé J, Lecoules S, Coutant G, Béchade D, Algayres JP. Hyponatrémie due au tramadol. Rev Med Interne 2007; 28:888-9. [PMID: 17624638 DOI: 10.1016/j.revmed.2007.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/06/2007] [Accepted: 06/15/2007] [Indexed: 11/23/2022]
Abstract
We reported a 92-year-old woman with hyponatremia (117 mmol/l) occurring three days after the introduction of tramadol. Diagnosis of inappropriate antidiuretic hormone secretion was based on blood and urinary analysis and dosage of antidiuretic hormone. Natremia became normal after tramadol cessation and fluid restriction. Natremia must be measured when neurological abnormality occurs with tramadol treatment.
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Affiliation(s)
- J-P Le Berre
- Service de médecine interne, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Bladé JS, Desramé J, Corberand D, Lecoules S, Blondon H, Carmoi T, Zyani M, Béchade D, Algayres JP. [Diagnosis of anemia in alcoholic cirrhosis]. Rev Med Interne 2007; 28:756-65. [PMID: 17559980 DOI: 10.1016/j.revmed.2007.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 05/03/2007] [Indexed: 01/29/2023]
Abstract
PURPOSE Anemia in patients with alcoholic liver cirrhosis is a common issue. The diagnosis could be difficult because of the multiplicity of causes, usually associated, and specificities in the diagnostic approach. This subject has not been reviewed for almost two decades. We propose a review based upon analysis of the literature and our clinical experience. CURRENT KNOWLEDGE AND KEY POINTS Because of the alcoholism and the biological consequences of the liver disease, laboratory findings, especially the mean corpuscular volume, should be interpreted with caution in the diagnostic approach. Despite these drawbacks, the diagnosis of anemia is detailed according to the usual plan: normocytic, macrocytic and microcytic anemias. Finally, we propose practical guidelines. FUTURE PROSPECTS AND PROJECTS Further prospective studies should assess the real burden of nutritional deficiencies, easily treatable. The prognostic significance of hemolytic anemias in patients with alcoholic liver cirrhosis should be studied.
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Affiliation(s)
- J-S Bladé
- Clinique médicale, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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9
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Affiliation(s)
- D Béchade
- Department of Gastroenterology, Val de Grâce Hospital, Paris, France.
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Béchade D, Durand X, Desramé J, Rambelo A, Corberand D, Baranger B, Farge D, Algayres JP. [Etiologic spectrum of mesenteric panniculitis: report of 7 cases]. Rev Med Interne 2007; 28:289-95. [PMID: 17316921 DOI: 10.1016/j.revmed.2006.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 12/30/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Mesenteric panniculitis is a rare disorder characterized by nonspecific inflammation and/or necrosis and/or fibrosis in the adipose tissue of the bowel mesentery. Its signification, primary or associated with other diseases, is a subject of controversy. METHODS A descriptive and retrospective study of patients with an abdominal CT examination showing features of mesenteric panniculitis and for whom biopsy with immunohistochemical examination was obtained in all cases. RESULTS Seven patients were enrolled (4 men and 3 women) with a median age of 62,1 years. None of the patients without an identified etiology had a history of abdominal surgery. An associated disease was identified in 4 cases: breast cancer (1), non-Hodgkin's lymphoma based on peripheric lymph nodes biopsy (2) and cryoglobulinemic vascularitis based on renal biopsy (1). In the 3 remaining cases, isolated mesenteric panniculitis was the only abnormality despite thorough imaging and pathologic investigations. CONCLUSION Except an obvious malignancy context or a history of abdominal surgery, a pathologic examination of the mesenteric panniculitis lesions is necessary, especially to eliminate another mesenteric disorder. Mesenteric panniculitis is often associated with lymphoma.
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Affiliation(s)
- D Béchade
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Abstract
INTRODUCTION Thromboembolic events are serious complications in patients with inflammatory bowel disease. EXEGESIS An 18-year-old patient, with a one year history of ulcerative colitis, presented with cerebral venous thrombosis during the decreasing period of corticotherapy after an active phase of the disease. Under treatment, the neurological disorder rapidly improved. No inherited thrombophilia was found. CONCLUSION The role of acquired and inherited risks factors is discussed.
