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Biomedical subjects

P Acquaviva

Publications and source records attributed to P Acquaviva.

At least 19 recordsLinked to original sources
PubMed1995

Total and free methotrexate pharmacokinetics, with and without piroxicam, in rheumatoid arthritis patients.

The pharmacokinetic profile of total and free methotrexate (MTX) and the effect of piroxicam on MTX pharmacokinetics was studied in 20 rheumatoid arthritis patients receiving a stable dosage of MTX (10 mg/week). Plasma protein binding ranged from 25 to 55%. To describe the variations with time of the unbound fractions a mathematical characterization relationship between the total and free MTX was used. Total and free MTX were correlated with the sigmoid maximum effect model. The slope factor (gamma) was proportional to the number of binding sites. The free fraction for a given patient can be evaluated from this relationship. Total clearance of MTX was not statistically different with piroxicam (8.0 l/h for total MTX, 13.7 l/h for free MTX) vs without piroxicam. Likewise, there were no significant difference in tmax, area under the plasma concentration vs time curve, distribution and elimination half-lives, mean resonance time, and volumes of distribution. Although the highest observed total MTX concentration was significantly lower with piroxicam, there were no significant pharmacokinetic interactions between low-dose MTX and piroxicam.

Adult↗
PubMed1991

[Surgical treatment of ruptures of the rotator cuff].

This study analyses the results of 30 surgical repairs of the rotator cuff. The basic problem was degenerative pathology in which medical treatment had been tried previously in all cases. The type of treatment was based upon preoperative evaluation and arthro-CT scan in particular. Results were invariably good, with regression of pain and recovery of activity. Muscle power was significantly correlated with the value of the tendon repaired, this being reflected overall by incomplete recovery.

Adult↗
PubMed1987

[Critical study of radiculomedullary and neuromuscular complications of ankylosing spondylitis].

Medullo-radicular and neuro-muscular involvements of ankylosing spondylarthritis, often reported in an analytic fashion in the literature, deserve to be the subject of a critical study. Various neurological manifestations secondary to exceptional atlo-occipital and sometimes axis-atlas subluxations and medullary lesions as well as syndromes of the cauda equina. The medullary lesions have an epidural origin (3 cases in the literature, 2 cases from the authors) or are secondary to a spondylodiscitis (4 cases in the literature) or secondary to both (1 case reported by the authors). As for syndromes of the cauda equina the authors report 3 cases to be added to the 55 published previously. It concerns always old spondylarthritis. The lesions combine posterior diverticula and lesions of the lamina. The treatment is usually ineffective. A special case is represented by forms with trophic disorders. More debatable are the radicular lesions, which, except for intercostal pain, should be linked to local pain. Electromyographic abnormalities are of no significance. Alterations of the paravertebral muscles viewed on the scanner X have, for now, an uncertain significance. Finally, various associations, without significance such as multiple sclerosis, diffuse muscular lesions and the classic spondylotic pseudo-tabes, should be rejected.

Adult↗
PubMed1986

[Dynamic bone scintigraphy in osteoarticular pathology].

Three-phase radionuclide bone scanning was performed in patients with algodystrophy or osteonecrosis. This method is used to improve the specificity of ordinary bone scan. It explores vascularization and blood pool, then bone uptake in two symmetrical articulations. Non-focal hyperaemia and late diffuse uptake are in favour of algodystrophy, whereas a distinct focal hypervascularization and late uptake predominant in the femoral condyle area seem to be in favour of pre-radiological osteonecrosis.

Arthritis↗
PubMed1986

[Peroperative endoluminal dilatation or recanalization (DELPO or RCPO) in arteriopathies of the lower extremities. A new therapeutic weapon for the vascular surgeon. Apropos of 42 cases].

