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Biomedical subjects

B Sauvezie

Publications and source records attributed to B Sauvezie.

At least 19 recordsLinked to original sources
PubMed1994

Early dental loss in Sjögren's syndrome. Histologic correlates. European Community Study Group on Diagnostic Criteria for Sjögren's Syndrome (EEC COMAC).

Early dental loss is a well-known complication of Sjögren's syndrome. Forty percent (n = 16) of 39 consecutive patients with the syndrome had early dental loss. Dental loss correlated positively with histologic grading at lip biopsy. There was no significant correlation with any other feature of Sjögren's syndrome, including saliva flow. In 11 partially edentulous or completely edentulous patients, dental loss occurred 9 years on average before the first symptom of xerostomia. Early dental loss may reflect a silent involvement of the salivary glands and suggests that changes in saliva biochemistry occur long before xerostomia.

Adult↗
PubMed1994

[From sedimentation rate to inflammation profile].

The main biological sign of inflammation is an increase in erythrocyte sedimentation rate (ESR). However it can be falsely normal (polyglobulia, cryoglobulinemia, hemoglobinopathy) or spuriously high in the absence of inflammation (anemia, hypergammaglobulinemia). In cases of doubt, the acute phase reactants (APR) should be measured: C reactive protein (CRP), fibrinogen, haptoglobin, alpha 1 acid glycoprotein. They have different kinetics of variation and various degrees of increase (some--the so called "negative" proteins--actually decrease). Several pitfalls can be avoided if it is remembered that the APR themselves can be modified by causes other than inflammation: low fibrinogen in intravascular coagulation, very low haptoglobin in hemolysis, raised orosomucoide in renal insufficiency and elevated transferrin in iron deficiency. Furthermore liver insufficiency or leakage through the kidney or gut lesions can lower them. In some patients, the observed levels of APR are thus the result of opposite trends. In complex cases, these pathological mechanisms are more apparent on profiles which express the concomitant blood levels of several APR in a normalized or comparative manner. In medical practice, ESR serves first and foremost to detect an inflammatory syndrome. CRP is prominent among the APR because its changes show a great sensitivity, are independant of those of ESR and have a time course fitting closely that of the inflammatory processes. Profiles yield detailed information but rarely provide major evidence in the quest of a diagnosis or the choice of a treatment. Because of their cost they are to be used only in difficult cases.

Biomarkers↗
PubMed1994

[Primary antiphospholipid syndrome of fatal course and osteoarticular cytosteatonecrosis].

The antiphospholipid syndrome produces acute occlusions of arteries and veins. This syndrome can cause a multiple organ systems failure whose outcome is often fatal. The authors report a case of the primary, antiphospholipid syndrome characterized by this fatal outcome, a so-called "devastating" syndrome following pulse steroids. In this patient, the antiphospholipid antibodies had been found after presenting bone-marrow fat necrosis, which led to extensive lesions of knees, hips and shoulders. Damage to the cell membranes in necrotic lesions might have promoted the immune response against phospholipids. The potential risks of pulse doses of steroids in the antiphospholipid syndrome are documented by the present observation, which also suggests that antiphospholipid antibodies should be determined in cases of fat necrosis of all origins.

Antiphospholipid Syndrome↗
PubMed1994

[Renal manifestation in POEMS syndrome].

The authors report four cases of POEMS Syndrome with renal involvement. Two had renal failure and mild proteinuria. The two others had hyporeninemic hypoaldosteronism with type IV renal tubular acidosis in the first and hyperkalemia alone in the second. In the two cases, renal biopsy showed mesangial proliferation. Evolution was favourable when the plasma cell proliferation could be checked. In POEMS pathophysiology of renal involvement remains unknown. Soluble factor(s) produced by plasma cells may be responsible for most signs and symptoms perhaps as a result of increased vascular permeability.

