Comparison of once-daily evening versus morning sustained-release theophylline dosing for nocturnal asthma.

Eight diurnally active (approximately 0730-1100 hr) adults (41-61 yr) suffering from nocturnal asthma volunteered for a double-blind, cross-over randomized study of a once-daily dosing (600-900 mg/24 hr) of Armophylline (Rorer s.a., France), a sustained-release theophylline given either at 0800 hr or 2000 hr for 8-day durations. Study variables monitored daily were: (a) self-measured peak expiratory flow (PEF), heart rate, oral temperature and self-rated fatigue checked every 2 hr during the waking span as well as upon spontaneous nocturnal awakenings and (b) duration and subjective characteristics of sleep rated every morning. In addition, serum theophylline concentration (STC) plus the variables in (a) were sampled every 2 hr during the 24 hr of the eighth day of each timed treatment span. Rx at 0800 hr was associated with a nocturnal dip in PEF of 20 +/- 2.8% (X +/- S.E.M.) from the level achieved at the time of the diurnal crest; Rx at 2000 hr moderated the nocturnal fall; it was only 10 +/- 2.1% and within the physiologic limits of non-asthmatic persons. The STC peak height (Cmax) was greater (P less than 0.05) and time-to-peak (Tmax) shorter (P less than 0.005) with Rx at 0800 hr than at 2000 hr. With Rx at 2000 hr an STC plateau of approximately 12 hr resulted. A statistically significant correlation (r = 0.86; P less than 0.01) between PEF and the corresponding-in-time STC was observed with Rx at 2000 hr but not with Rx at 0800 hr. A small, but statistically significant, higher heart rate resulted from 2000 hr dosings in five out of eight subjects relative to the 0800 hr dosing. There were no differences in the sleep characteristics nor in oral temperature between dosing times. Once-daily (600-900 mg) SRT dosing at 2000 hr controlled the nocturnal dip of bronchial patency with no major side-effects in diurnally active adult patients with nocturnal allergic asthma.

[Giant cell thromboangiitis in a patient taking an oral contraceptive (author's transl)]. / Thromboangéite à cellules géantes au cours d'une contraception orale. Etude anatomo-clinique et immunologique.

Pathological examination in a patient who developed an ischemic cerebrovascular accident while taking an oral contraceptive demonstrated widespread lesions in the right and left carotid regions. Histological examination revealed the presence of an obliterating thromboangiitis in the arterial walls, with subendothelial fibrosis of the intima, arterial thrombosis, and a marked giant cell reaction where the lesions were in contact with the internal elastic layer. Immunological and biological anomalies confirmed the inflammatory nature of the lesion with the presence of anti-ethinyl estradiol antibodies in the serum and circulating blood immune complexes. These biological and histological results suggest the immunological nature of the mechanism of origin of the cerebrovascular accident in this case.

PIP: The article presents the case of a 28-year-old patient, on oral contraception for 2 years, who suddenly developed massive right hemiplagia. Pathological observations revealed widespread lesions in the right and left carotid regions, while histological observations revealed the presence of obliterating in the arterial walls, causing arterial thrombosis and giat cell reaction where the lesions were in contact with the internal elastic layer. Antiethinyl estradiol antibodies were found in the serum, together with immune circulating complexes. Such results suggest the immunological nature of the case presented.

[Chronotherapy of tenoxicam]. / Chronothérapie du ténoxicam.

A study was carried out in order to investigate the chronotherapy (dosing time dependency) of an NSAID, the tenoxicam administered in ankylosing spondylitis, rheumatoid arthritis and osteoarthritis of the hip. These variations in efficacy exist as much for pain as for stiffness and maximum efficacy is obtained with administration at 8 am or 12 pm. Since the tolerance was good, we recommend midday as an optimal once-a-day dosing time.

[New osteoformative agents for osteoporosis]. / Les nouveaux traitements ostéoformateurs de l'ostéoporose.

