Presse Med
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RADIOLOGICAL EVALUATION CRITERIA: To date, outcome of therapeutic trials examining structure modifying treatments has been basically assessed with repeated measurement of joint spaces on plain x-rays. In the ECHODIAH study, these measurements demonstrated an advantage in favor of treatment with diacerein. ⋯ The PHARE study on the epidemiology of osteoarthritis includes three types of patients referred to orthopedic surgeons for degenerative hip disease and undergoing total hip replacement within three Months. Analysis of data collected should provide a better understanding of the factors leading to implantation of total hip prosthesis in daily practice and help determine the validity of total hip replacement or its indication as the main outcome assessment criterion for therapeutic trials.
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GREAT PROGRESS: The use of purified insulins obtained by genetics has dramatically lowered the frequency of insulin hypersensitivity. This frequency has decreased from 1 to 55% with non purified insulins and to 0.1 to 2% with newly generated insulins.
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DEGRADATION AND REPAIR: Osteoarthritis generally occurs in a context of an overloaded normal cartilage matrix or normal loading of a vulnerable cartilage matrix. Interleukin-1 appears to be principally indicated in degradation phenomena while transforming growth factor (TGFbeta) is mainly implicated in phenomena of excessive synovial and chondrocyte repair observed at the same time as degradation. ⋯ Two mechanisms of action have been validated: in vitro inhibition of interleukin-1 (IL-1) synthesis, the main cytokine involved in cartilage destruction, and activity on the synthesis of proteoglycans, and hyaluronic acid, the principal component of cartilage. Other studies presented here have provided further details concerning other mechanisms of action of diacerein.
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Historical Article
[The defense and illustration of proper nouns in cardiology].
THE PROS AND CONS: The fact that proper nouns are used in medicine is regularly criticised (notably because of the lack of scientific rigour). However, such use in cardiology remains an active tradition for three, historical, precision and linguistic, reasons. ⋯ THE OUTCOME OF PROPER NOUNS: Some proper nouns become inescapable and classic, others become outmoded whilst new ones regularly appear. A proper noun can become forgotten with the regression of a disease, a decline in clinical semiology or in that of a technique.
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THE RHEUMATOLOGIST'S CONTRIBUTION: Several data favor regular referral of patients with osteoarthritis to rheumatology specialists and/or continued follow-up by general practitioners. Important elements include difficulties in establishing the initial diagnosis, technical procedures, and individual adaptation of drugs and/or non-drug treatments.