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Biomedical subjects

B Duquesnoy

Publications and source records attributed to B Duquesnoy.

At least 37 records · Page 2Linked to original sources
PubMed1998

Is bone turnover a determinant of bone mass in rheumatoid arthritis?

OBJECTIVE: To study the relationship between bone turnover markers and bone mineral density in patients with rheumatoid arthritis. METHODS: We studied 54 patients, 24 of whom were receiving low dose steroids, and compared them to 54 age and sex matched controls. RESULTS: An 8.2% decrease of femoral neck bone mineral density (BMD) was found in patients not taking steroids compared with controls (confidence interval 1.2-15.3%). Serum markers of bone turnover -- namely, procollagen type I C-terminal propeptide (PICP) and procollagen type I N-terminal propeptide (PINP), which reflect bone formation, and procollagen type I C-terminal telopeptide, which reflects bone resorption -- were significantly increased compared with controls (p < 0.05, p < 0.01, p < 0.01, respectively). Both PINP levels and PICP levels were correlated with the femoral neck BMD as well as osteocalcin levels: R = -0.32 (p < 0.05), R = -0.29 (p < 0.05), and R = -0.42 (p < 0.01), respectively. The best independent predictors of bone mass (stepwise multiple regression analysis) at the femoral neck were steroid use, osteocalcin levels, age, height, the presence of rheumatoid factor, and the Health Assessment Questionnaire score, which explained 61.6% of the variance in femoral neck BMD. CONCLUSION: Elderly patients with RA using steroids with severe disease and high levels of osteocalcin have marked osteoporosis at the hip.

Adult↗
PubMed1997

Treatment of severe, recalcitrant reflex sympathetic dystrophy: assessment of efficacy and safety of the second generation bisphosphonate pamidronate.

The objective of the study was to assess the efficacy and the safety of pamidronate (APD) in recalcitrant reflex sympathetic dystrophy (RSD). Ten women and 13 men with a mean (+/-standard deviation, SD) age of 44 +/- 11 years were included. The involved sites were: the ankle (n = 10), the foot (n = 7), the hand (n = 3), the hip (n = 2), the knee (n = 2) and the shoulder (n = 1). Some patients had more than one site involved. Mean (+/-SD) duration of the disease was 15 +/- 13 months. RSD was in pseudo-inflammatory phase in 16 patients and in ischaemic phase in 7 patients. RSD was post-traumatic in 17 cases; 11 patients have been previously treated unsuccessfully by sympathetic blockades. APD was administered intravenously (perfusion) to a dose of 1 mg/kg/day during 3, 2 or one day. Fourteen patients received APD during 3 consecutive days whereas 7 patients have been treated during 2 consecutive days and 2 patients only during 1 day mainly due to adverse events. Efficacy was assessed by a decrease of pain = visual analogic scale (VAS, 0-100 mm) and verbal scale (PVS, range 0-3). Moreover, the patient and the observer have estimated the efficacy of the treatment on a verbal scale (EVS, range 0-3). Measurements of these parameters were performed immediately before the treatment and 7, 30, 60 and 90 days later. The maximum duration after treatment was 9 months. A significant decrease of VAS and PVS were observed between D0 and D30 (p = 0.0002 and p = 0.0002 respectively), D0 and D60 (p = 0.0004, p = 0.0004 respectively), and D0 and D90 (p = 0.00003, p = 0.0001 respectively). A significant increase of EVS was only observed between D0 and D90 (p = 0.03). Adverse events were noted in 14 patients: transient fever (n = 6), venous inflammation (n = 2), transient symptomless hypocalcaemia (n = 3), nausea (n = 1), lymphopenia (n = 1), transient hypertension (n = 1). These results suggest an efficacy of APD in recalcitrant RSD. Double-blind placebo controlled studies are required to back up these preliminary results.

Adult↗
PubMed1997

[Osteoporosis in pregnancy: apropos of 2 cases].

Two women, 31 and 19 years old, developed acute back pain with non-traumatic vertebral fractures one month after delivery in one case, and during the 9th month of gestation in the second case. For the first patient, the evolution was favorable with an increase of bone mineral density (15.2% over fourteen months under calcium and vitamin D). Ten years later, the osteoporosis of the second patient worsened without any new pregnancy. Our observations suggest the possibility of different pathogenies in pregnancy-associated osteoporosis.

Adult↗
PubMed1997

Selective induction of the secretion of cathepsins B and L by cytokines in synovial fibroblast-like cells.

