Biomedical subjects
Publications and source records attributed to P Lafforgue.
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Magnetic resonance imaging (MRI) was performed in 60 patients with vertebral compression fractures caused by either bone metastasis (BM) or osteoporosis (OP). In the BM group (20 patients, 62 BM with 22 compression fractures), the signal was decreased on T1-weighted images in all cases and was usually increased on T2 sequences, in the whole vertebral body or in patchy areas. The vertebral body showed a diffuse posterior bulging in 85% of patients; malignant infiltration often involved pedicles, posterior arch or soft tissues. In the OP group (40 patients, 160 vertebral fractures): a significant recession of one of the corners of the vertebral body, different from metastatic bulging, was observed in 37% of patients; the spinal cord signal depended on the stage: during the first 4 months, the signal was low on T1 and high on T2 sequences, with a characteristic band disposition, which may involve most of the vertebral body even in mild fractures; the modifications extended to the pedicles in 5 cases; after 6 months, the signal was normal. MRI specificity was 92% between malignant versus benign compression fractures. MRI had a better sensitivity than bone scan for depicting vertebral BM. In OP, MRI signal modifications disappeared several months before increased uptake of technetium. This study emphasizes the value of MRI for the diagnosis of osteoporotic versus metastatic vertebral compression fractures when morphological and chronological parameters are added to the signal intensity analysis.
Twenty patients with "idiopathic" bone infarction were studied. There were 18 men and 2 women, age 30 to 69 years, at the time of the diagnosis (mean age = 49 years). Sixty-five lesions were recorded with a marked predominance to the lower extremities (77 p. cent are located around the knees) and to the metaphysis (only three pure diaphyseal lesions). Considered asymptomatic, these lesions were painful in 6 patients. They are multiple, and in this case symmetrical, in 12 patients (60 p. cent). X-Rays disclose the classic heterogeneous ball-like, smoke twirled or encapsulated calcifications. A periosteal thickening opposite the lesions was observed in 6 patients; this may be the only radiological sign. Finally, 18 of the 65 lesions were not visible on standard X-Rays, and obvious on MRI. The MRI aspect is characteristic and may be superposed on the basic lesions already described in the course of aseptic osteonecroses of the femoral head. This is, besides, the most sensitive test, snowing a larger number of more extended necroses than the other examinations. CT scanning as well as scintigraphy present a limited advantage. More than half of the patients also present epiphyseal aseptic osteonecroses, often multiple (55 sites for 13 patients), and often unrecognized. The etiological factors are in fact common to both of these diseases: steroid therapy, alcoholism, dyslipidemia, idiopathic forms. Among the possible causes, the literature mentions lupus erythematosus, renal transplant, cytosteatonecrosis, arteriopathies while there is no post-traumatic form. All of the characteristics of these bone infarctions determine a topographic form of the osteonecrotic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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Most therapeutic tests of osteoarthritis treatments are assessed by criteria based either on fundamental data or on clinical data, which is often subjective. A quantified analysis of locomotion can be used to determine the spatiotemporal indices (stride length and duration), kinematic indices (walking speed, velocity peak), and symmetry criteria that are relevant to the assessment of locomotor handicaps in patients with osteoarthritis. This study examined the progression of locomotor abilities in 11 subjects aged 49-69 (mean 60.9) years with knee osteoarthritis before and after treatment with a non-steroidal anti-inflammatory drug. Naproxen sodium (1100 mg) was given once a day for seven days. The condition before and after treatment was evaluated by quantitative analysis of locomotion, estimation of pain on a visual analogue scale, and assessment of the degree of functional disability. Significant improvement in locomotor indices (proportional increase in walking speed 17.8%) and in degree of pain (proportional decrease 27%) as estimated on the analogue scale was found after non-steroidal anti-inflammatory drug treatment. The lack of a significant correlation between the decrease in pain experienced by the patients and the objective improvement of their functional capabilities emphasises the need in further studies of new treatments to accompany the patients' own assessments of self improvement with a quantitative analysis of the way in which they walk.
Three new cases of neurological complication by osteoporotic compression are reported. They are: a medullar compression by compression of D12 in a 66 year old woman, a deficient cruralgia by compression of L1 in a 67 year old man, and another deficient cruralgia due to the compression of L3 and L4 in a 55 year old woman. The literature presents 16 cases of neurological compressions by vertebral compressions attributed to the osteoporosis: two in 1958, and the others as from 1987. The only recently recognized feature of these complications can be explained by the axiom according to which "there are no neurological complications in the course of osteoporotic compressions" and by the introduction of new diagnosis techniques. However, the critical analysis of the published cases enables us to retain only 11 indisputable cases which, with our three observations, allows us to define certain features: the osteoporosis does not have any particularity compared to the uncomplicated form; the dorsolumbar junction is preferentially affected; the neurological complication occurs progressively and belatedly; the usual mechanism is the recoil of one of posterior vertebral corners, different from the globally convex bulging of tumoral compressions: it could be an element of the differential diagnosis. The surgical treatment gives better results.
