[Myasthenia gravis and autoimmune thyroiditis during the treatment of rheumatoid polyarthritis withD-penicillamine. Anatomoclinical study of 1 case].
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Biomedical subjects
Publications and source records attributed to F Delbarre.
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Ketoprofen (19.583 R. P., Profenid N. D., Orudis) labelled with tritium was administered orally to 4 patients (3 men - 1 woman) at a dose of 150 mg (therapeutic dose) with a radioactivity of approximately 500 muCi. Tritiated ketoprofen capsules, which disintegrated in the stomach, were administered in particle size of the same order as in the clinical trial material. The ketoprofen plasma levels and the quantities of the compound excreted in the urine and faeces were measured for 5 days after the administration of the capsules. Ketoprofen is absorbed rapidly and its plasma levels, which vary from patient to patient, can be comparatively high (9 to 21.3 mg/l), but these levels fall rapidly by 2 or 3 half-lives. Ketoprofen and its metabolites are excreted mainly in the urine (approximately 85% of the radioactivity administered is excreted within 5 days) and to a very limited extent in the faeces (within 5 days: approximately 1 to 8% of the radioactivity administered). Thus the evaluation of the radioactivity shows that the compound and its metabolites are almost completely excreted by the 5th day after administration. The ketoprofen urinary excretion rate is fairly closely correlated with the disappearance of the compound from the plasma. Overall measurements of the compound in the plasma and urine show that ketoprofen undergoes a relatively significant degree of metabolic transformation in man since, on an average, approximately 55% of the administered compound is recovered as metabolites from urine samples. In faeces, the relative significance of the transformation into lipo-soluble metabolites and water-soluble substances suggests that the metabolic transformation has a bacterial origin which varies in different individuals. The parameters of the pharmacokinetics of ketoprofen and its metabolism show no differences between the sexes in the cases studied.
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The authors report the case of a man suffering from rheumatoid arthritis treated for almost 5 years with chlorambucil. Death occurred 9 years after the onset of the disease at the age of 55 years with a picture of acute megacaryoblastic leukaemia.
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The antigenicity of aqueous extracts of osteoarthritic and rheumatoid synoviale was studied in patients with rheumatoid arthritis, other diseases and in normal controls by the mean of leucocyte migration test, lymphoblastic transformation test and cutaneous reactions. In 59% cases of rheumatoid arthritis an inhibition of the migration of leucocytes was found but there was no relation between this test and the clinical state, the evolution, rheumatoid serology and other laboratory parameters. In some cases of rheumatoid arthritis an inhibition of the migration of leucocytes was observed also with a pericardial and hepatic extract. In normal controls the leucocyte migration test is always negative, but it is positive in 37% of cases of various inflammatory and neoplastic diseases and the difference is not significant considering the percentage of positivity of the test in rheumatoid arthritis. The lymphoblastic transformation test and the cutaneous reactions were always negative in rheumatoid arthritis and in controls. Thus, the leucocyte migration test using a synovial extract as an antigen does not bring evidence in favour of an auto-immune conflict in rheumatoid arthritis.
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The authors propose a method for the quantitative functional exploration of the salivary glands using two objective criteria, on the one hand the level of fixation in the parotid of technetium 99m injected in the form of its pertechnate and on the other hand by the fraction of radioactivity found in different specimens of saliva collected in the course of a test carried out using a pharmacological agent free of toxic effects--lemon juice. The quantitative results obtained and its simplicity render the method particularly useful in evaluating the course of salivary function in all forms of disorder, pathological or iatrogenic.
