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Biomedical subjects

D Kuntz

Publications and source records attributed to D Kuntz.

At least 37 records · Page 2Linked to original sources
PubMed1995

Dialysis arthropathy: outcome after renal transplantation.

PURPOSE: Patients treated by long-term maintenance hemodialysis frequently develop a form of chronic arthropathy that is strongly associated with beta 2-microglobulin amyloid deposition and related, at least in part, to beta 2-microglobulin retention. Successful renal transplantation is followed by a rapid fall in serum beta 2-microglobulin levels and might allow dissolution of amyloid deposits. The purpose of this work was to investigate the effects of renal transplantation on dialysis arthropathy. PATIENTS AND METHODS: Fourteen renal transplant recipients were selected on the basis of previous hemodialysis treatment for at least 10 years (mean 16) and a history of chronic joint pain prior to transplantation. They all received 10 to 17.5 mg/d of prednisone. Posttransplant rheumatologic manifestations were studied prospectively and compared to pretransplant rheumatologic manifestations recorded in medical charts and reported during patient interviews. Pretransplant and posttransplant articular roentgenograms were separately analyzed by three observers who were blinded to timing of the films. Beta 2-microglobulin amyloid was identified by Congo red staining and immunohistology. RESULTS: After a mean posttransplant interval of 54 months (range 12 to 121), the articular condition was improved in 10 patients, unchanged in 1, and worsened in 3, according to patients' assessments. The number of painful joints decreased significantly (P < 0.05) as compared to the pretransplant period. However, the number and size of subchondral bone erosions remained unchanged, destructive arthropathies generally worsened, and articular beta 2-microglobulin amyloid deposits were identified in 2 patients, 2 and 10 years after renal transplantation, respectively. CONCLUSION: Renal transplantation appeared to arrest progression of beta 2-microglobulin amyloid in dialysis patients, but it neither led to dissolution of deposits nor prevented progression of destructive arthropathies. Most articular symptoms were improved, probably as a result of corticosteroid therapy.

Adult↗
PubMed1995

Methotrexate related B lymphoproliferative disease in a patient with rheumatoid arthritis. Role of Epstein-Barr virus infection.

A 57-year-old woman receiving low dose methotrexate (MTX) for rheumatoid arthritis (RA) developed a B lymphoproliferative disease (LPD) that was initially considered as large cell non-Hodgkin's lymphoma of B cell phenotype. Epstein-Barr virus (EBV) cytotoxic latent membrane protein-1 (LMP-1) expression was found in some large cells. The lymphoproliferative disease reversed with MTX discontinuation and without chemotherapy. These EBV-associated LPD in patients with RA receiving MTX or other immunosuppressive agents seem to be similar to those triggered by EBV in transplant patients receiving cyclosporine A. MTX withdrawal and short followup should be considered before chemotherapy since spontaneous regression is possible.

Arthritis, Rheumatoid↗
PubMed1994

Paradiaphyseal calcific tendinitis with cortical bone erosion.

OBJECTIVE: To determine the clinical, radiologic, and histologic features of calcific tendinitis with cortical bone erosion. METHODS: The records of 6 patients with paradiaphyseal calcific tendinitis and adjacent bone cortex erosion were reviewed. RESULTS: Calcific tendinitis involved the linea aspera in 4 patients, the bicipital groove in 1 patient, and the deltoid insertion in another. Calcium deposits were associated with cortical bone erosions, revealed on plain radiographs in 4 patients and computed tomography scans in 2. Bone scans were performed in 2 patients and showed local hyperfixation of the isotope. In 4 patients, suspicion of a neoplasm led to a biopsy. Calcium deposits appeared to be surrounded by a foreign body reaction with numerous giant cells. Apatite crystals were identified by transmission electron microscopy and elemental analysis in 1 surgical sample. CONCLUSION: Paradiaphyseal calcific tendinitis with cortical bone erosion is an uncommon presentation of apatite deposition disease.

