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Biomedical subjects

P Bourgeois

Publications and source records attributed to P Bourgeois.

At least 19 recordsLinked to original sources
PubMed1992

[Unsatisfactory results of intradiscal injection of triamcinolone hexacetonide in the treatment of sciatica caused by intervertebral disk herniation].

Sciatica caused by intervertebral disc herniation can be treated with intradiscal injection of chymopapain. A search for a cheaper and less allergizing product led to triamcinolone hexacetonide, this procedure being known as "nucleorthesis". The first results at 6 months were encouraging. In 3 centres where triamcinolone hexacetonide was tested with a more than 2 years' follow-up 92 patients could be evaluated. The results obtained were considered satisfactory in 34 patients (36.9 percent), but they were poor in 19 patients (20.6 percent), and 39 patients (42 percent) had to be operated upon within 2 years. Return to surgery took place within the 6 months following nucleorthesis in 18 patients (19.56 percent) and beyond this period in 17 patients (22.8 percent) with degradation of the results. Moreover, calcifications were found in 19 out of 38 patients; they were of varying size, sometimes detected only at computerized tomography, and some of them appeared to produce symptoms. All considered, the failure rates, the number of patients who required surgery and the occurrence of large and sometimes symptomatic calcifications make triamcinolone nucleorthesis unacceptable compared with the recognized percentages of success with papain nucleolysis and surgical operations. For these reasons, we consider that this treatment should be abandoned.

Anti-Inflammatory Agents↗
PubMed1992

[Causes and mechanisms of sciatic pains].

Pain along the sciatic nerve can be due to many causes. Sciatica of radicular origin caused by compression of L5 or S1 root is usually separated from truncular or peripheral sciatica. Radicular sciatica is divided into mechanical sciatica and the so-called inflammatory sciatica. In the majority of cases radicular pain is of mechanical origin and due to discal herniation in L4-L5 or L5-S1. The herniation can be visualized by lumbar computerized tomography or by radiculography. However, discal herniation alone does not fully account for the pain suffered, and inflammatory processes around the disc and the nerve root play an important role. Posterior intervertebral osteoarthritis and lumbar canal stenosis also are frequent causes of sciatic pain. Truncular sciatica is much less frequent and should incite clinicians to investigate for pelvic tumoral infiltration. Peripheral sciatica is usually caused by suffering of the external popliteal nerve around the neck of the fibula, but it may also be caused by compression of a ramus from the internal popliteal nerve, resulting in tarsal tunnel syndrome or in Morton's syndrome.

Humans↗
PubMed1992

Bone marrow scintigraphy in lung carcinomas using nanosized colloids: when is it useful and how useful is it?

Bone marrow scintigrams (MS) combined with single photon emission computed tomographic investigation of the liver (liver SPECT) were obtained using 99Tcm-labelled human serum albumin nanosized colloids in 52 patients with histologically proven lung carcinomas (adenocarcinomas = 17, squamous cell = 16, small cell = 14, large cell = 5, 31 generalized cases at the time of the first MS investigation among whom 13 patients had proven skeletal metastases). They were compared with conventional bone scintigrams (BS) as well as clinical, biological, radiological and follow-up data obtained for the same patients. In the present series, MS appeared as sensitive as BS in diagnosing skeletal metastases (77%) if all abnormal MS and BS presentations are considered as diagnostic, but more sensitive (77% versus 54%) if more restrictive analytical criteria are applied. The two investigations yielded the same specificities whatever the analytical criteria applied. These preliminary conclusions have, however, to be confirmed on larger populations than the present series. The most striking differences between BS and MS were observed in the case of small-cell lung carcinomas, with more lesions detected by MS than by BS. Liver SPECT also made it possible to diagnose seven and to suspect one out of the ten situations of hepatic metastases. The combination of liver spect and MS in the framework of a single injection of 99Tcm-labelled nanosized colloids thus allowed us to diagnose 80% of the patients with osseous and/or hepatic metastasis or 40% of all generalized cases.

Adenocarcinoma↗
PubMed1992

Primary Sjögren's syndrome preceding the presentation of systemic lupus erythematosus as a benign intracranial hypertension syndrome.

The case is reported of a 41 year old white woman who developed systemic lupus erythematosus (SLE) seven years after primary Sjögren's syndrome and four years after the association of Sjögren's syndrome with Jaccoud's arthritis. The SLE was detected by a benign intracranial hypertension, which is a rare neuro-ophthalmic presentation of lupus. No associated conditions linked to benign intracranial hypertension syndrome were seen in this patient and the hypertension syndrome recurred one year later.

