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Biomedical subjects

J Sany

Publications and source records attributed to J Sany.

At least 163 records · Page 9Linked to original sources
PubMed1987

Serum bone gla-protein in multiple myeloma.

Serum bone gla-protein (SBGP), a marker of bone formation, was measured by radioimmunoassay in 57 patients with multiple myeloma (MM) and correlated with presenting features and disease activity. As a whole, patients with MM did not differ from normal controls or from patients with a monoclonal gammopathy of undetermined significance, but a significant percentage of abnormal values of SBGP was found in this MM population (18% of cases, P less than 0.005). At the time of diagnosis, SBGP was significantly lower in advanced disease (Stage III) than in less active disease (Stage I and II) with mean values of 4.4 +/- 2.7 ng/ml and 7.1 +/- 1.9 ng/ml, respectively (P less than 0.02). SBGP levels inversely correlated with the severity of the disease, the lowest values being observed in patients with extensive lytic bone lesions frequently associated with hypercalcemia (2.9 +/- 1.7 ng/ml). These data suggest the presence of a strong osteoblastic inhibition, at the body level, in the majority of patients (80%) with active osteoclastic MM (uncoupled process). However, a small subset of myeloma patients (20%) presented coupled MM, as defined by increased bone resorption (i.e., lytic bone lesions +/- hypercalcemia) and increased bone formation (i.e., increased SBGP values). Similar features of coupling-uncoupling were observed during disease progression. Finally, serial studies performed in 15 patients confirm these findings and the relation of SBGP levels to disease activity. Of major interest was the observation of a return of SBGP levels from low to normal values during remission induction, after successful completion of a plateau phase. According to these data, SBGP appears to be a new and promising marker for the clinical evaluation of MM.

Adult↗
PubMed1987

Prospects in the immunological treatments of rheumatoid arthritis.

Different trends in the therapeutic immunomodulation of rheumatoid arthritis (RA) have been developed since a few years. Early treatment and/or combined treatments using 2 or 3 classical remission inducing drugs could improve the clinical results. Diet and especially eicosapentanoic acid could influence the clinical signs of RA. Among the non specific immunodepressive agents, methotrexate is of major interest. Immunodepressive agents partly selective of a lymphocyte subpopulation: cyclosporin A, total lymphoid irradiation, act on CD4 cells. Some experimental immunomodulating drugs are under study: type II interferon, thymic hormones, immunoglobulins of placental origin. The specific immunotherapy of RA is still experimental and only used in animal with very promising results. Anticlass II HLA monoclonal or polyclonal antibodies could be one of the major treatments of autoimmune diseases within a few years. The treatment of RA by anti-idiotype antibodies remains, at this moment, theoretical.

Adjuvants, Immunologic↗
PubMed1987

[Contribution of bone biopsy with histomorphometry in the evaluation of monoclonal gammopathy].

Histomorphometric analysis of bone specimen from the iliac crest was performed to determine total trabecular resorption surface (TTRS) in 46 patients presenting with a monoclonal gammopathy, which was benign in 17 cases and malignant in 29 others. In benign gammopathies, 14 patients had normal TTRS; no adverse progression, representing a malignant B-cell lymphoproliferative disorder occurred after 40 months of follow-up. The three other patients presented increased areas of resorption in contact with lymphoplasmocyte nodules or pure plasmocytes and had an unfavorable course: multiple myeloma, Waldenström's disease, and chronic lymphocytic leukemia. In myeloma, an increase in TTRS was observed when the bone marrow is invaded confirming the dominant local activity of an "osteoclast activating factor". TTRS is all the more extensive according to bone marrow invasion or in IgA or light chain myeloma, all of which are especially destructive of bone. It thus appears that determination of TTRS by bone histomorphometry is of diagnostic importance to recognize the benign or malignant nature of the disorder and has prognostic value in case of multiple myeloma. Bone histomorphometry thus appears as a useful tool in the thorough assessment of monoclonal gammopathies.

Biopsy↗
PubMed1987

Regulation of interleukin-2 production in rheumatoid arthritis.