PURPOSE: Antiresorptive therapy are usual treatment of osteoporosis, but they prevent no more than 40 or 60% of osteoporotic fracture. Thus, there is a need for osteoformative agents that can further augment bone mass and reduce risk fracture more substantially. CURRENT KNOWLEDGER AND KEYPOINTS: Daily injections of 1-34 aminoterminal fragment of PTH increase bone formation and bone mass. A randomized study recently demonstrated that PTH 1-34 decrease the risk of vertebral and non vertebral fracture, and the place of this treatment in the strategy of osteoporosis treatment is to demonstrate. Oral administration of strontium salt at low dosage level stimulate bone formation and decrease bone resorption. Preliminary data needs to be confirmed by a multicenter antifracture study. Retrospective results with statins in three international studies have not be confirmed by the only randomized clinical trial. Use of low dose intermittent fluoride therapy are still recommended by some authors. FUTURES PROSPECTS AND PROJECTS: Effects of insuline like growth factor I and other growing factor on bone turnover have to be confirmed in human, and pharmacological and tolerance problems have to be solved.

[Preventive drug therapy of postmenopausal osteoporosis]. / Les thérapeutiques médicamenteuses préventives de l'ostéoporose postménopausique.

Osteoporosis, one of the most important disorders associated with aging, needs active prevention. Estrogen therapy prevents the early phase of bone loss and decreases the incidence of subsequent osteoporosis related fractures. All estrogens are probably not equally effective against post menopausal bone loss. In USA conjugated equine estrogens are the most used. In Europe estrogen therapy is usually applied with 17 beta estradiol with different ways of administration. If estrogen therapy cannot be used, there are limited datas about the use of bisphosphonates or calcitonins in the prevention of post menopausal bone loss, but not still any data about the subsequent incidence of fractures. In all cases, calcium supplementation is effective.

[Malignant peritoneal mesothelioma occurring in periodic disease: apropos of a case]. / Mésothéliome péritonéal malin survenant au cours d'une maladie périodique: à propos d'un cas.

INTRODUCTION: Peritoneal mesothelioma is a rare malignant neoplasm that might be linked to chronic peritoneal inflammation. As well, the association peritoneal mesothelioma-familial Mediterranean fever is uncommon. EXEGESIS: We report the case of a 60-year-old man who presented for 30 years with standard periodic familial Mediterranean fever accompanied by acute abdominal episodes, sensitive to colchicine. Between 1988 and 1995, acute abdominal episodes were accompanied by more and more profuse recurrent ascites, partially resolving under colchicine treatment. In 1995, the last episode was severe (with loss of weight and inability to tolerate feeding) and conducted to the patient's death due to peritoneal mesothelioma, as confirmed by the biopsy. CONCLUSION: Profuse and recurrent ascites is unusual in standard periodic familial Mediterranean fever. Asbestos exposure at the origin of peritoneal mesothelioma is not well documented. Furthermore, the disease clinical and paraclinical features are misleading, and the diagnosis is based on histology. The prognosis is severe, and treatment is usually disappointing. Our observation clearly demonstrates the interconnection between an unusual form of profuse and relapsing ascites that occurred in the course of a periodic disease and peritoneal mesothelioma. The potential role of recurrent peritonitis related to familial Mediterranean fever in the pathogenesis of the tumor is discussed.

[Association of mycosis fungoides and Jaccoud syndrome]. / Association d'un mycosis fongoïde et d'un syndrome de Jaccoud.

We report here a case of a 49 year-old woman who developed a unilateral Jaccoud's arthropathy 9 years after a mycosis fungoides of the left hand. This rheumatic affection, described in 1866, is a deformation of the hands or of the feet linked to a periarticular disease without any bone lesion. Many causes have been registered but the most frequent etiology is the systemic lupus erythematosus. The mycosis fungoides had never been reported as yet to be responsible to the Jaccoud's arthropathy.

[Corneal crystalline deposits in monoclonal gammapathy: a report of two cases]. / Kératopathie cristalline des gammapathies monoclonales: à propos de deux cas.

