Lipoprotein(a) in patients initiating antiretroviral therapy.

OBJECTIVES: The interaction between lipoprotein(a), an emerging cardiovascular risk factor, and antiretrovirals (ARVs) has been less well studied than the interaction between either cholesterol or triglycerides and these drugs. In this study we assessed the effect of initiating antiretroviral therapy (ART) on lipoprotein(a) levels. METHODS: Fasting samples from 95 patients initiating ART with nucleoside/nucleotide reverse transcriptase inhibitors plus nonnucleoside reverse transcriptase inhibitors or protease inhibitors were obtained. Lipids and lipoproteins were determined until week 48. RESULTS: As in the general population, the study population showed a highly skewed lipoprotein(a) distribution (median 9.9 mg/dL, range 0.1-110 mg/dL). The study population was divided into individuals with lipoprotein(a) >or=30 mg/dL at baseline (n=28) and those with <30 mg/dL (n=67). Almost exclusively, patients with high lipoprotein(a) at baseline (median 51.6 mg/dL) showed a profound increase of median 26.7 mg/dL (week 24). This effect was not associated with specific ARVs and was independent of changes in other lipids. The low-lipoprotein(a) group (baseline median 7 mg/dL) showed a small increase of median 2.6 mg/dL (week 24). CONCLUSIONS: Marked increases in lipoprotein(a) after initiation of ART were mainly restricted to patients with high baseline levels. This may have clinical implications as patients with high lipoprotein(a) are at higher risk for myocardial infarction and stroke.

Simultaneous determination of the new HIV protease inhibitor lopinavir (ABT 378) and of indinavir(1), amprenavir, saquinavir, ritonavir (ABT 538)(2) and nelfinavir(3) in human plasma by gradient HPLC.

Protease inhibitors are known by their inhibition of a viral protease that leads to production of immature and non-infectious virus particles. The novel protease inhibitor KALETRA is a co-formulation of lopinavir and ritonavir. Ritonavir reduces the metabolization of lopinavir by the cytochrome P450 3A4 isoenzyme which leads to markedly increased plasma levels of lopinavir(4). A new rapid and sensitive HPLC method for the simultaneous determination of lopinavir, indinavir, amprenavir, saquinavir, ritonavir and nelfinavir in human plasma has been developed. An aliquot of 500 microl plasma, spiked with internal standard, was extracted with 500 microl 0.1 M ammonium hydroxide solution and 5 ml tert. -butyl ether. After drying under a nitrogen stream, the residue was redissolved in an eluent consisting of 50 mM phosphate buffer, pH 5.40 and acetonitrile (50:50, v/v). Chromatographic separation was accomplished on a C-18 column using a non-linear gradient elution and ultraviolet detection at 215 nm.

[Radiological double contrast features of early lesions in Crohn's colitis (author's transl)]. / Frühveränderungen bei Crohnscher Kolitis im Doppelkontrast.

We have performed 131 double contrast barium enemas in 81 cases of granulomatous colitis or ileocolitis. 53 cases showed "early lesions": Inflammatory mucosa, lymphoid hyperplasia, aphtoid or varioliform ulcers and primary complexes. In 39% "early lesions" were the only granulomatous lesions of the colon. Several types of "early lesions" may appear in the same patient. 18 patients were subjected to a series of double contrast barium enemas. The lesions progressed in 12 cases and regressed in 6 cases. "Early lesions" may develop into segmental coblestone pattern. The radiological findings were confirmed by endoscopy or operation in 91% of our cases. A perfect double contrast barium enema is necessary to detect these "early lesions" which are important for diagnosis, treatment and possibly even for the prognosis in this disease.

[Granular cell tumors of the esophagus. Apropos of a case associated with bronchial carcinoma and treated by endoscopic excision]. / Les tumeurs à cellules granuleuses de l'oesophage. A propos d'un cas associé à un carcinome bronchique et traité par exérèse endoscopique.

