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Biomedical subjects

J F Maillefert

Publications and source records attributed to J F Maillefert.

At least 55 records · Page 3Linked to original sources
PubMed1997

Bone scintigraphy equipped with a pinhole collimator for diagnosis of avascular necrosis of the femoral head.

The objective was to compare the sensitivities for diagnosis of avascular necrosis of the femoral head of bone scintigraphy equipped with a pinhole collimator and with an high resolution parallel collimator. Bone scintigraphy equipped with a pinhole collimator and with an high resolution parallel collimator were performed in 16 patients with bilateral (n=7) or unilateral (n=9) avascular necrosis of the femoral head. Bone scintigraphy equipped with a pinhole collimator documented a photopenic defect in 78.3% of the necrotic hips, while bone scintigraphy equipped with an high resolution parallel collimator documented a defect in 47.8%. There was no false-positive diagnosis of avascular necrosis of the femoral head on either bone scintigraphy equipped with a pinhole or with an high resolution parallel collimator. In conclusion, bone scintigraphy equipped with a pinhole collimator has a greater sensitivity for diagnosis of avascular necrosis of the femoral head than bone scintigraphy equipped with an high resolution parallel collimator.

Adult↗
PubMed1997

Muscle metabolism changes with training in the nonamputated limb after vascular amputation: interest of phosphorus 31 NMR spectroscopy.

OBJECTIVE: To determine by 31P nuclear magnetic resonance (NMR) spectroscopy the efficacy of training in improving aerobic metabolism of calf muscle in nonamputated limb after recent vascular amputation; to assess the possible associated microcirculatory changes; and to evaluate the need for noninvasive monitoring techniques during training in the nonamputated limb after recent vascular amputation. DESIGN: Prospective study, before and after training. Subjects served as their own controls and were compared with a control group. SETTING: Rehabilitation center of a university hospital. PATIENTS: Ten unilateral vascular amputated patients were included with ankle systolic index between 0.5 and 0.8 in the nonamputated limb, and 10 control subjects without cardiovascular disease or risk factors of atherosclerosis with ankle systolic index of >.95. INTERVENTION: Walking with prosthesis at self-selected velocity over increasing walking distance, arm training at a workload of 60% of a maximal arm test, and analytical exercises of the nonamputated leg (dynamic contractions against low resistance). Subjects received training as inpatients, 5 days a week. MAIN OUTCOME MEASURES: Before and after training, ankle systolic index, forefoot transcutaneous oxygen tension (TcPO2) and veno-arteriolar reflex, and digital plethysmography of the second toe with reactive hyperemia test were studied. Changes in calf muscle pH, phosphocreatine (PCr), and inorganic phosphate (Pi) were measured by 31P NMR spectroscopy at rest and during a plantar flexion-type incremental protocol. RESULTS: There was no significant difference in ankle systolic index (.63 +/- .10 vs .64 + .07) or in TcPO2 (42 +/- 11 vs 44 +/- 10mmHg), and there was reappearance of veno-arteriolar reflex in 3 cases, of a plethysmographic signal in 2 cases, and of the positivity of the reactive hyperemia test in 3 cases. No differences were found with 31P NMR spectroscopy at rest before and after training. At the same workload (1 watt) the difference of the ratio (PCr/(PCr + Pi)) of rest to effort (PCr depletion) was significantly increased in the amputated patients (.423 +/- .159 vs .145 +/- .058; p < .01). This difference of ratio was lower after training (.360 +/- .158 vs .423 +/- .159; p < .05). The pH was less acid between the two periods. CONCLUSION: Vascular monitoring with systolic index and TcPO2 is necessary to follow and to prevent serious ischemia of the nonamputated limb. Claudication is often not detected because of early exhaustion during walking. Training after recent vascular amputation improves the skeletal muscle oxidative capacity.

Amputation, Surgical↗
PubMed1997

Mental nerve neuropathy as a result of hepatitis B vaccination.

We describe a 20-year-old woman who presented with polyarthralgia and sensory neuropathy, including mental nerve neuropathy. The symptoms were attributed to hepatitis B vaccination. This unusual cause of mental nerve neuropathy has not been previously described. However, as the use of hepatitis B vaccination is growing, adverse side effects, including mental nerve neuropathy, should be observed with an increased frequency.

