[Salivary nitrates. New perspectives concerning the physiological function of saliva]. / Les nitrates salivaires. Nouvellesperspectives concernant les fonctions physiologiques de la salive.

For many years, nitrate ions have been thought to be "toxic agents", but scientific reality seems very different. The source of nitrate ions is double: exogenous and endogenous, and the metabolism of nitrates is partly salivary. The strong concentration of nitrate ions in saliva has many beneficial physiological effects. Salivary nitrate has anti-infectious effects on the oral cavity and all along the digestive tract. They give cardiovascular protection, are instrumental in the adaptive relaxation of the stomach by acting on smooth stomach muscles and have a protective action on the gastric mucosa.

Septic arthritis of lumbar facet joints. A review of six cases.

Hematogenous infection of the facet joints by pyogenic organisms is exceedingly rare. We report six cases of lumbar facet joint septic arthritis due to hematogenous spread of a pyogenic organism. A review of the literature identified ten anecdotal reports of similar cases. An analysis of these 16 cases showed that the diagnosis was based mainly on imaging study findings and that clinical data failed to discriminate between facet joint septic arthritis and infectious discitis. Increased uptake on the radionuclide bone scan was an early finding and the pattern of uptake was different from that seen in discitis. Computed tomography was the investigation that best delineated the facet joint lesions. Magnetic resonance imaging of the lumbar spine was superior over computed tomography in demonstrating spread of the infection to the epidural space and/or soft tissues and in some instances demonstrated enhancement of the infected facet joint on T1 images after gadolinium injection. Aspiration of the facet joint under fluoroscopic guidance was required only when blood cultures were negative or when the diagnosis of the septic nature of the arthritis was in doubt. Blood cultures yielded a Staphylococcus aureus in the six cases in our series. Appropriate antimicrobial therapy was successful in most cases. In our series, four of the six patients had posterior epiduritis, pyomyositis, or an abscess in the paraspinal muscles or psoas muscle, suggesting that some epidural infections or psoas muscle abscesses believed heretofore to be primary may in fact be complications of facet joint septic arthritis. Facet joint septic arthritis is a new aspect of pyogenic spinal infections that deserves to be considered in patients with febrile spinal syndromes not explained by discitis.

[The risk/benefit ratio of low-dose cyclosporin in the treatment of severe rheumatoid arthritis]. / Etude du rapport efficacité/tolérance de la ciclosporine à faibles doses dans le traitement de la polyarthrite rhumatoide sévère.

Although the efficacy of cyclosporine therapy in rheumatoid arthritis has been established, there have been no long term studies of the risk/benefit ratio of cyclosporine A in severe rheumatoid arthritis. A prospective, open-label one-year study included 106 patients (83 women and 23 men; mean age 53 years; mean disease duration, 11 years) with rheumatoid arthritis. Mean number of previous second-line treatments was four and 69% of patients had failed methotrexate therapy. The initial dosage of cyclosporine was 3 mg/kg/d and was increased if needed up to 5 mg/kg/d. The dosage was reduced in the event of serum creatinine elevation (by more than 30% versus baseline) or diastolic blood pressure elevation (above 95 mmHg). The statistical analysis was performed on an intention-to-treat basis. In the 45 patients who completed the one-year study period, the mean dosage was 3.6 +/- 1 mg after six months and 3.3 +/- 1 mg/kg/d after one year. Significant improvements were seen in all the clinical efficacy parameters. The mean reduction in corticosteroid dosage was 0.5 mg/d. The study drug was discontinued prematurely in 61 patients (36 because of adverse events and 21 because of inefficacy). Twelve of the 56 patients with serum creatinine level elevation on at least one occasion and seven of the 35 patients with diastolic blood pressure elevation were taken off the study drug.

Intraosseous fat necrosis and metaphyseal osteonecrosis in a patient with chronic pancreatitis: MR imaging and CT scanning.

Necrosis of fatty bone marrow is an unusual complication of several pancreatic disorders. We describe a patient with polyarthritis, sterile subcutaneous abscess and osteolysis arising during the course of alcoholic chronic pancreatitis. MR images of one knee showed multiple foci of abnormal signal intensity within the marrow of the distal femur and proximal tibia, consistent with intraosseous fat necrosis. CT scans showed significant changes in the cancellous bone in these areas compatible with metaphyseal osteonecrosis.

[Polyarthritis revealing hairy cell leukemia]. / Polyarthrite révélatrice d'une leucémie à tricholeucocytes.

A female patient simultaneously developed hematologic evidence of hairy cell leukemia and marked but short-lived inflammatory involvement of a number of joints. Both these groups of symptoms resolved simultaneously and rapidly under alpha-2 interferon therapy. This course suggests that the arthritis was a rheumatologic manifestation of the hematologic disease. The concomitant occurrence in this patient of arthritis, splenomegaly and leukopenia was suggestive of Felty syndrome: these two conditions need to be differentiated.

[Fasciitis and Shulman's syndrome. A nosologic discussion]. / Fasciites et syndrome de Shulman. Un débat nosologique.

