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Biomedical subjects

D Wendling

Publications and source records attributed to D Wendling.

At least 91 records · Page 5Linked to original sources
PubMed1995

Spontaneous fracture of the odontoid process in a patient with ankylosing spondylitis. Nonunion responsible for compression of the upper cervical cord.

Tetraparesis due to a spontaneous fracture of the base of the odontoid process occurred in a patient with undiagnosed, advanced ankylosing spondylitis. Few cases of insufficiency fractures of the proximal cervical spine in patients with loss of spinal mobility have been reported in the literature. The pathologic lesions that can cause severe neurologic compromise are reviewed. Because functional impairment and neurologic loss are common even after surgical decompression and stabilization, these lesions should be looked for during a careful physical evaluation followed by appropriate investigations.

Fractures, Spontaneous↗
PubMed1995

[Hereditary angioneurotic edema: an underestimated medical emergency. Apropos of 33 cases].

INTRODUCTION: Hereditary angio-oedema is a poorly understood disease. In more than 70 p. 100 of the cases, diagnosis is made 5 to 10 years after the first manifestations despite their typical nature. PATIENTS AND METHODS: We examined retrospectively 33 cases of hereditary angio-neurotic oedema treated at the Besançon University Hospital from 1973 to 1990. RESULTS: Laryngeal oedema was the most dangerous complication causing a critical episode in 22 cases. Ten patients were given danazol. DISCUSSION: This study emphasizes that preventive treatment is essential, based on danazol which should be prescribed at the lowest dose which gives a 50 p. 100 rise in the C2 complement fraction (usually 50 to 200 mg/day). Life-threatening attacks should be treated with purified C1 INH, although there are still problems with drug supply.

Adolescent↗
PubMed1995

The B7 cross reactive group and spondyloarthropathies: an epidemiological approach.

OBJECTIVE: To study the association between the B7 cross reactive group (B7, B40) and spondyloarthropathy (SpA), taking into account patients with atypical features. METHODS: We studied the main clinical and paraclinical features of 51 patients with rheumatoid arthritis, 55 with SpA, 120 with mechanical diseases, and 160 with inflammatory rheumatism not fulfilling the diagnostic criteria currently used. This descriptive analysis was performed using multiple correspondence factorial analysis to identify subgroups among unclassified patients and select SpA variants. We compared HLA frequencies among these groups versus a control group. RESULTS: We identified a subgroup close to the axial SpA and related to B7 (OR:5.91, p = 0.0008), whereas B40 is related to patients close to the peripheral SpA. CONCLUSION: B7 is related to axial SpA variants manifested by inflammatory low back pain according to Calin's criteria, with either extraarticular signs or sacroiliitis. Followup of such patients is required to determine whether their disease is a new entity or can be considered SpA.

Adult↗
PubMed1994

[Nailfold capillaroscopy and ankylosing spondylarthritis: incidence of anomalies, but absence of diagnostic and prognostic value].

Vascular involvement is seldom reported in ankylosing spondylitis (AS). In this study, microcirculation was evaluated by nailfold capillaroscopy in 32 defined AS patients compared to a control group (C) of 14 sciatica. Capillary findings were divided into five groups: normal, minor dystrophies, edema, microangiopathy, stagnation. Capillaroscopic abnormalities were more frequent in SA as compared to C, for edema (40% vs 7%) and microangiopathy (15% vs 0%). P = 0.01. There were neither clinical nor biological differences between AS patients with and without microangiopathy. Capillaroscopy abnormalities seem frequent in AS and may be secondary to an immune complex mechanism.

Adolescent↗
PubMed1994

[Spondylarthropathies and the IgA system].

The spondyloarthropathies (SA) implicate bacterial infections of mucosal origin. IgA synthesis capacity in vitro is normal in AS. IgA increase is secondary to a specific immune response to the bacterial antigens implicated in the disease's pathogenesis. IgA participate to immune complex formation, which may lead to some extraarticular features of the disease (e.g. renal, cutaneous or vascular). There is also an increase of secretory IgA reflecting the activation of the two compartments of this humoral immune response, part of a coherent pathophysiological scheme of the disease. In a practical point of view, IgA serum levels may be considered as a biological parameter of SA activity.

Antigen-Antibody Complex↗
PubMed1994

[Leukocyte expression of the LFA-1 adhesion molecule in spondylarthropathies].

The expression of adhesion molecule Leukocyte Function Antigen-1 (LFA-1) on peripheral blood leukocytes was evaluated (using a monoclonal antibody anti CD11a/LFA-1) in 52 spondylarthropathies (SA) (35 HLA B27 positive), 12 healthy patients, 24 active rheumatoid arthritis (RA) and 12 systemic lupus (SLE) patients. LFA-1 expression on lymphocytes was similar in the different groups of patients, but LFA-1 expression on granulocytes was higher in SA than in controls (p < 0.05) or in RA or SLE. Fluorescence intensity of anti LFA-1 staining on SA granulocytes correlated with serum IgA levels. There was no difference between HLA B27 positive/negative, biologically inflammatory (CRP > 21 mg/l)/non inflammatory SA patients. This study seems to confirm the granulocyte and IgA involvement in immunopathogenesis of spondylarthropathies.

Adolescent↗
PubMed1993

[Monoclonal antibodies and rheumatoid polyarthritis].

