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C Marcelli

Publications and source records attributed to C Marcelli.

At least 19 recordsLinked to original sources
PubMed2001

[Dual x-ray absorptiometry assessment of bone density of the proximal tibia in advanced-stage degenerative disease of the knee].

PURPOSE OF THE STUDY: Axial deformity secondary to degenerative joint disease of the knee can modify stress forces. Certain studies have reported an inversely proportional relationship between degenerative disease and osteoporosis. The aim of this prospective study was to quantify the horizontal linear distribution of bone density using dual x-ray absorptiometry (DXA) of the proximal tibia as a function of the femoral neck bone density in patients with knee osteoarthritis. MATERIAL AND METHODS: Between September 1996 and March 1998, 90 cases of primary degenerative joint disease of the knee were programmed for total knee arthroplasty. Prior to the procedure, the patients were assessed clinically and radiologically according to the International Knee Society (IKS) criteria. The mechanical femorotibial angle was measured in all patients and the varus angles were recorded. Most of the patients were women (65 p. 100) with a mean age of 70 +/- 5 years. Valgus knees were excluded from this series. The mean mechanical femorotibial angle was 172 +/- 5 degrees. Fifteen patients had a normal axis (16 p. 100), 32 had a varus measuring 4 degrees to 10 degrees (35 p. 100) and 43 had a varus measuring 10 degrees or more (48 p. 100). The overall varus distance was 6.4 +/- 2 cm. All patients had two DXA explorations: femoral neck to determine the bone status according to the WHO criteria (normal, osteopenia, osteoporosis), knee to determine the linear distribution of bone density of the proximal tibia. A 7 mm high band including 7 regions of interest covering the width of the tibia were explored in the area where the tibial cut was to be made. These 7 regions of interest were: R1, R2 under the lateral compartment, R6, R7 under the medial compartment, and R3, R4, R5 on either side of the tibial spines. The level of significance was set at 5 p. 100. RESULTS: The mean Z score (0.54 +/- 1) in the 90 patients showed a symmetrical distribution. These patients were representative of their age range. Their T score was - 1.40 +/- 1 (m +/- SD) and most had osteopenia (54 p. 100) according to the WHO criteria, although 16 p. 100 had osteoporosis. Mean bone density of the knee was 0.898 +/- 0.163 g/cm(3) and was correlated with that of the femoral neck (r=0.61, p=0.001). There were significant correlations between the differences in the bone densities of the knee compartments (R6-R2, R7-R1) and the mechanical femorotibial angle [(r=0.39, p=0.0001); (r=0.52, p=0.001)]. Irrespective of the overall bone density, there was a strong medial compartment overloading, which correlated with the degree of varus deformation. CONCLUSION: DXA assessment of bone mineral density of the proximal tibia is a simple, reliable, precise and reproducible method. The distribution of bone density in the degenerative knee depends on the degree of deformation. The average level depends on the subject's general state of mineralization. Osteoporosis does not protect against degeneration of the knee joint since 16 p. 100 of our patients had osteoporosis according to the WHO criteria.

Absorptiometry, Photon↗
PubMed1999

Evolution of lumbar bone mineral content during adolescence and adulthood: a longitudinal study in 395 healthy females 10-24 years of age and 206 premenopausal women.

In a longitudinal study of 395 normal 10- to 24-year-old female volunteers, 105 of whom were initially premenarcheal, lumbar bone mineral density (BMD) and content (BMC) were measured by dual-energy X-ray absorptiometry (DXA) at inclusion and after a 2-year interval. The mean age of menarche was 13.1 +/- 1.1 years (n = 395). In a multiple regression analysis the BMD and BMC relative gains were highly correlated with the height and weight relative gains and with the time since menarche (r = 0.91 and r = 0.93, respectively). The mean relative annual increments in body height, in L2-4 vertebral height, in BMD and in BMC peaked respectively at 1.5, 1.0, 0.6 and 0.7 years before menarche. The four perimenarcheal years, beginning with the first pubertal clinical signs, are essential for bone acquisition, since 46.7% of adult BMC is acquired during this period. Two years after menarche, BMC is 85% of the adult value. Seven years after menarche no further significant variation in BMC is observed. In 206 menstruating women 27-47 years old, a DXA lumbar measurement was also performed after a 4-year interval. There was a small but significant increase of 0.3%/year in BMD and 0.7%/year in BMC, contrasting with the results in the young population. This could be explained by a volumetric expansion with aging, which is supported by a small increase in L2-4 area (0.4%/year). In conclusion, this longitudinal study on the lumbar site emphasizes the importance of the pre- and perimenarcheal period, when half of lumbar adult BMC is acquired. This suggests that greater attention must be paid to this period regarding nutrition and physical activity.