We have investigated the potent influence of some cytokines, tumour necrosis factor-alpha (TNF-alpha), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and interferon-gamma (IFN-gamma), on the secretion of cysteine proteinases (cathepsins B and L) by cultured synovial fibroblast-like cells from patients with rheumatoid arthritis (RA). After treatment of synovial fibroblast-like cells with cytokines, culture media were evaluated for cathepsins B and L by enzyme immunoassays, and for cathepsin B and L activities using the enzymatic substrates. Z-Phe-Arg-AMC and Z-Arg-Arg-AMC, and specific inhibitors. Treatment of synovial fibroblast-like cells with TNF-alpha or PDGF resulted in a marked increase in cathepsin B secretion. Moreover, after prolonged PDGF treatment, the amount of secreted cathepsin B returned to the low control level. In contrast, bFGF led to increased cathepsin L secretion. IFN-gamma induced both cathepsin B and L secretion. Our results show that cytokines induce a selective secretion of cathepsins B and L by synovial fibroblast-like cells. This selective effect of cytokines on the secretion of cysteine proteinases suggests that synovial fibroblast-like cell-mediated articular degradation is a highly regulated process.

Arthritis, Rheumatoid↗
PubMed1997

ICAM-1, E-selectin, and TNF alpha expression in labial salivary glands of patients with rheumatoid vasculitis.

OBJECTIVE: To assess the expression of ICAM1, VCAM1, E-selectin, CD44, and TNF alpha in labial salivary glands of patients with rheumatoid vasculitis. METHODS: Labial salivary glands from six patients with rheumatoid vasculitis before and after treatment, six aged matched rheumatoid arthritis patients without clinical evidence of rheumatoid vasculitis, 10 patients with primary Sjögren syndrome, 10 patients with rheumatoid arthritis and proven secondary Sjögren syndrome, and six controls were tested with specific antibodies. RESULTS: ICAM1, E-selectin, and TNF alpha were significantly expressed in endothelial cells and perivascular cellular infiltrate only in rheumatoid vasculitis before treatment. CONCLUSIONS: The expression of ICAM1, E-selectin, and TNF alpha allows an assessment of the activity of the vasculitic process in rheumatoid vasculitis. Labial salivary gland biopsy findings in patients with rheumatoid arthritis and visceral vasculitis without purpura or neuropathy (that is, mesenteric, coronary, or cerebral vasculitis) would be of interest and are examples where labial salivary gland tissue is more accessible than the affected tissue.

Arthritis, Rheumatoid↗
PubMed1997

Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis.

OBJECTIVE: To compare the results of pulmonary function tests (PFTs) and high resolution computed tomography (HRCT) of the lungs in rheumatoid arthritis (RA) patients. METHODS: Sixty eight patients (54 women, 14 men) fulfilling the revised criteria for RA were consecutively included in a transversal prospective study. Their mean age was 58.8 years (range: 35-82) and the mean duration of the disease was 12 years (range: 5-16). Rheumatoid factor was positive in 52 patients (76.5%). Fifty two patients (76.5%) were lifelong non-smokers. Detailed medical and drug histories were obtained. PFTs comprised spirometry and gas transfer measurements. Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height. HRCT was undertaken with a Siemens Somatom Plus. RESULTS: A significant decrease of FEV1/ FVC, FEF25%, FEF50%, FEF75%, FEF25-75%, and TLCO was observed (p < 0.05) and 13.2% of the patients had a small airways involvement defined by a decrease of FEF25-75% below 1.64 SD. The most frequent HRCT findings were: bronchiectasis (30.5%), pulmonary nodules (28%), and air trapping (25%). The patients with small airways involvement had a high frequency of recurrent bronchitis (75% v 34%, p = 0.05) and bronchiectasis (71% v 23%, p = 0.019). The patients with bronchiectasis were characterised by low values of FEV1, FVC, FEF25-75%, and TLCO (p < 0.01), a high prevalence of small airways involvement (29% v 5%, p = 0.019), and a low prevalence of HLA DQA1 *0501 allele (14% v 33%, p < 0.05). CONCLUSION: This study suggests a significant association between small airways involvement on PFTs and bronchiectasis on HRCT in unselected RA patients.

Adult↗
PubMed1997

How useful are bone turnover markers in rheumatoid arthritis? Influence of disease activity and corticosteroid therapy.

