Tazi Zoubida - Academia.edu (original) (raw)
Papers by Tazi Zoubida
International Archives of Medicine, 2016
Churg-Strauss syndrome (CSS) is a rare multisystemic disorder of unknown origin and cardiac invol... more Churg-Strauss syndrome (CSS) is a rare multisystemic disorder of unknown origin and cardiac involvement is one of the most serious manifestations of the disease. Vasospastic angina and myocardial infarction are unusual clinical manifestations of Churg-Strauss syndrome (CSS). We report a case of Churg-Strauss syndrome coexistent with myocardial infarction due to coronary vasospasm. A 25-year-old man with bronchial asthma and allergic rhinitis was admitted to our hospital because of acute respiratory distress and recurrent chest pain. Angiography showed severe spontaneous coronary artery spasm with healthy arteries. Cardiac MRI objectify a transmural ischemic involvement. Myocardial infarction due to coronary vasospasm was diagnosed. In addition, marked eosinophilia, eosinophilic pneumonitis, chronic sinusitis, a nasal endoscopy was performed objectifying nasal polyposis. The histological analysis of the polyposis biopsy revealed extravascular eosinophilic infiltrates. The patient was put on a combination therapy of glucocorticoids and cyclophosphamide.
Thrombosis Research, May 1, 2014
The Pan African medical journal, 2011
Thrombosis Research, May 1, 2014
No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients ... more No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients at risk of venous thromboembolism and assess the rate of appropriate thromboprophylaxis. This was a national, observational, multicentre survey of venous thromboembolism risk and thromboprophylaxis use in hospitalized patients. Data were collected on a predefined date in three university hospitals in Morocco using a standardized pre-printed form. Thromboembolic risk was assessed according to the American College of Chest Physicians (ACCP) 2008 guidelines. Patients were classified as "thromboprophylaxis indicated" or "thromboprophylaxis not indicated". 784 patients were analysed: 307 (39.2%) medical and 477 (60.8%) surgical. 421 (53.7%) were female. Medical patients were older than surgical patients (57.6 ± 11.5 vs. 46.2 ± 16.9 years, p<0.0001) and were more likely to have risk factors for thromboembolism (50.5% vs. 45.7% of patients, p=NS). 57% of patients without contraindications or bleeding risk were at risk of thromboembolism according to ACCP guidelines and thromboprophylaxis was prescribed to 42.8% of these patients. In contrast, 7.4% of patients with no thromboembolic risk also received thromboprophylaxis (proportion agreement: 61.0%; Kappa=0.296). Over half (54.5%) of medical patients at risk of thromboembolism did not receive thromboprophylaxis whereas 6.3% of those with no risk did receive it (proportion agreement: 76.4%; Kappa=0.433). These figures were 57.9% and 9.2%, respectively, for surgical patients (proportion agreement: 52.7%; Kappa=0.191). Thromboprophylaxis was given to 19.2% of patients with contraindications or a bleeding risk. Educational initiatives are imperative to inform doctors about appropriate thromboprophylaxis.
Thrombosis and Haemostasis, 2021
Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by ... more Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a ...
Journal of Hepatology, 2019
La Revue de Médecine Interne, 2002
La Revue de Médecine Interne, 2006
![Research paper thumbnail of [A case of disseminated cryptococcosis complicating treatment of pemphigus vulgaris with prednisone and azathioprime]](https://attachments.academia-assets.com/71861123/thumbnails/1.jpg)
](L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosup... more L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosuppresseurs et dont l'évolution peut être rapidement fatal en cas de retard diagnostic. Nous rapportons le cas d'une patiente âgée de 70 ans, ayant des antécédents de pemphigus vulgaire traité par prednisone et azathioprime et admise dans le service de médecine Interne pour des nodules sous cutanés atypiques. Le diagnostic retenu était celui d'une cryptococcose disséminée. L'évolution était rapidement fatale malgré le traitement antifongique.
The Pan African …, 2011
L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosup... more L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosuppresseurs et dont l'évolution peut être rapidement fatal en cas de retard diagnostic. Nous rapportons le cas d'une patiente âgée de 70 ans, ayant des antécédents de pemphigus vulgaire traité par prednisone et azathioprime et admise dans le service de médecine Interne pour des nodules sous cutanés atypiques. Le diagnostic retenu était celui d'une cryptococcose disséminée. L'évolution était rapidement fatale malgré le traitement antifongique.
