Pathomorphologic characteristics of posttraumatic acetabular dysplasia.

OBJECTIVES: The pathomorphology of posttraumatic acetabular dysplasia differs fundamentally from the classic developmental dysplasia of the adolescent. The aim of this report is to qualify and quantify the pathomorphologic characteristics of the posttraumatic acetabular dysplasia and to define the requirements for adequate corrective surgery in this type of dysplasia. DESIGN AND MATERIAL: Retrospective review of the anteroposterior (AP) radiographs of ten patients with symptomatic posttraumatic acetabular dysplasia. In five cases, false profile views and in five cases computed tomography (CT) scans were also available for investigation. Measurements of distances and angles on radiographs and CT scans were made by pencil and goniometer. RESULTS: On the AP radiographs, posttraumatic acetabular dysplasia shows uniformly deformed true pelvis with an angular deformation of the innominate bone averaging 20 degrees in the region of the acetabular fossa that causes the concavity of the pelvic brim to increase in direction of the involved acetabulum and creates both a lateral and a caudal displacement of the acetabulum, averaging twenty-three millimeters and nine millimeters, respectively. The increased width of the inner wall of the acetabulum, measuring an average of eleven millimeters, makes lateralization of the center of the femoral head reach a mean of forty-three millimeters. The acetabular deformity in all cases shows a pronounced lateral deficiency. Ventral deficiency is moderate. All ten posttraumatic dysplastic acetabuli show marked retroversion averaging 27 degrees. In contrast, the contralateral acetabuli shows a mean anteversion of 23 degrees. CONCLUSIONS: The morphology of this kind of acetabular dysplasia is uniform and differs significantly from that seen in classic developmental dysplasia of the hip. For reconstructive surgery of such a hip, the challenge to abolish the lateralization of the hip joint to restore normal body weight lever arm is imperative. Because acetabular retroversion is a reproductive feature of posttraumatic dysplasia, it is important to avoid further reduction of the posterolateral containment of the femoral head and augmentation of the anterior acetabular wall, increasing the risk of anterior impingement.

[Osseous manifestations and hemoglobinopathies C (author's transl)]. / Manifestations osseuses et hémoglobinopathies C.

The authors report two cases of hemoglobin C trait and hemoglobin C disease with bone tuberculosis and, in the first case, bone infarction of one condyle two years after the tuberculosis of the other knee. This suggests the possibility of osseous manifestations in the course of hemoglobin C trait or hemoglobin C disease apart from hemoglobin SC disease.

[Remarks about twelve cases of pneumococcal septicemias (author's transl)]. / A propos de 12 cas de pneumococcémies.

Twelve cases of pneumococcal septicemias are studied in a department of internal medicine. These septicemias involved pneumonias often large, multilobular and bilateral, with often pleural effusion purulent or not and in one occurrence meningitis. There was three deaths by acute respiratory failure in one case of liver cirrhosis and in another case of chronic lymphocytic leukemia. Conditions of antibiotherapy and possible intensive care are discussed, prognosis factors as splenic insufficiency (in sickle cell anemia and after splenectomy) and immune defense against pneuococcus are recalled.

[Fever, hepatic granulomatosis, electrocardiogram changes, and a positive serodiagnosis for Yersinia enterocolitica: two case reports (author's transl)]. / Fièvre, granulomatose hépatique, troubles électrocardiographiques et sero-diagnostic positif pour Yersinia enterocolitica. Deux observations.

Though no bacteria were isolated, a diagnosis of Yersinia enterocolitica infection was confirmed in two patients by strongly positive serology tests, with levels much above the normal. Both patients had fever, hepatic granulomatosis, and electrocardiogram anomalies, and there was associated dysuria and prostatitis in one case. The authors review the hepatic, urinary, and electrocardiogram manifestations reported in the published literature, and describe the antigenic and serologic relationships existing between Y. enterocolitica type 9 and Brucella abortus.

[Criteria of identification of schistosomiasis caused by Schistosoma hamatobium and S. mansoni (486 patients: 275 case of schistosomiasis)]. / Critères d'identification des schistosomoses à s. haematobium et à s. mansoni (486 malades : 275 schistosomoses)

Out of a total of 486 patients who originated from French Equatorial Africa, from the West Indies or from the Indian Ocean, the authors identified 275 cases of schistosomiasis of which 230 were due to S. Hematobium and 45 to S. Mansoni. The diagnostic methods were biopsy of the rectal mucosa, immunofluorescence, in the West Indians, examination of the stools, in the Africans examination of the urine, intravenous urography and less often cystoscopy. The value of these investigations was studied in each case, then by comparison with one another and with data in the literature. The most valuable investigation was biopsy of the rectum, better in Africans than examination of the urine, immunofluorescence and better than cystoscopy when this was possible.

[Therapeutic and economic aspects of dracunculosis in a Parisian hospital]. / Aspects thérapeutique et économique de la dracunculose dans un hôpital parisien.

We studied 18 cases of dracunculosis treated in our department of Internal Medicine in Paris. The mean duration of the hospital stay is 38 days (15 to 90). The cost of this stay, calculated on the basis of the daily charge, accounts for 93.3 % of the total cost. The longest stays are due to serious subcutaneous infections at the site of the worm and to multiple or complex associated diseases. Average charge for laboratory test, roentgenograms or other investigations amounts to 4.4 % of the cost of the hospital stay. A significant part of these investigations is warranted by cellulitis and the diagnosis of associated conditions. Antibodies prescribed for subcutaneous infections account for almost all of the drug expense (2.3 % of the total cost). Thus, investigations and treatment together amount to only 6.7 % of the daily charge. Traditional treatment of dracunculosis is based on manual extraction of the worm. Thiabendazole was added in 12 of the 18 patients. The average duration of hospitalization (34 days) and average charge for investigations and drug treatment (FF 611) were less in these 12 patients than in the 6 others (47 days, FF 1286). However, this result is to be considered with caution as the number of patients in each group is small, treatments were assigned without any statistical rule, subcutaneous infections were more or less serious and associated diseases may have had a bearing on results.

[Two cases of tuberculosis of the skull cap (author's transl)]. / L'ostéite tuberculeuse de la voûte crânienne.

The authors report two cases of tuberculosis of the skull cap. The first in a Black African with heterozygous sickle cell disease also presenting with: tuberculosis of the cervical lymph nodes, subcutaneous frontal tumefactions bacteriologically confirmed to be of tuberculous origin, multiple lacunae of the vault from the same origin; the second case is an Asian woman having a multifocal tuberculous osteitis involving the skull, spine, pelvis and probably the same affection in the spleen. These cases are a reminder that the principal features of tuberculosis of the skull vault are very often associated with other tuberculous lesions, and to the problems of diagnosis it entails; the existence of a subcutaneous tumefaction of the vault or of any accessible site one can aspirate and/or perform biopsy constitutes a diagnostic aid.