Biomedical subjects
M Caroit
Publications and source records attributed to M Caroit.
[Villonodular synovitis of the astragalo-scaphoid joint. A new case].
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[Bone density and biological markers in a population of 330 women].
A population of 330 non-selected women underwent determination of bone density by means of Bi X absorptiometry of the lumbar spine and femur. The findings showed a negative correlation with the time since the menopause and a positive correlation with the duration of genitally active life and with substitutive hormonal treatment. The determination of the L1 density can replace that of the entire lumbar spine in cases in which osteoarthritis, atheroma or crushing make this determination unreliable. Conclusions cannot yet be based on measurements of the neck of femur. Changes in the biological markers in function of bone density values are difficult to interpret. The measurement of bone density and the assay of biological markers reflect two distinct phenomena, both of which must be taken into consideration in assessing osteoporotic risk.
[Epidemiology of osteoarthritis. Several remarks].
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[Definition of and diagnostic criteria for osteoarthritis. Application of anti-osteoarthritis agents to clinical experimentation].
The best definition of osteoarthritis is anatomical, but to be rigorous must include the biochemical characteristics of osteoarthritis cartilage. The most appropriate diagnostic criteria for clinical trials are those of Lequesne. However, radiological criteria assume that osteoarthritis had already developed and should be modified in order to permit the inclusion of early stages of osteoarthritis. The ACR classification criteria are less appropriate to the needs of clinical trials because of their lack of specificity. They are, nevertheless, of interest to the clinician in diagnosis and to the epidemiologist because of their simplicity. Diagnostic criteria of early-stage osteoarthritis proposed by Amor are of great interest to the clinician. However, their application to clinical trials still suggests certain difficulties. One can hope that such difficulties will be resolved with the development of M.R.I. and/or the discovery of novel biologic markers.
[Scapulohumeral periarthritis. Etiology, physiopathology, diagnosis and principles of treatment].
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[Acute leukaemias after treatment using cytotoxic agents for rheumatological purpose. 19 cases among 2006 patients(author's transl)].
The authors undertook a retrospective study to determine the number of acute leukaemias developing amongst 2006 patients suffering from chronic inflammatory rheumatic conditions and connective tissue disorders, treated with cytotoxic agents. The follow-up period ranged from 1 to 13 years. Nineteen leukaemias were found, essentially granulocytic, with a latent period of 5.7 +/- 2, 8 years after the beginning of treatment. This incidence of almost 1% of leukaemias is probably less than the actual percentage since a number of patients were lost on follow up and since the period of observation is as yet too short. The majority of patients has been treated for more than one year. No cases were seen amongst patients treated for less than six months, or with less than 1g of chlorambucil or 50 g of cyclophosphamide. The risk would seem to be the same for both alkylating agents. No patients treated with azathioprine developed leukaemia, but few patients received this drug. Amongst 35 patients treated for severe psoriatic arthropathy with chlorambucil, 4 developed leukaemia. This particularly high percentage is such that all trials of alkylating agent in this condition should be stopped. The prevalence of leukaemia seen in the series as a whole is comparable to that found in mass studies carried out in various malignant diseases treated by cytotoxics. Awareness of this risk should, lead to even stricter limitations before the use of cytotoxic drugs in rheumatological conditions.
[Risk of acute leukosis after treatment of chronic inflammatory rheumatism and connective tissue inflammation with immunosuppressive cytotoxic drugs. Results of a retrospective study of 2,006 treated patients].
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[Celebration of the 50th anniversary of the French League against Rheumatism (proceedings)].
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[Contribution to the study of scapulo-humeral periarthritis: anatomical lesions of simple chronic painful shoulder].
The authors restate that simple pain of the shoulder, which is a form of scapulo-humeral periarthritis characterized by the existence of pain without limitation of movement, is almost always associated with lesions of the tendons of the short muscle teres of the shoulder. They term chronic simple pain of the shoulder the rare cases where, despite therapy that is reputed to be efficient, there is a gradual development lasting more than one year, either continuously or with relaps periods of less than three weeks. They show that these chronic shoulders are practically always associated with a rupture of the coat of the muscle teres or a calcification of the tendons of the teres coat. Ruptures are as much frequent in men as in women and calcifications definitely more frequent in women (60%). Before 30 years of age, the most frequent lesion is almost always a calcification, and after 65 rupture is more common. Between 30 to 65, the probability of a calcification in a chronic simple painful shoulder, goes from 100% to 0, while the probability of a rupture increases from 0 to 100%.
Double-blind trial of ketoprofen compared with placebo in osteoarthrosis of the hip.
In this study, patients suffering from osteoarthrosis of the hip received two successive periods of treatment, A and B, each of two weeks, with either ketoprofen or a placebo. The daily dosage of ketoprofen was 150 mg in three divided doses of 50 mg. In each case the findings necessary for diagnosis and for assessment of progress during the treatment were recorded. At the end of the trial, the patient's preference for one or other of the two periods of treatment was used as the criterion. The results were analysed by the sequential method. The therapeutic effects assessed by the various criteria included in the protocol (patient's subjective assessment, pain at rest, duration of morning stiffness, distance walked without pain, range of movements, etc.) were also recorded. Nine cases were sufficient to provide a statistically significant result in favour of ketoprofen. In eight cases the preference was definitely in favour of ketoprofen. In a single case there was no preference for one or other of the two periods of treatment (failure of both ketoprofen and placebo). Tolerance to ketoprofen was excellent.
