Biomedical subjects
Publications and source records attributed to G Pallardy.
A 22-year-old woman with an osteoid osteoma of capitate bone presented initially with arthritis of wrist. Bone scan imaging and digital subtraction angiography allowed diagnosis of a nidus. This case draws attention to articular manifestations of osteoid osteoma.
A randomized, double-blind study was made of 39 patients with discolumbar hernias that were unresponsive to medical treatment. They were treated either by nucleolysis with chymopapain (4 000 U of discase), or by discography followed by injection of distilled water as a placebo. After one month, treatment was found to be successful in 55% of cases undergoing nucleolysis and in 26% of cases receiving the placebo. The results after 3 months were 65% and 42%. respectively. After one month, the intensity of lumbar pain decreased by 44% on average in the group treated by chymopapain, and by 0% in the placebo group. Radicular pain decreased by 53% in the first group and by 26% in the placebo group, and improvement in Lasègue's sign was 51% and 20%, respectively. Analgesic treatment was reduced in patients treated by chymopapain: 65% of patients in the first group report some or much improvement in their sciatica, whereas this figure was 26% in the placebo group (p less than 0.02). Contralateral sciatica was observed in 3 patients of the placebo group. The average give in the disc one month after nucleolysis was 34% in the chymopapain group and 27% in the placebo group, without correlation with the clinical result. On average, patients were monitored for one year after nucleolysis, and during this year 6 patients from the chymopapain group were operated upon, compared with 10 patients from the placebo group. Although these results are at the limit of statistical significance because of the number of patients studied, they confirm the innocuousness and effectiveness of chymopapain in the treatment of discolumbar hernias.
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Congenital afibrinemia is a rare disease, transmitted by an autosomal recessive mode, and due to deficient fibrinogen. Osseous involvement is exceptional, since only 2 cases have been reported. We describe a third case. The roentgenographic features are well limited radiolucent lesions, arising in the medullary space, and slightly expanding. These lesions are related to fibrous cysts, resulting from intraosseous hemorrhages. Spontaneous resolution may occur: the absence of fibrin deposits and blood clot probably favours resorption.
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The authors report 6 cases of isolated "ivory" vertebra which were confirmed as being due to Paget's disease after trocar biopsy. They analyse the radiological characteristics and find evidence of constant involvement of the posterior arch which shows the classical signs of Paget's disease: bone condensation, increase in size and cortico-medullary de-differentiation.
Thirteen cases of osteoid osteoma of the phalanxes are reported: 10 fingers and 3 toes. Any phalanx may be affected, with no preference for a particular site, in the young adult. Segmentary tumefaction of the soft parts near the lesion is a more consistent sign than pain, which is often quite minimal. Radiographies demonstrate the increase in the size of the phalanx, whose matrix is condensed. All radiographic techniques must be used to determine the exact location of the nidus, that is always very small (1 to 2 mm), and whose total removal is the only guarantee of cure.
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Profile films of the lumbar region show the vacuum-disc phenomenon fairly frequently especially at the L5-S1 level and when there is disc degeneration. Two varieties can be distinguished : one with a well-defined enlarged medial image, and a more limited type which is often anterior, at the fibrous ring level and in contact with the vertebral plates. The latter is seen less frequently, but needs to be considered, as it precedes the changes seen in the nucleus pulposus in the intersomatic alteration. It has been shown that this image is of gaseous origin. It is caused by the liberation of gas into a newly-formed intersomatic cavity situated either in the nucleus pulposus or fibrous ring levels. The vacuum-disc phenomenon is of great diagnostic value as it is usually found in relation to degenerated discs and permits orientation of diagnosis towards classical arthrosis or Pott's pseudo-arthrosis when atypical radiological images are seen.
The authors studied 577 records of rheumatoid arthritis examined radiologically in the Department of Radiology B of Cochin Hospital: 165 patients showed evidence of lesions of the cervical spine. The risk of cervical involvement in rheumatoid arthritis is thus not negligeable: 28%. This involvement may occur at any time during the course of the disease and presents as pain or by rare and more or less slight neurological manifestations. Radiologically emphasis must be placed upon the orientation points of straight and lateral films, and the value of lateral films with the neck in flexion. Atlanto-axial dislocation is the commonest lesion, usually measured by the distance separating the anterior arch of the atlas from the odontoid peg. However, other lesions are possible, in particular involvement of the lateral masses and erosion or destruction of the odontoid. It is astonishing to discover large dislocations (of up to 10 mm) which remain well-tolerated, with minimal clinical signs. However, it is the neurological risk of quadriplegia (even though minimal) which remains the constant worry since it may result from the slightest trauma or forced movement of the neck. Fixation, usually posterior occipital C1-C2, may be indicated. It is thus necessary to carry out a routine radiological examination of C1-C2 at reasonable intervals during the clinical surveillance of a patient with rheumatoid arthritis.
The authors present a rather rare case of sarcoidosis in a 12 year old child. Boney involvement constitutes the first manifestation of the condition, with micro-cystic radiological appearance of the second phalanges of both third fingers. The chest X-ray demonstrated glandular and parenchymatous involvement. The diagnosis was histologically confirmed by osseous biopsy. The authors compare their case with other previously published cases.
The study is based upon 155 cases of Cushing's syndrome and shows the diagnostic value ognosis of the suprarenal lesion responsible was possible. Bilateral suprarenal hyperplasia was always recognised with accuracy. Pneumoretroperituneum is the technique of choice for the surveillance of the therapeutic effects of synthetic anti-cortisols (especially O.P.'D.D.D.).