Popliteal cyst presenting as an anterior tibial mass.
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Biomedical subjects
Publications and source records attributed to A Thevenon.
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In contrast to the complications of hyperthyroidism, the bone lesions associated with hypothyroidism have not been extensively studied. A prospective study was conducted in 20 adults with protothyroid acquired hypothyroidism did not reveal any abnormalities in the parameters of phospho-calcium metabolism or the concentrations of PTH and the metabolites of vitamin D. The histomorphometric study of bone revealed hyperosteoidosis reflected by a considerable increase in the index of thickness of the osteoid, essentially affecting the relative osteoid volume. The surfaces of resorption and the bony trabecular volume were within normal limits and the rate of calcification was slightly decreased. The modifications of the histomorphometric investigation can be interpreted as a consequence of the slowing down of the basal osseous activity (BMR) due to thyroid hormone deprivation.
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The first part of the article is a general review of the various drug treatments available for algodystrophy : purely symptomatic, analgesic treatment, vaso-active drugs, calcitonin. The major advance over the last few years has been the use of beta-blockers and calcitonin but, to date, only one double blind trial has been published. This study demonstrated the value of calcitonin after one month of treatment. The authors undertook a retrospective study of 651 cases and a prospective study of 91 cases and based their work on the evaluation of various treatments prescribed separately examining each therapeutic sequence rather than each individual case. Three treatments stood out by their frequent use : griseofulvin, calcitonin and beta-blockers. Each of these drugs was effective in more than 60 p. cent of cases. It is impossible, in such a study, to formulate a hierarchy of the various treatments. Only controlled studies will be able to establish their order of effectiveness. The results vary somewhat according to the site of the algodystrophy. The best therapeutic response is obtained in lesions involving the hip leading to a very favourable prognosis.
The extra-articular manifestations of RA are numerous and various. Among the latter, pleural involvement is not exceptional, but it is often overlooked for it may be latent. There have been few recent studies of this relationship. The authors report 13 cases of rheumatoid pleurisy collected over the last 7 years in rheumatology and chest units. They recall the frequency of pleurisy, their constitutional background, their clinical and radiological appearances and emphasise the diagnostic interest of a biochemical study of the pleural fluid: a fall in the glucose content and of complement levels are the main changes. A study of the complement system carried out in 11 patients showed a fall in total complement and of the C3 and C4 fractions in the pleural fluid, which shows local consumption of immunological origin. This factor and the clinical picture may be important in diagnosis. The course of these pleural effusions is favourable, complications are exceptional; their treatment is mainly the basic treatment of RA.
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A case of retention of urine after ophthalmic zoster is reported. The sphincter vesicae disorder was of central origin, being caused by a meningoencephalitis. The patient progressively recovered. The respective responsibilities of brain suffering and meningeal involvement in these urinary tract disturbances are discussed.
According to recent studies, vitamin D deficiency may contribute to the osteoporosis observed in elderly subjects, with reduced intestinal calcium absorption and secondary hyperparathyroidism. Vitamin D deficiency is often present in elderly people, due to inadequate diet and confinement at home. The administration of either oral vitamin D in doses of 4,000 IU per day, or six-monthly intramuscular injections of ergocalciferol 600,000 IU, combined with a daily intake of at least 1 g of calcium brings back to normal both 25 OH D concentrations and parathyroid hormone levels. When pursued for one year, these treatments also maintain the formation of cortical bone, as shown by the metacarpal index. As for the concentration of 25 OH D, it seems that 60 to 75 nmol/l are necessary to restore calcium homeostasis. The dietary habits of elderly people are such that a supplement of medicinal calcium is required. Finally, we regard the parenteral form of ergocalciferol as being preferable to the oral form at that age for better compliance with treatment.
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X-rays of the hands and wrists of 100 patients suffering from rheumatoid arthritis (RA) were compared to those of 65 control subjects matched for age and sex. Osteoarticular destruction was assessed using Larsen's index and by carpal bone deformities; ulnar deviation of the fingers (UDF) and radial deviation of carpal bones (RDC). No significant asymmetry of lesions in the right or left hands can be demonstrated, whatever the subsets of patients and osteoarticular manifestations studied. After a one year course, there is no significant difference between patients and control subjects. Only the index of carpal deformity is significantly high and the clinical course progresses between 1 and 5 years (p = 0.02). The difference becomes significant for UDF (p less than 0.01) after the disease evolves for 5 to 10 yrs. UDF is correlated with carpal osteoarticular lesions (p = 0.01) and metacarpophalangeal lesions (MCP). Different osteoarticular lesions of the hand are correlated with each other. The close correlation between UDF and RDC and MCP involvement has been confirmed by various statistical tests. Comparison of seropositive and seronegative patients with RA only reveals a more marked disturbance of MCP in the seropositive patients. Various methods of assessing osteoarticular deformities and joint destruction are discussed. Finally, the etiopathogenic mechanisms causing deformities of the hand in RA were studied, and the authors reviewed the importance of the initial involvement of soft tissues and therapeutic implications whereby prevention of disease extension using prompt local therapy is recommended.
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