[Role of radiology in the diagnosis of joint chondrocalcinosis. The so-called atypical symptomatic aspects]. / La place de la radiologie dans le diagnostic de la chondrocalcinose articulaire. Les aspects symptomatiques dits atypiques.

In a preceding article, we described "pseudogout" which is the expression of an episode of acute synovitis related to microcrystals of dehydrated calcium pyrophosphate invading the joint. This brutal episode of inflammation, predominantly occurring in the knee joint, is the most spectacular, most frequent and most characteristic manifestation of articular chondrocalcinosis. We attempted to demonstrate the important role of radiographs in the diagnosis, discovering in many cases the microcrystal impregnation of cartilage and fibrocartilage. But articular chondrocalcinosis, as has been shown by a large number of clinical and radiological surveys, may present a wide range of atypical or misleading forms, much different from the classic pseudogout. Among the different clinical presentations, some have no particularly special radiographic expression, showing only the common chondrocalcinosis lesions seen during the acute episodes of microcrystal related synovitis. This is the case in different situations of inflammation, notably subacute arthritis, purely algic forms and exsudative forms (chronic hydarthrosis, haemarthrosis). Complete clinical latency is also observed in certain cases. But many cases of articular chondrocalcinosis involve manifest radiological lesions which often appear to be secondary. This may occur in chronic inflammatory forms of chondrocalcinosis which can simulate rheumatoid polyarthritis. Careful analysis of the symptomatology should help to avoid confusion, especially when the radiograph reveals only degenerative lesions which often cause destructive damages. In other cases, a perfectly characteristic articular chondrocalcinosis is associated with typical polyarticular lesions of osteoarthritis. These cases often have the particularity of involving joints usually spared by the common arthrosic disease, especially in the upper limbs. They are also remarkable due to the amount of lytic damage. The deep destructive damage to joints during chondrocalcinosis may produced a particularly striking picture. Such damage is seen in approximately one-third of the cases. The onset is marked by sudden renewal of former arthrosic-type pain and by the development of major functional incapacity. Often, the radiograph is the only examination capable of revealing the diagnosis. The extent of bone destruction varies greatly. Sometimes it is limited to subchondral bone but in other cases underlying bony structures are also involved leading to extensive damage to the epiphysis. The distribution of lytic lesions varies. Damage may occur in the knee, the coxofemoral and the shoulder joints. Surgery is often absolutely indicated. In a number of cases of chondrocalcinosis, especially those involving the knee and the shoulder, true intraarticular foreign bodies may be encountered, opaque calcified or ossified formations simulating osteochondromatosis, existing along with destructive damages.(ABSTRACT TRUNCATED AT 400 WORDS)

[Role of radiology in the diagnosis of joint chondrocalcinosis. Calcium pseudogout]. / La place de la radiologie dans le diagnostic de la chondrocalcinose articulaire. La pseudo-goutte calcique.

Chondrocalcinosis is a really frequent clinicopathologic entity, which is caused by the penetration of calcium pyrophosphate dihydrate microcrystals into the structures of the joint, including hyaline cartilages and fibrocartilages--hense its name--as well as the synovial fluid and membrane. Calcium gout, which preferentially appears in the knees, is the most spectacular and characteristic symptom of chondrocalcinosis, expressing a crisis of acute microcrystal synovitis, of which it has all the usual clinical features, and thus simulating uratic gout. The positive diagnosis is based on: a) the radiologic demonstration of articular calcifications in the lining cartilages, forming a continuous or fragmented opaque border on the subchondral bone, from which it is separated by a light space, and/or in the fibrocartilaginous structures (most often the menisci, the symphysis pubis, the disk of the inferior radioulnar joint) where they appear as small, irregular clusters with blurred or cloudy margins. The knee is the most frequent site of calcium impregnation images, both in hyaline cartilages and in fibrocartilages. b) the presence of calcium pyrophosphate microcrystals in the synovial fluid; their nature is usually demonstrated convincingly enough with a conventional light microscope; c) needle biopsy findings of microcrystalline clusters embedded in the synovial membrane, that can be easily identified with routine staining. In practice, demonstrating radiologic signs, when these are characteristic and can be detected in their preferred sites, allows recognizing diffuse chondrocalcinosis in satisfactory safety conditions after a calcium gout crisis, as well as in the presence of the many atypical or misleading symptomatic aspects of this microcystal arthropathy, that will be the subject of a further paper.

[Chordoma of the mobile spine. Report of 9 cases. Review of the literature]. / Chordomes du rachis mobile. A propos de neuf cas. Revue de la littérature.

