[Carcinomatous meningitis revealed by rachialgia with stiff neck].
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Biomedical subjects
Publications and source records attributed to A Hubault.
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The physiopathological mechanisms leading to precipitation of pyrophosphate in the articular cartilage remain unclear. Numerous findings suggest an error in pyrophosphate metabolism: excessive production or defective degradation, a primary modification of the fundamental substance leading to crystallization, a chondrocyte dysfunction being a possible cause of these two anomalies. The relationships between deposition of calcium pyrophosphate and changes in the subchondral osseous plaque common to several metabolic diseases are even more mysterious.
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In this study, patients suffering from osteoarthrosis of the hip received two successive periods of treatment, A and B, each of two weeks, with either ketoprofen or a placebo. The daily dosage of ketoprofen was 150 mg in three divided doses of 50 mg. In each case the findings necessary for diagnosis and for assessment of progress during the treatment were recorded. At the end of the trial, the patient's preference for one or other of the two periods of treatment was used as the criterion. The results were analysed by the sequential method. The therapeutic effects assessed by the various criteria included in the protocol (patient's subjective assessment, pain at rest, duration of morning stiffness, distance walked without pain, range of movements, etc.) were also recorded. Nine cases were sufficient to provide a statistically significant result in favour of ketoprofen. In eight cases the preference was definitely in favour of ketoprofen. In a single case there was no preference for one or other of the two periods of treatment (failure of both ketoprofen and placebo). Tolerance to ketoprofen was excellent.
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Jejuno-colic and jejuno-ileal anastomoses may provoke arthritis. The recently recognized physiopathology is that of arthritis due to immune complexes related to pullulation of Escherichia coli and of Bacilus fragilis. These cases of arthritis, usually sensitive to therapy, have, in some stutborn cases, required the re-establishment of intestinal continuity, which in each case has made the joint phenomena disappear.
In this trial, the patients suffering from osteoarthritis of the hip received either ketoporfen or a placebo successively for 2 treatment periods, A and B, of 14 days each. The daily dosage of ketoprofen was 150 mg in 3 doses of 50 mg. In each case treated, the parameters necessary for the diagnosis and those necessary to assess progress under treatment are reported. At the end of the trial, results have been rated according to the preference of the patient for treatment period A or B. The results were analysed by the sequential method. The therapeutic results reported were obtained from various criteria stated in the protocol (subjective evaluation by the patient, pain when resting, duration of morning stiffness, distance of pain-free walking, amplitude of movements, etc.). Nine cases were sufficient to produce a significant statistical result in favour of ketoprofen. In eight observations a preference in favour of ketoprofen was apparent. In one case only, there was no preference for either one or the other of the two treatment periods (failure of ketoprofen and of the placebo). Ketoprofen was excellently tolerated.
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There are several neurological complications of Paget's disease. They may concern the medulla, the cauda equina, and also the cerebral trunk, the cranial nerves, and the brain. Complications are rare when the great frequency of Paget's disease is considered. But they should be recognized because they constitute an aspect of the disease the treatment of which is usually well tolerated of even negligible. The signs of involvement of the medulla, of the cauda equina, and those which complicate the basilar impressions usually develop in a progressive and not very spectacular fashion. Nevertheless, they should be recognized as soon as possible so that therapeutic measures may be taken. The results of modern medical treatments, calcitonin, cellulolytic medications, and possibly others are already sufficiently established to justify their use initially. Indications for surgical treatment appear when a check in medical therapy is observed after three months of treatment.
Encephalopathies caused by intoxication with bismuth are liable to be complicated by arthropathies of the shoulder, on one or both sides, of an osteolytic, and probably osteonecrotic, type involving to a greater or lesser extent the humeral head and/or by destruction of articular cartilage with ateration and flattening of the heumeral head. The relation between these arthropathies and bismuth intoxication appears certain but is not yet understood. The strict electivity of the condition for the shoulder is not understood either. Certain analogies indicate similarity with metabolic arthropathies.
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