RESUMEN
OBJECTIVE: Evaluation of the efficacy and safety of a single oral dose of a 1200 mg sachet of chondroitin 4&6 sulfate (CS 1200) vs three daily capsules of chondroitin 4&6 sulfate 400 mg (CS 3*400) (equivalence study) and vs placebo (superiority study) during 3 months, in patients with knee osteoarthritis (OA). DESIGN: Comparative, double-blind, randomized, multicenter study, including 353 patients of both genders over 45 years with knee OA. Minimum inclusion criteria were a Lequesne index (LI) ≥ 7 and pain ≥ 40 mm on a visual analogue scale (VAS). LI and VAS were assessed at baseline and after 1-3 months. Equivalence between CS was tested using the per-protocol procedure and superiority of CS vs placebo was tested using an intent-to-treat procedure. RESULTS: After 3 months of follow-up, no significant difference was demonstrated between the oral daily single dose of CS 1200 formulation and the three daily capsules of CS 400. Patients treated with CS 1200 or CS 3*400 were significantly improved compared to placebo after 3 months of follow-up in terms of LI (<0.001) and VAS (P < 0.01). No significant difference in terms of security and tolerability was observed between the three groups. CONCLUSION: This study suggests that a daily administration of an oral sachet of 1200 mg of chondroitin 4&6 sulfate allows a significant clinical improvement compared to a placebo, and a similar improvement when compared to a regimen of three daily capsules of 400 mg of the same active ingredient.
Asunto(s)
Sulfatos de Condroitina/administración & dosificación , Osteoartritis de la Rodilla/tratamiento farmacológico , Dolor/tratamiento farmacológico , Administración Oral , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Resultado del TratamientoRESUMEN
To appreciate hyperlipidaemia as a contributing factor to reflex sympathetic dystrophy (RSD), we have evaluated basal lipidic values (cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A1, B) and frequency of hypertriglyceridaemia (Turpin's diagnosis criteria) in 75 cases of RSD and in 75 paired controls. No difference exists in both groups with regard to frequency of hypertriglyceridaemia or basal lipidic values. These values seem independent of age, sex, duration of localization or etiology (traumatic or nontraumatic) of RSD. Hyperlipidaemia does not seem a contributing factor to RSD.
Asunto(s)
Hiperlipidemias/complicaciones , Distrofia Simpática Refleja/etiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Hipertrigliceridemia/complicaciones , Lípidos/sangre , Masculino , Persona de Mediana Edad , Distrofia Simpática Refleja/sangre , Distrofia Simpática Refleja/complicacionesRESUMEN
Five-hundred-thirteen regional intravenous guanethidine blocks were carried out in 125 cases of algodystrophy (118 adults), after failure of other treatments in 120 cases (Group I) and without previous treatments in 5 (Group II). A positive result occurred in 85 cases of Group I (71%) and in the 5 cases of Group II, after 4.5 +/- 1.7 blocks. In Group I the results did not differ significantly between upper (33 cases) and lower (87 cases) limb or in regard to sex, age, duration of disease, nature of previous treatments. The presence of psychic disorders was accompanied by less frequent (p less than 0.02) positive results. The tolerance was satisfactory in 85.6% of cases: 22 moderate side effects authorized a continuation of the blocks, 22 serious ones indicated interruption, especially one case of thrombophlebitis and another one of very transitory acute ischaemia. The risk of intolerance was significantly raised (p less than 0.02) by age. The regional guanethidine blocks seemed to be a good treatment for algodystrophy after failure of other treatments.