The case of a granular cell tumor of the lower esophagus associated with a bronchial carcinoma is reported. The esophageal tumor was discovered by radiological and endoscopic examination for symptoms of gastroesophageal reflux and caused dysphagia after 6 1/2 years. An associated bronchial carcinoma led to the endoscopic removal of the esophageal tumor immediately prior to the thoracotomy. Eight days after operation the patient presented an hematemesis probably related to the endoscopic polypectomy. The course can be considered favorable after 17 months concerning the esophageal as well as the pulmonary situation. Histologically the esophageal tumor was a typical granular cell tumor and the bronchial tumor a squamous cell carcinoma. Seventy-nine cases of granular cell tumors of the esophagus have been published; 10 p. 100 of the cases are associated with bronchial, digestive or otorhinolaryngeal carcinoma. The onset of the carcinoma is usually subsequent to the esophageal tumor, justifying prolonged surveillance. This is the third case of a granular cell tumor of the esophagus treated by endoscopic polypectomy; this type of treatment requires close short-term follow-up because of the risk of hemorrhage as well as long-term follow-up because of the possibility of a second esophageal localization.

[Abetalipoproteinemia. Apropos of 2 cases]. / L'abêtalipoprotéinémie. A propos de deux cas.

The cases of two sisters with abetalipoproteinemia are reported. Both presented the complete clinical and biological features of the disease: ataxia, retinitis pigmentosa, lack of apolipoprotein B, chylomicrons, LDL and VLDL, reduced titers of serum cholesterol and triglycerides, acanthocytosis, very low levels of serum vitamin A and E. Abetalipoproteinemia is a rare autosomal inherited disease. It is usually revealed during early childhood by steatorrhea and failure to thrive; ataxia and retinitis pigmentosa appear later. The originality of these two cases stems from: 1) their late and fortuitous diagnosis: the first sister was investigated at the age of 42 after the discovery of a vitamin K induced coagulation disorder. The other sister was 39 when she was routinely examined as a family member; 2) the presence of constipation without any other suggestive digestive complaint. However, white discoloration of the duodenal mucosa seen at endoscopy and lipid droplets within the intestinal absorptive cells at biopsy were characteristic. Barium studies showed diffuse involvement of the small bowel which was displaced by an enlarged sigmoid. Treatment consists of administration of vitamin A and vitamin E which prevent or delay ocular and neurologic symptoms. Vitamin K is associated whenever necessary.

Contribution of discography to the diagnosis and treatment of lumbar disc herniation.

In this study, based on 600 cases of lumbar disc herniation treated by chemonucleolysis, the authors underline the importance of performing good discography and interpreting its results. A discographic classification of intervertebral disc deterioration is suggested. A CT-discographic study is reported and its results are compared with those of standard discography. On the basis of these studies, the authors have established methodological data concerning the efficacy of chemonucleolysis and its evaluation.

[What is the contribution of echography in Crohn disease?]. / Quel est l'intérêt de l'échographie dans la maladie de Crohn?

The alimentary tract often contains some gas which may obstruct the passage of the ultrasonic beam. However, when a pathological process involves the intestinal wall, a "target" pattern or a "pseudo-kidney" pattern may be visualized by ultrasound. It is also possible to visualize by US examination some complications of Crohn's disease: intestinal obstructive lesion with distended loops, fistula, abscesses and renal or biliary lithiasis. Because sonography is non-invasive and simple to perform without radiation exposure, it should often be used in Crohn's disease as the initial diagnosis and as the following-up test.

[HIV-lipodystrophy syndrome]. / Das HIV-assoziierte Lipodystrophiesyndrom.

CLINICAL FINDINGS: The HIV-associated lipodystrophy syndrome is reported with an increasing incidence predominantly in HIV-seropositive patients on antiretroviral therapy. The core of the lipodystrophy syndrome consists of fat loss in face, extremities and buttocks with or without a visceral fat accumulation, hyperlipidemia and a disturbed glucose metabolism are considered essential parts of the syndrome too. Additional metabolic abnormalities are regarded as syndrome related. PATHOGENESIS: Currently identified risk factors associated with the development of lipodystrophy are antiretroviral treatment (duration, number and kind of drugs), low CD4 cell count, higher age and metabolic abnormalities. The currently favored hypotheses to explain the lipodystrophy syndrome are essentially based on the assumption that antiretroviral treatment is the cause of the disorder. TREATMENT: The short-term benefit of antiretroviral treatment is greater than the disadvantages of the lipodystrophy syndrome, in the long term, however, the cardiovascular risk associated with the metabolic disturbances may result in an increased mortality on its own. The current approach to treatment includes modification of antiretroviral therapy and specific treatment of symptoms.

