[Synovial amylosis and subcutaneous plasmocytic nodules].
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Biomedical subjects
Publications and source records attributed to C Dromer.
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The purpose of this study was to determine magnetic resonance imaging (MRI) features of osteoid osteomas and to evaluate the place of MRI in the diagnostic workup of suspected osteoid osteoma by comparing its diagnostic value with that of computed tomography (CT). Nine patients with radioclinical features highly suggestive of osteoid osteoma were investigated using bone scintigraphy, CT scan and MRI. MRI sequences were weighted for T1 (TR: 500 ms-TE: 34 ms), T2 (TR:2000 ms-TE:50-100 ms) and T1 after intravenous injection of gadolinium-DTPA contrast material. The appearance of the nidus and surrounding area were analyzed, as well as the accompanying inflammatory reaction involving the bone marrow, soft tissues or synovium. All patients had surgical treatment. Clinical recovery was achieved in every case. Histological studies confirmed the diagnosis of osteoid osteoma in 7 patients. In two cases, histological confirmation was not obtained and the exact nature of the lesion therefore remained in doubt, although clinical and scintigraphic findings as well as the subsequent course were consistent with the diagnosis of osteoid osteoma. In 5 cases, MRI proved inferior to CT scan for detecting the nidus. MRI disclosed edema of the bone marrow not seen on CT scan sections in 5 cases, edema of the soft tissues in three cases, and synovitis with joint effusion in one patient with an epiphyseal osteoid osteoma. At present, MRI plays only an ancillary role in the diagnosis of osteoid osteoma, which rests on the concomitant use of bone scintigraphy and CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)
Two typical cases of Parsonage-Turner syndrome with reflex sympathetic dystrophy syndrome and adhesive capsulitis of the shoulder are reported. The rarity of this combination is discussed.
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Prosthetic tracheobronchial stents provide palliative treatment for narrowed airways where surgical resection is inadvisable. Over a 1-year period, 28 Gianturco expanding wire stents were used in 15 patients for nonneoplastic indications: pure fibrous airway stenosis (6), fibroinflammatory stenosis (4), and tracheobronchial malacia (5). Insertion was technically straightforward. A satisfactory airway lumen with immediate improvement in ventilatory function was obtained in all patients. After insertion all patients had an irritation-type cough that either subsided spontaneously (10 patients) or was successfully suppressed with inhaled corticosteroid therapy (5 patients). The most common complication (12 patients) was granuloma formation leading to stent removal in 3 patients with fibroinflammatory stenosis. Other complications were dysphagia (1), suction catheter entrapment (1), and fatal massive hemoptysis (1). At a mean follow-up of 13 months (range, 3 to 19 months) all remaining stents are functioning well with no displacement or infection. Overall results were satisfactory in pure fibrous stenoses and tracheobronchial malacia but poor in the presence of inflammation. Tracheobronchial wire stents can be successfully used in selected patients.
Donor airway ischemia is the main cause for defective tracheal or bronchial healing after double-lung transplantation. Anatomical studies and bronchial arteriograms have shown that the right intercostal bronchial artery is constant (95% of instances) and provides an important blood supply to the distal trachea, the carina, and the right bronchial tree as well as to the left side through a subcarinal and periadventitial anastomostic network. To maintain this important bilateral bronchial circulation, it is of capital importance not to mobilize the arteries individually and to avoid large dissections around the carina. Both bronchi can thus be revascularized by indirect aortic reimplantation using a bypass graft to a single aortic patch that includes the origin of the right intercostal bronchial artery. Furthermore, the origin of other vessels (a common trunk and left arteries) can be found within a short distance of the right intercostal bronchial artery and possibly be contained within the same aortic patch. From a series of 56 lung transplantations, 8 patients underwent restoration of the bronchial vascularization using a recipient saphenous vein graft between the donor bronchial arteries and the anterior aspect of the recipient's ascending aorta. A lower tracheal anastomosis was performed. Bronchial arterial blood supply was evaluated both by endoscopy and by arteriography at about the 15th postoperative day. The bronchial circulation was visualized at this time in five of seven arteriographies, and this was associated with excellent tracheal healing in all 8 patients.
