Biomedical subjects
J Dequeker
Publications and source records attributed to J Dequeker.
Ileocolonoscopy and spondarthritis.
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Mineral metabolism and bone mass at peripheral and axial skeleton in diabetes mellitus.
Bone mineral content (BMC), mineral homeostasis, and diabetes control were evaluated in 31 Caucasian insulin-dependent diabetic patients (disease duration 18.3 +/- 7.7 yr, mean +/- SD) with normal kidney function. To evaluate bone mass, we performed radiogrammetry and single- and dual-photon absorptiometry. In women, a significantly lower mean BMC was found in the distal radius, at a mixed trabecular-cortical (P less than .01) and a cortical (P less than .05) site, as well as in the lumbar spine (P less than .02). In diabetic men, mean BMC was significantly reduced at the trabecularcortical (P less than .01) and cortical (P less than .05) sites of the radius but not in the lumbar spine. When expressed as densities (i.e., BMC/width or lumbar BMC/area), only the BMC/width at the radius cortical area was significantly reduced in women (P less than .05). The results of the radiogrammetry showed a larger endosteal diameter in the diabetic women, resulting in a significantly lower cortical thickness (P less than .05). Diabetic men did not show abnormalities on radiogrammetry. Diabetic patients had diminished serum calcium and phosphorus concentrations (P less than .001), whereas serum parathyroid, 25-hydroxyvitamin D3, and concentrations of both total and free 1,25-dihydroxyvitamin D3 were normal. No correlation between parameters of diabetes control (HbA1, insulin dose, and triglycerides) or calcium-regulating hormones and BMC were found. These data confirm that, despite large overlap of individual values, mean bone mass at the peripheral skeleton is significantly decreased in diabetic patients. Moreover, we report that the BMC of the lumbar spine is significantly reduced in female diabetic patients.
Whipple's disease in a patient with longstanding seronegative polyarthritis.
We describe a middle-aged woman with Whipple's disease. She suffered from a seronegative rheumatoid-like polyarthritis for more than 20 years before the diagnosis of Whipple's disease was made. This case shows that arthritis may be a feature of occult Whipple's disease. Without gastrointestinal symptoms, diagnosis is very difficult. Diagnosis is important because treatment can rapidly improve this life-threatening disease.
Staging and follow-up of rheumatoid arthritis of the knee. Comparison of sonography, thermography, and clinical assessment.
Twenty patients with longstanding polyarticular rheumatoid arthritis (including knee involvement) were selected for this study. The severity of the knee synovitis was assessed before and during treatment (with intra-articular corticosteroid injections) using clinical scores, sonography, and thermography. In all patients, the inflammation regressed during treatment. During follow-up, the quantity of synovial fluid, as measured sonographically 10 days after the start of therapy, correlated best with the clinical status. Maximal regression of synovial thickening was noted on delayed sonograms performed three months after treatment. Thermographic peak temperature showed good correlation with the clinical status, but the thermographic index was unreliable.
Diagnosis of rheumatoid arthritis.
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Candida parapsilosis in a patient receiving chronic hemodialysis.
A case of Candida parapsilosis involving the left wrist in an immunocompromised host is described. The arthritis followed an indolent course, present for about 1 year before specific treatment was started. There was no response to 2-month ketoconazole therapy, and an open drainage had to be performed. In addition to crystal arthropathies and the more common infectious arthritides, one should be aware of arthritides with opportunistic microorganisms in immune compromised hemodialysis patients.
D-penicillamine therapy and interstitial lung disease in scleroderma. A long-term followup study.
Sequential lung function tests were performed on 17 scleroderma patients who were treated with D-penicillamine (DP) (total of 66 treatment years) and on 10 control scleroderma patients who were not treated or were treated with low-dose prednisone (total of 25 treatment years). Cusum plots showed significant differences between the 2 groups in their cumulative changes in carbon monoxide diffusing capacity (DLCO) (P less than 0.005) and in DLCO/lung volume (P less than 0.02). The end value of the DLCO was greater than 10% lower than the initial value in 3 of the 17 DP-treated patients versus 5 of the 10 control patients (P less than 0.01, Fisher's exact probability test); in 3 DP-treated patients and 8 control patients (P less than 0.003, Fisher's exact probability test), the end value of the DLCO/lung volume was greater than 10% lower than the initial value. We conclude that DP has a beneficial effect on interstitial lung disease in patients with scleroderma.
