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E Vignon

Publications and source records attributed to E Vignon.

At least 73 records · Page 4Linked to original sources
PubMed1997

A pragmatic cost-effectiveness study of routine epidural corticosteroid injections for lumbosciatic syndrome requiring inhospital management.

A multicenter randomized study was conducted using a pragmatic approach to evaluate the benefits and costs of routine epidural corticosteroid injections for the treatment of lumbosciatic syndrome requiring inhospital management. The primary evaluation criterion was whether other treatments were required after one to three injections. The 108 patients were randomly allocated to treatment with or without routine epidural corticosteroids. Rest and a nonsteroidal antiinflammatory drug were used in all patients. The two groups were comparable at baseline except for a larger proportion of males in the routine epidural corticosteroid group. Patients in the routine epidural corticosteroid group were more likely to require other treatments, but the difference was only of borderline significance after adjustment for gender. Results showed that physicians based their treatment decisions primarily on whether an improvement in the clinical status of the patient was apparent at the second visit. None of the other factors studied influenced treatment decisions. Clinical efficacy criteria were identical in the two groups. Hospital costs contributed most of the total cost, and the mean cost was higher in the routine epidural corticosteroid group. These data suggest that adding an epidural injection as a first-line treatment to rest and a nonsteroidal antiinflammatory drug for the treatment of lumbosciatic syndrome requiring inhospital management results in additional costs and no gain in efficacy.

Adolescent↗
PubMed1997

Radiographic features predictive of radiographic progression of hip osteoarthritis.

OBJECTIVES: To evaluate potential radiographic predictors of hip osteoarthritis progression. PATIENTS AND METHODS: A prospective, longitudinal two-year study was conducted in patients meeting American College of Rheumatology criteria for hip osteoarthritis. Hip osteoarthritis progression was defined as a greater than 0.5-mm decrease in joint space width measured using a magnifying glass marked at intervals of 0.1 mm, at the site of maximum joint space narrowing, by a single investigator who was blinded to the chronological order of the radiographs. Radiographic parameters determined at study entry were as follows: presence of osteophytes, osteosclerosis, and subchondral cysts; femoral head migration (superolateral, superomedial, concentric); and severity (joint space width in mm, Kellgren and Lawrence grade, subjective evaluation of joint space narrowing). RESULTS: In the 463 study patients, joint space width decreased from 2.2 +/- 0.8 at baseline to 1.7 +/- 1.0 mm after two years (P < 0.0001). Radiographic progression was seen in 148 patients (32%). Radiologic parameters predictive of disease progression in the multivariate analyses were as follows: CONCLUSION: Our data suggest that a number of baseline radiological features including distribution of joint space loss, subchondral bone production, and severity of joint space loss are predictive of progression of hip osteoarthritis.

Aged↗
PubMed1996

[Coxarthroses].

Osteoarthritis of the hip is a frequent disease affecting 2 to 4% adults. The main symptoms are inguinal pain, hip movement limitation and thigh muscular atrophy. The diagnosis is usually made of on antero-posterior radiograph of the pelvis and Lequesne's lateral view that show joint space narrowing and osteophytosis. There is no correlation between radiographic lesions and clinical symptoms. The mean rate of joint space narrowing progression was shown to be of about 0.30 mm/year but inter-patients variations are very large. The evolution is more sever in older patients and when there is no osteophyte. New imaging techniques are necessary only if diagnosis is impossible on standard radiographs but not for the surgical decision. The treatment of hip osteoarthritis requires analgesic, NSAIDs and symptomatic slow actin drugs for osteoarthritis. Total hip arthroplasty is necessary when medical treatment is non effective on pain and disability.

Humans↗
PubMed1996

Quantitative radiography in osteoarthritis: computerized measurement of radiographic knee and hip joint space.

Radiographic joint space narrowing is the hallmark of progression in osteoarthritis (OA). An accurate measure of progression for OA requires a precise quantitative method. New techniques have been designed to quantitatively assess knee and hip joint space using computer analysis of digitally stored radiographs. The interobserver coefficient of variation of the technique ranges from 1% to 3.3% and is clearly better than that obtained by the use of dividers and rule. A precise standardization of the radiological procedure as well as use of films of good quality are required for a good reproducibility of the method. The computerized measurement of joint space size from standard radiographs is applicable to monitor progression of hip and knee OA, and appears to be of value in the evaluation of disease-modifying therapies for OA.

Arthrography↗
PubMed1996

Assessment of urinary hydroxypyridinium cross-links measurement in osteoarthritis.