Forty-two DELPO or RCPO were performed using coaxial balloon catheters through surgical vascular approach for 35 cases of advanced lower limb arterial disease (stages: pronounced II: 6, III: 13, IV: 12, subacute ischemic: 4). The DELPO involved the following arteries: iliac: 12, deep femoral: 3, superficial femoral: 12, popliteal: 5, leg artery: 8, stenosis of popliteal anastomosis: 2, and was combined with a reconstructive arterial operation in 26 cases (proximal: 11 times, distal: 14 times or intersegmental: twice in relation to the surgical procedure). The DELPO was conducted alone in 9 cases and the RCPO alone in 6 cases, the surgical approach being preferred to the percutaneous route. Early results were rated as good in 89%, with clinical failures requiring amputation in 4% and failure of the method in 7%. The DELPO allows two objectives to be reached. First, when combined with a surgical procedure it reduces the extent and therefore the degree of surgical aggression while creating improved hemodynamic conditions for vascular reconstruction (improved proximal or distal beds or both). Second, when performed alone DELPO or RCPO enable safe, reliable treatment of lesions usually approached by a percutaneous endoluminal dilatation procedure.

Aged↗
PubMed1985

[Muscular scanning in polyarthritis and rheumatology].

Atypical features were observed in 7 out of 120 cases of rheumatoid arthritis and in 3 out of 4 cases of polymyositis. A vermicular image was observed burrowing into the muscles, which head a "worm eaten" appearance. This series is too small to allow definitive conclusions, but this appearance is very different from the other features observed in muscular pathology such as myopathy or neurogenic amyotrophy. A "combed" appearance of the paravertebral muscles was also observed in 4 cases of rheumatoid pelvispondylitis. The authors also present several examples which illustrate the value of the CT scan in focal disease (lipomas, hydatid cysts, muscle angiomas).

Arthritis, Rheumatoid↗
PubMed1985

[Resection graft prosthesis (PTFE) of the carotid bifurcation (RGPCB). A new alternative to endarterectomy or to venous bypasses for the treatment of cervical carotid atheromatous stenoses. Technique and indications].

Carotid endarterectomy, possibly followed by an enlarging angioplasty using a venous patch or a prosthesis, is standard treatment for cervical atheromatous lesions. However, this technique may be impossible to apply and a bypass operation may be necessary. J.M. Cormier has proposed the use of a venous by-pass by autologous internal saphenous graft as an alternative to endarterectomy, and reported very favorable results. The usual procedure is lateral implantation into common carotid artery followed by end-to-end implantation into internal carotid artery. The object of this paper is to demonstrate the interest of total resection of the pathologic carotid artery bifurcation followed by total replacement with a prosthesis in PTFE (Goretex) with bifurcated thin walls (new bifurcation constructed by the surgeon) and 3 end-to-end anastomoses (common carotid proximally and internal and external carotids distally). This repair procedure is simple, orthoanatomic, and complete, ensuring permeability of the two axes, internal and external, and is logical. It avoids the thrombo-embolic risk related to the walls after endarterectomy which are often imperfectly smooth leaving a distal intimal projection difficult to prevent or to fix. This thrombotic in situ risk of the endarterectomized wall is shown by isotopic studies with Indium 111-labelled platelets, and most secondary neurologic accidents, definitive, sometimes fatal, or transient, are due to this phenomenon. The three anastomoses in healthy zones considerably reduces this risk. The use of PTFE in femorodistal bypass surgery has been shown to give a good level of long-term permeability even for poor distal beds, and to present a low septic risk compared with Dacron prosthesis. This material was therefore considered a good alternative to a venous graft for the carotid vessels. The technique was used 12 times in 11 patients, between 1984 and 1985, without occlusion, or mortality. One patient developed a transient ischemic accident related to a low output and with multiple pedicles lesions, but there were no sequelae. All shunts were seen to be permeable on follow up venous angiography. Wider experience and a longer review period are necessary before proposing this method, but initial results of its use have been encouraging.