Adolescent↗
PubMed1999

[AA amyloidosis complicating sarcoidosis].

INTRODUCTION: Amyloidosis combined with sarcoidosis has been very rarely described. EXEGESIS: We report the case of a 72-year-old man presenting with sarcoidosis and amyloidosis AA. The association of peripheral and retroperitoneal adenopathies accompanied by loss of weight and histopathological results conducted to the diagnosis of sarcoidosis, excluding other causes. Corticosteroid therapy led to a decrease in clinical manifestations and after 2 years, clinical signs of amyloidosis have not progressed. CONCLUSION: According to results previously described in the literature and the description of the present case, we conclude that sarcoidosis can be complicated by amyloidosis AA, the presence of which may justify corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMed1999

Does spinal morphology influence the occurrence of low back pain? A retrospective clinical, anthropometric, and radiological study.

OBJECTIVE: Insurance companies are showing considerable interest for measurement devices claimed to be effective in evaluating risks associated with occupational or sporting activities. The aim of this study was to evaluate the potential influence of spinal morphology on the risk of low back pain. METHODS: 1500 male construction work apprentices aged 16 to 23 years underwent spinal measurements at the Caen Teaching Hospital from 1991 to 1996. The 384 subjects with abnormal measurements or a history of spinal pain underwent plain radiography and a second set of spinal measurements done by a different examiner using a different device. The following radiological parameters were studied: incidence angle, junction couple, Ferguson's index, L1-L5 lordosis angle and L1-S1 lordosis angle. RESULTS: In the 152 retrospectively studied subjects, no significant differences in static spinal parameters were found between subjects with and without a history of low back pain. The type of lordosis was correlated with the incidence angle but not with the junction couple. CONCLUSION: In our population, spinal measurements were not correlated with a specific morphological pattern of the lumbar spine or pelvis, and neither was a history of low back pain correlated with a specific pattern of lumbar and pelvic balance.

Adolescent↗
PubMed1999

Heritability of bone mineral density.

OBJECTIVE: To evaluate the influence of genetic background as a determinant of peak bone mass. PATIENTS AND METHODS: We compared lumbar spine bone mineral density in 175 girls with a bone age of 16 years or older and in their premenopausal mothers. We also investigated the influence of a family history of osteoporosis on lumbar spine bone mineral density in 275 women and their 559 daughters. RESULTS: In the 175 mother-daughter pairs, heritability (h2) was significantly different from 0 (P < 0.0001) for lumbar spine bone mineral density (h2 = 53%; 95% confidence interval [95% CI] = 28.5-77.6%), bone mineral content (h2 = 62.3%; 95% CI = 37.7-86.8%), bone mineral density adjusted for body mass index (h2 = 56%; CI = 31.5-80.5%), and bone mineral content adjusted for body mass index (h2 = 68.2%; CI = 43.6-92.7%). However, the heritability estimations lacked accuracy, as shown by the wide 95% CIs. Osteopenia and osteoporosis were found in 16.4% and 1% of the mothers, respectively. In the subgroup defined by osteopenia or osteoporosis in the mother, lumbar spine bone mineral density was significantly higher in the daughters than in the mothers (0.994 +/- 0.095 g/cm2 versus 0.895 +/- 0.098 g/cm2; P < 0.0001), whereas the opposite was true in the subgroup defined by normal bone mass in the mothers (1.068 +/- 0.110 g/cm2 versus 1.109 +/- 0.098 g/cm2; P = 0.0003). Nevertheless, lumbar spine bone mineral density was significantly lower in the daughters of low-bone-mass women than in those of normal-bone-mass women (0.994 +/- 0.009 g/cm2 versus 1.069 +/- 0.012 g/cm2; P = 0.0006). These findings suggest a role of genetic factors inherited from the father and also indicate that bone mass gains during adulthood contribute to achievement of the optimal peak bone mass. In the family history study, bone mass was lower in the subjects with a family history of osteoporosis (123 of the 559 daughters, Z-scores normalized for height, weight, and pubertal status: bone mineral density Z-score, -0.054 +/- 1.104; bone mineral content Z-score, -0.014 +/- 1.079; 58 of the 275 mothers: bone mineral density, 1.048 +/- 0.107 g/cm2; bone mineral content, 43.3 +/- 6.8 g) than in those without a family history of osteoporosis (436 daughters, bone mineral density Z-score, 0.006 +/- 0.981; bone mineral content Z-score, -0.007 +/- 0.985; 217 mothers: bone mineral density, 1.070 +/- 0.127 g/cm2; bone mineral content, 43.8 +/- 6.7 g); however, none of these differences were statistically significant. CONCLUSION: Our findings challenge the currently popular concept of marked bone mass heritability but are consistent with early genetic influences on lumbar spine bone mass. Thus, optimization of the peak bone mass acquired during growth may help to prevent osteoporosis.

