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E Toussirot

Publications and source records attributed to E Toussirot.

88 records · Page 5Linked to original sources
PubMed1992

[Aspects and role of spinal MRI in the assessment of solitary plasmacytoma and multiple myeloma. Apropos of 11 cases].

Spinal MRI was performed in 9 multiple myeloma and 2 solitary plasmacytoma, using sagittal, T 1-weighted (TR: 350-550 ms/TE: 15-26 ms) and T 2-weighted (TR: 2,000-2,500 ms/TE: 60-120 ms) sequences, with additional gadolinium injection in 3 cases. MRI features were the following: 1) round, patchy lesions with low T 1 signal highlighted by gadolinium and bright T 2 signal were present in 10 of the 11 patients: all osteolytic lesions seen on plain X-rays corresponded to such lesions and biopsy performed in 4 cases showed massive marrow replacement by plasma cells. 2) overall marrow signal was dramatically decreased in 3 patients (2 of whom had a high tumoral mass). 3) extra-dural compression was present in 4 cases. 4) 25 vertebral compression fractures (10 of whom with a "benign" appearance) and focal fat deposition were seen. 5) postradiation treatment examination seemed predictive of the outcome in the 2 solitary plasmacytomas. MRI proved to be more sensitive than plain X-rays or bone scintigraphy. Number and size of focal tumor-like lesions did not correlate with the low marrow signal appearance. Both correlated poorly with overall tumoral mass but diffuse abnormalities were associated with rapidly fatal outcome in three cases. These features might reflect qualitative rather than quantitative patterns of the disease (nodular or diffuse macroscopic marrow replacement). These findings are in agreement with those of the few previous studies. MRI is valuable for spinal cord damage assessment. It appears less accurate in benign versus malignant vertebral compression fracture determination than it does in bone metastasis. Its prognostic value is still questionable.

Aged↗
PubMed1992

[Complete and dissociated forms of Poland's syndrome (5 cases)].

The authors report 5 cases of aplasia of pectoralis major including 2 associated with a malformation of the hand falling within the context of Poland syndrome, which is a relatively common congenital malformation consisting of an association in varying degrees of hypoplasia of pectoralis major and a complex malformation of the homolateral hand. The pathogenesis of this malformation is gradually emerging and while familial cases have been reported, the majority of Poland syndromes are sporadic. The hypothesis involving interruption of the embryonic blood supply of the subclavian arteries during a critical period of embryonic development at about the 46th day is the most attractive. This hypothesis also enables extension of the manifestations seen to other congenital malformation syndromes. However, it could be disproved in one of our cases and the notion of early embryonic damage was more plausible.

Adolescent↗
PubMed1991

[Stress fractures during fluoride therapy. Physiopathological value of histomorphometry].

Bone histomorphometry was carried out in 11 women, aged 53 to 80 (mean = 69.6), treated with fluoride for vertebral osteoporosis for more than 6 months and having suffered one or more stress fractures (1 to 4 sites, mean = 1.7 sites) during that time. Classical contraindications were complied with in all cases but 2 patients did not have any combined calcium supplement. In 6 cases, histomorphometry showed no sign (notably hyperosteoidosis) of the effects of fluoride on bone. Bone trabecular volume was markedly below the fracture threshold in 4 patients. This group refractory to fluoride included the two patients who had received no calcium supplement. In 5 cases, histomorphometry showed hyperosteoidosis of normal or low thickness, with a normal mineralisation rate, reflecting the effects of fluoride on bone. However, bone trabecular volume remained below the fracture threshold in all cases. In all 11 cases, bone structure studied in polarised light was lamellar and there was no increase in cortical porosity. These results suggest that the imputability to fluoride of peripheral bone accidents must be viewed very relatively (the persistence of an insufficient bone trabecular volume being the feature usually found) or, at any event, that its possible iatrogenic effect is not linked to bone remoulding abnormalities.

Aged↗
PubMedDate not supplied

Marked elevation of serum N-acetyl-beta-D-hexosaminidase activity in rheumatoid rheumatoid arthritis.

