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Biomedical subjects

E Noel

Publications and source records attributed to E Noel.

At least 19 recordsLinked to original sources
PubMed1999

Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee: results of a multicenter, randomized, controlled trial.

OBJECTIVE: To evaluate the efficacy of joint lavage and intraarticular steroid injection, alone and in combination, in the treatment of patients with symptomatic knee osteoarthritis (OA). METHODS: Ninety-eight patients with painful tibiofemoral OA were enrolled in a prospective, randomized, controlled, 2 x 2 factorial-design trial of 6 months' duration. The 4 treatment groups consisted of 1) intraarticular placebo (1.5 ml of 0.9% normal saline), 2) intraarticular corticosteroids (3.75 mg of cortivazol in 1.5 ml), 3) joint lavage and intraarticular placebo, and 4) joint lavage and intraarticular corticosteroid. Outcome measures evaluated at baseline, week 1, week 4, week 12, and week 24 included severity of pain (100-mm visual analog scale [VAS]), global status (100-mm VAS), and Lequesne's functional index. RESULTS: No interaction between steroid injection and joint lavage was demonstrated. Patients who had undergone joint lavage had significantly improved pain VAS scores at week 24 (P = 0.020). In contrast, corticosteroid injection had no long-term effect (P = 0.313); corticosteroid injection was associated with a decrease in pain only at week 1 (P = 0.003) and week 4 (P = 0.020). After week 4, Lequesne's functional index was not significantly improved regardless of the assigned treatment. CONCLUSION: Compared with placebo, both treatments significantly relieved pain but did not improve functional impairment. The effects of the 2 treatments were additive. Cortivazol provided short-term relief of pain (up to week 4). The effects of joint lavage persisted up to week 24.

Aged↗
PubMed1999

Magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder.

OBJECTIVES: To describe magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder. PATIENTS AND METHODS: Twenty patients with idiopathic adhesive capsulitis of the shoulder underwent magnetic resonance imaging involving two spin-echo T2-weighted sequences with fat saturation and two spin-echo T1-weighted postgadolinium sequences; for all sequences, sections were obtained in the oblique coronal and transverse axial planes. Findings were compared to those obtained using the same imaging protocol in 15 patients with clinical manifestations of rotator cuff tear. RESULTS: Postgadolinium enhancement of the joint capsule and synovial membrane was seen in the rotator interval in all 25 adhesive capsulitis patients and in the axillary recess in 22 of the 25. Only one of the 15 rotator cuff tear patients had this finding. In both groups, postgadolinium enhancement occurred in the subacromial bursa, in the rotator cuff tendons, and in the acromioclavicular joint. No significant rotator cuff tears were found in any of the adhesive capsulitis patients. CONCLUSION: In difficult cases, magnetic resonance imaging with gadolinium injection can contribute to the diagnosis of idiopathic adhesive capsulitis of the shoulder.

Adult↗
PubMed1999

[Coraco-humeral space and rotator cuff tears].

PURPOSE OF THE STUDY: The anterior or subcoracoïd impingement is often mentioned but remains unprecise as far as clinical, radiological or even anatomical lesion are concerned. The purpose of our work was to study the different factors influencing the subcoracoïd space in case of cuff tear. METHODS: Our study was based on 206 shoulders operated for full-thickness rotator cuff tear. The SubCoracoïd Space (SPS), measured in millimeters on pre-operative arthro-CT-scan, was defined by the shortest distance between the coracoïd process and the humeral head. Muscular statement of the rotator cuff componants was graded according to Goutallier's and Bernageau's classification. According to literature data, we chose "6 mm" value as an inferior limit for normality. Shoulders were dispatched into three groups: group 1 was composed of supraspinatus +/- infraspinatus tears (59 cases), group 2 was composed of isolated lesions of the subscapularis (57 cases) and group 3 was composed of large cuff tears (supraspinatus +/- infraspinatus) involving also the subscapularis (90 cases). RESULTS: There was a statistically significant relationship between SCS narrowing, duration of symptoms and the non-traumatic onset. When there was no subscapularis lesion (group 1) the mean SCS was 9 +/- 2 mm, in 3 cases the SCS was inferior to 6 mm. In group 2 (isolated lesion of the subscapularis), the results were similar with 9 mm as an average and 3.5 p. 100 SCS inferior to 6 mm. On the contrary, in group 3 we found the major percentage of SCS inferior to 6 mm (27 p. 100) with an average of 7.7 +/- 3.5 mm. The long head of the biceps had no influence on the SCS. There was a strong statistically significant relationship between SCS size and fatty degeneration of the subscapularis muscle (p < 10-4) and infraspinatus muscle (p = 0.0004). Eventually, there was a statistically significant correlation between the subcoracoïd space and the sub acromial space. DISCUSSION: Measurements of the SCS in isolated lesions of the subscapularis show that the coracoïd process is not the mechanical factor responsible for tendon rupture. SCS narrowing is the consequence of a large cuff tear involving both the subscapularis and the infraspinatus tendon. Subscapularis tear is a necessary but not a sufficient condition by itself for SBS narrowing. Complete tear of the infraspinatus tendon and above all the muscular degeneration of the infraspinatus muscle is the other necessary condition for SCS narrowing. The horizontal control of the humeral head depends on subscapularis-infraspinatus muscular balance control. According to Patte's hypothesis SCS narrowing corresponds to an horizontal anterior translation of the humeral head due to fatty degeneration of subscapularis and infraspinatus muscle.

