Jacques Henri Barrier

Endocrine function in 98 HIV-infected patients: a prospective study.

Endocrine function was prospectively evaluated in 98 patients (73 men and 25 women) infected by HIV in various stages of illness: Centers for Disease Control groups II (19), III (20), IVA and IVC2 (27), IVC1 and IVD (32). Testing included baseline and post-stimulation evaluation of gonadal, thyroidal, and adrenal axes. Although adrenal function was within normal values in most cases, with no differences between patient groups, nine out of 98 patients had either a low baseline or post-stimulation serum cortisol, cytomegalovirus adrenalitis being suspected in two cases. Mineralocorticoid response was normal in all individuals. The main abnormalities were sick euthyroid syndrome with low tri-idothyronine and/or thyroxine in 16% of patients and hypotestosteronemia in 29% of men with AIDS. These abnormalities, related to a functional deficiency of the hypothalamic-pituitary axis, were highly correlated with the degree of illness, i.e. weight loss and low CD4+ cell count. It was concluded that endocrine dysfunction in HIV-infected patients is rarely of clinical significance, that it is related more to cachexia and advanced disease than to HIV or opportunistic infections, and that it could serve as a prognostic marker.

Giant Cell Arteritis with or without Aortitis at Diagnosis. A Retrospective Study of 22 Patients with Longterm Followup

Objective. Studies have shown that aortitis may be present in half the patients with recent-onset giant cell arteritis (GCA). We assessed whether aortitis at diagnosis affects longterm outcome in patients with GCA. Methods. We retrospectively analyzed the longterm outcome of a prospective cohort of 22 patients with biopsy-proven GCA who all had aortic computed tomography (CT) evaluation at the time of diagnosis of GCA between May 1998 and November 1999. Longterm outcome, especially vascular events such as aortic aneurysm, mortality, relapses of GCA, and requirement for steroids, was assessed in 2011 by chart review and patient/physician interviews. Results. At disease onset, 10/22 patients had aortitis on CT scan. Patients with and without aortitis had similar baseline characteristics, including cardiovascular risk profile. At the time of the study, 12/22 (57%) patients had died. Vascular causes of death were more frequent in patients with aortitis (5/7 vs 0/5; p = 0.02). A higher number of vascular events was noted in patients with aortitis (mean events per patient 1.33 vs 0.25; p = 0.009). Stroke was more frequent in patients with aortitis. These patients seemed to exhibit a more chronic or relapsing disease course, and they were less likely to completely discontinue steroid therapy (p = 0.009, log-rank test). Conclusion. Our study suggests for the first time that inflammatory aortic involvement present at onset of GCA could predict a more chronic/relapsing course of GCA, with higher steroid requirements and an increased risk for vascular events in the long term.

Role for vascular investigations in giant cell arteritis.

Giant cell arteritis is characterized by diffuse arterial inflammation that selectively involves the superficial temporal arteries but can occur in larger arteries. Various vascular investigations can assist in diagnosing and evaluating the extent of giant cell arteritis. Imaging techniques, mainly Doppler ultrasonography of the superficial temporal arteries, seem less reliable for the diagnosis than temporal artery biopsy, which is safe and remains indispensable. Investigations of larger arteries can detect asymptomatic stenotic lesions, which are common, particularly in the axillary and subclavian arteries. Involvement of the aorta can cause life-threatening dissection or aneurysmal rupture. Imaging techniques useful for diagnosing aortic involvement include ultrasonography, computed tomography, magnetic resonance imaging, and aortography. Although there is no standardized strategy for aortic lesion detection, helical computed tomography may be valuable.