The authors reported 9 cases of chordomas of the mobile spine: 6 lumbars and 3 cervicals. There are 5 men and 4 women. Mean age at diagnosis is 60 years old. Mean delay between the first clinical manifestations and the diagnosis is 22 months. Clinical findings are not specific. Roentgenologic findings show 2 typicals aspects: a lytic lesion on the lateral side of the vertebrae frequently involving more than one cervical vertebrae, a mixed lesion (lytic and sclerotic) or only sclerotic was detected only at the lumbar spine. Magnetic resonance imaging and computed tomography are the most useful investigations to determine the local extension of the tumor. Certitude of the diagnosis is always microscopic. Evolution is difficult to precise in this kind of embryological tumor. Radical surgery at the earliest time is the best guarantee of a better prognosis which still remain severe.

[The new clinical picture of primary hyperparathyroidism. Diagnostic circumstances and current symptomatic characteristics. Results of a multicenter study]. / Le nouveau visage clinique de l'hyperparathyroïdie primitive. Circonstances de diagnostic et caractères symptomatiques actuels. Résultats d'une enquête multicentrique.

Primary hyperparathyroidism (PHP) is particularly interesting at this time because of the modifications of its traditional symptoms, which have renewed the conditions of its diagnosis. This is the result of a better knowledge and consequently an increased frequency of the simple forms, mild or clearly atypical, usually expressing the initial stages of the disease which are now better detected. The relative part of the classical manifestations of the disease is therefore reduced as well. In order to verify this fact, the authors have initiated a retrospective study of 535 recent cases of PHP, over 12 years, comparing them with 322 older cases, examined and operated upon between 1954 and 1976 by P.L. Chigot. Analysis of the differences that were noted, was the subject of a statistical evaluation. The first result of this investigation is that PHP remains a disease affecting predominantly women, especially between the ages of 40 and 60 years, and beyond that age to a lesser degree. In comparing the data obtained from analyzing the circumstances of discovery of the disease and its symptoms, the most striking modification consisted in a real drop in the frequency of bony lesions. These modifications are much more rare, only exceptionally presenting their classical characteristic X-ray appearance and they only represent a factor of contingency in the clinical picture of PHP. This is probably the result of a much earlier discovery of the disease. The incidence of renal insufficiency is also remarkably low, probably for the same reason. In return, asthenia and urinary lithiasis are now the major symptoms of PHP.(ABSTRACT TRUNCATED AT 250 WORDS)

Coexisting rheumatoid arthritis and ankylosing spondylitis.

Since the second publication by some of the present authors in which 10 patients with coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were described, 7 new cases have been found. For accuracy, all cases of the original study still available were reexamined. Of the total of 17 cases, 13 were male and 4 female. All had positive tests for rheumatoid factor and 6 had subcutaneous nodules. The male predominance and the frequency of nodules are consistent with other publications. In addition, our study demonstrates the strong association of each of these 2 diseases with its genetic marker: the antigen HLA-DR4 was present in 8 of 12 cases tested and the antigen HLA-B27 was present in 16 of the 17 cases. The coexistence of these 2 classical rheumatological entities in the same patient appears to occur by chance and is probably often overlooked.

Variation of surface density and other parameters in remodeling of trabecular bone in various conditions.

To appreciate the remodeling of the trabecular bone, the static morphometric parameters of surface density (SV(TRAB/BONE] and volumetric fraction (VV(TRAB/BONE] of cancellous bone were measured and compared to remodeling parameters, i.e., the surface extents of active/inactive resorption, active bone formation and nonmineralized bone. Iliac bone biopsies from 28 subjects with spasmophilia, osteoporosis and primary hyperparathyroidism were studied by means of a Nachet-France NS 2000 automatic image analyzer and a Zeiss ocular integrator; the results obtained in each group showed comparable values for the two methods (r = .8 for each group, with P less than .01). The remodeling parameters measured by means of the ocular integrator were compared with the variation measurements of the trabecular surface density, SV(TRAB/BONE). The correlation between the inactive osteoid surface and the coefficient of variation of the mean (CVM of SV(TRAB/BONE] on sections was significant for the three pathologic groups. The average mean values and standard errors of the mean of this latter parameter for the spasmophilia and hyperparathyroidic groups were, respectively, 0.063 +/- 0.008 and 0.092 +/- 0.012. Analysis of the experimental data shows that the simple global measurement of CVM (SV(TRAB/BONE] by means of an automatic image analyzer supplies information on the skeletal state during tissue remodeling.