The regulation of interleukin-2 (IL-2) production was investigated using mononuclear cells from synovial fluid (SF) and peripheral blood of 12 patients with classical and active rheumatoid arthritis. Decreased phytohemagglutinin (PHA) stimulated IL-2 production by lymphocytes was observed in rheumatoid peripheral blood (5.3 +/- 10.9 units/ml) and SF (3.8 +/- 5.2 units/ml) compared to peripheral blood from 12 normal donors (18.1 +/- 15.4 units/ml) and SF from 5 patients with other rheumatic diseases (11.9 +/- 10.9 units/ml). Indomethacin, phorbol myristate acetate and irradiation of suppressor cells increased IL-2 values in rheumatoid SF and peripheral blood but did not restore normal IL-2 production. IL-2 production did not correlate with clinical activity in patients with RA.

Adolescent↗
PubMed1987

[Value of synovectomy under arthroscopy in the treatment of persistent synovitis in chronic inflammatory rheumatic diseases].

Twelve patients suffering from an inflammatory rheumatic disorder with chronic synovitis of the knee joint were treated by synovectomy using a pneumatic chondrotome under arthroscopic control in combination with abundant articular lavage. All patients had been treated with one or several chemical or radioisotopic synovial instillations followed by failure of treatment or a rapid recurrence of synovitis. Eight patients had a rapid and good or very good therapeutic result with regression of synovitis and of pain during the first month after the synovectomy. This result appears to be maintained more than one year later in the case of the first patients treated. Four patients had a manifest but incomplete improvement. Postoperative follow-up was unremarkable, hospitalization period was short, and no physical rehabilitation was necessary. However, one patient developed stiffness of the knee joint which required its movement under general anesthesia. Arthroscopy with synovectomy and articular lavage appear to offer an interesting therapeutic resolution in case of chronic synovitis unresponsive to medical measures, both locally and systemically administered. Short-term results appear better than those obtained with conventional surgical synovectomy and postoperative follow-up is much simpler.

Adult↗
PubMed1987

[Characterization of chronic lymphocytic proliferation in a female patient having rheumatoid polyarthritis with neutropenia].

The authors have studied the case of a female patient with rheumatoid polyarthritis, who developed a lymphocytic proliferation in the blood, the marrow, and the liver, associated with a neutropenia. Several similar cases have been recently reported in the literature. The cellular proliferation is made of large granulous lymphocytes and the study of membrane markers enables to find the following homogeneous phenotype: E rosette+, CD8+, HNK-1+, FcR+, CD4-luminal diameter "divided by degrees - -, IgS-, HLA class II-. This lymphocytic sub-population produces little interleukin-2, responds weakly to mitogens (PHA, CON A, PWM), and inhibits the response of normal lymphocytes to the same mitogens. These lymphocytes have a weak natural killer activity but, on the contrary, develop a very strong cytotoxic activity which is antibody-dependent. Clinically, splenomegaly, anemia and infections are frequent and hepatomegaly or thrombopenia more rare. Adenopathies are never present. The evolution is chronic in nature and not very aggressive, although the lymphocytic proliferation is monoclonal in origin, as demonstrated in molecular biology studies. The neutropenia might be secondary to an inhibiting effect of lymphocytes on the granular precursors of the bone marrow. There is a definite association between this lympho-proliferative syndrome and rheumatoid polyarthritis, and this association appears to be different from the Felty's syndrome.

Adult↗
PubMed1986

Characterization of an expanded subpopulation of large granular lymphocytes in a patient with rheumatoid arthritis.

We describe a rheumatoid arthritis patient who was found to have chronic T cell lymphocytosis and neutropenia. She had an increased number of lymphocytes in the peripheral blood, bone marrow, and liver, and the expanded lymphocyte subset consisted of large granular lymphocytes with a homogeneous phenotype. Of the previously described patients with these large granular lymphocytes, almost one-fourth have had rheumatoid arthritis.

Adult↗
PubMed1986

Importance of quantitative histology of bone changes in monoclonal gammopathy.