Adult↗
PubMed1994

The politics of suffering: the impact of the U.S. embargo on the health of the Cuban people. Report of a fact-finding trip to Cuba, June 6-11, 1993.

The past several years have been difficult for the Cuban people. The economies of Cuba's major trading partners have collapsed. The 33-year U.S. embargo was tightened with passage of "The Cuban Democracy Act of 1992" to include trade--mostly in food and medicines--by subsidiaries of U.S. companies in other countries. The March 1993 "Storm of the Century," which devastated communities from the Caribbean to Canada, caused an estimated $1 billion in damage to Cuba. A mysterious disease known as neuropathy, which can affect vision, appeared in late 1991 and has spread throughout the island. All this has created a situation of scarcity and uncertainty that has affected all aspects of Cuban society, including its health care system. In June 1993 a delegation that included members of the American Public Health Association traveled to Cuba to investigate the current health situation in the country, with an emphasis on the impact of the U.S. embargo. The delegation found that compared to two and three years ago, the general standard of living in Cuba and the quality of health services have declined dramatically. It concluded that while the overall health of the Cuban population has not yet seriously eroded as a result of the economic decline, severe problems threaten to emerge in the future. The delegation called for lifting of the embargo as part of a new approach in U.S. policy toward Cuba.

Adult↗
PubMed1994

[Osteoarthritis with rice bodies rich in calcium microcrystals. 4 cases with ultrastructural study].

Rice bodies are often found in inflammatory joint fluid specimens, especially from rheumatoid arthritis patients, but have rarely been reported in osteoarthritis. We found rice bodies in knee joint fluid specimens from four of 88 patients with osteoarthritis. There were three males and one female. Age ranged from 61 to 86 years. Three patients had slowly progressive knee osteoarthritis and one had rapidly destructive disease. Abundant, recurrent effusions occurred in all four patients despite one to five local corticosteroid injections per patient and radiation synovectomy in two patients. The joint fluid specimens contained 120 to 320 cells/mm3 and large numbers of rice bodies that stained with alizarin red S. Transmission electron microscopy studies showed that the rice bodies were composed of fibrin and contained numerous intra- and extra-cellular calcium crystals composed of apatite alone in two cases and of a combination of apatite and calcium pyrophosphate dihydrate in the two others. Collagen fibers and fragments of bone and cartilage were present in a few rice bodies. Phagocytic cells, type C synoviocytes, chondrocytes and a few inflammatory cells were also seen. These rice bodies composed mainly of fibrin and apatite may have played a role in the pathogenesis of the recurrent joint effusions in our patients.

Aged↗
PubMed1993

[Non-surgical treatment of Dupuytren disease using needle fasciotomy].

Short-term and five-year outcomes after nonsurgical treatment of Dupuytren's contracture by needle fasciotomy were studied. Among the 138 patients who were evaluated, 90 (123 hands) were seen five years after the procedure. Outcome was excellent or good in 81% of cases in the short term and 69% of cases after 5 years. Adverse events included skin breaks (20 hands, 16% of cases), digital dysesthesia due to nerve damage (3 patients, 2% of cases), and local infection (3 patients, 2% of cases). Five-year recurrence rate was 50.4%. These findings demonstrate the value of needle fasciotomy especially in the early stages of Dupuytren's disease.

Dupuytren Contracture↗
PubMed1993

Revisiting physician impact analyses: predicted versus observed hospital resource use.

In order to determine the accuracy of predictions made using Physician Impact Analysis (PIA), a comparison was undertaken of predicted versus actual resource use for 10 new physician specialists at a southern Ontario community hospital. The predictions were done from 1987 to 1989 using methodology recommended by the Ontario Hospital Association (OHA) and available at that time. This included (1) Hospital Medical Records Institute data and (2) a hospital service department survey. A comparison was made between PIA predictions and actual physician resource utilization data gathered in 1991. There was little agreement between the two. The usefulness of PIA rests largely on its ability to generate accurate predictions about a new physician recruit's number of cases and hospital resource use. However, because this research was undertaken in only one community hospital, further evaluation of the PIA process is recommended.