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Affiliation(s)
- D Béchade
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Le Berre JP, Coutant G, Lecoules S, Desramé J, Amezyane T, Béchade D, Algayres JP. Des anomalies cornéennes et cérébrales. Rev Med Interne 2006; 27:631-2. [PMID: 16530890 DOI: 10.1016/j.revmed.2006.01.014] [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] [Received: 01/12/2006] [Accepted: 01/18/2006] [Indexed: 11/20/2022]
Affiliation(s)
- J P Le Berre
- Service de médecine interne, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 119, rue de Javel, 75230 Paris cedex 05, France.
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Amezyane T, Pouit B, Bassou D, Lecoules S, Desramé J, Blade JS, Béchade D, Algayres JP. Une cause rare de lombosciatique. Rev Med Interne 2006; 27:494-6. [PMID: 16310292 DOI: 10.1016/j.revmed.2005.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 10/03/2005] [Indexed: 10/25/2022]
Affiliation(s)
- T Amezyane
- Clinique médicale, HIA Val-de-Grâce, 00446 ARMEES cedex, France
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Béchade D, Desramé J, Raynaud JJ, Coutant G, Algayres JP. [Lymphocytic colitis following administration of mianserine]. Rev Med Interne 2005; 27:78-80. [PMID: 16260071 DOI: 10.1016/j.revmed.2005.09.006] [Citation(s) in RCA: 1] [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] [Received: 06/06/2005] [Accepted: 09/09/2005] [Indexed: 11/22/2022]
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Lecoules S, Blade JS, Bordier L, Desramé J, Coutant G, Bechade D, Algayres JP. [A spinal disease which causes toothache...]. Rev Med Interne 2005; 26 Suppl 2:S307-9. [PMID: 16129185 DOI: 10.1016/s0248-8663(05)81295-0] [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: 11/29/2022]
Affiliation(s)
- S Lecoules
- Clinique médicale, hôpital d'Instruction de Armées du Val-de-Grâce, Paris, France
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Lecoules S, Jagou M, Blade JS, Desramé J, Coutant G, Algayres JP. La malédiction des Balkans: gare au coup de bélier !…. Rev Med Interne 2005; 26 Suppl 2:S292-3. [PMID: 16129179 DOI: 10.1016/s0248-8663(05)81289-5] [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: 11/21/2022]
Affiliation(s)
- S Lecoules
- Clinique médicale, hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France
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Coutant G, Lecoules S, Desramé J, Camparo P, Gros P, Rapp C, Raynaud JJ, Béchade D, Algayres JP. [Inflammatory pseudotumor of lymph node]. Rev Med Interne 2005; 26:242-6. [PMID: 15777587 DOI: 10.1016/j.revmed.2004.11.018] [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] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Accepted: 11/18/2004] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Inflammatory pseudotumor of lymph node is a rare case in the etiology of fever of unknown origin. OBSERVATION We report the observation of a woman, aged 40, hospitalized with intermittent fever revealing under-diaphragm adenopathy related to inflammatory pseudotumor of lymph node. CONCLUSION Inflammatory pseudotumor of lymph node is a rare pathology whose nosological definition is unclear. It should probably be considered as belonging to a category different from the inflammatory pseudotumor of other organs. The diagnosis presents itself in case of isolated adenopathy or prolonged fever and is based on an anatomopathology that essentially calls to mind a lymphoma. The evolution of the condition is shown to be favorable : it can lead to a spontaneous remission, or call for a non-steroid anti-inflammatory treatment, or a steroid therapy.
