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Biomedical subjects

M Bély

Publications and source records attributed to M Bély.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Generalized septic infections in rheumatoid arthritis. Study of autopsy material].

In the randomized autopsy material of 161 patients with rheumatoid arthritis (RA), a letal, generalized septic infection (GSI) was observed in 22 cases (13.66%). The GSI was accompanied by a pyarthros in 12 (7.45%) and no pyarthros in 10 (6.21%) cases. The clinical parameters of 22 septic RA patients were compared with 139 age and sex matched RA patients without GSI. The average age of septic patients decreased (p < 0.02), with low serum electrophoretic b-globulin level (p < 0.04), and high Waaler-Rose (p < 0.02) and Latex level (p < 0.004). The clinical parameters of 22 septic patients were compared with 76 age and sex matched RA patients without sepsis, vasculitis, or generalized secondary amyloidosis (GSA), and/or miliary epitheloid granulomas of tuberculous type (mT). The differences between the two groups of patients were the same, with a statistically more pronounced age difference (p < 0.005). 29 out of 161 patients (18.01 %) suffered from a clinically manifest diabetes mellitus (in 6 patients accompanied by sepsis), and 11 (6.83 %) from a clinically latent diabetes mellitus (in 2 patients accompanied by sepsis). There was no significant relationship between sepsis and manifest diabetes mellitus. The controlled and treated diabetes mellitus does not influence the frequency of lethal sepsis. Significant correlations were found between sepsis and latent diabetes mellitus (based on the histological detection of amyloid deposition localized to the islets of Langerhans (p < 0.02). 34 out of 161 patients (21.12%) suffered from a generalized secondary amyloidosis (in 3 patients accompanied by sepsis). There was no significant relationship between sepsis and generalized secondary amyloidosis. The thickness of adrenal cortex represents the effect of steroid therapy. Critical random check, using the Mann-Whitney tests, supports significance relationship between the adrenal cortex atrophy and fatal sepsis (p < 0.010). The follicular lymphoid depletion in the spleen represents the effect of immunosuppressive therapy. The size of lympho-follicles decreased significantly in sepsis (p < 0.004). The long term corticosteroid therapy and immunosuppressive represent a potential danger for sepsis.

Adolescent↗
PubMed1993

[Generalized secondary amyloidosis in rheumatoid arthritis].

Generalized (systemic) secondary amyloidosis was a post mortem finding recorded in 28 patients (25.2%) by amyloid specific Congored staining according to Romhányi, from 111 randomized autopsy cases with rheumatoid arthritis. Amyloidosis was present most frequently in the gastro-intestinal tract, the heart, kidney, thyroid gland, spleen and in the suprarenal glands. The quantity of amyloid deposits is usually the highest in the organs that are most frequently have deposits. The amyloidosis is a progressive cumulative process. The conclusion is that the organs where there are frequently high quantities of amyloid is where the deposits begin and where there are infrequently any deposits or low quantities is where the deposits develop later. Biopsy of the most frequently involved organs are suggested for early diagnosis of amyloidosis. Comparing the laboratory parameters (at the last hospitalisation), the amyloidotic patients were anaemic, with low haemoglobin level (p < 0.05), the renal function significantly decreased, the carbamid (p < 0.001), and kreatinin level high (p < 0.05), with frequent proteinuria (p < 0.0001).

Adrenal Glands↗
PubMed1993

[Fatal myocardial lesion in systemic lupus erythematosus].

The authors present the case of a 47-year old female patient. She suffered from a moderate activity SLE for two years. The outcome of SLE was changed by an ulcer because of leg injury, which was repeatedly infected. Severe polyarthritis, leucopenia, thrombocytopenia, clinical signs of vasculitis and in the last two months fever, high ESR, and pericarditis appeared. The angina pectoris, the cardiac decompensation, the electrocardiogram, the echocardiogram was suspect to diffuse myocardial lesion. Cardiac decompensation caused the death of the patient. Besides the activation of her autoimmune disease, infection was suspect in the patient taken immunosuppressive and steroid drugs, though it could not be verified. Autopsy verified besides the recent necrosis of heart without reaction, and multifocal myocardial abscess, which appeared possible in the terminal phase.

