Search PubMed⌕ Search

Biomedical subjects

B Cortet

Publications and source records attributed to B Cortet.

70 records · Page 4Linked to original sources
PubMed1994

[Value of vertebroplasty combined with surgical decompression in the treatment of aggressive spinal angioma. Apropos of 3 cases].

Vertebral hemangiomas can cause difficult-to-treat neurological complications. We report our experience with three such cases. Patients no. 1 and 2 were females aged 64 and 71 years, respectively; patient no. 1 had a two-year history of weakness in the lower limbs and patient no. 2 had a five-month history of back pain. Both these patients had a pyramidal syndrome in the lower limbs. Patient no. 3 was a 61 year old male with a one-year history of left sciatica. Roentgenograms were suggestive of a hemangioma occupying the entire T8 (cases 1 and 2) or L5 (case 3) vertebra. Computed tomography and magnetic resonance imaging confirmed this diagnosis and showed that patients 1 and 2 had an anterior epidural hemangioma opposite T8 impinging on the spinal cord. In patients 1 and 2, treatment consisted in embolization of T8 followed by transpedicular injection of 6 cc of methylmethacrylate into the body of T8. One cubic centimeter of histoacryl was also injected in each lamina. The third patient had a similar vertebroplasty procedure without prior embolization since he had no epidural hemangioma. One patient (no. 1) developed intercostal neuralgia of several hours duration after the procedure. All three patients subsequently underwent laminectomy (T7-T8 with removal of the epidural hemangioma in cases 1 and 2, L5 in case 3). The pyramidal syndrome resolved within 15 days in patients 1 and 2; the nerve root pain resolved within 48 hours in patient 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Ankylosing gout. Apropos of 2 cases].

Development of ankylosis of joints involved with gouty arthritis is an exceedingly rare event of which only ten examples have been reported. Most patients had chronic, tophaceous gout that had not received adequate medical attention. The authors report two new cases including one in a patient with no documented history of acute gout. The first patient was a 72 year old noninsulin-dependent diabetic male who had been given a diagnosis of gouty polyarthritis with tophi seven years earlier. The second was a 42 year old male with no history of acute gout in whom hyperuricemia had been diagnosed at the age of 22 years upon evaluation for obesity. Both patients had ankylosis of the ankles and proximal interphalangeal joints of the hands. A marked decrease in range of motion of the wrists was found in the second patient. Roentgenograms showed complete ankylosis of the tarsus and partial ankylosis of the tibiotarsal joints in both patients, as well as ankylosis of the carpus in the second patient. The pathophysiology of ankylosis during gouty arthritis is poorly understood. A pannus containing abundant urate crystals is found upon pathological examination. Antihyperuricemic agents can reverse urate deposition but have no effect on ankylosis.

Adult↗
PubMed1993

[Value of the assay of protein SAA and urinary antitrypsin activity in osteoarticular infections].

Erythrocyte sedimentation rate is normal in 20% to 25% of patients with discitis due to common pathogens. We evaluated serum amyloid A (SAA) protein and urinary trypsin inhibitory activity in osteoarticular infections comparatively with erythrocyte sedimentation rate and serum C-reactive protein in 20 patients including 14 with discitis due to common pathogens and 6 with septic arthritis. Assays were performed on D0, D8, D15, D30, and D60 after initiation of antimicrobial therapy. On D0, all four markers were significantly higher in patients with septic arthritis than in patients with discitis. C-reactive protein levels exhibited the fastest kinetics with a return to normal values within 15 days in both conditions. Urinary trypsin inhibitory activity was only slightly elevated in patients with discitis and returned to normal within 30 days in both conditions. Serum amyloid A levels required 30 to 60 days to return to normal. Erythrocyte sedimentation rate exhibited the slowest kinetics, with normal values being achieved only after 60 days. Although simple, rapid, and inexpensive, urinary trypsin inhibitory activity determination exhibits poor sensitivity. Serum amyloid A assay is not routinely available but may be a valuable parameter for monitoring patients whose erythrocyte sedimentation rate and C-reactive protein level are normal (as in 2 of our patients with discitis).

Arthritis, Infectious↗
PubMed1993

[Aspergillus spondylodiscitis. Apropos of 5 cases].

