[Unrecognized tendinopathy of the posterior tibial muscle in the 5th decade].
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Biomedical subjects
Publications and source records attributed to J Claustre.
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In 10 cases, the authors describe the musculo-cutaneous nerve syndrome in the foot. It involves pain and paresthesias located on the dorsal aspect of the foot, occurring after local trauma or repeated microtraumas (ill fitted shoes), promoted by a static disorder (anterior hollow foot, calcaneal valgus). The diagnosis is essentially clinical, based on the presence of a Tinel sign on the dorsum of the foot and on the infiltration test. The treatment consists in the combination of local measures and steroid infiltration. Neurolysis is only indicated in case of failure of the medical treatment (4 cases). Then, it always proves to be effective.
Almitrine increases ventilation by stimulating the peripheral arterial chemoreceptors. This study assessed the effects of acute and chronic almitrine treatments on the dopamine (DA) and norepinephrine (NE) contents and utilization rates in the rat carotid body. Almitrine (5 mg/kg ip) caused a 34% reduction in DA content after 30 min. Extending the almitrine treatment for 15 days (one daily ip injection) produced a further progressive diminution in DA stores (-55%; P less than 0.01). The utilization rate of DA measured after inhibiting catecholamine biosynthesis by alpha-methyl-p-tyrosine was strongly reduced by almitrine (-98% after 15 days; P less than 0.01). The effects of almitrine were dose dependent. The noradrenergic activity was much less altered by the drug. The data showed that almitrine can modify the dynamics of DA in rat carotid body producing a decrease in both content and utilization rate.
In man, the major portion of plasmatic and urinary catecholamines is found in a conjugated/sulfate form. The biological characteristics of the conjugates (formation sites, kinetics of appearance and disappearance from the plasma, genetic regulation, influence of biological factors) are different from those of the free forms. Physiopathological data show that the dosage conjugated catecholamines together with that of free amines, provides interesting informations on the integrative level of sympathetic activity and on the regulation of the catecholamines plasma concentrations by conjugation. In these two objectives, the dosage of DA sulfate proves very important.
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The formation and excretion of conjugated catecholamines (CA) was studied in conscious rats after sympathetic stimulation by hypoxia (5.5-6% O2, 4 h). Hypoxia induced a rapid and intense increase of free epinephrine (E, X 12) and norepinephrine (NE, X 6) but only a limited enhancement of free dopamine (DA, X 2). Sulfate conjugates of E and NE had kinetics similar to the free forms, while glucuronides were only moderately and lately altered. In contrast to free and sulfated DA, DA glucuronide, the major plasma conjugate, was decreased (-25%). This result suggests that DA glucuronide, unlike other CA conjugates, is not related to detoxication but might supply a CA precursor. Urinary conjugates badly reflected plasma conjugates. In normoxic controls, CA conjugates prevailed in the plasma, whereas the free amines prevailed in the urine. Hypoxia increased mainly the excretion of E and NE glucuronide but not of the free amines. Urinary DA, free or conjugated, was decreased (-25%), a result in keeping with plasma DA glucuronide only. The poor relations between plasma and urine catecholamines pinpoint the importance of the kidney in CA handling.
The concentrations of free and sulfated 3,4-dihydroxyphenylacetic acid (DOPAC) were measured in rat plasma to investigate their potential central or peripheral origin. Stimulation of central dopamine (DA) metabolism by a long-acting neuroleptic, pipotiazine (PPZ) selectively increased plasma levels of DOPAC sulfate whereas peripheral inhibition of monoamine oxidase by debrisoquin sulfate decreased free DOPAC levels only. These data suggest that the two forms of plasma DOPAC (free and sulfate) may have independent topographic origins. Peripheral DA pools seem to be the most likely sources for plasma free DOPAC whereas central dopaminergic neurons mainly contribute to plasma sulfated DOPAC. Our findings thus demonstrate that plasma DOPAC sulfate may be a useful indicator for central DA function in rat. Although further experiments are necessary to extrapolate our findings from rat to man, arguments are given indicating that measurements of plasma DOPAC sulfate might be of interest in human pathological and pharmacological investigations.
Two cases of calcaneum "stress" fractures are reported. The fracture, which was unilateral in the first case and bilateral in the second, occurred 15 and 18 months respectively after the initiation of fluoride treatment for osteoporosis. The simultaneous discovery of thyrotoxicosis in the second patient suggests that the role of hyperthyroidism in the occurrence of these fractures be discussed in addition to that of fluoride treatment.
We have developed a method to selectively estimate free, glucuronidated and sulfated catecholamines (epinephrine [E], norepinephrine [NE], dopamine [DA]) in a single plasma sample. The method incorporates the first step of the catecholamine radioenzymatic assay and the selective enzymatic hydrolysis of conjugates by glucuronidase or sulfatase preparations. The method has been applied to rat and human plasma with a view to determine the relative importance of either conjugate (sulfate or glucuronide) toward free catecholamines. No previous reports were available for the concentration of either conjugate in rat plasma or the level of glucuronide conjugate in human plasma. Both sulfate and glucuronide conjugate of the three catecholamines were found in rat and human plasma, at different levels. Sulfate conjugates predominated in man and glucuronides in rat. In human, hand immersion in ice water for three minutes, which increased free catecholamine levels in the first minutes of the test, elicited too a delayed increase of glucuronide levels at the 30th minute (except for DA glucuronide which was already elevated at the third minute). As to the sulfates, only E sulfate was increased at the 10th minute. Our results suggest that glucuronidation may be an important pathway for catecholamine metabolism in man at rest or under sympathetic stimulation. In rat, our data point out the influence of blood sampling conditions (dietary, catheterization, decapitation) on the studied compounds and suggest that the nearest conditions from basal state may be fulfilled in sucrose-fed catheterized rats. The predominance of glucuronides in rat plasma agrees with previous metabolic reports.