Abscess↗
PubMed1993

[Disease-modifying factors in chronic polyarthritis. Correlations amongsystemic vasculitis, secondary amyloidosis, septic infections and occurrence of miliary epitheloid-cell granuloma. A review of autopsies].

The following findings were obtained from autopsies performed on 169 deceased with chronic polyarthritis (CP): systemic vasculitis in 26 cases (15.4%), systemic secondary amyloidosis in 32 cases (18.9%), sepsis in 13 cases (7.7%) and miliary epithelioid-cell granulomatosis (probably tuberculosis) in six cases (3.6%). Vasculitis was combined with amyloidosis in five patients, with sepsis in two and with miliary epithelioid-cell granulomatosis in four. Critical random check, using the Mann-Whitney test, did not support significance of relationship between vasculitis and amyloidosis or fatal sepsis, whereas significant correlations were found to exist in CP cases between vasculitis and miliary epithelioid-cell granulomatosis (P < 0.005). The latter had no effect on the severity of vasculitis, but the incidence of the granulomatous type of vasculitis was higher with significance (P < 0.02). The conclusion is that biopsy evidence of granulomatous vasculitis in CP patients should be followed by systematic clinical search for miliary tuberculosis because of above-average incidence of that combination.

Adolescent↗
PubMed1992

[Osteoblastoma in the iliac crest].

An 18 year old male patient is reported with a five year history of mild pain in his right hip. Radiological investigation showed a typical feature for osteoblastoma of iliac bone, with two niduses. En bloc excision was performed. The histological examination's result was also osteoblastoma.

Adolescent↗
PubMed1992

[Molecular genetic, laboratory and clinical study of serum amyloid P].

Studying the gene polymorphism of serum amyloid P a common constituent of amyloid deposits two restriction fragment length polymorphism patterns were found among Hungarian rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus (SLE) patients and healthy controls. Although no direct connection between DNA polymorphism and the frequency of amyloidosis in three patient groups was found, a marked predominance of the heterozygosity in all studied groups has been described. Authors found close correlation between the serum levels of SAP and CRP in juvenile rheumatoid arthritis, but failed to find the same correlation in SLE and healthy controls. Moreover, the serum level of CRP of heterozygous patients were significantly higher than that of homozygous patients within the juvenile rheumatoid arthritis patient groups.

Amyloid↗
PubMed1992

Cardiac changes in rheumatoid arthritis.

We reviewed the autopsy material of 169 patients with rheumatoid arthritis (RA) and studied the cardiac changes is these patients. Systemic vasculitis was observed in 26 cases (15.38%) among 169 patients with RA. In 17 cases (10%) we found vasculitis of the subepicardial and/or intramural coronary vessels. Coronary arteritis or arteriolotis has led to multifocal small, and/or large myocardial infarctions in 10 cases (5.9%) and was the cause of progressive cardiac insufficiency, the direct cause of death. Multifocal circumscribed myocardial infarction reported in rheumatoid disease. In 8 cases rheumatoid nodules were found in the myocardium, 3 of them related to vasculitis. We suggest that rheumatoid nodules are the most severe form of necrotizing granulomatous vasculitis. Pathognomic nodular rheumatoid pericarditis was seen in 3 cases and diffuse rheumatoid pericarditis in another case. Pathognomic nodular valvulitis was found in 7 cases. Rheumatoid nodules localized to the epi-, myo-, or endocardium were observed on 9 patients. Generalized secondary amyloidosis was observed in 32 (18.93%) of the 169 patients with RA. Secondary amyloidosis was prevalent in the heart in 29 of 32 cases (relative frequency: 90.62%).

