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Biomedical subjects

B Delcambre

Publications and source records attributed to B Delcambre.

At least 127 records · Page 7Linked to original sources

[Lateral radiculography in the vertical position for the diagnosis of narrow lumbar canal].

Results obtained in 66 cases emphasize the value of lateral imaging to increase sensibility of radiculography in the diagnosis of narrow lumbar canal. In all cases, in fact, the anteroposterior diameter of the opacified canal diminished in the standing position in proportions varying from 20 to 50%, and furthermore, in 20% of patients diagnosis was only possible from this image. Narrowing of the canal was considered as being present in patients with an anteroposterior canal diameter in the standing position that was less than 11 mm in corrected values. This image appears therefore to be an essential one, particularly as clinical symptomatology of narrow lumbar canal is very often atypical (62% of cases). Moreover, contrary to widespread opinions, computed tomography is sometimes less sensitive than radiculography in this type of disorder.

Humans↗

[Bone effects of hypothyroidism in adults. Apropos of 20 cases].

In contrast to the complications of hyperthyroidism, the bone lesions associated with hypothyroidism have not been extensively studied. A prospective study was conducted in 20 adults with protothyroid acquired hypothyroidism did not reveal any abnormalities in the parameters of phospho-calcium metabolism or the concentrations of PTH and the metabolites of vitamin D. The histomorphometric study of bone revealed hyperosteoidosis reflected by a considerable increase in the index of thickness of the osteoid, essentially affecting the relative osteoid volume. The surfaces of resorption and the bony trabecular volume were within normal limits and the rate of calcification was slightly decreased. The modifications of the histomorphometric investigation can be interpreted as a consequence of the slowing down of the basal osseous activity (BMR) due to thyroid hormone deprivation.

Adult↗

[Phospho-calcium metabolism and bone histomorphometry in chronic alcoholism. Apropos of 25 cases].

Twenty five subjects, chronic alcoholics for more than five years, without any past history or clinical signs of portal hypertension or oedemato-ictero-ascitic decompensation, were examined by laboratory tests reflecting phosphoro-calcium metabolism and by transiliac bone biopsy with histomorphometric examination of nondecalcified bone. The subjects were fairly homogeneous in terms of liver function and liver disease, when present, was only minimal. The phosphoro-calcium parameters were generally normal, but hypomagnesaemia was observed. On the other hand, the histomorphometric study often revealed marked alterations: hyperosteoidosis: raised index of osteoid thickness (IOT) in 15 of the 25 cases, increase in the relative osteoid volume (ROV) in 12 cases and increase in the osteoid area (OA) in 8 cases. The bony trabecular volume (BTV) was only mildly reduced (13 out of 24) and there was increased resorption, reflected by an increase in the area of resorption (AR) seen in 15 cases, associated with a moderate increase in the area of periosteocytic lacunae (APOL). The essential changes consist of hyperosteoidosis with morphological osteomalacia in 60% of cases and reduction of the trabecular volume in 54%. Comparison of the different parameters reveals the following histomorphometric profile: BTV; AR; ROV; OA; IOT; APOL. Thus, histological bone changes occur in chronic alcholics before the appearance of signs of liver failure. These quantitatively minor changes are suggestive deficiency type bone.

Adult↗

[Clinical study of Bi-Profenid in rheumatologic practice].

The effectiveness and tolerance of Bi-Profenid as 150 mg tablets were analyzed in a multicenter study. Each of the 288 patients entered in the study had one of the main conditions found in rheumatologic practice: arthrosis of the hip or knee, rheumatoid arthritis or ankylosing spondylarthritis. Each patient was given one 150 mg Bi-Profenid tablet twice daily for 30 days. Overall effectiveness, as assessed by the pain scale test, produced improvement in 87.3% of cases. In degenerative rheumatic diseases, nocturnal pain, pain upon mobilization and walking distance were very significantly improved. In inflammatory rheumatic diseases, the significantly improved parameters were nocturnal pain, morning stiffness and functional indexes of rheumatoid arthritis. Tolerance was outstanding or very good in 77.1% of cases and the dropout rate was only 7.6%.

Adult↗

[5-year treatment of rheumatoid polyarthritis with D-penicillamine].

A series of thirty patients with rheumatoid arthritis in whom D-penicillamine therapy was initiated more than five years ago was analyzed. Results were satisfactory in nine patients: two (6.6%) are still taking D-penicillamine and seven (23%) have experienced stabilization of their disease. In nine patients (28%) therapy was discontinued before the end of the third year because of adverse side-effects; no harmful side-effects were recorded after the third year. In ten patients (33%) D-penicillamine was discontinued because of ineffectiveness, either during the first year because of non-responsiveness (3 patients) or after the first two years because of escape phenomenon (7 patients). The authors compare their series to those previously reported in the medical literature. They believe that D-penicillamine should be given in progressive and moderate doses (averaging 600 mg per day). The mean duration of therapy with D-penicillamine was 27 months, lower than that recorded with chrysotherapy or anti-malarials; in 30% of patients, D-penicillamine was discontinued because of adverse side-effects. These findings show that, though D-penicillamine may be useful, it should be considered only after chrysotherapy.

Arthritis, Rheumatoid↗

[A new case of rheumatoid nodulitis].

