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C Marcelli

Publications and source records attributed to C Marcelli.

At least 19 recordsLinked to original sources
PubMed1999

[AA amyloidosis complicating sarcoidosis].

INTRODUCTION: Amyloidosis combined with sarcoidosis has been very rarely described. EXEGESIS: We report the case of a 72-year-old man presenting with sarcoidosis and amyloidosis AA. The association of peripheral and retroperitoneal adenopathies accompanied by loss of weight and histopathological results conducted to the diagnosis of sarcoidosis, excluding other causes. Corticosteroid therapy led to a decrease in clinical manifestations and after 2 years, clinical signs of amyloidosis have not progressed. CONCLUSION: According to results previously described in the literature and the description of the present case, we conclude that sarcoidosis can be complicated by amyloidosis AA, the presence of which may justify corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMed1999

Does spinal morphology influence the occurrence of low back pain? A retrospective clinical, anthropometric, and radiological study.

OBJECTIVE: Insurance companies are showing considerable interest for measurement devices claimed to be effective in evaluating risks associated with occupational or sporting activities. The aim of this study was to evaluate the potential influence of spinal morphology on the risk of low back pain. METHODS: 1500 male construction work apprentices aged 16 to 23 years underwent spinal measurements at the Caen Teaching Hospital from 1991 to 1996. The 384 subjects with abnormal measurements or a history of spinal pain underwent plain radiography and a second set of spinal measurements done by a different examiner using a different device. The following radiological parameters were studied: incidence angle, junction couple, Ferguson's index, L1-L5 lordosis angle and L1-S1 lordosis angle. RESULTS: In the 152 retrospectively studied subjects, no significant differences in static spinal parameters were found between subjects with and without a history of low back pain. The type of lordosis was correlated with the incidence angle but not with the junction couple. CONCLUSION: In our population, spinal measurements were not correlated with a specific morphological pattern of the lumbar spine or pelvis, and neither was a history of low back pain correlated with a specific pattern of lumbar and pelvic balance.

Adolescent↗
PubMed1999

Heritability of bone mineral density.

OBJECTIVE: To evaluate the influence of genetic background as a determinant of peak bone mass. PATIENTS AND METHODS: We compared lumbar spine bone mineral density in 175 girls with a bone age of 16 years or older and in their premenopausal mothers. We also investigated the influence of a family history of osteoporosis on lumbar spine bone mineral density in 275 women and their 559 daughters. RESULTS: In the 175 mother-daughter pairs, heritability (h2) was significantly different from 0 (P < 0.0001) for lumbar spine bone mineral density (h2 = 53%; 95% confidence interval [95% CI] = 28.5-77.6%), bone mineral content (h2 = 62.3%; 95% CI = 37.7-86.8%), bone mineral density adjusted for body mass index (h2 = 56%; CI = 31.5-80.5%), and bone mineral content adjusted for body mass index (h2 = 68.2%; CI = 43.6-92.7%). However, the heritability estimations lacked accuracy, as shown by the wide 95% CIs. Osteopenia and osteoporosis were found in 16.4% and 1% of the mothers, respectively. In the subgroup defined by osteopenia or osteoporosis in the mother, lumbar spine bone mineral density was significantly higher in the daughters than in the mothers (0.994 +/- 0.095 g/cm2 versus 0.895 +/- 0.098 g/cm2; P < 0.0001), whereas the opposite was true in the subgroup defined by normal bone mass in the mothers (1.068 +/- 0.110 g/cm2 versus 1.109 +/- 0.098 g/cm2; P = 0.0003). Nevertheless, lumbar spine bone mineral density was significantly lower in the daughters of low-bone-mass women than in those of normal-bone-mass women (0.994 +/- 0.009 g/cm2 versus 1.069 +/- 0.012 g/cm2; P = 0.0006). These findings suggest a role of genetic factors inherited from the father and also indicate that bone mass gains during adulthood contribute to achievement of the optimal peak bone mass. In the family history study, bone mass was lower in the subjects with a family history of osteoporosis (123 of the 559 daughters, Z-scores normalized for height, weight, and pubertal status: bone mineral density Z-score, -0.054 +/- 1.104; bone mineral content Z-score, -0.014 +/- 1.079; 58 of the 275 mothers: bone mineral density, 1.048 +/- 0.107 g/cm2; bone mineral content, 43.3 +/- 6.8 g) than in those without a family history of osteoporosis (436 daughters, bone mineral density Z-score, 0.006 +/- 0.981; bone mineral content Z-score, -0.007 +/- 0.985; 217 mothers: bone mineral density, 1.070 +/- 0.127 g/cm2; bone mineral content, 43.8 +/- 6.7 g); however, none of these differences were statistically significant. CONCLUSION: Our findings challenge the currently popular concept of marked bone mass heritability but are consistent with early genetic influences on lumbar spine bone mass. Thus, optimization of the peak bone mass acquired during growth may help to prevent osteoporosis.

