[Erythema nodosum and cholestatic hepatitis during treatment with D-penicillamine].
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Biomedical subjects
Publications and source records attributed to X Phelip.
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The authors report the results of a systematic study of 37 hospitalized cases of rheumatoid arthritis. The neurological and muscular clinical signs are usually discrete. Electrophysiological examination is the basis for a classification in terms of the extent and the intensity of the neuropathy. Clinical and laboratory correlations are established permitting the individualization of a group of patients with severe neuropathy. The histological, morphometric and ultrastructural examination of 12 muscle and nerve biopsies reveal the high incidence of these lesions and the constancy of capillary involvement.
The detection of serum immune complexes in cases of rheumatoid arthritis (RA) was performed using four different detection techniques: cryoglobuline (CG), the polyethylene glycol C1q test (PEGC1q), the 125I labelled C1q test (C1qBA) and the detection of anticomplement power (ACP). CG, PEGC1q, and C1qBA are more often positive in cases of sero-positive RA than in sero-negative RA (p less than 0,001 for each test). There are significant and relatively concordant correlations between the positivity of these three tests and certain clinical and laboratory parameters in particular, the level of rheumatoid factor (p less than 0,001) and the presence of extra-articular manifestations. When ACP is found in cases of RA of recent onset, it is associated, in sero-positive cases of RA, with the presence of immune complexes and a more severe form of the disease.
According to a national study, the currently available vascular investigations give fragmentary information. Ultrasound velocimetry is usually normal, but sometimes, it reveals, early in the course of the disease, an original finding, diastolic flow. Thermography demonstrates thermic gradients in phase I, hyper- or iso-thermia in phase II and hypothermia in phase III. Capillaroscopy can demonstrate pericapillary edema, venulo-capillary stasis and tortuosities which are non-specific criteria, only significant by their associations. This study needs to be pursued in order to define the course of these vasomotor changes.
The leukocyte mobilization "in vivo" was assayed in 16 patients with rheumatoid arthritis and 10 normal subjects using the modified Senn's technique. The rate of leukocytes mobilization (LMR) is variable: in 5 cases lower than normal. No correlation is found with latex or Waaler-Rose titer, total complement in the serum, but the lowest rates of leukocyte mobilization are in previously treated patients. After 48 hours of indomethacin treatment, the LMR decreases significantly both in the patients and in the normal subjects. These results show that the abnormal "in vivo" LMR is more related to drug therapy than disease.
The authors report two personal cases and review published cases of femoral paralysis due to hematoma of the internal iliac fossa complicating anticoagulant treatment. The interest of pelvic body scanning is emphasised both in diagnosis and for the assessment of the course of various hematomas of the internal iliac fossa. A plan for treatment is proposed in which surgery is of great importance. The latter is always effective both for the pain and the motor deficiency, a precise topographical localisation of the hematoma may be a decisive argument in favour of an early operation.
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The study of 25 samples of synovial membrane taken from 118 subjects with articular chondrocalcinosis makes it possible to identify three histological aspects : the complete forms showing a crystalline deposit of calcium pyrophosphate of variable volume and alterations of an inflammatory or degenerative type ; incomplete forms showing no calcium deposit, but in which one can observe two sorts of modifications : forms of chondroid metamorphism or inflammatory stigmatas causing an indeterminate chronic synovitis ; finally, forms of superficial fibrosis of the chorion are sometimes encountered. In all, the synovial membrane in articular chodrocalcinosis is often little different from an arthrosic or senile one. However, the presence of crystalline deposits rich in calcium and phosphorous and varying in size can, in the face of certain articular manifestations of uncertain cause, point to the existence of an articular chondrocalcinosis.
Spontaneous haemarthrosis may occur during the evolution of articular chondrocalcinosis. It occurs mainly in older women and involves the knee in particular. The disorder may recur in the same or in different joints. A study of 11 case histories and counts of red blood corpuscles in samples of synovial fluid confirm that bleeding occurs more readily in chondrocalcinosis than in arthrosis alone. The proposed mechanism of haemarthrosis is only a hypothesis, but it is possible to imagine the onset of microcrystalline flow in a joint that is senile and affected by arthrosis. It is suspected that repeated haemarthrosis favours an oseolytic evolution in certain cases of chondrocalcinosis.
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The authors sought serum antinuclear antibodies by the indirect immunofluorescent method in 3,260 patients, and found these antibodies in 293 of them. 90 patients had a level equal or greater than 1/50. Among the latter, 54 had some form of collagen disease. The following facts are emphasized: -- antinuclear antibodies are always present in lupus erythematosus. Their levels fall under the influence of treatment when nephritis occurs; -- their frequency is greater (13 cases out of 16) during scleroderma, with often a hazy appearance; -- they are lower during rheumatoid arthritis (23% of cases had a significant level), and their presence is not a sign of worse prognosis; -- they were absent in other forms of collagen diseases.
Two complications of Paget's disease are presented : they include an osteogenic sarcoma and a giant-cell tumour (GCT) of the lumbar spine with a radiculo-medullary compression syndrome. The rarity of sarcomatous degeneration of the spine affected by Paget's disease is emphasized and also the unusual character of the spinal GCT which develop in the presence of Paget's disease. As in the present case, it is often difficult to confirm the benign or malignant character of a GCT and the principal criteria of this classification are discussed.
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