EMC - Rhumatologie-Orthopédie最新文献

{"title":"Manifestations ostéoarticulaires des hémopathies malignes (myélome exclu)","authors":"S. Roux (Professeur agrégé) ,&nbsp;X. Mariette (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcrho.2004.10.006","DOIUrl":"10.1016/j.emcrho.2004.10.006","url":null,"abstract":"<div><p>Bone involvement is a rare event in lymphomas, except in patients with adult T-cell leukaemia/lymphoma associated with HTLV-I. It is usually characterised by lytic bone lesions located in the metaphysis of long bones or in the axial skeleton. The occurrence of bone lesions reflects a progression of the disease, affecting the prognosis that is related to lymphoma histologic features and staging. Bone lesions may occur in some lymphoproliferative disorders such as LLC or Waldenström’s disease, or in myeloproliferative disorders. They may reflect a progression to a more aggressive disorder with a worse prognosis. Specific bone lesions are rare, and other diagnoses should be entertained, including osteitis or osteomyelitis precipitated by immunodeficiency. Joint involvement in haematological malignancies is most of the time related to infectious complications such as septic arthritis, or to metabolic disorders such as gout. Arthritis related to leukaemic synovitis is a well-recognized complication of leukaemia in children, but acute and chronic leukaemia may also cause arthritis in adults. Vasculitic syndromes, primarily cutaneous leucocytoclastic vasculitis, associated with arthralgias or arthritis, have been described in association with haematological malignancies, especially in hairy cell leukaemia, and may antedate their diagnosis. Haematological malignancies are important to consider in the diagnosis of bone pain or arthritis, and should be suspected particularly in presence of radiological abnormalities, in presence of fever or persistent inflammation in blood tests, as well as in cases of unexplained arthritis, refractory arthritis, or arthritis accompanied by severe pain.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 2","pages":"Pages 109-124"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85677716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus érythémateux systémique","authors":"O. Meyer","doi":"10.1016/j.emcrho.2004.08.005","DOIUrl":"10.1016/j.emcrho.2004.08.005","url":null,"abstract":"<div><p>The systemic lupus is an autoimmune disease characterized by cutaneous-articular, visceral (kidney, nervous system, serous membranes), and haematological lesions. Due to the various groups of symptoms that have been observed, classification criteria have been proposed; these are useful for cohort comparisons, but are not adequate for individual diagnosis. Grouping main clinical manifestations allows to distinguish benign forms – mainly the cutaneous-articular, and the serous (pleuropericarditis) types – from the severe visceral, renal, central neurological, haematological (thrombopenia, haemolytic anaemia), and thrombotic forms. The immunological diagnosis is based on the evidence of high levels of antinuclear antibodies and, less frequently, of native anti-DNA antibodies, or antinucleosome. Other antibodies are useful for the diagnosis, despite their rareness: anti-Sm, and anti-ribosome antibodies. In one case out of three, antiphospholipid antibodies are associated with arterial or venous thrombotic complications, or with obstetrical accidents. The disease evolves spontaneously, by successive attacks, more or less regressive. Prognosis depends on the severity of the visceral sequelae after adequate treatment, with the mortality reduced to 1% per year of disease duration. Therapy is based on symptomatic treatments (aspirin, antihypertensive agents, hypolipidemic agents, anticoagulant drugs), long-acting medications (synthetic antimalarial drugs, methotrexate,…), corticoids dosed according to the severity of clinical manifestations, and immunosuppressive drugs (cyclophosphamide, azathioprin, mycophenolate).</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 1-32"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75155112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bonnes pratiques en imagerie dans les tumeurs osseuses","authors":"L. Leflot (Chef de clinique-assistant),&nbsp;H. Ducou Le Pointe (Professeur des Universités, praticien hospitalier),&nbsp;M. Lenoir (Ancienne chef de clinique-assistante),&nbsp;S. Ariche-Maman (Chef de clinique-assistante),&nbsp;J.-P. Montagne (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcrho.2004.08.004","DOIUrl":"10.1016/j.emcrho.2004.08.004","url":null,"abstract":"<div><p>Assessment of bone tumours by imaging may require the use of all radio-diagnostic techniques. X-ray remains essential. It assesses the progression of the lesion and is useful in considering one or more diagnoses on the basis of morphological and topographic criteria. CT-scanning is used for spatial resolution by exploring anatomic areas insufficiently visualized by X-ray; this technique is reliable for the study of bone cortex and tumour matrix. Contrast resolution and multiple plan acquisition which are useful for analysing tumour spread, are the major assets of MRI. Bone scintigraphy is of special interest in determining whether there is one lesion or more. US-scan, angiography, interventional radiology have specific indications. Depending on the radiographic characteristics of the tumour, several attitudes are recommended, varying from the absence of any additional investigation when benignity is obvious, to complete staging, prior to biopsy, in case malignant tumour is suspected.