Adult↗
PubMed1997

The long term effects of traumatic brain injury on the roles of caregivers.

This study was conducted to identify the long term effects of traumatic brain injury (TBI) on the roles of caregivers. The subjects consisted of 155 caregivers of survivors with TBI who were randomly selected from 15 midwestern state brain injury association databases. A questionnaire was developed by the researchers to determine factors affecting role changes of caregivers. The Role Checklist, by Barris, Oakley and Kielhofner, was also included with the questionnaire. Both were mailed to each selected caregiver and used for data gathering. The data obtained were analysed to determine existing trends in the data. Graphs were utilized to depict the trends that was identified. The following trends and conclusions established by this research include: (a) behavioural effects of the survivor with a TBI are associated with the number of role changes experienced by caregivers; (b) participation in support systems is associated with the number of role changes experienced by caregivers; and (c) caregivers who care for a person with a TBI in the home will show a larger number of role changes than those who do not provide direct care for a person with a TBI.

Adult↗
PubMed1996

Deficiency in antioxidant factors in patients with alcohol-related chronic pancreatitis.

Free radicals have been suspected to play a role in the pathogenicity of alcohol-related chronic pancreatitis. The aim of this study was to determine the status of several antioxidant parameters in these patients and examine the factors that are likely to influence them. Thirty-five subjects (23 males and 12 females, mean age 48 +/- 8 years) with disease proven by endoscopic pancreatography and 14 healthy controls (6 males and 8 females, mean age 44 +/- 7 years) were included in the study. Biochemical antioxidant parameters included: selenium, zinc, and copper levels in plasma; glutathione peroxidase in plasma and erythrocytes; plasma malondialdehyde concentrations assessed by thiobarbituric acid reactants; and serum vitamin E and A levels. Selenium and vitamin E oral intake was assessed by a five-day diet analysis. Hemoglobin (130 +/- 16 vs 143 +/- 15 g/liter), vitamin E (8 +/- 5 vs 16 +/- 9 mg/liter), vitamin A (30 +/- 11 vs 49 +/- 12 micrograms/dl), selenium (54 +/- 20 vs 87 +/- 11 micrograms/liter), and plasma glutathione peroxidase (903 +/- 313 vs 1326 +/- 168 units/liter) were significantly lower in patients than in controls (P < 0.05). In contrast, white blood cell count, C-reactive protein, and plasma copper levels were significantly higher in patients than in controls. Cholesterol, triglycerides, iron, ferritin, total proteins, zinc, and malondialdehyde were not different. Vitamin E was lower in patients with steatorrhea, while vitamin A was lower in patients with concomitant diabetes mellitus. Dietary intakes were not different between patients and controls. In conclusion, patients with alcohol-related chronic pancreatitis have low blood levels in many antioxidant factors. Dietary intakes of some of them (selenium and vitamin E) are adequate, however. Such deficiencies are secondary to pancreatic insufficiency and probably to increased requirements related to enhanced oxidative stress.

Adult↗
PubMed1995

Pitfall of stiff shoulder: inveterated posterior dislocation.

The authors relate the observation of an inveterated bilateral posterior dislocation, occurring during a generalized epileptic attack and mimicking a painful stiff shoulder. The clinical signs (i.e. aetiologic circumstances causing a forced internal rotation, limitation or absence of external rotation) and radiological data, especially the necessity of a profile X-ray, which lead to the diagnostic are reiterated. The interest of computerized tomography in the pre-operative assessment is underscored.

Epilepsy, Tonic-Clonic↗
PubMed1995

CT and MRI evaluation of tenosynovitis of the rheumatoid hindfoot.

