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Biomedical subjects

M Laroche

Publications and source records attributed to M Laroche.

At least 55 records · Page 3Linked to original sources
PubMed1997

Inflammatory rheumatism and nasal polyposis.

We report five cases of seronegative inflammatory rheumatism associated with nasal polyposis. The patients were four women and one man, mean age 49.5 years (range 42-59 yrs.). Two patients had polyarthralgia predominating in the hands, wrists and knees and two patients had symmetrical acromelic polyarthritis. The fifth patient, a woman, had oligoarticular arthritis. In a single female patient, X-rays showed moderate erosions of both tarsometatarsal bones. The inflammatory syndrome was moderate with mean ESR 23 (12-38) and immunological investigations were negative except for the presence of pANCA (50-200 U) in three patients. HLA-A1, B8, and Bw35 antigens were found in three of the five patients. In all cases, nasal and sinus polyposis (NSP) preceded rheumatism and the joint symptoms were accompanied by worsening of the ENT symptoms. NSP was confirmed by CT scan of the nasal fossae and sinuses. Polyps were surgically removed in four patients and the histology showed neither granuloma nor vasculitis. In four patients the joint symptoms, which responded poorly to nonsteroidal anti-inflammatory drugs (NSAIDs), improved markedly after ENT treatment (surgery and topical steroids) and synthetic antimalarials. The concomitant course of the joint and ENT symptoms suggests there may be a link between inflammatory rheumatism and NSP.

Adult↗
PubMed1997

[Systemic manifestations of hemorrhagic rectocolitis: apropos of a case of hemorrhagic rectocolitis associated with multiple sclerosis].

Extra-intestinal manifestations of inflammatory bowel diseases are frequent and numerous. We report a case of ulcerative colitis associated with multiple sclerosis, ankylosing spondylitis and pyoderma gangrenosum. This observation shows the rare association of ulcerative colitis-multiple sclerosis, and extra-intestinal manifestations of inflammatory colitis are discussed.

Colitis, Ulcerative↗
PubMed1997

Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head.

OBJECTIVES: To assess the outcome of core decompression in the treatment of osteonecrosis of the femoral head related to the volume of necrotic bone measured according to a previously reported method. METHODS: Twenty hips corresponding to strictly Ficat stage II underwent magnetic resonance imaging and the volume of necrotic bone was expressed as a percentage of the volume of the entire head measured on each slice. All hips underwent core decompression and the outcome was evaluated at 24 months. The primary evaluation criterion was radiological appearance: the outcome was considered as good if the hip remained stage II and poor if the disease progressed. RESULTS: Twenty four months after core decompression, half the cases remained stable and in half the disease had progressed. Outcome seemed to be related to the volume of necrotic bone (average 22% in the good outcome group versus 45% in the poor outcome group (p = 0.0051)) and was independent of risk factors, age, and histological type. CONCLUSIONS: The volume of necrotic bone should be taken into account in the evaluation of any treatment, bearing in mind that in more than one third of cases this volume will probably decrease, especially at the beginning of the disease process.

Adult↗
PubMed1997

An X-ray absorptiometry study of reflex sympathetic dystrophy syndrome.

X-ray absorptiometry (Lunar DPX) was performed before and after treatment to determine bone mineral content and density, as well as fat-free mass and body fat, in 28 males and 11 females with a mean age of 37 years who met Doury's criteria for reflex sympathetic dystrophy syndrome. Mean disease duration was eight months. Before treatment, as compared to the unaffected limb, bone mineral content was decreased by 8.8%, bone mineral density by 9.6%, and fat-free mass by 6.2%, whereas body fat was increased by 6%. These differences were largest in those patients with the longest disease durations. The severity of bone loss was not correlated with the outcome, the severity of roentgenographic lesions, or whether the patient was evaluated at the warm or cold stage of the disease process. Study parameters were unchanged after three months both in patients who were and were not improved. After nine to 12 months, increases in bone and fat-free mass were seen in those patients whose clinical manifestations had subsided.

Absorptiometry, Photon↗
PubMed1997

Hyperparathyroidism during lithium therapy. Two new cases.

