Biomedical subjects
Publications and source records attributed to J L Leroux.
Shoulder pain is usually caused by periarthritis. Impingement syndrome and frozen shoulder (adhesive capsulitis) are the more frequently clinical aspect observed. A shoulder standardised clinical examination often give a precise lesional diagnostic. Complementary examinations are useful to distinguish other cause of shoulder pain.
Three cases of nerve root compromise in elderly women with insufficiency fractures of the sacrum are reported. Neurological compromise is generally felt to be exceedingly rare in this setting. A review of 493 cases of sacral insufficiency fractures reported in the literature suggested an incidence of about 2%. The true incidence is probably higher since many case-reports provided only scant information on symptoms; furthermore, sphincter dysfunction and lower limb paresthesia were the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery was the rule. The characteristics of the sacral fracture were not consistently related with the risk of neurological compromise. In most cases there was no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. We suggest that patients with sacral insufficiency fractures should be carefully monitored for neurological manifestations.
A case of tophaceous gout of the navicular bone in a 24-year-old woman is reported. Emphasis is placed on the conditions that might have been precipitating, i.e., anorexia nervosa and alcoholism, and the mechanisms by which increased uric acid level may be explained. The main radiographic patterns of tophaceous gout of the foot are recalled to avoid unnecessary surgery in future cases.
STUDY DESIGN: A case of multiple psoas abscesses after Dove lumbar spine fixation is reported. OBJECTIVES: To review the diagnosis and treatment of deep infection after internal spinal fixation. METHODS: The possibility of septic complications after spinal surgery that may present with a degenerative pattern is examined. The clinical and computed tomographic findings of a psoas abscess are recalled. RESULTS: Surgical drainage of the purulent collection was performed along with prolonged parenteral antibiotic treatment. CONCLUSION: Infection should be considered as a cause of recurrence of pain after internal fixation of the lumbar spine.
Human blood polymorphonuclear cells (PMN) from seven patients with active rheumatoid arthritis (RA) were compared for their capacities to produce leukotrienes ex vivo before (D0) and 24 hr (D1) after glucocorticoid pulse therapy. The present study shows for the first time that endogenous arachidonic acid metabolism via 5-lipoxygenase pathway is significantly increased after glucocorticoid administration, leading to increased generation of the unstable precursor leukotriene A4 (LTA4) followed by predominant non-enzymatic LTA4 opening and leukotriene B4 (LTB4) omega-hydroxylation pathway. These results are unexpected since usually glucocorticoids are usually thought to decrease inflammatory mediator biosynthesis and, moreover, they work to the detriment of the clinical improvement of the patient. The results are discussed in terms of product inactivation and cellular cooperation with monocytes and endothelial cells.
The conversion of endogenous arachidonic acid (AA) by polymorphonuclear cells (PMN) from patients with rheumatoid arthritis (RA) was studied before (D0) and one day (D1) after antiinflammatory drug therapy. The biosynthesis of 5,15-diHETE and lipoxins (LXS), were investigated ex vivo, after PMN stimulation by ionophore A23187 without exogenous addition of 15-HETE. The eicosanoids were resolved by RP-HPLC and simultaneously detected at 246 and 302 nm respectively. Large amounts of 5,15-diHETE (50 to 400 ng/10(7) PMN) and significant levels of LXS (from 2 to 20 ng/10(7) PMN) were produced with individual differences between donors. Metabolite levels varied between patients but this work showed for the first time a linear relationship between the amounts of 5,15-diHETE and LXS. Moreover LXS production after treatment may be related to long-term clinical improvement of patients.
Results of three clinical tests for detecting shoulder impingement syndrome (Neer's, Hawkins', and Yocum's tests) and four tests for determining the location of the rotator cuff lesion (Jobe's test [supraspinatus], Patte's test [infraspinatus], lift-off test [subscapularis], and palm-up test [long head of the biceps brachii]) were compared to intraoperatively observed anatomic lesions in 55 consecutive patients who had surgery for Neer's syndrome. For Jobe's and Patte's tests, both pain (denoting tendinitis) and functional impairment (denoting tendon rupture) were evaluated. All clinical tests were done by the same examiner and all surgical procedures (acromioplasty with or without rotator cuff repair) by the same surgeon. The location and extent of the lesions (size of the tear in the 34 patients with rotator cuff defects) were determined intraoperatively. The sensitivity, specificity, and positive and negative predictive values of each test were calculated. Sensitivity was satisfactory but specificity was poor, in particular for determining the location and type of rotator cuff lesions. The severity of functional impairment during Jobe's and Patte's maneuvers was not correlated with the size of the tear.