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Affiliation(s)
- G Coutant
- Clinique médicale, HIA du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Desramé J, Delacour H, Béchade D, Adem C, Raynaud JJ, Lecoules S, Coutant G, Algayres JP. Fistule pancréatico-péritonéale avec bisalbuminémie. Presse Med 2005; 34:223-6. [PMID: 15798534 DOI: 10.1016/s0755-4982(05)88252-1] [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: 10/22/2022] Open
Abstract
INTRODUCTION Pancreatic fistulas are a complication that occur in 3 to 15% of cases during the progression of chronic or acute pancreatitis, usually alcohol-induced. Bisalbuminemia is characterised by two albumin fractions on serum protein electrophoresis. The presence of Bisalbuminemia is inconsistent and has only rarely been reported. OBSERVATION A 42 year-old man, excessive drinker, developed pancreatic ascites related to a pancreatic-peritoneal fistula and associated with transitory bisalbuminemia. Treatment was medical with good short term results. DISCUSSION Ascites was secondary to a pancreatic-peritoneal fistula. It can be constitutional or acquired and transitory, and secondary to prolonged treatment with b-lactamines in a patient with kidney failure or a pancreatic fistula.
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Affiliation(s)
- J Desramé
- Clinique médicale, Hôpital d'Instruction des Armées Val de Grace, 74 boulevard Port Royal, 75005 Paris, France.
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Desramé J, Duvic C, Bredin C, Béchade D, Artru P, Brézault C, Defuentes G, Poirier JM, Dourthe LM, Coutant G, Chaussade S, de Gramont A, Algayres JP. [Hemolytic uremic syndrome as a complication of gemcitabine treatment: report of six cases and review of the literature]. Rev Med Interne 2005; 26:179-88. [PMID: 15777580 DOI: 10.1016/j.revmed.2004.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 11/23/2004] [Indexed: 11/23/2022]
Abstract
UNLABELLED Hemolytic uremic syndrome is a rare condition during gemcitabine therapy. METHODS We report six new cases of hemolytic uremic syndrome related to gemcitabine, three issued from a retrospective study of 136 consecutive patients treated with gemcitabine for which a systematic screening of this side effect has been performed and 29 cases with clinical data available identified in the literature in order to better characterised frequency and clinical presentation of this side effect. RESULTS In our series, frequency of HUS is 2.2% and is higher than this previously reported (0.015%) or estimated with the data of clinical trials analysed (0.072 %). For 35 cases with clinical data available, the patients were always treated for a local advanced and/or metastatic disease. For our cases and for literature cases, at the time of diagnosis of hemolytic uremic syndrome, mean number of doses received (mean+/-standard deviation. Minimum/maximum)) (personal cases: 26.5+/-6.6. 16/36, literature cases: 21+/-11. 8/54), cumulative dose received (g/m2) (personal cases : 24.5+/-6.3. 16/31.6, literature cases: 21.7+/-12.4. 2.4/54) and duration of treatment (months) (personal cases: 8.2+/-1.9. 5.6/11, literature cases: 8.5+/-4.0. 3/18) are very closed and high individual variations observed for these factors are not consistent with a time and/or dose dependant toxicity. New-onset hypertension or exacerbation of underlying hypertension is the most common clinical manifestation, with mild anemia; thrombocytopenia is inconstant. The degree of severity of renal failure is highly variable. The existence of subacute clinical form with progressive worsening of the symptoms and biological form at the time of diagnosis suggest the interest of a systematic clinical and biological screening of this side effect, before each injection of gemcitabine. Early prognosis is linked to the evolution of hemolytic uremic syndrome and after hemolytic uremic syndrome healing, cancer progression. Treatment include gemcitabine discontinuation, antihypertensive drugs and if necessary fresh frozen plasma. CONCLUSIONS Systematic clinical and biological screening of hemolytic uremic syndrome during gemcitabine therapy should allow to better know this complication, to recognize and treat it earlier with a potential positive impact for patients.
