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J P Valat

Publications and source records attributed to J P Valat.

At least 19 recordsLinked to original sources
PubMed1995

Massive osteolysis of the cervical spine. A case report.

STUDY DESIGN: This study described the course of a case of massive osteolysis (Gorham's disease) of the cervical spine and discussed the literature data. OBJECTIVES: To describe a case of massive osteolysis of the cervical spine with fatal outcome and to discuss the classification of the disease among osteolysis and its therapeutic modalities. SUMMARY OF BACKGROUND DATA: Massive osteolysis is a rare condition (fewer than 100 cases reported in the literature) of unknown etiology, which may involve any bone in the body, with a propensity for the shoulder and pelvic girdle. Few cases of cervical spine involvement were reported. METHODS: The case of a 32-year-old man with fatal progressive massive osteolysis of the cervical spine despite multiple attempts to achieve surgical stabilization was reported. RESULTS: Massive osteolysis was characterized by complete destruction of all or part of a bone by angiomatous tissue and may have represented a local disturbance of osteoclastic activity. No successful therapy was proposed, and the prognosis of spine involvement was very poor. CONCLUSIONS: Massive osteolysis is a rare condition with no successful therapy. The hypothesis of involvement of circulating preosteoclasts in the osteolytic process may suggest treatment attempts with diphosphonates because of the futility of standard bone grafting techniques in spine involvement.

Adult↗
PubMed1995

Psoriatic onycho-periostitis. Report of three cases.

Authors report three cases of psoriatic onycho-periostitis (great toe in two cases, thumb in one case). In a recent study, they demonstrated that osteoperiostitis of the distal phalanx of the great toe was significantly more frequent in patients with psoriatic arthritis than in other groups (cutaneous psoriasis, rheumatoid arthritis, spondylarthropathy, connective tissue diseases, and control subjects), suggesting that the existence of osteoperiostitis of the distal phalanx of the great toe is valuable for the diagnosis of psoriatic arthropathy.

Adult↗
PubMed1994

Plant thorn synovitis diagnosed by magnetic resonance imaging.

Plant thorn synovitis is an overlooked cause of monoarthritis, with difficulties in diagnosis and treatment (1). We report on a case of thorn induced synovitis, not confirmed by histopathology, but strongly suspected by magnetic resonance imaging (MRI), that visualizes the foreign body (first case reported).

Adult↗
PubMed1994

[Automated percutaneous nucleotomy. Results in 50 patients].

Automated percutaneous discectomy was introduced by Onik et al. in 1985 for the treatment of lumbar disk herniation. Success rates have ranged from 42% to 86%. We evaluated efficacy and looked for factors with a bearing on outcome in a retrospective study of 50 patients. Patients who did not have subsequent surgery were evaluated at least six months after the procedure, using the criteria developed by Mac Nab and by Stauffer and Coventry. The procedure was successful in 31 patients (62%) and failed in 19 (38%). Thirteen patients with failed automated percutaneous discectomy required surgery. Severe disk degeneration was significantly predictive of treatment failure. Lumbar spinal stenosis was also associated with lower success rates. Two patients developed infectious discitis after the procedure. Automated percutaneous discectomy may be less satisfactory than nucleolysis. Further studies are needed to determine the role and efficacy of this method for the treatment of lumbar disk herniation.

Adolescent↗
PubMed1993

[Denervation of the posterior lumbar vertebral apophyses by thermocoagulation in chronic low back pain. Results of the treatment of 103 patients].

The facet syndrome seems to be a common cause of low back pain. Percutaneous radiofrequency lumbar facet denervation, developed by Shealy, may be of therapeutic value in facet syndrome patients. This method consists in thermocoagulation of the middle branch of the dorsal primary ramus of the spinal nerve. The authors report their experience with this technique in a retrospective series of 103 patients with chronic low back pain ascribed to facet syndrome. Results were evaluated after 6 and 24 months using a questionnaire and the Stauffer and Coventry classification. Among the 86 patients who completed the questionnaire, 38.4% considered the treatment successful, whereas 61.6% considered that it had not been of benefit. According to the Stauffer and Coventry classification, there were 20.9% excellent results, 22.1% fair results, and 57% failures. Results were better in those patients with a negative history for surgical discectomy. Success rates reported in the literature vary widely, from 14% to 76%. Interpretation of these data is difficult since studies used a broad range of treatment techniques, evaluation methods, and patient selection criteria. A prospective study using stringent inclusion criteria and appropriate evaluation criteria taking quality of life into account is needed to determine the role of percutaneous facet denervation among other treatment options available to low back pain patients.

Adult↗
PubMed1993

[Injection into the lumbar vertebrae in chronic low back pain. Results in 206 patients].

Facet syndrome is an apparently common although not readily identifiable cause of low back pain. To evaluate the efficacy of corticosteroid facet joint injection for the treatment of low back pain, we retrospectively studied 206 patients with low back pain ascribed to facet syndrome. Effectiveness was evaluated on the basis of a clinical score and of a questionnaire completed 10 to 34 months after treatment. Success rate was 53.9% according to the clinical score (23.3% excellent results and 30.6% average results) and 41.74% according to the questionnaire. Results were better in patients who were not gainfully employed and had a negative history for occupational injury and surgical discectomy. Success rates in earlier studies varied from 22% to 76% in the short term and from 8% to 62% in the long term. These broad ranges denote substantial variations in evaluation criteria and patient selection. Only two placebo-controlled trials have been performed. There is a need for a prospective study with strict inclusion criteria and appropriate evaluation criteria taking quality of life into account to determine the role of facet joint injection in low back pain.