The aim of this study is to re-evaluate urinary collagen cross-links, previously proposed as markers of osteoarthritis (OA). The urinary excretion of collagen cross-links, pyridinoline (PYD) and deoxypyridinoline (DPD), was measured using high-performance liquid chromatography (HPLC) in 114 patients with OA, 19 patients with rheumatoid arthritis (RA) and 40 healthy subjects. An increase in PYD and DPD, expressed per millimole of creatinine, was confirmed in RA. However, PYD and DPD in patients with hip OA, knee OA and polyOA were similar, and did not differ from controls. In patients with radiographic end-stage OA, PYD and DPD were significantly higher than in patients with an early OA, but not significantly higher than in controls. The PYD/DPD ratio did not vary with the OA stage. Thus, urinary collagen cross-links are not elevated in OA, but could reflect bone sclerosis and/or erosion in late OA.

Adult↗
PubMed1996

Radiological progression of hip osteoarthritis: definition, risk factors and correlations with clinical status.

OBJECTIVES: To determine a cut off value for changes in radiological joint space width that allowed definition of radiological progression of hip osteoarthritis not related to measurement method errors and, thereafter, to determine factors predictive of radiological progression of hip osteoarthritis and to evaluate the correlations between clinical and radiological parameters. METHODS: A prospective, longitudinal (one year duration), multicentre study was made of patients with osteoarthritis of the hip (American College of Rheumatology criteria). Data on clinical activity (pain, functional impairment), demographic data (age, gender, body mass index), and femoral head migration (superolateral, superomedial, concentric) were collected when the patient entered the study; radiological grade (joint space width in millimetres at the narrowest point using a 0.1 mm graduated magnifying glass, evaluated by a single observer unaware of the chronology of the films) was recorded at the patient's entry to the study and after one year. RESULTS: Analysis of the means of the differences between two analyses performed by a single observer of 30 pairs of radiographs (one performed after an interval of one year) (0.06 (SD 0.23)) suggested that a change of more than 0.56 mm (2 SD) after a one year follow up could define progression of osteoarthritis of the hip. Of the 508 patients recruited, 461 (91%) completed the one year follow up and radiological progression was observed in 102 (22%). The factors predictive of radiological progression that were identified in the multivariate analysis were: radiological joint space width at entry < or = 2 mm, superolateral migration of the femoral head, female gender, Lequesne's functional index > 10, age at entry > 65 years (odds ratios 2.11, 4.25, 2.51, 2.66, 1.90, respectively). The level of clinical parameters (pain, functional impairment) and the amount of symptomatic treatment required (non-steroidal anti-inflammatory drugs and analgesic intake) accounted for 20% (p < 0.0001) of the variability of the changes in radiological joint space width over the one year study period. CONCLUSION: These data suggest that radiological progression of hip osteoarthritis could be defined by a change in joint space width of at least 0.6 mm after a one year follow up period, is correlated with the changes in clinical status of the patients, and is related not only to demographic data (age, gender), but also to some specific characteristics of osteoarthritis (localisation, radiological severity, clinical activity).

Aged↗
PubMed1995

[Primary AL-type amyloidosis disclosed by Horton disease].

Primary systemic amyloidosis rarely affects the walls of small and medium-sized vessels. We report a case of primary AL amyloidosis masquerading as giant cell arteritis at the onset of the disease, revealed by the temporal arteritis biopsy, and successfully treated by corticotherapy for three years. Histology of temporal arteritis confirms the diagnosis of amyloidosis (characteristic birefringence with Congo red). We discuss in this case the diagnosis of primary amyloidosis revealed by Horton disease, or the coincidental association of these two diseases.

Aged↗
PubMed1995

Progression of digital osteoarthritis: a sequential scintigraphic and radiographic study.

Hand radiographs and scintigraphy were obtained initially and at the 4-year follow-up in 15 patients with symptomatic osteoarthritis (OA) of distal and/or proximal interphalangeal joints. For each joint, a 0-15 score was obtained for the OA radiographic lesions read blind by the same observer. An abnormal isotope retention over a bone reference area was assessed and quantified. The predictive value of scintigraphy for the OA radiographic progression was confirmed and shown to be improved by a second investigation. During the study period, the percentage of radiographic OA joints increased from 66.3 to 76.6%, but joints showing an abnormal scan decreased from 40 to 22.5%. Progression of the OA radiographic score was closely related to scintigraphic changes. The mean difference between the final and initial OA score was -0.08 in joints with two normal scans (N = 115), +0.73 in joints showing a first abnormal and a second normal scan (N = 94) and +1.8 in joints with two abnormal scans (N = 14) or a scan becoming abnormal (N = 47). An abnormal scan appears to represent a transient event, and this event is associated with a period of progression of digital OA. Potentially, anti-OA therapies that suppress joint isotope retention might slow down OA progression. The magnitude of joint isotope retention was positively correlated with the OA radiographic score established at the same time (R = 0.61 and P < 0.001), but showed no predictive value for progression of the latter.

