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Biomedical subjects

E Noël

Publications and source records attributed to E Noël.

At least 19 recordsLinked to original sources
PubMed2001

Management of nontuberculous infectious discitis. treatments used in 110 patients admitted to 12 teaching hospitals in France.

The optimal management of pyogenic discitis is not agreed on. No randomized clinical trials of short-course or oral antibiotic regimens have been published to date. To shed light on this issue, we reviewed the management of patients admitted for pyogenic discitis to one of 12 networked rheumatology departments. In this cross-sectional observational study, each department included the first ten patients admitted starting in January 1997 for treatment of pyogenic discitis. One hundred ten patients met the inclusion criteria, 67 men and 43 women, with a mean age of 60.6 +/- 13.7 years (range, 17-86 years). Mean time from symptom onset to diagnosis was 39.6 +/- 39.8 days (range, 24 h-240 days). Blood cultures were positive in 47.3% of patients, and the percutaneous discal and vertebral biopsy in 63.6% of cases; these two investigations identified the causative organism in 79 cases (72.8%). Mean duration of the rheumatology department stay was 31.3 +/- 14.1 days (range, 4-78 days). Antibiotics were given intravenously to 103 (93.6%) patients, for a mean of 25.5 +/- 17.6 days (range, 4-124 days); duration of intravenous antibiotic therapy was longer than 4 weeks in 36.5% of patients. Only seven (6.4%) patients received primary oral antibiotics with no parenteral antibiotics. One hundred patients were given oral antibiotics at the same time as and after intravenous antibiotics, for a mean duration of 87.2 +/- 43.6 day (range, 20-278 days); Bracing was used in 98 (89.1%) patients. Although antibiotic selection was rational and in agreement with current recommendations, wide differences were noted across centers regarding intravenous treatment duration, hospital stay duration, and total treatment duration.

Abscess↗
PubMed2001

Reliability, validity, and sensitivity to change of the Cochin hand functional disability scale in hand osteoarthritis.

OBJECTIVE: To assess the reliability, validity and sensitivity to change of the Cochin hand functional scale in hand osteoarthritis (OA). BACKGROUND: The Cochin hand functional disability scale has been validated in rheumatoid arthritis. DESIGN: Patients with hand OA according to Altman's criteria were included. Impairment outcome measures (VAS of pain, hand score of tenderness, clinical hand score of impairment, Kallman's radiographic scale), functional disability measures [Cochin scale, Revel's functional index (RFI), Dreiser's functional index (DFI)] and patients' perceived handicap (VAS) were recorded twice, at baseline and at a 6-month follow-up visit. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. Sensitivity to change was assessed using the effect size (ES) and the standardized response mean (SRM), and the non-parametric Spearman rank correlation coefficient (r) was used to assess the correlation between quantitative variable changes and patient's overall opinion. RESULTS: 89 patients (8 males, mean age 63 years) were included. Interobserver reliability was excellent (ICC=0.96). The Bland and Altman method showed no systematic trend. Correlations of the Cochin scale score with RFI (r=0.86), DFI (r=0.87), VAS of handicap (r=0.67), VAS of pain (r=0.54), tenderness (r=0.51), clinical impairment (r=0.32), and Kallman's radiographic scale (r=0.13) indicated a good construct validity. Factor analysis extracted four main factors, accounting for 65% of the total variance. 51 patients were evaluated at the 6-month visit. The Cochin scale score had worsened with SRM and ES values of -0.26 and -0.17 respectively. Changes in the score had one of the highest correlation (r=0.47) with the patient's overall opinion. CONCLUSION: The Cochin hand functional disability scale which was first developed to assess the rheumatoid hand can be used to evaluate functional disability in hand OA.

Adult↗
PubMed2001

[Value of CT bursography in the evaluation of rotator cuff tears].

PURPOSE: To describe the technique and assess the value of subacromial CT bursography in patients with partial surface tear of the rotator cuff tendon. MATERIALS AND METHODS: 15 patients with shoulder pain suggestive of tendinopathy or tear of the rotator cuff were evaluated with subacromial CT bursography. RESULTS: Subacromial CT bursography was normal in 4 patients. Partial surface tear was detected in 7 patients [irregularities (n=2), defect (n=2), superficial tear (n=3)]. Full thickness tear was detected in 4 patients. CONCLUSION: The authors described the technique for subacromial CT bursography to visualize partial surface tears of the rotator cuff tendon. This simple and reliable technique could be an alternative to MR imaging, especially when MR evaluation is not possible.