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 59-79"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86959370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cartilage articulaire normal : anatomie, physiologie, métabolisme, vieillissement","authors":"X. Chevalier ,&nbsp;P. Richette","doi":"10.1016/j.emcrho.2004.10.005","DOIUrl":"10.1016/j.emcrho.2004.10.005","url":null,"abstract":"<div><p>The normal joint cartilage is a highly specialized tissue, characterized by its mechanical properties. It is located between two bone surfaces, and due to its capacity of resistance to compression and elasticity forces and its very low friction coefficient, it helps sliding movements of these bone surfaces. The cartilage is a tissue free of any vascularization and innervation, which lives on some molecules from the synovial fluid that penetrate the cartilage surface. The normal cartilage is constituted by a single type of cells, the chondrocytes, and an extracellular matrix. The renewal of this matrix is a very slow process, and normal chondrocytes are quiescent cells that barely divide. The extracellular matrix is located far from the cell and consists of a condensed network of type II collagen tangled fibres (marker of the differentiated character of the chondrocyte) of which the disposition vary from surface to depth. Macroaggregates of hydrophilic proteoglycans are imprisoned in this network, so the collagen fibres are put on the water-loaded proteoglycans pressure. The cyclic pressures imposed to the cartilage induce movements of these molecules of water inside the matrix. The extracellular matrix is stabilized both by the glycoproteins and by small proteoglycans of whom one of the functions is to bind the molecules to each other. Close around the chondrocyte, an acid pH atmosphere contains high amounts of bridging molecules, attached on one side to membrane receptors and on the other side to matrix molecules. Among these membrane receptors, the integrins function as mechanoreceptors necessary for cell survival. Any change in such integrins and/ or in the pericellular environment results in metabolic, and then phenotypic modifications of the chondrocyte. With ageing, modifications of the cartilage may occur, mainly with a reduced amount of chondrocytes and with qualitative and quantitative modifications of proteoglycans. Above all, this senescent cartilage reveals a diminished resistance to mechanical stress, which may result in potential osteo-arthritis. A strong relationship exists between the ageing cartilage and the osteo-arthritic disease. Multiple causes may induce diminished resistance to mechanical stress. Increased apoptosis may result from pericellular modifications and promote osteo-arthritis. The main function of the joint cartilage is to favour the joint movement whichever its motivation. The cartilage covers bone epiphyses and may be considered as a damper with a very low coefficient of friction and a very high coefficient of resistance to compression forces.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 41-58"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.10.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78758562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapport de congrès de l’AOSSM à Quebec City, Canada, 24-27 juin 2004","authors":"P. Djian","doi":"10.1016/j.emcrho.2004.10.002","DOIUrl":"10.1016/j.emcrho.2004.10.002","url":null,"abstract":"","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 107-108"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91005483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Main de l’hémiplégique","authors":"Y. Allieu (Professeur de chirurgie orthopédique et traumatologie à la faculté de médecine de Montpellier) ,&nbsp;P. Denormandie (Chirurgien, neuro-orthopédiste) ,&nbsp;J.-N. Goubier (Chirurgien de la main et du membre supérieur, attaché à l’hôpital Saint Antoine)","doi":"10.1016/j.emcrho.2004.08.006","DOIUrl":"10.1016/j.emcrho.2004.08.006","url":null,"abstract":"<div><p>The hemiplegic hand is a spastic and paralytic hand due to central neurological lesions. Two completely different types must be distinguished: the hand of the child with cerebral palsy which is the subject of almost all the studies on surgery of the hemiplegic hand, and the hand of the brain damaged adult (after vascular hemiplegia or brain traumatism). In this second type, the indications in a functional aim are very rare, due to the associated cerebral disorders. However, the indications in a hygienic or aesthetic aim are common and make this surgery, which is not very well known and which can greatly improve the global functions of these patients, a winning surgery. The surgical indications are based on a specific clinical study of the hand completed by the use of anaesthetic blocks, electromyographic studies and use of botox. Apart from this lesional study, they must take into consideration general and cognitive conditions. It is thus possible to distinguish two types of hands: the “Potentially Functional Hand” which can recover after treatment its functional possibilities which will never be total but will be useful, and the “Potentially Non Functional Hand” which will remain functionally unusable. The aim of this surgery is to correct muscular disorders between agonist and antagonist and the osteo-articular deformations that they bring about. For this, the nerve can be treated (hyponeurotisation, neurectomy, neuro-surgery) or on the muscle by relaxing the agonist muscles (muscular disinsertion, tendon lengthening…) or by strengthening the action of the antagonist muscles by tendon transfers. The articular stabilisation of the wrist, of the digital chains and of the thumb in a good position can be performed by arthrodesis or tenodesis.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 80-94"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74093009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chirurgie computérisée de la fixation des vis pédiculaires. Techniques et pratique clinique","authors":"P. Merloz (Professeur des Universités, praticien hospitalier) ,&nbsp;J. Tonetti (Praticien hospitalier) ,&nbsp;H. Vouaillat (Assistant hospitalo-universitaire) ,&nbsp;C. Huberson (Ingénieur de recherche, TIMC, IMAG, CNRS) ,&nbsp;J. Troccaz (Directrice de recherche, TIMC, IMAG, CNRS) ,&nbsp;A. Eid (Praticien hospitalier) ,&nbsp;J. Cazal (Chef de clinique-assistant) ,&nbsp;S. Plaweski (Praticien hospitalier) ,&nbsp;S. Blendea (Interne des Hôpitaux) ,&nbsp;A. Badulescu (Attaché, consultant) ,&nbsp;H. Benyahia (Interne des Hôpitaux) ,&nbsp;C. Faure (Professeur des Universités, Praticien hospitalier) ,&nbsp;C. Vasile (Interne des Hôpitaux)","doi":"10.1016/j.emcrho.2004.08.007","DOIUrl":"https://doi.org/10.1016/j.emcrho.2004.08.007","url":null,"abstract":"<div><p>Imaging, sensing and computing technologies that are being introduced to aid in the planning and execution of surgical procedures on spine are providing orthopaedic surgeons with a powerful new set of tools for improving clinical accuracy, reliability and patient outcomes while reducing costs and operating times. Current computer assisted spine surgery systems typically include four steps. 