Corneal immunoglobulin deposits are an unusual complication of lymphoproliferative affections such as monoclonal gammapathy of indeterminate significance, essential cryoglobulinemia, or multiple myeloma. Although uncommon, this crystalline keratopathy may be the first clinical sign of these malignant disorders. We report two cases of paraproteinic crystalline keratopathy: the first case is associated with a multiple myeloma, combined with cryoglobulinemia, and the second case with monoclonal gammapathy of indeterminate significance. In both cases, corneal crystalline deposits appeared before general clinical symptoms. In the first case, the systemic therapy made no change in the biomicroscopic aspect of the corneal deposit, despite immunoglobulin level normalization in the serum. Conversely, in the second case, we noticed a substantial regression of the corneal crystalline deposits as the systemic normalization. A review of the literature clarified the variety of clinical dorms of paraproteinic crystalline keratopathy, the physiopathogenics hypotheses that are currently being discussed, and the possible therapeutic modalities.

[Subacute edematous polyarthritis in the elderly. 9 cases]. / Polyarthrite subaiguë oedémateuse bénigne du sujet âgé. Neuf observations.

We report 9 cases of a recently described syndrome: subacute oedematous polyarthritis of the elderly. The condition is characterized by its sudden onset and by the presence of important oedema of the four limbs, symmetrical polyarthritis, marked inflammatory syndrome and negative serological test for the rheumatoid factor. Men are predominantly affected, and many of them are carrying the HLA B7 antigen. The illness subsides within a few months without sequelae. It seems that this syndrome should be clearly distinguished from late onset rheumatoid arthritis and polymyalgia rheumatica.

[Enthesopathies in ankylosing spondylitis and seronegative inflammatory rheumatism. 28 cases]. / Les enthésopathies dans la spondylarthrite ankylosante et les rhumatismes inflammatoires séronégatifs. 28 observations.

A few demonstrative cases of severe and disabling enthesopathy in patients with ankylosing spondylitis (AS) and related syndromes, psoriatic arthritis (PA) or Reiter's disease (RD) have prompted the authors to investigate the incidence of enthesopathy in such patients. A retrospective clinical and radiological study was conducted in 48 patients (mean age: 34.8 years) 27 of whom had AS, 9 RD and 12 PA. The overall incidence of enthesopathy was 58.3%. Beside the classical calcaneal lesions (50%), extracalcaneal manifestations of the disease involving the knees and shoulders were found in 39% of the patients. The HLA B27 antigen was detected in 87% of patients with enthesopathy, while 82% had clinical inflammation of the spine. The mean duration of clinical symptoms due to enthesopathy was 2-6 weeks in 36% and 6 months to 1 year in 45%. One striking feature of enthesopathy in this series was the lack of response to steroidal and non-steroidal anti-inflammatory drugs contrasting with the response of the associated arthritis. Since enthesopathies appear to be of diagnostic significance in the group of arthropathies of the spine, their incidence in other articular diseases should be the object of systematic comparative evaluations. A diffuse exacerbation of enthesopathy may constitute the initial manifestation of seronegative HLA B27 positive arthropathy, which is not without therapeutic implications.

[A one-year prospective study of disodium etidronate versus 17 beta estradiol in the prevention of postmenopausal osteoporosis]. / Etude prospective versus 17 beta estradiol de l'étidronate disodique en prévention de l'ostéoporose post-ménopausique. Etude sur un an.

This prospective, controlled, nonrandomized, one-year trial in women included less than ten years after menopause was designed to compare the preventive efficacy on postmenopausal bone loss of replacement percutaneous 17 beta estradiol versus intermittent disodium etidronate. Twenty-five patients took oral disodium etidronate in a daily dosage of 200 mg in two-month courses separated by two-month intervals, with 1 g/day elemental calcium. Twenty-three patients used percutaneous 17 beta estradiol in daily dosage of 1.5 mg for the first twenty days of each month, then 20 mg oral dydrogesterone for the remaining ten days. At baseline the two groups were comparable as concerns age, mean time since menopause (5.1 versus 4.3 years), weight, height, and lumbar bone mineral density as measured by dual-photon X-ray absorptiometry. After one year of treatment, in both groups, bone mineral density was unchanged as compared with baseline, whereas serum alkaline phosphatase levels were significantly reduced. In the estrogen group, biochemical markers for bone turnover showed no significant changes, where as in the etidronate group urinary calcium and urinary hydroxyproline were significantly reduced. These data suggest that disodium etidronate is a satisfactory alternative to estrogens for the short-term prevention of postmenopausal bone loss when hormone replacement therapy is contraindicated or refused by the patient and when preventive therapy is warranted on the basis of measurable risk markers.