[Scintigraphic study of reflex algodystrophy]. / Etude scintigraphique des algodystrophies réflexes.

Isotope investigation of reflex sympathetic dystrophy is not limited to an evaluation of bony up-take, it also includes examination of the early dynamic scintigraphy of the vessels. The late views of bone scans reflect, above all, the bone's affinity for phosphate complexes i.e. the degree of osteoblast activity. Generally, dystrophies, independent of their site, show increased locoregional uptake, often quite intense, which appears early in the course of the disease. This supports histopathological findings. There are several advantages in using the bone scan in the investigation of reflex dystrophy: early diagnosis before the development of radiological signs, precise evaluation of the local extension of the dystrophic process and detection of the incidence of multifocal forms, follow-up of the course of the disease, definition of new clinical forms: patchy algodystrophy partial, decalcifying dystrophy, sub-radiological dystrophy, the aetiology in certain sites (especially the hip). Early dynamic scans that dystrophy is accompanied by an increase in the vascular compartment and decreased circulatory flow, a sign of the local stage of the disease. There is also an increase of the interstitial compartment, greater than that of the vascular compartment, explaining the presence of edema. The pathophysiological information gained from dynamic studies is matched by the therapeutic information: evaluation, or even prediction, of the effect of a given drug (cortisone, calcitonin).

[Hodgkin's disease with muscular involvement. 2 cases (author's transl)]. / Maladie de Hodgkin avec atteinte musculaire. 2 observations.

The authors report on two cases of Hodgkin's disease with muscular involvement. This exceptional complication occurred during the terminal phase of a stage IV disease in one case and during remission of a stage III disease in the other case, where it responded to combined chemotherapy. Muscular lesions in Hodgkin's disease may be due to extension from adjacent tissues or from dissemination through the blood stream. They do not necessarily indicate a more severe prognosis.

Multiple myeloma after phenytoin therapy.

We report a case of multiple myeloma in a 48-year-old woman treated with phenytoin for 55 months. This association may be fortuitous. The depressive effect of phenytoin on the immune responses, however, could account for the occurrence of the dysglobulinaemia. This case points out the need for periodic examination of serum proteins in patients chronically treated with hydantoin derivatives.

[Bone scintigraphy: diagnostic value and indications (author's transl)]. / La scintigraphie osseuse: sa valeur diagnostique, ses indications.

Bone scintigraphy is of considerable help in the diagnosis and follow-up of osteo-articular diseases. It also makes it possible to globally assess skeletal damage in cases with multiple bone lesions and to detect bone complications of diseases and therapies. To these advantages must now be added its contribution to the aetiological diagnosis of some arthropathies with subradiological lesions.

[Extraskeletal uptake in bone scintigraphy]. / Les fixations extra-squelettiques en scintigraphie osseuse.

Interpretation of a bone scan requires perfect knowledge not only of normal appearances and of the various methods of expression of bony lesions but also of normal or pathological extra-skeletal uptakes which can : (1) be a source of interpretation owing to their superposition with a bony segment. (2) provide useful further information directly linked to the bony disorder studied. (3) permits the unexpected discovery of lesions of the soft tissues. A careful clinical examination of the patient, and knowledge of the whole of the history permits one to explain most of the scanning abnormalities observed.

Radionuclide imaging in hip abnormalities.

The uptake of Tc-99m-diphosphonate was studied topographically and quantitatively on 258 diseased hips. For many diseased hips, bone scintigraphy provides items of information that complement the clinical, radiological, and biological data, with which it should always be compared. The localization, extent, and intensity of the uptake differ greatly according to the hip disorder studied, and depend not only on the cause of the lesion but also on its stage of evolution. Bone scintigraphy can shed light on the etiologic diagnosis of a painful hip at the beginning of its evolution, before definite roentgenographic signs appear, thanks to some very precise characteristics of the uptake, this is the case for transient osteoporosis of the hip, aseptic osteonecrosis, Legg-Perthes disease, early arthritis of the hip joint, and stress fractures of the femoral neck or of the pubic rami.

[Pericarditis as the presenting manifestation of acute monoblastic leukemia-Report of a case and review of the literature (author's transl)]. / Péricardite inaugurale d'une leucémie aiguë monoblastique. Description d'un cas et revue de la littérature.

A case of acute monoblastic leukemia in a 68-year-old man is reported in which one of the presenting manifestations was a pericardial effusion. A blood-stained fluid was removed from the pericardium. The pericardial fluid showed blast cells on microscopical examination. The patient was treated with 6-Mercaptopurine and Methotrexate and achieved a short partial remission. He died of general infection, 4 months after the start of his illness. We found in the medical literature 30 additional cases with a mean age of 24 +/- 16 years and a striking male predominance (68. p. 100). We found 15 acute lymphoid leukemias, 9 acute myeloid leukemias, 4 acute indifferentiated leukemias, and 2 acute nontyped leukemias. The leukemic pericardial involvement is often associated with splenomegaly, adenopathy and pleural effusion. The management procedures include pericardiocentesis, general of local chemotherapy, irradiation of the cardiac area. The prognosis is generally poor, with a mean survival of 5 months.

Acute leukaemia after prolonged chlorambucil treatment for non-malignant disease: report of a new case and literature survey.

A case of acute myeloblastic leukaemia is reported in a patient treated with chlorambucil during 72 months for multiple sclerosis. In a review of the medical literature, 43 additional reports of acute leukaemia after chlorambucil therapy for non-malignant diseases were found. Most cases are of a non-lymphoid type and preceded by various blood and bone marrow abnormalities. The prognosis is poor with a short survival. The risk of developing acute leukaemia after long-term immunosuppressive treatment with chlorambucil is emphasized.

The diagnostic value of 99m Tc-diphosphonate bone imaging in transient osteoporosis of the hip.

We present topographic and quantitative studies of 99m Tc-diphosphonate bone scans from 46 patients and 25 control subjects in which we found transient osteoporosis of the hip (TOH) (12 cases--2 bilateral), early aseptic osteonecrosis of the femoral head (19 cases--2 bilateral), early coxitis (11 cases), and stress fracture of the femoral neck (4 cases). Active TOH was characterized by intense, homogeneous increased uptake of the entire femoral head, extending to the acetabulum and the neck, and sometimes to the shaft. The scintigram of TOH differed greatly from that in the other hip disorders studied. Bone scintigraphy can help to diagnose the cause of pain in a hip before definite roentgenographic signs appear.

[Scintigraphic characteristics of coxopathies: etiologic importance]. / Caractéristiques scintigraphiques des coxopathies leur valeur étiologique.

Morphological and quantitative studies of the uptake of diphosphonates labelled with technetium 99m were done on 179 pathological hips : 106 aseptic osteonecroses of the femoral head, including 20 at an early stage, 11 algodystrophias (transitory osteoporoses of the hip), 20 coxarthrosis, 16 cases of Paget's disease, 12 isolated malignant lesions of the femoral neck. The location, extent and intensity of the uptake are very variable and depend not only on the etiology of the lesions but also on their stage of evolution. Bone scintigraphy provides, for numerous pathological hips, pieces of information which complete the results of the clinical, radiological and biological study, with which it should always be compared. It can shed light on the etiologic diagnosis of a painful hip at the beginning of its evolution, before the appearance of rare x-ray signs, thanks to certain very precise characteristics of the labelling. This is the case for algdystrophias, osteonecroses, coxitis and strain fractures of the femoral neck.