Kystes colloïdaux familiaux : Suivi neuroendocrinologique

in XVIIIème Congrès de la Société Française d'Endocrinologie - Abstract book (2000)

Adénomes hypophysaires familiaux isolés non liés avec la mutation somatique NEM-1 : Suivi de 27 patients

in XVIIIème Congrès de la Société Française d'Endocrinologie - Abstract book (2000)

Adénomes hypophysaires producteurs de TSH : Suivi à long terme de 40 cas

in XVIIIème Congrès de la Société Française d'Endocrinologie - Abstract book (2000)

Patologia hipofisaria y NEM-1

in Revista Argentina de Endocrinologia y Metabolismo (2000), 37(3), 181-193

Multiple Endocrine Neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by neoplasia of the parathyroid glands, the endocrine pancreas and the anterior pituitary gland. Recently the ... [more ▼]

Multiple Endocrine Neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by neoplasia of the parathyroid glands, the endocrine pancreas and the anterior pituitary gland. Recently the identification on chromosome 11 (locus q13) of the gene responsible for MEN 1 has allowed direct genetic diagnosis of MEN 1-affected family members. To date almost 300 families have been described and genetically characterized. The genetic etiology of most pituitary tumours remains unknown. Pituitary adenomas can develop sporadically or as a part of multiple endocrine neoplasia type 1. In this review, the recently published data on the pathology of the MEN 1 syndrome will be summarized. The clinical, morphological and genetic aspects of sporadic and MEN 1-associated pituitary adenomas will be outlined. [less ▲]

Controverses thérapeutiques: le traitement de la maladie de Basedow

in Revue Médicale de Liège (1999), 54(7), 606-610

Hyperthyroidism is a common clinical condition with an annual incidence of about 1%. Approximately, 1 in every 20 women will develop this condition during a lifetime. Most cases are due to Graves'disease ... [more ▼]

Hyperthyroidism is a common clinical condition with an annual incidence of about 1%. Approximately, 1 in every 20 women will develop this condition during a lifetime. Most cases are due to Graves'disease. Solitary toxic nodules and toxic multinodular goiters are also important but less frequent causes. In this article, we will consider only the treatment of Graves'disease. Anti-thyroid drugs, surgery and radio-iodine, all represent effective forms of treatment. There is, however, little consensus regarding the treatment of choice for specific cases. This article discusses the advantages and disadvantages of each treatment. [less ▲]

Les adénomes somatotropes: etude clinique, biologique et neuroradiologique portant sur 85 cas d'acromégalie suivis à l'Hôpital de la Timone.

Master of advanced studies dissertation (1999)

Introduction Selective acromegaly for acromegaly may have a wide range of remission rates, ranging from 40 to 80% in published series. These heterogeneous results rely not only on the surgeon experience ... [more ▼]

Introduction Selective acromegaly for acromegaly may have a wide range of remission rates, ranging from 40 to 80% in published series. These heterogeneous results rely not only on the surgeon experience, but also depend on the use of different biochemical remission criteria. Aim of the work The first part of this study is to evaluate clinical, biochemical and radiological data in a consecutive series of 85 patients diagnosed with acromegaly and followed-up by the endocrine team of Prof Jaquet in La Timone University Hospital (Marseille, FRANCE). The aim of the second part of this study is to settle a predictive model of surgical remission , after univariate and multivariate analysis of this clinical, biochemical, radiological and pathological data. Methods Biological criteria of acromegaly surgical remission included: normal IGF1 values according to age and sex, mean GH values <2µg/L and GH<1µg/L after 75g OGTT. In mixed somatotroph adenomas, remission criteria also included prolactin and alpha subunit hypersecretion normalization at last follow up. Results The first part of the study included 85 acromegalics (39 males, 46 females). Mean age at diagnosis was 43,5 years (range 13-68) and mean delay of acromegaly diagnosis was 6,2± 4,7 years.Mean follow up was 29 ±32 months. Among the 85 patients: 52/85 had headaches, 33/80 had a visual impairment (scotomas= 22, quadrantopsias= 2, hemianopsias= 9). Mean hormonal values at diagnosis were: GH=66,5µg/L (range 1-1730), IGF1=769 (range 300-1900 µg/L), PRL=27,3 µg/L (range 9-130, n=67), alpha subunit=4,4 UI/L (range 0,2-60). Pituitary MRI identified 3/19 microadenomas (frontal diameter<10 mm) invading cavernous sinus and 49/66 macroadenomas (frontal diameter equal or > 10 mm) with invading features. Frontal diameter had a good correlation with cavernous sinus invasion (r=0,48 , p<0,01) and sphenoidal sinus extension (r=0,46,p<0,01). GH hypersecretion had a good positive correlation with tumoral diameter (r=0,46 , p<0,01). In the second part of the study, there were 72 acromegalic patients that underwent transphenoidal surgery by the same neurosurgeon (Prof F. Grisoli), with a mean post surgical follow up of 26 months. Using astringent biochemical remission criteria, there were 27 patients (38%) in remission and 45 patients not cured. In univariate analysis none of the following criteria was predictive of remission: age, sex, headaches, visual disturbances, adenoma immunostaining. Pathological data included: 29 GH adenomas, 18 mixed GH/alpha SU, 12 mixed GH/prolactin, 11 GH/prolacti/alpha SU and two mixed GH (with TSH and/or LH staining). In univariate and multivariate analysis MRI radiological signs of invasion (carotideal extension) and mean tumoral diameter>22 mm independently predicted surgical failure (p<0,0001 and p=0,00054 respectively). Conclusions In this series GH nadir <1 µg/L is highly specific (89%) as an early surgical remission criteria (day 8) , whereas normalization of IGF1 is not predictive. Using astringent biochemical remission criteria, only 38 % of patients were in remission. Our multivariate predictive model identified MRI radiological cavernous sinus invasion and tumor diameter as main failure presurgical predictive factors.In GH tumors which diameter was >30 mm, surgical failure was 100%. Clinicians should integrate these parameters when evaluating surgical treatment in acromegaly. [less ▲]

