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Biomedical subjects

R M Javier

Publications and source records attributed to R M Javier.

At least 19 recordsLinked to original sources
PubMed2005

[Ankylosing spondylitis and osteoporosis].

PURPOSE: Ankylosing Spondylitis (AS) is an inflammatory rheumatism characterized by its disease course with flares leading to progressive ankylosis of the spine related to paravertebral ligamentous and discal structures ossification. AS patients suffer significantly more vertebral fractures than control groups. These fractures could affect cervical spine. They are due to either ankylosis-related flawed spine compliance or AS-induced osteoporosis. CURRENT KNOWLEDGE AND KEY POINTS: The physiopathology of this osteoporosis is multi-factorial, but essentially linked to AS-related inflammatory phenomenons. It is marked by reduced bone density (at lumbar spine and femoral neck), increased bone turnover (with increased urinary C-telopeptide cross-linked collagen type 1), but without any significant change in phosphocalcic blood parameters. Histological features are depressed bone formation, with either maintained or increased resorption. FUTURE PROSPECTS: The screening of this osteoporosis is based upon investigating people at risk (progressive inflammatory AS) using dual-energy x-ray absorptiometry and biochemical markers of bone turnover. Treatment is based upon a modulation of both inflammatory phenomenons and bone remodelling using bisphosphonates and anti-TNF alpha.

Biomarkers↗
PubMed2004

[Spinal extradural meningiomas: MRI findings in two cases].

Spinal extradural meningiomas are rare and may be easily confused with malignant neoplasms. We report two unusual cases of epidural spinal meningioma one within the left C6-C7 foramen and the other within the left posterolateral epidural space at the T3-T4 level. Low signal intensity of the tumor on T2-wi, thickening and enhancement of the dura with only the possibility of bone erosion are the most characteristic MR findings.

Adult↗
PubMed2001

Fatal Aspergillus fumigatus Myositis in an immunocompetent patient.

A 69-year old farmer developed Aspergillus myositis in the right psoas and paravertebral muscles extending to the retroperitoneum and the fifth lumbar vertebra. The infection appeared after two local instillations of steroid for back pain. Although the patient was not immunocompromised, surgical drainage and antifungal therapy failed to cure him; he died of a bacterial pulmonary superinfection while cultures of the abscess drainage fluid grew Aspergillus. The likely portal of entry in this patient was direct inoculation during infiltration of the steroid; the steroid probably caused a local impairment in host defenses. Only six cases of Aspergillus myositis have been reported previously. All of them occurred in severely immunosuppressed patients and the outcome was fatal in all cases.

Abscess↗
PubMed2000

Rapid chondrolysis after an intra-articular leak of bone cement in treatment of a benign acetabular subchondral cyst: an unusual complication of percutaneous injection of acrylic cement.

Percutaneous injection of methylmethacrylate is now increasingly employed to treat bone lesions, both malignant and benign. However, the risks of this procedure are still to be fully established. In this report, we describe a case of rapid chondrolysis appearing after the intra-articular leakage of cement during injection of an acetabular subchondral cyst, resulting in hip replacement. Although the mechanism of such chondrolysis is unknown, this event suggests a chondrolytic effect of the acrylic cement. Thus, it is essential to systematically search for the presence of an intra-articular passage before injecting bone cement into a peri-articular cyst. This unusual complication highlights the need for rigorous evaluation of the benefits and risks of percutaneous injection of acrylic cement in the treatment of benign lesions, especially close to an articulation.

Acetabulum↗
PubMed1999

The pitfalls of planar three-phase bone scintigraphy in nontraumatic hip avascular osteonecrosis.

