[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.

[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.

[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.

[Primary hyperparathyroidism. History]. / L'hyperparathyroïdie primaire. Historique.

The term primary hyperparathyroidism currently refers to the clinical and biological manifestations resulting from the hypersecretion of parathyroid hormone by one or several parathyroid adenomas. This entity is a recent one since it goes back to 1925. The clinical picture resulting from this anomaly, were first described as Recklinghausen's fibrous osteitis, which was not justified since Recklinghausen had not established the relationship between the clinical manifestations and the adenoma discovered by Mandl, then under the name of parathyroid osteosis. This term was justified at a time when the disease presented only bony manifestations with biological evidence. Primary hyperthyroidism is the current appellation, demonstrating that the disease is now a biological disease, often discovered systematically, with therapeutic progress, progress in biological identification and possibility of medical forms without mandatory surgical outcome. Bibliographic references accompany the various stages of this historical reminder.

[Arthroscopy of the non-inflamed knee (traumatic or not). Apropos of 500 cases]. / L'arthroscopie du genou non inflammatoire (traumatique ou non). A propos de 500 observations.

Arthroscopy is not a new technique, as it has been in use for more than half a century, but it is now coming of age. On the basis of 500 cases, the authors demonstrate its value in the investigation and treatment of internal derangements of the knee for which it is very often difficult to make an aetiological diagnosis. In the case of meniscectomy, it makes up for the lack of formal reliability of arthrography. It can detect a little known disease: diseases of the synovial reflections and it reveals the incidence of meniscal and ligamentous lesions which often pass unnoticed. In each of these areas; arthroscopy is not only a valuable aid to diagnosis, but also a therapeutic advance in that it allows short stay hospitalization and although, like all forms of surgery, it carries its risks, it seems to be an advance on the techniques used up until now.

[Study of 108 cases of cervico-brachial neuralgia: the concepts of idiopathic cervico-brachial neuralgia and cervico-arthrotic cervico-brachial neuralgia]. / Etude de 108 névralgies cervico-brachiales. Les concepts de névralgie cervico-brachiale idiopathique et de névralgie cervico-brachiale cervicarthrosique.

On the basis of a series of 108 cases of cervicobrachial neuralgia a study was made of the clinical characteristics, circumstances of appearance, associated neurological signs, sequelae, relapses, and aetiologies of these observations. This series permits consideration of the aetiopathogenesis of cervicobrachial neuralgias of rheumatic origin from a new angle. The disco-osteophytic nodule does not appear to play the role classically attributed to it. Three forms are distinguished: idiopathic cervicobrachial neuralgia of transient occurrence with a cyclic duration and little tendency to recurrence and not related to concomitant arthrotic lesions; long-term cervicobrachial neuralgia lasting more than 20 weeks and always requiring a search for narrow canal and root anomaly -sometimes the form of onset of cervicarthrotic myelopathies; cervico brachialgia caused by cervicarthrosis seen after the age of 60 and consisting of projected pain rather than true cervicobrachial neuralgia, often recurrent.

[Value of metrizamide myelography with tomodensitometry for study of the cervical spine]. / Intérêt de la myélographie-métrizamide avec tomodensitométrie, pour l'étude du rachis cervical.

52 metrizamide myelographies practiced with tomodensitometry were studies (23 normal cases); 6 cervicarthrosic myelopathies; 2 intra medullar tumors; 1 extra medullar tumor; 19 syringomyelias). The technical procedures are discussed for the different diseases. This test has proven highly interesting for the study of syringomyelias and tumors. It allows the presence of narrow canals to be demonstrated, but does not yet indicate discal hernias. The role of tomodensitometry, in relation to other exams, is demonstrated.

[Cervical arthrosic myelopathies. Study of a series of 35 cases. Pathogenetic and therapeutic reflections]. / Les myélopathies cervicarthrosiques. Etude d'une série de 35 observations. Réflexions pathogéniques et thérapeutiques.