Asunto(s)
Guanetidina , Bloqueo Nervioso , Distrofia Simpática Refleja/terapia , Adulto , Anciano , Envejecimiento/fisiología , Estudios de Evaluación como Asunto , Extremidades/irrigación sanguínea , Femenino , Guanetidina/administración & dosificación , Guanetidina/efectos adversos , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Distrofia Simpática Refleja/fisiopatología , Caracteres SexualesRESUMEN
We report a case of an immunocompetent man who developed primary spinal intramedullary malignant lymphoma. This condition occurs in about 0.9 p. 100 of primary central nervous system non-Hodgkin lymphomas in non-AIDS patients. Magnetic resonance imaging was nonspecific but suggestive. Like the brain localization, prognosis is poor. Because of the high frequency of recurrence, usually confined to the central nervous system with neuraxis dissemination, treatment must be delivered to the entire neuraxis. But more effective treatment strategies with radiotherapy-chemotherapy combinations will be needed. Feasibility and toxicity patterns remain to be determined.
Asunto(s)
Seronegatividad para VIH , Linfoma no Hodgkin/patología , Neoplasias de la Médula Espinal/patología , Encéfalo/patología , Terapia Combinada , Medios de Contraste , Resultado Fatal , Gadolinio DTPA , Humanos , Linfoma no Hodgkin/terapia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias de la Médula Espinal/terapia , Vértebras TorácicasRESUMEN
PURPOSE: To report magnetic resonance imaging abnormalities in reflex sympathetic dystrophy of the foot. METHODS: Retrospective study of 22 algodystrophies of the foot, in warm phase in 17 cases, in cold phase in 5. RESULTS: Algodystrophy in warm phase: Bone medullary abnormalities were noted in 17 cases (decrease of signal intensity was found in T1 weighted images, increase of signal intensity in T2 weighted images, in T1 and T2 with fat-saturation, in T1 with gadolinium), located at the increased uptake technetium site in 16 cases. T1 and T2 weighted images with fat-saturation and T1 with fat-saturation after injection of gadolinium were pathological in all cases, T1 was normal in 2 cases. Soft tissues abnormalities were noted in 11 cases, joint effusion in 8 cases, synovial hypertrophy enhanced by gadolinium in 2 cases and a subchondral linear area of hypointense signal on T1 and T2 images was not present after gadolinium injection in 1 case. Six fractures were detected. Algodystrophy in cold phase: no bone edema, no synovial hypertrophy, no joint effusion, no soft tissues abnormalities, no fractures are detected. CONCLUSION: The results suggest that the MRI has a considerable value in diagnosis during the warm phase of reflex sympatetic dystrophy of the foot. The normal MRI findings during the cold phase could be important to understand its etiology.
Asunto(s)
Enfermedades del Pie/diagnóstico , Imagen por Resonancia Magnética , Distrofia Simpática Refleja/diagnóstico , Adulto , Enfermedades de la Médula Ósea/diagnóstico , Edema/diagnóstico , Femenino , Enfermedades del Pie/fisiopatología , Traumatismos de los Pies/diagnóstico , Fracturas Óseas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Distrofia Simpática Refleja/fisiopatología , Estudios Retrospectivos , TemperaturaRESUMEN
Non-steroid anti-inflammatory drugs and/or gold salts were unsuccessful alone in providing symptom relief in three men with rheumatoid psoriasis. All three were treated with bromocriptine (5 mg/d in 2 doses) after verification of normal baseline and protirelin-stimulation prolactin levels. There was a beneficial effect in nocturnal pain relief, morning stiffness, the Lee and Ritchie scores and biological markers of inflammation. Two of the patients were able to return to regular work occupation after 15 and 45 days. In the third patient, bromocriptine was discontinued due to nausea and dizziness but was reintroduced successfully in fractionated doses after recurrence of the symptomatology. Treatment was continued without secondary adverse effects for 3 to 9 months providing continued symptom relief. Bromocriptine can be an effective adjuvant for the management of rheumatoid psoriasis.
