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2.
Joint Bone Spine ; 68(6): 547-53, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11808997

ABSTRACT

This article reviews the role of metabolic factors, including metalloproteinases and cytokines, in the occurrence of degenerative disk disease and disk herniation. Given that mechanical factors alone cannot cause disk degeneration, studies must explore metabolic, genetic, nutritional, and age-related factors. Zinc metalloproteinases exert particularly important effects, not only directly, but also indirectly through promotion of neovascularization. The production of these enzymes is dependent on a number of cytokines and on the cell changes they induce. This complex effect acts both on disk matrix degeneration and on the pain generated by contact between the protruding disk and the nerve roots. However, it can have a favorable effect by promoting resorption of the herniated disk. Available data on the role for mechanical factors on the disk chondrocyte metabolism and on metalloproteinase production show that mechanical and metabolic factors interact closely to produce disk disorders.


Subject(s)
Cytokines/metabolism , Intervertebral Disc Displacement/enzymology , Intervertebral Disc Displacement/etiology , Intervertebral Disc/enzymology , Matrix Metalloproteinases/metabolism , Chondrocytes/enzymology , Humans , In Vitro Techniques , Intervertebral Disc/cytology , Intervertebral Disc/physiopathology , Intervertebral Disc Displacement/physiopathology , Low Back Pain/etiology , Low Back Pain/metabolism , Low Back Pain/physiopathology , Matrix Metalloproteinases/classification
3.
Joint Bone Spine ; 67(5): 471-4, 2000.
Article in English | MEDLINE | ID: mdl-11143917

ABSTRACT

A case of cerebral and sacral ependymoma revealed by cerebellar syndrome and sciatica in a 68-year-old man is reported. Bone metastases were diagnosed seven months after surgical excision of the brain tumor.


Subject(s)
Bone Neoplasms/secondary , Cerebellar Neoplasms/pathology , Ependymoma/secondary , Sacrum/pathology , Aged , Bone Neoplasms/diagnostic imaging , Cerebellar Neoplasms/surgery , Ependymoma/surgery , Humans , Lumbosacral Region/diagnostic imaging , Magnetic Resonance Imaging , Male , Sacrum/diagnostic imaging , Sciatica/etiology , Sciatica/pathology , Tomography, X-Ray Computed
4.
Rev Rhum Engl Ed ; 66(7-9): 370-80, 1999.
Article in English | MEDLINE | ID: mdl-10526377

ABSTRACT

OBJECTIVES: To study the prevalence of back pain and spinal alignment abnormalities in children aged 10 to 14 years; to define subsets of subjects with similar clinical profiles; and to identify factors associated with pain in the thoracic or lumbar spine. PATIENTS AND METHODS: 972 five- and nine-graders completed a back pain questionnaire at school and were examined by a school physician for spinal alignment abnormalities and for motion range limitation in the spine and/or lower limbs. Multivariate analysis was used to define clinical subsets and to identify factors associated with back pain. RESULTS: The point prevalence of back pain increased with age, from 14.3% in the ten-year-olds to 24% in the 14-year-olds. Girls were more likely than boys to report back pain, which was usually located in the low back. The prevalence of scoliosis increased with age and was higher in the girls. Multivariate analysis identified five clinical profiles: no spinal pain; nonserious spinal pain with no impact on medical service utilization or physical activities; spinal pain unrelated to an injury; injury-related spinal pain not treated by drugs or physical therapy; and injury-related spinal pain treated by drugs and physical therapy. Several factors associated with spinal pain were identified, with variations across the five groups.


Subject(s)
Low Back Pain/epidemiology , Spine/abnormalities , Adolescent , Child , Female , France/epidemiology , Humans , Kyphosis/complications , Kyphosis/epidemiology , Low Back Pain/etiology , Male , Prevalence , Scoliosis/complications , Scoliosis/epidemiology , Surveys and Questionnaires
5.
Rheumatology (Oxford) ; 38(5): 463-7, 1999 May.
Article in English | MEDLINE | ID: mdl-10371287

ABSTRACT

OBJECTIVE: To discuss the relationships between SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome and the group of spondylarthropathies. METHODS: Few reports of familial SAPHO have been published. We describe three children, two sisters and one brother, whose clinical and radiological presentation was in accordance with SAPHO syndrome. RESULTS: Two children developed psoriasis, and one child palmoplantar pustulosis. Both sacroiliac and sternoclavicular joints were involved in these three cases. Some features in our observations are also common to psoriatic arthritis. No association was found with HLA antigens, but a history of trauma preceding the onset of symptoms was present in all three children. CONCLUSIONS: We can consider that SAPHO is nosologically related to spondylarthropathies. Psoriatic arthritis could be the missing link between SAPHO and spondylarthropathies. It is likely that both genetic and environmental factors are involved.