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Affiliation(s)
- J Desramé
- Clinique médicale, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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Defuentes G, Lecoules S, Desramé J, Béchade D, Coutant G, Flocard F, Algayres JP. [Amyotrophic lateral sclerosis during multiple myeloma]. Rev Med Interne 2004; 25:766-8. [PMID: 15471606 DOI: 10.1016/j.revmed.2004.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Accepted: 06/07/2004] [Indexed: 04/30/2023]
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21
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Defuentes G, Lecoules S, Desramé J, Coutant G, Algayres JP. [Polymyositis during adult-onset Still's disease]. Rev Med Interne 2004; 25:531-3. [PMID: 15219374 DOI: 10.1016/j.revmed.2004.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 03/18/2004] [Indexed: 10/26/2022]
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Defuentes G, Lecoules S, Bladé JS, Desramé J, Raynaud JJ, Béchade D, Coutant G, Algayres JP. Une camerounaise bien habillée. Rev Med Interne 2004; 25 Suppl 2:S218-20. [PMID: 15460455 DOI: 10.1016/s0248-8663(04)80008-0] [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: 11/21/2022]
Affiliation(s)
- G Defuentes
- Clinique médicale, hôpital d'Instruction des Armées du Val-de-Grâce, 74, boulevard Port-Royal, 75005 Paris, France
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Aparicio T, Desramé J, Lecomte T, Mitry E, Belloc J, Etienney I, Montembault S, Vayre L, Locher C, Ezenfis J, Artru P, Mabro M, Dominguez S. Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly. Br J Cancer 2003; 89:1439-44. [PMID: 14562014 PMCID: PMC2394343 DOI: 10.1038/sj.bjc.6601310] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The tolerance and efficacy of oxaliplatin and irinotecan for metastatic colorectal cancer are unknown in elderly patients. Methods. All consecutive patients over 74 years treated with oxaliplatin or irinotecan for metastatic colorectal cancer were enrolled. The tumour response was assessed every 2–3 months and toxicity was collected at each cycle according to World Health Organisation criteria. A total of 66 patients were enrolled from 12 centres. The median age was 78 years (range, 75–88 years); 39 patients had no severe comorbidity according to the Charlson score. In total, 44 and 22 patients received oxaliplatin or irinotecan, respectively, in combination with 5-fluororuracil±folinic acid or raltitrexed in 64 patients. A total of 545 chemotherapy cycles were administered in first (41%), second (51%) or third line (8%). A dose reduction occurred in 190 cycles (35%). Complete response, partial response and stabilisation occurred in 1.5, 20 and 47% of patients, respectively. The median time to progression and overall survival were 6.8 and 11.2 months in first line and 6.3 and 11.6 months in second line, respectively. Grade 3 and 4 toxicity occurred in 42% of patients: neutropenia 17%, diarrhoea 15%, neuropathy 11%, nausea and vomiting 8% and thrombopenia 6%. There was no treatment-related death. In selected elderly patients, chemotherapy with oxaliplatin or irinotecan is feasible with manageable toxicity.
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Affiliation(s)
- T Aparicio
- Service d'Hépato-Gastroentérologie, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, AP-HP, Paris 75018, France.
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Affiliation(s)
- L Védrine
- Service de clinique médicale, hôpital d'instruction des armées du Val-de-Grâce, 75230 Paris cedex 05, France.
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Desramé J, Béchade D, Goasdoué P, Defuentes G, Raynaud J, Renard J, Généreau T, Coutant G, Algayres J. Un prurit trompeur…. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80650-1] [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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Béchade D, Berthelet O, Desramé J, Lecoules S, Coutant G, Algayres JP. [Recurrent cholestatic jaundice in adult-onset Still's disease]. Rev Med Interne 2002; 23:1034-5. [PMID: 12504244 DOI: 10.1016/s0248-8663(02)00733-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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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Desramé J, Delacour H, Béchade D, Lecoules S, Védrine L, Coutant G, Clerc Y, Algayres J. La fistule pancréatico-péritonéale : Une étiologie de bisalbuminemie acquise. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Béchade D, Palazzo L, Desramé J, Duvic C, Hérody M, Didelot F, Coutant G, Algayres JP. [Pancreatic metastasis of renal cell carcinoma: report of three cases]. Rev Med Interne 2002; 23:862-6. [PMID: 12428491 DOI: 10.1016/s0248-8663(02)00693-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/28/2022]
Abstract
INTRODUCTION The pancreas is an uncommon site of metastasis from renal cell carcinoma. EXEGESIS Three observations are described in this review which is aimed at reporting recent data on diagnosis, prognosis and therapeutic features of this kind of metastasis 0: The average space of time between nephrectomy and the diagnosis of the metastasis was 16 years. They have been fortuitously discovered in 2 cases, in patients who did not complain of any pancreatic symptom, during abdominal ultrasonography done for another reason. In the third case, pancreatic symptoms led to the diagnosis. Endoscopic ultrasonography (EUS) was useful to diagnose multiple lesions misdiagnosed on CT-scan or MRI imaging. EUS patterns are characteristic, but histological and cytological examinations of EUS-guided needle biopsies are difficult to study according to the hypervascularized character of these metastasis. CONCLUSION The diagnosis of pancreatic metastasis must be suggested for patients suffering from a pancreatic mass with a previous medical history of late renal cell carcinoma. According to their hypervascularized character, the negativity of EUS-guided needle biopsies could strongly direct the diagnosis. When surgery is possible, the survival rate is better than in primary pancreatic adenocarcinoma and is even better than in pancreatic metastasis from other sites.