Monoclonal antibodies allow to foresee selective immunotherapy in rheumatoid arthritis (RA). Several molecules implicated in the immunopathogenesis of the disease represent the targets (antigens) of monoclonal antibodies already used in man: T cell antigens, T cell activation antigens, adhesion molecules, cytokines. The first open studies gave promising results. However complementary investigations are requested to confirm the clinical efficacy and to precise the real place of these biologic agents in the strategy of treatment of RA or auto-immune diseases.

Antibodies, Monoclonal↗
PubMed1993

Treatment of severe rheumatoid arthritis by anti-interleukin 6 monoclonal antibody.

Interleukin 6 (IL-6) appears to be a potential mediator of inflammation that may contribute to the pathogenesis of joint inflammation in RA. Anti-IL-6 monoclonal antibodies (Mab) may represent a new tool in RA treatment. Five patients with RA, after previous anti-CD4 therapy (B-F5) without antimouse immunization were included in our open pilot study. The anti-IL-6 Mab (B-E8, IgG1) was given intravenously (10 mg/day) for 10 consecutive days in hospital. No side effects were noted. Clinical and biological (C-reactive protein) improvement appeared during the treatment period. However improvement was transitory (mean: 2 months). Unexpectedly serum IL-6 levels increased in 4 patients with this treatment that seemed to have antiinflammatory effects. Further studies are required to evaluate the real benefit and the mode of action of this Mab.

Antibodies, Monoclonal↗
PubMed1992

[Bone and visceral manifestations of lipoatrophic diabetes. Apropos of a case].

Lipoatrophic diabetes, known by pediatricians as Lawrence-Seip disease or Berardinelli lipodystrophy syndrome, is an infrequent condition of which approximately one hundred cases have been published to date. A case in a 24-year-old female with a fifteen-year follow-up is reported. Manifestations included acanthosis nigricans, generalized lipoatrophy, hirsutism, muscle hypertrophy, and intellectual impairment. Biologic tests revealed insulin-resistant diabetes mellitus with major diet-dependent type V hypertriglyceridemia. The patient had nephrotic syndrome (focal and segmental endocapillary proliferative glomerulonephritis without dense deposits). Phosphorus and calcium determinations were normal, as were the endocrinologic tests. Roentgenograms of the bones disclosed increased density of axial bones and large epiphyseal defects with increased bone density as determined by osteodensitometric studies. The bone manifestations of this syndrome have been documented but are often overshadowed by the severe metabolic alterations.

Abnormalities, Multiple↗
PubMed1992

[Monoclonal antibodies in the treatment of rheumatoid arthritis].

Monoclonal antibodies (MoAb's) make it possible to treat rheumatoid arthritis with selective immunotherapy. These antibodies may be directed against various targets, such as lymphocyte activation antigens, cytokines or subpopulations of lymphocytes (notably TCD4 +), involved in the pathogenesis of the disease. Recent open studies have demonstrated the feasibility and safety of this therapeutic method, but the number of patients who entered the trials is still low, and the clinical, biological and immunological results vary considerably in importance and duration, without remission. No response predictive factor could be elicited from these studies. The murine origin of these MoAb's exposes to the frequent risk of immunization which may interfere with the effectiveness and safety of a second treatment. Some possibilities can already be envisaged, including potentiation of the MoAb by coupling with a cytotoxic agent (anti-CD5 + ricin) and "humanization" of murine MoAb's (chimeric anti-CD4) reducing the risk of immunization. Further (controlled) trials therefore are indispensable to evaluate the true rank occupied by this therapeutic method in rheumatoid arthritis.

Antibodies, Monoclonal↗
PubMed1992

[Rapidly destructive lumbar spondyloarthropathy in chronic hemodialysis].

Rapidly destructive spondyloarthropathy occurring in the lumbar spine of 2 chronically hemodialysed patients is reported. These lesions resembled infectious spondylitis. Histological examination revealed deposits of amyloid in the L3-L4 intervertebral space in one patient, which could be a causative factor in the joint destruction. The other favouring circumstances and pathogenesis of this condition are discussed.

Aged↗
PubMed1992

Treatment of rheumatoid arthritis with anti CD4 monoclonal antibody. Open study of 25 patients with the B-F5 clone.

Twenty-five defined severe RA patients (pts) (17 F, 8 M) were treated in an open study with a CD4 murine monoclonal antibody (Mab) (B-F5 clone, IgG1). Mab's daily dose was 10 mg (1 pt), 15 mg (2 pts), 20 mg (17 pts), 30 mg (4 pts) and 50 mg (1 pt) for 10 days. Tolerance was fair. Clinical improvement occurred during treatment period or within the first month in all but 2 patients, irrespective of Mab dosage. Improvement duration was variable (1 to 12 months), half of the patients still show signs of improvement at month 4. Biological parameters (CRP) improved parallel to the clinical. At day 180, 25% of the patients showed a reduction of 50% or more of the initial CRP values. There is no modification of RF titers, renal and hepatic parameters. Sequential evaluation showed a decrease of B, TCD3, CD4, CD8 lymphocytes and monocytes two hours after Mab infusion and return to baseline in 20 hours. Xenogenic immunization occurred in 6 patients without influence upon clinical response. These modifications are moderate and transient and do not account for the more prolonged effect in some cases, nor do they offer any prediction of further clinical response.

Adult↗