[The Amfortas phenomenon].
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Biomedical subjects
Publications and source records attributed to R Treves.
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OBJECTIVE: To obtain prospective data on feasibility and safety of intra-articular injections of hylan G-F20 in patients with symptomatic hip osteoarthritis (OA). METHODS: Fifty-seven patients with primary hip OA, Kellgren-Lawrence grade II-III, aged > or = 40 and walking pain 50-90 mm on a visual analogue scale (VAS) were enrolled in an open-label, multicentre pilot trial. Hylan G-F20 (2 ml) was injected intra-articularly (IA) in the hip under fluoroscopy at D0, and follow-up visits were performed at D7-30-60-90. The possibility of a second injection at D30-60 or 90 was considered if the reported pain level was equivalent to baseline. Adverse events, walking pain (VAS), WOMAC index, patient and physician's global assessment were recorded at each visit. RESULTS: Twenty-five patients 1 injection and 32 received 2 injections. Transient hip pain was reported following 10.1% of injections, but no patient withdrew from the study because of this. Two mild synovial fluid aseptic effusions occurred after the first injection. No systemic device-related adverse event was reported. Walking pain decreased from 69.3 mm at entry to 39.5 mm at the end point (p < 0.0001). All other outcome measures decreased significantly. CONCLUSION: Viscosupplementation with hylan G-F20 is feasible, easy to perform and well-tolerated in hip OA. A double-blind, controlled study should be performed to confirm data on its efficacy.
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The authors report 13 cases which permitted them to discuss the clinical signs, which were multiple, completed by further investigations of which the most important was lipiodol myelography. The treatment included usually surgical operation accompanied by radiotherapy, chemotherapy and sometimes immunotherapy. This combined treatment gave a better prognosis espeically in patients operated at stages I, II and III, and we obtained 25% favourable results.
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The authors report a case of Felty's syndrome in which are discussed over the data of literature: clinical features, hematological characteristics with a study of neutropenia mechanism and therapeutic possibilities.
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Vitamin B1, B6 and B12 are frequently prescribed in rheumatic diseases as analgesic drugs. If some fundamental data suggest their analgesic potential, especially in animal models, there are very few clinical trials in human demonstrating their efficacy in rheumatology. Looking at these data from the literature, we should reconsider our prescription of vitamin B.
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It is well known that methotrexate (MTX), used at high dosage in cancer patients, must not be combined with a non-steroidal anti-inflammatory drug (NSAID) because of high risk of side effects; prescribed at low dosage (< or = 15 mg per week) in rheumatoid arthritis patients, MTX is often combined with an NSAID. Some cases reported in the literature underline the potential toxicity of the association of low dose MTX with an NSAID, but most of the pharmacological studies do not confirm this hypothesis. Except for salicylates, NSAIDs do not affect the absorption, distribution, protein binding, area under the curve, half-life, or the elimination of MTX. Therefore, if necessary, MTX (< or = 15 mg per week) can be combined with an NSAID during the treatment of rheumatoid arthritis.