Adolescent↗
PubMed1997

[Fatigue fractures of the foot].

A stress fracture is a very localized change in bone remodeling occurring in a normal bone that is subjected to an unusual repeated cyclic loading. It is a common fracture in military recruits and recreational or competitive athletes. A typical medical history and a local bone tenderness at physical examination suggest the diagnosis that is confirmed by a local "hot" spot on the radionuclide bone scan. Radiographic signs are delayed and inconstant. Radiographs show the fracture line or a bone sclerosis as the result of fracture healing. Although every bone may be involved, depending on the type of the physical activity, metatarsals and calcaneus are the most frequent locations in the foot. The treatment of a stress fracture in the foot consists in a 4 to 6 nonweight-bearing immobilisation followed by a graduated return to march and sport.

Adult↗
PubMed1997

Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study.

We used an experimental software measuring the hip axis length (HAL) and bone mineral density (BMD) in specific regions of the lower and upper part of the femoral neck on dual-energy X-ray absorptiometry scans. To determine whether these parameters were significant predictors of the type of hip fracture, we measured 167 healthy women (controls), 24 women with trochanteric, and 42 women with cervical hip fractures within the EPIDOS prospective cohort. EPIDOS is a multicenter prospective study on risk factors for hip fracture performed in 7575 elderly women living at home, aged 75-95 and conducted in five French centers (Amiens, Lyon, Montpellier, Paris, Toulouse). Measurements were performed on data acquired at baseline before the occurrence of fracture. In the cervical fracture group, HAL was significantly longer than in controls (94.2 vs. 92.3, p = 0.03), and the associated odds ratio (OR) adjusted for age, weight, and total femoral neck BMD was significant (OR = 1.64, 95% confidence interval [CI] 1.06-2.55). In contrast, HAL was not significantly different from controls in the trochanteric fracture group. Femoral neck diameter was not a predictor of fracture. The upper and lower femoral neck BMD was lower in the trochanteric fracture group than in controls, and both measurements predicted trochanteric femoral neck fracture. In contrast, the prediction of cervical femoral neck fracture was enhanced by measuring only the upper part of the femoral neck (OR = 2.79 vs. 1.97 for the total femoral neck) while BMD of the lower part was not different from controls. Hip axis length is a predictor of femoral neck fracture. Femoral neck BMD distribution is different between cervical and trochanteric fractures. These results support the hypothesis of a different pathophysiological mechanism between the two types of hip fractures.

Absorptiometry, Photon↗
PubMed1997

Septic arthritis of lumbar facet joints. A review of six cases.

Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis. Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis.

Abscess↗
PubMed1996

Amyloidosis-related cauda equina compression in long-term hemodialysis patients. Three case reports.

STUDY DESIGN: These case reports illustrate the neurologic manifestations due to beta 2 microglobulin amyloid deposition at the lumbar spine level in long-term hemodialysis patients. OBJECTIVE: Radiologic investigations suggested the amyloid origin of extradural soft tissue deposition, which was confirmed by histologic examination after surgical excision. SUMMARY OF BACKGROUND DATA: Although cervical myelopathy is a recently recognized complication of long-term dialysis-related beta 2 microglobulin amyloidosis, neurologic manifestations due to amyloid deposition at the lumbar spine level have rarely been reported. METHODS: Three case reports of cauda equina compression in long-term hemodialysis patients are presented. Follow-up radiography, computed tomography, and magnetic resonance imaging were performed and patients underwent surgical decompression of the thecal sac. RESULTS: In two patients, the compression resulted from the development of a destructive spondylarthropathy, and from the infiltration of extradural spaces and ligaments by an abnormal soft tissue. The third patient had lumbar spinal stenosis due to multiple disc protrusion and to hypertrophy of facet joints and ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compression. Histologic examination of the excised fibrous tissues disclosed amyloid deposits in intervertebral discs, apophysial joints, and ligaments. CONCLUSIONS: In long-term hemodialysis patients, cauda equina compression may develop as the consequence of beta 2 microglobulin amyloid deposition in lumbar intervertebral discs, facet joints, and ligaments. Magnetic resonance imaging is well suited to show the extent of the compression and supports the argument for the amyloid origin of extradural soft tissue.

Adult↗
PubMed1996

Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study.