Aspects singuliers et atypiques de la chondrocalcinose articulaire. / Singular and atypical aspects of articular chondrocalcinosis

A condrocalcinose articular se mostra cada vez mais frequente, particularmente nas mulheres idosas. A existencia de formas familiares esta largamente confirmada. Seu carater hereditario e talvez ligado ao haplotipo HLA2 W25. Entre as formas secundarias, tem interesse particular, atualmente, aquelas determinadas possivelmente por uma insuficiencia tiroidiana. A fisionomia sintomatica da condrocalcinose e suficientemente conhecida pela descricao de numerosas formas clinicas que, embora com sua aparencia singular, merecem, em razao de sua frequencia, ser integradas dentro do quadro caracteristico da afeccao; destaque deve ser dado para aquelas que caracterizam o desenvolvimento de uma hermatrose, de corpos livres tipo osteocondromatose sinovial e sobretudo de lesoes destrutivas, remarcaveis por seu carater altamente invalidante. O mecanismo patogenico da condrocalcinose continua ainda desconhecido. O acumulo de pirofosfato inorganico no meio articular parece firmemente demonstrado. Ignora-se, entretanto, suas razoes.A formacao de nucleos microcristalinos cartilaginosos nao esta ainda claramente explicado, da mesma maneira que o aparecimento dos cristais dentro do liquido sinovial. Um tratamento e uma prevencao eficazes continuam sendo uma esperanca, ja que as incertezas fisiopatogenicas continuam por ser aclaradas

[Concentration of gold in macrophages of the bone marrow in rheumatic diseases subjected to chrysotherapy]. / Concentration de l'or par les macrophages de la moelle osseuse au cours d'affections rhumatismales soumises à la chrysothérapie.

Ultrastructural investigation of bone marrow cells of histiocytic lineage to determine the presence of microcrystals containing gold was carried out in 12 patients. Eleven patients had classical or definite rheumatoid arthritis and one had palindromic rheumatism; the duration of these diseases ranged from 6 months to 10 years. Two patients had never received chrysotherapy and therefore served as controls. The remaining 10 patients had been treated with sodium aurothiopropanolsulfonate for periods ranging from 1 week to 4 years and 4 months without any clinical signs of laboratory findings--hematological changes in particular--of drug intolerance. No crystalline structures could be found in the 2 controls or in the patient who had just begun treatment. Conversely, in the 9 other patients, the lysozymes of bone marrow macrophages contained needle-like microcrystals containing one atom of gold for two atoms of sulfur, i.e. identical in proportion to the injected product. For equivalent total doses, deposits appeared to be equally numerous regardless of the time span between the last injection and the sampling (2-21 months). These crystals were present in the bone marrow several years after the beginning of chrysotherapy. The actual mechanism of their precipitation remains unknown at present.

A comparative study of benoxaprofen and ketoprofen in ankylosing spondylitis.

Benoxaprofen, 600 mg once daily, was compared with ketoprofen, 100 mg twice daily, in a double-blind parallel study of 23 patients with definite active ankylosing spondylitis. Results were assessed using the following measurements: day pain, night pain, and spinal stiffness. Spinal stiffness was determined by means of standard clinical tests. Patient's evaluation and physician's overall assessment at the end of therapy also were taken into account. Under these conditions, the therapeutic response for benoxaprofen was good/very good, 8; fair, 2; and no response, 2. For ketoprofen, the response as good/very good, 5; fair 3; and no response 3. This study shows that benoxaprofen provides very good therapeutic effectiveness in the treatment of ankylosing spondylitis. This is confirmed by the absence of any statistically significant difference between the results observed with benoxaprofen and with ketoprofen, a drug known to be of value in ankylosing spondylitis. The clinical and biologic tolerance of benoxaprofen in this study was quite satisfactory.

[Value of tomodensitometry in the diagnosis of lumbar disk hernias]. / Intérêt de la tomodensitomérie dans le diagnostic des hernies disclaes lombaires.

The authors relate their experiences concerning tomodensitometric examination to evaluate the herniation of a disk. 45 patients and 50 herniations of a disk have been studied. 39 herniations have sustained surgical procedures. The tomodensitometric examination and the radiculosaccography have been performed among these patients in order to compare the findings. The fact that there has only been 3 failures prove the reliability of tomodensitometric examination; among these failure there is 2 post-operative recurrences and one L4 L5 herniation. The radiculosaccography fails 5 times (1 L4 L5 herniation and 4 L5 S1 herniations). There is not any common negative in the two methods. Because of its total innocuity (no injection of any kind) the tomodensitometric examination seems to be the first exploration to prescribe when an herniation of a disk is resistant to clinical treatment and when a surgery is planned.