La maladie de Horton simple : modalités thérapeutiques

Resume D’une maniere generale Les corticoides restent la base du traitement de la maladie de Horton et la prednisone est la molecule de choix. Ils permettent une amelioration des symptomes et diminuent considerablement le risque de cecite. Plusieurs formes cliniques de la maladie doivent etre individualisees afin de preciser pour chacune d’entre elles les modalites de la corticotherapie et les traitements eventuels a associer. Maladie de Horton non compliquee Les formes simples de la maladie de Horton se definissent par l’absence d’atteinte oculaire, l’absence d’atteinte clinique des arteres de gros calibre, l’absence de corticoresistance, et l’absence de corticodependance a un haut niveau (formes simples devenant secondairement compliquees). Modalites de la corticotherapie Ces formes simples justifient un traitement d’attaque a la dose de 0,7 mg/kg/j de prednisone alors que les assauts cortisoniques n’ont pas de justification precise. Des doses initiales quotidiennes plus faibles de prednisone, 0,5 mg/kg/j voire moins, semblent exposer a un risque plus eleve de reprise evolutive de la maladie mais sont neanmoins a evaluer. Questions satellites La iatrogenicite des corticoides pose des problemes chez les patients corticodependants et ceux recevant un traitement d’attaque trop long. Le risque d’osteoporose cortico-induite est particulierement important au cours de la maladie de Horton. Enfin, il n’existe toujours pas d’etude prospective permettant de preciser les indications des anticoagulants ou des anti-agregants plaquettaires en phase aigue de la maladie.

Les risques potentiels du sevrage en corticoïdes au cours de la maladie de Horton. Étude prospective de 22 malades

We carried out a prospective study on stopping steroid use in 22 cases of giant cell arteritis. 30% had transitory insufficient adrenal function. CD8 cells monitoring may be useful in order to decide withdrawing steroids.

Place des explorations vasculaires dans la maladie de Horton

Resume La maladie de Horton est une arterite inflammatoire diffuse, touchant preferentiellement les arteres temporales superficielles, mais pouvant se localiser aux arteres de plus gros calibre. Differentes techniques dˈexploration vasculaire peuvent apporter une aide dans le diagnostic ou le bilan dˈextension de cette affection. A visee diagnostique, les techniques dˈimagerie, principalement lˈechographie couplee au Doppler des arteres temporales superficielles, apparaissent moins performantes que la biopsie dˈartere temporale, qui reste un geste indispensable et bien tolere. Lˈexploration vasculaire des arteres de gros calibre permet de depister de frequentes stenoses parfois asymptomatiques, avec un tropisme preferentiel pour les axes axillo-sous claviers. Lˈaortite de Horton est une forme particulierement grave de la maladie, pouvant se compliquer de dissection ou de rupture dˈanevrisme aortique. Les techniques dˈimagerie pouvant conduire au diagnostic dˈaortite sont lˈechographie, la tomodensitometrie, l’imagerie par resonance magnetique (IRM) ou lˈaortographie. Le depistage des lesions aortiques nˈest pas codifie mais le scanner spirale de lˈaorte pourrait avoir un interet dans cette indication.

Absence d'association privilégiée entre la maladie de Horton et les maladies thyroïdiennes autoimmunes

Abstract Some studies emphasized the possible coexistence of giant cell arteritis (GCA) and autoimmune thyroid diseases and suggested a relationship. Our prospective study concerned 39 patients who had GCA. We measured autoantibodies and thyroid function and compared the results to those of a control group. No statistical difference was found. Our conclusions differ from those of other authors.

Paralysie du III révélant une primoinfection à cytomégalovirus chez une adulte immunocompétente (aspects IRM)

The involvement of a target organ in immunocompetent patients is a rare occurence in cytomegalovirus infection. Neurological localisations are most frequent during reactivation phase than primo-infection. We report a CMV primo-infection revealed by an isolated attack of the III left cranial nerve, with cerebral MRI features.

Polymorphisme anatomo-clinique des vascularites liées au VIH. Existe-t-il un mécanisme auto-immun ?

Four dissimilar cases of vasculatis related to HIV-1 infection led us to consider the mechanism of vascular lesions (direct involvement of HIV or opportunistic agents (CMV) or auto-immune disease. Therapy is difficult in such cases because of possible worsening of immunodepression.

Double syndrome neurologique paranéoplasique : un tableau clinique trompeur au diagnostic difficile

A 60 year old man presented a peripheral neurophathy and encephalitis. He died. The autopsy found a bronchic carcinoma.