[Treatment of shoulder arthropathy in chronic hemodialysis patients: preliminary results of surgery].
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Biomedical subjects
Publications and source records attributed to M Megard.
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Antigens of HLA loci A, B and DR were determined in 35 elderly patients with primary articular chondrocalcinosis and compared with a control population. The B15 antigen was present in 13 out of 35 patients, i.e. 37.1% as against 13% of controls (chi 2 = 13.4; pc = 0.05) and the BW21 antigen in 8 out of 35 patients, i.e. 22.8% as against 6.6% of controls (chi 2 = 10.25; pc less than 0.005). These results confirm those of a previous study carried out in the same unit, which showed a 41% incidence of HLA B15 antigen in patients with chondrocalcinosis. The HLA B15 antigen seems to be a marker of imbalanced binding with a susceptibility antigen. Calculation of the relative risk shows that an elderly subject with HLA B15 antigen if about 4 times more liable to articular chondrocalcinosis than a subject without this antigen.
Serum parathyroid hormone was assayed in 16 elderly patients with primary, roentgenographically proved, articular chondrocalcinosis. Mean value, i.e. 4.10 + 1.16 mUI/ml, was compared to that of a control group of 16 subjects matched for sex and age without chondrocalcinosis, living in the same geriatric institution, i.e. 3.94 + 1.43 mUI/ml. The difference is not significant (t = 0,35). Latent hyperparathyroidism is therefore not demonstrated in primary proved articular chondrocalcinosis in the elderly.
Following a 7-month treatment with heparin, a young pregnant woman with a history of multiple phlebites complicated by pulmonary infarction developed osteoporosis with multiple compression fractures of the vertebrae. Histomorphometric analysis of a transiliac bone biopsy showed severe osteoporosis with rarefaction of the spongy bone, considerable increase of osteoclasts and fall in osteoblasts. The cortex was not atrophic and was the seat of active reconstruction. Clinical and experimental data have shown that prolonged, high dosage heparin treatment may result in such osteopenias. Heparin acts synergistically with the parathyroid hormone to stimulate bone resorption, at the same time increasing bone collagen metabolism and modifying its structure. Clinical heparin osteoporosis, however, is rare, which suggests that other factors intervene. The risk of osteoporosis must be taken into account when heparin therapy is considered in pregnant women who are at high risk of thromboembolism.
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