[Use of hydroxychloroquine and prednisone in the presence of serum autoimmunity in female infertility]. / Utilisation de l'hydroxychloroquine et de la prednisone en présence d'une auto-immunité sérique dans l'infertilité féminine.

OBJECTIVE: Presence of non-specific autoimmunity (antinuclear antibodies without antigenic specificities and/or antiphospholipid antibodies without criteria of antiphospholipid syndrome) seems to be associated with unexplained female infertility. The objective is to study the characteristics of patients who undergone treatment for non-specific antibodies in Medically Assisted Procreation (MAP). METHODS: Ten patients were prospectively followed at MAP center of Grenoble University Hospital. Patient characteristics were collected and evaluated. All patients had a consultation in internal medicine unit as well as an autoimmune assessment (antinuclear antibodies, APL especially) in search of defined autoimmune disease (exclusion criterion). The treatments undertaken were at clinician' discretion. RESULTS: One patient received quadritherapy (heparin, platelet antiaggregant, prednisone and hydroxychloroquine), 5 received triple therapy, 3 had dual therapy, and one patient had prednisone only. The 10 patients had a pregnancy under treatment, 8 of which were completed without complications. The control of autoimmunity under treatment appears to show a decrease in serum antibody levels. Tolerance was good (delayed hypersensitivity to hydrochloroquine resulted in discontinuation of therapy in only one patient). CONCLUSION: The presence of non-specific serum autoimmunity in a context of infertility appears to be pathogenic and immunomodulatory treatments are clinically and/or biologically effective. A prospective and interventional study with a larger number of patients is needed to assess the efficacy of such treatments in patients with unexplained infertility.

[Cortical fissures in Paget's disease]. / Fissures corticales de la maladie de Paget.

Cortical bone fissures in Paget's disease develop on the convex surfaces of the femur or tibia. They may be present in large numbers, but this is not related to the degree of diaphysial curvature. The presenting symptom is pain. The course is usually towards recovery though a total fracture may rarely occur. Degeneration is never observed.

Syndesmo-odontoid joint and calcium pyrophosphate dihydrate deposition disease (CPPD).

Twenty-seven patients with definite or probable CPPS have been investigated with systematic frontal and lateral tomograms of the cervicooccipital region. In 12 cases there were calcifications of the syndesmo-odontoid region. These calcifications are of two different types: linear calcifications (5 cases) and mottled calcifications (7 cases). The anatomic location of these calcifications is the transverse ligament or other structures of the syndesmo-odontoid joint. Although this type of calcification has already been described in other rheumatic diseases, it must lead to search for CPPD in the usual locations.

Arterial and venous signs of tumors within the fourth ventricle.

A positive diagnosis of tumors located within the fourth ventricle should be based on specific signs therby excluding other space occupying lesions in the posterior fossa. These are a typical omega form of the hemispheric cerebellar branches on the lateral projection, and an also typical inverted 3 form of the PICA in the semiaxial projection. Alteration of the veins of the lateral recess of the fourth ventricle and of the precentral cerebellar vein are important venous signs. Indirect signs are found in the absence of tonsillar herniation with arterial and venous signs of AP stretching of the cerebellar tonsils.

A standardized method for computed tomography of the orbits.

A standardized method for the CT exploration of the orbital region has been searched for. This method makes it possible to visualize the entire orbital region with a minimum of 4 tomographic scans, each section 6 mm thick. The reference line chosen for this exploration is parallel to the optic nerve and joins the projection of the inferior border of the orbit on the lateral view with the upper border of the ear to the scalp. After each tomographic scan the patient is moved so that the new scanning line is still parallel to the reference line but distant by 9 mm from the previous one.

[Use of tomodensitometry in the pathology of the orbit]. / L'application de la tomodensitométrie à la pathologie des orbites

A standardised method with an original reference line in C.A.T. exploration of the orbital region permits to visualize the entire orbital region with four tomographic scannings when using 6 mm tomographic sections. Some exemples of orbital lesions are demonstrated as optic nerve tumor, dysthyroïd exopthalmos, maxillary sinus tumor with extension into the orbit.