We report two new cases of hyperparathyroidism during lithium therapy. The patients were a 50-year-old male and a 48-year-old female under lithium for bipolar disease. Both developed osteoporosis without fractures and laboratory test abnormalities consistent with moderate hyperparathyroidism. Although only 30 or so cases of lithium-associated hyperparathyroidism have been reported, as many as 10 to 15% of lithium-treated patients may have laboratory test evidence of hyperparathyroidism. Typically, urinary calcium excretion is normal, serum phosphate levels are moderately decreased and cyclic AMP levels are normal. An adenoma is the most common lesion. Surgery is usually required in patients whose clinical and laboratory test abnormalities persist despite discontinuation of the drug. Lithium-associated hyperparathyroidism may be due to dysregulation of the caliostat, a feedback loop that subordinates parathyroid hormone secretion to serum calcium levels. Little is known about lithium-induced osteoporosis. Trabecular bone was predominantly affected in one of our patients and cortical bone in another.

Bipolar Disorder↗
PubMed1997

Phosphate excretion in reflex sympathetic dystrophy syndrome before and after a single infusion of pamidronate.

To clarify the relations between reflex sympathetic dystrophy syndrome and moderate phosphate diabetes, we prospectively determined urinary phosphate excretion parameters (clearance, renal tubular reabsorption of phosphate and threshold of tubular reabsorption of phosphate) in 37 patients with reflex sympathetic dystrophy syndrome before and after treatment with 60 mg of pamidronate (n = 23) and in 35 age- and sex-matched controls. Urinary phosphate excretion parameters were identical in cases and in controls. Fourteen of the 23 cases treated by pamidronate were improved after one to two months. Pamidronate had no effect on phosphate excretion. Four cases versus only one control had phosphate diabetes (X2 = 0.18). Three of the four cases with phosphate diabetes failed to respond to pamidronate therapy but improved under phosphate and 1,25-diOH vitamin D3 therapy.

Adult↗
PubMed1997

Osteoporotic vertebral fractures in a man under high-dose inhaled glucocorticoid therapy. A case-report with a review of the literature.

A 65-year-old man had surgery in June 1995 for femoral neuralgia. The plain films of the spine were normal at the time. In September of the same year, when he was beginning to walk gradually longer distances, he started experiencing back pain. Crush fractures of T8 and L2 were seen on plain films. His pain worsened, and he was admitted in December 1995. A third set of plain films disclosed fractures of all the vertebral bodies from T8 through L5, with increased density of the endplates of the same vertebras. Serum and urinary levels of calcium and phosphate were normal. Dual-energy X-ray absorptiometry demonstrated osteoporosis predominating in the trabecular bone. Evidence of increased bone resorption was seen on the histomorphometric study. Large amounts of dihydroxypyridinoline were found in the urine. Investigations for the classical causes of osteoporosis in males were unrewarding. Careful questioning revealed that the patient had been taking inhaled beclomethasone for seven years to treat chronic obstructive lung disease. Serum levels of cortisol and ACTH were low, consistent with a diagnosis of treatment-induced hypercorticism. To our knowledge, this is the first reported case of osteoporotic vertebral fractures in a male due to inhaled glucocorticoid therapy. Inhaled glucocorticoids are generally believed to induce only minimal systemic effects. However, decreased serum osteocalcin levels and increased urinary excretion of bone resorption markers have been reported in patients under inhaled beclomethasone therapy. Low spinal bone mineral density values correlated with the degree of pituitary-adrenal gland suppression as evaluated using the ACTH test have also been found in several groups of patients treated with inhaled glucocorticoids.

Administration, Inhalation↗
PubMed1997

Bone and joint involvement in adults with Werner's syndrome.

A 45-year-old man with Werner's syndrome had large asymptomatic calcium deposits about the elbows, hips, and shoulders. During the four-year follow-up, he developed insufficiency fractures of the pelvis, both ulnas, one radius and one metatarsal, all of which failed to heal. Bone mineral densities evaluated by dual-energy X-ray absorptiometry were at the lower end of the normal range, but a histomorphometric study showed a reduction in trabecular bone volume and marked decreases in osteoid parameters with a calcification rate of zero. Serum assays of 25 hydroxy vitamin D3, 1,25 dihydroxy vitamin D3, osteocalcin and alkaline phosphatase were normal. The nonunions in this patient may have been caused by impaired osteoblast function associated with Werner's syndrome and/or by decreased activity of growth factors involved in bone repair.

Bone Density↗
PubMed1997

No link between avascular necrosis of the femoral head and antiphospholipid antibodies.

The rate of occurrence of antiphospholipid antibodies was compared in 47 patients with avascular necrosis of the femoral head and in 47 controls matched on age and sex. Antiphospholipid antibodies were looked for using three techniques in each patient, namely the VDRL test, an ELISA for anticardiolipin, and a circulating anticoagulant detection procedure involving three different tests. The VDRL and the tests for circulating anticoagulants were negative in all the patients and controls. No significant between-group difference was found for the ELISA, which was positive in three patients and two controls.