PURPOSE: This study documented the previously reported lower sensitivity of routine planar three-phase bone scintigraphy (BS) performed using a high-resolution parallel-hole collimator compared with MRI to diagnose nontraumatic avascular necrosis of the hip (AVN). METHODS: Six observers reviewed 143 bone scintigrams obtained in patients with nontraumatic hip pain (n = 120) or a control group (n = 23). All patients had a standard radiograph and MRI within 2 months of the BS. Of 280 hips, 148 (53%) were painful on the day of the examination. The osteonecrosis group (AVN) consisted of 93 instances of AVN in 58 patients. Although it departs from the clinical situation, this method evaluated the intrinsic performance of the imaging method. The data were analyzed using a receiver operating characteristic method. RESULTS: For the six observers, the A(z) values were 0.65, 0.67, 0.66, 0.67, 0.73, and 0.79, respectively, and 0.66, 0.71, 0.75, 0.81, 0.81, 0.82, and 0.84 after removing hip diseases other than AVN through data manipulation. Bone marrow edema, as seen on MRI, was the most frequently reported misleading sign in false-positive diagnoses, especially in the early or late phases of the disease. False-negative diagnoses misclassified the scans as "asymptomatic hips" in 28 of 30 cases. Twenty-two of 30 scans appeared normal, but these AVN lesions were small (<25%) and were discovered by chance on MRIs that displayed bilateral involvement associated with radiographic evidence (stage 0 or 1). Thirteen of 20 patients were followed for 3 or more years, and only one worsened. CONCLUSIONS: BS is not indicated to diagnose possible contralateral AVN if the hip is asymptomatic. This study emphasizes the results from the literature; if indicated, a radionuclide hip investigation requires the use of a pin-hole collimator, a SPECT study with scatter correction and iterative reconstruction algorithms, or both.

Adult↗
PubMed1999

Bone mineral density in men treated with synthetic gonadotropin-releasing hormone agonists for prostatic carcinoma.

PURPOSE: We evaluate the relationship between the use of synthetic gonadotropin-releasing hormone (Gn-RH) agonists and bone loss in men. MATERIALS AND METHODS: Bone mineral density and parameters of mineral metabolism were evaluated in 12 patients with stage C prostatic carcinoma before and after 6, 12 and 18 months of treatment with 3.75 mg. triptorelin intramuscularly every 4 weeks. RESULTS: Of the 12 patients 9 were evaluated after 6, 7 after 12 and 6 after 18 months of therapy. In comparison with month 0, the lumbar and femoral neck bone mineral density tended to decrease at month 6 (-3 and -2.7%, p = 0.31 and 0.17, respectively), at month 12 (-4.6 and -3.9%, p = 0.13 and 0.13) and at month 18 (-7.1 and -6.6%, p = 0.12 and 0.027). A second analysis revealed that the lumbar and femoral neck bone mineral density was significantly decreased on the last evaluation compared to month 0 (p = 0.05 and 0.028, respectively). The serum osteocalcin was increased during treatment, suggesting an accelerated bone turnover in men treated with Gn-RH agonists. CONCLUSIONS: The use of Gn-RH agonists in men may induce an accelerated bone loss. Further studies are needed to confirm these results and to evaluate the incidence of osteoporotic fractures in men treated with Gn-RH agonists.

Adenocarcinoma↗
PubMed1999

[Drug-induced osteopathies].

Several drugs can induce bone disorders. Steroid-induced osteoporosis is the best known of all drug-induced bone disorders. However, bone disorders have also been described in association with newer drugs (LH-RH analogs, retinoids, cyclosporine, etc.). The purpose of this revue is to familiarize radiologists with drug-induced bone disorders in order to achieve earlier diagnosis, hence, improve treatment.

Antacids↗
PubMed1998

Pancytopenia secondary to hemophagocytic syndrome in rheumatoid arthritis treated with methotrexate and sulfasalazine.

Hemophagocytic syndrome is an exceptional cause of pancytopenia. Its etiologies are most commonly viral or bacterial infections, lymphoproliferative syndromes, acquired or congenital immunodeficiencies, systemic diseases, or immunomodulatory treatment. We describe a patient with rheumatoid arthritis (RA) treated with methotrexate (MTX), sulfasalazine, and low dose corticosteroids, whose case was seriously complicated by the occurrence of acute febrile pancytopenia. The pancytopenia appeared secondary to hemophagocytic syndrome triggered by Escherichia coli septicemia. The evolution was marked by severe aggravation of RA, probably due to release of cytokines from macrophages (tumor necrosis factor-alpha, interleukin 6). Reintroduction of MTX (without sulfasalazine) resulted in partial remission and there was no reappearance of new hematological anomalies after 16 month followup. A knowledge of this syndrome is particularly important, since it mimics drug toxicity and other complications such as lymphoproliferative diseases.

