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Bearing in mind earlier studies which established a link between arteriosclerosis and mineral loss, or fragility of the bones, and also our recent study showing that patients with arterial disorders of the lower limbs also suffered from osteoporosis, we carried out a histological study of the number and appearance of the intraosseous vessels and trabecular bone volume in the femoral heads of patients undergoing surgery for either fracture of the femoral neck or osteoarthritis of the hip. The number of thick-walled vessels, arterioles or arterial capillaries was significantly diminished in the femoral heads of patients with fractures of the femoral neck (p = 0.007). In addition, in the latter patients, arteriosclerotic vascular lesions (rupture of the internal elastic lamina, medial thickening and fibrosis) were more frequent than in patients with osteoarthritis of hip. The possibility that, through chronic ischemia, arteriosclerosis may lead to disturbance of bone remodelling and loss of the mechanical properties of bone has not been contradicted by these findings.

Endogenous 13- cis - and all- trans -retinoic acids have been quantitated in human serum using a solvent extraction procedure followed by isocratic reversed phase high performance liquid chromatography and UV detection. In healthy adults, after an overnight fasting period, the concentrations of 13- cis - and all- trans -retinoic acids yielded 5.3 ± 2.43 nmol/l and 11.8 ± 3.3 nmol/l, respectively (mean ±SD). The method has been successfully applied to the analysis of both isomers in serum from patients with idiopathic skeletal hyperostosis in whom, the 13- cis - as well as all- trans -retinoic acid levels were raised as compared to the control group.

Crude extracts from 115 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates were analyzed biochemically. The TEM-3 type was encountered 108 times, SHV types were encountered 7 times, and the TEM-26 type was encountered only once. For the last one, the gene was identified; an adenine was detected at position 925, as in blaTEM-26B not in blaTEM-26.

Routine renal tubular investigations in 8 osteoporotic men, in whom phosphorus/calcium balance studies were normal or almost normal revealed moderate phosphorus (PD) or bicarbonate (BD) diabetes possibly responsible for their decalcification. Osteoporosis affected the spine and lower limbs, resulting in clinical pictures of frequently recurrent spontaneous algodystrophy. Histomorphometric studies revealed an increase in surface areas of resorption, the diagnosis of PD being based upon the finding at several successive investigations, in the absence of any drug treatment, of a phosphorus clearance of greater than 20 ml/min and/or a phosphorus reabsorption level of less than 80%. Arterial HC03 levels of greater than 21 mEg/l and a fractional bicarbonate excretion (FBE) of greater than 15% enabled the diagnosis of bicarbonate diabetes (proximal tubular acidosis). These cases of PD and BD appeared to be secondary to proximal tubulopathies for which no known etiology was found.

A primary myopathy limited to the spinal muscles and of late onset was suspected in 14 patients with a mean age of 66. These patients had an anterior inflection of the trunk and were unable to rotate the lumbar spine on the pelvis. This incurvation of the trunk, starting at around age 60, was reducible in a horizontal position and increased with tiredness. The CT scan appearance of the spinal muscles of these patients was hypodense and heterogeneous, different from the atrophy found in the elderly with lumbar osteoarthrosis, comparable with the lesions described in primary myopathies. Histologically, lesions of fibro-adiposis were major, accompanied by mitochondrial abnormalities. The frequent existence of a family history would be in favour of a genetically transmitted condition.

The authors report data collected in a study of the association of narrow lumbar canal and vertebral hyperostosis. Five centres (Montpellier, Toulouse, Lille, Lyons and Paris) participated in this cooperative study which was both retrospective and prospective. Grid case forms were sent to homogenise the date provided. Two hundred and sixty nine cases of symptomatic lumbar canal stenosis were collected; 89 (33 per cent) had hyperostosis. Hyperostosis was definite in 74 cases and probable in 15 other cases. Certain radiological and/or CT scan morphological factors seen frequently in the hyperostosis patients group led us to undertake a second study in 2 of the 5 centres (Montpellier and Toulouse) in order to identify their specificity. Twenty eight items were adopted and studied by 3 different evaluators (2 rheumatologists and one radiologist) in the X-ray films and CT scan documents of 100 patients with acquired lumbar canal stenosis with or without hyperostosis (46 and 54 cases respectively). The most discriminative appearances, which we suggest as diagnostic criteria of narrow lumbar canal with hyperostosis concern anterior and/or posterolateral marginal somatic bone proliferations on the non-articular surfaces of the posterior apophyses and ossifications of the posterior joint capsule and of the ligaments (ligamentum flavum--posterior longitudinal ligament--supraspinous ligament). Four of these 6 criteria are necessary to make the diagnosis of lumbar stenosis with hyperostosis. The radiological and CT scan appearances of lumbar hyperostosis appear to differ from ordinary degenerative changes of osteoarthrosis and hyperostosis may be held responsible for compression of the dural cul-de-sac.