Thirty-nine patients with rheumatoid arthritis who had presented with tarsitis before, were investigated at the level of the rearfoot. The first 17 patients had CT with previous tenography when it was possible; the following 22 patients had MRI with gadolinium injection. Tendon involvement appeared in 52.9% of the cases on CT, and in 90% of the feet on MRI; therefore, in case of clinical or radiological signs of tarsitis, it appears that tendon involvement must be suspected. With the two procedures the tibialis posterior tendon lesions were very predominant. In the majority of the patients (31/39), there was associated involvement of two or more tendons. If there is a ruptured tendon, the authors think that one must be cautious with surgical tendinous transfer; indeed, the long-term results of this surgical procedure present a strong probability of being compromised in rheumatoid arthritis which is a progressive disease.

Adult↗
PubMed1995

Biodistribution of liposome-associated bupivacaine after extradural administration to rabbits.

After one extradural injection of 0.25% bupivacaine 0.3 ml and 3H-bupivacaine 0.005 mCi in multilamellar liposomes, no systemic radioactivity (plasma, liver, heart muscle) was obtained for 1 h, and the labelling was less than that of systemic distribution of plain bupivacaine for the following 3 h. In contrast, radioactivity in the lumbar spinal nerves peaked in the first hour and remained higher than that of plain bupivacaine for 4 h. No radioactivity was measured in cerebrospinal fluid. Small unilamellar vesicles incorporating 3H-cholesterol did not significantly label spinal nerves and central nervous structures indicating that the mode of action of liposomal bupivacaine did not involve uptake by nerve structures. Rapid uptake of radioactivity by spinal nerves suggested exchange of bupivacaine between liposomes and nerve sheaths.

Anesthetics, Local↗
PubMed1995

sIL-2R levels in rheumatoid arthritis: poor correlation with clinical activity is due in part to disease duration.

The serum levels of soluble interleukin-2 receptors (sIL-2R) were measured in an attempt to determine whether they correlated with 'disease activity' in 59 patients suffering from rheumatoid arthritis. Our results indicate that serum levels of sIL-2R do not permit patients to be classified as having active or inactive disease according to standard clinical indices. A correlation between sIL-2R and disease duration could offer one explanation for the current discrepancies found in the literature.

Aged↗
PubMed1995

Arthrography and computed arthrotomography study of seventy patients with primary glenohumeral osteoarthritis.

Seventy patients with primary glenohumeral osteoarthritis underwent roentgenographic and computed tomography studies. Glenohumeral joint space loss and a normal acromiohumeral space were the roentgenographic inclusion criteria. Women made up 61% of the sample. The dominant shoulder was affected in 95% of cases and both shoulders in 41%. Mean age at first evaluation was 65 years. Arthrography showed a tear confined to the supraspinatus tendon in 16 cases (23%); no patients had tears involving more than one tendon. Computed tomography demonstrated glenoid retroversion (mean 16 degrees) but was unable to differentiate primary glenoid dysplasia from wear due to osteoarthritis. Posterior subluxation of the humeral head was found in 28 cases (40%) but was not consistently correlated with the presence of glenoid retroversion.

Adult↗
PubMed1995

Vertebral osteomyelitis due to Capnocytophaga.

The first case of vertebral Capnocytophaga infection in an immunocompetent subject is reported. The patient was a 75-year-old woman with low back pain and a decline in general health. Plain roentgenograms disclosed erosions in the upper endplate of L4 and the lower endplate of L3 with no lesions of the intervening disk. Magnetic resonance imaging confirmed that the disk was normal. The organism was identified only by a repeat vertebral biopsy with bacteriologic cultures in a CO2-enriched atmosphere. The patient achieved a full recovery. Patients with suspected bone infections should be evaluated for portals of entry (Capnocytophaga is a normal inhabitant of the oral cavity) and should undergo multiple microbiological studies aimed at detecting a broad range of organisms.

Aged↗
PubMed1993

[Aseptic osteomyelitis].

Based on a series of eight personal cases and a review of the literature, this study tries to define the diagnostic elements of aseptic osteomyelitis. Although sternocostoclavicular sites are immediately suggestive of the diagnosis, lesions of the pelvis and spine and long bones of the limbs are particularly difficult to diagnose. Inflammatory type pain occurred in episodesover a number of years and responded to NSAIs and possibly diphosphonates. Laboratory abnormalities were usually confined to a raised ESR, but alterations of the IgA levels, similar to those observed in ankylosing spondylitis were observed in four cases. Hyperostosis occurred late in the course, preceded by signs of osteomyelitis, periosteitis or enthesitis. Histology does not provide any formal conclusions. The most suggestive lesions are those of nonspecific aseptic osteomyelitis, followed by a Paget-like appearance. The interpretation of these findings may be complicated by the presence of eosinophils, giant cells or mast cells. Two elements are very valuable for establishing the diagnosis: the presence of infraradiological anterior thoracic increased uptake on bone scan and the presence of a skin disorder, either severe acne or, more especially, palmoplantar pustulosis.