Adult↗
PubMed1992

Generalized secondary amyloidosis in rheumatoid arthritis.

The autopsy material of 215 RA patients was studied to determine 1) the frequency of generalized secondary amyloidosis (GSA), 2) the frequency and extent of amyloid deposits in various organs, 3) the chronological succession of amyloid deposition in various organs. The tissue specimens were fixed in 8% formaldehyde solution and embedded in paraffin. Serial sections were cut and stained with HE and Congo-red according to Romhányi, without alcoholic differentiation. The average amount of amyloid deposition in various organs was determined on a 0 to 4 plus scale. Thirty-seven cases were found to contain stainable amyloid (17.2%). The frequency and degree of amyloid deposition in different organs of RA cases with GSA are summarized in the following table. [table: see text] The frequency and extent of amyloid deposits in various organs may be linked to the ratio of cardiac output distributed over a different tissue mass. In conclusion, the tissues and organs often showing high quantities of amyloid are the sites where the deposits begin. Where deposits are infrequent or of low quantity deposits develop later. Amyloid deposits early in the wall of blood vessels, first of all within the GI tract, heart, kidneys, thyroid gland, spleen and the adrenal glands.

Adult↗
PubMed1991

[Heart alterations in chronic polyarthritis].

Described in this paper are pathomorphological alterations to the heart postmortem recorded from 100 deceased with rheumatoid arthritis. Vasculitis of subepicardial or intramural rami of coronary arteries was recorded from twelve cases and had caused multiple myocardial necrosis in ten of these. These developments had led to progressive cardiac insufficiency which actually then was the direct cause of death. Formal pathogenesis of vasculitis-related multifocal myocardial necrosis in concomitance with rheumatoid arthritis had never been described in the literature before, although such reference would have been justified for the clinical consequences for which it deserves to be emphasised as a nosological entity in its own right. Isolated rheumatic nodes were detected in the myocardium of five of the decreased and could be attributed to rheumatic arteritis in two cases. Those myocardial rheumatic nodes, according to the author's view, represent the severest form of necrotising rheumatic vasculitis. Pathognomonic pericarditis was found in four cases (2 pericarditis nodularis and 2 pericarditis rheumatica). Pathognomonic nodular valvulitis was identified in another four cases. Systemic secondary amyloidoses were found to be present in 24 of the above 100 deceased with chronic polyarthritis. The heart was involved in 23 of these 24 cases (95.8%).

Adult↗
PubMed1991

Changes of the lung in rheumatoid arthritis--rheumatoid pneumonia. A clinicopathological study.

The frequency and patho-histological characteristics of pulmonary changes were studied on the autopsy material of 100 patients with rheumatoid arthritis (RA). The formal pathogenesis and different stages of vasculitis, rheumatoid nodule, interstitial pneumonia, rheumatoid pleuritis, obliterative bronchiolitis, amyloidosis and the so-called rheumatoid pneumonia in the lungs is discussed. The rheumatoid pneumonia is a disseminating inflammatory lobular-sublobular process, not described previously. The frequency of rheumatoid pneumonia was 4%. The rheumatoid pneumonia is characterized by the necrotic vasculitis, fibrinoid necrosis or thrombovasculitis of the pulmonary and bronchial arterioles, and of small arteries. Because of the diminished blood supply distal to the vascular changes inflammatory foci may develop, more or less respecting the anatomic borders of pulmonary tissue. The lobular-sublobular inflammation is basically of non haemorrhagic character. Because of the recurrent nature of vasculitis, foci of inflammation in different stages can be observed in the lungs simultaneously side by side. Clinically the rheumatoid pneumonia was accompanied by severe RA, according to the frequency and severity of acute exacerbations. In all 4 cases of rheumatoid pneumonia the pulmonary process had been proven clinically and radiologically. Rheumatoid pneumonia occurred subsequent to recurrent arthritis following steroid withdrawal, and it was resistant to antibiotics.