Subject(s)
Acquired Hyperostosis Syndrome/diagnostic imaging , Arthritis, Psoriatic/diagnostic imaging , Family Health , Acquired Hyperostosis Syndrome/genetics , Acquired Hyperostosis Syndrome/pathology , Arthritis, Psoriatic/genetics , Arthritis, Psoriatic/pathology , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Child , Diagnosis, Differential , Female , Humans , Male , Nuclear Family , Osteomyelitis/diagnostic imaging , Osteomyelitis/genetics , Osteomyelitis/pathology , Radiography , Wrist Joint/diagnostic imaging , Wrist Joint/pathology
6.
Rev Rhum Engl Ed ; 66(2): 86-91, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10084167

ABSTRACT

Paragangliomas are infrequent, usually benign tumors developed from neuroectoderm cells. The neck is the most common location, although some cases arise within the abdominal cavity, usually in the retroperitoneal space. We report five cases with bone metastases. In three patients, convincing evidence was obtained that the primary was in the retroperitoneal space. Clinical manifestations of metastatic bone disease occurred up to 17 years after the diagnosis of paraganglioma. Useful data were obtained from plain radiographs, magnetic resonance imaging, serum and urine catecholamine assays, and above all meta 123iodobenzylguanidine scintigraphy. Histologic and immunohistochemical studies of the lesion yielded the definite diagnosis. Surgery and radiation therapy are the two mainstays of therapy. Although rare, metastatic forms of paraganglioma should be borne in mind. This diagnosis should be entertained in patients with bone lesions and recent-onset arterial hypertension, irrespective of whether they report a history of surgery for a tumor, and even if this tumor was removed many years earlier and labeled benign.


Subject(s)
Bone Neoplasms/secondary , Paraganglioma/secondary , Retroperitoneal Neoplasms/pathology , Adult , Aged , Bone Neoplasms/diagnosis , Bone Neoplasms/therapy , Combined Modality Therapy , Diagnosis, Differential , Fatal Outcome , Female , Follow-Up Studies , Humans , Humerus , Lumbar Vertebrae , Male , Middle Aged , Neoplasm Recurrence, Local , Paraganglioma/diagnosis , Paraganglioma/therapy , Retroperitoneal Neoplasms/therapy , Ribs , Thoracic Vertebrae
7.
Eur Spine J ; 8(6): 426-8, 1999.
Article in English | MEDLINE | ID: mdl-10664298

ABSTRACT

An international congress about "the back of children and teenagers and the prevention of backache" was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP). Some epidemiological data show a high incidence of LBP during and after the rapid growth phase, with the concomitant possibility of continued or recurrent evolution. MRI studies reveal frequent signs of disc degeneration: they start after the growth phase, spread during adolescence and are often correlated with backache. An immunohistological study seems to confirm the presence of degenerative-type alterations and changes in collagen in the vertebral plates and nucleus of juvenile spine. These data must be confirmed, and their relation to natural history and prognosis of juvenile LBP have to be clarified by longitudinal studies.


Subject(s)
Low Back Pain , Adolescent , Adult , Aging/physiology , Child , Humans , Intervertebral Disc Displacement/complications , Low Back Pain/epidemiology , Low Back Pain/etiology , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Radiography , Risk Factors
9.
Rev Rhum Engl Ed ; 64(6): 375-81, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9513609

ABSTRACT

OBJECTIVES: To study the activity and concentrations in joint fluid of gelatinases (A or matrix metalloproteinase (MMP)-2 and B or MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), and stromelysin-1 (MMP-3). METHODS: Synovial fluid specimens obtained as part of a diagnostic or therapeutic procedure were studied. Protein levels were determined, cells counted, crystals looked for and microbiological studies done. Gelatinolytic activity was determined quantitatively using computerized zymography. Proteins were identified by electrotransfer and immunorevelation. TIMP-1 and stromelysin-1 were assayed using an ELISA. Results were confronted with laboratory test and clinical findings. RESULTS: Of the 50 specimens studied, 25 were from joints with mechanical disorders and 25 from joints with inflammatory disorders. Activated MMP-2 was found in all the specimens, with no differences between the two groups. MMP-9 was found only in its inactive form. MMP-9, TIMP-1 and MMP-3 were found more often in inflammatory than in mechanical fluids and the levels of MMP-9 and TIMP-1 were correlated with neutrophil counts. In the 16 fluids from rheumatoid arthritis patients, levels of MMP-9 and TIMP-1 were closely correlated with serum C-reactive protein levels. CONCLUSIONS: MMP-9, TIMP-1, and MMP-3 levels show striking differences between inflammatory and mechanical joint fluids.


