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Biomedical subjects

J M Ristori

Publications and source records attributed to J M Ristori.

At least 19 recordsLinked to original sources
PubMed2005

Septic arthritis as a late complication of carcinoma of the breast.

OBJECTIVES: To see if a past history of radiation therapy is a risk factor for septic arthritis. METHODS: We retrospectively searched our records of 282 patients with septic arthritis and found 10 cases of septic arthritis post-radiotherapy, all in females. We analysed our group, correlating them with the literature. We also compared our patients with a group of septic arthritis patients without radiation therapy. RESULTS: Nine had had radiation therapy for carcinoma of the breast. The shoulder joint was involved in six and the sternoclavicular joint in three. The tenth patient had had brachytherapy and radiation for carcinoma of the cervix and presented with septic arthritis of the hip. The mean age of the patients was 69 yr (49-82 yr). The mean time elapsed since radiation was 16 yr (3-34 yr). Twenty-three cases of shoulder septic arthritis in patients without past radiation therapy were selected for comparison. The five patients with past radiation therapy had fever less often and a longer time lapse before diagnosis. They required longer antibiotherapy. However, this prevented neither bone destruction nor relapse. CONCLUSIONS: In our study, a past history of radiation therapy was observed in 6/50 infections of the shoulder, 3/5 infections of the sternoclavicular joint, 6/23 cases of septic arthritis of the shoulder and all cases of septic arthritis of the sternoclavicular joint for females. Radiation therapy seems to be a risk factor for septic arthritis. Diagnosis would be aided by a greater awareness of the clinical and radiological features of this septic arthritis.

Aged↗
PubMed2004

[Fluoroscopy guided L5-S1 transforaminal injection as a treatement for s1 radiculopathy].

OBJECTIVE: To assess the efficacy of fluoroscopy guided L5-S1 transforaminal steroid injections for the treatment of S1 radiculopathy secondary to intervertebral disk disorder. METHOD: 41 patients were included: prospective study (20 patients) and retrospective study (21 patients). All patients suffered from S1 radiculopathy secondary to nerve root compression by intervertebral disk material, as demonstrated by lumbar spine CT. The patients underwent 2 fluoroscopy guided L5-S1 transforaminal injections of steroid (Hydrocotancyl 125 mg), at 8 days interval. RESULTS: 60% of patients showed significant improvement of their painful radiculopathy at day 8 (n:41), 60-67% at day 30 (n:41) and 67% at day 90 (n:18). CONCLUSION: Fluoroscopy guided L5-S1 transforaminal injection showed good efficacy in the treatment of S1 radiculopathy.

Adrenal Cortex Hormones↗
PubMed2002

No changes in the distribution of organisms responsible for septic arthritis over a 20 year period.

OBJECTIVE: To assess changes in the distribution and resistance of the pathogens responsible for septic arthritis over a 20 year period in patients admitted to the same hospital unit. PATIENTS AND METHODS: Retrospective study of the hospital records of patients admitted between 1979 and 1998 for septic arthritis with positive microbiological diagnosis after blood or joint cultures, or both. RESULTS: 303 cases of septic arthritis were studied, 141 in the period 1979-88 and 162 in the period 1989-98. The incidence between the first and second period did not vary significantly for the staphylococci (67% v. 63%), streptococci (16% v. 20%), and Gram negative bacilli (7% v. 10%). Tuberculous infections decreased from 9% to 4% (p<0.04). No gonococci were isolated in the second 10 year period. Among the staphylococcal species, there was an increase in the number of coagulase negative staphylococci (10 cases v. 21, p<0.05) between the two periods. There was no significant difference in the frequency of occurrence of methicillin resistant pathogens (12.6% v. 16.6%). The number of streptococcal B infections increased (2 v. 10 cases), and beta-lactamine resistant pneumococci emerged. In the second 10 year period, patients were older and were more likely to have co-existing disease, particularly tumoral growth, and less commonly were receiving dialysis. Localisation of joint infection was comparable except for an increase in prosthetic knee infections. CONCLUSION: The distribution and sensitivity of pathogens causing septic arthritis changed little over a 20 year period.

Adult↗
PubMed2001

Pamidronate in the treatment of diffuse sclerosing osteomyelitis of the mandible.

Diffuse sclerosing osteomyelitis of the mandible is characterized by bouts of intense pain, sometimes associated with trismus and paresthesia, and leads to progressive deformity. It is of unknown etiopathology, but it is suggested to be one manifestation of the synovitis, acne, pustulosis, hyperostosis, osteomyelitis syndrome, the other features of which may have been overlooked. Treatment results are disappointing, and decortication may be necessary to achieve an acceptable outcome. We report a case restricted to the mandible that responded favorably to treatment with pamidronate. Further trials of pamidronate in patients with diffuse sclerosing osteomyelitis of the mandible, even in those with the aforementioned syndrome, are needed to assess its effectiveness.

