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Biomedical subjects

M Soubrier

Publications and source records attributed to M Soubrier.

At least 73 records · Page 4Linked to original sources
PubMed1993

Polyarticular septic arthritis.

Twenty-five cases of polyarticular septic arthritis (PASA) were observed in our department over a 13-year period. They accounted for 16.6% of all septic arthritis (15% on average in the literature). A male predominance was noted in our patients, as well as in the literature. The knee was the most frequent location followed by the elbow, shoulder, and hip, in varying order depending on the series. An average of 4 joints was involved. The causative microorganism was Staphylococcus aureus in 20/25 of our patients and in about 50% of published cases. Other frequently causative organisms were streptococci and gram-negative bacteria. Blood cultures and joint aspirations were positive in 19/22 and 23/25 of our cases, respectively. Other septic lesions were noted in 10/25 of our cases. Fever and severe leukocytosis were absent at admission in 5/25 (literature, 37%) and 10/25 of our 25 patients, respectively. The underlying disease was rheumatoid arthritis in 13/25, while 9 of the other patients had immunodepression caused by drugs or by concurrent illness. Typically, rheumatoid arthritis was long-standing and erosive, patients having ulcerated calluses on the feet. This skin source was also noted in 23/36 published cases of PASA in rheumatoid arthritis. Systemic lupus erythematosus was an uncommon disease in PASA, but its presence promoted gram-negative infection. Despite effective therapy with 2 antibiotics, 8/25 patients died, a prognosis that is equally severe in cases reported in the literature (30%) and one that has remained surprisingly stable over the last 40 years. For comparison, the death rate was only 4% in our patients with MASA. Factors contributing to a poor prognosis were age greater than 50 years, rheumatoid arthritis as an underlying disease, and disease of staphylococcal origin. Septic polyarthritis should be considered even when the clinical picture is not florid--when patients have low fever and normal white blood cell counts. Nor should the simultaneous involvement of distant joints rule out infection. Indeed, the frequency of underlying rheumatic disease and its treatment may further confuse the clinical presentation. Joints suspected of harboring infection should be aspirated, including those previously affected by the concurrent rheumatism.

Aged↗
PubMed1993

[Tuberculous septic polyarthritis caused by Mycobacterium bovis].

Infections due to Mycobacterium bovis have become uncommon. We report a case with polyarthritis and cutaneous nodules suggesting a rheumatic disease. This 61 year old male under corticosteroid therapy for asthma developed febrile arthritis of the right wrist and cutaneous nodules that resolved rapidly under treatment with penicillin M and an aminoglycoside. Six months later, he developed arthritis of the right wrist and both elbows, as well as infection of a right hip prosthesis. The left wrist and left knee were then affected concomitantly. The cutaneous nodules recurred. A giant cell granuloma without caseous necrosis was found upon examination of a biopsy specimen from a nodule. Granulomatous lesions with caseous necrosis were seen in a specimen of synovial membrane from the right wrist. Antituberculous treatment ensured resolution of the arthritides and nodules but failed to prevent loosening of the hip prosthesis. Acid-fast bacilli were found in the specimens taken during removal of the prosthesis. After three months, cultures of synovial membrane specimens from the knee grew Mycobacterium bovis.

Arthritis, Infectious↗
PubMed1993

[Trigeminal neuropathy and connective tissue diseases].

Connective tissue diseases are a rare and poorly understood etiology of trigeminal neuropathy. In a retrospective multicentric study covering 12 years. 12 cases were identified in the archives of the Departments of Neurology, Rheumatology and Internal Medicine: 4 were associated with progressive systemic sclerosis. 4 with mixed connective tissue diseases and 4 with Sjögren's syndrome. In 9 of the cases, the neuropathy led to the diagnosis of connective tissue disease. Trigeminal neuropathy usually developed during the evolution of the connective-tissue disease but, in 3 cases, it preceded other clinical signs. As a rule, the connective tissue disease was relatively inactive when the trigeminal nerve was involved. The neuropathy was usually unilateral (9 times), localized to the inferior branch(es) of the trigeminal and manifested itself by an isolated sensation of cutaneous numbness associated with paresthesias. Only one patient had mixed motor and sensory involvement. The topography of the lesions (peripheral, truncal, radicular or central nuclear) remains unknown in most cases, however, electromyographic study of the blinking reflex in 2 patients confirmed peripheral neuropathy in both of them. Corticotherapy had only a minor effect: neuralgia was rare and carbamazepine was ineffective. The pathogenicity of trigeminal involvement is discussed and these observations are compared to the 151 cases reported in the literature.

Adult↗
PubMed1993

[Vitamin-resistant hypophosphatemic rickets and spinal cord compression. Apropos of 2 cases].