Asunto(s)
Artritis Psoriásica/tratamiento farmacológico , Bromocriptina/uso terapéutico , Antagonistas de Hormonas/uso terapéutico , Adulto , Humanos , Masculino , Persona de Mediana Edad , Calidad de VidaRESUMEN
The distribution of alpha-1-antitrypsin phenotypes was similar in 555 controls and 98 patients with ankylosing spondylitis: the MM phenotype (including "main" MM subtypes, i.e., M2M2 and M3M3, and "secondary" MM subtypes) was found in 86% of subjects and "rare" phenotypes combining M, F, S, and Z in 14%. Six per cent of the controls and none of the ankylosing spondylitis patients had the M4M4 phenotype (p < 0.01). Respiratory function tests were performed in 49 patients with axial ankylosing spondylitis and 30 controls matched on sex, age, body mass index, smoking status, nonsteroidal antiinflammatory drug use and distribution of "main" and "secondary" phenotypes (no subjects in this study had "rare" phenotypes); the significant reduction in chest expansion seen in the ankylosing spondylitis group (5.6 +/- 2.7 cm versus 8.7 +/- 1.2; p < 0.001) was correlated with total capacity (p < 0.04) and vital capacity (p < 0.001). Restrictive ventilatory dysfunction was seen in four ankylosing spondylitis patients versus no controls (p < 0.02). Proximal airway obstruction, pulmonary distension and decreases in the diffusing capacity for carbon monoxide were seen in similar proportions of ankylosing spondylitis patients and controls. In the ankylosing spondylitis group, evidence of pulmonary distension included increases in mean residual functional capacity and mean residual volume (105.6 +/- 21.2% versus 94.8 +/- 17.4, p < 0.03, and 100.3 +/- 22.8% versus 88.6 +/- 17.9, p < 0.04, respectively) and bullous emphysema in the lung bases in two patients (versus no controls). In the small subgroup of ankylosing spondylitis patients with lung distension or a decreased diffusing capacity for carbon monoxide, smokers and nonsmokers were evenly balanced but subjects with "secondary" phenotypes outnumbered those with "main" phenotypes (p < 0.02); in contrast, our data suggested that smoking may play the central role in the proximal airway obstruction. Our findings suggest that in addition to previously established causes of pulmonary involvement in ankylosing spondylitis a "secondary" MM phenotype (i.e., neither M2M2 nor M3M3) may be a risk factor for lung distension and impaired diffusing capacity for carbon monoxide.
Asunto(s)
Trastornos Respiratorios/etiología , Fumar , Espondilitis Anquilosante/complicaciones , alfa 1-Antitripsina/genética , Adulto , Heterocigoto , Homocigoto , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Trastornos Respiratorios/fisiopatología , Pruebas de Función Respiratoria , Fumar/efectos adversos , Espondilitis Anquilosante/genética , Espondilitis Anquilosante/fisiopatología , Factores de Tiempo , alfa 1-Antitripsina/clasificaciónAsunto(s)
Artritis Reactiva/sangre , Hiperprolactinemia/sangre , Prolactina/análisis , Hormona Liberadora de Tirotropina/administración & dosificación , Adulto , Artritis Reactiva/etiología , Humanos , Hiperprolactinemia/complicaciones , Masculino , Persona de Mediana Edad , Valores de Referencia , Espondilitis Anquilosante/sangreRESUMEN
The authors report three cases of migratory algodystrophy of the knee. Repeated isotope bone scan, CT scan and nuclear magnetic resonance were used to monitor the movement in situ of the pathophysiological process of algodystrophy. In one case, CT scan revealed localised hypertrophy of the soft tissues located immediately over the bone lesions.
Asunto(s)
Rodilla , Imagen por Resonancia Magnética , Distrofia Simpática Refleja/diagnóstico , Adulto , Anciano , Humanos , Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Cintigrafía , Distrofia Simpática Refleja/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The effect of L-Thyroxine suppressive therapy (207.3 +/- 46.1 mcg/d) on lumbar spine bone density (BMD) was assessed in 51 patients thyroidectomized for carcinoma since 1 to 19 years (mean = 6 +/- 5.4 years); the bone densities of these patients were compared with those of 51 age sex weight-matched control subjects. Trabecular bone density was evaluated by single energy quantitative tomography. The vertebral BMD was not significantly different between the patients receiving suppressive doses of L-T4 and the control group (162.8 +/- 40.4 vs 162.7 +/- 39.8 mg/cm3). We found no relationship between the duration of L-Thyroxine therapy and BMD. Thus, doses of L-T4 sufficient for suppressing plasma thyroid stimulating hormone but no high enough for causing biochemical thyrotoxicosis have no harmful effect on trabecular bone mineral density.