Adult↗
PubMed1990

[Secondary amyloidosis in chronic polyarthritis].

Systemic secondary amyloidosis was a post-mortem finding recorded from 24% of patients with classical chronic polyarthritis. In 80 to 100% of all cases, amyloidosis was present in heart, thyroid gland, kidneys, adrenal gland, pancreas, spleen, and gastro-intestinal canal. It was recordable, in 50 to 70% of all cases, from liver, aorta, lungs, and lymph nodes. Nerves, muscles, skin, and synovial membrane were less often affected (10 to 40% of all cases). No amyloidosis was recorded at all from the brain. Amyloid depositions differed greatly in intensity by organs. The most massive deposits were found in the gastrointestinal tract, kidneys, adrenal glands, thyroid gland, and spleen. Amyloid depositions were moderate in heart, pancreas, lungs, and liver. They were extremely low in lymph nodes, muscles, nerves, synovial membrane, and skin. The author assumes amyloid deposition to be associated with increase in arterial or venous concentrations of circulating amyloid precursors. Frequency and intensity of amyloid depositions in different organs may be linked to blood supply to the latter. The higher the minute volume of a given organ, the more strongly pronounced is the amyloidosis in it. In the context of amyloidogenesis, consideration should be given, as well, to locally delimited factors, such as organ motility.

Adult↗
PubMed1989

[Pancreatitis in rheumatoid arthritis found in autopsy material].

Authors have studied in autopsy samples of 80 patients having suffered from rheumatoid arthritis the incidence and types of pancreatitis. There were 6 acute, 4 chronic-recurrent and 11 chronic severe or moderately severe pancreatitis observed. In the ethiology of pancreatites the ductal origin, cholelithiasis and uraemia were not found to be of exclusively significance. In 3 cases a pancreatitis was found accompanied by vasculitis and a typical histological pattern characterized by the vasculitis-thrombovasculitis of arterioles and small arteries with simultaneously occurring necrotic foci. In one case a pancreatitis due to severe amyloidosis could be verified. Authors draw attention to the frequent occurrence of pancreatitis in patients suffering from rheumatoid arthritis and the difficulties of a clinical diagnosis.

Amyloidosis↗
PubMed1989

[A retrospective analysis of x-ray changes of the hip joint].

In 74 patients who had an endoprothesis implanted for a radiologically defined coxarthrosis preoperative radiographs were compared with contact radiographs of the resected femur head. In case of a reduction of the radiological width of the articular cavity an evaluation of the underlying cartilage damage at the femur head and the acetabulum is possible in one half of the cases. We were able to confirm cysts on the post-resection radiographs in 85.1% of the cases. Small bone fragments interpreted as necrosis, bone sclerosis and small indents of the femur head were confirmed in 70% of the cases. In the resected joint 7.8% more erosions were found than in-vivo. Sclerotic atrophy was seen twice as often in the resected joint than in-vivo. A comparison of the trabecules of the spongiosa for the evaluation of bone structure is possible only in part with the method described here.

Hip Joint↗
PubMed1989

Surgical solution of femoral fibrosarcoma. Experience obtained by a 9-year follow-up.

Biopsy followed by tumour removal and replacement by autologous bone tumour at the distal end of the femur were performed. Histologically, the tumour proved to be benign. Three years later progression was observed and epiphyseodiaphyseal resection was made because of on excessive tumour. Histology revealed a fibrosarcoma. Consolidation was hindered by osteomyelitis and fracture, recovery could be achieved only by a series of operations. These histological and operative difficulties are documented and the importance of extremity-saving operations is discussed. Our patient has been free of complaints 9 years after epiphyseodiaphyseal reseaction.

Adult↗
PubMed1988

[Lung changes in chronic polyarthritis].

Pulmonary alterations in cases of chronic polyarthritis are covered in this paper. The investigations reported were based on literature data and on the author's own postmortem examinations. Rheumatoid pneumonia is defined as an independent disease in its own right.

Adult↗