Adolescent↗
PubMed1992

Abnormal humoral immune response to mucosal antigenic stimulation in patients with lung cancer.

Previous studies have suggested an inverse relationship between atopy and cancer of mucosal surfaces. Atopy is classically assessed by detecting specific immunoglobulin E (IgE) antibodies against inhalant allergens. However, Platts-Mills recently proposed that atopy is the ability of an organism to recognize and to respond to limited doses of allergens presented at the mucosal level by producing not only IgE, but also immunoglobulin A and immunoglobulin G (IgG) antibodies. The authors compared the prevalence of atopy in 103 patients with lung cancer (a model of mucosal cancer), 51 patients with chronic obstructive pulmonary disease matched for age, sex, and smoking habits with patients with lung cancer, and 102 healthy control subjects. The authors investigated whether the IgG response to antigens presented at the mucosal level, exacerbated in atopic subjects, might inversely be decreased in patients with lung cancer. Serum IgE antibodies against five common inhalant allergens (Dermatophagoides pteronyssinus [Der p1], Aspergillus fumigatus, grass pollen, and cat and dog danders) were detected through a radioallergosorbent test assay. Serum IgG antibodies against allergens naturally presented at the mucosal level (respiratory mucosa with Der p1 and digestive mucosa with betalactoglobulin [BLG] and soya proteins [SP]) were measured through a solid phase enzyme-linked immunosorbent assay test. Atopic status was assessed in 19 patients (18.4%) with lung cancer, 9 patients (17.6%) with chronic obstructive pulmonary disease (COPD), and 18 healthy control subjects (17.6%). Distributions of specific IgG levels were represented on frequency histograms after natural logarithmic transformation and showed reduced levels of anti-Der p1 and anti-BLG IgG in the cancer population compared with the control populations but similar levels of anti-SP IgG. Influence of sex, age, smoking habits, histologic type of cancer, and its extent could be excluded. The authors' results show no difference in the prevalence of atopy between the three groups. They document a selective, rather than general, defect in the immune response initiated at the mucosal level in patients with lung cancer, the most frequent mucosal cancer in man.

Administration, Inhalation↗
PubMed1992

Serum N terminal procollagen III fragment: a predictive marker of joint destruction in rheumatoid arthritis?

The level of the N terminal fragment of procollagen III (P3NP) levels of 100 consecutive patients affected by rheumatoid arthritis (RA) were evaluated in comparison with disease activity markers (erythrocytes sedimentation rate, C reactive protein), immunological status (rheumatoid factors, immune complexes) and joint destruction (assessed according to the Steinbrocker index). P3NP levels showed no significant relationship either to disease activity or to immunological status; however, a strong association was fond between X-ray grade and P3NP values. A two-year retrospective study of 32 patients belonging to the original 100 patient population allowed us to assign a predictive value for joint destruction to the P3NP level in the early stage of the disease.

Adult↗
PubMed1992

[Total prosthesis on a rheumatoid knee].

Results of 81 total knee replacements in 67 patients with rheumatoid arthritis were studied. Mean follow-up was three years. Pain was the main reason for knee replacement surgery; knee mobility was well preserved prior to surgery. Failure occurred in four patients, as the result of infection, due in three instances to skin necrosis. Arthrodesis of the knee proved necessary in these patients. The fourth patient developed delayed hematogenous infection which was treated by a change of prosthesis. At follow-up, 82% of patients reported no pain and 18% moderate pain. Mean passive flexion was 113 degrees +/- 17 degrees. HSS score was 83.6 +/- 1.3 and all the patients except for the four with prosthesis failure stated that they were satisfied on very satisfied. Mechanical results were satisfactory, with a mean mechanical femur-tibial angle of 180.4 degrees. A circling line was visible at follow-up in 40% of operated knees but was partial in every case. No reoperations for prosthesis loosening were required. These data show that total knee replacement is the only reliable and radical treatment of rheumatoid arthritis of the knee and should be performed as soon as fixed flessum or axial deviation develops.

Adult↗