Adult↗
PubMed2000

Frozen shoulder.

Stiffness is a consistent but nonspecific symptom of primary frozen shoulder, a condition defined by restriction of passive motion in all planes without glenohumeral abnormalities on plain radiographs. Since the first description by Duplay in 1872, theories and descriptions of the lesions have varied over time and across authors, with the main target of the condition being reported as the subacromial bursa in some studies and the rotator interval in others. Recent publications have pointed out similarities with Dupuytren's contracture. Magnetic resonance imaging has helped to understand the lesions by showing a specific pattern of postgadolinium enhancement during the first few months after symptom onset. Pain relief is the main objective of therapy. Oral medications have not been adequately evaluated, with the exception of glucocorticoids, which hasten the resolution of nighttime pain to a modest degree. Intra-articular glucocorticoid injections are effective and are best performed under arthrographic control. It has been suggested that intra-articular glucocorticoid injections should be combined with joint capsule distension. An additional injection into the subacromial bursa has been found useful in patients with refractory pain. Motion range recovery is not always complete after 18 to 24 months and can be improved by physiotherapy. Methodological difficulties have precluded demonstration in formal studies of the undeniable benefits of physiotherapy. Joint capsule distension, and even more so arthroscopic capsulotomy with gentle mobilization, have provided promising results in patients with persistent stiffness, although the optimal time for performing these techniques remains to be determined.

Bursitis↗
PubMed1999

[Pathology of the rotator cuff].

In daily practice painful shoulder is frequent. Rotator cuff pathology (traumatic, microtraumatic or both) is frequently involved. Treatment is closely related to diagnosis, which directly depends on features given by the triad "questioning, clinical exam, standard X-rays". In some very precise cases this triad will be completed by more complex exams (arthro CT, MRI). Rotator cuff pathology is diversified: either tendinopathies (calcifying or not) or tears (partial or transfixiant). Rotator cuff tear's natural evolution is a slow aggravation to a final subacromial arthrosis or an excentrated omarthrosis in a certain term which tolerance may vary.

Diagnosis, Differential↗
PubMed1998

[Peripheral thrombopenic purpura associated with acquired toxoplasmosis].

Acquired Toxoplasma Gondii infection has a benign course in adults and children immunologically competent. Thrombocytopenia is much more common during congenital toxoplasma infection and the rare cases of purpura associated with acquired toxoplasmosis are usually not thrombocytopenic. We report a case of thrombocytopenic purpura in an immunocompetent child, associated with active acquired toxoplasmosis. In rare circumstances, acquired toxoplasmosis in an immunocompetent patient may be associated with severe thrombocytopenia. However, the low incidence of such cases makes a therapeutic consensus difficult.

Adult↗
PubMed1996

[The acromio-humeral interval. A study of the factors influencing its height].

PURPOSE OF THE STUDY: The narrowing of the Acromio Humeral Interval (AHI) under 6-7 mm, lower limit reported in normal shoulder, has been considered to be a specific indicator for full-thickness cuff tears. The purpose of this study was to analyse the factors influencing the AHI. METHODS: 264 shoulders were operated on between 1984 and 1994 for full thickness tear of the supraspinatus and infraspinatus associated or not with an anterior cuff lesion. All patients had X-ray with A.P. view of the shoulder in neutral rotation. The AHI was defined as the shortest distance measured between the inferior cortex (dense line) of the acromion and the humerus. CT arthrogram was performed in 84 patients to analyse cuff muscular fatty degeneration. A full thickness tear was confirmed and measured by surgical approach in all cases. RESULTS: There was a moderate significant relationship (p < 0.05) between AHI and symptoms duration. There was a significant relationship between AHI and tear size (p < 0.05). When the supraspinatus tendon was only torn, the mean AHI was 9.5 +/- 0.17 mm (4.5 per cent of narrowing AHI). When supra and infraspinatus tendon were torn, the mean AHI was 7.5 +/- 0.4 mm (28 per cent of narrow AHI) and when an anterior lesion was associated, the mean AHI decreased to 5.4 +/- 0.5 mm and the percentage of narrow AHI increased to 63 per cent. The AHI was not influenced by the biceps rupture: with a similar symptoms duration, the mean AHI was 9 +/- 0.5 mm with biceps tear versus 9.2 +/- 2 mm when the biceps was normal. However, the mean AHI decreased to 5.5 +/- 0.6 mm when the long head of the biceps was dislocated and the AHI was less than 7 mm in 61 per cent of the cases. A highly significant relationship was found between the AHI and the infraspinatus muscle degeneration. We have found 100 per cent incidence of AHI narrowing when the infraspinatus was degenerated (mean AHI 2.2 +/- 1.1 mm). A moderate similar relationship was found concerning the supraspinatus muscle (p < 0.05) and no relationship was found with the subscapularis degeneration. DISCUSSION: The infraspinatus, external rotator of the humerus, seems to be the major active depressor of the humeral head. The biceps tendon, which is a passive depressor of the humerus, has no influence on the AHI whatever it is ruptured or not. However biceps dislocation is associated with significant humeral head superior migration. Symptoms duration and cuff tear size seem to be only secondary factors affecting the AHI. CONCLUSION: AHI narrowing should evocate a severe cuff tear with biceps dislocation or muscular degeneration. In these cases, surgical repair might be questionable. AHI value is more prognostic than diagnostic.

