[Corynebacterium spondylodiscitis after diskectomy].
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Biomedical subjects
Publications and source records attributed to A Daragon.
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A decrease in bone density of the spine has been reported in individuals with hypercalciuria and the finding of the latter in osteoporosis patients is not uncommon. We studied 21 men and 8 women (mean age 47 +/- 13) with idiopathic hypercalciuria (IHCU) defined by an urinary calcium of more than 7.5 mmol/24 h in men and 6.25 mmol/24 h in women. The duration of IHCU was 10 (+/-) 8 years. Among the 29 patients, 24 had one or more renal calculi. Twenty one had been treated, by low calcium diet only (and diuresis), combined with a thiazide diuretic, or sodium phytate, or phosphorus. Bone mineral content (BMC) was measured in the lumbar spine and the upper end of the femur using an ORIS ODC 200 densitometer and compared with 29 control subjects paired for age and sex. No difference was found between the two groups concerning BMC values in either the spine or the 3 femoral sites (neck, Ward, trochanter). BMC was not correlated with urinary calcium. Thus individuals with IHCU showed no decrease in their bone mass, among this group seen in a department of nephrology. The influence of the treatment of IHCU remains to be defined.
Serum total, ultrafiltrable and protein-bound magnesium, and urinary fractional excretion of magnesium were studied in patients with primary hyperparathyroidism (before and after surgery) and in patients with hyperparathyroidism, malignant hypercalcemia and chronic renal failure with or without hemodialysis. Whereas serum total Mg was unchanged in patients with primary hyperparathyroidism, the ultrafiltrable magnesium concentration was higher than in the control group and higher before than after surgery. The total and the ultrafiltrable magnesium concentrations were highly correlated in the overall patients with Ca-related metabolic disorders, suggesting that renal function had no influence on the relation between these two parameters. Moreover, in malignant hypercalcemia, our results suggested that PTH-like peptides might be less effective than PTH in renal handling of Mg as previously described for Ca.
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Bacterial osteitis of the discs and the vertebrae is rare after fixing the uterus to the promontary of the sacrum. Only 30 cases have been reported in the literature. Twelve cases were found in a Rheumatology Unit over a period of 12 years from 1975-1987. The initial symptoms of septic osteitis were low back pain or sciatica, and fever. They were confirmed by radiological evidence. Bacteriological diagnosis was obtained in every case by fine needle aspiration of the disco-vertebral space retrieving staphylococci or gram-negative bacilli. The same agent was found in blood cultures in four or five cases. Potentiating pathogenic factors include urinary tract infections, prosthetic material, and surgical errors.
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In a family of four patients with ankylosing spondylarthritis, the study of HLA typing has permitted to establish the dissociated transmission of the B27 antigen and the spondylarthritis: as a matter of fact, if the father and his two sons have the disease, and carry the B27, one of the daughters is also definitely affected with spondylarthritis according to New York criteria, and does not carry the B27. This young woman, also, does not present in her haplotype the genes of susceptibility to psoriasis, B13, B17, CW6, DR7, nor the antigens giving cross reactions with B27, type CREG, B7, B22, B40. So, this young woman seems to have inherited from her father a genetic predisposition toward the disease without transmission of antigen B27 and it is supposed that if this gene is linked to the HLA system by an unbalanced binding, it was transmitted after recombination in her father.
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Non-hodgkin's lymphomas have benefitted from recent progresses in pathology and from new classifications having a prognostic value. In reference to a case of primary osseous lymphoma, we mention their definition and main characteristics. We stress the good sensitivity of the osseous scintigraphy to detect the osseous localizations of lymphomas. These secondary osseous lymphomas have a poor prognosis. The difficulties of the pathological diagnosis are frequent, but should decrease with the wider use of immunohistochemical marking of the bone or node biopsies.
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The search for diabetes in a patient with crural neuralgia is well established practice. The prevalence of diabetes in the general population is not known, and studies attempting to demonstrate a relationship between diabetes and radiculopathies have been inconclusive. In the present study, fasting and postprandial blood glucose determinations, as well as 14 other parameters, were analyzed in 88 patients with classical sciatica, 27 with crural neuralgia, and 42 with only back pain. Multidimensional statistical analysis revealed that patients with crural neuralgia were older than those with classical sciatica or only back pain, and that there were no differences in blood glucose regulation. The concept that diabetes is found more frequently in patients with crural neuralgia should be revised, since age appears to be the only factor responsible for changes in glucose regulation.
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