A renal angiomyolipoma with a challenging presentation: a case report.

INTRODUCTION: Renal angiomyolipoma is considered a benign mesenchymal tumor composed of fat, smooth muscle, and blood vessels. It represents 1-3% of solid renal tumors. Despite this tumor's benignity, it can be aggressive with a locoregional extension. CASE REPORT: A 41-year-old north African caucasian woman consulted with chief complaints of right lower back pain with no hematuria and no urinal sign. Thoracic-abdominopelvic contrast-enhanced computed tomography showed a right inferior polar heterogeneous renal mass complicated with venous thrombus ascending to the right atrium level. The patient underwent radical nephrectomy under extracorporeal circulation and direct supervision of the fatty thrombus at the right atrium level. The postoperative period was uneventful. The final histologic examination was concordant with renal angiomyolipoma. CONCLUSION: Renal angiomyolipoma is the most common benign kidney tumor. Despite its benignity, it can be associated with lethal complications such as hemorrhage, and it can also show signs of local extension mimicking malignant tumors. The cornerstone of the treatment remains surgery.

[Supracondylar fractures of the humerus in children]. / Les lésions nerveuses dans les fractures supra-condyliennes de l'humérus chez l'enfant.

PURPOSE OF THE STUDY: The most frequent type of elbow fracture in children is by far the supracondylar fracture. This type of fracture also raises the greatest risk of nerve injury. We wanted to study the clinical and prognostic features of nerve injuries in children presen-ting supracondylar fractures of the humerus. MATERIAL AND METHODS: We analyzed the files of 55 children with nerve lesions identified among 1 180 files on supracondylar fractures in children. Most presented Lagrange and Ribault stage IV fractures. Nerve injuries involved the radial nerve (n=28), medial nerve (n=20), and ulnar nerve (n=7). The nerve injury was diagnosed before treatment in 32 children, and after treatment in 23. When nerve injury was identified before treatment, closed reduction had been used for eleven fractures and open reduction for 21. Nerve injury identified after treatment was found in eleven fractures after closed reduction and in 12 fractures after open reduction. RESULTS: When nerve injury was recognized at the initial examination, spontaneous nerve recovery was achieved in all cases, irrespective of the treatment modality, within a maximum of four months. When nerve injury was recognized after treatment, spontaneous nerve recovery was obtained in twenty cases. Time to recovery was longer. The three other cases required nerve exploration with neurolysis for two and a nerve graft for one. DISCUSSION: Nerve injury discovered after treatment is either caused by or aggravated by the treatment. Prognosis is less favorable than for injuries discovered at the initial examination. This highlights the importance of carefully searching for nerve deficit, even partial deficiency, in all children presenting a supracondylar fracture of the humerus. It also emphasizes the importance of care in obtaining bone reduction if the initial examination did not reveal any nerve deficit.

[Osteoid osteoma of the olecranon]. / Ostéome ostéoïde de l'olécrane.

We report a case of osteoid osteoma of the olecranon which developed in the greater sigmoid cavity. The patient was a 22-year-old male who complained of arthritic-like symptoms limited to the elbow joint and progressing for three years. Rheumatoid arthritis then tuberculosis were entertained as possible diagnoses. The diagnosis of osteoid osteoma was not established until the disease had progressed for three years and had already become stiff due to epiphyseal remodeling. Resection of the nidus only alleviate pain and joint motion was not improved.

[Septic dislocation of the hip secondary to BCG vaccination]. / Luxation septique de la hanche secondaire à la vaccination par le BCG.

We report a case of septic dislocation of the hip in an eight-month-old infant secondary to BCG vaccination. The usual treatment of septic arthritis with surgical drainage and broad spectrum antibiotics was unsuccessful. Cure was achieved after institution of an anti-tuberculosis treatment and a second surgical drainage. This rare complication of BCG vaccination can develop several months after administration of the vaccine. Diagnosis is often difficult to establish due to the minimal clinical and non-specific clinical expression. Early radiological signs are also non-specific. Identification of the causal agent can be most difficult. Certain diagnosis is generally achieved after biopsy and pathology examination. Despite the attenuated virulence of the vaccine, anti-tuberculosis treatment is indispensable to achieve cure. Surgery drainage alone is insufficient.