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Affiliation(s)
- D Béchade
- Service de clinique médicale, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris, France.
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Desramé J, Sabaté JM, Agher R, Bremont C, Gaudric M, Couturier D, Chaussade S. Assessment of hypothalamic-pituitary-adrenal axis function after corticosteroid therapy in inflammatory bowel disease. Am J Gastroenterol 2002; 97:1785-91. [PMID: 12135036 DOI: 10.1111/j.1572-0241.2002.05786.x] [Citation(s) in RCA: 17] [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: 12/11/2022]
Abstract
OBJECTIVES In patients with inflammatory bowel disease (IBD), little is known about the effect of long term corticosteroid therapy (CT) on the hypothalamic-pituitary-adrenal (HPA) axis function. Our aim was to assess HPA axis function in IBD, before the end of CT, during the tapering phase. METHODS HPA axis function was assessed with cortisol (ng/ml) measurement before (T0) (normal > 100) and 60 min (normal > 210) after 0.25 mg tetracosactide (Synacthen immédiat) injection (T60) in 55 consecutive cases of IBD attacks. Abnormal response was defined as a T60 <210. The attacks were separated into two groups according to the result of the Synacthen test (ST). RESULTS In all, 36 of 55 ST were abnormal. The time for recovery normal HPA axis function was 7.2+/-1.3 months. Duration of disease since onset, past history of surgical or immunosuppressive treatment, severity and extension of the attack, need for surgical or immunosuppressive treatment, total cumulative and mean daily corticosteroid dose, total duration of CT, and steroid dose at the time of ST were not significantly different in the two groups. In multivariate analysis a past history of CT was predictive of abnormal ST (OR = 8.4, 95% CI = 2.2-31.5, p = 0.0009). Among patients with a past history of CT, the time (months) elapsed between the last course of CT was significantly longer in those with normal ST than in those with abnormal ST (45.5+/-13.5 vs 15.4+/-6.0; p = 0.02), and in multivariate analysis a duration free of CT < 15 months was predictive of abnormal ST (OR = 15.00, CI = 1.23-183.00, p = 0.03). CONCLUSIONS In all, 65% of the ST were abnormal. These results suggest that ST should be performed before corticosteroid withdrawal, especially in patients with recent past history of CT.
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Affiliation(s)
- J Desramé
- Services d'Hépato-Gastroentérologie, Hôpital Cochin, Paris, France
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30
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Kalach N, Desramé J, Bonnet C, Commegeille P, Couturier D, Chaussade S, Hance P, Dupont C, Raymond J. Helicobacter pylori seroprevalence in asymptomatic pregnant women in France. Clin Diagn Lab Immunol 2002; 9:736-7. [PMID: 11986290 PMCID: PMC119970 DOI: 10.1128/cdli.9.3.736-737.2002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of our study was to evaluate the incidence of Helicobacter pylori seropositivity in two different populations of asymptomatic pregnant women from different geographic origins during two separate time periods. A retrospective study of consecutive sera obtained from 169 and 302 asymptomatic pregnant women in 1990 and 1999, respectively, was carried out. The global H. pylori seroprevalences for 1990 and 1999 were 21.3 and 21.5% (where P is nonsignificant), respectively. For both periods the H. pylori seroprevalences were significantly higher in non-French pregnant women (66.6 and 50.6%) than in French pregnant women (18.7 and 11.2%) (P = 0.01 and 0.001, respectively). H. pylori seroprevalence in French pregnant women decreased significantly from the first period (18.7%) to the second one (11.2%) (P = 0.03).
