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Biomedical subjects

A Prost

Publications and source records attributed to A Prost.

At least 19 recordsLinked to original sources
PubMed1997

Super-acute aseptic spondylitis as the first manifestation of round calcifying nucleopathy in a 77-year-old man. A case report.

STUDY DESIGN: This is a report of an unusual case of very late onset, symptomatic, round calcifying nucleopathy. OBJECTIVE: To describe this unusual case of calcifying nucleopathy in a 77-year-old man who had no previous back problems, but had a history of diffuse skeletal hyperostosis. SUMMARY OF BACKGROUND DATA: The resorption of calcifying nucleopathy associated with reactional spondylitis is a classic occurrence in children but is rare in adults. METHODS AND RESULTS: Spondylitis was diagnosed on the basis of pain, a transient Babinski's sign, and systemic inflammation. Radiographs, a bone scan, and magnetic resonance imaging revealed a large calcified nucleopathy of the T12-L1 disc associated with spondylitis of T12. The calcification disappeared within 3 weeks, and recovery was clinically and biologically complete after treatment consisting of only rest and analgesics. CONCLUSION: A diagnosis of resorption of a round calcifying nucleopathy is not to be excluded in the elderly patient. This event can mimic an infectious spondylitis clinically and biologically.

Aged↗
PubMed1997

Antiperinuclear factors are present in polyarthritis before ACR criteria for rheumatoid arthritis are fulfilled.

OBJECTIVE: To show that antiperinuclear factor (APF) may be useful for the diagnosis of rheumatoid arthritis at a time when the American College of Rheumatology (ACR) criteria are not yet fulfilled. METHODS: Testing for APF-IgG (1:100 threshold) and rheumatoid factors (RF) was done in 60 patients with polyarthritis of recent onset during a three year follow up. RESULTS: At the end of the study, 21/40 rheumatoid arthritis were positive for RF and 31/40 for APF, including 18/40 cases (45%) in which ACR criteria were not yet fulfilled. CONCLUSIONS: APF are useful in the diagnosis of early rheumatoid arthritis.

Antibodies, Antinuclear↗
PubMed1997

Joint manifestations in myelodysplastic syndromes. A report of three cases presenting as polymyalgia rheumatica.

We report three cases of polymyalgia rheumatica occurring after (n = 1) or shortly before (n = 2) a diagnosis of myelodysplastic syndrome. These cases demonstrate that: 1) inflammation and bleeding are not the only causes of anemia in patients with inflammatory joint disease; 2) side effects of drugs, Felty's syndrome and large granular lymphocyte expansion are not the only causes of neutropenia in this setting; 3) lymphomas and monoclonal gammopathies are not the only hematologic diseases that can present under the guise of polymyalgia rheumatica; 4) a high index of suspicion for a myelopoietic disorder should be maintained in patients who have not only joint symptoms and cytopenia, but also vasculitis, neurologic symptoms, thyroid disorders or protein electrophoresis abnormalities. Because myelodysplastic syndromes are due to clonal proliferation of abnormal stem cells, our cases are in line with recent investigations suggesting that abnormalities of bone marrow stem cells are involved in the pathogenesis of some inflammatory joint diseases. Studies of the clonality and karyotype of synovial cells from affected joints might lend further support to this hypothesis.

Aged↗
PubMed1997

Lumbar spinal stenosis: a review.