Adults with X-linked vitamin-resistant hypophosphatemic rickets can develop spinal cord compression as a result of spinal canal stenosis due to involvement of the spine with the increased periosteal and ligamentary calcification which is typical of the disease. Two cases are reported. In both patients, spinal cord compression manifested as rapidly progressive spastic paraplegia due to compression at T9 and T5, respectively. Decompressive laminectomy ensured full recovery in one case but was ineffective in the other. In both cases, paraplegia developed approximately one year after initiation of therapy combining a metabolite of vitamin D and phosphorus in high doses. Current imaging techniques (CT scan, magnetic resonance imaging) provide highly accurate information on the anatomic mechanism of the stenosis, its often multiple locations, and its course. Three factors are involved in the stenosis, in variable degrees: thickening of the laminae, hypertrophy of the facet joints, thickening and calcification of the yellow ligament. Magnetic resonance imaging is the investigation of choice in these patients. A deleterious effect vitamin D-phosphorus treatment cannot be outruled. The appropriateness of initiating this treatment should be prudently discussed and treated patients should be closely monitored.

Follow-Up Studies↗
PubMed1993

[Demyelinating involvement in Borrelian neuropathies].

Five patients (4 men, 1 woman, aged 51-67), were hospitalized for peripheral painful neuropathies. The serological survey and the dramatic responses to penicillin confirmed the responsibility of Borrelia burgdorferi in all 5 cases. Electromyographical studies showed evidence of demyelination: prolonged distal latency, slowing down of nerve conduction velocity. In 3 patients this pattern was related to axonal degeneration as shown by fibrillation potentials and reduced voluntary motor unit potentials recorded on needle examination. The other two showed no axonal degeneration. One also had motor conduction blocks. Such a demyelination could be due to vasculitis of the vasa nervorum described in tick-bone meningoradiculitis.

Aged↗
PubMed1992

[The missing inflammatory syndrome].

An inflammatory disease is sometimes suspected despite a normal erythrocyte sedimentation rate (ESR). When this dissociation is present, the reasons for the lack of ESR elevation, which concern the red cells, the plasma and the laboratory techniques, must be excluded, the reality of the inflammatory syndrome being then confirmed by assay of the inflammatory proteins. However, an inflammatory syndrome is missing in 5 to 10 percent of inflammatory diseases, more frequently in cases of polymyositis or scleroderma, less frequently in those of giant cell arteritis. Little information can be found in the literature, concerning the missing inflammatory syndrome. Does it confer peculiar semeiological or prognostic features? Is the dissociation related to the patient, as would appear in some special cases, or to the disease, as suggested by the small rise of the C-reactive protein in acute episodes of lupus erythematosus? The absence of inflammatory syndrome is a source of diagnostic problems when the symptoms are atypical or when there are no specific signs of the suspected disease. Differential diagnoses, especially non-inflammatory diseases, must then be carefully discussed. Improving our knowledge of the missing inflammatory syndrome would require the creation of this key-word.

Arthritis, Rheumatoid↗
PubMed1992

[Takayasu's disease disclosed by isolated involvement of the ascending aorta].

The authors report the histological discovery of a case of Takayasu syndrome affecting the ascending aorta. This involvement appearing to concern only the aorta, with no symptomatic complaints nor any laboratory abnormalities indicative of an inflammatory syndrome, corticosteroids were not prescribed. Management consisted of biennial monitoring by transthoracic and transesophageal ultrasonography of the aorta and the supra-aortic main vessels together with monitoring of laboratory parameters.

Adult↗
PubMed1992

[Lumbosacral pain revealing intramural rectal abscess. Apropos of 2 cases].

Intramural abscess of the rectum is an uncommon (7%) form of perianal abscess in which the suppuration moves upwards within the rectal wall. Diagnosis is usually readily established on the presence of prominent anorectal symptoms and on rectal examination findings. However, atypical cases occur occasionally. Two cases of intramural abscess with misleading presenting symptoms suggestive of rheumatologic disease are reported herein. Both patients had subacute lumbosacral pain suggestive of an inflammatory condition. In one patient, the correct diagnosis was established two years after onset of symptoms when the patient passed pus per rectum. In the other, endoscopic ultrasonography readily evidenced the abscess. Modern imaging techniques including endorectal ultrasonography, CT scan with enhancement and MRI are very helpful for the diagnosis of such difficult cases. Intramural rectal abscess should be added to the list of possible nonspinal visceral etiologies routinely looked for during the evaluation of patients with atypical lumbosacral pain.

Abscess↗
PubMed1992

[Neuromuscular complications of D-penicillamine in rheumatoid arthritis].

Between 1979 and 1990 we have seen 8 patients (7 females) with rheumatoid arthritis (RA) who developed a neuro-muscular involvement while on D-penicillamine (D.P.). Five of them had a drug-induced myasthenia. D.P. withdrawal led to a complete recovery in 1.5 to 5 months. Another patient presented with a myopathy which led to the diagnosis of Grave's disease. She was treated with D.P. for 4 months. D.P. was reintroduced and 5 months later a myasthenic syndrome developed. A thymoma was discovered 1 year later. In the last 2 patients D.P. induced polymyositis which, in one, was associated with features of systemic lupus erythematosus. In the other patient, the evolution was fatal in spite of D.P. withdrawal, high dose steroids and plasma exchanges. A literature survey has shown 150 D.P. induced myasthenia and 38 D.P. induced polymyositis cases.

