Biomedical subjects
B Avouac
Publications and source records attributed to B Avouac.
[Lumbago. Socioeconomic, epidemiological and medicolegal aspects].
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[Role of radiology in the diagnosis of joint chondrocalcinosis. Calcium pseudogout].
Chondrocalcinosis is a really frequent clinicopathologic entity, which is caused by the penetration of calcium pyrophosphate dihydrate microcrystals into the structures of the joint, including hyaline cartilages and fibrocartilages--hense its name--as well as the synovial fluid and membrane. Calcium gout, which preferentially appears in the knees, is the most spectacular and characteristic symptom of chondrocalcinosis, expressing a crisis of acute microcrystal synovitis, of which it has all the usual clinical features, and thus simulating uratic gout. The positive diagnosis is based on: a) the radiologic demonstration of articular calcifications in the lining cartilages, forming a continuous or fragmented opaque border on the subchondral bone, from which it is separated by a light space, and/or in the fibrocartilaginous structures (most often the menisci, the symphysis pubis, the disk of the inferior radioulnar joint) where they appear as small, irregular clusters with blurred or cloudy margins. The knee is the most frequent site of calcium impregnation images, both in hyaline cartilages and in fibrocartilages. b) the presence of calcium pyrophosphate microcrystals in the synovial fluid; their nature is usually demonstrated convincingly enough with a conventional light microscope; c) needle biopsy findings of microcrystalline clusters embedded in the synovial membrane, that can be easily identified with routine staining. In practice, demonstrating radiologic signs, when these are characteristic and can be detected in their preferred sites, allows recognizing diffuse chondrocalcinosis in satisfactory safety conditions after a calcium gout crisis, as well as in the presence of the many atypical or misleading symptomatic aspects of this microcystal arthropathy, that will be the subject of a further paper.
[Chondracalcinosis. Etiology, diagnosis, treatment].
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[Algodystrophy. Etiology, diagnosis, development, principles of the treatment].
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Thigh pain and multiple vertebral osteonecroses: value of magnetic resonance imaging.
We describe a 74-year-old woman who presented with referred thigh pain associated with multiple osteonecroses of the T12, L1 and L2 vertebrae. Magnetic resonance imaging was found to be a valuable diagnostic aid, revealing signs of spinal cord and nerve root compression related to the collapsed vertebrae. Biopsy of T12 confirmed the benign nature of the vertebral compression fracture. Our patient also showed histologically documented osteoporosis.
[Myelodysplastic syndrome complicating the course of multiple myeloma].
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Report of 4 cases of Pasteurella multocida septic arthritis.
Pasteurella multocida is frequently responsible for infections in man due to wounds inflicted by animals (generally cats or dogs). However, the development of septic arthritis is a rare complication. We report 4 cases of Pasteurella multocida septic arthritis with demonstration of the organism in the joint in each case. Two cases presented with monoarthritis (sternoclavicular joint and wrist) and 2 cases had polyarticular involvement from the outset.
[Oligoarthritis in Pasteurella multocida inoculation pasteurellosis].
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[Difficulties in the evaluation of the basic treatment of rheumatoid polyarthritis: a role for the scales of quality of life?].
Evaluation of the efficacy of basic treatment of rheumatoid arthritis comes up against a large number of difficulties: absence of any single validated criterion in the form of a composite index with weighting of different factors, need for long term trials without any change in combined treatment and difficulties keeping all patients in such trials until their completion. These problems have led to the use of global evaluation as activity criterion, accepting treatment withdrawals and changes in combined treatment. This conversion of explicative trials to pragmatic trials results in difficulties in their interpretation. Trials based upon a pragmatic approach using quality of life scales are efficacy criterion should resolve some of methodological problems which may be encountered in the evaluation of basic treatment of R.A. Quality of life scales investigate three essential areas: physical activity, the social dimension and the psychological domain of emotional existence. Certain specific questionnaires such as "AIMS" are particularly suitable for rheumatological use. These quality of life scales are designed to quantify the usefulness of basic treatment, enabling evaluation which completes knowledge which may be acquired in terms of efficacy in explicative trials.
[Social impact of osteoarthritis. Risk/benefit--cost/effectiveness ratio of osteoarthritis treatments].
The development of a drug for the fundamental treatment of osteoarthritis requires that its efficacy should be proven clinically. This implies that there must be a clear definition of the evaluation criterion (slowing down in the progression of osteoarthritic lesions). Marketing of a drug depends on the efficacy/safety relationship, but any assessment of the value of a fundamental treatment for osteoarthritis goes beyond the framework of a study of its efficacy. Its usefulness can be measured in terms of scales estimating the quality of life that are related to the osteoarthritic disease. Overall criteria, such as the level of maintenance treatment, can be used in comparative, randomized, double blinds trials. Pragmatic trials seem to afford a methodology which is suited to the evaluation of usefulness and therapeutic benefit. The basis of cost/effectiveness, cost/usefulness and cost/benefit studies relies on a comparison of the cost of osteoarthritis and its treatment with the benefits brought about by such treatment.
[Non-steroidal anti-inflammatory agents. What is the future?].
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[Inflammation and pain: physiopathologic relations, therapeutic specificities].
A certain number of mediators in the body fluids are common to the regulation of both the inflammation reaction and the modification of pain impulses. In particular, prostaglandins are involved in both physiopathological processes. Inhibition of their biosynthesis provides at least a partial explanation for the analgesic properties of non steroidal anti-inflammatory agents and analgesics. The two classes of drugs have different pharmaceutical-clinical profiles, especially where safety is concerned, and this is probably explained by selective inhibition of the prostaglandins. The antipyretic and platelet aggregation inhibitory properties, gastrointestinal toxicity and induction of bronchospasm of each drug depend on the ability or inability of the various molecules to either inhibit, increase or leave unaffected the local synthesis of prostaglandins.
[The value of nuclear magnetic resonance in tuberculosis of the posterior vertebral arch. A case report].
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[Chordoma of the mobile spine. Report of 9 cases. Review of the literature].
The authors reported 9 cases of chordomas of the mobile spine: 6 lumbars and 3 cervicals. There are 5 men and 4 women. Mean age at diagnosis is 60 years old. Mean delay between the first clinical manifestations and the diagnosis is 22 months. Clinical findings are not specific. Roentgenologic findings show 2 typicals aspects: a lytic lesion on the lateral side of the vertebrae frequently involving more than one cervical vertebrae, a mixed lesion (lytic and sclerotic) or only sclerotic was detected only at the lumbar spine. Magnetic resonance imaging and computed tomography are the most useful investigations to determine the local extension of the tumor. Certitude of the diagnosis is always microscopic. Evolution is difficult to precise in this kind of embryological tumor. Radical surgery at the earliest time is the best guarantee of a better prognosis which still remain severe.
[Non-steroidal anti-inflammatory agents. Prospects].
The presence of very large numbers of non-steroidal anti-inflammatory agents (NSAIAs) on the market is warranted by the wide variation in efficacy from one patient to another and by individual sensitivity in terms of adverse effects. The inhibition of cyclo-oxygenase constituted the only explanation for the mechanism of action of anti-inflammatory agents for many years. The search for products with new pharmacological properties is essentially aimed at improving tolerance. Methods for evaluating the tolerance of NSAIAs, particularly before they are put on the market, must be improved since all NSAIAs pose serious problems due to adverse effects. The risk depends on the nature of the molecule, toxicological data, particularly the effects on the reproductive process, length of treatment, underlying predisposition, and the disease being treated.
[Non-steroidal inflammatory agents].
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[Menopause-osteoporosis: a challenge to modern society. Genova symposium (CRIS)].
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