Genetic determinants of bone mineral content at the spine and radius: a twin study.
The possible role of genetic and/or environmental factors in determining bone mass has been investigated in 30 pairs of twins (16 monozygotic and 14 dizygotic) divided in two age groups (below and above 25 years of age). Bone mineral content was evaluated by single- and dual photon absorptiometry at the distol third of the radius for peripheral cortical bone and in the lumbar spine for the axial bone. The "within pair" variance has been used as an index of genetic influence. A significant (p less than 0.01) genetic determinant was found for the bone mass of the radius in adults and for the spinal bone mass in the age group younger than 25 years. The heritability index h2 was 0.75 for cortical BMC and 0.88 for axial BMC. Such a genetic determinant could not conclusively be demonstrated in adult twins for the spine and in youngsters for the cortical bone, suggesting that environmental factors may play a more dominant role in growth of cortical bone during adolescence and diminution of axial bone during adult life.
Studies on EDTA extracts and collagenase digests from osteoporotic cancellous bone of the femoral head.
Using EDTA extraction and collagenase digestion, cancellous bone of the femoral heads from 10 normal and 9 osteoporotic subjects were analyzed for their contents of collagen, sialoprotein, proteoglycan and carbohydrate. The percentage of extracted matrix proteins of the osteoporotic bone in EDTA was significantly decreased, as was the collagenase-resistant fraction (p less than 0.05). The sialic acid level in osteoporotic bone matrix was lower than in controls (p less than 0.05). The alterations found in bone matrix constituents in osteoporotic bone relative to controls suggest that in osteoporosis and fractures, not only bone mass changes, but also bone quality changes play a role in bone strength.
Collagen and non-collagenous protein content (osteocalcin, sialoprotein, proteoglycan) in the iliac crest bone and serum osteocalcin in women with and without hand osteoarthritis.
Quantitative and qualitative variations in bone composition were studied in postmortem iliac crest bone specimens from 32 women aged 60 to 75, grouped according to the presence of osteoarthritis at the hand joints. The EDTA extraction yield of macromolecules was significantly greater in the osteoarthritis group. Collagen and osteocalcin content were significantly increased and proteoglycan content decreased in the osteoarthritis group. No difference in sialoprotein content was found. In a clinical study of 20 patients with generalised osteoarthritis, we found compared to 15 controls also significantly increased serum levels of osteocalcin. These results indicate in an unselected group of cases that differences in bone matrix constituents exist between elderly women with and without an osteoarthritic constitution. The finding that these alterations are present even far away from the articular lesion, and the fact that the serum osteocalcin levels are elevated, indicate that osteoarthritis is part of a more generalised bone disease and not a purely cartilage disease.
Systematic ileocolonoscopy and bowel biopsy study in spondylarthropathy.
In order to evaluate the frequency of ileitis in a population of patients with spondylarthropathy, an ileocolonoscopy with biopsies was performed in 88 consecutive patients with back pain and/or asymmetric oligoarthritis. Ileitis was more frequent in both the oligoarthritis group (7/36), especially in the non-Reiter's subgroup without known distant infection (5/17), and in the spondylitis group (12/28), when compared to the control group (1/24). This was statistically significant only in the latter group (chi squared 10.317, df1, p less than 0.005). These results do not confirm the very high frequency of ileitis in oligoarthritis reported by others. The clinical significance of this ileitis needs further research.
Biochemical anatomy of human bone: comparative study of compact and spongy bone in femur, rib and iliac crest.
Using EDTA extraction procedure, compact and spongy bone from human femur, rib and iliac crest were compared in terms of their content in collagen, sialoprotein, proteoglycan and carbohydrate. The bone matrix sizes displayed significant variations, the femur having the smallest size and iliac crest the largest one. No significant difference in the matrix size has been found between the spongy and compact bone. The EDTA extractability of the spongy bone was higher than that of the compact bone, with femur showing the lowest extractability. The collagen content of the 3 bones studied was similar although the femur had slightly lower values. The sialic and uronic acids and hexose contents were higher in the femur than in the rib and iliac crest. The collagen/hexose, collagen/sialic acid and collagen/uronic acid ratios in the bone matrix were highest in the iliac crest and lowest in the femur, suggesting that alterations in the amounts of bone matrix can affect the mechanical properties of different parts of the bony skeleton and vice versa.