OBJECTIVE: To study N-acetyl-beta-D-hexosaminidase (NAHase) activity in the sera of rheumatoid arthritis (RA) patients and to determine its source. METHODS: NAHase activity in the serum and synovial fluid of RA patients was measured with p-nitrophenyl beta-N-acetylglucosaminide as substrate. The p-nitrophenol released was measured spectrophotometrically in an ELISA reader. Rabbit articular chondrocytes in primary culture were stimulated with interleukin-1 beta (IL-1 beta). RESULTS: Serum NAHase activity was higher in 35% of the RA patients than in healthy patients. The median activity was about twice that of the serum of healthy volunteers. RA patients with high serum NAHase activity also had more joint destruction (85%) than those with normal NAHase activity (57%, p < 0.05), but their inflammatory status was similar. The source of NAHase in RA was investigated by assaying it in RA synovial fluids (SF) and measuring its release from articular chondrocytes in primary culture. NAHase activity was detected in all 23 RA SF, at a median concentration that was 2 times that of the serum. NAHase activity in the medium of articular chondrocytes was stimulated by IL-1 beta (p < 0.005 compared to unstimulated cells), suggesting that cartilage is a source of serum and SF NAHase activity. CONCLUSION: The serum concentration of the matrix hydrolase, NAHase, is higher in destructive RA than in inflammatory RA.

Adolescent↗
PubMedDate not supplied

Erosive polyarthritis and Crohn's disease. A case with HLA DRB1 determination.

The authors report the case of a 49-year-old woman with an asymmetrical, seronegative and peripheral polyarthritis with erosions, who subsequently developed Crohn's disease. She was diagnosed as having an erosive Crohn polyarthritis as no evidence of rheumatoid arthritis was found. However, the patient was homozygote for DR4 and the HLA DRB1 oligotyping was 0401/0404. This corresponds to two susceptibility alleles for rheumatoid arthritis responsible for the severity of this disease. Erosive polyarthritis is rarely encountered in inflammatory bowel diseases. The underlying mechanism of the erosions in these conditions is unknown but granulomatous synovitis with contiguous erosive bone changes has been reported. HLA DR has not been previously reported in erosive Crohn polyarthritis. The homozygosity for DR4 with DRB1*0401/0404 subtypes suggests that DR4 could contribute to the erosive course in this patient. This question is of interest, and HLA DR must be further studied in inflammatory bowel diseases with erosive arthritic manifestations.

Arthritis↗
PubMedDate not supplied

Pseudo Felty's syndrome. A polyclonal disease with a favorable prognosis. Report of two cases with Southern blot analysis of TCR.

The authors report two patients with large granular lymphocyte (LGL) expansion associated with rheumatoid arthritis corresponding to pseudo Felty's syndrome. These cells have natural killer and T cell surface antigen markers. LGL are a heterogeneous population and expansion of these cells is responsible for leukemia, which is generally a monoclonal proliferation. It has been suggested that Epstein-Barr virus (EBV) is a putative agent in this leukemia. No EBV DNA was found with a polymerase chain reaction analysis in the lymphocyte DNA of our two patients. Some cases of pseudo Felty's syndrome have exhibited a monoclonal pattern on Southern blot analysis of the T cell receptor. On the contrary, our two cases showed a polyclonal pattern with TCR beta chain Southern blot analysis. This fact, associated with the mild course seen in both over more than twenty years, suggest that pseudo Felty's syndrome is a disease with a good prognosis.

Adult↗
PubMedDate not supplied

Crohn's disease associated with seropositive rheumatoid arthritis.

We report two cases of rheumatoid arthritis (RA) associated with Crohn's disease (CD). The first case was a 60-year-old man with longstanding CD who next developed a seropositive, nodular RA. This patient also had bilateral sacroiliitis, but without positive HLA B27. The second was a 65-year-old female with a 15-year history of seropositive RA who presented secondarily a CD. No sacroiliitis or nodules were found in this patient. Both patients were DR1 (DRB1* 0101). Gold salts were only given in the second case and were stopped many years before the gastrointestinal symptoms. A similar case report has been previously described consisting in an ulcerative colitis complicating a seronegative HLA-B27 RA with sacroiliitis. The gastrointestinal involvement in RA may be broad and includes many causes: drug-induced colitis (including gold enterocolitis) vasculitis and amyloidosis located in the gut, associated bowel disease such as collagenous colitis, and also infectious agents. In addition, erosive polyarthritis associated with gastrointestinal manifestations can present a problem in the differential diagnosis between RA and an enteropathic arthritis. Finally, the coexistence by chance of inflammatory bowel disease and RA is suggested by the low occurrence of these two conditions in the same patient.