Acidosis, Renal Tubular↗
PubMed1994

[Longitudinal stress fractures of the tibia. Apropos of 3 cases].

Longitudinal stress fractures of the tibia are rare: only 16 cases have been published. We report three cases, in two men aged 54 and 70 years and in one women aged 73. The patients had pain when bearing weight on the affected limb. The pain increased over a few weeks. A diagnosis of arthritis of the ankle joint was entertained in 2 cases. Among the three patients, one was suffering from rheumatoid arthritis and had had Ender nails due to fracture of the femoral neck of the same limb. The longest delay for diagnosis was six months. Plain radiographs were normal in two cases. A technetium 99m MDP bone scan showed increased uptake of the whole shaft of the tibia in one patient, on the lower end of the tibia in two others. Computed tomography was performed in two cases and showed the stress fracture. Diagnosis was often delayed because clear changes at plain X-ray examination, periostal reaction often being delayed. Technetium 99m bone scan early showed increased uptake. CT scan showed callus formation and sometimes the fracture itself. MRI has been studied little.

Aged↗
PubMed1994

[Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature].

Twenty-four cases of septic arthritis in rheumatoid arthritis patients were compared with 99 cases of septic arthritis in patients without rheumatoid arthritis. In addition, 238 previously published cases of septic arthritis with rheumatoid arthritis were analyzed. Fifteen percent of our patients with septic arthritis had rheumatoid arthritis, which was typically of long duration (mean 15 years), erosive, and seropositive. Fifty-four per cent (28% in the literature) and 9% of patients with and without rheumatoid arthritis, respectively, had pyarthrosis of multiple joints. The knee represented one-third of infected joints and the elbows and wrists were more often infected in patients with than without rheumatoid arthritis. S. aureus was recovered in 80% versus only 60% of patients with and without rheumatoid arthritis, respectively. The source of sepsis was often a skin lesion, in particular at the foot, emphasizing the need for early orthopedic treatment of deformities responsible for skin lesions. Monoarticular infection was more likely to be due to an intraarticular injection. Mortality rate was 17% in patients with rheumatoid arthritis (23% in the literature) versus 7% in patients without rheumatoid arthritis. Staphylococcal infection and infection of multiple joints were associated with higher mortality rates (35% and 49%, respectively). The mortality rate in polyarticular infections has failed to decline over the last 35 years. Initial failure to distinguish septic arthritis from an exacerbation of rheumatoid arthritis contributes to the high mortality rate. The diagnosis of septic arthritis rests on a high index of suspicion. Septic arthritis cannot be ruled out based on absence of local inflammation, fever, or hyperleukocytosis or on presence of inflammation of multiple joints. Joint fluid specimens should routinely be sent to the microbiological laboratory and should be inoculated in blood culture bottles at the least suspicion.

Aged↗
PubMed1993

[Vertebral compression in epilepsy. Analysis of 8 cases].

Epileptic seizures can produce dislocations or fractures of the limbs and vertebral compression fractures. We tried to determine the clinical and radiological features of the latter in 8 patients: 6 men and 2 women including one aged only 41 years. The often multiple compression fractures involved the first thoracic (n = 3) and the intermediate thoracic (n = 3) or lower lumbar (n = 2) vertebrae but, contrary to common osteoporosis, never the thoracolumbar hinge. In 2 cases, the appearance of the fracture and the neurological signs led to surgery. Posterior dislocation of the shoulder was associated with the fractures in 2 cases. Chronic alcoholism (4 cases), anti-epileptic drugs (1 case) or corticosteroids (1 case) might have facilitated a demineralization which was however not obvious on X-ray films. The seizure was a first ever event in 6 cases. In the absence of controls the fracture was considered to be spontaneous. These particularities explain why a metastatic compression fracture was initially suspected in 3 cases, leading to explorations which sometimes were aggressive. In the presence of a suspicious vertebral compression fracture the clinician must consider the possibility of an epileptic seizure, a trauma which is sufficient to explain the fracture, as shown by the complications of electro-convulsive therapy.

