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Biomedical subjects

L Moulinier

Publications and source records attributed to L Moulinier.

At least 37 records · Page 2Linked to original sources
PubMed1996

Membranoproliferative glomerulonephritis, p-antineutrophil cytoplasmic antibodies, and rheumatoid arthritis. Report of a case.

Many rheumatoid arthritis patients have renal dysfunction induced either by the drugs used to treat their joint disease or by the chronic inflammation. A case of rheumatoid arthritis with p-antineutrophil cytoplasmic antibodies and mesangial glomerulonephritis that progressed to type I membranoproliferative glomerulonephritis is reported. The glomerular abnormalities were diagnosed by two renal biopsies done at a one-year interval. Reasons for the first and second renal biopsies were renal dysfunction with hematuria and impure nephrotic syndrome, respectively. Unusual features in this case include the succession of two histologic forms of glomerular disease in a patient with rheumatoid arthritis, the correlation between p-antineutrophil cytoplasmic antibody titers and activity of the renal disease. In addition, type I membranoproliferative glomerulonephritis is exceedingly rare in rheumatoid arthritis patients.

Aged↗
PubMed1996

Pamidronate infusions for the treatment of Paget's disease of bone.

Effective pamidronate dosages in Paget's disease of bone have not yet been determined. We prospectively compared two pamidronate dosages (60 mg and 120 mg) in 26 patients whose baseline alkaline phosphatase level was at least two-fold the upper limit of normal. Pamidronate was given as three-hour infusions of 60 mg each. Follow-up was two years. The two groups were comparable at baseline except for higher alkaline phosphatase and hydroxyproline levels in the group treated with 120 mg pamidronate. Efficacy on laboratory parameters was greater in the higher dosage group. Osteocalcin levels showed little change. In both dosage groups, alkaline phosphatase levels fell significantly versus baseline, and the difference persisted throughout the two-year follow-up. Urinary hydroxyproline excretion remained significantly reduced versus baseline during the first 12 months and rose subsequently. A return to normal of the two study parameters six months after treatment was associated with longer duration of the biologic treatment response. A survival curve analysis confirmed this finding and suggested that a return to normal of laboratory parameters was predictive of clinical remission. The drug was well tolerated. Adverse effects were mild and similar to those recorded during earlier studies.

Aged↗
PubMed1995

Study of the intraosseous vessels of the femoral head in patients with fractures of the femoral neck or osteoarthritis of the hip.

Bearing in mind earlier studies which established a link between arteriosclerosis and mineral loss, or fragility of the bones, and also our recent study showing that patients with arterial disorders of the lower limbs also suffered from osteoporosis, we carried out a histological study of the number and appearance of the intraosseous vessels and trabecular bone volume in the femoral heads of patients undergoing surgery for either fracture of the femoral neck or osteoarthritis of the hip. The number of thick-walled vessels, arterioles or arterial capillaries was significantly diminished in the femoral heads of patients with fractures of the femoral neck (p = 0.007). In addition, in the latter patients, arteriosclerotic vascular lesions (rupture of the internal elastic lamina, medial thickening and fibrosis) were more frequent than in patients with osteoarthritis of hip. The possibility that, through chronic ischemia, arteriosclerosis may lead to disturbance of bone remodelling and loss of the mechanical properties of bone has not been contradicted by these findings.

Aged↗
PubMed1995

Isokinetic strength testing for evaluating the efficacy of intravenous immune globulin therapy for inclusion body myositis.

Inclusion body myositis is a disease of striated skeletal muscle of unclear etiopathogenesis. Its diagnosis is difficult. Corticosteroids and immunosuppressants are of limited efficacy. Positive responses to intravenous immune globulins have recently been reported in a few patients. We used a CYBEX 6000 isokinetic dynamometer to evaluate the efficacy of intravenous immune globulin therapy in a patient with inclusion body myositis. Measurements were done at the flexors and extensors of the knee, at baseline and four and eight months after treatment initiation. A course of intravenous immune globulins (2 g per course) was given every month for five months then every two months. Isokinetic muscle strength measured at an angular speed of 180 degrees/second increased by more than 41% at both knees. As compared with muscle imaging studies (computed tomography, X-ray absorptiometry, ultrasonography, magnetic resonance imaging), isokinetic strength testing has the advantage of providing data on functional improvements under treatment.

Humans↗
PubMed1995

Lactose intolerance and osteoporosis in men.