Data Collection↗
PubMed1993

[Erdheim-Chester disease: report of a case, review of the literature and discussion of the relation to Langerhans-cell histiocytosis].

Erdheim-Chester disease is an endogenous, non-genetically-determined lipidosis characterized by infiltrates of foamy, lipid-laden histiocytes and by bilateral symmetric foci of sclerosis in appendicular long bones. The clinical spectrum ranges from focal bone lesions to systemic disease with life-threatening visceral involvement. In one third of patients, roentgenograms show focal osteolysis within areas of sclerosis. Authors report a new case of Erdheim-Chester disease documented by two bone biopsies in different sites. Features in their patient included: 1) osteolysis and sclerosis of the long bones of the limbs and maxillas, with CT scan evidence of cortical rupture; 2) on magnetic resonance imaging studies, heterogeneous foci of decreased signal intensity on T1 images and heterogeneous areas of moderately increased signal intensity on T2-weighted images; 3) increased serum osteocalcin levels; 4) laboratory evidence of chronic inflammation with no extraosseous manifestations. The clinical, radiological, and pathological features of Erdheim-Chester disease are different from those of Langerhans cell histiocytosis. However, three cases of patients with both conditions have been reported in the literature, suggesting that there may be links between the two diseases.

Aged↗
PubMed1993

[Measurement of vertebral bone density. Quantitative tomodensitometry or dual-photon absorptiometry?].

We have compared vertebral bone density measurements (QCT and DXA) in women in the postmenopausal period who underwent both examinations. Our aim was to study the results and to define the respective indications of QCT and DXA in various clinical pictures of osteoporosis. The subjects of the study were distributed into various groups according to the presence or absence of vertebral collapse and/or peripheral fractures. The results of the measurements were expressed as Z-scores (deviation from age-normal average) to suppress the age effect and to make comparison between both methods possible. The values of both measurements are significantly lower in case of vertebral involvement. QCT is more sensitive than DXA to discriminate vertebral collapse. A vertebral fragility threshold was defined at a Z-score of -1 with DXA and -1.25 with QCT, corresponding to the best sensitivity for an acceptable specificity. The results of densitometry suggest that there is a peripheral osteoporosis, different from vertebral osteoporosis, as early as the postmenopausal period. Since DXA is easy to implement, it can be used to screen osteoporosis. When the vertebral measurement with DXA is normal although osteoporosis is obvious (previous collapse or fracture), QCT must be used as it is more sensitive.

Absorptiometry, Photon↗
PubMed1992

Bioavailability of fluoride in postmenopausal women: comparative study between sodium fluoride and disodium monofluorophosphate-calcium carbonate.

Fluoride (F) increases trabecular bone mass and can be used in the treatment of osteoporosis with crush fractures. As the bioavailability of sodium fluoride (NaF) can be impaired by concomitant absorption of calcium, both drugs have to be ingested separately. However, disodium monofluorophosphate-calcium carbonate (MFP-Ca), another F compound, allows a single administration. In a cross-over randomized study, we compared the bioavailability of both drugs under regular conditions of prescription. Ten postmenopausal women (aged 48-77 years) with glomerular filtration rate (GFR) greater than 70 ml/minute and without bone disease entered the study. Each received 25 mg of NaF [i.e., 11.3 mg F ion (F-)] fasting and 100 mg of Na2FPO3-1250 mg CaCO3 (i.e., 13.2 mg F-) with breakfast in a single dose separated by an 8-day washout. After dosing, plasma F levels and fractionated and total urinary F collection were determined during a 24-hour period using a specific electrode. Results show a significant shorter lag time absorption (Tmax = 1.4 +/- 0.2 hour) and a higher maximal concentration (Cmax = 260 +/- 60 ng/ml) for MFP-Ca than for NaF (Tmax = 2.5 +/- 0.4 hour; Cmax = 200 +/- 85 ng/ml). However, areas under curve (AUC) for MFP-Ca (1711 +/- 195 micrograms/liter/hour) and for NaF (1202 +/- 147 micrograms/liter/hour) were not significantly different. The relative bioavailability of both F compounds related to their fluoride content (i.e., 1.22 for AUC ratio) was equivalent, according to the Westlake method. These data provide the first evidence of comparable bioavailability of two F compounds in a population of postmenopausal women.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Long-term survival and prognostic factors in stage II-III multiple myeloma treated with conventional chemotherapy].

