Biomedical subjects
Publications and source records attributed to C Roux.
Vertebral fracture is a typical and frequent complication of trabecular osteoporosis. It is responsible for pain and disability. Diagnosis is supported by X-rays and some pitfalls must be known and avoided. Physical treatment is important in order to prevent recurrence. Among different treatments available in osteoporosis, ostrogenotherapy must be discussed, even after fractures have occurred.
OBJECTIVE: To compare the efficacy and safety of tiludronate and etidronate at the same dosage (400 mg/day) for the treatment of active Paget's disease of bone. METHODS: We studied 234 patients with radiologic lesions characteristic of Paget's disease of bone and serum alkaline phosphatase (AP) concentrations at least twice the upper limit of normal, in a prospective, randomized, double-blind, multicenter clinical trial lasting 6 months. Patients were randomly allocated into 1 of 3 treatment groups: tiludronate for 3 months followed by placebo for 3 months, tiludronate for 6 months, or etidronate for 6 months. Serum AP levels and urinary hydroxyproline excretion were measured at baseline and after 3 months and 6 months. Patients with a reduction of at least 50% in the serum AP concentration were considered to be responders. RESULTS: After 3 months, the proportion of responders was higher in the tiludronate group (57.4%) than in the etidronate group (13.9%) (P < 0.0001). In the etidronate group, this percentage was lower among patients who had received previous treatment with a bisphosphonate (2.3%) than among those who had not (28.6%) (P < 0.01). Previous bisphosphonate treatment was not associated with response in the tiludronate group. After 6 months, the proportion of responders did not differ between the 2 tiludronate groups (60.3% and 70.1%), but was lower in the etidronate group (25.3%) (P < 0.0001). There was a higher proportion of patients with treatment-resistant disease (< 25% reduction of serum AP) in the etidronate group (51.9%) than in the tiludronate 3-month group (17.9%) or the tiludronate 6-month group (19.5%) (P < 0.0001). Gastrointestinal disturbances were more common, and occurred earlier, with tiludronate, but they were mostly mild, requiring no treatment. CONCLUSION: Tiludronate at 400 mg/day for 3 months or 6 months is more effective than the same dosage of etidronate for 6 months in the treatment of Paget's disease.
To assess the rate of bone loss in patients with inflammatory bowel disease, we prospectively studied 35 patients (17 women) aged 36 +/- 13 (range 17-60) years, 14 of whom had Crohn's disease and 21 with ulcerative colitis (including 12 with ileoanal anastomosis). Bone mineral density was measured by dual-energy X-ray absorptiometry at the lumbar spine and femoral neck. The follow-up was 19 +/- 8 months. During this period, 14 patients received oral steroids. Lumbar bone density changes expressed as a percentage per year were -3.1 +/- 4.9%, -6.4 +/- 7.5% and +2.0 +/- 4.0% in Crohn's disease and ulcerative colitis without and with ileoanal anastomosis respectively (p = 0.007). The same pattern was observed at the femoral neck. Mean annual lumbar bone density changes were -6.2 +/- 7.0% and +0.9 +/- 3.9% in patients with and without steroids during follow-up (p = 0.002). We conclude that patients with inflammatory bowel disease are at risk of lumbar and femoral bone loss. However, bone loss is not observed in patients with ileoanal anastomosis.
Gonadotropin releasing hormone (GnRH) agonists have shown to be effective in the treatment of several sex-hormone-dependent conditions. However, their use could be limited by the bone loss they induce. To evaluate the use of nasal salmon calcitonin (sCT) in preventing this bone loss, 40 patients with endometriosis were treated for 6 months with triptoreline (3.75 mg monthly) and calcium (1 g daily), and randomized in three groups-placebo, sCT 100 IU daily and sCT 200 IU daily-in a prospective double-masked study. Dual-energy X-ray absorptiometry and biochemical parameters were used to evaluate the benefit of the treatment. At baseline, there were no statistically significant differences between the groups. After 6 months, estradiol and biochemical markers of bone metabolism were at postmenopausal levels, with no difference between the groups. There was no difference in bone loss in the three groups, at all sites. Mean lumbar bone loss was 4.01 +/- 2.59% (mean +/- SD) in this population. In this study dosages of 100 IU and 200 IU daily of nasal sCT were insufficient to prevent bone loss during GnRH agonist treatment.
