Erosive azotemic osteoarthropathy: possible role of amyloidosis.
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Biomedical subjects
Publications and source records attributed to J Malghem.
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Spondylolysis is generally regarded as a stress-fracture acquired early in life by predisposed persons. However, the early stages of spondylolysis are seldom recorded in clinical practice. This can be explained by the fact that the delayed roentgenological detection of early stress lesions of bone in general, is aggravated by technical difficulties encountered at the level of the low lumbar spine. Consequently, healing of spondylolysis is extremely scarce in the experience of most clinicians who essentially observe old and usually inactive pars separations. Therefore, two radiological patterns of developing spondylolysis are stressed: 1: an isolated stress sclerosis of both pedicle and pars, reflecting the overload of the corresponding posterior elements and 2: partial cracks of the isthmus starting at its antero-inferior cortex, near the pedicle. Such developing defects were observed in 20 patients: in 5 cases of primary spondylolysis, as an isolated finding, and in 15 other cases during formation of a pars defect at the opposite side of a primary unilateral spondylolysis. Bilateralization of primary unilateral defects is indeed a common sequence of events. In addition, healing of bilateral defects of L4 or L5 was observed in 7 adolescent patients: 5 boys and 2 girls aged 8 to 16 (mean 12.5). The corresponding defects were invariably of recent origin. Therefore, in case of low back pain in adolescent patients engaged in athletic activities, it should be remembered that routine roentgenograms showing an apparently normal pars do not completely rule out a developing defect. In such cases, a repeated X-ray study with close scrutiny of the pars could then reveal an early spondylolysis which is still apt to heal.
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Facet joint arthrography was performed in 11 patients with lumbar spondylolysis. An abnormal communication between the two facet joints bordering the separated par interarticularis was observed in nine of these patients. This communication occurred through a channel in the area of the defect. In one patient with bilateral spondylolysis of the L5 vertebra, both left adjacent apophyseal joints were observed to communicate not only with one another, but also with the contralateral facet joints, through a transverse channel joining the isthmic areas of L5. Significant pain relief following intra-articular administration of anesthetics and corticosteroids was recorded in 5 patients, for periods lasting from 2 to 10 months. Spondylolysis considerably alters the soft tissues of the adjacent facet joints. Irritation of these structures might explain certain complaints of patients with spondylolysis.
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Abnormal radiological opacities are sometimes observed after intra-articular injection of osmic acid. These opacities are radio-opaque because osmium is a heavy metal (atomic number = 76). They are usually found near the suprapatellar pouch which is the usual injection site. A parasynovial injection (or back flow from the joint cavity) of some of the osmic solution, followed by concentration and fixation of the osmic deposits at this level, seems to be the cause of these radiological opacities. This could be the reason for the poor clinical results encountered in some cases of osmic acid therapy followed by such deposits.
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