Adult↗
PubMed1993

Polyarticular septic arthritis.

Twenty-five cases of polyarticular septic arthritis (PASA) were observed in our department over a 13-year period. They accounted for 16.6% of all septic arthritis (15% on average in the literature). A male predominance was noted in our patients, as well as in the literature. The knee was the most frequent location followed by the elbow, shoulder, and hip, in varying order depending on the series. An average of 4 joints was involved. The causative microorganism was Staphylococcus aureus in 20/25 of our patients and in about 50% of published cases. Other frequently causative organisms were streptococci and gram-negative bacteria. Blood cultures and joint aspirations were positive in 19/22 and 23/25 of our cases, respectively. Other septic lesions were noted in 10/25 of our cases. Fever and severe leukocytosis were absent at admission in 5/25 (literature, 37%) and 10/25 of our 25 patients, respectively. The underlying disease was rheumatoid arthritis in 13/25, while 9 of the other patients had immunodepression caused by drugs or by concurrent illness. Typically, rheumatoid arthritis was long-standing and erosive, patients having ulcerated calluses on the feet. This skin source was also noted in 23/36 published cases of PASA in rheumatoid arthritis. Systemic lupus erythematosus was an uncommon disease in PASA, but its presence promoted gram-negative infection. Despite effective therapy with 2 antibiotics, 8/25 patients died, a prognosis that is equally severe in cases reported in the literature (30%) and one that has remained surprisingly stable over the last 40 years. For comparison, the death rate was only 4% in our patients with MASA. Factors contributing to a poor prognosis were age greater than 50 years, rheumatoid arthritis as an underlying disease, and disease of staphylococcal origin. Septic polyarthritis should be considered even when the clinical picture is not florid--when patients have low fever and normal white blood cell counts. Nor should the simultaneous involvement of distant joints rule out infection. Indeed, the frequency of underlying rheumatic disease and its treatment may further confuse the clinical presentation. Joints suspected of harboring infection should be aspirated, including those previously affected by the concurrent rheumatism.

Aged↗
PubMed1993

[Tuberculous septic polyarthritis caused by Mycobacterium bovis].

Infections due to Mycobacterium bovis have become uncommon. We report a case with polyarthritis and cutaneous nodules suggesting a rheumatic disease. This 61 year old male under corticosteroid therapy for asthma developed febrile arthritis of the right wrist and cutaneous nodules that resolved rapidly under treatment with penicillin M and an aminoglycoside. Six months later, he developed arthritis of the right wrist and both elbows, as well as infection of a right hip prosthesis. The left wrist and left knee were then affected concomitantly. The cutaneous nodules recurred. A giant cell granuloma without caseous necrosis was found upon examination of a biopsy specimen from a nodule. Granulomatous lesions with caseous necrosis were seen in a specimen of synovial membrane from the right wrist. Antituberculous treatment ensured resolution of the arthritides and nodules but failed to prevent loosening of the hip prosthesis. Acid-fast bacilli were found in the specimens taken during removal of the prosthesis. After three months, cultures of synovial membrane specimens from the knee grew Mycobacterium bovis.

Arthritis, Infectious↗
PubMed1993

[Involvement of the foot in reactive arthritis. A retrospective study of 105 cases].