Adult↗
PubMed1997

Multifocal malignant fibrous histiocytoma of the spine.

A 40-year-old patient was seen because of a three-month history of low back pain unresponsive to standard therapy. Crush fractures of T12 and L2 were seen on plain radiographs. A magnetic resonance imaging study disclosed lesions of all the vertebral bodies from T12 to the sacrum sparing the disks and epidural space. Histologic features of a vertebral biopsy specimen was consistent with malignant fibrous histiocytoma of the bone. The multifocal distribution caused some reluctance to accept this diagnosis, which was, however, confirmed by detailed immunohistochemical studies and reevaluation of the histologic slides by independent observers who were unaware of the initial diagnosis. Chemotherapy with doxorubicin and cisplatin was started but the patient died 15 months after the diagnosis. Malignant fibrous histiocytoma mainly affects the metaphyses of the long tubular bones. The spine is a very uncommon site of localization of this tumor. The multifocal spinal lesions in our patient may have been produced by metastases from an unidentified primary or by direct spread via the perivertebral soft tissues of a primary located in a vertebral body. The management of malignant fibrous histiocytoma relies on a combination of surgery and chemotherapy. Although complete excision of the tumor can be followed by prolonged survival, the prognosis is bleak in unresectable forms.

Adult↗
PubMed1996

Expression of the multidrug resistance glycoprotein 170 in the peripheral blood lymphocytes of rheumatoid arthritis patients. The percentage of lymphocytes expressing glycoprotein 170 is increased in patients treated with prednisolone.

The objective was to evaluate the expression of the multidrug resistance P-glycoprotein (P-gp) in peripheral blood lymphocytes (PBL) of patients with rheumatoid arthritis (RA). PBL from 68 RA patients and 44 controls were evaluated. RA patients had a mean disease duration of 10.7 yr, with a mean number of past resistances to DMARDs of 0.82, and were treated with NSAIDs (n = 34), DMARDs (n = 25) and prednisolone (n = 40). Fluorescence flow cytometry was used to assess P-gp membrane expression on PBL. In the RA group, the percentage of PBL expressing P-gp was higher in patients treated with prednisolone than in other patients [mean +/- S.D.: 10.7 +/- 15.8% vs 3.3 +/- 7.6%, P < 0.03, Student] and was not related to other therapies, age, sex, RA duration, number of past resistances to DMARDs, activity, ESR, CRP. The percentage of PBL expressing P-gp did not differ in RA and control groups, but was higher in the prednisolone-treated RA patients than in controls. Prednisolone could induce a rise in the percentage of PBL expressing P-gp. On the contrary, patients with a high percentage of PBL expressing P-gp could be more resistant to DMARDs and need prednisolone earlier. Further studies are needed to address this question and to evaluate the potential implication of P-gp in drug resistance in RA.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1995

Systemic effects of epidural dexamethasone injections.

OBJECTIVES: to evaluate potential systemic effects of a single epidural injection of dexamethasone. PATIENTS AND METHODS: each of nine patients (five males and four females, mean age 47 +/- 11.8 years) admitted for sciatica was given a single epidural injection of 15 mg dexamethasone acetate. Before the injection (D0) and two (D2), seven (D7) and 21 (D21) days after the injection, the following laboratory tests were performed: serum cortisol and ACTH in the morning after an overnight fast, free cortisol in a 24-hour urine collection, fasting serum levels of glucose, triglycerides and cholesterol, serum levels of sodium and potassium. Blood pressure was measured on D0, D2, and D7. RESULTS: Serum cortisol, ACTH and urinary cortisol were profoundly decreased on D2 and D7 but normal on D21. There were no changes in fasting serum glucose, triglycerides, cholesterol, sodium or potassium levels. CONCLUSION: a single epidural injection of 15 mg dexamethasone acetate is associated with transient adrenal suppression, denoting passage of the steroid into the systemic bloodstream. However, evidence of hypercorticism is usually lacking.

Adrenocorticotropic Hormone↗