Three men with osteoporotic fractures were found to have lactase deficiency and low dietary calcium intakes, decreased urinary calcium, and moderately increased serum osteocalcin and parathyroid hormone levels. Histomorphometric studies demonstrated increases in osteoid parameters and resorption surfaces. The few studies of the links between osteoporosis and lactase deficiency have yielded discordant results. A low calcium intake due to aversion to dairy products caused by the lactase deficiency may promote the development of osteoporosis.

Aged↗
PubMed1994

Renal tubular disorders and arteriopathy of the lower limbs: risk factors for osteoporosis in men?

In order to clarify the risk-factors for men with vertebral fractures due to osteoporosis, we carried out a study of 51 cases. Twenty-five percent of patients had an endocrine disorder (hyperparathyroidism, hypogonadism, hyperthyroidism) or had received corticosteroids. These patients were compared with 26 age-matched controls. Eleven patients compared with 2 of the 26 control subjects had arteriopathy of the lower limbs; 11 patients had hypercalciuria or hyperphosphaturia compared with 3 of the control subjects. Arteriopathy appears to be associated with osteoporosis in older patients (mean age 71 years), whereas renal tubular disorders were found in younger patients (mean age 45 years).

Aged↗
PubMed1994

Breast granuloma and C.R.S.T. syndrome.

One case of CRST syndrome with breast granuloma is presented. The presumed diagnosis were infectious or neoplastic diseases. High doses of corticosteroids led to improvement in breast nodules.

Breast Diseases↗
PubMed1994

[Osteocalcin and smoking].

Smoking is a risk factor for osteoporosis. Nicotine and nonnicotine tobacco smoke components have been shown to depress osteoblast activity in a number of in vitro and animal studies. To determine whether smoking is associated with depressed osteoblast activity in humans, we measured serum osteocalcin levels (using a radioimmunological method based on an antibody to human osteocalcin) in 24 male or female smokers and 24 matched nonsmokers. Overall, osteocalcin levels were significantly lower in smokers (15 +/- 6.95 ng/ml) than in nonsmokers (21.27 +/- 8.34 ng/ml) (p = 0.007). The difference between smokers and nonsmokers was significant in males (15.3 +/- 4.5 vs 23.27 +/- 9.7; p = 0.02) but not in females (16.27 +/- 8.9 vs 19.45 +/- 6.7; p = 0.2). These data suggest that smoking may induce osteoblast depression, either directly or via hormonal changes.

Adult↗
PubMed1994

[Rheumatic manifestations of chronic hepatitis C and response to the treatment with interferon alpha-2b].

Chronic hepatitis C can be responsible for a broad range of autoimmune manifestations, including cryoglobulinemia and Sjögren's syndrome. We report our experience with six patients (five women and one man; mean age 55.6 years) in whom hepatitis C was diagnosed during evaluation of joint symptoms. Polyarthralgia was the main symptom and was often accompanied with myalgia; a polyalgic syndrome was seen in some patients. Isolated cytolysis was consistently found, although, in some instances, liver enzyme elevations were moderate and postdated the onset of the clinical symptoms. The diagnosis of hepatitis C was confirmed by recombinant immunoblot assay (RIBA) in every case. The polymerase chain reaction (PCR) detected hepatitis C virus RNA in five of the six patients. Histological findings were characteristic of chronic hepatitis. All six patients had immunological test abnormalities, which included presence of rheumatoid factors (2 of 6), positive antinuclear antibodies without anti-DNA antibodies (3 of 6) and low serum complement levels (3 of 6). A cryoprecipitate was found in four of the six patients. Four patients reported symptoms of sicca syndrome and two had Chisholm grade III lesions upon examination of salivary gland biopsy specimens. Four patients were given a six-month course of interferon alpha. In three of these four patients, evaluation at the end of the treatment showed abatement or resolution of symptoms, normal liver function tests, unchanged or diminished antinuclear antibody titers, and normal serum complement levels. In the remaining patient, no changes in symptoms or transaminase levels occurred during interferon alpha treatment. In conclusion, rheumatic symptoms can be the most prominent manifestation of chronic hepatitis C.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗
PubMed1994

[Increase of CA 19.9 in dysimmune inflammatory rheumatism. Apropos of 6 cases].

