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Biomedical subjects

M Lequesne

Publications and source records attributed to M Lequesne.

At least 19 recordsLinked to original sources
PubMed1992

Longitudinal radiologic evaluation of osteoarthritis of the knee.

Radiologic assessment appears to be an objective standard for longterm evaluation of osteoarthritis (OA) and it is inexpensive, quick, simple and noninvasive. We conducted a one year followup study of patients with OA of the knee to evaluate the reproducibility and validity of this evaluation. The intra and interobserver reproducibility of the radiologic variables were evaluated on 275 and 539 patients, respectively, and found to be satisfactory (intraclass coefficient of correlation above 0.70 for the evaluation of the space narrowing of the joint). During the one year followup study, there was a slight but statistically significant deterioration of the joint space narrowing, evaluated on a 6 grade scale on 360 patients (p less than 0.001). The changes in the joint space narrowing were more closely correlated with treatments received by the patients for OA (nonsteroidal antiinflammatory drug (NSAID) intake, synovial fluid aspiration) than with changes in the recorded clinical variables (pain on a visual analog scale, Lequesne algofunctional index). Moreover, some factors such as obesity, generalized OA and flares of OA appeared to be correlated with the deterioration of joint space narrowing. Further studies are necessary to confirm and/or explain the relationship between the deterioration of the joint space narrowing and such factors (i.e., NSAID intake, obesity, flares of OA, generalized OA), which were detected in this study.

Aged↗
PubMed1991

[Tendinitis of the hip region].

Tendinitis and bursitis are less common around the hip than around the shoulder. Nevertheless, they must be recognized to avoid unnecessary and costly diagnostic errors. Their various clinical forms are studied in detail. Tendino-bursitis of the gluteus medius muscle is the most frequent in its subacute form, but it is rare in its acute, pseudo-gouty form. Calcification of the reflected tendon of the rectus femoris muscle often closely resembles arthritis of the hip. Synovial cysts of the psoas bursa and rupture of the gluteus medius tendon are rare but must be known. Local injections of corticosteroids play an important part in the treatment of these diseases.

Hip Joint↗
PubMed1991

Indices of severity and disease activity for osteoarthritis.

Several indices have recently been constructed by rheumatologists for the assessment of clinical status in osteoarthritis of the extremities. These include the algofunctional indices for the hip and knee (Lequesne), the Western Ontario and McMasters Universities (WOMAC) index (Bellamy), patients and investigator's overall opinion (results of drug trials), global evaluation of change in handicap (self-assessment), and articular index of physical examination in nature (Doyle et al). Each of the above indices have been validated by their respective authors. Presently, we propose to further validate the disease-activity indices.

Humans↗
PubMed1991

[Conflict between psoas and total hip prosthesis].

This conflict leads to a chronic irritation of the psoas by the antero-medial part of the cup, but it has been poorly described in the past. A study of six patients suffering from this trauma, and who were re-operated revealed that the muscle was worn thin in front of the prominent cup. In the case of 4 of the 6 patients pain had started to occur shortly after total hip replacement. The following symptoms were noted among all 6 patients: pain was suffered during flexion--extension movements--walking up stairs--arising from a chair. Pressure on the medial part of the groin was painful, especially during active elevation of the lower limb. Passive mobility was normal and painless. Psoas bursitis was observed in three cases. The main cause of this conflict is the protrusion of the cup beyond the antero-medial edge of the acetabulum; this protrusion may be either due to a bone graft or a bit of cement, but most often an acetabular insufficiency (congenital dysplasia) favors the formation of this anterior overhang. The spiral cup screwed into the bone can be especially aggressive when it protrudes. Treatment includes the resection of the overhang, but post-operative results will be uncertain unless the resection is really complete. In the case of 4 patients the results of such an intervention were only mild to poor. This problem can be avoided by proper care and preventive measures in the original replacement avoiding all projections beyond the anterior edge of the acetabulum--cup, bone graft, cement, especially if dysplasic.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[How to evaluate the long-term course of osteoarthritis. Tests for trials of fundamental treatments (spine excluded)].

The best assessment tests for long term trials on osteoarthritis (OA) of the hip and knee are the following, in order of relevance value (consensus of french experts): 1) the loss of joint space thickness on successive radiographies; 2, 3) the indices of the severity for OA of the hip and knee; the investigator's overall opinion; 4) the patient's overall opinion (visual analogue scale of handicap); 5, 6, 7) the pain level (visual analogue scale); the time for going up and down a standard flight of stairs and the time of pain in this distance; the limitation of two articular movements; 8) the increase of either analgesics or NSAIDs consumption; 9) concerning OA of fingers, the number of joints newly involved on successive radiographies. At present, only the radiological tests 1 and 9 are validated. The clinical tests 2 to 8, valuable for short term trials, have yet to be validated for long term follow-up. Recommended duration of trials is three years. A rigorous organisation is necessary to avoid erroneous inclusions: all data recorded in the pre-inclusion visit have to be checked by the principal investigator. Since we have not yet a validated chondroprotective agent as a reference drug, the trial must be randomised, double blind, placebo controlled, parallel group study.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

[Pain-function indices for the follow-up of osteoarthritis of the hip and the knee].

