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Biomedical subjects

R M Flipo

Publications and source records attributed to R M Flipo.

At least 127 records · Page 7Linked to original sources
PubMed1988

Dialysis-related beta 2 microglobulin-amyloid arthropathy. Improvement of clinical symptoms after a switch of dialysis membranes.

Amyloidosis containing beta 2 microglobulin (beta 2m) and joint pains are frequent complications of long-term hemodialysis. In a prospective study the authors planned to act on dialysis arthropathies (DA) by improving beta 2m depuration: for 8 patients suffering from DA we replaced usual cuprophane membranes (CU) by high permeability polyacrylonitrile membranes (PAN). DA was diagnosed on the presence of severe disabling arthralgias in the absence of any other obvious etiology, and on the presence of at least 3 among 6 criteria. The efficacy of the switch of DM was assessed on 6 criteria including the patient's own evaluation at the end of the study and a joint pain severity index. Clinical evaluation and beta 2m measurement were carried out at the start of the trial and after a mean duration of dialysis on PAN of 6 months. An improvement in joint symptomatology and a decrease of joint severity index were noted in the 8 cases. Our results suggest that the change of DM has a favorable influence on DA. This improvement could result either from a better beta 2m depuration or from a better biocompatibility of PAN than the CU previously used.

Amyloidosis↗
PubMed1988

[Osteoarthropathy of hemodialysis: development at 2 years after passage on high permeability membrane].

In a group of 80 patients dialyzed at the same dialysis center, dialysis arthropathy was diagnosed in ten of them. Before commencing the study all ten patients were undergoing hemodialysis with cuprophan membrane (CU). We then replaced CU with high permeability membrane (polyacrylonitrile AN 69 Hospal or polysulfone) in eight of these ten patients. Clinical and radiological evaluation as well as bêta 2 microglobulin measurement were performed at the onset of the study and at one year and two years intervals after replacing the dialysis membrane. An improvement of joint symptomatology was noted in all patients. However, the radiological abnormalities appeared unchanged or aggravated and the mean serum concentration of bêta 2 microglobulin was lower at the end of the study but not significantly.

Adult↗
PubMed1987

[Current aspects of osteoarticular pathology of hemodialyzed patients. Study of a population of 80 patients].

Eighty patients studied for several years (average length of time: 76 months, 24 on hemodialysis for over 10 years), were the subject of a prospective study of osteoarticular manifestations. Clinically, these manifestations were found in 58 patients (72 p. cent). Among them, 15 suffered from inflammatory painful episodes (shoulders and fingers) and 10 presented a decreased finger mobility. Radiologically, it is possible to describe 7 types of specific images: erosive arthropathy of the fingers (8 p. cent), multiple carpal cavities (10 p. cent), cavity of the humeral head (9 p. cent), cervical spondylolisthesis (5 p. cent), multiple diaphyseal lacunae (1 p. cent). Some clinical and radiological manifestations are frequently associated and seem to represent a specific pathological group: dialysis in progress for more than ten years, carpal tunnel syndrome, inflammatory-type arthralgias, osseous cavities and spondylo-arthropathy. Biologically, there are numerous disturbances concerning the sedimentation rate, fibrinemia, aluminum blood level, phosphorus blood level, parathyroid hormone and beta-2-microglobulin blood level. The study of bone or synovium biopsies, carried out 20 times, permitted to discover amyloid deposits in 8 instances and microcrystals in 3 instances. The physio-pathogeny of these manifestations leads to evoke the role of many factors (aluminum, microcrystals, silicon, hyperparathyroidism, amylosis). The occurrence of a form of amylosis where a protein homologous to beta-2-microglobulin was isolated, appears to be feasibly the consequence of a bio-incompatibility of the dialysis membranes.

Bone Diseases↗
PubMed1987

Current aspects of osteoarticular pathology in patients undergoing hemodialysis: study of 80 patients. Part 1. Clinical and radiological analysis.

Eighty patients undergoing longterm hemodialysis were evaluated for joint function and radiographic abnormalities. Mean age of the population was 53 years, and mean duration of dialysis was 76 months (24 patients underwent dialysis for more than 10 years). Fifty-eight patients (72%) had joint symptoms; nonspecific arthralgia was the most frequent. Fifteen patients had morning stiffness and interrupted sleep due to arthralgias (shoulders 9, fingers 3) and 10 patients had diminished finger mobility. Radiographic evaluation showed 7 classes of lesions which are not characteristic of renal osteodystrophy or degenerative lesions, including erosive arthropathies of the fingers (8%), multiple carpal bone cysts (10%), cysts of the humeral head (9%), cysts of the hip (11%), erosive spondyloarthropathies (9%), cervical spondylolisthesis (5%) and multiple diaphyseal lacunae (1%). Overall, 42 distinct radiological lesions were observed in a total population of 23 patients. Twenty-nine of these lesions occurred in patients undergoing dialysis for at least 10 years. Certain clinical and radiological patterns were frequently combined after dialysis for more than 10 years: carpal tunnel syndrome, inflammatory joint pain, bone cysts and spondyloarthropathies.