Subject(s)
Arthritis, Rheumatoid/metabolism , Collagenases/metabolism , Gelatinases/metabolism , Metalloendopeptidases/metabolism , Synovial Fluid/enzymology , Adolescent , Adult , Aged , Aged, 80 and over , Collagenases/analysis , Enzyme-Linked Immunosorbent Assay , Female , Gelatinases/analysis , Humans , Male , Matrix Metalloproteinase 2 , Matrix Metalloproteinase 3/analysis , Matrix Metalloproteinase 3/metabolism , Matrix Metalloproteinase 9 , Metalloendopeptidases/analysis , Middle Aged , Tissue Inhibitor of Metalloproteinase-1/analysis , Tissue Inhibitor of Metalloproteinase-1/metabolism
11.
Rev Rhum Engl Ed ; 63(4): 278-84, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8738447

ABSTRACT

We report a study of 100 patients admitted to the Grenoble Regional Teaching Hospital between July 1985 and February 1994 for femoral neuralgia due to degenerative spinal disease. A herniated disk resulting in nerve root impingement was found in 79 patients (83 herniated disks) and lumbar spinal stenosis in 21. The level of nerve root compromise was L2-L3 in eight cases, L3-L4 in 35 cases, and L4-L5 in 40 cases. Herniated disks were divided into several groups based on their location with regard to the intervertebral foramen: posterolateral herniations were entirely contained within the spinal canal (n = 12; 14.5%), whereas far lateral, or foraminal, herniations (n = 71; 85.5%) involved the intervertebral foramen. Twenty-nine foraminal herniations (34.9%) had a component located within the spinal canal (medioforaminal herniations), 33 (39.8%) were entirely contained within the foramen (pure foraminal herniations), and nine (10.8%) were located lateral to the foramen (lateroforaminal herniations). As compared with posterolateral herniations, foraminal herniations were associated with shorter symptom duration at admission (p < 0.05), a greater likelihood of nocturnal exacerbation of pain (p < 0.001) and of a positive femoral stretch test (p < 0.01), and failure of the pain to worsen during Valsalva maneuvers (p < 0.01).


Subject(s)
Femoral Nerve/diagnostic imaging , Intervertebral Disc Displacement/diagnostic imaging , Nerve Compression Syndromes/diagnostic imaging , Neuralgia/diagnostic imaging , Spinal Nerve Roots/diagnostic imaging , Spinal Stenosis/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Middle Aged , Neurologic Examination
12.
Spine (Phila Pa 1976) ; 20(15): 1713-8, 1995 Aug 01.
Article in English | MEDLINE | ID: mdl-7482023

ABSTRACT

STUDY DESIGN: This study examined the effect of radio-frequency thermocoagulation on cadaveric disc material. Radio-frequency lesions are induced to decompress the nerve root by coagulating the nucleus pulposus. OBJECTIVES: The purpose of this study was to assess the potential of the radio-frequency lesion technique for treating lumbar disc herniation percutaneously. The effect of radio-frequency thermocoagulation on cadaveric disc material was studied. SUMMARY OF BACKGROUND DATA: An intradiscal bipolar electrode is used for the thermocoagulation of the nucleus pulposus. METHODS: Lumbar discs of 27 adult cadavers were used for the experiments within 72 hours of donors' deaths. The physical and thermal parameters of intradiscal radio-frequency thermocoagulation were determined experimentally. Acute macroscopic and histologic changes before and after thermocoagulation were investigated. The temperature distribution of the tissue surrounding the disc was measured during the operation using thermocouples to evaluate potential heat damage. Also, computed tomography and magnetic resonance imaging of the disc were performed before and after thermocoagulation. RESULTS: Macroscopic observation showed that the lesion induced by radio-frequency thermocoagulation is homogeneous and intense without necrosis, and is limited to the nucleus pulposus. Histologically, the endplates and vertebral bodies were unaffected and an architectural disorganization of the stroma of the nucleus pulposus was seen. The temperature increase of the tissue surrounding the discs did not exceed 3-4 C. CONCLUSION: A bipolar electrode and a radio-frequency alternating current permits percutaneous intradiscal thermocoagulation for destruction of a portion of disc material in a cadaveric spine.


Subject(s)
Diskectomy, Percutaneous/methods , Electrocoagulation/methods , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Adult , Humans , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/pathology , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Radiography , Treatment Outcome
13.
Rev Rhum Engl Ed ; 62(5): 365-75, 1995 May.
Article in English | MEDLINE | ID: mdl-7655870

ABSTRACT

The authors report the findings of a national survey conducted at the request of the French Society for Rheumatology to list the rheumatic manifestations that can be inaugural in Hodgkin's disease or non-Hodgkin's malignant lymphoma. This was an exploratory, retrospective, descriptive study of 146 patients from 22 rheumatology departments. A number of clinical features (young male, nocturnal sweats, generalized pruritus, protracted fever, central or peripheral lymphadenopathy) and laboratory test abnormalities (evidence of severe inflammation) considerably increased the likelihood of Hodgkin's disease rather than malignant lymphoma. The diagnosis of bony involvement requires multidisciplinary studies of tumor specimens.