The authors report two cases of multiple myeloma which were typical both clinically and in the laboratory but XRay examination, on the other hand, showed appearances of osteocondensation. In the first case, XRay showed both lesions of osteolysis in the cranial vault and homogeneous condensation of D11 and L1, together with the left iliac crest. In the other case, there was osteolysis of the acetabulum together with areas of osteocondensation distributed throughout the pelvis and upper ends of the femurs, with two areas of annular fibrosis circumscribing the area of osteolysis, finally, homogeneous condensation of the skull. In both cases, bone biopsy confirmed the diagnosis of multiple myeloma showing both osteofibrosis and plasma cell infiltration of the bone marrow. This also permitted the authors to note the absence of any myelofibrosis or metamorphic neo-osteogenesis. Illustrated by these two cases, condensing multiple myeloma is a rare entity, the special clinical characteristics of which reside in its fairly frequent coexistence with peripheral neuritis which is probably similar to a para-neoplastic syndrome. The radiological appearances are mainly of four types: 1) Focal areas of bony condensation. 2) Areas of annular fibrosis circumscribing osteolysis. 3) Appearances of radial spicules, or 4) Osteocondensation extending to a fairly large part of the skeleton. The laboratory signs are identical with those in other types of multiple myeloma with a few exceptions, such as, rareness of hypercalcemia, more frequent tendency to hypocalcemia, rise in alkaline phosphatase, in a few cases. Bone biopsy confirms the diagnosis. The osteofibrosis resulted here from thickening of the osteoid seams by laying down of successive layers of bony substance, irregularly calcified and, also secondarily, metamorphic neo-osteogenesis in a few rare cases which also included myelofibrosis.
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The number of large circulating hyperbasophilic mononuclear cells - referred to as hyperbasophilic immunoblasts (HBI)- is often increased in collagen disease and rheumatoid arthritis (RA) and grossly reflects the degree of disease activity. In contrast, in psoriatic arthropathy the percentage of (HBI) is within the normal range. HBI are mainly involved in immune reactions and may provide a valuable routine test for the assessment of the latter in disease states and for the predicition of relapse in chronic collagen diseases. Immunofluorescent techniques applied to samples from active autoimmune diseases have shown that a number of HBI are Ig-producing B-blasts. Moreover, in a few cases these intracytoplasmic immunoglobulins exhibited a rheumatoid factor-like activity, a finding which promises to yield additional information on the immunopathogenesis of RA.
The effect of the intra-articular injection of radioactive erbium 169 and yttrium 90 on the growth of the leg in rabbits has been studied. I colloid state these isotopes are used clinically for synovial ablation. These beta emitters slow down bone growth in proportion to the amount of radioactivity injected. If the joint has previously been damaged by an inflammatory arthritis the effect of the radiation on the bone growth is reduced.
The authors studied the tissue groups in a first series of patients with properly diagnosed rheumatic disorders. They found HL-A W27 antigen in 84 percent of 50 cases of primitive ankylosing spondylarthritis in adults, in 33 percent of the 50 cases of Fiessinger-Leroy-Reiter syndrome, in 20 percent of the 40 cases of psoriatic polyarthritis (50 percent of the 12 cases with radiological sacroiliac involvement) and in 66 percent of the 6 cases of spondylarthritis associated with haemorrhagic rectocolitis. In a second series of 45 patients with unclassifiable inflammatory rheumatism, only the W27 antigen tested for and it was found in 33 percent of the patients. On the basis of these observations, which were compared with those in other publications, the authors confirm the absence of a clear correlation between the pathological picture and the presence of the W27 antigen. They discuss the significance of the association between the W27 antigen and the disease, and underline the diagnostic and sometimes the prognostic value of the W27 test in rheumatology.
An artificial language that makes it possible to put summarized results into a computer. Application of this method to the study of the results of one year consultations with 5650 patients in a institute of rheumatology. The authors present the results of one year's external consulta-with 5650 patients in the Rheumatology Institute of the Faculty of Medicine at Paris Cochin. These results were obtained by computer using an artificial language that made it possible to record and play back a spoken version of the summarized data from the patient's histories.
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Thirteen cases of infectious sacro-iliitis caused by pyogenic organisms are reported and compared with thirty-four cases in the literature. Staphylococcus was the commonest infecting organism (six cases). Two clinical patterns were noted, acute (nine cases) and subacute (four cases). Treatment was by antibiotics and bed rest in all patients. Surgery was indicated for diagnosis in three patients and for abscess in three patients. All of our patients had very good functional recovery.