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Affiliation(s)
- N Kalach
- Department of Pediatric Gastroenterology, Hôpital Cochin-Saint Vincent de Paul, Université René Descarte, Paris V, France
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Béchade D, Desramé J, Hélie O, Berthelet O, Coutant G, Hélie C, Algayres JP. [Mirizzi syndrome]. Presse Med 2002; 31:217. [PMID: 11878139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- D Béchade
- Service de Clinique Médicale, Service de radiologie diagnostique, Hôpital du Val-de-Grâce, 74 boulevard de Port-Royal, 75230 Paris
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Rapp C, Coutant G, Béchade D, Camparo P, Grimaud L, Baranger B, Desramé J, Helie C, Algayres J. Pseudo-tumeur inflammatoire ganglionnaire abdominale révélée par une fièvre prolongée inexpliquéeet un érythème noueux. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80186-7] [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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Béchade D, Desramé J, Damiano J, Berthelet O, Coutant G, Hélie C, Algayres JP. [Aortoduodenal fistula on aortic prosthesis]. Presse Med 2001; 30:1688. [PMID: 11760599] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- D Béchade
- Service de Clinique Médicale, hôpital du Val-de-Grâce, 74 boulevard de Port-Royal, 75230 Paris
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Béchade D, Baranger B, Desramé J, Szymczyszyn P, Eggenspieler P, Hélie C, Higuero T, Algayres JP. [Giant colonic diverticulum]. Gastroenterol Clin Biol 2001; 25:1032-4. [PMID: 11845061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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35
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Desramé J, Mitry E, Lecomte T, Atlan D, Vaillant JN, Julié C, Nordlinger B, Penna C, Rougier P. [Interest of a combined modality treatment in unresectable gallbladder carcinoma. A case report]. Gastroenterol Clin Biol 2001; 25:1034-6. [PMID: 11845062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Desramé J, Bronstein JA, Thiolet C, Bredin C, Ceccaldi B, Vergeau B, Farret O. [Coronary insufficiency after an oral intake of capecitabine]. Gastroenterol Clin Biol 2001; 25:829-30. [PMID: 11598548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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38
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Béchade D, Desramé J, Damiano J, Coutant G, Hélie C, Algayres J. Fistule aortodigestive sur prothèse aortique : nécessité du scanner abdominal en urgence. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83585-2] [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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Desramé J, Artru P, Béchade D, Duvic C, Coutant G, de Gramont A, Algayres J. Microangiopathie thrombotique secondaire à la gemcitabine : à propos de quatre observations. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83431-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Coutant G, Béchade D, Banal F, Helie C, Desramé J, De Revel T, Souleau B, Nedellec G, Algayres JP. Il était un foie. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83669-9] [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: 11/24/2022]
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41
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Damiano J, Coutant G, Béchade D, Desramé J, Hélie C, Algayres J. Une collection au niveau du muscle psoas. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Desramé J, Minvielle F, Thiolet C, Mennecier D, Ciribilli JM, Bredin C, Riemlinger H, Boyer B, Farret O. [Cystic dystrophia of the duodenal wall with aberrant pancreas. Value of magnetic resonance imaging for diagnosis]. Presse Med 2000; 29:1759-61. [PMID: 11098270] [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: 02/18/2023] Open
Abstract
BACKGROUND Cystic dystrophy of the duodenal wall is characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. Diagnosis is difficult and endosonography is considered as the most useful investigation. CASE REPORTS A 40-year-old man was hospitalized for abdominal pain triggered by ingestion of alcoholic beverages and for vomiting after food intake. The diagnosis of acute atypical cephalic pancreatitis was initially made. Magnetic resonance cholangiography then magnetic resonance imaging suggested the diagnosis of cystic dystrophy of the duodenal wall in a heterotopic pancreas which was confirmed by endosonography. DISCUSSION Magnetic resonance imaging evidenced several cystic formations within a thickened duodenal wall leading to the correct diagnosis. MRI appears to provide all the elements necessary for the diagnosis of cystic dystrophy of the duodenal wall, avoiding the need for invasive investigations.