Revue De Medecine Interne, 2002
Propos.-La maladie de Takayasu est une artérite inflammatoire chronique de la femme jeune touchan... more Propos.-La maladie de Takayasu est une artérite inflammatoire chronique de la femme jeune touchant essentiellement les gros vaisseaux. Nous rapportons une série marocaine, afin d'étudier les aspects clinicobiologiques et radiologiques de la maladie de Takayasu dans notre pays ainsi que ses modes d'évolution. Méthodes.-Nous avons colligé, de façon rétrospective, 47 cas d'artérite de Takayasu entre 1988 et 1999. Nous avons évalué les méthodes de diagnostic, le traitement et le suivi. Résultats.-Nous constatons une grande fréquence de l'atteinte des troncs supra-aortiques et moindre de l'atteinte aortique abdominale. Notre série se singularise par la rareté de l'atteinte de l'artère rénale. L'écho-doppler artériel est d'une grande utilité diagnostique. La corticothérapie a donné de bons résultats avec une amélioration des lésions dans plus de la moitié des cas et une stabilisation de la maladie dans 40 % des cas. La tuberculose est retrouvée chez 8,5 % des patients. Conclusion.-Le recours à l'écho-doppler et à l'angioscanner artériel sont des méthodes de diagnostic efficaces de la maladie de Takayasu. Le recours à la corticothérapie a donné de bons résultats à court et long terme. Nous ne notons pas de lien entre la tuberculose et la maladie de Takayasu dans notre série. © 2002 Éditions scientifiques et médicales Elsevier SAS Takayasu (maladie de) / écho-doppler / corticothérapie / tuberculose Summary-Takayasu's arteritis in Morroco. A study of 47 cases. Purpose.-Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Morrocan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country. Methods.-Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999. Results.-In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteritis were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients. Conclusion.-The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis. © 2002 Éditions scientifiques et médicales Elsevier SAS Takayasu's disease / ultrasound / corticosteroid / tuberculosis *Correspondance et tirés à part.
The Israel Medical Association journal : IMAJ, 2002
La Revue de Médecine Interne
The collagen vascular diseases and vasculitis, in particular, are occasionally associated with ch... more The collagen vascular diseases and vasculitis, in particular, are occasionally associated with chronic, relapsing lower extremity ulcerations. Different mechanisms can induce such ulcerations, and an understanding of the type of ulcerations is important in the differential diagnosis of patients with leg ulcerations in general, and management of these patients in particular. In this review, the authors analyze the various mechanisms of the leg ulcerations in these patients and their treatments: vasculitis, thrombosis, traumatisms, calcinosis, panniculitis, pyoderma gangrenosum, infections, and induced by treatments.
La Revue de Médecine Interne
From autoimmune hepatitis (AIH) classification which recognizes three types of AIH, we discuss th... more From autoimmune hepatitis (AIH) classification which recognizes three types of AIH, we discuss the main relations between hepatitis C virus (HCV) infection and AIH. Type I AIH is associated with antinuclear and antismooth muscle antibodies, and with other autoimmune diseases. There is no relation between type I AIH and HCV. Type I anti-liver kidney microsome and anti-liver cytosol I antibodies represent the hallmark of type II AIH. Among type II AIH, two subgroups emerged: type IIa AIH (10-40%) are true AIH (sensitive to steroids but worsens with interferon alpha), whereas type IIb AIH (60-90%) appear as a particular form of HCV hepatitis. Type IIb AIH have a moderate activity, a low titer of autoantibodies, anti-GOR antibodies but never anti-liver cytosol I, no sensitivity to steroids but are sensitive to interferon alpha. The hallmark of type III AIH are anti-cytosol antibodies, but these AIH have the same characteristics as type I AIH. The classification between true AIH (I, IIa, III) or "pseudo-AIH" due to HCV infection has major therapeutic implications. Steroids or immunosuppressive treatments are effective in type I, IIa and III AIH but have no efficacy in type IIb AIH. Alpha interferon has an efficacy in type IIb AIH, but it has no efficacy and may even worsen hepatitis in type I, IIa and III AIH.
La Revue de Médecine Interne
Several drugs have been shown to cause vasomotor troubles such as Raynaud's phenomenon, e... more Several drugs have been shown to cause vasomotor troubles such as Raynaud's phenomenon, erythromelalgia, vasculitis, livedo reticularis, or acrocyanosis. Vascular symptoms may develop a few weeks or more after drug initiation, particularly when other drugs are associated than can potentiate vascular side effects. In this review, the authors described the main characteristics of drug-induced vasculopathy, particularly those associated with ergotamine derivates, beta blocking agents or antineoplastic chemotherapy.