[A particular risk of prolonged immunosuppressive treatment: a case of acute myelomonocytic leukemia after chlorambucil treatment of severe rheumatoid arhtritis].
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Double-blind study of ketoprofen against a placebo in osteoarthritis of the hip.
In this trial, the patients suffering from osteoarthritis of the hip received either ketoporfen or a placebo successively for 2 treatment periods, A and B, of 14 days each. The daily dosage of ketoprofen was 150 mg in 3 doses of 50 mg. In each case treated, the parameters necessary for the diagnosis and those necessary to assess progress under treatment are reported. At the end of the trial, results have been rated according to the preference of the patient for treatment period A or B. The results were analysed by the sequential method. The therapeutic results reported were obtained from various criteria stated in the protocol (subjective evaluation by the patient, pain when resting, duration of morning stiffness, distance of pain-free walking, amplitude of movements, etc.). Nine cases were sufficient to produce a significant statistical result in favour of ketoprofen. In eight observations a preference in favour of ketoprofen was apparent. In one case only, there was no preference for either one or the other of the two treatment periods (failure of ketoprofen and of the placebo). Ketoprofen was excellently tolerated.
[Joint manifestations of Yersinia enterocolitica infections].
Different recent studies, notably Scandinavian studies, have described a "rheumatism" caused by Yersinia enterocolitica infection. The picture usually seen is that of a subacute, febrile oligoarthritis predominantly in the lower limbs, associated with diarrhoea and hyperleucocytosis, polynucleosis, and a marked increase in the sedimentation rate. Benign carditis may also be associated. The diagnosis rests on the discovery of the organism by coproculture and on serodiagnosis. Evolution is favourable within several weeks or several months. Treatment includes antibiotics and antinflammatory preparations.
[Etiological diagnosis of spondylitis. I. Clinical, biological and radiological aspects].
The authors compared the different elements of diagnosis contributed by the clinical examination, and by laboratory and radiological investigations in 33 cases of Pott's disease and 46 cases of non-tuberculous spondylodiscitis. They show that certain elements indicate the diagnosis of Pott's disease : associated visceral tuberculosis, and a radiogram showing in particular a centro-somatic notch, recent primary infection, absence of pain, minimum signs of medullary compression ; other elements on the other hand, indicate a diagnosis of non-tuberculous spondylodiscitis : a negative cutaneous tuberculin test, a positive haemoculture, humoral signs of melitococcosis or of typhoid fever, any indication of possible means of entry of infection in the two months before the disease, radiological signs of reconstruction in the first four months of evolution, location of the lesion in the anterior upper part of the vertebra, and to a lesser degree, the acute febrile nature of the clinical picture. The authors recall that the existence of a large abscess, of which there were no examples in the present series, is an indication in favour of tuberculosis.
[Etiological diagnosis of spondylitis. II. Vertebral puncture biopsy and surgical approach].
The authors tried to determine the ways in which vertebral puncture biopsy and the direct surgical approach can helpin the etiological diagnosis of spondylodiscitis, when the clinical radiological, and laboratory examination leave the clinician in doubt. Out of 28 vertebral puncture biopsies, proof of tuberculosis was obtained in 4 cases, and proof of a non-tuberculous cause was obtained in 1 case as a result of isolating the responsible organism. Thirty-eight cases were submitted to the direct surgical approach. When the indication for surgery was solely in order to investigate the etiology, proof of tuberculosis was obtained in half of the cases, and only exceptionally was a non-tuberculous organism discovered. In almost half the cases, the histological characteristics were non-specific and no organisms were detected. Most of these latter cases were, in fact, non-tuberculous spondylodiscitis, although subsequently some of them exhibited evidence of a tuberculous character. In the present state of knowledge, it seems that, in cases of clearly non-tuberculous spondylodiscitis, the direct surgical approach is not justified if the objective is solely to isolate the organism, so that its sensitivity to antibiotics can be tested. The following reasons are given for this conclusion : the direct surgical approach only rarely leads to isolation of the causal organism; although treatment based on knowledge of antibiotic sensitivity may help to restrict evolution of the disease, it does not reduce significantly, or only rarely, the permanent partial incapacity. If the results published by Seignon and Gougeon are confirmed, early needle puncture of the diskovertebral centre of the disease should be practised more widely.
[Vasomotor polyarthralgia].
The authors report 11 observations of middle-age women seeking medical treatment for polyarthralgia most often involving the hands and often several articulations of legs and arms, with pain sometimes increasing during the night and frequently accompanied by a feeling of stiffness in the morning. The clinical, biological, and radiological studies did not disclose any organic disease except for vasomotor disorders of the Raynaud's disease type, acrocyanosis, acrorigor and clubbed fingers. Therapy with vasodilator isoxsuprine caused the disappearance or the diminution of the pain in 10 out of 11 cases. The authors suggest that these polyarthralgia are the consequence of arterioloconstriction which is a disturbance common to all the vasomotor disorders observed in their 11 patients.