Aged↗
PubMed1992

[Giant synovial cyst of the shoulder. Apropos of a case].

Synovial cysts of the shoulder are rare. The case described illustrates the particular problems encountered at this site. As at other joints, these cysts appear during arthropathies of various types: degenerative or inflammatory (rheumatoid arthritis). They are often associated with rupture of the rotator cuff. Their essential characteristic is an expansive and recurrent tendency which leads to striking giant swellings, capable of causing vascular compression. Treatment involves surgical excision. This suffices when the cyst does not communicate with the joint cavity. In contrast, when there is a breach in the capsule through which the cyst derives its synovial fluid supply, repair is necessary to prevent recurrence.

Aged↗
PubMed1991

[Acute phase proteins in monoclonal gammapathies].

IL-6 is now recognized as a growth factor for plasma cells as well as a C Reactive Proteine inducer. This prompted a reappraisal of acute phase reactants in monoclonal gammapathies. Eight acute phase proteins were assayed in patients with multiple myeloma (n = 51), MGUS (n = 17) and Waldenström's macroglobulinemia (n = 5). The CRP level was above 10 mg/l in 27% of all myeloma patients, in 39% of patients with active myeloma, in 4 of 5 patients with Waldenström's macroglobulinemia and in none of the MGUS patients. Fibrinogen, alpha-1-antitrypsin and orosomucoid levels were significantly higher in the myeloma group than in the MGUS group. Differences were not significant for haptoglobin, ceruleoplasmin, transferrin, and alpha-2-macroglobulin. Serial assays in 22 myeloma patients showed that CRP levels were correlated with disease activity. A biologic inflammatory syndrome, defined as a significant variation in two or more acute phase reactants, was demonstrated in 41% of myeloma patients, 18% of MGUS patients, and 60% of Waldenström's macroglobulinemia patients. Active disease was significantly more common among myeloma patients with biologic evidence of inflammation, as compared with myeloma patients without biologic inflammation. These data suggest that similarly to IL-6 acute phase reactants are markers for disease activity in multiple myeloma.

Acute-Phase Proteins↗
PubMed1988

Cutaneous angiomas in POEMS syndrome. An ultrastructural and immunohistochemical study.

Cutaneous manifestations of POEMS (polyneuropathy, organomegaly, endocrinopathies, M-protein, and skin changes) syndrome in a 51-year-old white man included two types of hemangiomas, ie, cherry-type and subcutaneous hemangiomas. By light microscopy and immunohistochemistry, both types of tumors showed features of capillary hemangiomas. By electron microscopy, a peculiar finding of subcutaneous hemangiomas was the presence of slender abluminal processes of endothelial cells that were frequently anastomosing to form electron-lucent blebs. Although the precise etiopathogenesis of the vascular proliferations remains speculative, these lesions merit study since they constitute an easily recognizable marker of POEMS syndrome.

Estrogens↗
PubMedDate not supplied

Diagnostic value of serum and synovial procalcitonin in acute arthritis: a prospective study of 42 patients.

OBJECTIVE: To determine the diagnostic value of serum and synovial procalcitonin (PCT) for bacterial arthritis and to determine the cellular origin of synovial PCT. METHODS: A prospective study enrolled 42 patients with acute arthritis including 11 bacterial arthritis, 18 rheumatoid arthritis and 13 crystal induced arthritis. Diagnostic values of serum and synovial PCT levels were determined by a immunoluminometric assay (Lumitest PCT) and compared to those of classical inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, synovial fluid cellularity and both serum and synovial IL-6 and TNF alpha). Using fibroblast-like synoviocyte (FLS) cultures derived from rheumatoid arthritis (n = 4) and osteo-arthritis (n = 3) synovium, with or without stimulation by lipopolysaccharid or recombinant streptococcal protein 1/II, we attempted to determine whether synovial cells could be a source of PCT. RESULTS: Serum PCT was the best parameter to distinguish patients with acute bacterial arthritis from patients with crystal induced arthritis or rheumatoid arthritis. In setting of an acute arthritis serum PCT (> 0.5 ng/mL) achieved 55% sensitivity and 94% specificity for the diagnosis of bacterial arthritis, while CRP (> 50 mg/L) had 100% sensitivity but poor specificity (40%). Serum PCT appeared to be higher in patients with septic arthritis resulting from "systemic infection" than in cases resulting from direct inoculation. Synovial PCT was not useful to discriminate between infectious and non infectious arthritis in clinical practice. PCT could not be detected at significant levels in the conditioned medium from fibroblast-like synoviocyte cultures. CONCLUSION: Serum PCT is a poorly sensitive but specific marker of bacterial arthritis. Use of serum PCT in association with CRP could nevertheless be useful in an emergency situation for the diagnosis of bacterial arthritis.

Acute Disease↗