Biomedical subjects
Publications and source records attributed to J Chrétien.
Since no true roetgenographic lateral view of the hip is available, several different additional views of the hip have been described to complete the analysis obtained on the AP view. These different additional views of the hip are presented as well as their indications depending on the clinically suspected hip disease.
The diagnosis of tuberculosis in a person means that measures must be taken to prevent the transmission of Mycobacterium tuberculosis from source cases to healthy individuals. Tuberculosis needs to be rapidly identified, bacteriologically confirmed and treated. Contact tracing allows subjects to be found among close (home), regular (school, crèche, workplace), or occasional contacts. Besides clinical features, cutaneous tuberculin reactions and chest X-ray are the principal examinations that permit a decision to be taken regarding follow-up, chemoprophylaxis or BCG vaccination.
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Paget's disease, often an incidental finding, sometimes presents in the form of pain or signs of complications, such as spinal cord compression, malignant transformation or fissures. The diagnosis is established by laboratory tests, but essentially by radiological findings, based on three basic criteria: cortical thickening, loss of cortico-cancellous differentiation and enlargement of the bone, which deformity is a later sign. The diagnosis can usually be made on plain x-rays, but CT is useful in the case of early, difficult or unusual lesions and complications. CT can reveal mouth-eaten, vacuolar, network, clumped or mixed, fibrillary or ivory images. MRI is a last resort examination. Angioma, metastases and ivory vertebrae are the main differential diagnoses.
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The continuing presence of tuberculosis in the world and its reappearance in industrialized countries again emphasizes the need to maintain and reinforce tuberculosis control. Despite the existence of effective drugs, there are still, deplorably, nearly 20 million cases of active tuberculosis throughout the world, with at least 3 million deaths annually. Almost 1.7 billion people are infected with the Koch bacillus. These figures are approximate and probably underestimate the real situation, as precise epidemiological data are not available. The rules of tuberculosis control are reviewed in this article, with distinctions drawn between low prevalence countries, where the objective is to eradicate the disease, and high prevalence countries, where it must be contained and reduced as quickly as possible the interruption of the claim of transmission of tuberculosis and the necessary collective measures are described in turn. The role of new techniques, particularly those based on molecular biology, is discussed. The importance of case finding and treatment in groups at risk in France is underlined, as are the role of BCG and the importance of protective measures, particularly in hospitals and in vulnerable subjects. The association between tuberculosis and HIV is well-known, but the HIV epidemic does not seem to be the only reason for the current resurgence of the tuberculosis problem in France in particular.
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