Adult↗
PubMed1987

Current aspects of osteoarticular pathology in patients undergoing hemodialysis: study of 80 patients. Part 2. Laboratory and pathologic analysis. Discussion of the pathogenic mechanism.

Clinical and radiological analysis of a population of 80 patients undergoing hemodialysis showed a high incidence of joint symptoms and radiological abnormalities which could not with certainty be attributed to renal osteodystrophy (Part 1). In this same population, laboratory and pathologic studies were performed. Blood chemistry proved abnormal in most cases (fibrinogen, aluminum, beta 2 microglobulin). Histopathologic studies (bone or synovial) were performed in 20 samples. Amyloid deposits were found in 8 samples, and crystal deposits in 3. We consider the idea that amyloid may be responsible for the observed lesions to be an interesting possibility. A better understanding of the behavior of different dialysis membranes may clarify the pathophysiological mechanisms of this disease.

Adult↗
PubMed1986

[Erosive disk diseases of chronic hemodialysis patients. 3 cases of cervical localization].

The authors report three new cases of erosive disk disease in chronically hemodialysed patients. The cases included one man and two women, who were diagnosed, on the basis of cervical or shoulder pain, as having spinal injuries involving pinched disks, punched-out lesions and incipient condensation. Discal puncture was carried out in only one patient, and proved futile. All three patients were followed-up for periods of at least one year. These three cases raise the problem of erosive disk disease in long-term dialysis patients; several other cases have been reported recently. The etiology remains obscure, but the part played by amylosis, by apatite microcrystals and by the duration of dialysis treatment are all discussed. It would appear that a novel disease entity is indeed involved, one for which, although several etiologic factors can be suggested, it has not been possible to definitely identify any single cause as the exclusive origin of the lesions detected.

Adult↗
PubMed1986

[Current aspects of the osteoarticular pathology of hemodialysis patients. Results and discussion of a rheumatological survey].

In a prospective study, 80 patients undergoing long-term hemodialysis, 30% more than ten years, were evaluated for joint function and radiographic abnormalities; 58 patients (72%) had clinical symptoms; non-specific arthralgia was the most frequent; 15 patients had inflammatory pain (shoulders 9, hands 3) and diminution of finger mobility (10). Radiological examinations showed 40 abnormal findings in 23 patients (28%): erosive arthropathies of fingers (4), and multiple geodes of the carpus (8), of the humeral head (7) or of the hip (9). We also detected spondylolisthesis (4), erosive arthropathy of cervical (6) or lumbar (2) spine. Pathological study of synovial biopsies was performed in 16 cases. Amyloidosis was found in 4 samples taken routinely. In 2 other cases the biopsy was done on the basis of lesions seen on x-rays: we found amyloidosis in the synovial membrane in both patients and in the bone in one. In 8 patients we found C3 deposits positive in immunofluorescence. These results underline the role of amyloidosis in the mechanism of some arthropathies in long-term hemodialysis patients.

Adult↗
PubMedDate not supplied

["Spontaneous" hematoma of the psoas in Gaucher's disease].

The authors report a case of iliac muscle haematoma responsible for inguinal pain in a patient with Gaucher's disease type I. This exceptional cause of pain must now be considered side by side with the classical femoral head osteonecrosis and infectious coxitis. Magnetic resonance imaging appears to be the most sensitive and most specific examination for the aetiological diagnosis of hip pain in Gaucher's disease. In the absence of thrombocytopenia and franck abnormality of coagulation, the spontaneousness of the haematoma is discussed.

Adult↗
PubMedDate not supplied

[Pyoderma gangrenosum and paraneoplastic chronic polyarthritis disclosing Hodgkin's lymphoma].

Pyoderma gangrenosum is a rare skin disease of unknown pathogenesis associated, in almost 8 out of 10 cases, with a systemic disease, notably enterocolitis or hemopathy. We report the case of a 57-year old man who had been presenting with pyoderma gangrenosum for 5 years when he developed a rheumatoid-like seronegative chronic polyarthritis. The occurrence, some time later, of a supraclavicular adenopathy led to the diagnosis of Hodgkin's disease. To our knowledge, the pyoderma-chronic polyarthritis-Hodgkin's lymphoma association has never been reported. Treatment of the lymphoma resulted in complete disappearance of cutaneous and articular symptoms. The fact that neither the skin disease nor the polyarthritis recurred during a 3-year follow-up after treatment was discontinued, incites us to discuss the possibility that the pyoderma and the polyarthritis observed in this patient were neoplastic diseases.

Arthritis↗
PubMedDate not supplied

[Adult Still's disease. A too often unrecognized illness. A study of a series of 11 cases].

The authors report eleven new cases of adult Still's disease diagnosed during the last 5 years. This rare, though not exceptional, disease of unknown pathogenesis is difficult to diagnose in the absence of specific sign; it is in fact diagnosed by elimination. The clinical, laboratory and anatomical findings, as well as the treatment and outcome of these 11 cases are described, and this is followed by a discussion of the nosological, therapeutic and above all prognostic problems raised by the disease.

Adolescent↗