Adult↗
PubMed1996

[Arteriosclerosis and osteoporosis].

A certain number of elements suggest a link between arteriosclerosis and osteoporosis. Generally, osteoporosis in women is considered to result from altered secretion of sexual hormones after menopause and in elderly subjects from hyperparathyroidism secondary to calcium and vitamin D deficiency. As for the heart, the brain, the kidney or muscle, bone tissue could also be altered by vascular aging and arteriosclerosis. Large epidemiological studies have demonstrated a relationship between bone mineral density, measured by monophotonic absorptiometry and mortality due to cerebral vascular events. Several hypotheses have been proposed to explain this relationship including lower endogenous estrogen levels and arteriosclerosis of the renal vessels favoring perturbed vitamin D metabolism. Arteriosclerosis could also have a direct effect on bone tissue via an ischemic mechanism. The pathophysiolojical mechanisms are not fully understood, but could involve hormone and cytokine-dependent bone remodeling and the complementary actions of bone tissue and the hematopoietic bone marrow functioning as an unit. Further epidemiological studies would be useful to confirm the relationship between arteriosclerosis and osteoporosis. The efficacy of vasodilator drugs on osteoporosis could be tested and histology and immunochemical studies could help in our understanding of the effect of ischemia on bone metabolism.

Animals↗
PubMed1996

Effect of ovariectomy on intraosseous vascularization and bone remodelling in rats: action of tiludronate.

In order to study the action of tiludronate on the changes in intraosseous vascularization induced by ovariectomy, and to link these effects to those observed in bone remodelling, 30 female Sprague-Dawley rats (age 40 weeks) were studied. Ten rats were shamoperated and treated by vehicle, 10 rats were ovariectomized and treated by vehicle, and 10 rats were ovariectomized and treated orally with tiludronate, 0.16 mmol/kg/per day, 3 days a week for 16 weeks, from the day following ovariectomy. The rats were killed after 4 months, and a histomorphometric study and quantification of intraosseous vessels carried out on the sixth lumbar vertebra. The area of the intraosseous sinusoidal capillaries increased after ovariectomy, which also induced a moderate increase in resorption surfaces and osteoid surfaces leading to a decrease of 40% in the trabecular bone volume at the lumbar spine level. This bone mineral loss was completely prevented by tiludronate, which normalized the bone turnover. However, tiludronate was without any effect on intraosseous vascularization. These results indicate that the surface area of the intraosseous sinusoidal capillaries was correlated positively with resorption surfaces and negatively with trabecular bone volume and the number of bone trabeculae. In these experimental conditions, an inhibitor of bone resorption can exert its positive effect on bone mass without normalization of vascularization.

Animals↗
PubMed1996

Bone remodelling in monoclonal gammopathies of uncertain significance, symptomatic and nonsymptomatic myeloma.

In order to characterize the abnormalities of bone remodelling in the various stages of plasma cell disorders, we studied 60 patients (29 monoclonal gammopathies of uncertain significance (MGUS), 13 stage I myeloma, 18 stage III myeloma). We carried out histomorphometric study of bone biopsies in 34 patients and measurement of osteocalcin and the calciuria/creatinine ratio. Bone remodelling was approximately normal (BV/TV:21.2 +/- 7, ES:4.1 +/- 2, OS:16.5 +/- 10) in MGUS. Stage I myeloma was characterised by parallel increases in resorption surfaces and osteoid surfaces (BV/TV:18 +/- 5, ES/BS:7.4 +/- 3.5, OS/BS:24.8 +/- 11.5), of the ca/cr ratio and osteocalcin. In stage III myeloma, resorption surfaces and the ca/cr ratio showed an even greater increase while osteoid surfaces, osteocalcin and trabecular bone volume decreased (BV/TV 13.6 +/- 6, ES/BS:12.1 +/- 6, OS/BS:13.6 +/- 8.3). Osteocalcin and osteoid surfaces were correlated (r = 0.5). There was a positive correlation between osteocalcin and the number of plasmocytes in stage 1 myeloma (r = 0.64) and a negative correlation in stage III myeloma (r = 0.9). Bone remodeling was normal in MGUS; bone remodelling grew with a parallel increase of formation and resorption in stage I; bone resorption increased while bone formation decreased in stage III myeloma.

Aged↗
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↗