The foot is among the sites most often affected in spondyloarthropathies, whose diagnostic criteria include heel pain and sausage-like swelling of the toes. Few studies have systematically analyzed foot manifestations in reactive arthritides. We retrospectively reviewed 143 patients fulfilling Amor's criteria. One hundred five patients (73%) exhibited inflammatory involvement of one (n = 47) or both feet. In 8 cases no other articular sites were affected. Heel pain was reported by 36% of patients (52/143), within the first six months in half the cases. Both heels were painful in 26 patients. Heel pain was plantar in 36 cases, posterior in 7 cases, and bipolar in 4 cases. Roentgenographic calcaneal changes were found in 54 cases overall but in only 31 of the patients with heel pain. Sixteen patients had asymptomatic calcaneitis. Seventeen patients had involvement of the transverse tarsal joint, usually with no other affected joints. Involvement of the subtalar joint was rare (6 cases). Metatarsophalangeal manifestations were found in 44% of patients (64/143) and were symmetrical in 17 cases; 17 patients had changes of the great toe suggestive of gout. Interphalangeal arthritis was seen in 22% (32/143) of cases; in half these cases the first two rays were affected and sausage-like digital swelling was seen in 28 patients (20%). Permanent roentgenological damage was uncommon.

Adult↗
PubMed1992

[The missing inflammatory syndrome].

An inflammatory disease is sometimes suspected despite a normal erythrocyte sedimentation rate (ESR). When this dissociation is present, the reasons for the lack of ESR elevation, which concern the red cells, the plasma and the laboratory techniques, must be excluded, the reality of the inflammatory syndrome being then confirmed by assay of the inflammatory proteins. However, an inflammatory syndrome is missing in 5 to 10 percent of inflammatory diseases, more frequently in cases of polymyositis or scleroderma, less frequently in those of giant cell arteritis. Little information can be found in the literature, concerning the missing inflammatory syndrome. Does it confer peculiar semeiological or prognostic features? Is the dissociation related to the patient, as would appear in some special cases, or to the disease, as suggested by the small rise of the C-reactive protein in acute episodes of lupus erythematosus? The absence of inflammatory syndrome is a source of diagnostic problems when the symptoms are atypical or when there are no specific signs of the suspected disease. Differential diagnoses, especially non-inflammatory diseases, must then be carefully discussed. Improving our knowledge of the missing inflammatory syndrome would require the creation of this key-word.

Arthritis, Rheumatoid↗
PubMed1992

[Significance of inflammatory syndrome in the diagnosis of Horton's disease. Attempt at the application of Bayesian analysis].

This study was designed to investigate the value of biologic evidence of inflammation for the diagnosis of giant cell arteritis. Experienced physicians were asked to evaluate five pairs of medical records based on real cases. In each pair, one case lacked biologic evidence of inflammation. This study offered the opportunity to explore the feasibility of a simplified Bayes model. A blind evaluation obtained by showing the paired case-reports with similar evidence of inflammation in both cases of each pair to 14 specialty physicians yielded a likelihood of diagnosis of +/- 20%. Analysis of the 46 responses to the study demonstrated, despite wide variations, a significantly greater likelihood of diagnosis in the cases with evidence of inflammation. Nevertheless, 17% to 36% of physicians--according to the case-report--ascribed virtually no importance to the ESR. Most of the physicians considered temporal artery biopsy was warranted when the likelihood of diagnosis was greater than 25%. Emergency corticosteroid therapy while awaiting the histologic results was approved by most responders when the likelihood of diagnosis was greater than 65%. The "pre-test" likelihood, calculated assuming that sensitivity and specificity of the ESR are 0.99 and 0.50, respectively, ranged from 0.89 to 0.98 for the case-reports with no evidence of inflammation and from 0.16 to 0.59 for the case-reports with evidence of inflammation In theory, the figures for the two types of case-report should not differ by more than 20%. Use of a low value for specificity (0.05) would improve the fit of values in cases without evidence of inflammation but would increase discrepancies in the other cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Current aspects of inflammatory rheumatic diseases in elderly patients].

Rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR) are the most common rheumatologic diseases encountered in older patients. However, other disorders including spondylarthropathy and a variety of connective tissue diseases also occur in the elderly. PMR and the RS3PE syndrome seem to occur only in the elderly, although their symptoms may be difficult to differentiate from those of other conditions. Late-onset RA and, above all, late-onset spondylarthritis may have unusual presentations responsible for diagnostic mistakes. Pitting edema is typical of RS3PE syndrome but may also occur in other rheumatic diseases. This symptom seems to be associated with advanced age rather than with a specific cause. Because of these many unusual features, rheumatologic diseases in the elderly are often difficult to diagnose and to differentiate from a variety of other rheumatologic or nonrheumatologic conditions.

Aged↗
PubMed1992

[Neuromuscular complications of D-penicillamine in rheumatoid arthritis].

Between 1979 and 1990 we have seen 8 patients (7 females) with rheumatoid arthritis (RA) who developed a neuro-muscular involvement while on D-penicillamine (D.P.). Five of them had a drug-induced myasthenia. D.P. withdrawal led to a complete recovery in 1.5 to 5 months. Another patient presented with a myopathy which led to the diagnosis of Grave's disease. She was treated with D.P. for 4 months. D.P. was reintroduced and 5 months later a myasthenic syndrome developed. A thymoma was discovered 1 year later. In the last 2 patients D.P. induced polymyositis which, in one, was associated with features of systemic lupus erythematosus. In the other patient, the evolution was fatal in spite of D.P. withdrawal, high dose steroids and plasma exchanges. A literature survey has shown 150 D.P. induced myasthenia and 38 D.P. induced polymyositis cases.

Aged↗
PubMed1991

[Acute phase proteins in monoclonal gammapathies].

IL-6 is now recognized as a growth factor for plasma cells as well as a C Reactive Proteine inducer. This prompted a reappraisal of acute phase reactants in monoclonal gammapathies. Eight acute phase proteins were assayed in patients with multiple myeloma (n = 51), MGUS (n = 17) and Waldenström's macroglobulinemia (n = 5). The CRP level was above 10 mg/l in 27% of all myeloma patients, in 39% of patients with active myeloma, in 4 of 5 patients with Waldenström's macroglobulinemia and in none of the MGUS patients. Fibrinogen, alpha-1-antitrypsin and orosomucoid levels were significantly higher in the myeloma group than in the MGUS group. Differences were not significant for haptoglobin, ceruleoplasmin, transferrin, and alpha-2-macroglobulin. Serial assays in 22 myeloma patients showed that CRP levels were correlated with disease activity. A biologic inflammatory syndrome, defined as a significant variation in two or more acute phase reactants, was demonstrated in 41% of myeloma patients, 18% of MGUS patients, and 60% of Waldenström's macroglobulinemia patients. Active disease was significantly more common among myeloma patients with biologic evidence of inflammation, as compared with myeloma patients without biologic inflammation. These data suggest that similarly to IL-6 acute phase reactants are markers for disease activity in multiple myeloma.

Acute-Phase Proteins↗
PubMed1991

[Seronegative rheumatism of late onset. Incidence and atypical forms of spondylarthropathy].

The authors reviewed the files of male patients who have been hospitalized over a 12 year period for a rheumatoid-factor negative arthritis beginning after age 50. Polymyalgia rheumatica, psoriasis or crystal-induced arthritis were excluded. The remaining 105 observations were classified according to published criteria in rheumatoid arthritis (RA), reactive arthritis or ankylosing spondylitis (AS). Twenty-nine patients had RA and 29 had AS with equal numbers of axial and peripheral types. Four patients had reactive arthritis, one of them had also AS. Forty-four patients had "unclassified arthritis". Among the latter, 14 were B27 positive, 21 were B27 negative, 9 were not typed. Some features were more frequent in B27+ patients: an assymetrical oligoarthritis of the lower limbs with minimal signs of inflammation at synovial analysis or at synovial biopsy; frequent unilateral edema; marked, constitutional signs; very high ESR. Nine patients, all B27+, met the diagnostic criteria of spondylarthropathy. B27 typing thus appears relevant to the classification of late-onset, seronegative rhumatisms.

Arthritis, Reactive↗