Neurologic compromise due to degenerative disorders of the lumbar spine are designated by the generic term "lumbar spinal stenosis". Differences in the interpretation of this term exist across the fields of pathology, radiology, and rheumatology, creating significant confusion. Rheumatologists view lumbar spinal stenosis as a functional rather than an anatomic entity and hold that its diagnosis should be based on clinical grounds. As in disk disease, imaging studies lack sensitivity and specificity, are poorly correlated with the level and severity of manifestations and are of no assistance for predicting the preoperative or postoperative outcome. A detailed history is the mainstay of the diagnosis and also carries great weight for estimating the level of impairment due to spinal stenosis. In contrast, "objective" physical findings have little predictive value and are poorly correlated with both quality of life indicators and postoperative outcomes. The effect of surgery remains unpredictable in the individual patient. Remarkable uniformity has occurred among published series regarding the rate of poor surgical outcomes (about one case in three), postsurgical worsening of symptoms (one case in six) and postsurgical complications (one case in ten). Accurate data are lacking on the short-term and long-term efficacy of conservative therapy (local corticosteroid injections and kinesiology). Randomized studies are needed to compare conservative therapy and surgery in terms of quality of life and other long-term outcomes in patients who fail initially to respond to conservative management. Improved knowledge of the natural history of this ill-defined syndrome is among the benefits expected from such studies.

Age Factors↗
PubMed1996

Rheumatoid arthritis as a bone marrow disorder.

Both the concept of rheumatoid arthritis (RA) as an autoimmune process restricted to joints and the major role of T cells in its pathogenesis have been challenged in the literature. Fibroblastlike and macrophagelike synoviocytes play an important role in RA pannus, and these cells originate in or have their counterpart in bone marrow (BM). Yet the B cell autoimmunity characteristic of RA occurs early, and synovial tissue, like BM, favors the B cell response. Because BM is abnormal in RA, and because germinal centers are unique to RA synovium, RA could be regarded as a disorder of the microenvironments able to sustain B cell response. In fact, RA could even begin in BM, with its onset facilitated by stem cell abnormalities. Moreover, most viruses suspected of playing a role in RA share a BM tropism. This may explain why RA frequently overlaps with other autoimmune disorders and benign lymphoproliferations, such as large granular T lymphocytosis. Because remissions from RA have been reported after BM transplantation, careful studies of the rheumatological outcome of RA patients undergoing such therapeutic procedures are needed. Although RA is a complex process, it can be considered initially as a stem cell disorder requiring treatment similar to that administered to transplant patients. Animal models have provided convincing evidence for these assumptions.

Animals↗
PubMed1996

Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study.

Despite previously carrying out a first open study of sacroiliac injection of long-acting corticosteroid, it was not possible to evaluate the role of a placebo effect. We therefore performed a double-blind study in 10 patients/13 articulations, suffering painful sacroiliitis. At 1 month, 5/6 sacroiliac joints injected with corticosteroid described a relief of > 70%, in comparison to 0/7 of the placebo group (P < 0.05). Dolometry showed a marked decrease in the corticosteroid group from (mean +/- S.E.M.) 6.8 +/- 0.6 to 1.3 +/- 0.3, and decreases were mild in the placebo group: 7.0 +/- 0.6 to 5.2 +/- 0.5 (P < 0.005). Six of the seven sacroiliac joints of the placebo group and two patients with failure and relapse of the corticosteroid group were reinjected with corticosteroid. At 1 month, 12/14 (85.7%) were assessed as having a good result. Results were still significant at 3 months (62%) and 6 months (58%). Tolerance was good or very good in 86% of the cases, and we did not report any notable complication. This technique is safe and very efficient, and it has to be considered more widely in patients with contraindications or complications with NSAID, or if the medical treatment is unable to control sufficiently the active sacroiliitis.

Adrenal Cortex Hormones↗
PubMed1996

Osteoporotic fractures revealing anorexia nervosa in five females.

Anorexia nervosa affects 0.5% to 1% of female adolescents. The course is chronic in 50% of cases, causing substantial bone loss with osteoporotic fractures after a few years of amenorrhea. This is probably an underestimated problem. The diagnosis of anorexia nervosa is readily missed, as illustrated by five cases reported herein. The five patients were females aged 17 to 44 years who were only slightly underweight (mean weight, 43.6 kg; body mass index < 20 kg/m2). The first fracture occurred seven to 24 years after the onset of anorexia nervosa. Three patients had vertebral crush fractures, and two had peripheral insufficiency fractures. Bone mineral density measured by absorptiometry was very low (mean lumbar z-score, -3.7 SD). Three patients, who were all members of health care professions, knew that they had anorexia nervosa but failed to report this condition. In the other two patients, the amenorrhea had been mistakenly ascribed to other causes (Stein-Leventhal syndrome and psychogenic anovulation). None of the patients was receiving medical follow-up. Anorexia nervosa should be considered routinely in women who are slightly underweight. The patients often deny abnormal menstruation or eating behaviors. The diagnosis rests on determination of the body mass index, a thorough history emphasizing current and past gonadal dysfunction, and evaluation of the diagnostic criteria for anorexia nervosa. Osteoporosis is probably a common but underestimated complication of anorexia nervosa, particularly before the menopause. Enhanced awareness of this condition should allow earlier detection of a greater number of cases.