Eosinophilic fasciitis or Shulman's syndrome is linked to scleroderma, systemic sclerodermia as various types of localized sclerodermia, by a nosological relationship analyzed by the authors. But, excluding the one concerning eosinophilic fasciitis and deep morphea, the authors seem to believe that the current differences are still justified, since the clinical picture and the levels of the histological lesions vary from one entity to the other. The nosological debate concerning eosinophilic fasciitis demonstrates also that a histologically recognized fasciitis has no complete specificity. By far, it goes beyond sclerodermia. Inflammation of the fascia is possible in the course of disseminated lupus erythematosus and other connective tissue inflammations. It is also described beyond connective tissue inflammations during rhizomelic pseudo-polyarthritis, and mostly in the course of three diseases: Texier's disease, drepanocytosis, and the spanish toxic syndrome, where it may be associated to a hypereosinophilia.

[Respiratory manifestations of ankylosing spondylitis (50 cases)]. / Manifestations respiratoires de la spondylarthrite ankylosante (50 observations).

Fifty patients with ankylosing spondylitis underwent radiography of the chest. In addition, 2 of them had bronchography, 3 had computerized tomography (CT) of the chest, 9 had respiratory function tests and 8 head ventilation/perfusion study by the Xenon method. Seven thoracic images were questionably specific of spondylitis, showing plural symphysis, strips of atelectasis, pleural thickening, apical pulmonary sclerosis and opacities of the diaphragmatic hilum. CT proved valuable in 1 case to confirm pulmonary fibrosis and in 2 cases to reveal that pleural thickening was continuous with an opacity ensheathing the vertebral body. In 7 out of 9 cases the functional restrictive deficit was accompanied by normal or supranormal functional residual capacity and increased residual volume. In all patients explored by the Xenon method, there was apical-caudal inversion of the ventilation/perfusion ratio. These findings suggest 3 pathogenic hypotheses: mere sequelae of hypoventilation, specific lung tissue fibrosis, extension by continuity of the vertebra-ensheathing process to the subpleural spaces.

[Cardiac manifestations of atrophying polychondritis. Apropos of a case disclosed by pericardial effusion and auricular flutter]. / Les manifestations cardiaques de la polychondrite atrophiante. A propos d'un cas se manifestant par un épanchement péricardique et un flutter auriculaire.

We report the case of a 50 year old patient, hospitalised with a clinical record suggestive of acute pericarditis and disturbance of auricular rhythm of the flutter type. The consciousness of muscular pain, subcutaneous peri-articular nodules developing over periods of 10 to 15 days and the appearance of chondritis of the right auricle on the 2nd day of hospitalisation led to a diagnosis of atrophying polychondritis. A two-dimensional, TM echocardiographic examination confirms the presence of a discrete, pericardial effusion and presents evidence for a concentric hypertrophy and a heterogeneous aspect of the left ventricular myocardium. In atrophying polychondritis, a rare systemic disease the diagnosis for which is essentially clinical, complications readily set in the form of cardiovascular attacks, sometimes lethal (valvulopathies essentially aortic, aneurysm of the ascending aorta, disturbances of rhythm and conduction, myocardial necrosis, etc). A pericardial attack has already been reported for this condition but uniquely according to electrocardiographic criteria, the lack of specificity of which is known. Our case report confirms the possibility of a pericardial reaction and, in addition, permits the observation of a hypertrophy and a heterogeneous aspect of the myocardium which has not yet been reported in the literature.

[Cleidocranial dysostosis. Contribution to its study apropos of 2 personal cases (an isolated and a familial form)]. / La dysostose cléido-crânienne. Contribution à son étude à propos de deux cas personnels (une forme isolée et une forme familiale).

Cleidocranial dysostosis is a rare embryopathy affecting the whole osseous system. Anomalies predominate on skull, chest and dentition but the whole skeleton can be affected especially pelvic girdle and spine. An autosomal transmission is often demonstrable; isolated forms are very uncommon. We present two cases fortuitously diagnosed in our ward: a familial cleidocraniopelvic major form and an incomplete isolated form. The treatment must be especially oriented towards dental malformations.

[Superselective arteriography of the hip. Technic, normal appearance and 1st results in primary osteonecrosis of the femoral head]. / Artériographie super-sélective de la hanche. Technique, aspect normal et premiers résultats dans les ostéonécroses primitives de la tête fémorale

The arteries vascularising the femoral head were selectively catheterised via the axillary, or left humeral route. Injection into the posterio circumflex artery revealed an interruption of the superior capsular branches in necroses of the femoral head at their onset. In the more develped lesions either a persistence of the obstruction of the capsular branches or a revascularisation was found.

[Chronic atrophying polychrondritis]. / Polychondrite chronique atrophiante

After the description of the clinical signs (chondritis, arthritis, eye signs, cardiovascular signs) and laboratory signs of chronic atrophying polychrondritis, the authors study its pathology and the electron microscope findings, its diagnosis and the most recently proposed criteria, its course and therapeutic difficulties, its classification and finally discuss recent biochemical and immunologic data and the pathogenesis.