CA 19.9 is a marker for several cancers, including ductal adenocarcinomas of the pancreas. CA 19.9 elevation is rarely found in patients without benign or malignant digestive system disease. We studied serum CA 19.9 levels in patients with a variety of inflammatory joint diseases, including rheumatoid arthritis (n = 20), lupus, Sjögren's syndrome or U1RNP-associated connective tissue syndrome (Sharp's syndrome) (n = 11), dermatopolymyositis (n = 8), and giant cell arteritis or polymyalgia rheumatica (n = 8). The mean CA 19.9 level in each of these groups was not significantly different from the value seen in a group of patients with osteoporosis. Six patients had persistent marked elevation in serum CA 19.9 levels. Two had Sjögren's syndrome, two had Sharp's syndrome and two had dermatopolymyositis. None of these six patients had evidence of tumoral disease despite a follow-up of several years. Likely explanations for the CA 19.9 elevation were chronic pancreatitis in one case and lung disease in the other five. In patients with lung involvement due to inflammatory joint disease, CA 19.9 elevation may indicate severe disease and may be of use for monitoring the lung condition.

Adult↗
PubMed1992

Lumbar and cervical stenosis. Frequency of the association, role of the ankylosing hyperostosis.

The authors report a study of 47 patients admitted for cervical myelopathy (N = 17) or symptomatic lumbar spinal stenosis (N = 30). Nine patients had clinical evidence of coexisting cervical myelopathy and lumbar spinal stenosis. Ten out of the 17 patients having cervical myelopathy had lumbar spinal stenosis as evidenced by sagittal tomography and/or computerized tomography. Nine out of the 30 patients admitted for symptomatic lumbar spinal stenosis had coexisting cervical canal stenosis as evidenced by sagittal tomography. Thirteen out of these 19 patients with both cervical and lumbar canal stenosis had also ankylosing spinal hyperostosis.

Humans↗
PubMed1992

Stenosis of the lumbar spinal canal in vertebral ankylosing hyperostosis.

Certain morphologic features frequently observed in radiography or computed tomography (CT) scan in patients with hyperostosis led us to study the association between a narrowed spinal canal and vertebral hyperostosis. Twenty-eight items were selected and studied by three different investigators (two rheumatologists and one radiologist) in radiographs and CT scans of 100 patients with acquired stenosis of the lumbar canal, with or without hyperostosis (46 and 54 cases, respectively). The most distinctive points that we suggest can be used as diagnostic criteria of the hyperostotic narrowed lumbar canal are anterior or posterior lateral marginal somatic osseous proliferations, proliferations of the nonarticular aspects of the posterior apophyses, and ossifications of the posterior articular capsule and of the ligaments (yellow ligament, posterior longitudinal ligament, and the supraspinal ligament). Four of these six criteria should be present to establish the diagnosis of hyperostotic lumbar stenosis. The appearance of lumbar hyperostosis on X-ray or CT scans differs from that of simple degenerative changes due to arthrosis, and the hyperostosis can be held responsible for dural compression.

Aged↗
PubMed1991

Measurement of aortic blood flow by Doppler echocardiography: day to day variability in normal subjects and applicability in clinical research.

To assess the reliability of Doppler ultrasound for detecting serial changes in cardiac output in response to experimental interventions, the day to day variability of the minute distance of aortic flow was determined in seven normal subjects maintained in a tightly controlled environment with regard to diet and activities. Measurements were made at the same time on 5 to 6 sequential days from an apical window with use of both continuous wave and pulsed wave Doppler techniques. Two statistical measures of reliability were calculated, the intraclass coefficient of correlation (R), which varies between 0 (null reliability) and +1 (perfect reliability), and the 95% confidence interval for the error-free value of a single measurement. For sequential measurements of arterial pressure, 24 h urinary volume and sodium excretion and body weight, the intraclass coefficients of correlation ranged from 0.85 to 0.99, indicating low day to day variability consistent with tight environmental control. Continuous and pulsed wave modes were proved equally and highly reliable for measuring minute distance of aortic flow. However, continuous wave Doppler ultrasound provided acceptable signals more frequently than did the pulsed wave technique. For continuous wave Doppler ultrasound, R was 0.87 (p less than 0.00001); the 95% confidence interval was +/- 1.81 m/min (or 11% of the mean of all measurements), which indicates that this method can be used in a single individual to detect a greater than 11% change in minute distance measured once before and after an intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Narrow cervical canal and lumbar canal. Frequency of the association, role of hyperostosis].

