ABSTRACT
We studied 5 patients (aged 8 to 18) presenting chronic calcipenia with hyperphosphatemia and an increase in C terminal-specific immunoreactive parathyroid hormone. Systematic radiography of the hands revealed 2 cases with signs of subperiosteal resorption characteristic of hyperparathyroidism and 2 cases of cortical fibrillation. These cases were monitored by measuring phosphate levels in the urine after injection of parathyroid hormone (Ellsworth-Howard test), by determining urinary elimination of cyclic AMP after injection of parathyroid hormone (Chase-Aurbach test) and by assaying cyclic AMP levels in the plasma after intravenous administration of parathyroid hormone (Tomlinson-Hendy test). These 3 measurements revealed no changes upon injection of parathyroid hormone, even after administration of vitamin D, thus suggesting renal resistance to parathyroid hormone. The absence of cyclic AMP secretion is suggestive of perturbation of the membrane receptor. Histomorphometric study of the bones showed an increase in resorption and osteoid areas and in the relative osteoid volume without modification of osteoid thickness, which is very suggestive of an effect of parathyroid hormone on the bone. Pseudohypoparathyroidism was, then, characterized by renal resistance to parathyroid hormone and an effect of the latter on bone cells.
Subject(s)
Bone and Bones/pathology , Parathyroid Hormone/physiology , Pseudohypoparathyroidism/pathology , Adolescent , Bone and Bones/drug effects , Child , Female , Humans , Male , Parathyroid Hormone/pharmacology , Pseudohypoparathyroidism/physiopathology , Pseudohypoparathyroidism/urineABSTRACT
An anterolateral cervical epidural abscess occurred in the course of a septicaemia caused by Staphylococcus aureus. Early diagnosis, before permanent neurological signs developed, was provided by CT scan without myelography. Total recovery occurred with antibiotic therapy alone.
Subject(s)
Abscess/diagnostic imaging , Spinal Diseases/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Abscess/drug therapy , Acute Disease , Aged , Anti-Bacterial Agents/therapeutic use , Epidural Space , Female , Humans , Immobilization , Spinal Diseases/drug therapy , Staphylococcal Infections/drug therapy , Tomography, X-Ray ComputedABSTRACT
The first part of the article is a general review of the various drug treatments available for algodystrophy : purely symptomatic, analgesic treatment, vaso-active drugs, calcitonin. The major advance over the last few years has been the use of beta-blockers and calcitonin but, to date, only one double blind trial has been published. This study demonstrated the value of calcitonin after one month of treatment. The authors undertook a retrospective study of 651 cases and a prospective study of 91 cases and based their work on the evaluation of various treatments prescribed separately examining each therapeutic sequence rather than each individual case. Three treatments stood out by their frequent use : griseofulvin, calcitonin and beta-blockers. Each of these drugs was effective in more than 60 p. cent of cases. It is impossible, in such a study, to formulate a hierarchy of the various treatments. Only controlled studies will be able to establish their order of effectiveness. The results vary somewhat according to the site of the algodystrophy. The best therapeutic response is obtained in lesions involving the hip leading to a very favourable prognosis.