UNLABELLED: Rheumatoid arthritis is associated with osteopenia possibly related to increased bone resorption. Until recently, the markers used to evaluate bone turnover lacked specificity, and as a result studies were difficult to interpret. OBJECTIVES: To study bone remodeling in patients with rheumatoid arthritis, with special attention to the effects of corticosteroid therapy. PATIENTS AND METHODS: Forty-eight patients (36 women and 12 men) with a mean age of 54.6 +/- 11.6 years and a mean disease duration of 11 +/- 9 years were studied. Thirty-nine patients (81%) had positive tests for rheumatoid factors, and 21 (43.7%) were under corticosteroid therapy, with a mean treatment duration of 4.5 +/- 2.9 years and a mean daily dosage of 9.4 +/- 2.5 mg prednisone. A group of age- and sex-matched controls was also studied. Serum levels of procollagen Type I C-terminal propeptide (PINP), procollagen Type I N-terminal propeptide (PINP), and procollagen type I C-terminal telopeptide (ICTP) were determined in all patients and controls. The first two markers reflect bone formation and the last bone resorption. Other tests performed in each patient were the erythrocyte sedimentation rate, serum C-reactive protein, serum total alkaline phosphatase, serum osteocalcin, 24-hour urinary hydroxyproline excretion, and calcium/creatinine ratio in a morning urine sample. Several clinical parameters were used to evaluate disease activity and severity in the rheumatoid arthritis patients. RESULTS: ICTP levels were significantly elevated in the patients as compared with the controls (6.6 +/- 3.9 ng/ml versus 3.1 +/- 1.2 ng/ml, P = 0.0001), whereas no significant differences were found for PICP or PINP. Similar results were found when the analysis was confined to nonsteroid-medicated patients. Conversely, PICP levels were higher in steroid-medicated patients than in controls (P = 0.0132) and were correlated with steroid therapy duration (r = 0.436). ICTP levels were correlated with age (r = 0.3), Lee's index (r = 0.585), the Health Assessment Questionnaire score (r = 0.391), and the erythrocyte sedimentation rate (r = 0.442). Urinary hydroxyproline excretion was elevated in 41.6% of the patients. CONCLUSION: Our data suggest that rheumatoid arthritis is associated with increased bone resorption, and that steroid therapy further accelerates bone remodeling in this disease.

Adrenal Cortex Hormones↗
PubMed1997

Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma.

UNLABELLED: Osteolytic metastases and spinal myeloma lesions are difficult to treat because they denote disseminated malignant disease. The pain-relieving and other effects of radiation therapy are delayed. We evaluated short- and medium-term outcomes of vertebroplasty in this indication, in patients with severe or excruciatingly severe pain (McGill-Melsack score 4 or 5) unresponsive to narcotics. PATIENTS AND METHODS: forty vertebras were treated in 37 patients including 29 with bone metastases and eight with multiple myeloma. Mean age was 58 years (range 36-83). The spinal segment involved was the cervical spine in five cases, the thoracic spine in 12 and the lumbar spine in 23. Vertebroplasty was done under fluoroscopy guidance after premedication and local anesthesia. RESULTS: thirty-six patients (97.3%) reported a decrease in their pain 48 hours after the procedure; five of these patients (13.5%) were completely free of pain, 20 (55%) were significantly improved and 11 (30%) were moderately improved. One patient failed to respond. The clinical results were not correlated to the extent of vertebral body filling. Beneficial effects were increased or unchanged in 100% of cases after one month, 88.9% after three months and 75% after six months. Leakage of the cement outside the vertebral body occurred in 29 cases (72.5%), usually into the paraspinal soft tissues (n = 21,52.5%). Leakage was usually clinically silent and only two patients developed severe nerve root pain due to leakage into a neural foramen, with in both instances a favorable outcome after surgery. CONCLUSION: Vertebro- plasty is simple and effective for the treatment of osteolytic metastases and multiple myeloma lesions, but should be performed only in centers with neurosurgical and/or orthopedic surgery units because of the possibility of severe complications.

Adult↗
PubMed1997

Contribution of calcaneal ultrasonic assessment to the evaluation of postmenopausal and glucocorticoid-induced osteoporosis.