Quantitative histology of bone changes, using undecalcified transiliac bone biopsies (UTBB), was performed blindly in 46 individuals with monoclonal gammopathy (MG), including 17 with MG of undetermined significance (MGUS) and 29 with overt multiple myeloma (MM). Three MGUS presented an excess of osteoclastic resorption (OR) in the vicinity of clusters of tumour cells and developed overt B cell malignancies, chronic lymphocytic leukaemia, Waldenström's disease and MM respectively. On the other hand, MGUS with normal OR remained stable (median follow-up = 28 months), with one exception who developed a systemic amyloidosis. In MM, excessive OR was only observed in areas invaded by myeloma cells. OR was frequently normal in active MM lacking myeloma cells in UTBB. Active MM without lesions on radiography had excessive OR. IgA and pure Bence Jones MM appeared more osteoclastic than IgG cases (P less than 0.05). Of major interest was the finding that one third of MM presented histological bone changes similar to osteoporosis, osteosclerosis or osteoblastic metastasis. Two major findings must be emphasized from the current data: UTBB could be of major interest for the early detection of a B cell malignancy; heterogeneity of myeloma bone condition is unexpected. If some changes appear directly related to the tumour (i.e. excessive OR or osteoblastic dysfunction), some others are probably accidentally associated with it (i.e. osteoporosis), both needing treatment other than chemotherapy.

Aged↗
PubMed1986

Prognostic factors and staging in multiple myeloma: a reappraisal.

To assess the important factors in the prognosis and staging of multiple myeloma (MM), we have correlated the presenting clinical features of 147 previously untreated patients with MM with the survival duration using multiple regression analyses. We have included the three major available myeloma-staging systems (MSS), ie, Durie-Salmon (DS), Medical Research Council (MRC), and Merlini-Waldenström-Jayakar (MWJ), plus two new variables related to disease activity: the serum beta 2-microglobulin level (S beta 2M) and the instantaneous rate of bone resorption. Our study confirms the validity of the three MSS in the prediction of survival duration, with a slight but significant advantage for the DS MSS. Among single variables, S beta 2M was the most powerful indicator of prognosis (P less than .0001), serum albumin level being the only variable adding to this significantly (P = .02). Of major interest, S beta 2M alone was a better indicator than MRC and MWJMSS. Finally, S beta 2M and the serum albumin level, variables not included in the three MSS, were better indicators than the classical DS MSS and could be combined simply to give a very powerful system of stratification.

Calcium↗
PubMed1985

Human placenta-eluted gammaglobulins in immunomodulating treatment of rheumatoid arthritis.

Thirty-one patients with severe rheumatoid arthritis were treated with intravenous perfusion of human placenta-eluted gammaglobulins. These gammaglobulins, which are IgG eluted from placental tissue, have strong immunomodulating properties in vitro. Several clinical trials were tested to find the optimal useful dosage. A 50 percent improvement was considered a good result and was obtained in 60 percent of patients with rheumatoid arthritis. The best results were obtained in patients receiving 1,500 mg daily seven days each month. Six subjects had a long remission of their disease after the end of treatment. The side effects were usually minor. In all patients, an immunostimulation of lymphocyte function was shown, even when they had no improvement. A control group of patients underwent perfusion with IgG from placental blood without any clinical or immunologic effect. It is suggested that the in vivo effects of placenta-eluted gammaglobulins might be mediated by polyspecific anti-HLA-DR antibodies.

Adult↗
PubMed1985

Acute effects of salmon calcitonin in multiple myeloma: a valuable method for serial evaluation of osteoclastic lesions and disease activity--a prospective study of 125 patients.