Adult↗
PubMed1992

[Rheumatic wrist].

The wrist is frequently involved in the course of inflammatory rheumatism. The clinical and radiological features of the arthritis may guide the diagnosis when wrist involvement is isolated. The rheumatoid wrist may associate articular and tendon sheath synovitis, nerve compressions, muscle atrophy and deformities. X-rays reveal increased volume of the soft tissues, followed by cartilaginous destruction. Magnetic resonance imaging may detect the lesions early in their course. RS3PE, rheumatoid arthritis of the elderly, never induces destructive lesions. Still's disease is distinguished from rheumatoid arthritis by the predominant involvement of the radiocarpal and intercarpal joints with relative sparing of the metacarpo-phalangeal and proximal interphalangeal joints. Jaccoud's hand may be observed in the course of lupus with metacarpo-phalangeal dislocation of capsulo-ligamentous origin without cartilaginous destruction. Wrist involvement is often asymmetrical in ankylosing spondylitis. In psoriatic rheumatism, arthritis of the wrist is similar to that observed in rheumatoid arthritis, but demineralization is less common and occurs later and constructive lesions are associated with pinching.

Arthritis, Psoriatic↗
PubMed1992

[Autoimmune diseases after unusual exposure to silica or silicones. 3 cases].

A woman, who had intensively used an abrasive cleansing powder rich in silica for 12 years, developed a connective tissue disease consisting of destructive inflammatory oligoarthritis, Gougerot-Sjögren's syndrome, Raynaud's syndrome, anti-nuclear antibodies and hypocomplementemia. Another woman, who had sprayed silicone-glaze on cables for 15 years, suffered from edematous scleroderma. A man, who had sprayed the same silicone-glaze on cables over a 20 year period, had a subluxing arthropathy. These autoimmune syndromes were compared with diseases classically induced by exposure to silica and silicone. To the best of our knowledge, these means of exposure have not been reported previously and merit being known in the aim of prevention.

Adult↗
PubMed1992

Estimation of right ventricular ejection fraction by means of 99Tcm-macroaggregates.

A method is described for assessing right ventricular ejection fraction (RVEF) by means of 99Tcm-macroaggregates (MAA). The method consists of performing, in right anterior oblique (RAO) projection, a direct ECG-gated data acquisition over 120 s, as soon as the intravenous administration of the tracer is started. The activity returning to the left heart being negligible, background is limited to the lung activity overlapping the right ventricle. The distribution of lung activity in the gated frames is, however, exactly the same as that in the lung perfusion image, it can therefore be subtracted using static lung scintigraphy acquired directly after the gated study. Considering the count density distributions in the corrected end-diastolic (ED) and end-systolic (ES) frames and the first harmonic phase and amplitude images, ED and ES RV regions of interest (ROIs) are delineated for the calculation of RVEF. It has been shown that using 5 mCi 99Tcm-MAA, the ED count obtained is similar to that usually observed during a 20 mCi 99Tcm first-pass study. Intraobserver variation is acceptable and there is a good correlation between the RVEF calculated by this method and that obtained by means of a steady-state ECG-gated 81Krm technique. As the method presents similar advantages to those offered by 81Krm while using 99Tcm, it constitutes, in our opinion, a good approach for estimating RVEF in routine clinical practice.

Humans↗
PubMed1991

[Environmental chemicals: their clinical significance in rheumatology].

Over the past years, various illnesses including features of connective tissue disorders (e.g. systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease), and rheumatoid arthritis, seemingly related to exposure to environmental materials have been reported. This paper presents some typical case reports and review major environmental associations seen in rheumatology, along with their epidemiology, clinical and laboratory features, possible pathogenesis, prognosis, and potential therapy.

Adult↗
PubMed1991

The actual survival rate in systemic lupus erythematosus: study of a 1976 cohort.

The purpose of this study was to establish the actual survival rate of a cohort of 51 patients with systemic lupus erythematosus (SLE) all of whom were followed during 12 years from 1976 to 1988 and to evaluate the prognostic significance of the severe complications of the disease. Forty-eight were females. The mean age was 28.5 at onset, 36.2 at diagnosis and 42 at entry; 80% had four or more 1982 ARA criteria at diagnosis and 96% in 1988. Survival rates were: 96% at two years, 86.3% at five years and 74.5% at twelve years. The main cause of death was infection (62%); SLE was directly responsible in only one case. Manifestations considered as severe occurred in almost two-thirds of the cases without any concordance in the time sufficient to recognize different severe forms of the disease.