The sagittal and anterior position of the hyoid bone is at the origin of the changes in orientation of the palatine laminae. A posterior-anterior movement of this bone allows the tongue to liberate the posterior part of the oral cavity; the palatine laminae rotate forwards and downwards. The opposite case is verified in the same way; the naso-palatine canal is a very malleable area, allowing a lowering of the anterior part of the palatine laminae. The vertical variations of the hyoid bone have little effect on the palate.
Fourteen Rhesus-positive patients with idiopathic thrombocytopenic purpura or thrombocytopenia associated with human immunodeficiency virus (HIV) infection were treated with intravenous Rhesus antibodies. The mean total dose was 6,800 micrograms administered over a 3 to 6 days' period. A significant rise in platelet count was observed in 13 of the 14 Rhesus-positive patients, but not in 3 Rhesus-negative patients used as controls. This rise was usually transient, lasting less than 3 weeks, but it persisted for more than 3 months in 2 cases. Treatment was well tolerated; transient signs of haemolysis appeared in 11 patients who did not require transfusion. Rhesus antibodies are quick-acting, the number of platelets being doubled as early as the second day of treatment. Interaction between antibody-coated red blood cells and macrophages is a possible mode of action and a feasible therapeutic approach in selected patients with autoimmune of HIV-mediated thrombocytopenia.
An epidemiological survey of dental caries prevalence has been conducted in North of France on a representative sample of 6 to 15 year old children. Six departments were studied: Nord, Pas de Calais, Somme, Aisne, Oise and Seine-Maritime. 2,772 children were randomly selected and examined. A dft index of 3,38 was found at 6 years which increased slightly until 8 years (3.71) and then decreased regularly to 0.57 at 12 years. The mean DMFT was 0.31 at 6 years, 4.10 at 12 years and 6.92 at 15 years. At the same ages, the respective values of DMFS were 0.56; 8.65 and 14.22. The plaque index increased up to 10 years (1.57), was stable from 10 to 13 years and decreased until 15 years. The calculus index increased up to 8 years. It was stable between 9 and 12 and increased again until 14 years. The gingival index varied in relation to age.
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The anti-inflammatory effect of natural glucocorticoids is often overlooked, as shown by these two cases of inflammatory rheumatism flare-up which occurred after surgical treatment of Cushing's syndrome. The disorder in the first case was exacerbation of a probable rheumatoid arthritis; in the second case an unlabelled inflammatory rheumatism appeared in a context of postoperative corticotropic deficiency. In both cases a purely substitutive hydrocortisone therapy resulted in dramatic regression of the articular symptoms. It is well known that rheumatismal manifestations may occur in patients with slow adrenal failure. The determinant factor seems to be a glucocorticoid deficiency, either isolated or associated with others, since cortisol exerts and anti-inflammatory activity. In patients with corticotropic deficiency following surgical treatment of Cushing's disease, the endogenous corticosteroid therapy of hypercortisolism is interrupted, allowing the aggravation or emergence of inflammatory rheumatism.
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The use of carbon is widespread in fields as wide as aeronautics, cars, electricity or electronics. The biomedical applications of carbon are also numerous. The purpose of our work is to test four experimental carbon fibers (A, B, C and D; B being the negative control) to determine the best clinical application. Four tests of cytocompatibility are carried out (cell viability, inflammatory test, cell proliferation and cell morphology). Two different cell lines are used: the L132 cell line (epithelial embryonic pulmonary human cell) and the HaCaT line (human normal spontaneously immortalized skin keratinocytes). The results of the biological tests are compared with those of a carbon fiber sample already marketed as a bandage in the treatment of infected wounds: Actisorb "Plus (J2). The various tests show us that only two experimental samples are slightly cytotoxic (A, D). On the other hand, no sample supports cell adherence. A, B, C and D do not have an inflammatory effect. J2 appears at the same time cytotoxic and inflammatory. Consequently, being given the physical presentation and the biological properties of experimental samples (A, C and D), we intend them for an application in the field of wound healing, as a bandage. Also further experimentation is needed.
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Results are reported of the use of new imaging methods, CT scan and magnetic resonance imaging, in 12 patients with algodystrophy of femoral head. During the early stages a CT scan can detect partial demineralizations, observed on MR images in sagittal sections. When the disease is installed the CT scan images show global demineralization, but the MR images with coupled T1-T2 study appear to be more pathognomonic (hyposignal extended in T1 with hypersignal in T2, associated with a more marked subchondral hyposignal in T1 as in T2) particularly in relation to the osteonecrosis of femoral head.