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Affiliation(s)
- J Desramé
- Service de Pathologie digestive, HIA Bégin, Saint Mandé.
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43
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Mennecier D, Coutant G, Pagnoux C, Béchade D, Desramé J, Algayres JP. [Tumor of the ampulla of Vater]. Presse Med 2000; 29:1793. [PMID: 11098282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- D Mennecier
- Service de Médecine interne, Hôpital d'Instruction des Armées du Val de Grâce, Paris
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Duvic C, Desramé J, Hérody M, Nédélec G. Acute poststreptococcal glomerulonephritis associated with thrombotic microangiopathy in an adult. Clin Nephrol 2000; 54:169-73. [PMID: 10968697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The simultaneous occurrence of acute poststreptococcal glomerulonephritis and thrombotic microangiopathy is rare. A 47-year-old woman was admitted with acute renal failure, hematuria, edematous nephrotic syndrome and severe hypertension. This acute nephritic syndrome occurred two weeks after left leg erysipelas. The patient also had signs of intravascular hemolysis, low serum levels of C3 and C4 and elevated antistreptolysin-O titer. Kidney biopsy confirmed postinfectious glomerulonephritis with diffuse hypercellularity and humps, and simultaneous subendothelial hyalin deposits and fibrinoid arteriolar thrombi. The patient received four antihypertensive drugs, acetylsalicyclic acid and plasma infusions. Renal function improved, hypertension was controlled and serum levels of C3 and C4 complement components returned to normal within three months. This case illustrates the occurrence of thrombotic microangiopathy in association with acute poststreptococcal glomerulonephritis. This simultaneous appearance supports a role of neuraminidase in this disease.
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Affiliation(s)
- C Duvic
- Clinique de Néphrologie et Unité d'Hémodialyse, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France
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45
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Desramé J, Béchade D, Patte JH, Jean R, Karsenti D, Coutant G, Algayres JP, Daly JP. [Yellow nail syndrome associated with intestinal lymphangiectasia]. Gastroenterol Clin Biol 2000; 24:837-40. [PMID: 11011259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The yellow nail syndrome, a combination of yellow discoloured nails, lymphedema and pleural effusions, is a rare clinical condition. We report a case of the yellow nail syndrome associated with intestinal lymphangiectasia revealed by chylous ascites and protein-losing gastroenteropathy. This association reported in only three cases in the literature leads us to discuss the relations between yellow nail syndrome, primitive intestinal lymphangiectasia and primary lymphatic disorders.
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Affiliation(s)
- J Desramé
- Clinique Médicale, HIA du Val-de-Grâce, Paris.
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46
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Béchade D, Algayres JP, Coutant G, Bili H, Desramé J, Daly JP. [Segmental non-gangrenous ischemic colitis during a non-steroidal anti-inflammatory treatment]. Rev Med Interne 1999; 20:184-5. [PMID: 10227102 DOI: 10.1016/s0248-8663(99)83041-0] [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: 11/24/2022]
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47
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Mennecier D, Cruel T, Desramé J, Nizou C, Ciribilli JM, Vergeau B. [Helicobacter heilmannii, another agent responsible for acute gastritis in the human]. Presse Med 1998; 27:1436. [PMID: 9793044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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48
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Desramé J, Mathurin P, Rozov R, Sabaté JM, Poynard T, Opolon P, Denis J. [Isolated ascites revealing a hypothyroidism. Study of 2 cases]. Gastroenterol Clin Biol 1998; 22:732-5. [PMID: 9823564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Ascites is an uncommon feature of hypothyroidism. We report two patients with hypothyroidism revealed by ascites. Among the 44 myxedema ascites cases found in the literature, there were observed 17 cases of ascites as the first manifestation of hypothyroidism. In this rare presentation of hypothyroidism, diagnosis is often delayed. Biological analysis of ascites usually shows high protein and cholesterol concentrations and a low or high cell count with a high proportion of lymphocytes. An increase in capillary permeability may play a role in the pathogenesis of ascites.