A series of 35 myelopathies was studied. The clinical characteristics are detailed. Gaseous myelography remains the best contrast test for establishing this diagnosis, making it possible to distinguish between spinal cords with constriction by stages and "trestle spinal cords" these two conditions often seem related. The medical treatments are disappointing, and one can improve the lesional syndrome but rarely the post-lesional syndrome. Surgery by posterior laminectomy gives in the long run only 45 per cent of improvement. On the basis of these observations, the authors state the opinion that the majority of the cases combining a cervicarthrosis and melyopathy after the age of 55, reveal of mixed, vascular and mechanical pathogeny. Surgery appears most useful in young patients whose spinal cord is congenitally constricted and shows sings of clinical distress.

[Osteoid osteoma. 5 cases]. / L'ostéome ostéoïde a propos de cinq observations

With reference to five cases of osteoid osteoma, including two para-articular cases with articular reaction, two cases with neurological manifestations, and one case with a rare costal lesion, the authors demonstrate the difficulty of diagnosis in this disease, which is, in principle, well known. In some cases the observations extended over seven years. The authors also review the literature on this subject.

[Treatment of psoriatic rheumatism]. / Les thérapeutiques du rhumatisme psoriasique.

The authors report on the results of a cooperative study done in collaboration with dermatologists and rheumatologists in order to determine the therapeutic incompatibilities resulting from the co-existence of two diseases, both of unknown cause, namely arthropathies and dermopathies. They make an non exhaustive review of the litearature concerning the different medical or physical methods used. They attempt to outline a therapeutic schema according to the different clinical forms and the more or less large extent of the skin disease.

[Rheumatic manifestations of primary hypogammaglobulinemia in the adult]. / Les manifestations rhumatismales de l'hypogammaglobulinémie primaire de l'adulte

With reference to 27 cases reported in the literature (of which 1 was personal) of primary hypogammaglobulinaemia in adults (PHGGA) with rheumatic manifestations, and following a statistical study, the authors think that the rheumatic manifestations that precede, accompany, or follow primary hypogammaglobulinaemia in adults are not coincidental. These manifestations occur in 10 percent of patients. The clinical and radiological pictures, and the associated infections and immunological disorders form a particular clinical entity and lead to therapeutic difficultires. In this connexion, the authors mention in particular pathogenic problems related to hypogammaglobulinaemia in adults and the rheumatic manifestations.

[Neurosensory complications of Paget's disease]. / Les complications neurosensorielles de la maladie de Paget

The authors made a bibliographic study and report their conclusions with reference to problems concerning a personal series of 17 patients who had undergone an ocular examination, a cranial radiography studying the joint, a bilateral radiotomographic study of the ossicles and of the petrosal bone, an audiogram, and a bilateral electronystagmogram: 1. the rarity of angioid striae, the existence of which, in the view of the authors, does not allow Paget's disease to be included within the framework of the systemized elastorrhexis, 2. the frequency of ocular vascular lesions, 3. deafness is a constant phenomenon, when the cranial arch is affected usually in combination with other lesions ; the deafness is sometimes of transmission or sometimes of perception, but it can precede the cranial lesions. The signs of these can be found radiologically in the chain of ossicles and in the cochlea by means of special projections. The part played by basilar pressure in this deafness is negligible. Labyrinth disorders are rarely met.

[Rheumatic manifestations of Gougerot-Houwers-Sjögren syndrome]. / Les manifestations rhumatismales du syndrome de Gougerot-Houwers-Sjögren.

The authors retrospectively survey the concept of the Gougerot-Houwers-5jögren syndrome which links articular disease with the "dry" syndrome (pharyngitis sicca) and then go on to study the rheumatic conditions found in the Gougerot-Houwers-Sjögren syndrome. They point out that the association between the "dry" syndrome and rheumatic appearances varies in frequency according as whether the problem is seen from a rheumatological, dermatological, ophthalmological or stomatological point of view. They establish the frequency of the various rheumatic conditions, stressing the importance of the association with rheumatoid polyarthritis. They study the associated biological and visceral backgrounds, the thyroid, renal, digestive, blood, neural, allergic and immunological conditions and describe the rheumatic appearances of the other collagenoses associated with the "dry" syndrome. They conclude with the current difficulty of restricting the scope of the Gougerot-Houwers-Sjögren syndrome when histological and scintigraphic techniques have broadened it. They would like to see exact criteria adopted to define this syndrome.