Adolescent↗
PubMed1991

Mechanism of analgesia induced by hypnosis and acupuncture: is there a difference?

Hypnosis and acupuncture can alleviate experimentally induced pain but the mechanism of analgesia remains unclear for both techniques. Experimental pain was induced by cold pressor test (CPT) in 8 male volunteers. Analgesic effect of hypnosis (HA) and acupuncture (AA) was assessed before and after double-blind administration of placebo or naloxone, in a prospective, cross-over study. We found that pain intensity was significantly lower with HA as compared with AA, both with naloxone (P less than 0.001) and placebo (P less than 0.001). Within HA or AA groups, pain scores did not differ significantly when naloxone or placebo was administered. During AA, however, pain scores were similar to control values when naloxone was given (P = 0.05) but decreased significantly with placebo (P less than 0.002). Analog scales for pain intensity and pain relief showed a good correlation (r = 0.94). Plasma levels of beta-endorphins did not change significantly in any combination. Heart rate, peripheral arterial blood pressure and skin conductance were very insensitive indices to assess pain intensity or relief, as well as intensity of acupuncture stimulation or depth of hypnotic trance. We conclude: (1) HA and AA can significantly reduce pain from CPT, and HA is more effective than AA: (2) HA and AA are not primarily mediated by the opiate endorphin system; and (3) plasmatic levels of beta-endorphins are not significantly affected by either HA or AA nor by naloxone or placebo administration.

Acupuncture Analgesia↗
PubMed1991

Bone marrow scintigraphy in prostatic carcinomas.

Bone marrow scintigrams (MS) were performed on 73 men with histologically proven prostatic carcinomas. Follow-up data were available in 24 cases. Thirty-six patients had skeletal metastases at the time of the first MS investigation. They were compared with conventional bone scintigrams (BS) as well as clinical, biological, radiological and other follow-up data obtained for the same patients. At the present stage of revision and of follow-up of our patients, MS appeared less sensitive than BS in diagnosing skeletal metastases (94% as against 100% if all abnormal MS and BS presentations are considered as diagnostic or 83% as against 86% if more restrictive analytic criteria were applied). On the other hand, MS showed slightly higher specificity (81% for MS as against 73% for BS) when all abnormal MS and BS presentations are considered as diagnostic. With more restrictive diagnostic criteria, BS remains more specific (100%) than MS (87%). Nevertheless, the likelihood of bone metastasis is low when a normal MS is found in case of dubious BS situations, but high when the MS is pathological. In 11 patients with skeletal metastasis for whom follow-up investigations were available, MS appeared better than (4 cases) or equivalent to (6 cases) BS for evaluating the responses and the ultimate evolution of the disease. Marrow scintigrams are thus a useful tool in cases of dubious BS and for evaluating the response of skeletal metastasis to treatment.

Aged↗
PubMed1991

99Tcm-HMPAO-labelled leucocytes for bone marrow scintigraphy and evaluation of skeletal lesions. Comparison with 99Tcm-HSA colloid results.

Bone marrow scintigrams obtained 2-6 h and/or 20-24 h after injection of 99Tcm-HMPAO-labelled leucocytes (LeuSc) in 16 patients (seven males, nine females, average age 57 years, either with benign or malignant haemopathy, or with benign or metastatic skeletal diseases) have been compared to corresponding pictures obtained 20 min after injection of 99Tcm-labelled human serum albumin nanosized colloids (NanSc, performed within a week thereafter). Overall distribution of the colloids and of the labelled leukocytes at the level of the bone marrow appeared to be the same. Fresh vertebral fractures as well as metastatic lesions of the axial skeleton appeared as cold defects in both investigations. Fractures of the ribs as well as one metastatic lesion involving one trochanter could not be identified. Although all seven lesions involving Th9 to L4 could be clearly investigated with LeuSc, only three could be recognized with NanSc. It is concluded that, in patients with cancerous diseases, LeuSc is better than NanSc in demonstrating lesions in the case of dubious conventional osseous scintigrams as well as in the case of neurological or skeletal symptoms at the level of the lumbar and/or low thoracic regions.

Bone Diseases↗