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Affiliation(s)
- J Desramé
- Service d'Hépato-Gastroentérologie, Hôpital Pitié-Salpêtrière, Paris
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49
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Coursaget P, Buisson Y, Enogat N, Bercion R, Baudet JM, Delmaire P, Prigent D, Desramé J. Outbreak of enterically-transmitted hepatitis due to hepatitis A and hepatitis E viruses. J Hepatol 1998; 28:745-50. [PMID: 9625307 DOI: 10.1016/s0168-8278(98)80222-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [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: 12/04/2022]
Abstract
BACKGROUND/AIMS One hundred and eleven patients with acute hepatitis and 61 controls were investigated for hepatitis serological markers in order to determine the viral etiology of cases involved in a waterborne epidemic of hepatitis observed in 1993 in Djibouti, Republic of Djibouti (East Africa). These cases occurred both in indigenous Djiboutians, and in French soldiers and their families in Djibouti. A retrospective study of the viral etiology of acute hepatitis cases observed in French soldiers and relatives living in Djibouti during the 3-year period preceding the epidemic was also undertaken. METHODS HAV, HBV and HCV infections were investigated using commercial ELISA tests. HEV infections were investigated by testing IgG and IgM-specific antibodies by means of three different ELISA tests using recombinant proteins or synthetic peptides. RESULTS Hepatitis A was observed in 37 (33%) and hepatitis E in 43 (39%) of the 111 cases of acute hepatitis recorded during this epidemic. Hepatitis B represented only 6% of the indigenous cases and hepatitis C was not observed among the cases investigated. Anti-HEV IgG antibodies were also detected in 19% of the indigenous control group. CONCLUSION These results suggest that both HAV and HEV were responsible for this waterborne epidemic of acute hepatitis. However, HAV and HEV infections were not equally distributed between French expatriates and Djibouti residents. Whereas HAV infections were mainly observed in French patients, HEV was almost exclusively found in indigenous patients. This study reports for the first time a waterborne outbreak of acute hepatitis simultaneously due to HAV and HEV.
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Affiliation(s)
- P Coursaget
- Institut de Virologie de Tours and Laboratoire d'Immunologie des Maladies Infectieuses, Faculté de Pharmacie, Tours, France
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50
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Molinié C, Desramé J. [Viral hepatitis E]. Med Trop (Mars) 1996; 56:285-8. [PMID: 9026599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Thanks to progress in serologic techniques evidence was obtained in 1980 showing that acute hepatitis epidemics observed in India were due to neither virus A nor virus B. The presence of another virus was confirmed and its genome was cloned and sequenced in 1991. Hepatitis virus E is a small RNA virus that differs from other known human viruses. Man and probably a few animal species maintain dissemination by the fecal route. Subjects not previously contaminated are susceptible and produce protective antibodies. Contamination occurs by the fecal-oral route general from water or tainted food. Direct contamination is rare. Vertical transmission from mother to fetus can also be observed. Outbreaks of the disease are characterized by epidemic proportions, preferential involvement of adolescent and young adults, and high incidence of fulminant cases especially in pregnant women. Outbreaks have been observed in endemic settings in southern Asia, Africa, and Mexico where sporadic cases are observed. Endemic areas are found in all developing countries. Hepatitis E is not clinically different from other acute viral hepatitis. Asymptomatic forms are common especially in children. The course of the disease is usually benign with little risk of development of chronic symptoms and cirrhosis. However hepatitis E is associated with a high incidence of severe cases with a mortality of 1 to 2% from icteric forms which occur in 15 to 20% of cases involving women contaminated during the last three months of pregnancy. Diagnosis can be made using either synthetic proteins or recombinant peptides. for the epitopes of the virus. Prevention depends on protection of the water supply and proper sewage disposal. Successful active immunization of monkeys holds promise for development of a vaccine. Due to its magnitude and high mortality rate hepatitis E is a major health problem for numerous regions around the world including Southeast Asia.
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Affiliation(s)
- C Molinié
- Service de Pathologie Digestive, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
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