[Cervical spine: why do I manipulate?].
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Biomedical subjects
Publications and source records attributed to P Vautravers.
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Reiter syndrome occurs as a reaction to various infections, either by intracellular microorganisms (Chlamydia, Mlycoplasma) or by intestinal bacteria (dysenteric bacilli, Salmonella, Campylobacter, Klebsiella, Yersinia). Four personal observations of Reiter syndrome following yersinial infections (Yersinia enterocolitis in two cases and Yersinia pseudotuberculosis in the two other cases) are reported. Data concerning the yersinial etiology of Reiter syndrome are reviewed.
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Inflammatory rhumatisms simulating rheumatoid arthritis belong to the manifestations of the reactions of leprosy. Pathology of these arthritis variate with the type of reaction. In the present observations, it must probably be the transition from a tuberculoid leprosy to a lepromatosis form in which the immunological state looks like the lupus one.
Using the technic of Pillot and Grangeot (précipitation by PEG 6,000 at 2.5%, followed radial immuno-diffusion), the authors have detected circulating immune complexes (CIC) 38 times in a group of 55 RA. The presence of CIC is significantly more frequent in sero-positive RA, but without correlation between the concentration of CIC and the positivity rate of Waaler-Rose reaction. There is no correlation between the evolutive state of RA and the presence or the concentration of CIC. The sedimentation rate is, in mean, significantly higher in RA with CIC; but, among these, there is no correlation between sedimentation rate and the concentration of CIC. In the group studied, the CIC are present in all cases of RA with vasculitis or visceral symptoms.
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Published data on the efficacy and presumptive modes of action of spinal manipulations are reviewed, as well as current problems with the technique. Although the best-designed studies have shown promising results, the efficacy of spinal manipulations has not as yet been firmly proven. The mode of action may involve mechanical changes in the disk and facet joints, but neurological mechanisms probably play the key role. Complications of cervical spinal manipulations are rare. To protect patients, French law requires that spinal manipulations be performed only by licensed physicians, who are the only professionals capable of establishing the accurate diagnosis before undertaking manipulations.