We evaluated ultrasound propagation through the calcaneus using the Achilles Lunar unit in patients with postmenopausal or glucocorticoid-induced osteoporosis. Speed of sound, broadband ultrasound attenuation and a combination of these two parameters called stiffness were determined. Reproducibility was 0.23%, 2.6%, and 2.6% for these three parameters, respectively. Bone mineral density measured at the spine and femoral neck by absorptiometry was significantly correlated with all three ultrasound parameters in the women with postmenopausal osteoporosis (n = 47) and in the controls (n = 42). In the patients with glucocorticoid-induced osteoporosis (n = 35), only speed of sound was significantly correlated with the bone mineral density measurements. Mean values in the subjects with postmenopausal osteoporosis and in their age-matched controls were 1473 +/- 27.2 m/sec versus 1500.6 +/- 29.6 m/sec for speed of sound, 95.3 +/- 9.6 dB/Mhz versus 105.7 +/- 10.1 dB/Mhz for broadband ultrasound attenuation, and 56.1 +/- 13.2 versus 70.9 +/- 14.1 for stiffness, indicating a significant difference (P < 0.01). Z scores were -0.91, -1.1, -0.93, -0.97, and -1.05 for bone mineral density at the spine, bone mineral density at the femoral neck, speed of sound, broadband ultrasound attenuation and stiffness, respectively. Receiver Operating Characteristic curves showed that there were no statistically significant differences between the ultrasound parameters at the calcaneus and the absorptiometry measurements at the spine and femoral neck. Mean values in glucocorticoid-treated patients and age-matched controls were 1480 +/- 26.9 m/sec versus 1505.1 +/- 30.3 m/sec for speed of sound, 99.2/-11.4 dB/Mhz versus 105.9 +/- -10.2 dB/Mhz for broadband ultrasound attenuation, and 60.7 +/- 14 versus 72.1/14.5 for stiffness, again indicating a significant difference (P < or = 0.01). Z scores were -0.55, -0.65, -0.8, -0.67, and -0.78 for bone mineral density at the spine, bone mineral density at the femoral neck, speed of sound, broadband ultrasound attenuation and stiffness, respectively. Our data suggest that ultrasound parameters measured at the calcaneus are useful for evaluating postmenopausal and glucocorticoid-induced osteoporosis.

Absorptiometry, Photon↗
PubMed1996

Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.

PURPOSE: To determine whether the percentage of vertebral lesion filling and the leakage of methyl methacrylate have any clinical significance at follow-up. MATERIALS AND METHODS: Forty percutaneous vertebroplasties were performed for metastases (30 cases) and myeloma (10 cases) in 37 patients. A computed tomographic scan was obtained 1-8 hours after methyl methacrylate injection and was used to assess the percentage of lesion filling by methyl methacrylate and the leakage of methyl methacrylate into the epidural tissues, neural foramina, intervertebral disks, venous plexus, and paravertebral tissue. The results were correlated with those obtained at clinical follow-up. RESULTS: Partial or complete pain relief was sustained in 36 of 37 patients. Pain relief was not proportional to the percentage of lesion filling. Clinical improvement was maintained in most patients. The 15 epidural leaks, eight intradiskal leaks, and two venous leaks of methyl methacrylate had no clinical importance. Two of eight foraminal leaks produced nerve root compression that required decompressive surgery. One of 21 paravertebral leaks produced transitory femoral neuropathy. CONCLUSION: Pain relief can occur despite insufficient lesion filling. In most patients, intradiskal and paravertebral leaks of cement had no clinical importance.

Bone Cements↗
PubMed1996

Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases.

A retrospective medical record-based study of cases of peripheral pyogenic arthritis diagnosed in a rheumatology department between 1966 and 1993 was conducted. Of the 197 cases, 179 were evaluable. Pyogenic arthritis accounted for 0.68% of admissions and 30.3% of bone and joint infections during the study period. Incidence rose gradually from 2.2 new cases per year between 1966 and 1970 up to 6 to 10 new cases per year since 1991. In 88% of cases a single joint was involved, with the most commonly affected sites being the knee (32.5%), hip (22.2%), shoulder (12%) and sacroiliac joint (11.4%). Of the 22 patients with polyarticular arthritis, 19 had involvement of two joints. A portal of entry was identified in 53% of cases. Of the 13% of iatrogenic cases, half occurred after a local corticosteroid injection. The pathogen was identified in 65% of cases. Staphylococcus aureus was the most common organism (56%) followed by streptococci (9.5%) and E. coli (7%). Only three patients had gonococcal arthritis. Mean duration of therapy was four months. Although complications were exceedingly rare, three patients died and three others developed septic shock. Our data suggest that the presentation of pyogenic arthritis has remained essentially unchanged. In particular, we found no increase in iatrogenic forms, in contrast to recent experience with vertebral osteomyelitis.