Aged↗
PubMed1983

[Bone and phosphoro-calcium metabolism in reflex sympathetic dystrophy].

A combined study organised by the French Society of Rheumatology was devoted to the investigation of bone and phosphoro-calcium metabolism in cases of reflex sympathetic dystrophy. The following observations were made: the usual phosphoro-calcium parameters are not altered, apart from a slight elevation of the urinary calcium in multifocal forms of the disease, during the 3rd and 4th months; the level of PTH, studied in 11 patients, was normal in each case; the examination of 8 bone biopsies, one performed in the 7th week and six others performed during the 3rd and 4th months of the disease, showed, initially, invasion of the spongy tissue by oedema, signs of marrow stress and bone stress, with a reduction in the number of osteoblasts, without any marked alteration of bone remodelling. At a later stage, the biopsy shows intense bone remodelling with hyperosteoclastosis and hyperosteoblastosis and the formation of irregular bone tissue which later becomes lamellar. Electron microscopic study of two biopsies revealed signs of acellular demineralisation with normal appearance of the osteoblasts and osteoclasts.

Bone and Bones↗
PubMed1983

[The joint in algodystrophy. Joint fluid, synovium, cartilage].

The joint fluid in cases of algodystrophy was studied in 17 samples. It is poor in cells (275/mm3 with a mean of 15% polymorphs). The protein level was studied 4 times and was equal to or greater than 40 g/l, i.e. double the normal value. A detailed histological examination of 33 biopsies of synovial tissue reveals a typical appearance of the synovium in algodystrophy, defined by 6 features, 2 negative and 4 positive: absence of hyperplasia of the synovial lining, absence of any real inflammatory cell infiltrate, presence of a marked hypervascularity, an oedema of the chorion, especially marked in the first weeks of the disease, hyperplasia of the walls of some arterioles, and fibrosis of the chorion which becomes more marked as the disease progresses and which is predominantly in the deeper layers. The authors recall that articular cartilage can show superficial alterations of structure with areas of fibrosis.

Biopsy↗
PubMed1982

[Algodystrophy: predisposition and pathogenic factors. Results of a multicentric survey concerning 765 cases].

The authors analyze the results of a cooperative and retrospective survey of seven hundred and sixty five cases of reflex dystrophies of all localizations. Most of the etiologies usually described were present. As for predisposing factors, some, such as psychic or vascular factors and alcoholism, seem to have been overestimated. Others, such as diabetes or hypertriglyceridemia, are confirmed as predisposing factors. Recurrent forms, the summation of trigger actions or predisposing factors are relatively rare. These findings can mean that the "reflex dystrophic ground", if it exists, remains largely to be discovered. Among the various possible localizations of reflex dystrophy, only the hip a real etiopathogenic individuality.

Adolescent↗
PubMed1981

[Arterial thrombosis of the femoro-popliteal axis. An exceptional case of vascular complication by exostosis (author's transl)].

The authors report an exceptional case of arterial thrombosis of the femoro-popliteal axis, caused by a bony exostosis of the femur. It was a man of 48 years, presenting with sub-acute ischemia of the left lower limb. The different examinations showed an extensive femoro-popliteal artery thrombosis centered by a bony exostosis of the inferior third of the femur. The patient was successfully operated upon with resection of the exostosis and saphenous vein femoro-popliteal by-pass. A review of the literature shows the rarity of vascular complication of exostosis and particularly of thrombosis, previously reported only 4 times. An explanation of the mechanism involves the repeated trauma on the artery in this narrow region and the possibility of superimposed atheroma.

Arteriosclerosis↗
PubMed1976

[Diabetes and synovial chondromatosis (author's transl)].

In the series of the fourty cases of synovial chondromatosis observed at the the department of rheumatology of Marseille since 1960, seventeen patients were suffering from diabetes mellitus, all of them not-insulin-dependent. This raises the question of the nature of this association, not previously reported.

Adult↗