Subject(s)
Hodgkin Disease/complications , Lymphoma, Non-Hodgkin/complications , Rheumatic Diseases/complications , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Medical Records , Middle Aged , Multivariate Analysis , Pain , Retrospective Studies , Rheumatic Diseases/diagnosis , Rheumatic Diseases/physiopathology
15.
Scand J Rehabil Med ; 26(3): 143-6, 1994 Sep.
Article in English | MEDLINE | ID: mdl-7801063

ABSTRACT

The purpose of this study was to determine the prevalence of back pain in school children and the role of several contributing factors; 1178 school children of both sexes answered a previously validated questionnaire. The cumulative prevalence of back pain was 51.2%. Lumbar and leg pain, and thoracic pain were more common. After multivariate analysis, five qualitative variables were correlated with back pain with a statistical, significant positive correlation with age, previous back injury, volley-ball, female sex and time spent watching television.


Subject(s)
Back Pain/epidemiology , Adolescent , Adult , Age Factors , Back Pain/etiology , Child , Female , Humans , Leisure Activities , Male , Multivariate Analysis , Prevalence , Risk Factors , Sex Factors , Surveys and Questionnaires
16.
Rev Rhum Ed Fr ; 60(11): 827-30, 1993 Nov 30.
Article in French | MEDLINE | ID: mdl-8054931

ABSTRACT

A 55 year old female with a history of three different malignancies including a cerebral glioblastoma developed two bone metastases (in the spine and iliac crest). Histologic and immunohistochemical studies of biopsy specimens demonstrated the presence of glial fibrillary acidic protein, establishing that the bone tumors were metastases from the glioblastoma. Specific features of these rare metastases are discussed.


Subject(s)
Bone Neoplasms/secondary , Brain Neoplasms/pathology , Glioblastoma/pathology , Ilium , Spinal Neoplasms/secondary , Thoracic Vertebrae , Female , Glial Fibrillary Acidic Protein/analysis , Glioblastoma/secondary , Humans , Magnetic Resonance Imaging , Middle Aged , Neoplasm Invasiveness , Prognosis
18.
Rev Rhum Ed Fr ; 60(2): 144-51, 1993 Feb.
Article in French | MEDLINE | ID: mdl-8136807

ABSTRACT

Low back pain is generally believed to be common among hospital employees. This cross-sectional, retrospective study was carried out to determine the annual incidence of low back pain ascribable to occupational injuries in hospital employees and to evaluate factors influencing the prognosis of these injuries. In 1989, 70 employees working at the Grenoble Teaching Hospital (GTH) reported an occupational injury responsible for low back pain. Each of these employees filled out an epidemiological questionnaire during a routine evaluation by a rheumatologist. Overall annual incidence of occupational injuries with subsequent low back pain was 1.9% among GTH employees. Higher incidences were seen among employees whose occupations involved patient transfer, as well as among nursing assistants. Activities associated with an increased risk of low back pain included handling of patients or objects and work requiring prolonged periods in uncomfortable positions or in the standing position. A previous history of low back disease and a longer period of time in the current work were also associated with an increased risk of low back pain. Characteristic clinical profiles of patients with low back pain subsequent to occupational injury were determined by occupation and type of hospital department. The analysis of long-duration absence from work and long-term consequences on career confirmed the significant adverse socioeconomic impact of these injuries.


Subject(s)
Low Back Pain/epidemiology , Occupational Diseases/complications , Personnel, Hospital , Academic Medical Centers , Adult , Female , France/epidemiology , Health Surveys , Humans , Incidence , Low Back Pain/etiology , Male , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies , Socioeconomic Factors , Workload
20.
Rev Rhum Mal Osteoartic ; 59(5): 349-51, 1992 May.
Article in French | MEDLINE | ID: mdl-1411197

ABSTRACT

In a 39-year-old patient with tibial productive osteitis, Propionibacterium acnes was identified in a surgical specimen of the bone lesion. Similar cases have been reported by others. The possibility that P. acnes may play in a pathogenic role in the SAPHO syndrome by causing inflammatory or infectious changes is discussed.


Subject(s)
Gram-Positive Bacterial Infections/complications , Hyperostosis/etiology , Propionibacterium acnes , Tibia , Adult , Female , Humans
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