Five cases of Aspergillus discitis in male patients are reported. Three patients had impaired immune responses as a result of immunosuppressive therapy following a heart transplant (two cases) or hairy cell leukemia (one case). Two patients had a recent history of mycobacterial infection. All five patients were hospitalized for severe spinal pain suggestive of an inflammatory disease with no neurological abnormalities. Erythrocyte sedimentation rate was elevated in every case. The diagnosis of discitis was suspected on spinal roentgenograms and established by computed tomography and/or magnetic resonance imaging. In three patients the spine was the only site of Aspergillus infection (lumbar discitis in two cases and thoracic discitis in one case). One patient developed Aspergillus infection of several disks (L1-L2, L2-L3, and L4-L5) after Aspergillus endocarditis with embolization to the left lower limb. Another patient developed discitis after an Aspergillus lung infection. In every case, Aspergillus fumigatus was recovered in cultures of specimens harvested by a percutaneous needle biopsy of the intervertebral disk. All five patients were treated by itraconazole which was given as single drug therapy in one case and in combination with 5-flucytosine and amphotericin B in four cases. Recovery was achieved in every case after four to six months of this drug therapy. In contrast to most previously reported cases, none of the five patients reported herein required surgical treatment. Efficacy of conservative treatment in this study may be related to the use of itraconazole in every case.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Causes and mechanisms of sciatic pains].

Pain along the sciatic nerve can be due to many causes. Sciatica of radicular origin caused by compression of L5 or S1 root is usually separated from truncular or peripheral sciatica. Radicular sciatica is divided into mechanical sciatica and the so-called inflammatory sciatica. In the majority of cases radicular pain is of mechanical origin and due to discal herniation in L4-L5 or L5-S1. The herniation can be visualized by lumbar computerized tomography or by radiculography. However, discal herniation alone does not fully account for the pain suffered, and inflammatory processes around the disc and the nerve root play an important role. Posterior intervertebral osteoarthritis and lumbar canal stenosis also are frequent causes of sciatic pain. Truncular sciatica is much less frequent and should incite clinicians to investigate for pelvic tumoral infiltration. Peripheral sciatica is usually caused by suffering of the external popliteal nerve around the neck of the fibula, but it may also be caused by compression of a ramus from the internal popliteal nerve, resulting in tarsal tunnel syndrome or in Morton's syndrome.

Humans↗
PubMed1991

[Action of non-steroidal anti-inflammatory agents on the immune system].

It is widely admitted that the non steroidal anti-inflammatory drugs (NSAID) inhibits the synthesis of prostaglandins by blocking the membrane cyclo-oxygenase. The anti-inflammatory activity of these molecules is partly explained by the vaso-dilatational action of PG2 in particular. However this effect alone cannot account for all the properties of NSAID. The latter have an inhibitory action at the level of the various functions of neurophil leucocytes and to a lesser degree at the level of macrophages. For immune system itself, it seems the NSAID have a rather immunostimulant effect due to a major action on T lymphocytes. In the course of rheumatoid arthritis (RA), the NSAID are unable to modify the ratio CD4/CD8. Yet they may decrease the production of the rheumatoid factor (RF). This ability is related to a loss of the normal suppressive T cells inhibition exerted by PG. Besides the NSAID seem unable to modify the natural killer function (NK). Finally, the impact on the synthesis of interleukins (IL) notably 1 and 2 does not seem clear. Indeed several research papers give us contradictory results between animals and men and between physiological or pathological situations.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

["Spontaneous" hematoma of the psoas in Gaucher's disease].

The authors report a case of iliac muscle haematoma responsible for inguinal pain in a patient with Gaucher's disease type I. This exceptional cause of pain must now be considered side by side with the classical femoral head osteonecrosis and infectious coxitis. Magnetic resonance imaging appears to be the most sensitive and most specific examination for the aetiological diagnosis of hip pain in Gaucher's disease. In the absence of thrombocytopenia and franck abnormality of coagulation, the spontaneousness of the haematoma is discussed.

Adult↗
PubMedDate not supplied

Percutaneous vertebroplasty: state of the art.

Vertebroplasty is an effective new radiologic procedure consisting of the percutaneous injection of a biomaterial, usually methyl methacrylate, into a lesion of a vertebral body. This technique allows marked or complete pain relief and bone strengthening in most cases. The principal indications for vertebroplasty are osteolytic metastasis and myeloma, painful or aggressive hemangioma, and osteoporotic vertebral collapse with debilitating pain that persists despite correct medical treatment. Radiography and computed tomography must be performed in the days preceding vertebroplasty to assess the extent of vertebral collapse, the location and extent of the lytic process, the visibility and degree of involvement of the pedicles, the presence of cortical destruction or fracture, and the presence of epidural or foraminal stenosis caused by tumor extension or bone fragment retropulsion. Leakage of methyl methacrylate during vertebroplasty may cause compression of adjacent structures and necessitate emergency decompressive surgery; thus, the procedure should be performed only in a surgical center. The decision to perform vertebroplasty should be made by a multidisciplinary team because the choice between vertebroplasty, surgery, radiation therapy, medical treatment, or a combination thereof depends on a number of factors. Radiologists need to be aware of the various indications for vertebroplasty and of potential future developments and applications of the procedure.

Hemangioma↗
PubMedDate not supplied

Therapeutic percutaneous injections in the treatment of malignant acetabular osteolyses.

