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M Lequesne

Publications and source records attributed to M Lequesne.

At least 91 records · Page 5Linked to original sources
PubMed1976

[Coxarthrosis due to contusion].

Can a contusion cause coxarthrosis in the absence of both fracture and dislocation? Yes. To demonstrate this the authors report 6 cases that fulfil the following conditions: (1) Simple but violent contusion affecting the greater trochanter or the knee (dashboard accident) or a forced movement, such as in doing the splits; (2) immediate or slightly delayed pain, generally of short duration (a few weeks); (3) absence of coxarthrogenic malformations and absence of pre-existing signs of a pathological hip condition; (4) progressive coxarthrosis on the side of the contusion; (5) chronological relation between the development of the coxarthrosis images and the date of the contusion; (6) subjects less than 35 years of age, in order to eliminate cases with latent primary pre-coxarthrosis. The average age of the six patients at the start of the coxarthrosis was 24.7 years (range: 13 to 33 years); there were four men and two women. In five of the six cases a violent contusion in the trochanter region was involved as a result of a fall on a hard surface or a traffic accident. In one case a forced movement on landing from a jump was involved. Evolution in three periods is usual: the hip is painful either immediately or after a few weeks (particularly on rising after a period in bed for multiple injuries). This post-traumatic pain lasts from ten days to one month, rarely longer. It is followed by a period free of pain that may last from five months to ten years (average: five years). Subsequently there is pain every day and the onset of the limp associated with coxarthrosis. Radiographically the reduction of the joint space and/or the osteophytosis appears after three months to two years (average: one year). However, there may not be any pain associated with these lesions for a long time. The authors propose that the first five conditions enumerated above represent the essential medico-legal conditions of coxarthrosis by contusion. The restriction as regards age (No 6) was introduced only to show clearly the existence of post-contusive coxarthrosis. However, even if one or more of the medico-legal conditions are not fulfilled the imputability may still be valid. Some such cases are discussed.

Adolescent↗
PubMed1975

[Gout, hyperuricemia and femur head osteonecrosis (FHON)].

The authors report on 14 cases of osteonecrosis of the femoral head (ONFH) in patients suffering from gout. The cases of association were discovered over a period of 10 years among 232 patients with ONFH and 651 with gout. The necrosis had no particular characteristics except that there was a clear preponderence in males and a slight tendency to be bilateral; it occurred, perhaps, at a slightly earlier age. The patients with gout did not show any special clinical features ; the gout always preceded the necrosis, on average by 7 1/2 years. There was no obvious history of painful crises in the hip that could be attributed to the acute gout, except in one case. The excess of urate was detected by the baseline level of uricaemia (91 mg/litre on average), by the frequency of tophus (4 out of 14), and by the frequency of urinary lithiasis (2 out of 14), and did not appear to be any greater in the patients with gout and ONFH than it was in the whole of the population of gout patients. In those patients in whom it was estimated, the lipid analysis showed most frequently an increase in total lipids, in triglyceridaemia, and in cholesterolaemia. In the 5 patients in whom the investigations were sufficiently detailed, the dyslipidaemia was of Frederickson type II + IV (mixed hyperlipidaemia according to de Gennes' classification). Different physiopathological hypotheses are discussed by the authors, notably those concerned with micro-particulate fatty emboli (lipomicrons), which may obstruct, among others, the terminal arteries of the femoral head. Of the 6 patients for whom it was possible to obtain information, for an average period of 10 years since the onset of the necrosis, 2 had presented with untreated hyperlipidaemia and a severe general vascular illness (myocardial infarction in one case and regressive hemiplegia in the other). These findings lead to the conclusion that correction of the hyperlipidaemia by diet is indispensable to ensure the long-term survival of these patients.

Adrenal Cortex Hormones↗
PubMed1975

[The coxopathies of Paget's disease. Radio-clinical and anatomopathological study].

A systematic study was carried out on 105 patients with Paget's disease (60 men and 45 women, average age 62 years) involving the acetabulum and/or the femoral head in the juxta-articular zone. In two-thirds of the patients only the pelvis (in particular the acetabulum) was affected, in a quarter both the pelvis and the femoral head were affected, and in one case in ten only the femoral head. 1. 18 coincidental coxopathies should first be excluded (12 coxarthrosis, 2 coxitis, etx.). The occurrence of 17 percent of coxopathies not caused by Paget's disease is normal in older patients (Vignon and Jacquet; Sebban, Lequesne et al.). 2. In 105 cases, there were only 50 coxopathies really due to Paget's disease, of which almost half remained painless. 3. This proportion did not vary with age. On the other hand, coxopathy was more frequent in patients with bipolar, pelvifemoral Paget's disease and above all in Paget's disease with acetabular protrusio. 4. The radiographic appearance is slightly different from that of coxarthrosis; the reduction in joint space is more often internal or supero-internal (50 percent of cases); osteophytosis is usually moderate (22 percent of cases), or absent (48 percent). The geodes are rarely visible : 6 percent of cases. 5. The acquired bone deformations in patients with Paget's disease are classical. In 105 cases, the authors noted 14 acetabular protrusions, all with coxopathies, and 10 coxa vara, 5 of which had coxapathies. Anatomo-pathological studies did not reveal anything in particular about the bone : superimposition of the Paget's disease lesions and of the lesions usually found in cases of coxopathy due to overload, with a dense pressure cone. With reference to cartilage, the lesions of Paget's coxopathies presented several specific characteristics compared with those of common arthrosis : (1) the presence of particularly numerous cupshaped defects on the remaining cartilage; (2) a very basophilic, intra- and extra-cytoplasmic substance impregnated the chondroplasts of the bottom layer, nine times out of twenty-six, an anomaly not observed in cases of arthrosis; (3) pseudo-angiomatous vascular outgrowths from the bone, flush with the articular surface of the acetabulum are a source of bleeding during surgery.

Adult↗