Algo-functional or severity index for hip diseases (AFIH), proposed in 1980 and validated in 1981, and algo-functional or severity index for knee diseases (AFIK), validated in 1985-1987, were applied to osteo-arthritis of the hip and of the knee. With strictly standardized interviews and well-trained investigators (20 to 30 patients), these indices are reliable: the interobserver reproducibility is good (mean discrepancy: 1/2 point) and the score usually decreases 3 points (mean) under active drug treatment. Each index was individually validated. The severity index for hip is more discriminant than that for knee diseases. The place of each index among the other assessment tests was appraised according to their discriminant capacity. These indices are useful: 1) for drug trials (analgesics and NSAIDs); 2) for the long term follow-up and the so-called chondroprotective agents trials; 3) for a rational decision concerning hip or knee prosthesis (score reaching 8 to 12 points). These AFIH and AFIK are well suited to daily practice and are not time-consuming: 3 to 4 minutes for each.

Cross-Sectional Studies↗
PubMed1990

Methodology issues in the evaluation of NSAID in inflammatory rheumatic diseases.

The characteristics required of tests used in trials of nonsteroidal antiinflammatory drugs in patients with inflammatory rheumatic diseases in order for such tests to provide meaningful results are reviewed. Those tests most widely used in trials of patients with rheumatoid arthritis or ankylosing spondylitis are assessed, and the ability of such tests to discriminate among the treatment effects of different agents is considered. Finally, several statistical and procedural issues important to clinical trial methodology are discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

The osteoporosis of heparinotherapy and systemic mastocytosis.

Heparinotherapy and systemic mastocytosis are two unusual aetiologies of diffuse osteopenia, possibly linked by common pathophysiological factors. Osteoporosis related to heparinotherapy has only been observed in patients treated with doses higher than 10,000 units per day and for more than 4 months. Even in these, it is a rare disorder which has only been reported approximately 15 times in the world literature. Bone histomorphometry has demonstrated the occurrence of marked hyperresorption. In vitro, heparin appears to have resorptive and collagenolytic effects which could play a pathophysiological part in the disorder. Diagnosis of the osteopenic form of systemic mastocytosis may be difficult. Urticaria pigmentosa is a very important clue but may be misdiagnosed or even missing. Hepato or splenomegaly are inconstant. X-rays may show the coexistence of osteosclerotic lesions. Standard biochemical tests are of little help. The urinary excretions of the histamine metabolites methyl histamine and methyl imidazolacetic acid have been found increased when measured. Finally, the diagnosis is made by bone histology which must be performed without decalcification and read by a pathologist informed of the potential diagnosis. Toluidine blue stain shows that mastocytes are numerous in the bone marrow where they are grouped in foci. Histomorphometry demonstrates a high bone turnover with excessive resorption, which could be mediated by heparin or PG E 2 contained in mastocyte granules. Treatment is difficult and may involve cytostatic drugs and/or inhibitors of bone resorption: Clodronate has recently been reported to be at least transiently effective.

Female↗
PubMed1989

Informational indices. Validation of criteria and tests.

The informational indices comprise sensitivity, specificity and predictive value, and they give information on the probability of rheumatic disease being present or not. It is interesting that in clinical situations where the probability of the disease is appraised by the physician before the test, the probabilities may be strongly modified after the test. For example, if one estimates the pre-test probability of ankylosing spondylitis at 50% in a given patient, the HLA B27 antigen test will modify the probability of the disease as follows: B27 positive: probability 90% B27 negative: probability 7% The second part of the study discusses modern methods for the validation of diagnostic criteria and assessment tests. Validation of the latter includes inter- and intra-observer reproducibility, coefficient of variation, discriminating power of each assessment test in a double-blind "reverse" trial, in which the difference between placebo and active drug is the known base, the value of the tests being the unknown.

Arthritis, Rheumatoid↗
PubMed1979

[Partial decalcifying algodystrophy].

Partial decalcifying algodystrophy (PDA) appears in two forms: one, a radial form, affects, following a certain metameric topography, one or two radiuses of the hand or of the foot (two cases reported); the other, a zonal form, is more peculiar: only part of a condyle or of the femoral head, are demineralized for two to three months. The authors report 7 cases of this misleading zonal form, 2 of them after histological verification. The image leads to various diagnostic errors: osteitis or infectious osteo-arthritis, acute inflammation close to the bone, and especially malignant processes. However, zonal PDA has its own characteristics: demineralization, that becomes clear only during the second month, and quickly extends over a rather long sub chondral bone surface. Tomography is very useful: it demonstrates better the severe sub chondral osteoporosis and the retention of the bone sole, which becomes detached from the bone. Scintigraphy shows the massive localized or panregional hyperfixation and sometimes other infraradiological sites (hips, knee or ankle). Zonal osteoporosis remains partial and misleading for only 2 or 3 months, after which it becomes a classical panregional form. The rate of development is that of DA. Painful impotence quickly increases, with cure in 6 months.

Adult↗
PubMed1977

Increased association of diabetes mellitus with capsulitis of the shoulder and shoulder-hand syndrome.

Sixty consecutive patients with capsulitis of the shoulder (including those with shoulder-hand syndrome) seen in our clinic since 1971 underwent an oral glucose tolerance test (5 with previously recognized diabetes were excluded from this test). Capsulitis was primary in 35, secondary to other factors in 25 subjects. Females (34) out-numbered males (26). Their ages ranged from 40 to 72 years (mean age: 54 years). Sixty control subjects matched for age and sex with the 60 "capsulitis" patients underwent the same OGTT (except one with previously recognized diabetes). We have found diabetes in 17 out of 60 patients with capsulitis according to Hayner's criteria (12 according to Jackson's criteria) versus 7 (2 according to Jackson's criteria) in the 60 control subjects. The difference is statistically significant by both methods, with a p value of less than 0.02).

Adult↗