[Micturition disorders in elderly patients]. / Troubles mictionnels de la femme et de l'homme âgés.

After clinical evaluation, imaging is extremely important in determining the type of treatment and approach of micturition disorders in elderly. In this article, the advantages and limitations of each of the relevant techniques are reviewed and highlighting, with correlation to clinical evaluation. Sonography has become the most widely used technique to study bladder dysfunction. CT and MRI have specific indications.

[Intramural hematoma of ileum during anticoagulant therapy: study by double contrast intestinal transit (author's transl)]. / Hématome intramural de l'iléon sous traitement anticoagulant exploré par transit du grêle en double contraste.

Observation of a 52 years old man who is treated by anticoagulant who presents a subocclusive syndrome caused by an intramural hematoma of ileum. The radiological features are described in double contrast. Interest of the double contrast intestinal transit is discussed.

[The barium meal in chronical mesenteric ischemia. A report of a case with malabsorption (author's transl)]. / Le transit du grêle dans l'ischémie mésentérique chronique. A propos d'une observation avec malabsorption.

A 50 years old man with clinical manifestations of intestinal ischemia associated with malabsorption. On abdominal angiography an obstruction of the 3rd jejunal artery is seen. Barium meal revealed a diffuse jejunopathy with disappearance of mucosal folds and intestinal biopsy showed a complete loss of villi.

[The double contrast small bowel enema in Crohn's disease. 32 examinations (author's transl)]. / Le transit du grêle en double contraste dans la maladie de Crohn. A propos de 32 examens.

The authors have performed 150 double contrast small bowel enema. The results of 32 radiological examinations in Crohn's disease are reported. Four elementary alterations of the mucosal pattern can be described:--folding modifications,--mucosal defects,--different ulcers,--association between defects and ulcers drawing the classic "cobblestone" pattern. The transmural lesion is evident by fistules, strings, dilatations and mesenteric retractions. The conventionnal radiologic examination of the small bowel is satisfactory to show the manifestations of transmural lesion; but the double contrast enema is clearly more performing to characteristic mucosal lesions. So it appears indispensable to use this method for exploration of every Crohn's disease, to complete the conventionnal repletion enema.

[An unusual etiology of recurrent ulcerative colitis : Behçet's disease. Value of the double contrast barium enema (author's transl)]. / Une cause exceptionnele de colite ulcéreuse récidivante : la maladie de Behçet. Apport du lavement baryté en double contraste.

A recurrent ulcerative colitis in a Behcet's disease. The radiological features of this colitis are studied by a follow up of double contrast baryum enema. The diagnostic with Crohn's colitis is discussed.

[Esophageal disease: is cross sectional imaging contributive?]. / Pathologie de l'oesophage. L'imagerie en coupes a-t-elle un intérêt?

For a long time, esophagography and endoscopy were the major diagnostic tests used for evaluation of the esophagus. Now, the development of computed tomography, endosonography and MR imaging has permitted more comprehensive evaluation of esophageal diseases. Cross sectional imaging is essential to evaluate the relationship between esophageal lesions and adjacent mediastinal structures and to evaluate the thickness of the esophageal wall.

[Meckel's diverticulum in the adult. Double-contrast study of 7 cases]. / Le diverticule de Meckel de l'adulte. Etude en double contraste de 7 observations.

The authors report 7 cases of Meckel's diverticulum on a series of 500 double contrast small bowel enema (1,4%). In two cases, the diverticulum is not recognized by repletion study. So, they find that the double contrast small bowel enema is the most accurate method to detect a Meckel's diverticulum.

[Abdominal echography in colonic diseases]. / Intérêt de l'échographie abdominale en pathologie colique.