Adult↗
PubMed1993

The temporomandibular joint in rheumatoid arthritis: correlations between clinical and tomographic features.

Clinical and radiological involvement of the temporomandibular joint (TMJ) in rheumatoid arthritis (RA) varies greatly in the literature. Clinical and tomographic (sagittal plane) examination of the TMJ was performed in 26 patients with RA and 26 control subjects. Sixty-one per cent of the RA group had physical signs in the TMJ, compared with 42% in the control group (NS). Sixty-nine per cent of the RA group had erosive or cystic lesions of the TMJ compared with 31% of control subjects (P < 0.01). The clinical dysfunction score did not correlate with the tomographic TMJ score in patients with RA. It was found that a wide range of tomographic abnormalities occurs in patients with RA and in patients without the disease, and that there are no tomographic abnormalities specific for RA; however, the incidence of erosions and cysts of the mandibular condyle are significantly higher in patients with RA (P < 0.01), and should suggest the diagnosis. It was also found that there is no correlation between the clinical and tomographic findings of the TMJ in RA, and that the intensity of destructive lesions of the TMJ on tomography in RA is well correlated to the severity of the disease (evaluated with clinical and laboratory features).

Arthritis, Rheumatoid↗
PubMed1993

[Value of standard radiographies in the diagnosis of rotator cuff rupture].

To assess the value of the Leclercq maneuver (anteroposterior roentgenogram of the shoulder during resisted active abduction) for the diagnosis of rotator cuff tear, the medical records of 93 patients evaluated by glenohumeral arthrography, standard radiographs, and radiographs taken using the Leclercq maneuver were retrospectively reviewed. The comparison of patients with (n = 53) and without (n = 40) arthrographic evidence of rotator cuff tear demonstrated statistically significant differences for mean acromiohumeral space difference between the normal and affected shoulders, for the acromiohumeral space difference between the standard film and Leclercq maneuver film, and for presence of an inferior glenohumeral diastasis on the Leclercq maneuver film. An acromiohumeral space of 7 mm or less on standard radiographs proved a specific (0.975) but insensitive (0.24) sign of rotator cuff tear. This parameter measured on the Leclercq maneuver film exhibited better sensitivity (0.62) and excellent specificity. Other criteria with good specificity for rotator cuff tear included an acromiohumeral space difference between the normal and abnormal side of 2 mm or more (0.97), an acromiohumeral space difference between standard and Leclercq maneuver films of at least 4 mm, and existence of an inferior glenohumeral diastasis; however, sensitivities of these three parameters were poor (respectively 0.65; 0.20; and 0.19).(ABSTRACT TRUNCATED AT 250 WORDS)

Arthrography↗
PubMed1992

Treatment of psoriatic arthropathy.

Psoriatic arthritis develops in 5% of patients with cutaneous psoriasis. Management is similar to that of other chronic inflammatory joint diseases, and the characteristic features of psoriatic arthritis should be considered: the disease is usually mild, with unpredictable flares and remissions, and skin disease is a concomitant feature. Nonsteroidal antiinflammatory agents are the mainstay of therapy and usually provide adequate control. Among long-term treatments, parenteral gold salts, methotrexate, and azathioprine have been shown to be effective. Retinoids are often used in patients with extensive skin lesions. Other treatments are currently being evaluated (auranofin, colchicine, D-penicillamine, sulfasalazine, cyclosporine, and gamma-interferon). Antimalarials are difficult to handle and may cause progression of skin lesions. Topical treatments are indicated in every case. Indications depend on the specific features of psoriatic arthritis, the clinical pattern, and the severity of the condition.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Discitis after lumbar disc surgery. Features of "aseptic" and "septic" forms.

Two major types of postoperative discitis have been previously described: septic discitis and "avascular" or "chemical" discitis. Percutaneous discal biopsy is an important way of distinguishing these entities. In a retrospective study of 25 cases of postoperative discitis, three groups have been analyzed with bacteriologic and histologic tests: a group of nine patients (group A) with positive discal bacteriologic cultures; a group of eight patients (group B) with typical septic histologic tests but negative bacteriologic discal procedures; and a group of eight patients (group C) in whom the histologic picture was reminiscent of a mechanical process. No group was unique in any clinical and radiologic parameter. Group A and group B were quite similar in biological features, but group C had erythrocyte sedimentation rate and C-reactive protein serum levels significantly lower than groups A and B (P less than 0.01). After 4 weeks, these differences were still present. This study confirms that there are two main features of postoperative discitis that can be recognized by histologic and biological tests, allowing for different treatments.

Biopsy↗
PubMed1992

Direct coronal computed tomography of the temporomandibular joint in patients with rheumatoid arthritis.

Direct coronal computed tomography (CT) of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p < 0.05) but there was no significant difference in the incidence of other abnormalities. Bone changes were bilateral in RA. A wide range of CT abnormalities was present in patients with RA and in the control group. There are no CT abnormalities specific for RA, but the incidence of erosions and cysts of the mandibular condyle was significantly higher in the RA group and should suggest the diagnosis.

Arthritis, Rheumatoid↗