The prevalence of thyroid abnormalities was determined in 131 patients: group I = rheumatoid arthritis, 68 patients, group II = systemic immunological diseases (IIa Sjögren's syndrome, n = 6; IIb other rheumatic autoimmune disease, n = 17), group III = other rheumatic diseases n = 13 and control group (n = 27). Thyroid abnormalities (hypo, hyperthyroidism, nodular goiter) were frequent: 33.8% in group I, 100% in group IIa, 11.7% in group IIb. Hypothyroidism was present in 19.1% (group I), 50% (group IIa). 6% (group IIb). Autoimmune thyroiditis was found in 16.2% in group I, 100% in group IIa, 11.7% in group III. Thyroid diseases are frequent in patients with rheumatoid arthritis. Therefore thyroid tests might be performed in patients with rheumatoid arthritis.
A case of dermatomyositis in a patient with two different malignancies is reported. Skin lesions cleared only following exeresis of the second tumor. This case provides the opportunity for a discussion of the main theories put forward to explain relationships between dermatomyositis and malignant disease.
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A new case of simvastatin-induced acute rhabdomyolysis with heart failure after initiation of treatment with fusidic acid is reported. In most reported instances, statin treatment was initially well tolerated with muscle toxicity developing only after addition of another drug. The mechanism of this muscle toxicity is unelucidated but involvement of a decrease in tissue Co enzyme Q is strongly suspected.
On the basis of 193 cases of psoriatic arthropathy, the authors sought the incidence and rapidity of onset of signs suggestive of this type of rheumatic disorder when there are radiological lesions of the fingers and toes. They conclude that when such radiological lesions exist, signs suggestive of psoriatic arthropathy are frequent (90%), early (85% of cases of psoriatic arthropathy present for less than 5 years) and predominantly involve the distal parts of the fingers and toes (85.5%). The authors consider that the signs which distinguish psoriatic arthropathy from rheumatoid arthritis are due to an extrasynovial process of enthesopathic origin.
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The post operative evaluation and endoscopic follow-up of 34 tracheal or bronchial anastomoses after lung or heart-lung transplantation show some aspects of the tracheobronchial healing and difficulties in the healing process: primary type I mucomucosal healing in only 6 cases, secondary type II mucosal healing in 15, delayed type III healing after mucosal or deep parietal necrosis in 13, type IV distant ulcerations of mucosa and spur lesions in 12. Type III difficulties of healing mainly occur after double-lung transplantations which always suffer from ischemia. Autologous tracheal or bronchial sutures in 3 transplanted patients submitted to standard immunosuppressive therapy including corticosteroids were uneventful and type I. This experience suggests that among all factors having an influence on bronchial healing, ischemia of the donor tracheobronchial tree is predominant, justifying all attempts of bronchial revascularization after double-lung transplantation. The efficacy of the arterial revascularization is verified in 3 cases of tracheal anastomosis after double-lung transplantation with type I or II tracheal healing.
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Study of the HLA-B grouping of 193 patients with psoriatic arthropathy (PA), compared with that of a control series consisting of 2,706 healthy subjects representative of the French population, revealed a statistically significant link between PA and antigens B27, B17 and B16. In contrast to reported findings of earlier studies, the authors found no link between an HLA-B antigen and any particular topographical or anatomical form of PA. Antigen B27 was not statistically significantly linked with axial forms of PA nor did it protect against peripheral forms. There were neither more cases of peripheral involvement nor less of axial involvement among non-B27 PA patients. The only statistically significant link which could be shown was that between antigen B27 and sacroiliac involvement in recent PA, present for less than 10 years. The authors conclude that in 60 per cent of cases, PA is associated with a particular antigen: B16, B17 or B27. Involvement of the sacroiliac joints is more common in cases of B27 PA and above all occurs earlier than in others. Regardless of its HLA group, PA as it progresses shows an increasingly clear mixture of spinal, peripheral and sacroiliac lesions, which forms the basis of the originality of this condition.
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