Increased bone turnover has been suggested as a potential risk factor for osteoporotic fractures. We investigated this hypothesis in a prospective cohort study performed on 7598 healthy women more than 75 years of age. One hundred and twenty-six women (mean years 82.5) who sustained a hip fracture during a mean 22-month follow-up were age-matched with three controls who did not fracture. Baseline samples were collected prior to fracture for the measurement of two markers of bone formation and three urinary markers of bone resorption: type I collagen cross-linked N- (NTX) or C-telopeptide (CTX) and free deoxypyridinoline (free D-Pyr). Elderly women had increased bone formation and resorption compared with healthy premenopausal women. Urinary excretion of CTX and free D-Pyr, but not other markers, was higher in patients with hip fracture than in age-matched controls (p = 0.02 and 0.005, respectively). CTX and free D-Pyr excretion above the upper limit of the premenopausal range was associated with an increased hip fracture risk with an odds ratio (95% confidence interval) of 2.2 (1.3-3.6) and 1.9 (1.1-3.2), respectively, while markers of formation were not. Increased bone resorption predicted hip fracture independently of bone mass, i.e., after adjustment for femoral neck bone mineral density (BMD) and independently of mobility status assessed by the gait speed. Women with both a femoral BMD value of 2.5 SD or more below the mean of young adults and either high CTX or high free D-Pyr levels were at greater risk of hip fracture, with an odds ratio of 4.8 and 4.1, respectively, than those with only low BMD or high bone resorption. Elderly women are characterized by increased bone turnover, and some markers of bone resorption predict the subsequent risk of hip fracture independently of hip BMD. Combining the measurement of BMD and bone resorption may be useful to improve the assessment of the risk of hip fracture in elderly women.

Absorptiometry, Photon↗
PubMed1996

[Epidural lipomatosis: complication of long-term corticotherapy. Apropos of 2 cases].

Spinal epidural lipomatosis (SEL) is defined as the deposition of loose fat tissue in the epidural space. Two cases are reported which illustrate the main features of this uncommon disease. Most frequently SEL is revealed by neurologic manifestations such as an acute chronic spinal cord compression. Corticosteroid therapy and obesity are the main factors able to induce the disease. The common location of the SEL at the thoracic spine is explained by the physiologic abundance of fat and by the relative narrowness of the spinal canal at this level. An osteoporotic vertebral crush fracture which reduces the diameter of the canal frequently reveals the SEL. MRI confirms the diagnosis of SEL and shows the extent in the spinal canal. The treatment of SEL is difficult. The decrease or the stop of corticosteroid therapy has allowed the recovery in a few cases with chronic neurologic symptoms. The risks of a surgical procedure are important in these patients and the medical or surgical treatment should be discussed taking into account the clinical symptoms of SEL, its location and extent, and the risks of recurrence if corticosteroid therapy must go on.

Adult↗
PubMed1995

[Secondary osteoporosis].

Although primary osteoporosis is much more frequent than other diseases associated with osteopenia, the diagnosis of idiopathic osteoporosis should be made only after the causes of secondary osteoporosis have been excluded. Indeed, therapeutic efficiency in secondary osteoporosis depends mainly on the concomitant treatment of the actual cause of osteopenia. Glucocorticoid-induced osteoporosis is the commonest form of secondary osteoporosis, mainly for doses of prednisone of 0.1 mg/kg/day or greater. Hypogonadism in men and women, idiopathic hypercalciuria and chronic alcoholism in men are other frequent causes of osteopenia. The diagnosis of secondary osteoporosis is based on careful examination as well as biochemical and hormonal investigations. Together with the treatment of the associated disease, correction of other risk factors, calcium supplementation, and a regular program of weight-bearing physical activity may be of benefit to reduce bone loss. As fluoride is able to stimulate bone formation, it is an effective agent in the treatment of glucocorticoid or alcohol-induced osteoporosis.

Adrenal Cortex Hormones↗
PubMed1995

Pagetic vertebral ankylosis and diffuse idiopathic skeletal hyperostosis.

STUDY DESIGN: A retrospective radiologic analysis of Paget's disease of the spine. OBJECTIVES: The prevalence, anatomic distribution, mechanisms of formation of Pagetic vertebral ankylosis (PVA) and the possibility of a relationship to diffuse idiopathic skeletal hyperostosis (DISH) were assessed in a large population of persons with Paget's disease. SUMMARY OF BACKGROUND DATA: Acquired vertebral ankylosis is not a common feature of the Paget's disease of the spine and its mechanisms of formation remain unknown. In some reports, PVA was associated with radiographic signs of DISH. METHODS: Of 337 Pagetic patients monitored in the Division of Rheumatology from 1961 to 1990, all 245 who had entire spine radiographs were selected for study. Radiographs were studied for signs of Pagetic vertebral lesions and for spinal lesions of DISH. RESULTS: The study group contained 156 men with a mean age of 68 years (range 37-92) and 89 women with a mean age of 71 years (range 50-89). Fourteen PVA were observed on the radiographs of 11 men (mean age 68 years; range 60-76). One PVA was cervical, eight were thoracic, one thoracolumbar, three lumbar, and one lumbosacral. Eighty of the two hundred forty-five patients (32.6%) had characteristic features of DISH. Eight out of the eleven patients with PVA also had evidence of spinal lesions of DISH and radiographic features of DISH were observed contiguous to ten of the fourteen PVA. CONCLUSIONS: The scarcity of PVA reported in the literature and in our study (4.4% of 245 patients) suggests that constant progression of the disease from one vertebra to another by invasion of intervertebral disc space is rare. However, the higher incidence of PVA in men, their preferential location at the thoracic spine and their association with lesions of DISH suggest that progression of Pagetic lesions by invasion of bridging osteophytes may be an important mechanism for the intervertebral spread of Paget's disease.