In healthy subjects, the shoulder internal rotator muscle strength overrides the external rotators. This has been confirmed in different isokinetic studies showing the ratio of the relative strengths of the internal to external rotators to range from 1.3 to 1.5 points, depending on the study. The authors previously reported a decrease in the relative strength ratio of the internal to external rotators to close to 1 in patients suffering from Neer's impingement syndrome. The aim of the present study was to assess, long after surgery (mean, 44.5 months), the isokinetic strength performance of shoulder rotator muscles in 72 patients who had had operative treatment for chronic subacromial impingement using anterior acromioplasty, sometimes combined with cuff repair surgery. Tests were conducted with a Biodex Multi-Joint System in the plane of the scapula and in 45 degrees abduction at 60 degrees and 180 degrees per second. Peak torque and average power were calculated. The mean ratios of relative strengths of the internal to external rotators ranged from 1.3 to 1.6 points depending on the parameter studied and the test speed. These results indicate that surgery restores normal muscular balance between shoulder rotator muscles affected by the impingement syndrome.
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Drooping shoulder is a roentgenographic abnormality consisting in a discontinuity in the scapulo-humeral arch due to inferior subdislocation of the humeral head. Drooping shoulder is commonly seen in patients with injuries to the shoulder or neurological loss. Two cases of drooping shoulder due to staphylococcal arthritis (after local corticosteroid injections) are reported herein. The mechanism of the downward humeral displacement in septic arthritis is discussed. The other causes of drooping shoulder are reviewed. Precautions needed to avoid increasing the displacement during rehabilitation therapy are outlined.
The purpose of this study was to determine whether imbalance of the internal and external rotator musculature of the shoulder were etiological factors implicated in impingement syndrome. Shoulder torque measurements were obtained from 15 asymptomatic volunteers and 30 patients with chronic impingement syndrome, 15 of whom were evaluated after arthroscopic anterior acromioplasty. Isokinetic strength was assessed using the Biodex system in a modified position (in the plane of the scapula and in 45 degrees abduction) with test speeds of 60 degrees and 180 degrees per second. Internal and external rotator strength values and ratios were calculated for both peak torque and average power. Shoulder rotational strength values and the internal rotator/external rotator ratio were significantly higher in the dominant and nondominant control group shoulders than in the involved and uninvolved impingement shoulders for operated on and nonoperated on patients. These data demonstrate that primary change in the normal internal rotator/external rotator ratio of the shoulder is an etiological factor implicated in impingement syndrome not modified by anterior acromioplasty.
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A meningoencephalitis Behçet's disease revealing is reported. Magnetic resonance imaging is more sensitive than computerized tomography in detecting encephalitic lesions. However, no specific pattern may be retained. This exploration is non invasive and can be used to monitor the evolution after treatment.
Sacral insufficiency fractures are an often unsuspected cause of low-back pain in elderly women with osteopenia who have sustained unknown or only minimal trauma. The authors describe 10 cases of spontaneous sacral insufficiency fractures, confirmed by computed tomography, characterized by the onset of acute low-back pain. Differential clinical and radiographic diagnosis of these fractures is often difficult. Recognition of the characteristic scintigraphic patterns in sacral fractures, which are frequent in osteopenic patients, could avoid mistaken diagnoses and unnecessary tests or treatment. One of the striking feature of these sacral fractures is their invariable location. The fractures extend vertically in the sacral alae, parallel to the sacroiliac joints. They are located just lateral to the margins of the lumbar spine. This distribution suggests that such fractures could be partially caused by weight-bearing transmitted through the spine.
In women with lumbar osteoarthritis, measurement of the os calcis bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA) as an indication of vertebral fracture was evaluated. The in vivo precision of the method was 1.28%. Age- and sex-matched control curves were evaluated using a control of 193 females. The correlation between spine BMD and os calcis BMD was significant (r = 0.65, p << 0.001). For the osteoporotic women without osteoarthritis (n = 34), there was no significant difference in the spine and the os calcis Z-scores (-1.99SD and -1.83SD respectively). Whereas for osteoporotic women with osteoarthritis (n = 30) the spine Z-score was -0.49SD the os calcis Z-score was -1.92SD. The difference was significant (p < 0.001). Receiver operating characteristic (ROC) curves demonstrate the superiority of the os calcis as a measurement site over the lumbar spine, in correlation with existing crush fractures in the presence of osteoarthritis. It is concluded that when lumbar osteoarthritis occurs measurement of the os calcis BMD using DEXA is clinically useful for the estimation of bone mass.
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The authors determined the in vivo displacement of the instantaneous center of rotation (ICR) of the shoulder from data supplied by an optoelectronic system (ELITE System) which uses a specifically designed software program to achieve 3-dimensional analysis of abduction. The study involved 10 control subjects and 20 patients suffering from a periarticular disorder of the shoulder capsule retraction in 10 cases and rotator cuff tears before and after rehabilitation in 10 cases. This method provides an objective assessment of humeral head misalignment in relation to the glenoid cavity induced by the periarticular shoulder disorder and of the realignment achieved through rehabilitation. The proposed ICR calculation technique is entirely harmless for the patient in (particular because it requires no radiation analysis).