Percutaneous injection of methylmethacrylate or ethanol may provide marked pain relief or bone strengthening in patients with malignant acetabular osteolyses who are unable to tolerate surgery. Injection of methylmethacrylate is usually indicated when osteolysis involves the weight-bearing part of the acetabulum (ie, the acetabular roof); in all other cases, ethanol injection is preferred. Ethanol and methylmethacrylate injections may be performed together if both weight-bearing and nonweight-bearing parts of the acetabulum are involved or extensive soft-tissue involvement is present. Moreover, these injections may be performed prior to radiation therapy, which complements their action due to similar but delayed effects on pain, or after radiation therapy that failed to relieve pain or in cases of local recurrence. Radiography and computed tomography must be performed prior to therapeutic percutaneous injection to assess the location and extent of the lytic process, the presence of cortical destruction or fracture, and the presence of soft-tissue involvement. Fever and transitory worsening in pain may occur secondary to inflammatory reaction in the hours following injection; however, these side effects usually resolve spontaneously within 1-3 days. The decision to perform therapeutic percutaneous injections should be made by a multidisciplinary team because the choice between this option and alternative methods of treatment depends on several factors including the location of the lesion, the local and general extent of the disease, the pain and functional disability experienced by the patient, and the patient's state of health and life expectancy.

Acetabulum↗
PubMedDate not supplied

Causes of osteoporosis in males. A review of 160 cases.

BACKGROUND: The discovery of osteoporosis in a male requires a careful search for a cause. OBJECTIVE: To evaluate etiologic factors in male osteoporosis. PATIENTS AND METHODS: Males admitted to our department for osteoporosis were included if they had a nontrauma-related vertebral or peripheral fracture and/or a spinal or femoral neck bone mineral density value 2.5 standard deviations or more below the mean in young subjects. The study was retrospective from 1990 to 1995 and prospective from 1996 to 1997. During the prospective part of the study, each subject underwent a standardized battery of laboratory tests including renal tubular function parameters. Causes identified during these two periods were compared. RESULTS: Of the 160 patients included in the study, 28.1% had idiopathic osteoporosis, 22.5% had alcoholic osteoporosis, 19.4% had glucocorticoid-induced osteoporosis, 12.5% had osteoporosis due to moderate idiopathic proximal tubule dysfunction, and 8.8% had senile osteoporosis. The proportion of patients with idiopathic osteoporosis was 30% (23/76) during the retrospective part of the study and 26% (21/84) during the prospective part (nonsignificant difference). Moderate idiopathic proximal tubule dysfunction was found in 2.6% (2/76) and 21.4% (18/84) of patients during these two parts of the study, respectively, a difference ascribable to the routine determination of tubule function parameters during the second part of the study. CONCLUSION: An exhaustive search for a cause decreases the proportion of male osteoporosis cases that remain idiopathic. In our study, only 28% of cases were classified as idiopathic, a term that probably indicates involvement of multiple interrelated factors.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Axial osteomalacia with sacroiliitis and moderate phosphate diabetes: report of a case.

We report a new case of axial osteomalacia diagnosed in a 51-year-old white Caucasian male, made particular by its association with sacroiliitis, positive HLA-B27 antigen, and also moderate phosphate diabetes responsible for a decreased appendicular bone mass. The diagnosis was suspected when X-ray evaluation showed increased density and coarse trabeculation mainly involving the pelvis and spine. Dual energy X-ray absorptiometry confirmed the elevated bone density at the lumbar spine (T score: +1.92) contrasting with a decreased bone mass at the femoral neck (T score: -2.33). The diagnosis was confirmed by histomorphometry of the iliac crest showing marked thickening of the cortices (2190 microns +/- 0.574, N = 780 +/- 40) and an increased trabecular bone volume (33.24%, N = 14 +/- 3). Osteoid parameters were also markedly increased with an osteoid volume of 2.1% (N = 1.2 +/- 0.5) and a mean osteoid thickness of 28.7 microns (N = 13 +/- 2.5), with a normal bone fluoride content (0.082%, N < 0.10). Bone resorption as assessed on bone biopsy and by the measurement of markers of bone remodeling (serum procollagen type I C-terminal telopeptide and 24 hr urinary cross-laps to creatinine ratio) was increased. This latter finding was not necessarily due to axial osteomalacia and could be the consequence of moderate phosphate diabetes. The patient was treated with calcitriol which was promptly discontinued due to gastrointestinal symptoms and replaced by calcidiol without any significant effect on the low back pain.

Absorptiometry, Photon↗
PubMedDate not supplied

Factors influencing bone loss in rheumatoid arthritis: a longitudinal study.