Antirheumatic Agents↗
PubMed1996

Detection of Borrelia burgdorferi by DNA amplification in synovial tissue samples from patients with Lyme arthritis.

OBJECTIVE: To compare the detection rates of chromosomal flagellin gene from Borrelia burgdorferi in synovial tissue (ST) and synovial fluid (SF) using polymerase chain reaction (PCR) techniques. METHODS: B burgdorferi DNA was sought in SF and ST from 12 consecutive patients with Lyme arthritis and from 29 patients with noninfectious diseases (controls). RESULTS: No DNA amplification was observed in samples obtained from the 29 control patients, whereas B burgdorferi DNA was detected in all ST and/or SF samples from the 12 patients with Lyme arthritis. Results from 1 ST sample were not interpretable because of PCR inhibitors. Among the 11 remaining patients, 10 had positive ST samples, whereas only 4 had positive SF samples (P < 0.05). CONCLUSION: These data suggest that detection of chromosomal B burgdorferi DNA may be more efficient in ST than SF.

Adolescent↗
PubMed1995

Recurrent psoriatic onychoperiostitis induced by hydroxychloroquine.

Synthetic antimalarial agents can cause exacerbation of latent or patent psoriatic skin lesions. A case of psoriatic onychoperiostitis precipitated by hydroxychloroquine therapy is reported. The patient had primary Sjögren's syndrome, raising questions about the incidence and causation of the ungual abnormalities associated with this condition.

Female↗
PubMed1994

[Scaphoid fissure in algodystrophy: diagnostic value of MRI].

Stress fractures are exceptional in patients with reflex sympathetic dystrophy syndrome, even when bone loss is severe. We report a case of stress fracture of the navicular bone documented by magnetic resonance imaging. Recurrence of localized pain in patients with reflex sympathetic dystrophy syndrome suggests either a relapse of the syndrome or a bony fissure. Magnetic resonance imaging can provide early differentiation of these two conditions.

Fractures, Stress↗
PubMed1993

[Macrophage activation syndrome in lupus].

A patient with systemic lupus erythematosus developed unexplained fever, nonregenerative anemia, leukopenia, and elevations in serum triglyceride and ferritin levels. Bone marrow studies established the diagnosis of macrophage activation syndrome with active hemophagocytosis. No infectious cause was found but pulmonary nocardiosis developed during the course of the disease. Intravenous gammaglobulin therapy was followed by a transient remission. Cyclophosphamide was given subsequently. In lupus patients, macrophage activation syndrome is exceedingly rare and has the same clinical, laboratory, and histologic features as those seen in patients with hemopathies, infections, or immune deficiencies. Investigations for an underlying infection are often negative, suggesting that the macrophage activation syndrome is due to lupus-related immune changes. Treatment is not standardized and relapses are common. This diagnosis should be considered in lupus patients with febrile pancytopenia.

Adult↗
PubMed1993

[Infectious osteoarthritis of the pubis in sportmen. Apropos of 2 cases].

In athletes, osteoarthritis of the symphysis pubis is an uncommon condition that should be promptly differentiated from pubic pain due to microtrauma. The symphysis pubis is infected via the bloodstream, usually by a staphylococcus. Pubic pain with fever and severe disability suggests the diagnosis. Increased uptake of bone-seeking radionuclides is an early finding. Microbiological and histological studies of specimens obtained under radiological guidance confirm the diagnosis. Two new cases of pubic osteoarthritis in young athletes are reported. In one case the causative organism was a Peptostreptococcus, a gram-positive commensal organism normally found on the skin and mucous membranes.

Adolescent↗