In this retrospective study, survival and prognostic factors were analysed in 65 patients with stage II-III multiple myeloma with osteolytic lesions. Multiple myeloma was diagnosed from 1976 to 1984, and patients were treated with conventional chemotherapy. The response rate to initial chemotherapy was 46%. The median survival time was 31 months. The 10-year survival rate was 10%. Four variables were individually prognostic: response to initial chemotherapy, bone marrow plasma cell percentage, the Durie and Salmon staging system, a biological staging system derived from Durie and Salmon's biological criteria regardless of bone lesions. In the multivariate analysis, only two prognostic variables were retained, namely the response to chemotherapy and the biological staging system. No prognostic value was observed for the extent of osteolytic lesions. This study suggests that, in conventionally treated multiple myeloma, long-term survival has improved compared with the previous decade. It also indicates that the extent of osteolytic lesions has little value for the definition of high-risk myeloma.

Adult↗
PubMed1992

[Therapeutic maintenance and tolerance of sulfasalazine in rheumatoid polyarthritis. Retrospective study of 95 patients].

This retrospective study evaluated treatment with sulfasalazine (SAS) in a mean dosage of 2.1 g/day in 95 patients with rheumatoid arthritis (RA) who were followed-up for 3 months to 4 years. Mean disease duration was 7 years; 79 patients had previously received at least one disease-modifying drug. Four per cent of patients were lost to follow-up. Mean duration of treatment was 15 months (3 weeks-50 months). Treatment continuation rates were 57% at one year, 40% at two years, and 26% at three years. Reasons for discontinuation of SAS included adverse effects (n = 24), inefficacy (n = 33), and death unrelated to SAS therapy (n = 2). In four patients, SAS was discontinued within three months of the first dose because of a severe adverse effect (diffuse erythematous rash, diffuse bullous rash, hepatitis with jaundice, agranulocytosis). SAS-induced biologic markers for lupus were seen in one patient. Furthermore, 12% of evaluable patients developed antinuclear antibodies during SAS therapy. The SAS treatment continuation rate was higher (p = 0.05) among patients under 40 years of age (n = 18) than among older patients. This difference was due to a correlation between age and tolerance with less SAS-induced side effects in patients under 40 years of age (p = 0.03). The SAS treatment continuation rate was unrelated to the duration of rheumatoid arthritis or number of previous maintenance treatments. This study suggests that rheumatoid arthritis patients under 40 years of age exhibit better tolerance to SAS therapy.

Adolescent↗
PubMed1992

[Bone demineralization and cytokines].

Cytokines are secreted by several cell types in the bone microenvironment. These peptides act on bone cells by a paracrine or autocrine mechanism and play an important role, although not completely clarified, in the regulation of bone remodeling. Postmenopausal osteoporosis could be due to a local overproduction of some osteoclast-stimulating cytokines in response to estrogen deficiency. During chronic inflammatory joint diseases, such as rheumatoid arthritis, synovial cells produce large amounts of cytokines leading to increased local bone resorption and juxta-articular bone destructions. The local action of cytokines is also involved for interactions between tumoral cells and bone cells. These are secreted by the tumoral (metastatic or hemopoietic) cells, bone marrow cells, bone cells, or even could be released from the bone matrix during bone resorption. Recent progress in our knowledge in the field of cytokines have improved the understanding of the pathogenesis of these diseases and let hope future promising developments for more specific treatments.

Arthritis, Rheumatoid↗