OBJECTIVES: To assess the occurrence of bone loss in rheumatoid arthritis (RA) and to determine the factors influencing bone loss (particularly the usefulness of bone turnover markers) over an 18-month period. METHODS: A total of 51 patients were studied, 6 men and 45 females (of whom 35 were menopausal). Their mean age was 56 +/- 10 years and the mean RA duration was 12 +/- 10 years. Twenty-eight (55%) were receiving corticosteroids (10 mg/day for a mean duration of 6 +/- 5 years). Several clinical and biological parameters reflecting disease activity or severity were recorded both at the 0 and 18-month investigations. Bone turnover was assessed at baseline by measuring the serum levels of 4 biological markers. Three of them reflected bone formation, i.e., procollagen type I C-terminal propepeptide (PICP), procollagen type I N-terminal propeptide (PINP) and osteocalcin (OC). The fourth, procollagen type I-C terminal telopeptide (ICTP), reflected bone resorption. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry both at the lumbar spine (LS) and femoral neck (FN) at baseline and 18 months later. RESULTS: Bone loss occurred both at the LS: 2.1%, [95% CI: 0.8%-3.4%, P < 0.005] and femoral neck: 3.1%, [95% CI: 1.1%-5.1%, P < 0.005]. Bone loss was markedly increased for postmenopausal women at the FN: 5.3% [95% CI: 2.9%-7.6%, P < 0.005]. Bone loss was not statistically significantly different between users and non-users of steroids. Bone loss at the LS was significantly correlated with both osteocalcin (r = 0.51, P < 0.01) and ICTP levels (r = 0.32, P < 0.05). FN bone loss was correlated with the osteocalcin level only (r = 0.34, P < 0.05). Fast losers (bone loss at the LS above the median) had higher OC (P < 0.01) and ESR (P < 0.05) levels at baseline as compared with slow losers (bone loss at the LS below the median). CONCLUSION: Bone loss occurs in RA particularly at the FN and seems to be influenced by increased bone turnover and high levels of inflammation.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Evaluation of the effectiveness of serotonin (fluoxetine hydrochloride) treatment. Open study in fibromyalgia].

Primary fibromyalgia may involve an anomaly in the metabolism of serotonin responsible for the sleep disorders and diffuse pain. Effectiveness of an agent with pure serotonin-agonist properties (fluoxetin hydrochloride) was evaluated in 23 patients during a three-month open study. Treatment had no effect on pain severity, number of tender sites, or pain score. Sleep disorders improved and 57% of patients believed the treatment was effective. Adverse events were recorded in 43.4% of patients, with the most common being nausea (21.7%). Effectiveness and tolerance of fluoxetin hydrochloride in fibromyalgia are mediocre. A double-blind placebo-controlled trail versus a placebo is needed to clarify these preliminary findings.

Drug Evaluation↗
PubMedDate not supplied

Evaluation of bone mineral density in patients with rheumatoid arthritis. Influence of disease activity and glucocorticoid therapy.

OBJECTIVES: To study bone mass and the factors that influence bone mass in rheumatoid arthritis patients versus controls. PATIENTS AND METHODS: 85 patients (73 women) with a mean age of 57 +/- 11 years and a mean disease duration of 13 +/- 9 years were compared to 85 age- and sex-matched controls. Among the patients, 62 (76%) had positive rheumatoid factor tests and 51 (60%) were receiving steroid therapy, with a mean daily dose of 10 +/- 4 mg and a mean duration of 7 +/- 6 years. The following parameters were determined: morning stiffness duration, painful and swollen joint counts, Lee's and Ritchie's indices, Health Assessment Questionnaire score, erythrocyte sedimentation rate, and C-reactive protein. Bone mineral density was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (Sophos L-XRA). RESULTS: In the nonsteroid-treated patients, bone mineral density was similar to that in controls at the lumbar spine but was decreased by 8% (95% confidence interval [CI], 1.8-14.2%) at the femoral neck (0.76 +/- 0.14 g/cm2 versus 0.83 +/- 0.15 g/cm2; P = 0.03). Decreases of 11.5% (95% CI, 8.1-14.9%) at the lumbar spine and 10.4% (95% CI, 6.4-14.4%) at the femoral neck were found in the steroid-treated patients versus the nonsteroid-treated patients. In the patient group, femoral neck bone mineral density was significantly negatively correlated with age (r = -0.5), the Heath Assessment Questionnaire score (r = -0.27), and the erythrocyte sedimentation rate (r = -0.25), whereas only the first two variables were significantly correlated with lumbar bone mineral density. A multiple linear regression model including age, glucocorticoid use, rheumatoid factor, the Health Assessment Questionnaire score, and the erythrocyte sedimentation rate was constructed and adjusted for the number of variables. This model explained 44.7% of the variance of femoral neck bone mineral density. CONCLUSION: Rheumatoid arthritis is associated with a decrease in bone mass that is most marked in patients with active and/or severe disease and in those who take glucocorticoids.

Absorptiometry, Photon↗