We describe a case of stress fracture of the roof of the acetabulum, in a woman with osteoporosis. Magnetic resonance imaging gave abnormally low signals in T1 weighted images and high signals in T2 weighted images.

Although the link between phosphate diabetes and neoplasm or benign mesenchymal tumors has been well documented, the nature of the phosphaturia factor remains unknown. We describe two cases of phosphate diabetes associated with bronchogenic cancer. In these case reports, we suggest that fibroblasts or osteoblasts synthesize a phosphate eliminating substance.

The authors report the observation of 19 patients suffering from cruralgia, who have undergone a tomodensitometric examination. A foraminal hernia was revealed in 13 patients. Four other patients presented an arthrositic or hyperostositic foraminal stenosis. Only one patient was operated upon.

Two cases of multifocal osteonecroses are described. Two hips were affected in one case, 2 hips and 2 shoulders in the other. In both cases osteonecroses developed after intraarticular instillations of long-acting corticosteroids.

The intravertebral vacuum cleft phenomenon (IVC) was described in 1978 by Maldague et al. [12, 13] and thought to be a sign of ischemic vertebral collapse or osteonecrosis. Since then about 65 additional cases were reported and the initial assumption accepted by most authors. However, histopathological studies are rare and the exact significance of the lesion is still under discussion. We report 17 new cases, 4 of them including histopathological data and one related to a tuberculous spondylitis.

Core biopsy (CB) of the femoral head and neck was proposed as a treatment of osteonecrosis (ON) of the femoral head for the early stages of the disease (stages I and II without collapse) by Ficat and Utheza [1]. Actually this method has been revealed to be efficient and safe, with 78.9% of results good (radiological stabilisation), in 133 cases followed up for more than 5 years [2]. Hungerford and Zizic [3] presented similar results.

Conventional scintigraphy using a bone-imaging agent has been used for more than 15 years for investigating osteonecrosis, in particular of the femoral head. It usually shows increased uptake connected with new bone formation or simply with metabolic activity around the necrotic area. Characteristic decreased uptake is only rarely found using static scans. These delayed images (3 to 4 h after the injection of the bone-imaging agent) do not permit detection of the vascular disorder at the origin of ischaemia and osteonecrosis.

According to Ficat-Arlet’s classification, stages 3 and 4 osteonecrosis of the femoral head (ONFH) [1] are easy to diagnose using plain X-rays. But, in early stages, when X-rays are normal (stage 1) or when there is radiologic evidence of bone remodeling with no change in the overall shape of the head or joint space (stage 2), diagnosis can be more difficult and the use of other exploration methods is necessary. Our aim is to assess the sensitivity of both standard bone scintigraphy and intramedullary pressure (IMP) in histologically proven ONFH.

Autografts, because they are histocompatible, are the standard by which other bone grafts are judged. There is, however, increased morbidity for the patient from which large autografts, of limited supply in any case, must be obtained. In contrast, allografts are readily obtainable in large quantities and are used routinely in procedures for major limb salvage, trauma involving bone loss, and joint reconstruction. They have achieved sufficient success to warrant continued use, although a high incidence of nonunions, fatigue fractures, and occasional premature graft resorption suggest they are often poorly incorporated [3]. Of the two allograft materials, cancellous and cortical bone, the former shows a faster and more complete incorporation when donor and recipient are immuno- and histocompatible, as shown by Goldberg et al. [5]. Yet, they also display a higher incidence of histoincompatibility and cannot provide the immediate structural support required in some long bone procedures. Accordingly, cortical allografts with improved incorporability are viable alternatives to both autografts and cancellous allografts. The achievement of such improvement is enhanced with an understanding of cortical allograft incorporation in general and creeping substitution in particular. Because of the central role of neovascularization in all forms of healing, including that characteristic of graft incorporation, a study of neovascularization in cortical allografts was undertaken using the rabbit tibia implanted with an allograft-bearing bone chamber as its model. The goal of the subproject reported here was to test the hypothesis that the model yields data consistent with that of other cortical allograft models. An additional goal was to obtain the data in the form of quantitative measurements.

Osteonecrosis of the femoral head (ONFH) is considered to be of ischemic origin, i.e. due to a decrease in blood supply within bone tissue. This intraosseous blood flow cannot be measured directly in humans, but indirect evidence of circulatory changes can be seen even in early stages of ONFH: (a) decrease in bone blood flow (venous stasis on intramedullary venography), (b) a reduction of the vascular network (decreased gradient of the curves of early angioscintigraphic stages), (c) an increase in intramedullary pressure (IMP) of which the mechanism is unclear (microcirculatory obstruction? arteriolocapillary vasoconstriction?). Such an increase in IMP could provide an explanation for patients with painful ONFH (Arnoldi’s engorgement pain syndrome), especially in cases where pain is increased by coughing which also temporarily increases the IMP.