Asunto(s)
Carcinoma Papilar/tratamiento farmacológico , Carcinoma Papilar/fisiopatología , Neoplasias de la Tiroides/tratamiento farmacológico , Neoplasias de la Tiroides/fisiopatología , Tiroxina/uso terapéutico , Adulto , Densidad Ósea/efectos de los fármacos , Femenino , Humanos , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Tiroxina/farmacologíaRESUMEN
Alpha-1-antitrypsine (AAT) plasmatic level is higher (p less than 0.01) in 85 chronic inflammatory arthropathies than in 238 non inflammatory arthropathies (2.5+/0.7 versus 2.1+/0.4 g/l). Among 15 rheumatoid arthritis (RA) with evaluated phenotype, alleles M2 are less frequent and M3 more frequent than in 22 non inflammatory arthropathies (p less than 0.02). Some abnormal phenotype are observed: M2Z (AAT = 1.7) without pulmonary involvement (1 RA); M3S in 2 seronegative spondylarthropathies (1 pulmonary involvement without tobacco intoxication: DLCO/VA: 69% of theoric value; AAT = 1.4); ZZ in a systemic lupus erythematosus with panlobular emphysema and hepatic cirrhosis (AAT = 0.4). An AAT deficiency could explain some pulmonary involvements in chronic inflammatory arthropathies.
Asunto(s)
Artritis/sangre , Enfermedades Reumáticas/sangre , Deficiencia de alfa 1-Antitripsina , Adulto , Artritis/complicaciones , Artritis/fisiopatología , Enfermedad Crónica , Femenino , Humanos , Artropatías/sangre , Artropatías/fisiopatología , Enfermedades Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Fenotipo , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/fisiopatologíaRESUMEN
The aim of the present study is the evaluation two years apart of the effect of initial blood pressure values on ambulatory blood pressure determinations on the rise of microalbuminuria in 77 Type 1 diabetic patients. At the beginning of the study, subjects with incipient nephropathy have a whole day systolic and diastolic blood pressure greater than those whose microalbuminuria is below than 30 mg/24 h (127.7 +/- 15.1 mmHg versus 115 +/- 14.3 mmHg, p < 0.001; 76.6 +/- 8.1 mmHg versus 72.5 +/- 7.3 mmHg, p < 0.05). Among patients whose initial microalbuminuria was lower than 30 mg/24 h, incipient nephropathy will not be dependent on initial blood pressure values but conditioned by patients' age and duration diabetes of mellitus. On the other hand, blood pressure increases the microalbuminuria of the patients who had incipient nephropathy at the beginning of the study. In patients with diabetes mellitus, ambulatory blood pressure monitoring appreciates the impact of the pressure rise on the kidney, retina and heart.
Asunto(s)
Albuminuria/etiología , Presión Sanguínea/fisiología , Diabetes Mellitus Tipo 1/fisiopatología , Adulto , Anciano , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/orina , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Microquímica , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We report 16 cases of epiphyseal metatarsal stress fractures in 11 patients. Four patients had osteoporosis and two of these four were under fluoride therapy. Three of the fractures occurred upon resumption of weight-bearing. The fractures were distributed over the five rays; seven fractures were located to the second metatarsal. Manifestations were acute focal metatarsal pain, diffuse edema of the forefoot and inflammatory metatarsophalangeal arthropathy. Delayed, transient visualization of a linear area of epiphyseal sclerosis occurred in 14 cases. Radionuclide bone scans consistently showed early accumulation of the tracer in the metatarsal head. The focus of increased activity extended to the shaft in three cases. The main differential diagnoses are second ray syndrome, metatarsophalangeal arthritis, focal radial reflex sympathetic dystrophy of the foot and osteonecrosis of the metatarsal heads. The clinical and roentgenographic outcome was consistently favorable after one month without weight-bearing. These fractures can simulate, complicate, induce (two cases), reflex sympathetic dystrophy of the foot or occur concomitantly with (two cases).