Aged↗
PubMed2000

[Rheumatoid arthritis preceding microscopic polyangitis. Report of two cases].

INTRODUCTION: Although joint manifestations are common in microscopic polyangiitis (MPA), including arthralgia reported in 15-65% of cases and arthritis in 6-17%, there have been only two published cases of polyarthritis as the first manifestation of the disease. We report on two new cases. EXEGESIS: A 71-year-old woman had symmetric polyarthritis of the hands which initially suggested the existence of seronegative rheumatoid arthritis. A 52-year-old woman had seropositive asymmetric oligoarthritis. The diagnosis was not established until renal insufficiency appeared, prompting a renal biopsy which showed in both cases an extra-capillary glomerulonephritis and an anti-myeloperoxydase (p-ANCA) assay which was postive in both patients. The incidence and specificity of antineutrophil cytoplasmic antibodies (ANCA), including MPA, in rheumatoid arthritis are reviewed. CONCLUSION: Our two observations show that in cases of polyarthritis or oligoarthritis with renal involvement, testing for and typing of ANCA should be performed so as not to misdiagnose vasculitis.

Acute Kidney Injury↗
PubMed1999

HLA and self-limiting, unclassified rheumatism. A role for HLA-B35?

OBJECTIVE: To test the hypothesis of increased frequency of HLA-B35 in self-limiting, unclassified rheumatism (SUR). METHODS: Patients (n = 50) were included if they had swelling of one or more joints for more than 24 h and/or pain without trauma of 2 or more joints for one month or longer, and at least one of (1) history of joint swelling, (2) morning stiffness, (3) elevated erythrocyte sedimentation rate and/or C-reactive protein. Patients fulfilling diagnostic criteria sets of any rheumatic disease and patients with other identified diseases were excluded. Controls were 50 patients with rheumatoid arthritis (RA) and 199 healthy blood donors. RESULTS: HLA-B35 frequency (0.32) was significantly greater in SUR than in RA (0.14) and controls (0.17). HLA-DR4 frequency was significantly increased in HLA-B35 positive SUR, while that of HLA-DR1 was decreased (NS). Clinical characteristics of SUR were: history of atopy; transient, mono or oligoarticular synovitis and widespread, longlasting pain. HLA-B35 positive patients with SUR more often had hip, knee, or back pain than HLA-B35 negative patients. CONCLUSION: HLA-B35 frequency is increased in SUR, while HLA-DR1 frequency is not. A likely hypothesis of attenuated immune inflammation in SUR is further supported by results in juvenile RA, adult Still's disease, and a series of mild inflammatory arthritides, and by indirect evidence of decreased Th1 response and increased Th2 response in HLA-B35 positive patients with various conditions.

Adult↗
PubMed1998

Arterial obliteration in POEMS syndrome: possible role of vascular endothelial growth factor.

Acute arterial obliteration is a newly acknowledged manifestation of the POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes), in which overproduction of proinflammatory cytokines has been implicated. We describe a case in which serum levels of proinflammatory cytokines were normal or slightly raised. In contrast, vascular endothelial growth factor (VEGF) was greatly increased. This angiogenic and vascular permeability factor is involved in the development of atheromatous and thrombotic lesions and may be responsible for the arterial complications of the disorder.

Aortography↗
PubMed1997

[Does reactive arthritis caused by Brucella exist? Apropos of 4 cases].

OBJECTIVES: Arthritis observed in patients with Brucella infection is usually considered to result from live micro-organisms invading the synovia. We observed four cases of brucellosis in which the clinical and laboratory findings suggested a different mechanism: reactive arthritis. CLINICAL OBSERVATIONS: The diagnosis of brucellosis was made on the basis of serology tests in 3 patients and blood cultures in 1. All 4 patients presented oligoarthritis. The synovial fluid was sterile in 3. Antibiotics were ineffective in reducing joint pain and inflammation whereas local and systemic anti-inflammatory drugs were effective. Three patients also had other manifestations (sausage-shaped toes, talalgia, sacroiliitis) and fulfilled the diagnostic criteria for spondylarthropathy. All patients were positive for antigen HLA-B27. DISCUSSION: These observations suggest that Brucella should be added to the list of intracellular infectious agents capable of inducing reactive arthritis, despite the lack of all the diagnostic criteria. For some, such as the uretritis or diarrhea observed before joint involvement, it would be difficult to implicate the germ. Brucella serology should be part of the etiology work-up for reactive arthritis in endemic areas.

Adult↗
PubMed1997

Response to minocycline of arthritis associated with agammaglobulinemia. A case-report.