La Revue de Médecine Interne
The authors report the case of a woman aged 67 years who presented an acute ischemia of the lower... more The authors report the case of a woman aged 67 years who presented an acute ischemia of the lower limbs. A surgical exploration showed no atherosclerosis or thrombus. A biopsy of the femoral artery found an extensive mononuclear cell infiltration of the media and a fragmentation of internal elastic lamina. The diagnosis of Horton disease was considered and confirmed by the presence of clinical signs of polymyalgia rheumatica and inflammatory syndrome (erythrocyte sedimentation rate: 75 mm). Corticosteroid therapy was started with success. A year after discharge there was no recurrence of ischemic manifestations and the erythrocyte sedimentation rate was normal. Involvement of lower limbs in Horton disease is rare and exceptionally proven. But postmortem studies indicate that it is more frequent than previously reported. The diagnosis should be considered in the differential diagnosis of any unexplained case of peripheral vascular disease occurring in the middle-aged or elderly.
La Presse Médicale
Previous studies suggest that hyperhomocysteinemia may be a risk factor for arterial and venous t... more Previous studies suggest that hyperhomocysteinemia may be a risk factor for arterial and venous thrombosis. We retrospectively analyzed data from 75 patients with thrombosis. Thirty-four patients had arterial thrombosis, 22 venous thrombosis and 19 venous and arterial thrombosis. Of the 75 patients (49 men and 26 women, mean age 49 +/- 15 years) about two-thirds had recurrent episodes of thrombosis. Hyperhomocysteinemia was defined as serum homocysteine level above 14.1 mumol/l (mean + 2.7 SD in healthy subjects) and was found in 67 patients (89%, CI95% = 80-95). Mean total homocysteine concentration was 21.6 +/- 13.6 mumol/l for the 75 patients. About half of the patients were smokers, 35% had hypertension and 25% high serum cholesterol. There was no significant relationship between serum homocysteine level and smoking status, hypertension or serum cholesterol level. Ten patients (13%, CI95% = 7-23) had low serum cobalamin (< 150 pmol/l). Serum folates were < or = 10 nmol in 41% of the patients in the arterial thrombosis group (CI95% = 25-59), in 27% in the venous thrombosis group (CI95% = 11-50), and in 31% in the arterial and venous thrombosis group (CI95% = 13-57). Thirteen patients received vitamin B supplementation. Hyperhomocysteinemia decreased in 12/13 patients (CI95% = 64-100) and returned to normal values in 9/13 patients (69%, CI95% = 38-91). Our data show that hyperhomocysteinemia is frequently found in arterial and venous thrombosis. Further studies are needed to determine the clinical impact of homocysteine lowering therapy.
International Archives of Medicine, 2016
Churg-Strauss syndrome (CSS) is a rare multisystemic disorder of unknown origin and cardiac invol... more Churg-Strauss syndrome (CSS) is a rare multisystemic disorder of unknown origin and cardiac involvement is one of the most serious manifestations of the disease. Vasospastic angina and myocardial infarction are unusual clinical manifestations of Churg-Strauss syndrome (CSS). We report a case of Churg-Strauss syndrome coexistent with myocardial infarction due to coronary vasospasm. A 25-year-old man with bronchial asthma and allergic rhinitis was admitted to our hospital because of acute respiratory distress and recurrent chest pain. Angiography showed severe spontaneous coronary artery spasm with healthy arteries. Cardiac MRI objectify a transmural ischemic involvement. Myocardial infarction due to coronary vasospasm was diagnosed. In addition, marked eosinophilia, eosinophilic pneumonitis, chronic sinusitis, a nasal endoscopy was performed objectifying nasal polyposis. The histological analysis of the polyposis biopsy revealed extravascular eosinophilic infiltrates. The patient was put on a combination therapy of glucocorticoids and cyclophosphamide.
Thrombosis Research, May 1, 2014
The Pan African medical journal, 2011
Thrombosis Research, May 1, 2014
No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients ... more No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients at risk of venous thromboembolism and assess the rate of appropriate thromboprophylaxis. This was a national, observational, multicentre survey of venous thromboembolism risk and thromboprophylaxis use in hospitalized patients. Data were collected on a predefined date in three university hospitals in Morocco using a standardized pre-printed form. Thromboembolic risk was assessed according to the American College of Chest Physicians (ACCP) 2008 guidelines. Patients were classified as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;thromboprophylaxis indicated&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;thromboprophylaxis not indicated&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. 784 patients were analysed: 307 (39.2%) medical and 477 (60.8%) surgical. 421 (53.7%) were female. Medical patients were older than surgical patients (57.6 ± 11.5 vs. 46.2 ± 16.9 years, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) and were more likely to have risk factors for thromboembolism (50.5% vs. 45.7% of patients, p=NS). 57% of patients without contraindications or bleeding risk were at risk of thromboembolism according to ACCP guidelines and thromboprophylaxis was prescribed to 42.8% of these patients. In contrast, 7.4% of patients with no thromboembolic risk also received thromboprophylaxis (proportion agreement: 61.0%; Kappa=0.296). Over half (54.5%) of medical patients at risk of thromboembolism did not receive thromboprophylaxis whereas 6.3% of those with no risk did receive it (proportion agreement: 76.4%; Kappa=0.433). These figures were 57.9% and 9.2%, respectively, for surgical patients (proportion agreement: 52.7%; Kappa=0.191). Thromboprophylaxis was given to 19.2% of patients with contraindications or a bleeding risk. Educational initiatives are imperative to inform doctors about appropriate thromboprophylaxis.