A new case of rhumatoid nodulitis is reported in à 28 year old man presenting with rapidly regressive arthralgia, numerous rhumatoid nodules and metatarsal lesions without signs of associated arthritis. The biochemical profile was non-specific; serology was weakly positive for rhumatoid factor; there was no obvious immunological disorder (no circulating immune complexes, total complement and its various fractions within normal limits). The clinical findings, treatment and classification of this condition are discussed with reference to six other published cases with a similar clinical and paraclinical features.

Adult↗

[The reactive arthritis syndrome. Rheumatological limits].

The term reactive arthritis (RA) refers to an inflammatory joint disease in the absence of bacteria in the joint, but which is caused by a distant extra-articular infection. They occur as a result of a variety of infections, which are essentially genital or gastro-intestinal in subjects with a particular genetic predisposition characterized by the presence of the HLA-B27 antigen or one of the CREG group of antigens (B7 - B27 - BW22 - BW42). The most complete clinical expression of reactive arthritis is the Fiessinger-Leroy-Reiter syndrome. Apart from the reactive arthritis with a generally accepted aetiology such as those following infections of the genital tract (Chlamydia trachomatis, Ureaplasma urealyticum or of the gastrointestinal tract: Yersinia enterocolitica and pseudotuberculosis, Shigella flexneri, Salmonella minor, Campylobacter jejuni), the authors discuss the possibility of including, in a broader definition of RA, post-streptococcal arthritis and cases of arthritis following gonococcal, meningococcal and Brucella infections. RA does not always have a favourable clinical course. It is not exceptional to see a picture of recurrences with progression towards chronic inflammatory rheumatism.

Arthritis↗

[Chiari's osteotomy. Principles, results and indications. Apropos of 31 cases].

The authors present their experience of 31 cases of Chiari's pelvic osteotomy. The authors recall the principles and the biomechanical objectives of this operation and then they describe the operative technique, which is difficult to master. This osteotomy was performed in patients aged between 15 and 57, gave very good results in 13 cases, good results in 8 cases and mediocre results in 7 cases, of the 28 cases which have been followed up for more then a year. This procedure seems to have a very effective analgesic action, without a marked loss of joint amplitude, but sometimes at the price of a residual limp. This type of osteotomy finds its best indications in arthroses of the hip secondary to marked exposure of the femoral head.

Acetabulum↗

[Bone and phosphoro-calcium metabolism in reflex sympathetic dystrophy].

A combined study organised by the French Society of Rheumatology was devoted to the investigation of bone and phosphoro-calcium metabolism in cases of reflex sympathetic dystrophy. The following observations were made: the usual phosphoro-calcium parameters are not altered, apart from a slight elevation of the urinary calcium in multifocal forms of the disease, during the 3rd and 4th months; the level of PTH, studied in 11 patients, was normal in each case; the examination of 8 bone biopsies, one performed in the 7th week and six others performed during the 3rd and 4th months of the disease, showed, initially, invasion of the spongy tissue by oedema, signs of marrow stress and bone stress, with a reduction in the number of osteoblasts, without any marked alteration of bone remodelling. At a later stage, the biopsy shows intense bone remodelling with hyperosteoclastosis and hyperosteoblastosis and the formation of irregular bone tissue which later becomes lamellar. Electron microscopic study of two biopsies revealed signs of acellular demineralisation with normal appearance of the osteoblasts and osteoclasts.

Bone and Bones↗

[The joint in algodystrophy. Joint fluid, synovium, cartilage].

The joint fluid in cases of algodystrophy was studied in 17 samples. It is poor in cells (275/mm3 with a mean of 15% polymorphs). The protein level was studied 4 times and was equal to or greater than 40 g/l, i.e. double the normal value. A detailed histological examination of 33 biopsies of synovial tissue reveals a typical appearance of the synovium in algodystrophy, defined by 6 features, 2 negative and 4 positive: absence of hyperplasia of the synovial lining, absence of any real inflammatory cell infiltrate, presence of a marked hypervascularity, an oedema of the chorion, especially marked in the first weeks of the disease, hyperplasia of the walls of some arterioles, and fibrosis of the chorion which becomes more marked as the disease progresses and which is predominantly in the deeper layers. The authors recall that articular cartilage can show superficial alterations of structure with areas of fibrosis.

Biopsy↗

[Treatment of algodystrophies].

The first part of the article is a general review of the various drug treatments available for algodystrophy : purely symptomatic, analgesic treatment, vaso-active drugs, calcitonin. The major advance over the last few years has been the use of beta-blockers and calcitonin but, to date, only one double blind trial has been published. This study demonstrated the value of calcitonin after one month of treatment. The authors undertook a retrospective study of 651 cases and a prospective study of 91 cases and based their work on the evaluation of various treatments prescribed separately examining each therapeutic sequence rather than each individual case. Three treatments stood out by their frequent use : griseofulvin, calcitonin and beta-blockers. Each of these drugs was effective in more than 60 p. cent of cases. It is impossible, in such a study, to formulate a hierarchy of the various treatments. Only controlled studies will be able to establish their order of effectiveness. The results vary somewhat according to the site of the algodystrophy. The best therapeutic response is obtained in lesions involving the hip leading to a very favourable prognosis.

Adrenergic beta-Antagonists↗