Adolescent↗
PubMed1997

[Fatigue fractures of the foot].

A stress fracture is a very localized change in bone remodeling occurring in a normal bone that is subjected to an unusual repeated cyclic loading. It is a common fracture in military recruits and recreational or competitive athletes. A typical medical history and a local bone tenderness at physical examination suggest the diagnosis that is confirmed by a local "hot" spot on the radionuclide bone scan. Radiographic signs are delayed and inconstant. Radiographs show the fracture line or a bone sclerosis as the result of fracture healing. Although every bone may be involved, depending on the type of the physical activity, metatarsals and calcaneus are the most frequent locations in the foot. The treatment of a stress fracture in the foot consists in a 4 to 6 nonweight-bearing immobilisation followed by a graduated return to march and sport.

Adult↗
PubMed1997

Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study.

We used an experimental software measuring the hip axis length (HAL) and bone mineral density (BMD) in specific regions of the lower and upper part of the femoral neck on dual-energy X-ray absorptiometry scans. To determine whether these parameters were significant predictors of the type of hip fracture, we measured 167 healthy women (controls), 24 women with trochanteric, and 42 women with cervical hip fractures within the EPIDOS prospective cohort. EPIDOS is a multicenter prospective study on risk factors for hip fracture performed in 7575 elderly women living at home, aged 75-95 and conducted in five French centers (Amiens, Lyon, Montpellier, Paris, Toulouse). Measurements were performed on data acquired at baseline before the occurrence of fracture. In the cervical fracture group, HAL was significantly longer than in controls (94.2 vs. 92.3, p = 0.03), and the associated odds ratio (OR) adjusted for age, weight, and total femoral neck BMD was significant (OR = 1.64, 95% confidence interval [CI] 1.06-2.55). In contrast, HAL was not significantly different from controls in the trochanteric fracture group. Femoral neck diameter was not a predictor of fracture. The upper and lower femoral neck BMD was lower in the trochanteric fracture group than in controls, and both measurements predicted trochanteric femoral neck fracture. In contrast, the prediction of cervical femoral neck fracture was enhanced by measuring only the upper part of the femoral neck (OR = 2.79 vs. 1.97 for the total femoral neck) while BMD of the lower part was not different from controls. Hip axis length is a predictor of femoral neck fracture. Femoral neck BMD distribution is different between cervical and trochanteric fractures. These results support the hypothesis of a different pathophysiological mechanism between the two types of hip fractures.

Absorptiometry, Photon↗
PubMed1997

Septic arthritis of lumbar facet joints. A review of six cases.

Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis. Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis.

Abscess↗
PubMed1996

Amyloidosis-related cauda equina compression in long-term hemodialysis patients. Three case reports.

STUDY DESIGN: These case reports illustrate the neurologic manifestations due to beta 2 microglobulin amyloid deposition at the lumbar spine level in long-term hemodialysis patients. OBJECTIVE: Radiologic investigations suggested the amyloid origin of extradural soft tissue deposition, which was confirmed by histologic examination after surgical excision. SUMMARY OF BACKGROUND DATA: Although cervical myelopathy is a recently recognized complication of long-term dialysis-related beta 2 microglobulin amyloidosis, neurologic manifestations due to amyloid deposition at the lumbar spine level have rarely been reported. METHODS: Three case reports of cauda equina compression in long-term hemodialysis patients are presented. Follow-up radiography, computed tomography, and magnetic resonance imaging were performed and patients underwent surgical decompression of the thecal sac. RESULTS: In two patients, the compression resulted from the development of a destructive spondylarthropathy, and from the infiltration of extradural spaces and ligaments by an abnormal soft tissue. The third patient had lumbar spinal stenosis due to multiple disc protrusion and to hypertrophy of facet joints and ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compression. Histologic examination of the excised fibrous tissues disclosed amyloid deposits in intervertebral discs, apophysial joints, and ligaments. CONCLUSIONS: In long-term hemodialysis patients, cauda equina compression may develop as the consequence of beta 2 microglobulin amyloid deposition in lumbar intervertebral discs, facet joints, and ligaments. Magnetic resonance imaging is well suited to show the extent of the compression and supports the argument for the amyloid origin of extradural soft tissue.