Colestasis asociada a ticlopidina

in Gastroenterologia y Hepatologia (1997), 20(3), 128-30

The case of a 56-years-old male with cholestasis associated with ticlopidine is presented. Cholestasis is an infrequent adverse effect of this drug. The patient was admitted to hospital because of ... [more ▼]

The case of a 56-years-old male with cholestasis associated with ticlopidine is presented. Cholestasis is an infrequent adverse effect of this drug. The patient was admitted to hospital because of jaundice, choluria, and itching of one month of evolution. The patient had taken ticlopidine twice a day for 3 months up to one week prior to admission for peripheral arteriopathy. Biopsy was performed showing acinar cholestasis and portal inflammatory infiltrate compatible with cholestasis due to hypersensitivity. Ticlopidine was discontinued by the patient himself one week prior to admission. The drug was not readministered and the evolution of the clinical and biochemical parameters of cholestasis decreased. The patient was asymptomatic and laboratory data were normal 4 months later. [less ▲]

Pseudoaneurisma gigante del ventriculo izquierdo

in Prensa Medica Argentina (1996), 83(10), 919-924

A 85 years old patient was hospitalized because of thoracic pain, lasting since three months. He suffered of Parkinson's disease and he was a smoker. The pain increased with cough and Vansalva's test. His ... [more ▼]

A 85 years old patient was hospitalized because of thoracic pain, lasting since three months. He suffered of Parkinson's disease and he was a smoker. The pain increased with cough and Vansalva's test. His left arm was cianotic. An arterial obstruction was suspected. Dopler ultrasound of the left arm confirmed a partial obstruction of the left axillar artery. Surprisingly, thoracic scan and MRI found an important cardiomegaly. The heart was in contact with the diaphragmatic and gastric region. Ecocardiography confirmed a 7 cm pseudo aneurysm of the left ventricle. Coronarography showed extreme hypokinesia of the left ventricle. There was also an obstruction of the right coronary and 50 % stenosis of the left coronary. Pseudo aneurysm was a complication of myocardial infarction of the left ventricle. Surgery was offered to the patient, but he declined the intervention. He was dismissed with medical treatment and anticoagulation. The patient deceased three months later. [less ▲]

Hipertension arterial renal en el anciano

in Romero Villanueva, Horacio; Farah, Ruben (Eds.) Hipertension en el anciano (1996)

The kidney is both a key regulator of arterial pressure and a target organ of hypertension in the elderly. The aging kidney presents several anatomical and functional changes. Main anatomical changes are ... [more ▼]

The kidney is both a key regulator of arterial pressure and a target organ of hypertension in the elderly. The aging kidney presents several anatomical and functional changes. Main anatomical changes are weight loss (250 g in the adult and 180g in the elderly) and cortical and glomerular atrophy. As a consequence, the glomerular filtration, (600 ml/min in the adult an 300 ml/min in the elderly) and the creatinine clearence usualy fall down in these patients. In considering pharmacological treatment, one needs to remember these important features. This chapter summarizes the different and most frequent causes of renal hypertension in the elderly and disscuss the main therapeutic implications. [less ▲]

Disfuncion ventricular en la infeccion HIV perinatal

in Prensa Medica Argentina (1995), 82

We studied cardiovascular function in four babies . There were three females (3, 6 and 9 months old ) and one 6 months old male with HIV perinatal infection (ELISA and Western blot positives). CD4 counts ... [more ▼]

We studied cardiovascular function in four babies . There were three females (3, 6 and 9 months old ) and one 6 months old male with HIV perinatal infection (ELISA and Western blot positives). CD4 counts were: 1150/mm3, 1250 /mm3, 950/mm3 and 1066/mm3 respectively. The first baby had pneumocystosis and oral candidiasis, and two other had bacterial pneumonia and viral brochiolitis as antecedents. We observed after echocardiographic Doppler evaluation right ventricle diastolic dysfunction in three cases. Interestingly there were no pulmonary hypertension. Diastolic and systolic left ventricle function was normal in all babies. Our previous results in 27 AIDS adult patients let us to identify mainly left ventricle dysfunction (Valdes E & al Prensa Medica Argentina 1994). On the contrary, right ventricle dysfunction was predominant in this small series. Lipshultz & al (Am J Cardio 1990) found in 31 perinatal AIDS ventricular dysfunction, myocardial dilatation, arrhythmias and pericardial effusion. Our results combined with a literature review point out cardiac dysfunction as a frequent finding in children with AIDS. As these alterations are not necessarily clinically apparent, we recommend routine echocardiographic evaluation in these patients. Physiopathological clues in AIDS cardiac dysfunction remain elusive: HIV cytotoxic myocardiopathy, opportunistic infections and/or viral autoimmune mechanisms have been considered as potential causes. [less ▲]