Adult↗
PubMed1995

Gangliosides from normal and osteoarthritic joints.

A decrease in all major gangliosides, contrasting with a marked increase in the GM3 third band (3B-GM3), has been demonstrated in osteoarthritic fibrillated cartilage. We found the 3B-GM3 in osteoarthritic fibrillated, grossly intact and osteophytic human cartilage, but it was undetectable in pig and bovine cartilage, bone, synovium, synovial fluid white cells, erythrocytes, and various extracellular tissues. We made a similar finding with lactosyl ceramide, the GM3 neutral glycolipid precursor. The search for an antibody against the 3B-GM3, as a possible specific antigenic marker of osteoarthritis (OA), was unsuccessful. However, an antibody against a molecule very close to 3B-GM3 on high performance thin layer chromatography, which will probably be identified as a glycosylphosphatidylinositol, was found in the serum of some patients with OA.

Animals↗
PubMed1995

Quantitative assessment of radiographic normal and osteoarthritic hip joint space.

Radiographic joint space narrowing (JSN) is the hallmark of progression in osteoarthritis (OA). We developed a technique of measuring joint space of the hip by computer analysis of digitally stored pelvic radiographs. The interobserver coefficient of variation was 3.3%. Mean joint space width (MJSW) and joint space surface were more sensitive to change than interbone distance. In a retrospective analysis of 69 OA hips, MJSW decreased 0.43 +/- 0.43 mm per year and was lower in patients with the hypertrophic form of OA. Limitations were due to radiograph quality. This computerized measurement method is applicable to monitor progression of hip OA and appears to be of value in the evaluation of disease-modifying therapies for OA.

Adolescent↗
PubMed1994

[Rate of joint space pinching in coxarthrosis].

Accurate measures of cartilage destruction are needed to evaluate the effects of chondroprotective agents in human osteoarthritis. Use of a digitalized image analyzer (HOLOGIC, ICMS software) to measure mean joint space width on roentgenograms of the hip is a simple, reliable method with a coefficient of variation of 3.3%. To determine the rate of joint space loss and to identify factors associated with this parameter, we retrospectively studied 56 hips with osteoarthritis in 39 patients (mean age at baseline 55.5 +/- 12 years; mean roentgenographic follow-up 5.2 +/- 3.6 years, mean number of roentgenograms per patient 3.7 +/- 1.1). Mean annual joint space loss was 13.5 +/- 16.6%, i.e., 0.42 +/- 0.38 mm, and was negatively correlated with the duration of roentgenographic follow-up (r = 0.95 and 0.97, p < 0.01). When only those subjects who were followed up for two to eight years were studied, mean joint space loss was only 6.7% with a considerably smaller standard deviation of 4.2%, i.e., 0.29 +/- 0.21 mm. No influence on the rate of joint space loss was found for age at onset of symptoms, age at the first roentgenographic study, side, gender, or location of the joint space narrowing. The roentgenographic stage or joint space width at baseline were positively correlated with the rate of joint space loss expressed as a percentage but not in mm. These data suggest that the absolute amount of cartilage lost is not influenced by the roentgenographic stage of the osteoarthritis at inclusion of the patient in the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Serum phospholipase A2 activity in osteoarthritis].

Serum phospholipase A2 activity in 67 osteoarthritis patients and 17 controls was determined using a radiolabeled specific substrate. Serum phospholipase A2 activity was significantly higher in osteoarthritis patients (115 +/- 73.6 dpm/h/ml) than in controls (45 +/- 25 dpm/h/ml) (p = 0.002). In 41 osteoarthritis patients, serum phospholipase A2 activity was unrelated to age, time since onset of osteoarthritis symptoms, duration of morning stiffness, Lequesne's index, roentgenographic stage of osteoarthritis, number of joints with osteoarthritis, erythrocyte sedimentation rate, or serum C-reactive protein levels. In 12 osteoarthritis patients who were evaluated twice at a mean interval of 46 days, changes in serum phospholipase A2 activity were unrelated to changes in Lequesne's index. Blind evaluation of long-term joint space loss was performed in 14 patients; serum phospholipase A2 activity increased only in those patients with progressive joint space loss, but the difference was not statistically significant as compared with the controls. These data suggest that serum phospholipase A2 activity is not useful in practice as a marker for osteoarthritis.

Adult↗