Thrombosis and Haemostasis, 2021
Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by ... more Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a ...
Journal of Hepatology, 2019
La Revue de Médecine Interne, 2002
La Revue de Médecine Interne, 2006
L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosup... more L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosuppresseurs et dont l'évolution peut être rapidement fatal en cas de retard diagnostic. Nous rapportons le cas d'une patiente âgée de 70 ans, ayant des antécédents de pemphigus vulgaire traité par prednisone et azathioprime et admise dans le service de médecine Interne pour des nodules sous cutanés atypiques. Le diagnostic retenu était celui d'une cryptococcose disséminée. L'évolution était rapidement fatale malgré le traitement antifongique.
The Pan African …, 2011
L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosup... more L'infection à cryptocoque est une complication redoutable chez les patients traités par immunosuppresseurs et dont l'évolution peut être rapidement fatal en cas de retard diagnostic. Nous rapportons le cas d'une patiente âgée de 70 ans, ayant des antécédents de pemphigus vulgaire traité par prednisone et azathioprime et admise dans le service de médecine Interne pour des nodules sous cutanés atypiques. Le diagnostic retenu était celui d'une cryptococcose disséminée. L'évolution était rapidement fatale malgré le traitement antifongique.
Revue De Medecine Interne, 2002
Propos.-La maladie de Takayasu est une artérite inflammatoire chronique de la femme jeune touchan... more Propos.-La maladie de Takayasu est une artérite inflammatoire chronique de la femme jeune touchant essentiellement les gros vaisseaux. Nous rapportons une série marocaine, afin d'étudier les aspects clinicobiologiques et radiologiques de la maladie de Takayasu dans notre pays ainsi que ses modes d'évolution. Méthodes.-Nous avons colligé, de façon rétrospective, 47 cas d'artérite de Takayasu entre 1988 et 1999. Nous avons évalué les méthodes de diagnostic, le traitement et le suivi. Résultats.-Nous constatons une grande fréquence de l'atteinte des troncs supra-aortiques et moindre de l'atteinte aortique abdominale. Notre série se singularise par la rareté de l'atteinte de l'artère rénale. L'écho-doppler artériel est d'une grande utilité diagnostique. La corticothérapie a donné de bons résultats avec une amélioration des lésions dans plus de la moitié des cas et une stabilisation de la maladie dans 40 % des cas. La tuberculose est retrouvée chez 8,5 % des patients. Conclusion.-Le recours à l'écho-doppler et à l'angioscanner artériel sont des méthodes de diagnostic efficaces de la maladie de Takayasu. Le recours à la corticothérapie a donné de bons résultats à court et long terme. Nous ne notons pas de lien entre la tuberculose et la maladie de Takayasu dans notre série. © 2002 Éditions scientifiques et médicales Elsevier SAS Takayasu (maladie de) / écho-doppler / corticothérapie / tuberculose Summary-Takayasu's arteritis in Morroco. A study of 47 cases. Purpose.-Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Morrocan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country. Methods.-Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999. Results.-In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteritis were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients. Conclusion.-The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis. © 2002 Éditions scientifiques et médicales Elsevier SAS Takayasu's disease / ultrasound / corticosteroid / tuberculosis *Correspondance et tirés à part.
The Israel Medical Association journal : IMAJ, 2002
La Revue de Médecine Interne
The collagen vascular diseases and vasculitis, in particular, are occasionally associated with ch... more The collagen vascular diseases and vasculitis, in particular, are occasionally associated with chronic, relapsing lower extremity ulcerations. Different mechanisms can induce such ulcerations, and an understanding of the type of ulcerations is important in the differential diagnosis of patients with leg ulcerations in general, and management of these patients in particular. In this review, the authors analyze the various mechanisms of the leg ulcerations in these patients and their treatments: vasculitis, thrombosis, traumatisms, calcinosis, panniculitis, pyoderma gangrenosum, infections, and induced by treatments.