1. A measurement process for collecting patient specific medical data: pre-operative images (CT, x-rays, MRI), intra-operative images (fluoroscopy, ultrasound images), intra-operative positions of tools or bones obtained using 3D localizers. 2. A registration process for aligning all images and data to the patient coordinate system using anatomical landmarks, bone surfaces digitized directly or with ultrasounds, x-rays. 3. A decision making process for generating a surgical plan on multi-modality information: interactive placement of tools or bones on images, monitoring of criteria (angles, positions, impingement….). 4. An action process for accurately achieving the goals specified in the plan: passive systems that display the position of tools or bones on images and data; semi-active systems that position drill or cutting guides; active robots. In the future, it is expected that computer assisted spine surgery systems will enable surgeons to measure the performances of surgical techniques accurately and consistently, which is a first step for optimization of surgery.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 95-106"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.08.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137350343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestations rhumatologiques des endocardites infectieuses","authors":"C. Marcelli (Professeur des Universités, praticien hospitalier, chef du service de rhumatologie)","doi":"10.1016/j.emcrho.2004.10.004","DOIUrl":"10.1016/j.emcrho.2004.10.004","url":null,"abstract":"<div><p>Various and frequent rheumatologic manifestations of infectious endocarditis may be encountered in clinical practice. Most of the time, they consist of arthralgias, inflammatory or infectious arthritis, rachialgias, or infectious spondylitis. A diagnosis of infectious endocarditis should be evoked in any case of unexplained rheumatologic manifestation, in particular when it is associated with a fever or an alteration of the overall health status. The frequency of infectious spondylitis increases in streptococcal endocarditis whereas the frequency of the other rheumatologic manifestations is identical, whatever the responsible germ. Numerous immunological abnormalities have been described in infectious endocarditis, in particular the presence of the rheumatoid factor, and that of circulating immune complexes. Rheumatologic manifestations are positively correlated to the presence of circulating immune complexes. Cardiac ultrasonography and haemoculture are the basic investigations for the diagnosis of infectious endocarditis. The antibiotherapy-induced improvement of the rheumatologic manifestations evolves parallel with the progressive vanishing of the biologic inflammatory syndrome and immunological abnormalities.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 1","pages":"Pages 33-40"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90912264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implants digitaux","authors":"P. Ledoux","doi":"10.1016/j.emcrho.2004.06.007","DOIUrl":"https://doi.org/10.1016/j.emcrho.2004.06.007","url":null,"abstract":"<div><p>Joint replacements in the hand are indicated in the treatment of rheumatoid arthritis, degenerative and post traumatic arthritis. This surgery has to be very precise because of the delicate equilibrium between bones, fulcra, ligaments, complex connections between tendon structures and precise lever arms of these tendons. For the first carpo-metacarpal joint, total replacement provides a good solution in terms of pain, range of motion, grip, grasp and key pinch. The related possibility of replacing a failing prosthesis provides a solution for loosened implants and makes the procedure more secured. For metacarpal and interphalangeal joints, two-piece rigid implants and silicone implants are available.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 6","pages":"Pages 542-563"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2004.06.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137440510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disque intervertébral et structures voisines de la colonne lombaire : anatomie, biologie, physiologie et biomécanique","authors":"F. Rannou (Chef de clinique-assistant, Post-doctorant),&nbsp;M.-A. Mayoux-Benhamou (Maître de conférences des Universités, praticien hospitalier),&nbsp;S. Poiraudeau (Professeur des Universités, praticien hospitalier),&nbsp;M. Revel (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcrho.2003.11.007","DOIUrl":"10.1016/j.emcrho.2003.11.007","url":null,"abstract":"<div><p>The lumbar spine can resist external stress and provide multidirectional mobility to the body, at the same time. Main anatomical structures of the lumbar spine are the intervertebral disk and the facet joints that are embedded in muscles and ligaments to provide resistance and mobility to the body. The main structure implicated in the pathogenesis of low back pain is the intervertebral disc, especially its degeneration, which is a prerequisite to disk herniation. The inflammatory process and mechanical stress are the two main causes of intervertebral disk degeneration. The anatomy, biology, physiology, and biomechanics of the lumbar spine are reviewed.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"1 6","pages":"Pages 487-507"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2003.11.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79764335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}