Acromion↗
PubMed1995

[MRI of the rotator cuff: evaluation of a new symptomatologic classification].

The different classifications use for the rotator cuff pathology seem to be incomplete. We propose a new classification with many advantages: 1) Differentiate the tendinopathy between less serious (grade 2A) and serious (grade 2B). 2) Recognize the intra-tendinous cleavage of the infra-spinatus associated with complete tear of the supra-spinatus. 3) Differentiate partial and complete tears of the supra-spinatus. We established this classification after a retrospective study of 42 patients operated on for a rotator cuff pathology. Every case had had a preoperative MRI. This classification is simple, reliable, especially for the associated intra tendinous cleavage.

Female↗
PubMed1994

[Isolated lesions of the subscapularis muscle. Apropos of 21 cases].

PURPOSE OF THE STUDY: The goal of this retrospective study is to describe the different anatomic lesions of the subscapularis and to precise the diagnostic value of the clinical and imaging tests. MATERIAL: Twenty-one cases of isolated tear of the subscapularis were operated on between 1989 and 1992. Affecting both sex, this lesion happens in younger patients than the rotator cuff tear concerning supra or infra-spinatus. The onset was most often traumatic but not specific. Four patients had no traumatic history. RESULTS: In 16 cases, the complaint was an unspecific chronic painful shoulder. The Jobe test was positive in 12 cases. The lift-off test was positive in 9 cases. Arthrography showed extravasation of dye into the subacromial bursa in 11 cases. Subscapularis lesion was suspected with the presence of dye spot on the lesser tuberosity on the A.P. view in external rotation (18 cases). Arthro-CT-scan was diagnostic in 12 cases, revealing dye spot touching the lesser tuberosity. At surgery, 3 types of lesions were found: complete ruptures or ruptures concerning the superior two-thirds of the tendon and letting intact the inferior muscular third (15 cases): partial superior lesions (5 cases) and a muscular tear of the inferior two-thirds. The long head of the biceps was dislocated in 5 cases, subluxated in 5 cases, ruptured in 3 cases and normal in 8 cases. DISCUSSION: The mechanisms of these lesions are probably different. The most common mechanism is traumatic but 4 patients had no traumatic injury. Degenerative changes of the tendon or subcoracoid impingement are also evocated. Arthrography permits a good screening but arthro-CT-scan is the most accurate to detect the lesion. Presence of dye touching the lesser tuberosity is a specific sign of the subscapularis lesion.

Adult↗
PubMed1994

[Neer's shoulder prosthesis: results according to etiology].