In the past few years, several studies have assessed the visualization of digestive diseases by ultrasound, but its clinical accuracy has been rarely defined. Thus we evaluated the contribution of sonographic examination as an initial diagnostic mean in the detection of colonic lesion. During a period of thirty six months (June 85-June 88) when we performed a standard sonographic abdominal examination, we utilized ultrasound to look for thickening or other modifications of the large bowel wall, if the clinical findings suggested a colonic disease. In these conditions we performed 453 US examinations. In our study, 363 cases were considered to be negative and the controls demonstrated colonic wall lesions in 24 cases. Thus the sensitivity was one of 77%. The sonographic examination was positive in 90 cases with 6 false positives. Thus our specificity reached 98.2% and the accuracy achieved was 93.3%. Thus sonographic examination appears to be a rapid, non invasive, mobile, mean of examining the abdominal cavity and also the large bowel in all patients. If this examination is negative, a colonic disease is possible since sensitivity is 77%. On the other hand, if the examination is positive, a colonic disease is very probable, since specificity reached 98.2%. The accuracy of US Colonic examination is 93.3% and with using abdominal plain film, theses percentages may be improved.

[Radiological aspects of gastric localizations of malignant non-Hodgkin's lymphoma. Apropos of 50 cases]. / Aspects radiologiques des localisations gastriques des lymphomes malins non hodgkiniens. A propos de 50 observations.

The authors describe radiological features of non Hodgkin's gastric lymphomas based on a study of 50 cases, with endoscopic correlation in 43 cases. Radiographic appearance is categorized as infiltrative (40 per cent), ulcerative (26 per cent), polypoid (10 per cent) and polymorphic (24 per cent). Gastric carcinoma is the most important differential diagnosis. Since staging, therapy and prognostic are different in these two diseases, accurate radiologic diagnosis is of particular importance. Combination of several peculiar radiologic signs suggest gastric lymphoma in 56 per cent of all the cases (16 per cent for endoscopy alone); this fact demonstrate the necessity of barium meal for a more accurate diagnosis of gastric lymphomas.

[Radiological aspects of rectal and colonic localizations of malignant non-Hodgkin's lymphoma. Apropos of 30 cases]. / Aspects radiologiques des localisations rectales et coliques des lymphomes malins non hodgkiniens. A propos de 30 cas.

The authors review radiological and endoscopical data of 30 patients with primary or secondary colonic and rectal non Hodgkin's lymphomatous involvement, and describe the radiologic pattern of this peculiar entity. Confirmation of the diagnosis is based in all cases on the pathological study of surgical specimens or per endoscopical biopsy. Eight patients (26%) presented non specific involvement secondary to small bowel or gastric localisation. The other patients (74%) had intrinsic lesions who may either remain localised (commonly endo-enteric type) or extend to whole of the colon (infiltrating type). After a description of the radiological features of these wide spectrum lesions, the authors consider the differential diagnosis and the respective contribution of colonic endoscopy and barium enema.

[Radiological features of non-gangrenous ischaemic colitis (author's transl)]. / Aspects radiologiques de l'ischémie colique non gangreneuse. A propos de 22 observations.

The authors have performed barium enema in 22 cases of non gangrenous ischaemic colitis. The diagnosis was established on the clinical, endoscopic and radiological data. The barium enema's radiological features and their evolution are described in particular thumbprinting, ulcerations, stenosis and sacculations. All these radiological signs were confirmed by endoscopic investigation or pathological examination. Abdominal angiography are carried out in 10 cases. The preferential site of the lesions is the descending colon. The differential diagnosis with other colitis are discussed and the diagnosis is easier when the barium enema is performed soon.

[Oesogastrointestinal involvement in Behcet's disease. A report of one case (author's transl)]. / Localisations digstives de la maladie de Behçet. A propos d'une observation.

The authors describe the radiological features of a patient with Behcet's disease, who had oesogastric ulcers and a terminal ileitis as major part of this clinical syndrome. The radiologic appearance of these localisations are discussed. The similarities of Behcet's disease to Crohn's disease are outlined.