BACKGROUND/AIMS: Patients with inflammatory bowel disease are at risk for osteopenia. To study the metabolic bone status of these patients, a cross-sectional study was conducted. METHODS: Eighty-four patients (49 women, 35 men) with inflammatory bowel disease, 34 of whom had Crohn's disease and 50 ulcerative colitis (including 18 with prior coloproctectomy and ileoanal anastomosis), underwent clinical, dietary, and spine radiological assessments. Bone metabolism was assessed by measuring serum levels of calcium, phosphate, parathyroid hormone (1-84), 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and osteocalcin. Lumbar and femoral neck bone mineral densities were measured by dual energy X-ray absorptiometry. RESULTS: Serum osteocalcin level was decreased in 29 patients (34%), 12 of whom had never undergone steroid therapy. The other biochemical markers of bone metabolism were in the normal range. Thirty-six patients (43%) had osteopenia, and 6 patients (7%) had vertebral crush fractures. Osteopenia was observed in 27 patients (52%) and 9 patients (28%) with and without corticosteroid therapy, respectively. No patient had clinical or biological signs of osteomalacia. Analysis of bone density (lumbar Z score) by a multiple regression analysis showed a statistically significant correlation with age, cumulative corticosteroid doses, sedimentation rate, and osteocalcin level (R2 = 0.76; P = 0.05). CONCLUSIONS: The results suggest that bone turnover in inflammatory bowel disease is characterized by low bone formation in the presence of normal levels of calcium-regulating hormones.
Tiludronate, a potent bisphosphonate, has been extensively evaluated in the treatment of Paget's disease of bone. Its ability to normalize bone turnover without impairing mineralization suggests that tiludronate represents an important therapeutic advance in the treatment of this progressive and disabling disease. Recent attention has focused on the development of appropriate short- and long-term treatment goals: namely the control of clinical symptoms, such as bone pain, and the reduction of bone turnover to within normal range, to lessen the risk of developing later complications, such as deafness, deformity and walking difficulties. This reduction of bone turnover is the primary aim of treatment. The clinical development of tiludronate has involved large-scale international multicenter trials. To allow the comparison of results obtained in a variety of clinical settings, great emphasis was placed on the use of consistent methodology across the program. This applied to patient selection, trial design, the evaluation of clinically meaningful effects of treatment and statistical analysis of results. Strict adherence to these principles has allowed us to compare the results of treatment with tiludronate in 85 centers in six countries across Europe. This paper illustrates the importance of clinical trial design in the evaluation of tiludronate and etidronate in the treatment of Paget's disease of bone, with a brief summary of results obtained from a recent comparative, prospective, double-blind, multicenter clinical trial. Effective suppression of bone turnover was assessed by monitoring the reduction in serum alkaline phosphatase and the ratio of urinary hydroxyproline/creatinine. Reduction in bone pain was assessed using Huskisson's visual analog scale. The results clearly show that tiludronate 400 mg/day for 3 months is more effective and as equally well tolerated as etidronate 400 mg/day.
OBJECTIVE: To evaluate the teratogenic or fetal risk of a long-acting GnRH agonist (GnRH-a) triptoreline acetate (Decapeptyl; Ipsen-Biotech, Inc., Paris, France), inadvertently administrated in the first weeks of pregnancy. DESIGN: Prospective follow-up of exposed pregnancies and case reports. SETTING: Teratology information service of a public hospital and pharmacovigilance department of the firm. PATIENTS: Inadvertent pregnant women receiving a treatment, mainly for endometriosis or IVF. INTERVENTIONS: Case by case, individual estimations of the risks have been provided. MAIN OUTCOME MEASURE: Each pregnancy issue has been analyzed. RESULTS: No teratogenic or fetal toxic effect has been noted. CONCLUSION: No specific hazard has been observed among newborns after inadvertent exposures to a GnRH-a during the first 20 weeks of pregnancy.
A previous study detailed the morphometric characteristics of living in-vitro fertilized human pronuclear zygotes and cleaved embryos. A comparison of the different embryo cell stages confirmed the asynchronous division process during early embryo development. Global results showed no evidence of morphometrical differences between embryo subpopulations according to their classical microscopical grading. In this report, further information on illumination of human embryos and analysis of image processing is given. Some examples of embryo images belonging to a normal asynchronous division process are shown. A new parameter was retrospectively attributed to each cleaved embryo based on whether or not they were considered to have undergone asynchronous division that qualified as normal. A non-parametric analysis of this preliminary sample showed that this qualifier was correlated with implantation and acted complementarily with embryo grading. In conclusion, the asynchronous division process qualified as normal and its deviations seem to be a new parameter to take into account during embryo scoring.