Adult↗
PubMed1996

Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study.

Increased bone turnover has been suggested as a potential risk factor for osteoporotic fractures. We investigated this hypothesis in a prospective cohort study performed on 7598 healthy women more than 75 years of age. One hundred and twenty-six women (mean years 82.5) who sustained a hip fracture during a mean 22-month follow-up were age-matched with three controls who did not fracture. Baseline samples were collected prior to fracture for the measurement of two markers of bone formation and three urinary markers of bone resorption: type I collagen cross-linked N- (NTX) or C-telopeptide (CTX) and free deoxypyridinoline (free D-Pyr). Elderly women had increased bone formation and resorption compared with healthy premenopausal women. Urinary excretion of CTX and free D-Pyr, but not other markers, was higher in patients with hip fracture than in age-matched controls (p = 0.02 and 0.005, respectively). CTX and free D-Pyr excretion above the upper limit of the premenopausal range was associated with an increased hip fracture risk with an odds ratio (95% confidence interval) of 2.2 (1.3-3.6) and 1.9 (1.1-3.2), respectively, while markers of formation were not. Increased bone resorption predicted hip fracture independently of bone mass, i.e., after adjustment for femoral neck bone mineral density (BMD) and independently of mobility status assessed by the gait speed. Women with both a femoral BMD value of 2.5 SD or more below the mean of young adults and either high CTX or high free D-Pyr levels were at greater risk of hip fracture, with an odds ratio of 4.8 and 4.1, respectively, than those with only low BMD or high bone resorption. Elderly women are characterized by increased bone turnover, and some markers of bone resorption predict the subsequent risk of hip fracture independently of hip BMD. Combining the measurement of BMD and bone resorption may be useful to improve the assessment of the risk of hip fracture in elderly women.

Absorptiometry, Photon↗
PubMed1996

[Epidural lipomatosis: complication of long-term corticotherapy. Apropos of 2 cases].

Spinal epidural lipomatosis (SEL) is defined as the deposition of loose fat tissue in the epidural space. Two cases are reported which illustrate the main features of this uncommon disease. Most frequently SEL is revealed by neurologic manifestations such as an acute chronic spinal cord compression. Corticosteroid therapy and obesity are the main factors able to induce the disease. The common location of the SEL at the thoracic spine is explained by the physiologic abundance of fat and by the relative narrowness of the spinal canal at this level. An osteoporotic vertebral crush fracture which reduces the diameter of the canal frequently reveals the SEL. MRI confirms the diagnosis of SEL and shows the extent in the spinal canal. The treatment of SEL is difficult. The decrease or the stop of corticosteroid therapy has allowed the recovery in a few cases with chronic neurologic symptoms. The risks of a surgical procedure are important in these patients and the medical or surgical treatment should be discussed taking into account the clinical symptoms of SEL, its location and extent, and the risks of recurrence if corticosteroid therapy must go on.

Adult↗
PubMed1995

[Secondary osteoporosis].

Although primary osteoporosis is much more frequent than other diseases associated with osteopenia, the diagnosis of idiopathic osteoporosis should be made only after the causes of secondary osteoporosis have been excluded. Indeed, therapeutic efficiency in secondary osteoporosis depends mainly on the concomitant treatment of the actual cause of osteopenia. Glucocorticoid-induced osteoporosis is the commonest form of secondary osteoporosis, mainly for doses of prednisone of 0.1 mg/kg/day or greater. Hypogonadism in men and women, idiopathic hypercalciuria and chronic alcoholism in men are other frequent causes of osteopenia. The diagnosis of secondary osteoporosis is based on careful examination as well as biochemical and hormonal investigations. Together with the treatment of the associated disease, correction of other risk factors, calcium supplementation, and a regular program of weight-bearing physical activity may be of benefit to reduce bone loss. As fluoride is able to stimulate bone formation, it is an effective agent in the treatment of glucocorticoid or alcohol-induced osteoporosis.

Adrenal Cortex Hormones↗