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Biomedical subjects

M Lequesne

Publications and source records attributed to M Lequesne.

At least 73 records · Page 4Linked to original sources
PubMed1988

Alternative therapies for high-risk elderly rheumatic patients.

The main high-risk conditions among elderly rheumatic patients are peptic ulcer, renal or hepatic insufficiencies, and bleeding problems (either spontaneous or iatrogenic). Because the incidence of these conditions is significant, elderly patients should be monitored for them regularly. Although nonsteroidal antiinflammatory drugs (NSAIDs) generally are avoided, these agents can be used in selected patients. High-risk elderly rheumatoid arthritis patients can be given prednisone and a carefully chosen disease-modifying antirheumatic drug. Although analgesics can be used instead of NSAIDs, their efficacy is poor. Local therapy, i.e. intraarticular injections, and even surgery are good alternative resources. In Europe, patients with osteoarthritis are often treated with NSAIDs. High-risk elderly patients may receive sufficient relief with analgesics. If relief is not adequate, hip or knee total prosthesis procedures must be performed earlier than would normally be done.

Aged↗
PubMed1985

[Non-arthrosic geodes in the femur head. Isolated or predominant geodes].

The isolated or predominant geodes of the femoral head without signs of coxarthritis or coxitis, seem to form in response to: osteochondritis dissecans in 9 cases where the sequester was only visible in profile films or oblique images for 5 cases, and only at time of operation in 2 cases; incipient necrosis in 3 adult cases, not evidenced in frontal films and only seen in profile films with the patient under axial traction; femoral head dysmorphia in 6 cases among which were 4 polyepiphyseal dysplasias and 2 coxa plana without radiographically apparent sequesters; induced increased pressure caused by congenital subluxation or a major disorder of posture and locomotion of lower limbs in 3 cases. In 2 cases no classification could be assigned to isolated or predominant geodes of the femoral head in spite of anatomic examination. The diagnosis of these isolated or predominant geodes of the head of the femur necessitates excellent films made from different angles of view (profile, "false" profile, usual profile, sometimes oblique shots, tomograms) and often enough a biopsy which must be obtained directly through the joint, not transcervically through the neck if a reliable specimen is desired. The surgical treatment indicated is voiding and packing to a maximum the geodes possibly correcting the former increased pressure discordance. But, in lots of cases the intensity of pain and discomfort remains moderate for years, so indication for surgery arises late after onset.

Adolescent↗
PubMed1982

[Rapid destructive arthropathy of the shoulder].

Within the general context of rapid destruction of the humeral head, destructive arthropathy of the shoulder, described here in six cases, is a diagnosis of elimination. Being neither infectious inflammatory, microcrystalline, nor neurological, this curious variety of degenerative pathology of the shoulder involves the following: 1) a particular group of sufferers: women aged 65 to 81 years; 2) prior signs, at least radiological, of deterioration in the rotator cuff; 3) rapid erosive osteolysis of the head of the humerus reducing its radiological area by 25 per cent in less than six months; 4) early narrowing of the scapulo-humeral joint space (Ist to 9th month); 5) transient appearance of calcium debris in the area of the joint; 6) a synovial effusion in some cases, often bloody. The destruction phase is associated with pain lasting from two months to two years. However at the stage of stable sequelae, pain is moderate or minimal. Differential diagnosis with destructive arthropathy due to articular chondrocalcinosis and necrosis of the head of the humerus is particularly discussed. The cause of rapid destruction is unknown. It may be multifactorial: advanced age (constant), osteoporosis, fragility of articular cartilage as evidenced by multiple localizations of osteoarthrosis (4 cases out of 6), enzymes in the bloody effusion, trauma (3 cases out of 7), and intra-articular injections of corticosteroid derivatives, in particular fluorinated (3 cases out of 7) may possibly play a role.

Aged↗
PubMed1981

Capsular constriction of the hip: arthrographic and clinical considerations.

Orthodox radiological examination of patients presenting with disorders of the hip, usually on account of pain and limitation of movement, may vary in diagnostic value. As a supplementary study we have employed arthrography. During this procedure we have, since 1970, routinely assessed the capacity of the joint capsule. The normal capacity varies from 20 ml in a large adult male to 14 ml in a small adult female. Significant reduction of this volume has been observed as a secondary complication of certain organic lesions, including four cases of synovial chondromatosis, one case of an intra-articular loose body, and one case of osteoid osteoma of femoral neck. In these secondary cases, the only common feature visible on the plain film was regional osteopenia. In these patients symptoms persisted until adequate surgical measures had been performed. (Descriptive term proposed: secondary capsular constriction of the hip: SCCH). In another group of seven patients, in whom orthodox radiological studies were unrewarding, arthrography was undertaken on account of persistent pain and limitation of movement. Similar reduction in the capacity of the joint was found, but in each case spontaneous resolution of the symptoms took place, without surgical intervention, in periods varying from three to 18 months. This self-limiting syndrome appears to be analogous to that of the "frozen shoulder" and, like the latter, is associated frequently with barbiturism.

Adult↗
PubMed1981

[Infra-radiographic decalcifying algodystrophy of the lower limb].

The authors have only reported cases responding to the following criteria: A) necessarily: 1) Clinical appearance of algodystrophy. 2) Intense hyperfixation of the bone scan. 3) X rays repeated a sufficient number of times always normal and submitted to the judgement of six rheumatologists not forewarned, to eliminate the subjective factor in the diagnosis of normality. 4) Clinical cure within the usual period. 5) Return to normal of the bone scan. B) Eventually: 6) Proved decalcifying algodystrophy from another joint site in the past history. 7) Histological appearance compatible with algodystrophy on bone biopsy. Four cases are presented (hip one case, knee two cases, ankle one case) which fulfill the five necessary criteria. The course seems shorter than in the classical decalcifying forms: 2 months instead of 4 1/2 months on average for the hip; 5 months instead of 7 months on average for the knee; 5 months instead of 12 months on average for the foot. This short course is in favour of the theory of early and rapid reconstructive bone changes, which do not leave the algodystrophy the time to demineralise the bone more than 30 to 50% which is the time necessary for the increased radiographic bone transparency to become clear.

Aged↗
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↗