A total of 304 human pronuclear zygotes and cleaved embryos from the 2- to 9-cell stages, obtained during invitro fertilization attempts, were photographed and retrospectively analysed after transfer for their morphology and size in relation to their developmental stage, using the Imagenia programme of a Biocom 500 image analyser. Morphometric parameters were calculated from the perimeters, surface measurements, theoretical diameters and circularity factors for the different structures analysed. This report provides the morphometric characteristics of living embryos. For the whole population the mean values were: 157.4 microns for the external zona pellucida diameter, 121.8 microns for the internal zona pellucida diameter, 17.9 microns for the thickness of the zona pellucida and 117.2 microns for the embryo cell mass diameter. The morphometric characteristics of the pronuclear-stage population were significantly different from the cleaved cell stages. If the zona pellucida and cell mass embryo diameters increased slowly from the 2- to 9-cell stages, embryonic external diameters were higher and zona pellucida thicknesses were lower in odd than even number blastomere embryos. Preliminary results show that in cases where implantation occurs, the embryo has a lower zona pellucida thickness. A comparison of the different embryo cell stages confirmed the existence of an asynchronous division process during early embryo development. Global results show no evidence of morphometric differences between subpopulations of the embryos according to their microscopic grading. Deviations from the normal asynchronous division process, however, appear to be a new parameter to take into account during embryo scoring.(ABSTRACT TRUNCATED AT 250 WORDS)
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STUDY OBJECTIVE: to investigate the time-course of clinical, laboratory test, and bone mineral density abnormalities in patients with mild phosphate diabetes treated for at least one year with calcitriol, 0.5 to 1.5 micrograms, and oral phosphate, 788 to 2300 mg per day, in three divided doses. PATIENTS AND METHODS: we studied eight patients with mild phosphate diabetes defined as a rate for tubular reabsorption of phosphate of less than 18% with a maximal rate for tubular reabsorption of phosphate (Tm) of less than 0.77 in the absence of any detectable cause of secondary tubular disease. Treatment efficacy was evaluated on the basis of pain severity, pain-related functional disability, serum phosphate and calcium levels, maximal rate for tubular reabsorption of phosphate, and dual-photon absorptiometry-measured bone mineral density. RESULTS: three patients experienced complete relief of pain and fatigue and were able to resume their normal activities. Partial relief was seen in two other patients. The three remaining patients had no response to treatment. Renal colic occurred in one patient. None of the patients developed hypercalcemia.
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Explore the source record for details and available documents.
Twenty-two cases of prolapse of the urethral mucosa, a benign affection mainly encountered in young black girls, were observed over a 9-year period (1983-1992). This pathology is still poorly understood and the aetiology has not been clearly determined. Treatment protocols, medical and surgical, vary. We prefer exeresis of the prolapsed mucosa, followed by suture. The results have been quite satisfactory.
A series of 60 cases of nephroblastoma treated at the Abidjan University Hospital from 1971 to 1981 were reported. Nephroblastoma is a frequent childhood tumour representing 26.40% of malignant childhood tumours. It is a tumour of the young child. There is no sex predominance and both sides are equally involved. The tumour is the only clinical manifestation and is always palapable. Factors of poor prognosis were often observed in our patients including: age less than 2 years with major tumour volume (56.6%), advanced stage (89.3%). Antimitotic treatment was used in all cases and in 16 surgery was required. The poor prognosis criteria observed in this series explain the poor outcome in most of the cases.
The objective of this article is to define the different stages involved in the 3D reconstruction of arteries and to review, from our experience and from the literature, the solutions already proposed. A full reconstruction framework includes the characterization of the imaging device (in terms of distortion and calibration), the specificity of the image acquisition process, the preprocessing that can be applied, the detection of the vascular structures, the 2D feature formation, the reconstruction itself, and the visualization aspects. They are examined according to a computer vision approach where two or three views are assumed to be available. Their generalization to temporal image sequences are also considered. Some of the material reported here is unpublished. The article allows the reader to identify the true critical issues that are not often clearly mentioned in the literature and the challenges that they convey. A final discussion presents a few perspectives in this area of research.
Previous studies have identified two high-molecular weight (280 and 330 kd) glycoproteins expressed by coated pits of the proximal renal tubule and yolk sac and have further established that, in vivo, antibodies to gp280 but not to gp330 induce fetal malformations. In the present study, we report the effect of these antibodies on the endocytic process by yolk sac visceral epithelial cells of rat embryos explanted at day 10 of gestation. Antibodies to gp280 markedly altered development of the yolk sac and embryo, induced malformations, inhibited by 40% the uptake of [14C] sucrose and perturbed the intracellular traffic of internalized proteins. Under control conditions, rat immunoglobulin G present in the culture medium was immunolocalized in lysosomes of epithelial cells, whereas in the presence of antibody, it was detected in small vesicles scattered through the apical cytoplasm. Alterations of the endocytic pathway were confirmed by experiments analyzing the uptake of peroxidase added to the medium for 2 to 60 minutes. The initial compartments of endocytosis visualized by peroxidase were increased in size and abnormal in shape and the transfer of the internalized peroxidase to the lysosomal compartment was delayed. In contrast, antibodies to gp330 had a minimal effect on embryonic development and did not induce fetal malformations. Endocytosis was only modestly altered; uptake of [14C] sucrose was decreased by 25%, and only minor modifications of the intracellular transit of peroxidase could be detected. We suggest that the key role of anti-gp280 antibodies is via trapping of the target antigen in the early endocytic compartment thus preventing its normal function in lysosomal transfer.