In patients presenting with bone necrosis of the femoral head the cartilage is usually well preserved until the terminal stage of the disease. In some instances, however, an early narrowing of the joint space can occur while the overall shape of the head remains unchanged (Stage I and II of the Arlet-Ficat classification [2]). This peculiar osteochondral type of necrosis is termed “ischaemic coxopathy” [4].

In a case of CPPD crystal deposition disease of the pseudorheumatoid type and of long duration, calcified constrictive pericarditis developed and was surgically treated. Analysis of the calcium deposit in the pericardium was carefully made by infrared absorption, x-ray diffraction, and thermogravimetry. It revealed that the deposit was composed of B-type carbonated apatite. Previously, both calcium pyrophosphate dihydrate (CPPD) and apatite crystals, either in the same place or in different tissues, have been reported in the same patient. These observations raise the possibility that the same metabolic error might lead to both types of crystal deposition.

This report summarizes clinical and x-ray studies of 20 cases of osteitis condensans ilii. Nine patients were observed from two to seven years. A similarity is suggested between the iliac condensation of this disease and that of osteoarthritis associated with dysplasia of the hip. Iste reporto summarisa studios clinic e radiologic in 20 casos de osteitis condensante iliac. Nove patientes esseva tenite sub observation durante inter two e seven annos. Es suggerite le existentia de un similaritate inter le condensation iliac in iste morbo e in osteoarthritis associate con dysplasia del coxa.

The authors carried out measurements of the gases (pH, PCO2, PO2, SaO2) on blood from the trochanter of 85 chronic hip diseases in 73 patients. Simultaneous measurements were made on the arterial blood and on the blood of the femoral vein of the same side. A statistically significant difference in blood PO2 and oxygen saturation between the group of necrosis of the femoral head and the group of osteoarthritic hips was found. There is a paradoxical oxygen hypersaturation in case of necrosis. This hypersaturation is observed to parallel the increase of the intramedullary pressure in the same bone area.

The remission of rheumatoid arthritis is a generally accepted concept, although few studies have been performed in this area. The authors report 32 cases of rheumatoid arthritis in remission in a population of 300 patients (10.7%). These cases of rheumatoid arthritis did not present any distinctive signs in comparison with the other patients. The remission was obtained an average of 6.5 years after the onset of the disease and has lasted, to date, for an average of 2.55 years. 30 of the 32 patients were still in remission at the last consultation. The criteria of remission proposed by the ARA are confirmed by these cases. The authors raise the question of the influence of basic treatment on the incidence of remission.

The study of two series of cases affected by vertebral hyperostosis allows the authors to underline the frequency with which the hip joint is affected and to describe the destructive forms seen in hyperostosis of the hip. In a first series of 101 cases the authors picked up 145 pathological hips which were probably or surely associated with hyperostosis. These hip disorders presented in three types: Type I (already described by J. Forestier et al.) with peri-articular proliferation and radiological integrity of the joint space; Type II with hyperostotic proliferation and narrowing of the joint space; Type III with epiphysial destruction. The study of a second series "of the development of 58 cases of hyperostotic hip disease" followed for 2-16 years raises the consideration that these three types are in fact three stages in the evolution of the condition.

From literature data and their own experience, the authors comment hematological complications, related to the use of D-penicillamine, mainly in theumatoïd arthritis. Hypereosinophilia is more common than thrombopenia, but, both complications are usually benign. Anemia alone is very rare. Leukopenia appears in 6% of treated patients, but pancytopenia is rare. Leukopenia and pancytopenia are the most severe complications, even fatal in some cases. The safest dose of D-penicillamine seems to be between 600 and 900 mg per day, provided that, however, regular hematological controls may be achieved.

High doses of retinol produce hyperostotic lesions in animals and humans. In this study we measured in fasting subjects and 5 hours after administering 50,000 IU of retinol, levels in the serum of retinol, retinol-binding protein (RBP) and prealbumin in 35 hyperostotic subjects (HVA) and 22 control subjects. Retinol levels were equally high after fasting and after consumption of vitamin A (p 0.01). The levels of retinol-binding protein and prealbumin increase in parallel, such that the molar ratios of retinol to retinol-binding protein or to prealbumin are not changed. Taken with literature data, those of the present study indicate that vitamin A is responsible for the production of hyperostotic lesions.

The authors report the case of a 68 year old man with histologically proven cancer of the prostate who progressively developed an ischioperineal tumor interfering with sitting, and in the pelvis x-ray it was ovular measuring 16 X 7.5 cm. This bone tumor, developed at the expense of the right ischeopublic ramus and the ischeal tuberosity, was well limited and circumscribed, with its central portion dense and the periphery giving a septate appearance. The biopsy of the tumor done under a brilliance amplifier showed that it was an osteosclerotic metastasis of an adenocarcinoma. It appears exceptional for a prostatic cancer metastasis to occur in such an expansive and massive form.

The authors emphasize two new methods for determining the real state of the cartilage and bone structure. These methods permit the early diagnosis of arthrosis and necrosis before X-ray changes appear and perhaps a better management and prognosis.