Absorptiometry, Photon↗
PubMed1996

Myositis ossificans circumscripta with spontaneous healing of a cortical cyst.

We report a case of myositis ossificans circumscripta with an initial periosteal reaction and subsequent development of a cyst in the underlying cortex. All the roentgenographic abnormalities resolved spontaneously and permanently. The unusual course may have been due to formation of a subperiosteal hematoma at the time of development of the soft tissue ossification.

Adult↗
PubMed1996

A potentially underrecognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves.

We describe a case of longstanding low back pain related to entrapment neuropathy of the L1-L2 dorsal ramus over the iliac crest. As 3 local anesthetic pain blocks (at the trigger point, 7 cm left of the L5 spine process and just above the iliac crest) were successful for 3 weeks each, a surgical procedure was performed. This corrected patient stricture of a voluminous dorsal ramus within a rigid osteofibrous orifice between the upper rim of the iliac crest and the thoracolumbar fascia. Pain decreased dramatically the same day and disappeared completely within less than a week.

Back Pain↗
PubMed1996

Pain due to bone insufficiency as a symptom heralding femoral neck fracture.

Although falls are a major factor in the occurrence of femoral neck fractures, their type and frequency have not been studied in detail. A few case-reports have demonstrated that bone insufficiency can lead to femoral neck fracture and that some falls occur as a result of acute pain preceding the fracture. Estimations of the proportion of femoral neck fractures due to bone insufficiency have ranged from 3% to 24%. We conducted a clinical study of 51 patients with recent femoral neck fractures (46 women and 5 men; mean age, 80.6 +/- 9.3 years). Of the 38 patients who fell from the standing position, three (5.9%) experienced acute pain before the fall. Five patients (9.8%) reported trivial trauma and eight (15.7%) no trauma. Twenty-three patients (45.5%) had hip pain during the weeks preceding the fracture; in 20 cases, the pain was located only to the hip that was subsequently fractured. Features associated with spontaneous fracture were pain during the preceding weeks (7/8; p<0.01), gradually worsening pain (6/7; p<0.02), pain in the inguinal or crural area (6/7), and recent onset of pain (< 3 months) (5/7). We believe that the incidence of bond insufficiency as a cause of femoral neck fracture has been substantially underestimated as a result of diagnostic difficulties and of the usually moderate severity of prefracture pain. Improved knowledge of prefracture symptoms provided by a prospective study may allow appropriate treatment by elimination of weight-bearing, avoiding a substantial number of femoral neck fractures.

Absorptiometry, Photon↗
PubMed1996

Low-grade spinal epidural infection. Report of a case.

A case of spinal epidural sepsis with an unusually indolent course is reported. Four months elapsed between onset of symptoms and initiation of treatment. Magnetic resonance imaging findings were atypical, with a gadolinium-enhanced hyposignal on T1 images but no hypersignal on T2 images. The difficulty of the diagnosis is illustrated by a review of the recent medical literature.

Aged↗
PubMed1995

[Magnetic resonance imaging for lumbar disk pathology. incidence of false negatives].