The metatarsal intercapital space is located in the forefoot, between two metatarsal heads and above the transverse inter-metatarsal ligament. The 2nd space is the narrowest, the 1st is the widest and the 3rd is the most mobile. It contains a connective tissue bursa which facilitates the sliding of the metatarsal heads. The existence of this bursa was confirmed in two cases of rheumatoid arthritis (at operation). As the bursa hypertrophies, it gradually extends beyond its normal site towards the dorsal or plantar region of the foot. The metatarsal intercapital space, like the metatarso-phalangeal joint, warrants thorough clinical investigation.
Catecholamine and metabolite excretion was studied in the cat after 6 h of 7.5% O2 hypoxia. Norepinephrine (NE) release from sympathetic nervous endings was strongly activated, whereas epinephrine (E) excretion was only slightly increased. A noteworthy result was the increase of dopamine (DA) and its metabolites [3-methoxytyramine (MT); 3,4-dihydroxyphenylacetic acid (DOPAC)] in urine samples. This increased release does not seem to originate from the central nervous system, but rather from peripheral dopaminergic structures; available knowledge on peripheral DA suggests that the hypoxia-induced DA release might be partly related to chemosensory or renal function. Indeed, in addition to enhanced DA and NE excretion, we observed an increase in sodium excretion that correlated with both DA and NE. Analysis of free and conjugated urinary metabolites showed that only free NE and both free and conjugated normetanephrine were increased in urine after hypoxic stress. Among DA metabolites, conjugated DOPAC was the main DA metabolite in the basal state and after hypoxia. Both the free and the conjugated forms of DA, MT, and DOPAC were increased by hypoxia.
Based on 20 years experience, and a personal series of 272 cases of reflex dystrophy (84 cases involving upper limbs, 188 cases involving lower limbs) admitted under a rheumatology unit equipped with all the available techniques of rehabilitative medicine, the authors stress the value of well conducted functional rehabilitation which, even alone, can obtain excellent results in the treatment of this disease, whatever the stage. The authors detail the modalities of this treatment. A local intra-articular or intra-canal injection of corticosteroids permits pain-free physiotherapy. The mobilisation of the lower limb is an urgent priority. Non-aggressive physiotherapeutic techniques should be adapted to the stage and the site of reflex dystrophy. Hydrokinesitherapy and the adaptation of craft techniques to occupational therapy also play an important part.
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We have found different patterns of adrenergic response to insulin-induced hypoglycemia in men and women. The differences involve the readiness of adrenergic reactivity, the magnitude of the responses, and the nature of secreted amines. In men, a strong and transient discharge of epinephrine (E) is observed in plasma, corresponding to a great increase in the urinary level of this amine in the 2 h period following insulin. In women, the adrenergic response is delayed and consists of moderately increased amounts of E and norepinephrine (NE) which persist in plasma for a longer period. From the correlations observed between urinary amount and the increase of plasmatic catecholamines after 30, 45, and 60 min, it may be assumed that urinary data may reflect the cumulative plasma levels of catecholamines in the corresponding period, but not the precise pattern of plasmatic changes. Our findings show that the differences in adrenergic behavior previously observed in men and women under the effect of psychological stress, may also be induced by a metabolic stimulus such a insulin hypoglycemia; however, women, but not men, exhibit a mild release of NE under this metabolic stress.
Deformations of the foot are a logical and predictable function of the biomechanics of the foot and the constraints undergone by the articulations of the foot, that are unstabilized by the inflammatory process. They result from the combination of three factors : anevolutive teno-articular synovitis, predictible forces (the weight of the extrinsic muscle, the anti-physiological foot), and the congenital morphotype of the foot. Typical deformations (peroneal " coup de vent " of the toes, triangular metatarsus), differ on the clinical level in keeping with the morphotype but respond to the same mechanism. The " coup de vent peronier " remains the most characteristic deformation and is furthered by the excentric action of the extrinsic muscles, and in particular the foot muscle. The common denomination of deformations of the back part of the foot is represented by the valgus calcanean, linked to the action of the weight on the orsion forces that is more or less modified. A better knowledge of the cause of these deformations would make it possible to avoid, if not their apparition, at least their worsening.
Meralgia paresthetica although it does not produce intensive pain is a cause of chronic disability, usually barely improved by medical treatment. From the report of two cases of neurolysis the authors stress on the possibility of entrapment neuropathy of the lateral femoral cutaneous nerve in its way through the femoral canal, between the inguinal ligament and the fascia-iliaca. Anatomically, there is in this canal a normal right angle between the horizontal portion (abdominopelvic) and the vertical course in the thigh. The compression is due to a thickening of the fascia-iliaca as it forms the postero inferior wall of this canal; the nerve is squeezed between the fascia and the inguinal ligament. In 60% of cases of meralgia paresthetica where this mechanism is involved, the funicular neurolysis appears to be a radical treatment.