Adult↗
PubMed1995

The relationship between osteoarthritis of the hands, bone mineral density, and osteoporotic fractures in elderly women.

To study the relationship between osteoarthritis (OA) and osteoporosis (OP), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multi-centre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD and the joint-space narrowing score. According to stepwise logistic regression and after off adjustment of BMD for age, women with an HOA combined score higher than 20 had significantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a higher score of HOA more rarely report a history of osteoporotic fracture.

Aged↗
PubMed1995

[Effects of an hydrosoluble fraction from bovine bone (Ossopan) on murine osteoblasts in culture].

The effects of an hydrosoluble fraction of the bovine bone extract Ossopan on cultured murine osteoblasts were assessed in this study. The hydrosoluble fraction from Ossopan, obtained by acid/ethanol extraction, contained significant amounts of TGF-beta 1. Calvariae from new-born rats were cultured for 1 month in synthetic medium (DMEM) supplemented with 10% fetal calf serum to allow cell proliferation; immunocytochemistry studies performed with a rabbit serum raised against alkaline phosphatase indicated that only osteoblasts were present in cell cultures. Using an XTT-based colorimetric cell proliferation assay, we showed that the hydrosoluble fraction of the bovine bone extract dose-dependently reduced the proliferation of cultured osteoblasts. A similar inhibition was obtained with a recombinant TGF-beta 1. Thus, the inhibitory effect of the hydrosoluble fraction of Ossopan on osteoblast proliferation should be due to the cytokines contained in this preparation.

Animals↗
PubMed1994

[Fluoride therapy. Influence on the microarchitecture and biomechanical properties of bone].

Fluoride, in the form prescribed as sodium or monophosphate fluoride for the treatment of vertebral osteoporosis, modifies the microscopic structure and biomechanical properties of bone tissue. For cancellous bone, the main effect of fluoride is a stimulation of bone formation leading to a hypertrophy of the remaining trabeculae. It may also have a beneficial effect by improving interconnections within the trabecular network. Although the mechanisms have yet to be fully understood, the process is probably dependent on the quality of the remaining network. The biomechanical properties of bone after fluoride therapy also are partly dependent on these modifications in the bone microstructure but also on fluoride's effect on bone minerals. When the concentration of fluoride becomes too high in bone, mineralization defects can occur causing major loss in mechanical resistance despite an increase in bone mass. Thus the beneficial effect of fluoride on wedge fractures of the spine in osteoporosis is probably the result of a balance between the effects of increased trabecular bone mass and modifications in bone mineralization. The respective intensities of these two phenomena also depend on the concentration of fluoride accumulated within the bone. This concentration is a function of the level of fluoride salt intake and its biodisponibility during treatment.

Biomechanical Phenomena↗
PubMed1994

Adult lumbar scoliosis. Epidemiologic aspects in a low-back pain population.

The frequency and characteristics of definite lumbar scoliosis in an adult common low-back pain population (n = 671) were assessed by a clinical and radiologic prospective study. The prevalence was 7.5% (N = 50), increasing with age: 2% before 45 years; 15% after 60 years. Scoliosis was revealed by low-back pain in adulthood in 86% of the cases. The mean Cobb angle was 21 +/- 11.4 degrees. A Cobb angle of more than 30 degrees was noted in 16% of the scoliotics, thus 1% of the entire population. The proportion of women increased with the severity of the scoliosis. Right and left side scolioses were equally noted. A correlation between the Cobb angle and age was found (0.3 degrees/yr; P < 0.05). Rotatory olisthesis was noted in 34% of the cases, more often in right side curves (P < 0.01). The lumbar scoliotic patients were distinguished by a more advanced age (62 +/- 12.4 yr vs. 49.6 +/- 15.5 yr; P < 0.001), a greater proportion of women (72% vs. 48%; P < 0.01), and a more likely involvement of L3 and L4 radicular pain (P < 0.05). Radicular thigh pain was related to unstable curves (P < 0.01). The lumbar scoliotic patients thus constitute a subgroup within the low-back pain population.

Adult↗