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J M Amigues

Publications and source records attributed to J M Amigues.

6 recordsLinked to original sources
PubMed1997

Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head.

OBJECTIVES: To assess the outcome of core decompression in the treatment of osteonecrosis of the femoral head related to the volume of necrotic bone measured according to a previously reported method. METHODS: Twenty hips corresponding to strictly Ficat stage II underwent magnetic resonance imaging and the volume of necrotic bone was expressed as a percentage of the volume of the entire head measured on each slice. All hips underwent core decompression and the outcome was evaluated at 24 months. The primary evaluation criterion was radiological appearance: the outcome was considered as good if the hip remained stage II and poor if the disease progressed. RESULTS: Twenty four months after core decompression, half the cases remained stable and in half the disease had progressed. Outcome seemed to be related to the volume of necrotic bone (average 22% in the good outcome group versus 45% in the poor outcome group (p = 0.0051)) and was independent of risk factors, age, and histological type. CONCLUSIONS: The volume of necrotic bone should be taken into account in the evaluation of any treatment, bearing in mind that in more than one third of cases this volume will probably decrease, especially at the beginning of the disease process.

Adult↗
PubMed1997

Hyperparathyroidism during lithium therapy. Two new cases.

We report two new cases of hyperparathyroidism during lithium therapy. The patients were a 50-year-old male and a 48-year-old female under lithium for bipolar disease. Both developed osteoporosis without fractures and laboratory test abnormalities consistent with moderate hyperparathyroidism. Although only 30 or so cases of lithium-associated hyperparathyroidism have been reported, as many as 10 to 15% of lithium-treated patients may have laboratory test evidence of hyperparathyroidism. Typically, urinary calcium excretion is normal, serum phosphate levels are moderately decreased and cyclic AMP levels are normal. An adenoma is the most common lesion. Surgery is usually required in patients whose clinical and laboratory test abnormalities persist despite discontinuation of the drug. Lithium-associated hyperparathyroidism may be due to dysregulation of the caliostat, a feedback loop that subordinates parathyroid hormone secretion to serum calcium levels. Little is known about lithium-induced osteoporosis. Trabecular bone was predominantly affected in one of our patients and cortical bone in another.

Bipolar Disorder↗
PubMed1997

Osteoporotic vertebral fractures in a man under high-dose inhaled glucocorticoid therapy. A case-report with a review of the literature.

A 65-year-old man had surgery in June 1995 for femoral neuralgia. The plain films of the spine were normal at the time. In September of the same year, when he was beginning to walk gradually longer distances, he started experiencing back pain. Crush fractures of T8 and L2 were seen on plain films. His pain worsened, and he was admitted in December 1995. A third set of plain films disclosed fractures of all the vertebral bodies from T8 through L5, with increased density of the endplates of the same vertebras. Serum and urinary levels of calcium and phosphate were normal. Dual-energy X-ray absorptiometry demonstrated osteoporosis predominating in the trabecular bone. Evidence of increased bone resorption was seen on the histomorphometric study. Large amounts of dihydroxypyridinoline were found in the urine. Investigations for the classical causes of osteoporosis in males were unrewarding. Careful questioning revealed that the patient had been taking inhaled beclomethasone for seven years to treat chronic obstructive lung disease. Serum levels of cortisol and ACTH were low, consistent with a diagnosis of treatment-induced hypercorticism. To our knowledge, this is the first reported case of osteoporotic vertebral fractures in a male due to inhaled glucocorticoid therapy. Inhaled glucocorticoids are generally believed to induce only minimal systemic effects. However, decreased serum osteocalcin levels and increased urinary excretion of bone resorption markers have been reported in patients under inhaled beclomethasone therapy. Low spinal bone mineral density values correlated with the degree of pituitary-adrenal gland suppression as evaluated using the ACTH test have also been found in several groups of patients treated with inhaled glucocorticoids.

Administration, Inhalation↗
PubMed1997

Bone and joint involvement in adults with Werner's syndrome.

A 45-year-old man with Werner's syndrome had large asymptomatic calcium deposits about the elbows, hips, and shoulders. During the four-year follow-up, he developed insufficiency fractures of the pelvis, both ulnas, one radius and one metatarsal, all of which failed to heal. Bone mineral densities evaluated by dual-energy X-ray absorptiometry were at the lower end of the normal range, but a histomorphometric study showed a reduction in trabecular bone volume and marked decreases in osteoid parameters with a calcification rate of zero. Serum assays of 25 hydroxy vitamin D3, 1,25 dihydroxy vitamin D3, osteocalcin and alkaline phosphatase were normal. The nonunions in this patient may have been caused by impaired osteoblast function associated with Werner's syndrome and/or by decreased activity of growth factors involved in bone repair.

Bone Density↗
PubMed1996

Comparative study of 4 diagnosis criteria sets for mixed connective tissue disease in patients with anti-RNP antibodies. Autoimmunity Group of the Hospitals of Toulouse.

OBJECTIVE: To evaluate the performances of 4 sets of criteria proposed to define mixed connective tissue disease (MCTD): the criteria of Sharp, Alarcón-Segovia, Kasukawa, and Kahn. As anti-U1-RNP antibodies appear indispensable to establish the diagnosis of MCTD, we wished to reevaluate these sets of criteria in patients who all had anti-U1-RNP antibodies. METHODS: We analyzed clinical and biological data to find which diagnostic criteria were met by 45 patients with anti-U1-RNP antibodies. We tested criteria for rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, polymyositis, Sjögren's syndrome, and 4 sets of criteria for MCTD. RESULTS: The criteria that best identified patients with MCTD were those proposed by Alarcón-Segovia, with 62.5% sensitivity and 86.2% specificity, comparable to Kahn's criteria. The overlap with other connective tissue diseases was found to be 16%. These results could be improved by using the term "myalgia" instead of "myositis" in the definition. This increased sensitivity to 81.3%, with no decrease in specificity. CONCLUSION: Alarcón-Segovia's and Kahn's criteria are the best classification criteria to define MCTD.

Adolescent↗