Biomedical subjects
Publications and source records attributed to S Pattin.
The authors report three cases of migratory algodystrophy of the knee. Repeated isotope bone scan, CT scan and nuclear magnetic resonance were used to monitor the movement in situ of the pathophysiological process of algodystrophy. In one case, CT scan revealed localised hypertrophy of the soft tissues located immediately over the bone lesions.
Five-hundred-thirteen regional intravenous guanethidine blocks were carried out in 125 cases of algodystrophy (118 adults), after failure of other treatments in 120 cases (Group I) and without previous treatments in 5 (Group II). A positive result occurred in 85 cases of Group I (71%) and in the 5 cases of Group II, after 4.5 +/- 1.7 blocks. In Group I the results did not differ significantly between upper (33 cases) and lower (87 cases) limb or in regard to sex, age, duration of disease, nature of previous treatments. The presence of psychic disorders was accompanied by less frequent (p less than 0.02) positive results. The tolerance was satisfactory in 85.6% of cases: 22 moderate side effects authorized a continuation of the blocks, 22 serious ones indicated interruption, especially one case of thrombophlebitis and another one of very transitory acute ischaemia. The risk of intolerance was significantly raised (p less than 0.02) by age. The regional guanethidine blocks seemed to be a good treatment for algodystrophy after failure of other treatments.
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In a preliminary retrospective study, 418 regional sympathetic blocks with guanethidine administered as treatment of 103 cases of algodystrophy gave 70 p. cent of positive results versus 55 p. cent in case of psychic disorders. The tolerance was correct in 85 p. cent but was decreased by old age.
Two sets of criteria have been proposed to discriminate spondylarthropathies (SA) from other rheumatic diseases. To evaluate their performance, we conducted a cross-sectional study in the patients observed during one week in 28 French Departments of Rheumatology by 91 staff-teaching physicians. The physicians had to apply these criteria to all their patients and had to classify them as definite SA, definite other rheumatic disease or possible SA. The analysis performed on the 2,088 patients with a definite diagnosis (124 SA and 1,964 controls) showed the following results: (table; see text) Of the 140 patients with possible SA, 37 fulfilled both sets of criteria, 22 the ESSG criteria alone and 12 the Amor criteria alone. These data suggest that a) the overall performance of these two sets of criteria is similar; b) this performance is better in the group of patients with a definite diagnosis; c) the patients without a definite diagnosis require a longer follow-up to assess the clinical relevance of these two sets of criteria.
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This retrospective review presents the results of treating 199 patients with sympathetic reflex dystrophy of the foot: 141 of traumatic and 58 of non-traumatic origin. Calcitonin (177 patients) improved or cured 62.2 p. 100 of these patients and was equally effective for pseudo inflammatory and ischemic (cold) stages of the disease. Among the therapeutic means available, regional sympathetic blockade with guanethidine (49 patients, 163 treatments) provided 80 p. 100 improvement or cure, with twice as many patients in the hot phase as in the cold. All patients were cured: 75 p. 100 in less than a year, 4.6 p. 100 with moderate, non-handicapping sequelae. Normal activities were partially reinstituted 3.5 +/- 2.8 months (post-trauma) or 1.9 +/- 1 months (non-trauma) after treatment. They were completely possible 5 months after the end of treatment in both groups. In the trauma group, 73 patients had work-related accidents: their evolution was the same as that of the other patients in this group. When present, psychological background (35 p. 100 of the cases) only delayed progress in the non-traumatic group (9.9 vs 6.5 months).
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Bone scintigraphy with technetium 99m pyrophosphates was used to study a series of 74 cases of algodystrophies. Though non-specific, this investigation was the determining factor for confirming the diagnosis in more than 48% of cases, by demonstrating early bone hyperfixation, its topographical characteristics, and the return to normal conditions after 3 to 12 months. Bone hyperfixation has to be exaluated together with clinical, biological, and radiological signs when considering the diagnosis, and though in half the cases it is not indispensable for diagnosis, it is always of value for determining the amount of extension of the algodystrophic process.
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Two cases of rheumatoid coxitis of the macrogeodic type are reported. In one case, there was a very large anfractuous cavity in the socket and head, complicated by a pathological fracture of the socket, which raised the suspicion of a malignant tumor. The authors review the characteristics of these macrogeodic forms of rheumatoid arthritis, about forty cases having been reported in the published literature.
The authors describe, on the basis of 7 cases, a special form of decalcifying algodystrophy not described in the literature, characterized by a very localized pain beginning gradually, or more often suddenly. It is of mechanical or mixed type, accompanied by local, pseudo-inflammatory signs being either apparent or discrete, very elective and very sharp pain upon palpation of a very limited area of a condyle or a tibial plate, with hyperfixation located through scintigraphy with technetium 99m polyphosphates, and regressing either spontaneously, or more quickly under treatment, of which thyrocalcitone is the essential part, without undergoing a phase of intense loco-regional demineralization. This form of algodystrophy, that they propose to call partial algodystrophy, can, like the other forms of algodystrophy, appear in monofocal or plurifocal form, either straight off or at a distance from the first incidence, which leads this new radioclinical type to be considered a simple form of algodystrophy of the limbs, midway between the types without radiological anomaly during development and the complete and extensive ones with major radiological signs. Finally, they underline the great value or scintigraphy in diagnosing this form of algodystrophy and algodystrophy without radiologic anomaly.
The authors report on 43 cases of calcaneitis seen out of 121 cases of Fiessinger-Leroy-Reiter syndrome. They describe the three developmental stages and show that the polymorphism of the radiological aspects realized depend on the very great variability of the speed of development of the pathological process from one case to another. Calcaneitis of the Fiessinger-Leroy-Reiter syndrome always ends in cure.
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Two cases of post-meningococcal inflammatory arthritis with a relapsing course in one case are reported. The authors then recall the characteristics of the joint manifestations during meningococcal infections in the light of other cases in the literature. These arthropathies are generally aseptic and their resistance to antibiotics is remarkable, whilst non- steroid anti-inflammatory drugs, even used alone as in one of the cases reported here, are remarkably effective. The pathogenesis of these cases of arthritis is not clear: it seems however according to Greenwood and Whittle that they are manifestations of immuno-allergic type. This "post-meningococcal rheumatism" may be compared to the gonococcal rheumatism of certain cases of Reiter's syndrome.