Biomedical subjects
Publications and source records attributed to M Basle.
An electron microscope study of 35 bone biopsies from patients with Paget's disease confirmed the constnat presence of intra-nuclear and intracytoplasmic inclusions, which seemed to be the most specific anomalies of the osteoclasts. The presence of these inclusions leads to their comparison with other inclusions described in certain affections for which the viral etiology is at present under discussion.
The authors report the variations in calcaemia and in circulating immunoreactive PTH produced by the intramuscular injection of 5 units of porcine calcitonin in normal subjects and in patients suffering from osteoporosis or Paget's disease. After having determined the levels of 25-hydroxy-vitamin D circulating in the different groups, the authors note that comparison of these variations makes it possible to regroup the different types of reaction following the injection of the hypocalcaemic hormone. In patients suffering from pure osteoporosis, hypocalcaemia was slow to appear, was of moderate intensity, but was prolonged. The osteoporo-malacia patients did not produce a specific reaction and certain of them appeared "insensitive" to calcitonin. Results obtained in patients with Paget's disease confirm the hypocalaemic action of calcitonin even at a low dosage. With this test, the authors hope to contribute to studies of demineralizing affections and to overcoming them.
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The authors report a case of vitamin resistant osteomalacia in an adult due to an apparently acquired absence of hepatic hydroxylation of vitamin D. This case was also of interest as the osteomalacia caused a state of type II pseudo-hypoparathyroidism which proved reversible on calcium drip. Thus a defect of hepatic hydroxylation of vitamin D may be a cause of vitamin resistant osteomalacia in the adult apart from the forms already described related to defect of renal hydroxylation of vitamin D. Hypocalcemia may be responsible for hypoparathyroidism due to the coexistence of a rise of circulating immuno-reactive PTH and an increase in urinary cyclic AMP. Normalisation of the calcemia permitted in this case, restoral of the efficacy of endogenous PTH.
Surgical anastomosis of the ureter in the sigmoid could lead to osteomalacia. The pathogenesis of this disease is rather complicated and involves several factors, the most important of which is hyerchloremic acidosis associated with modifications of transport across the intestinal lining, and in particular, the elimination of bicarbonates and the reabsorption of H+ ions. This systemic acidosis makes the calcium balance negative by mobilizing calcium bicarbonate from bone and possibly by inhibiting alkaline phosphatase activity. The role of PTH and vitamin D has yet to be satisfactorily explained. The authors present cases of osteomalacia following two uretero-sigmoidostomies, one for bladder exstrophy and the other after bladder removel for tumour. The physiopathological mechanisms of osteomalacia are briefly recalled together with indications of treatment.
The authors report the results of a study of 139 of their patients with severe rheumatoid arthritis, treated with chlorambucil of cyclophosphamide between 1965 and December 1973, with an observation period of 4 to 12 years. 8 patients were lost to follow-up, 38 died and 93 were reexamined. In this series 7 deaths were attributed to hemolymphoreticulopathy of various cytological types; 6 deaths were due to visceral cancer and 2 others to cancer of the tonsils. They confirm that such treatments increase the risk of hemopathy but apparently not the risk of visceral cancer. The risk was not a function of the total dose of the drug administered since no neoplasia was observed in the 25 subjects who received the highest doses. The addition of chlorambucil to cyclophosphamide seems to increase the risk of hemopathy. It was noticed that the 7 cases of hemolymphoreticulopathy occured after 60 years.