[Respective importance of the intradural contrast examination and of the scanning in operable sciatica]. / Intérêts respectifs de l'examen de contraste intradural et du scanner dans les sciatiques chirurgicales.

It is not always possible to determine the numerical predictive values of two different diagnostic tests such as contrast studies with myelography and evaluation by CT scan in the preoperative evaluation of sciatica. The reliability of these predictive calculations can be subject to error. However, the concordant results of most studies favor the CT scan. We have given the predictive values of these tests as mentioned in the literature along with our own series comparing these two methods. Overall, the CT scan is though to be a better diagnostic tool for medio-lateral herniated discs at the L5-S1 level which are not seen using amipaque due to the greater thickness of the epidural space and for lateral herniations at the L4-L5 and L5-S1 levels. Thus, the Ct scan evaluates more completely the anatomy of the lateral recesses. This is particularly helpful when the anatomical findings differ from that of a classical herniated disc, for example in elderly patients. With amipaque, whose diagnostic yield could be improved by a more careful reading of the roentgenograms, its usefulness lies in the ability to evaluate the entire length of the lumbosacral canal down to the conus medullaris, and gives a better view of the course of the nerve roots.

[Rhizomelic pseudopolyarthritis]. / La pseudo-polyarthrite rhizomélique.

Clinically, polymyalgia rheumatica is characterized by bilateral hip and shoulder pain predominant in the shoulder girdle, with a varying degree of alteration of the general condition. The erythrocyte sedimentation rate is often markedly increased. The dramatic effect of corticosteroids in low dosage confirms the diagnosis. The main problem is the relationship between the syndrome and giant cell arteritis, or Horton's disease. The therapeutic approach is strongly influenced by the risk of complications, notably ocular involvement. Another prognostic factor is the duration of the disease, which is difficult to predict.

[Nervous arthropathies]. / Arthropathies nerveuses.

In 1868, J.M. Charcot published his memoir "sur quelques athropathies qui paraissent dépendre d'une lésion du cerveau ou de la moelle épinière "based on 4 cases of tabes dorsalis. This work was subsequently developed and presented in London in 1881 when Sir James Paget acknowledged the significance of this entity. "Charcot's joint" has come in use to mean that particular joint disease which results, from nervous lesions, whatever its nature. A controversy lasted between those who thought, e.g. Volkman, that mechanical trauma is the significant pathophysiological factor and those, e.g. Charcot, who ascribed a trophic role to the spinal cord. At the beginning, Charcot thought that lesions of the anterior horn were responsible but finally concluded that be could not bring a precise answer to that point. Subsequently Raymond, Dejerine (who insisted on the absence of pain), Foix and Alajouanine, Alajouanine and his collaborators extended Charcot's observations. Alajouanine proposed that lesions of the sympathetic nervous system played a major pathophysiological role. In 1960 Castaigne and Cambier proposed a unified theory with complementary roles ascribed to trauma and to nervous lesions. In 1936, diabetic neuropathy was described by W. Jordan. In 1942, Thevenard described "acropathie ulcéro-mutilante" now widely known as hereditary sensory neuropathy. Amyloidosis, familial dysautonomia, congenital insensitivity to pain were added to the list of causes of Charcot's joint. Less well known are the works of Charcot on joint diseases in hemiplegics. These were later studied by Alajouanine and Thurel and de Sèze and Ryckewaert have proposed to call them "algoneurodystrophies décalcifiantes réflexes" a topic which nowadays arises much interest in rheumatology.

[Physiopathology of articular chondrocalcinosis]. / Physiopathologie de la chondrocalcinose articulaire.

The physiopathological mechanisms leading to precipitation of pyrophosphate in the articular cartilage remain unclear. Numerous findings suggest an error in pyrophosphate metabolism: excessive production or defective degradation, a primary modification of the fundamental substance leading to crystallization, a chondrocyte dysfunction being a possible cause of these two anomalies. The relationships between deposition of calcium pyrophosphate and changes in the subchondral osseous plaque common to several metabolic diseases are even more mysterious.

[Arthritis related to intestinal anastomoses]. / Les arthrites des anastomoses intestinales

Jejuno-colic and jejuno-ileal anastomoses may provoke arthritis. The recently recognized physiopathology is that of arthritis due to immune complexes related to pullulation of Escherichia coli and of Bacilus fragilis. These cases of arthritis, usually sensitive to therapy, have, in some stutborn cases, required the re-establishment of intestinal continuity, which in each case has made the joint phenomena disappear.

Double-blind study of ketoprofen against a placebo in osteoarthritis of the hip.

In this trial, the patients suffering from osteoarthritis of the hip received either ketoporfen or a placebo successively for 2 treatment periods, A and B, of 14 days each. The daily dosage of ketoprofen was 150 mg in 3 doses of 50 mg. In each case treated, the parameters necessary for the diagnosis and those necessary to assess progress under treatment are reported. At the end of the trial, results have been rated according to the preference of the patient for treatment period A or B. The results were analysed by the sequential method. The therapeutic results reported were obtained from various criteria stated in the protocol (subjective evaluation by the patient, pain when resting, duration of morning stiffness, distance of pain-free walking, amplitude of movements, etc.). Nine cases were sufficient to produce a significant statistical result in favour of ketoprofen. In eight observations a preference in favour of ketoprofen was apparent. In one case only, there was no preference for either one or the other of the two treatment periods (failure of ketoprofen and of the placebo). Ketoprofen was excellently tolerated.