[Cases of acute leukaemia following immunosuppressive therapy for disseminated sclerosis and for Behçet's syndrome (author's transl)]. / Leucémies aiguës survenues au décours d'une maladie de Bechçet et d'une sclérose en plaques traitées par immunosuppresseurs.

On the basis of two personal cases of acute leukaemia occurring following immunosuppressive therapy for disseminated sclerosis and for Behçet's syndrome, the literature is reviewed. Thirty three similar detailed cases were collected. They are characterised in general by the prolonged use of immunosuppression. The acute leukaemia affected the granulocyte series in the majority of cases. In 30%; the leukaemia was preceded by a phase of several months of preleukaemic type dysmyelopoiesis. The mechanisms of action explaining this carcinogenic risk in a general way are multiple: the role of marrow aplasia, chromosomal abnormalities, the activation of a leukaemogenic virus, the role of immunodepression and that of repeated antigenic stimulation may all be discussed. The risks associated with such treatment should thus be borne in mind when evaluating its indications.

[Acute leukaemias after treatment using cytotoxic agents for rheumatological purpose. 19 cases among 2006 patients(author's transl)]. / Leucémies aiguës après traitement par agents cytotoxiques en rhumatologie. 19 observations chez 2006 patients.

The authors undertook a retrospective study to determine the number of acute leukaemias developing amongst 2006 patients suffering from chronic inflammatory rheumatic conditions and connective tissue disorders, treated with cytotoxic agents. The follow-up period ranged from 1 to 13 years. Nineteen leukaemias were found, essentially granulocytic, with a latent period of 5.7 +/- 2, 8 years after the beginning of treatment. This incidence of almost 1% of leukaemias is probably less than the actual percentage since a number of patients were lost on follow up and since the period of observation is as yet too short. The majority of patients has been treated for more than one year. No cases were seen amongst patients treated for less than six months, or with less than 1g of chlorambucil or 50 g of cyclophosphamide. The risk would seem to be the same for both alkylating agents. No patients treated with azathioprine developed leukaemia, but few patients received this drug. Amongst 35 patients treated for severe psoriatic arthropathy with chlorambucil, 4 developed leukaemia. This particularly high percentage is such that all trials of alkylating agent in this condition should be stopped. The prevalence of leukaemia seen in the series as a whole is comparable to that found in mass studies carried out in various malignant diseases treated by cytotoxics. Awareness of this risk should, lead to even stricter limitations before the use of cytotoxic drugs in rheumatological conditions.

[Fibroblastic rheumatism. A clinical and histological entity]. / Le rhumatisme fibroblastique. Une entité clinique et histologique.

In 1980 was described for the first time a disease which seemed unknown until then. From that time three cases have been published. The current study summarizes their common characteristic, combining joint involvements to nodular-type involvements to systemic involvement, i.e. a specific histology. This entity has been named fibroblastic rheumatism. Nosologically, it is situated between juvenile fibroblastoses without joint involvement and with nodules, and adult sclerodermis with joint and systemic involvement without nodules.

[HLA markers and periodic disease [familial Mediterranean fever (F.M.F.)] (author's transl)]. / Marqueurs HLA chez les sujets atteints de maladie périodique (fièvre familiale méditerranéenne).

Thirty-one unrelated patients, 15-52 years old, were typed by microlymphocytotoxicity for 27 alleles of the HLA system. In addition, 12 families including 1 or more patient were also analysed. This criteria for diagnosis were those of Sohar et all. (Am. Intern. Med., 1967, 43, 227-253). All patients were of Israelite-Sephardin origin except two (Armenian and French); they were from North-Africa (Tunisia, Morocco and Algeria) and Israël. The results were compared to the antigen frequencies of 3 reference normal populations. The frequencies of the studied alleles do not differ from those of controls, except for HL-A28 and B14 slightly increased when compared to the normal frequencies. The study of 7 families with at least two sibs suffering from FMF shows a random distribution of the genotypes : 2 HLA identical, 6 different and 10 haploidentical diseased sibs. This distribution differs significantly (p less than 0.01) from that expected in the case of a recessive inheritance. These data do not support the hypothesis of a linkage between genes controlling FMF and HLA genes.