Aged↗
PubMedDate not supplied

Do minocycline and other tetracyclines have a place in rheumatology?

Tetracyclines are a family of antimicrobials with activity against a broad range of organisms including those that develop intracellularly. Links have been reported between some infections and some inflammatory joint diseases, with the most notable example involving mycoplasmas and rheumatoid arthritis. Reactive arthritides are known to be triggered by organisms found in the gastrointestinal or genitourinary tract, and antigenic material from these organisms has recently been demonstrated in synovial tissue from patients with reactive arthritis. These facts led to the hypothesis that tetracyclines may be useful in rheumatoid arthritis and reactive arthritis. Two controlled studies found that minocycline benefited rheumatoid arthritis patients when it was given either as an adjunct to another second-line treatment or as the only slow-acting drug. Lymecycline has been found to expedite recovery from reactive arthritis due to Chlamydia trachomatis, and tetracycline to decrease the incidence of reactive arthritis due to sexually-transmitted diseases. The safety profiles of these treatments were acceptable in all available studies but require further investigation during long-term administration. The benefits may be related to the immunomodulating effects of tetracyclines and/or to their ability to inhibit metalloproteases such as collagenases. Whether tetracycline therapy influences the course of radiologic lesions in rheumatoid arthritis remains unknown. However, minocycline therapy has given sufficient proof of its efficacy to make it an attractive alternative in rheumatoid arthritis.

Anti-Bacterial Agents↗
PubMedDate not supplied

Prospective study of the prevalence of bronchiectasis in rheumatoid arthritis using high-resolution computed tomography.

A prospective study of the prevalence of bronchiectasis in rheumatoid arthritis was conducted over an 18-month period in 46 patients (34 women and 12 men with a mean age of 60.1 years) meeting 1987 American College of Rheumatology criteria for rheumatoid arthritis. All patients underwent high-resolution computed tomography of the chest, whose results were confronted with a number of clinical, laboratory test and lung function testing parameters. Bronchiectasis or bronchiolectasis was found in 23 patients (50%) and was the most common abnormality detected by high-resolution computed tomography. When the four patients with isolated bronchiolectasis were excluded, the prevalence was 41%. Eighteen of the 23 patients had not been diagnosed with bronchiectasis before the study and 13 were free of respiratory symptoms. No significant differences were found between the 23 patients with and the 23 patients without bronchiectasis for age at onset or duration of the rheumatoid arthritis, extraarticular involvement, positive rheumatoid factors, bony erosions, use of corticosteroids or immunosuppressives, respiratory manifestations, smoking, or spirometry parameters. Patients without bronchiectasis were more likely to have impaired diffusion of carbon monoxide across the alveolar-capillary membrane. Among the patients with bronchiectasis, those with respiratory symptoms (n = 10) were more likely to have a history of lung disease and those without respiratory symptoms (n = 13) were more likely to have a diagnosis of bronchiectasis secondary to rheumatoid arthritis; no other differences were found between these two subgroups. Routine use of high-resolution computed tomography, a technique capable of demonstrating silent bronchiectasis, showed that bronchiectasis was the most common lung change in rheumatoid arthritis in our study. At the time of the study, there was no evidence that presence of bronchiectasis was associated with more severe joint or lung symptoms.

Adult↗
PubMedDate not supplied

Primary biliary cirrhosis and systemic lupus erythematosus. A new case report.

Systemic lupus erythematosus and primary biliary cirrhosis are two autoimmune disorders that rarely occur in the same patient. Ten well-documented cases have been reported to date. We add the case of a woman who was diagnosed with systemic lupus erythematosus at 54 years of age then with primary biliary cirrhosis 18 years later. Interestingly, primary biliary cirrhosis antedated the systemic lupus erythematosus in all the other reported cases. The possibility that a patient may develop more than one autoimmune disorder should be borne in mind.

Autoimmunity↗