The inverse relationship between osteoporosis and osteoarthrosis.
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Rheumatoid lymphedema.
Edema of the upper limbs is described in 3 men with rheumatoid arthritis. In all cases abnormal lymph vessels were documented on lymphography. Lymphangitis may explain the anomaly.
Immunomodulatory effects of treatment with naproxen in patients with rheumatic disease.
We evaluated the effects of a nonsteroidal antiinflammatory drug, naproxen, on phytohemagglutinin (PHA)-induced lymphocyte proliferation. When added in vitro to cultures of peripheral blood mononuclear cells, naproxen enhanced the proliferative response toward PHA of lymphocytes from rheumatoid arthritis (RA) patients but not from healthy volunteers, and it reduced prostaglandin E2 (PGE2) synthesis in the cultures. Oral treatment for 7 days with naproxen also resulted in a significant enhancement of the in vitro PHA-induced proliferation of lymphocytes from RA patients and from age-matched control patients with noninflammatory rheumatic diseases, but not from young healthy controls. This enhancement of PHA-induced lymphocyte proliferation after oral intake of naproxen was not accompanied by diminished in vitro PGE2 production in the cultures. It did occur when PGE2-producing monocytes were removed and when in vitro PGE2 synthesis was blocked with indomethacin. We conclude that oral treatment with naproxen has an immunomodulatory effect and improves in vitro PHA-induced proliferation of lymphocytes from rheumatic disease patients. This effect is not due to reduced PGE2 synthesis in the in vitro cultures, but reflects a more fundamental in vivo change in immunoregulation.
Regional variation of bone matrix components in osteoarthrotic and normal femoral heads.
Three regios of cancellous bone, two subchondral and one central, from the femoral heads of five normal and ten osteoarthrotic individuals were analysed for their content of collagen, sialoprotein, proteoglycan and carbohydrate. Confirming previous findings in osteoarthrotic bone this study shows that there are significant quantitative changes in matrix composition consisting of a decrease in collagen content and increase in noncollagenous proteins in osteoarthrosis. Since these matrix alterations were present in all areas of the femoral head, also at areas distal from the subchondral area, it is unlikely that these changes are secondary to bone remodeling near the joint destruction. Difference in matrix composition according to the area of the femoral head was also found in the controls, indicating that bone matrix proteins are related to mechanic properties of the bone. The more stress the bone has to withstand, the lower the collagen/noncollagenous protein ratio in its matrix. These observations suggest that in osteoarthrosis, the bone is stiffer and can therefore absorb less well impact loading and by transmitting it back to the cartilage provokes cartilage dysfunction.
Bone mineral content, cortical thickness and fracture rate in osteoporotic women after withdrawal of treatment with nandrolone decanoate, 1-alpha hydroxyvitamin D3, or intermittent calcium infusions.
Twenty-six post-menopausal osteoporosis patients were studied prospectively over a 2-yr period after the cessation of 2 yr of treatment with either nandrolone decanoate (anabolic steroid), 1 alpha hydroxyvitamin D3 or intermittent calcium infusions, the total observation period being 4 yr. Serial evaluations of bone mineral content in the radius, cortical thickness of the metacarpals and spinal roentgenograms were obtained. Nine patients who had been treated with 50 mg nandrolone decanoate every three weeks did not lose bone from the radius or the metacarpals during the 2 yrs following withdrawal of therapy. Eight patients who had received 1 microgram/day of oral 1 alpha hydroxyvitamin D3 retained a positive bone mineral content in the radius but lost cortical thickness from the metacarpals after withdrawal of therapy. Nine patients who had been treated with intermittent calcium infusions over 12 consecutive days annually did not lose further bone mineral content from the radius, but did lose cortical thickness at the expected rate during the 2-yr post-treatment period. The fracture rate at the end of the 4-yr observation period was 40% lower in the nandrolone decanoate group than in the 1-alpha-hydroxyvitamin D3 and calcium infusion groups. The results of this study indicate that, in contrast to oestrogen and calcium therapy, nandrolone decanoate and 1-alpha-hydroxyvitamin D3 have lasting beneficial effects, and that data obtained by photon absorptiometry do not always coincide with those obtained by radiogrammetry. These findings are highly relevant to the design of future therapeutic trials.