Hypocalcemia induced by salmon calcitonin (SCT) was evaluated in 125 patients with multiple myeloma (MM) and compared with 20 normal individuals (NCs) and 20 individuals with monoclonal gammopathy of undetermined significance (MGUS). It is now well documented that the maximum hypocalcemia (M delta CA) induced in man by SCT is related to the prevailing rate of osteoclastic resorption. In patients with MGUS, the level of M delta CA was normal. Conversely, the M delta CA was significantly abnormal in patients with MM (P less than .0001 for differences between NC/MGUS patients) and was correlated with (1) initial calcium levels (P less than .001), (2) the extent of lytic bone lesions (LBLs) (P less than .01), and (3) the myeloma cell mass (P less than .001) plus disease activity. The M delta CA was found to be of predictive value for new LBLs with or without hypercalcemia and to have dramatic influence on the survival of patients with MM. We conclude that the SCT-induced hypocalcemia test is of significant importance in the evaluation of the instantaneous rate of bone resorption and in the prognosis of patients with MM.

Adult↗
PubMed1985

[Regulation of natural killer activity by adherent cells in synovial rheumatoid medium].

The activity of natural killer cells in the synovial fluid, the synovial tissue and the peripheral blood was studied in 23 patients with active rheumatoid arthritis and was found to be significantly lower than that in the blood of 28 controls. This decrease was inversely related to the erythrocyte sedimentation rate. The preincubation of mononuclear cells with indomethacin significantly increased the natural killer activity in the blood of the controls and the patients with rheumatoid arthritis, but did not have any effect in the synovial compartment. The elimination of the adherent cells increased the natural killer activity in the blood of the controls and the patients with rheumatoid arthritis, but decreased this activity in the synovium. The stimulatory effect of synovial macrophages and the suppressor effect of the blood macrophages on the natural killer activity were confirmed when the adherent and non-adherent populations were mixed and these effects were reproduced by using supernatants of total mononuclear cells. The stimulation of the natural killer activity by interleukin 2 and poly-I:C, an interferon inducer, is independent of the macrophages in rheumatoid arthritis. These results suggest a deficient natural killer activity in active rheumatoid arthritis and a difference in the modulation of these natural killer cells by macrophages in rheumatoid synovium and normal or rheumatoid arthritis blood.

Adult↗
PubMed1984

[Psoriatic rheumatism].

Approximately 5% of patients with psoriasis develop chronic inflammatory joint disease which is clearly differentiated from rheumatoid arthritis by several features; absence of prevalence in females, elective involvement of distal joints of hands and feet, negative serologic tests, usually less severe outcome and absence of systemic manifestations. Conversely, psoriatic rheumatism resembles ankylosing spondylitis inasmuch as mainly sacroiliac but also vertebral involvement is common, with, in some instances, development of a typical pelvispondylitis. Thus, psoriatic rheumatism belongs to the group of seronegative spondylarthropathies. The genetic background of psoriatic rheumatism, with the exception of predominantly axial forms which are related to HLA B27, is very similar to that of isolated psoriasis, typified in particular by the frequency of HAL B17, B13 and B38. The immunologic disorders described in psoriasis and, more recently, in psoriatic rheumatism suggest that an immunologic dysfunction probably plays a significant part in the genesis of both conditions; however, the reasons why only a small proportion of patients with psoriasis develop joint disease remain obscure.

Chronic Disease↗
PubMed1984

Polyclonal immunoglobulins in malignant plasma cell dyscrasias.

Polyclonal immunoglobulins (Ig) were measured at diagnosis and/or following chemotherapy in 226 patients with a malignant plasma cell dyscrasia (PCD), including 11 patients with solitary myeloma (SM) and 215 patients with multiple myeloma (MM). At diagnosis, Ig synthesis suppression was observed in 80.7% of patients with MM but never in case of SM (p less than 0.001). In patients with MM, there was a clear correlation between IgA or IgM levels (but not IgG) and the total body burden of myeloma cells (p less than 0.01), the lowest levels being observed in patients presenting with the highest myeloma cell mass. Of major interest, for patients evaluated following the induction of chemotherapy, an increase of Ig, from low to normal levels, was only noted in case with a myeloma cell mass regression over 90% and successful achievement of a greater than or equal to 1-year plateau period. We concluded that polyclonal Ig evaluation appeared to be of diagnostic and prognostic values in the management of malignant PCD.

Humans↗