Asunto(s)
Epífisis/lesiones , Fracturas por Estrés/diagnóstico , Huesos Metatarsianos/lesiones , Anciano , Anciano de 80 o más Años , Enfermedades Óseas/complicaciones , Enfermedades Óseas/diagnóstico , Diagnóstico Diferencial , Femenino , Enfermedades del Pie/complicaciones , Enfermedades del Pie/diagnóstico , Fracturas por Estrés/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Diffuse uniform vertebral osteosclerosis in vertebra affected by osteoporotic crush fracture, without osteonecrosis is reported. Multiple fissure-fractures were seen upon magnetic resonance imaging.
Asunto(s)
Osteoporosis/complicaciones , Osteosclerosis/etiología , Enfermedades de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/etiología , Anciano , Femenino , Fracturas Espontáneas/etiología , Humanos , Imagen por Resonancia MagnéticaRESUMEN
Plasma levels of cholesterol, triglyceride, HDL-cholesterol, and apolipoproteins A1 and B were assayed in ninety patients (sixty-four male and twenty-six female) with reflex sympathetic dystrophy and in ninety controls matched for age, sex, and body mass index (BMI). No significant differences were found between the two groups for the proportions of patients with increased plasma cholesterol levels (6.6% versus 4.4%) or increased plasma triglyceride levels (40% versus 30%), as defined by Turpin's age and sex-specific criteria, or for mean values of these parameters. In the 38 patients with reflex sympathetic dystrophy of less than 3.5 months duration, plasma triglyceride levels were significantly higher than in the 38 matched controls (1.24 + 0.57 g/l versus 1.02 +/- 0.91; p = 0.04). In patients (n = 52) with disease of more than four months duration (range 4-39), plasma triglyceride levels were similar in the two groups. Lipidemia was similar in patients and controls regardless of age, sex, topography of the disease, clinical manifestations, and whether or not the disease was due to an injury. This study, in contrast to previous reports, failed to disclose an association between reflex sympathetic dystrophy and hyperlipidemia. Transient hypertriglyceridemia may occur during the first 3 1/2 months of the disease as a result of initial immobilization.
Asunto(s)
Lípidos/sangre , Distrofia Simpática Refleja/sangre , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas , Femenino , Humanos , Hipercolesterolemia/epidemiología , Hipertrigliceridemia/epidemiología , Metabolismo de los Lípidos , Masculino , Persona de Mediana Edad , Distrofia Simpática Refleja/complicacionesRESUMEN
Prolactin radioimmunoassay was carried out before and 15, then 30 min after intravenous infusion of protireline (0.2 mg) in 3 groups of male patients: 7 with reactive arthritis (HLA B27: 6; age: 25 +/- 6.3 yr), 13 with ankylosing spondylitis (HLA B27: 11; age: 33.2 +/- 14.7 yr), 5 with psoriatic arthritis (HLA B27: 1; age: 28.8 +/- 6.3 yr). The same test was carried out in sex-age-body mass index matched controls. Only the patients with reactive arthritis presented dynamic hyperprolactinaemia 15 and 30 min after protireline infusion and none of ankylosing or psoriatic arthritis groups. A complete failure of bromocriptine was observed in reactive arthritis. In 2 cases of psoriatic arthritis, adding bromocriptine to gold salts and nonsteroidal anti-inflammatory drug was followed by a drastic efficacy with spectacular improvement in clinical, biological and occupational status. Because none of the cases had hyperprolactinaemia, bromocriptine acted probably had an intrinic anti-inflammatory effect independent of its antiprolactinic effect.