Adolescent↗
PubMed1996

Evaluation of destructive spondyloarthropathies in hemodialysis by computerized tomographic scan and magnetic resonance imaging.

OBJECTIVE: The incidence of destructive spondyloarthropathies (SpA) in hemodialysis can reach 50% after 10 years of treatment. Few studies have analyzed the magnetic resonance (MR) appearance of destructive SpA and data are controversial. Our objective was to evaluate the computerized tomographic (CT) scan and MR appearance of destructive SpA in comparison to infectious spondylodiscitis. METHODS: 23 destructive SpA were observed in 11 patients who had undergone hemodialysis [mean duration of treatment 12 years (89-228 mo)]: 17 SpA of the cervical spine, one of the dorsal, and 5 of the lumbar spine. CT scans at all levels demonstrating narrowing and discovertebral erosions were performed without injection. MRI was performed with T1 and T2* weighted spin echo sequences (0.5T) without gadolinium injection. Radiographs were analyzed by 2 independent examiners. The data concerning MRI of infectious spondylodiscitis were based on a study of 57 personal cases and literature reports. RESULTS: CT scan appearance was similar in all cases, especially showing multiple small well defined lucencies of the vertebral endplates. In 9 patients, MRI showed low signal intensity of the disk and the adjacent vertebral endplates on T1 and T2* sequences. In no case was discal or vertebral high signal intensity on T2* sequence noted. No periodontoidal pseudotumor was observed. CONCLUSION: CT scans and MRI of destructive SpA, even nonspecific, are different from those observed in infectious spondylodiscitis, particularly due to the absence of discal and vertebral hypersignal on T2* sequences.

Aged↗
PubMed1996

[Spinal tuberculosis. Study of clinical and radiological aspects from a series of 82 cases].

We present a retrospective study of 82 cases of spinal tuberculosis diagnosed over the last 30 years. An increasing incidence of this disease not related to HIV infection has become apparent since 1992. 24% of patients were born outside continental France. The intradermal reaction was negative in 10% of patients. Discovertebral lesions detected in 93% of patients was the most frequent radiological presentation. Spondylitis with osteolysis or bone sclerosis at single or multiple levels was seen in the others. Tuberculous lesion of the posterior arch was associated in 10% of patients. In most cases CT scan showed a fragmentary vertebral destruction which was characteristic of the disease. MRI revealed the precise extent of the lesions into the spinal canal. Morphologic features suggestive of the tuberculous nature of paravertebral abcesses could be demonstrated when slices were performed in the axial or coronal plan. Tuberculous involvement of the spine is still a frequent disease. The main clinical and radiological findings are presented.

Adolescent↗
PubMed1996

Pneumocystis carinii pneumonia in rheumatoid arthritis patients treated with methotrexate. A report of two cases.

Use of methotrexate to treat rheumatoid arthritis is associated with pulmonary adverse effects in 3% to 5% of cases. In addition to immunoallergic lung disease, bronchitis and pneumonia due to pyogenic organisms, opportunistic lower respiratory tract infections have been reported, including, to our knowledge, 18 cases of Pneumocystis carinii pneumonia. We report two new cases of P. carinii pneumonia in methotrexate-treated rheumatoid arthritis patients. One case occurred in a 62-year-old woman with a nine-year history of seropositive rheumatoid arthritis treated for the last seven months with methotrexate, 15 mg per week, and prednisone, 10 mg/d. The other patient was a 58-year-old woman who had been diagnosed with rheumatoid arthritis 18 months earlier and had been receiving 15 mg per week of methotrexate for eight months in combination with 12.5 mg of prednisone per day. Both patients had negative tests for the human immunodeficiency virus. Symptoms consisted of fever, cough and dyspnea, with interstitial infiltrates on chest films, hypoxia, and lymphopenia (700 and 600/mm3, respectively). The diagnosis was confirmed by bronchoalveolar lavage. Both patients recovered under treatment with trimethoprim-sulfamethoxazole. An analysis of the 20 cases of P. carinii pneumonia reported to date in methotrexate-treated rheumatoid arthritis patients demonstrated a number of characteristics: the rheumatoid arthritis was of recent onset in some cases (a few months in one patient); lymphopenia was present in two thirds of cases; one-third of patients were not receiving corticosteroid therapy; the dosage and duration of methotrexate therapy varied widely, from 5 to 30 mg per week and two to 48 months; and four patients died.

Anti-Infective Agents↗