The authors undertook a retrospective study involving 47 records of patients hospitalised for cervical myelopathy as the main clinical feature (n = 17) or symptomatic narrow lumbar canal (n = 30). Nine of these patients had clinical signs of both cervical myelopathy and of narrow lumbar canal, 10 of the 17 patients with a cervical myelopathy had lumbar stenosis as shown by midline sagittal tomography and/or CT scan, 9 of the 30 patients hospitalised for symptomatic narrow lumbar canal had cervical stenosis as shown by midline sagittal tomography, 13 of these 19 patients with both cervical and lumbar stenosis had enveloping vertebral hyperostosis.

Cervical Vertebrae↗
PubMed1991

[Association of lumbar canal stenosis and ankylosing vertebral hyperostosis. Results of a multicenter study].

The authors report data collected in a study of the association of narrow lumbar canal and vertebral hyperostosis. Five centres (Montpellier, Toulouse, Lille, Lyons and Paris) participated in this cooperative study which was both retrospective and prospective. Grid case forms were sent to homogenise the date provided. Two hundred and sixty nine cases of symptomatic lumbar canal stenosis were collected; 89 (33 per cent) had hyperostosis. Hyperostosis was definite in 74 cases and probable in 15 other cases. Certain radiological and/or CT scan morphological factors seen frequently in the hyperostosis patients group led us to undertake a second study in 2 of the 5 centres (Montpellier and Toulouse) in order to identify their specificity. Twenty eight items were adopted and studied by 3 different evaluators (2 rheumatologists and one radiologist) in the X-ray films and CT scan documents of 100 patients with acquired lumbar canal stenosis with or without hyperostosis (46 and 54 cases respectively). The most discriminative appearances, which we suggest as diagnostic criteria of narrow lumbar canal with hyperostosis concern anterior and/or posterolateral marginal somatic bone proliferations on the non-articular surfaces of the posterior apophyses and ossifications of the posterior joint capsule and of the ligaments (ligamentum flavum--posterior longitudinal ligament--supraspinous ligament). Four of these 6 criteria are necessary to make the diagnosis of lumbar stenosis with hyperostosis. The radiological and CT scan appearances of lumbar hyperostosis appear to differ from ordinary degenerative changes of osteoarthrosis and hyperostosis may be held responsible for compression of the dural cul-de-sac.

Humans↗
PubMed1990

Long-term follow-up of patients after transcatheter direct current ablation of the atrioventricular junction.

The long-term follow-up study (41 +/- 23 months) of 47 patients undergoing direct current ablation because of drug-resistant supraventricular arrhythmias is reported. Significant early complications occurred in four patients and included hypotension, pericarditis, nonsustained polymorphic ventricular tachycardia and one sudden death. In 42 patients (86%), complete atrioventricular (AV) block was initially achieved. During the follow-up period, AV conduction resumed in 2 of these 42 patients. Of the seven patients in whom ablation was unsuccessful, two developed late complete AV block and three had symptomatic improvement. An improved activity level was reported among 83% of the patients with successful ablation. Health care utilization manifest as the number of hospital admissions per year before and after ablation decreased significantly after ablation (2.4 +/- 2.0 versus 0.3 +/- 0.5, p less than 0.001). Echocardiographic evaluation in five patients with a depressed left ventricular ejection fraction (27 +/- 7%) before ablation showed a significant increase (45 +/- 14%, p less than 0.05) after an average follow-up period of 31 months. New onset of congestive heart failure occurred after ablation in four patients, of whom two had no structural heart disease. The total mortality rate, including the one patient with sudden death, was 17% and was significantly higher among patients with underlying structural heart disease. Transcatheter direct current ablation is an effective treatment in patients with drug-resistant supraventricular tachycardia, providing a beneficial long-term outcome including an improved quality of life and a decrease in health care utilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Cerebral ischemic accidents and chronic disseminated intravascular coagulation of cancerous origin].

Cerebral infarcts in 3 patients revealed the presence of disseminated intravascular coagulation (DIVC) of cancerous origin before any clinical manifestations of the neoplasm. Neurologic manifestations of these consumption coagulopathies almost constantly produce a picture of diffuse encephalopathy, expression of disseminated microinfarcts; however, transient or constituted focalized ischemic accidents by occlusion of a medium sized artery are also possible, and this in the absence of non-bacterial thrombotic endocarditis. Biologic diagnosis of DIVC is not always simple, and screening tests (platelet count, prothrombin and fibrinogen levels) can remain within normal limits during chronic forms, as a result of a subjacent inflammatory syndrome, frequently associated with cancer. Two other specific serum tests are therefore of fundamental interest: assay of fibrin degradation products and tests for soluble complexes.

Adenocarcinoma↗