Magnetic resonance imaging (MRI) has had an impressive impact on evaluation of degenerative diseases of the spine. Nevertheless, false negatives can occur on images involving lumbar discs. Degenerative disc diseases documented on discrography and/or pathology examination of the discs can go unrecognized. Likewise sensitivity for the detection of protruding discal hernias is not totally satisfactory (20% false negatives). Finally, a magnetic resonance image visualizing displacement of the disc is not specific (10 to 15% false positives); images showing protrusion or hernia can be seen in 30% of asymptomatic patients. Although MRI gives slightly more information than other imaging techniques, false images do exist. Moreover, the usefulness of MRI to demonstrate disc disease in case of a negative CT-scan remains to be demonstrated.

Diagnostic Errors↗
PubMed1995

[Sports, bones and hormones. Multiple interactions].

Classically, sports activities are thought to have a beneficial effect on bone tissues. Actually, there are many interactions between sports activities and bone tissue and in certain cases complex hormone disorders may develop. Recent progress in the evaluation of bone structure (absorptiometry) and better understanding of the neuroendocrine functions have improved our knowledge of these interactions and helped provide answers as to the true effect of sports, and particular high-level training, on bone tissue. Mechanical stimulation of bone increases the level of both cortical and cancellous bone formation. The mechanical effect is localized in areas under particular constraint such as the lower limbs in runners and the upper predominant limb in tennis players. Inversely, hypoestrogenism, similar to anorexia nervosa, has been observed to be the cause of general bone loss and increased risk of osteoporosis in certain high level athletes. When these two opposing phenomena occur simultaneously, there is generally an overall loss of cancellous bone mass while bones submitted to major mechanical stress may be relatively protected. Amenorrhoea, particularly in long distance runners, generally occurs when training exceeds 30 km per week. Menarche may be delayed by 1 or 2 years when training begins early and dismenorrhoea is seen in 50% or more of the athletes. Amenorrhoea results from a central disorder due to insufficient pulsatile secretion of luteo-releasing hormone and subsequent hypogonadism. The role of beta-endorphins or catelestrogens on hypothalamic receptors has been suggested as the underlying mechanism. These different observations help provide answers to the different problems raised when providing counselling and care for high level athletes.

Amenorrhea↗
PubMed1995

Dorsal scalloping by calcified disc herniation.

SUMMARY OF BACKGROUND DATA: Disc herniation responsible for scalloping of vertebral body had been reported only at the lumbar level. RESULTS: The authors report on an unusual etiology of dorsal scalloping. A voluminous and calcified dorsal disc herniation was responsible for this, and within the center of the mass there was an unexpected hypersignal on nuclear magnetic resonance imaging. CONCLUSION: Scalloping does not preclude disc herniation, even at the dorsal level. Hyperintensity in T1-weighted images can reveal calcifications, as indicated in previous studies.

Calcinosis↗
PubMed1995

Specificity of antiperinuclear factor for rheumatoid arthritis in rheumatoid factor-positive sera.

Although antiperinuclear factor (APF) has the same specificity for rheumatoid arthritis (RA) as rheumatoid factor (RF), there is no evidence that this specificity is maintained in patients with positive RF-agglutination tests. Thus, we evaluated the specificity and usefulness of APF for RA diagnosis, regardless of RF titre. APF was tested (1:100 threshold) on 214 sera sent for RF evaluation over a 9-month period. These sera were previously determined to have latex or Rose-Waaler (RW) titres > or = 12 or 4 IU, respectively, but not necessarily above the threshold values of 100 and 32 IU. The APF test was performed blindly, and physicians were not advised of the results. In the patient population (119 RA and 95 non-RA) APF still demonstrated good specificity (0.82) for RA. As expected, APF proved useful for RA diagnosis in 28/33 (85%) RA cases with an RF level below 1:100 for latex and 1:32 for RW, thus reducing the number of 'seronegative' RA from 33/119 to 5/119. However, it also improved the serological positive predictive value for RA, even in cases when RW results were > or = 32 IU. Indeed, the positive predictive value for RA when both tests were positive was 0.94 (68/72), whereas concordant results (either positive or negative) for both APF and RW tests allowed correct classification (RA or non-RA) in 94% of cases.

Antibodies, Antinuclear↗