La Revue de Médecine Interne
From autoimmune hepatitis (AIH) classification which recognizes three types of AIH, we discuss th... more From autoimmune hepatitis (AIH) classification which recognizes three types of AIH, we discuss the main relations between hepatitis C virus (HCV) infection and AIH. Type I AIH is associated with antinuclear and antismooth muscle antibodies, and with other autoimmune diseases. There is no relation between type I AIH and HCV. Type I anti-liver kidney microsome and anti-liver cytosol I antibodies represent the hallmark of type II AIH. Among type II AIH, two subgroups emerged: type IIa AIH (10-40%) are true AIH (sensitive to steroids but worsens with interferon alpha), whereas type IIb AIH (60-90%) appear as a particular form of HCV hepatitis. Type IIb AIH have a moderate activity, a low titer of autoantibodies, anti-GOR antibodies but never anti-liver cytosol I, no sensitivity to steroids but are sensitive to interferon alpha. The hallmark of type III AIH are anti-cytosol antibodies, but these AIH have the same characteristics as type I AIH. The classification between true AIH (I, IIa, III) or "pseudo-AIH" due to HCV infection has major therapeutic implications. Steroids or immunosuppressive treatments are effective in type I, IIa and III AIH but have no efficacy in type IIb AIH. Alpha interferon has an efficacy in type IIb AIH, but it has no efficacy and may even worsen hepatitis in type I, IIa and III AIH.
La Revue de Médecine Interne
Several drugs have been shown to cause vasomotor troubles such as Raynaud's phenomenon, e... more Several drugs have been shown to cause vasomotor troubles such as Raynaud's phenomenon, erythromelalgia, vasculitis, livedo reticularis, or acrocyanosis. Vascular symptoms may develop a few weeks or more after drug initiation, particularly when other drugs are associated than can potentiate vascular side effects. In this review, the authors described the main characteristics of drug-induced vasculopathy, particularly those associated with ergotamine derivates, beta blocking agents or antineoplastic chemotherapy.
La Revue de Médecine Interne
The authors report the case of a woman aged 67 years who presented an acute ischemia of the lower... more The authors report the case of a woman aged 67 years who presented an acute ischemia of the lower limbs. A surgical exploration showed no atherosclerosis or thrombus. A biopsy of the femoral artery found an extensive mononuclear cell infiltration of the media and a fragmentation of internal elastic lamina. The diagnosis of Horton disease was considered and confirmed by the presence of clinical signs of polymyalgia rheumatica and inflammatory syndrome (erythrocyte sedimentation rate: 75 mm). Corticosteroid therapy was started with success. A year after discharge there was no recurrence of ischemic manifestations and the erythrocyte sedimentation rate was normal. Involvement of lower limbs in Horton disease is rare and exceptionally proven. But postmortem studies indicate that it is more frequent than previously reported. The diagnosis should be considered in the differential diagnosis of any unexplained case of peripheral vascular disease occurring in the middle-aged or elderly.
La Presse Médicale
Previous studies suggest that hyperhomocysteinemia may be a risk factor for arterial and venous t... more Previous studies suggest that hyperhomocysteinemia may be a risk factor for arterial and venous thrombosis. We retrospectively analyzed data from 75 patients with thrombosis. Thirty-four patients had arterial thrombosis, 22 venous thrombosis and 19 venous and arterial thrombosis. Of the 75 patients (49 men and 26 women, mean age 49 +/- 15 years) about two-thirds had recurrent episodes of thrombosis. Hyperhomocysteinemia was defined as serum homocysteine level above 14.1 mumol/l (mean + 2.7 SD in healthy subjects) and was found in 67 patients (89%, CI95% = 80-95). Mean total homocysteine concentration was 21.6 +/- 13.6 mumol/l for the 75 patients. About half of the patients were smokers, 35% had hypertension and 25% high serum cholesterol. There was no significant relationship between serum homocysteine level and smoking status, hypertension or serum cholesterol level. Ten patients (13%, CI95% = 7-23) had low serum cobalamin (< 150 pmol/l). Serum folates were < or = 10 nmol in 41% of the patients in the arterial thrombosis group (CI95% = 25-59), in 27% in the venous thrombosis group (CI95% = 11-50), and in 31% in the arterial and venous thrombosis group (CI95% = 13-57). Thirteen patients received vitamin B supplementation. Hyperhomocysteinemia decreased in 12/13 patients (CI95% = 64-100) and returned to normal values in 9/13 patients (69%, CI95% = 38-91). Our data show that hyperhomocysteinemia is frequently found in arterial and venous thrombosis. Further studies are needed to determine the clinical impact of homocysteine lowering therapy.