Biomedical subjects
Publications and source records attributed to S Lassoued.
A 75-year old man with rheumatoid arthritis developed bronchiolitis obliterans organizing pneumonia (BOOP), which responded to treatment with prednisolone (1 mg/kg/d) and cyclophosphamide (100 mg/d).
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Twenty-five patients with good-prognosis polyarteritis nodosa or Churg-Strauss syndrome entered a prospective, randomized, multicentre study comparing two treatments: either oral corticosteroids and oral cyclophosphamide (CY; 2 mg/kg/day) for 1 yr (group A), or oral corticosteroids and monthly i.v. CY pulses (0.6 g/m2) (group B) for 1 yr. The objective was to determine the optimal CY regimen. Judgement criteria were the efficacy of the treatment in controlling the disease and the development of side-effects. Among the 25 patients who could be analysed, complete recovery was achieved with the experimental treatment in 9/12 patients in group A and 10/13 patients in group B. Two patients in each group relapsed after the end of therapy and were well controlled by corticosteroids or other drugs. One failure occurred in each group. The mean follow-up was 60.8 +/- 14.5 months after the beginning of the treatment. Side-effects associated with the administration of CY and steroids were noted 27 times in group A vs 14 times in group B (not significant). The oldest patient in these series (group B) died of pneumonia. No superiority in terms of efficacy could be established between the two regimens; however, the number of patients included was too small to conclude definitively. Toxic side-effects were significantly more frequent in women (P < 0.02). The high number of adverse effects leads us to recommend pulse over oral CY and an overall lowering of the doses of immunosuppression.
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Eight patients with an age ranging from 72 to 83 years, seen in an outpatient clinic over a one-year period for stress fractures of the proximal tibia responsible for acute knee pain and effusion were studied retrospectively. Plain roentgenograms were often normal at presentation but subsequently showed sclerosis of the proximal tibia. Radionuclide bone scanning was the most useful investigation for early diagnosis. Potential risk factors were advanced: age, genu varum or valgum, overweight and vitamin D deficiency. Stress fracture of the proximal tibia should be considered in elderly patients with knee pain, effusion and normal roentgenograms. Elimination of weight-bearing ensures healing of the fracture.
A retrospective study of 36 allogeneic bone marrow transplant recipients was conducted to determine the rate of occurrence of and risk factors for avascular osteonecrosis. Eight patients developed osteonecrosis, after a mean time interval of 18 months. Multiple sites were often involved (mean 2.37 per patient). Advanced roentgenologic lesions were present at diagnosis in most instances. The occurrence of osteonecrosis was not significantly correlated with the initial hematologic diagnosis, the preparative regimen, serum lipid abnormalities, presence of acute or chronic graft-versus-host disease, or corticosteroid therapy characteristics. Intraosseous blood vessels exhibited histologic lesions consistent with a role of graft-versus-host-disease vasculitis in the occurrence of osteonecrosis in nonautologous bone marrow transplant recipients.
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The prevalence of thyroid abnormalities was determined in 131 patients: group I = rheumatoid arthritis, 68 patients, group II = systemic immunological diseases (IIa Sjögren's syndrome, n = 6; IIb other rheumatic autoimmune disease, n = 17), group III = other rheumatic diseases n = 13 and control group (n = 27). Thyroid abnormalities (hypo, hyperthyroidism, nodular goiter) were frequent: 33.8% in group I, 100% in group IIa, 11.7% in group IIb. Hypothyroidism was present in 19.1% (group I), 50% (group IIa). 6% (group IIb). Autoimmune thyroiditis was found in 16.2% in group I, 100% in group IIa, 11.7% in group III. Thyroid diseases are frequent in patients with rheumatoid arthritis. Therefore thyroid tests might be performed in patients with rheumatoid arthritis.
A case of dermatomyositis in a patient with two different malignancies is reported. Skin lesions cleared only following exeresis of the second tumor. This case provides the opportunity for a discussion of the main theories put forward to explain relationships between dermatomyositis and malignant disease.
The authors report three different types of cranial bone lesions due to a meningioma of the convexity. This rare tumour is most often benign, with variable radiological appearances. The diagnosis is often suggested by tangential views of the cranial vault and CT scan but meningioma remains a histological diagnosis, notably in its primary intra-osseous form without actual meningeal involvement. The prognosis is good and the risk purely local, by vascular or cerebral compression. Treatment is surgical, sometimes complicated by recurrence.
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