Seven to 22% of patients with agammaglobulinemia develop joint manifestations consisting of septic arthritis or aseptic arthritis of unclear pathogenesis. Intravenous gammaglobulin therapy seems effective on the latter condition but is burdensome and expensive. We report the case of a patient with common variable immunodeficiency and aseptic oligoarthritis in which minocycline therapy was effective in relieving the joint symptoms.

Agammaglobulinemia↗
PubMed1997

[Epiphyseal pain from cyclosporine in renal transplants].

In patients with renal transplant, cyclosporin has been implicated in the occurrence of osteoarticular pain. This syndrome, which we illustrate by two of our observations, is fairly stereo-typed. Osteoarticular pain begins around the second month post-transplant and in a symmetrical pattern involves, knees, ankles, tarsi, less frequently hips, and almost never upper limbs. Pain arises on standing and walking, which is severely impeded. Clinical examination is usually normal. Radiographs show patchy, subchondral osteopenia. Bone scintiscan documents numerous foci of increased uptake and MRI multiple areas of T1-weighted low signal intensity and T2-weighted high signal intensity. Pain disappears in three to six months. Ethiopathogeny is still a matter of discussion with frequent reference to reflex sympathetic dystrophy. The syndrome could also be related to a cyclosporin-induced increase in bone remodelling. Steroids could contribute, as could the healing of pre-transplant, renal osteodystrophy. Microfractures are common but it is not known whether they are causative through an ensuing reflex sympathetic dystrophy or whether they are simply but a consequence of increased bone remodelling.

Arthralgia↗
PubMed1997

An open study of the anti-TNF alpha agent pentoxifylline in the treatment of rheumatoid arthritis.

OBJECTIVE: Monoclonal antibodies to TNF alpha have a rapid therapeutic effect in rheumatoid arthritis. Pentoxifylline is an anti-TNF alpha agent that is easier to handle than antibodies. METHODS: An open prospective trial was conducted in 21 patients with active rheumatoid arthritis. Pentoxifylline was given in a daily dosage of 1,200 mg for at least one month. Five patients received the drug as a continuous intravenous infusion during the first seven days. RESULTS: After one month, a significant decrease in the pain severity score was noted, but all other clinical and laboratory efficacy parameters were unchanged. A limited response was seen in four patients. TNF alpha levels did not decrease under therapy. CONCLUSION: Under the conditions of our trial, the therapeutic benefits provided by pentoxifylline were too small to warrant use of this drug in severe refractory rheumatoid arthritis.

Antirheumatic Agents↗
PubMed1997

Vasculitis confined to the calves. Report of a case.

Polyarteritis nodosa is a systemic disease of which limited forms have been reported, with the most common involving the skin. Only 13 cases with lesions confined to the calves have been reported to date. We report a new case.

Female↗
PubMed1996

[Prognosis of multiple myeloma treated with conventional chemotherapy has not improved in 20 years].

The treatment of multiple myeloma has changed over the last 20 years. We investigated the effects of theses changes on patient survival in the current practice of a rheumatology ward. Two hundred and seventy-nine patients were hospitalised between 1972 and 1993: 30 from 1972 to 1976, 70 from 1977 to 1981, 86 from 1982 to 1986, 75 from 1987 to 1991 and 18 from 1992 to 1993. Staging according to Durie and Salmon was I in 8%, II in 29% and III in 65%. In principle, the initial therapy was monochemotherapy in 65% of the cases and polychemotherapy in 35%. At the time of the present study, 197 patients have died. The actuarial curves of survival were similar in all historical classes defined by the date of first admission. Curves of median of follow-up and of floating means were level between 1972 and 1990. No correlation was found between the date of first admission and survival in the 174 patients who died between 1972 and 1987. The following parameters were associated with longer survival: achievement of an objective response on chemotherapy, lower patient's age, high haemoglobin, low creatinine, low stage according to Durie and Salmon, low number of plasma cells in bone marrow, low calcemia and low levels of IgA, monoclonal component. The comparison of prognosis factors in historical classes showed a difference only for haemoglobin which was lower in the earlier class. The type of the first chemotherapy regimen varied widely between historical classes. The number of responders was significantly greater after polychemotherapy than after monochemotherapy but no correlation was observed between the type of chemotherapy and survival. The frequencies of early death, and the causes of death in general, were not different in the historical classes. The lack of improvement of survival over the last 20 years shows that the efficacy of current chemotherapies is limited, a conclusion which warrants the exploration of other therapeutic avenues.

Aged↗
PubMed1996

Subchondral insufficiency fracture of the femoral head.

We report two cases of subchondral insufficiency fractures of the femoral head. Clinical manifestations of this lesion are nonspecific. Radionuclide bone scanning demonstrates early hyperactivity. Initial roentgenograms are usually normal. Magnetic resonance imaging establishes the diagnosis and rules out other conditions.

Aged↗