The outcome of 80 glenohumeral arthroplasties with the Neer prosthesis in 77 patients with degenerative or inflammatory shoulder disease was evaluated after a mean follow-up of three years five months. The arthroplasties were performed because of intractable pain and functional disability due to destruction of the glenohumeral joint. The postoperative rehabilitation program focused on full recovery of joint motion and function in 65 cases and on joint stability with partial recovery of joint motion and function in 15 cases. According to the criteria developed by Neer, the outcome was excellent or satisfactory in 75% of cases and unsatisfactory in 25%. Constant's scores adjusted for age and gender varied widely across diagnostic categories, from a high of 76% in centered glenohumeral osteoarthritis (n = 40) to lows of 59% in rheumatoid arthritis (n = 21) and 45% in posttraumatic osteoarthritis (n = 10) or eccentric osteoarthritis due to cuff disruption (n = 9). At reevaluation, 70% of patients had little or no pain and 90% were satisfied with the outcome. The mean increase in flexion of the arm (39 degrees) was markedly influenced by the diagnosis. The increases in lateral rotation (mean 35 degrees) and medial rotation (four vertebral levels) of the arm were especially appreciated by the patients as having a very beneficial effect on the ability to perform everyday tasks. Complications included instability in three cases (two anterior dislocations and one posterior dislocation), glenoid component loosening in 11 cases (of which only four required reoperation) and rotator cuff tear in eight cases. Our results add to the existing evidence that nonconstrained shoulder implants, such as the Neer prosthesis, are both safe and effective in alleviating pain and improving joint function. They should be used in patients with refractory pain, disability due to restrictions in external and medial rotation of the arm and roentgenographic evidence of glenohumeral joint space loss.

Adult↗
PubMed1993

[Postero-superior glenoid impingement. Another impingement of the shoulder].

An impingement occurring between the deep side of the supraspinatus tendon and the postero-superior edge of the glenoid cavity was evidenced in a young sports thrower presenting with a partial tear of the deep side of the tendon. This impingement occurred when the arm was in abduction-retropulsion and in forced lateral rotation. It was visualized on arthroscopy. The semiology was mixed, including signs of anterior instability and cuff impairment. The possible causes of partial tears of the deep side of the supraspinatus are discussed: sub-acromial impingement of NEER, anterior instability with secondary impingement, postero-superior glenoid impingement.

Adult↗
PubMed1992

[Rheumatoid metatarsals, original development of the first metatarsals].

Weight-bearing roentgenograms of 308 feet of rheumatoid arthritis patients were analyzed. Several angles were determined, including the metatarsus primus adductus angle (between the first and second metatarsals, > or = 10 degrees) and the forefoot spread angle (between the first and fifth metatarsals, > or = 30 degrees). Pes planus was diagnosed when the internal arch angle was equal to or greater than 130 degrees. Tarsal arthritis was defined as the presence of joint space narrowing. Varus of the first metatarsal was correlated with tarsal arthritis and pes planus but not with duration of the disease. Forefoot spread was correlated with duration of the disease and erosive metatarsal disease but not with involvement of the midfoot. These data demonstrate that orthopedic treatment should be initiated as soon as involvement of the first metatarsal is detected and should be directed at the hindfoot, midfoot, and first metatarsal whose deformations occur concomitantly.

Adult↗
PubMed1991

Enzymatic degradation of tumor necrosis factor by activated human neutrophils: role of elastase.

Although the role of tumor necrosis factor-alpha (TNF) as mediator of inflammation is now well established, its interactions with polymorphonuclear neutrophils (PMN) are not fully understood. Therefore, we investigated the possible hydrolytic action on TNF of intra-lysosomal enzymes released by activated PMN in the extracellular medium. We first incubated 125I radiolabeled TNF in vitro with activated PMN and by HPLC analysis, we observed a degradation process completely blocked by the previous addition of alpha 1-Antitrypsin (AT) to the incubation medium. By comparing several degradative patterns of TNF obtained with purified leukocyte proteases and supernatant of activated PMN, we identified elastase as the major enzyme involved in this catabolic process of TNF. In a second part, we determined the bioactivity of the cleavage fragments of recombinant human TNF (rhTNF) by a cytotoxicity assay. None of the fragments was found biologically active. Our results suggest that, at inflammatory sites, an enzymatic degradation of TNF may occur in the pericellular area of activated PMN. This new catabolic pathway leading to inactivation of TNF might be regarded as an effective local negative feed-back process limiting the potentially toxic effects of this cytokine.

Cathepsin G↗
PubMed1991

[Postero-superior glenoid impingement. Another shoulder impingement].

An impingement occurring between the deep side of the supraspinatus tendon and the posterosuperior edge of the glenoid cavity was evidenced in a young sports thrower presenting with a partial tear of the deep side of the tendon. This impingement occurred when the arm was in abduction-retropulsion and in forced lateral rotation. It was visualized on arthroscopy. The semiology was mixed, including signs of anterior instability and cuff impairment. The possible causes of partial tears of the deep side of the supraspinatus are discussed: sub-acromial impingement of NEER, anterior instability with secondary impingement, postero-superior glenoid impingement.

Adult↗