Osteoid osteoma of the phalanx and metacarpal bone: report of 17 cases.

BACKGROUND: Osteoid osteoma (OO) is a slowly progressing benign osteoblastic tumour. In the hand, this tumour is rare. We propose a review of seventeen cases of OO of the phalanx and metacarpal bone. PATIENTS AND METHODS: During the period, between 1998 and 2011, a total of seventeen OO in the hand were confirmed by the pathological examination. They were 10 women and 7 men with an average age of 29 years (age range 17-76). The most common site of the tumour was the proximal phalanx in ten cases, followed by middle phalanx in four cases and metacarpal bone in three cases. The diagnosis of OO was highly required by clinical history. Standard radiographs showed variable images, but computed tomography, and it was useful to facilitate diagnosis and pre-operative planning. All patients underwent surgery (the tumour resection and autogenous bone grafting). In post-operative, there was an immediate pain relief with complete resolution of all symptoms. No recurrence was observed during the last follow-up period of 4 years and 2 months. CONCLUSION: The diagnosis of OO of the hand can be difficult, and it should be considered with bony pain or bony swelling, especially when the history is a chronic one. The CT scan allows visualisation and precise localisation of such benign tumour of the hand. The care should be taken to make the excision complete in order to avoid recurrence.

Bilateral posterior fracture dislocation of the shoulder.

The authors report a case of shoulder bilateral posterior fracture dislocation in a 42-year-old man with osteogenesis imperfecta history. The importance of the communition, the large size of articular surface involved and the poor quality of the bone indicate a bilateral total shoulder arthroplasty. At midterm outcome, a good range of motion of both shoulders was registered.

[Sciatica due to unusual causes: Tarlov cysts and nerve roots anomalies]. / Lombosciatique de causes inhabituelles: kystes de Tarlov et anomalies des racines nerveuses.

Tarlov cysts and nerve roots anomalies usually involve lumbosacral roots and are often asymptomatic. MRI has enabled recognition of many conditions that used to be missed by CT or myelography investigations performed for back and leg pain. However, even without additional compressive impingement (disc hernia, spondylolisthesis or lumbar canal stenosis) these anomalies can be responsible for sciatica, motor deficit and bladder sphincter dysfunction. Tarlov cysts are perinervous dilatations of the dorsal root ganglion. CT and especially MRI can reveal these cysts and their precise relations with the neighboring structures. Delayed filling of the cysts can be visualized on the myelogram. MRI is more sensitive than CT myelography for a positive diagnosis of nerve root anomalies, a differential diagnosis with disc hernia and classification of these anomalies. Surgical treatment is indicated for symptomatic Tarlov cysts and nerve root anomalies resistant to conservative treatment. Better outcome is observed in patients with an additional compressive impingement component. We report two cases of sciatica: one caused by Tarlov cysts diagnosed by MRI and the other by nerve root anomalies diagnosed by CT myelography. In both cases, conservative treatment was undertaken. The clinical, radiological and therapeutic aspects of these disorders are discussed.

[Multifocal tuberculous dactylitis: a case report]. / Dactylite tuberculeuse multifocale : à propos d'un cas.

INTRODUCTION: Tuberculous dactylitis (TD) is a rare disorder. It is the source of a diagnostic hardship as it is difficult to distinguish from other lesions. We report an unusual case with multiple affected sites both in hands and the right big toe. CASE REPORT: A 42-year-old female initially presented with two painful tumefactions affecting the left third finger and the right middle finger. These tumefactions had been present for two months. Conventional radiography and computed tomography of the hand revealed soft tissue swelling with bone expansion and cortical destruction in the proximal, middle and distal phalanx of the third finger, the proximal phalanx of the middle finger in the left hand, the proximal and middle phalanx of the middle finger of the right hand. Bone scintigraphy showed additionally infraradiologic localisation in the proximal phalanx of the first right toe. Pathology examination of a biopsy specimen revealed granulomatous osteitis with caseous necrosis. Antituberculosis treatment led to initial clinical remission followed by a recurrence and lesion spreading due to bacteria resistance. The second line treatment with Rifampicine, Ciprofloxacine, Ethambutol and Clarithromycine induced favorable outcome. CONCLUSION: Tuberculosis dactylitis is well tolerated for a long time leading to a late diagnosis which may favour its spreading. Antituberculosis treatment is effective but the functional outcome depends on early diagnosis.

[Cervical myelopathy revealing bone fluorosis]. / Myélopathie cervicale révélant une fluorose osseuse.

Bone fluorosis is a rare metabolic disease characterized by massive bone fixation of fluorine. It is seen endemically around phosphate mines in North Africa. Neurologic complications, such as medullar compression may rarely reveal the disease. We report a case of cervical myelopathy due to bone fluorosis causing tetraparesis. Medullar compression was caused by posterior vertebral ligament calcification. Diagnosis was based on the characteristic radiologic aspect, and confirmed by the dosage of serum and urine levels of fluorine. Cervical laminectomy resulted in significant pain improvement, despite persistent motor deficit.

[Skeletal fluorosis: a case report]. / Fluorose osseuse: à propos d'un cas.

The authors report a case of skeletal fluorosis described in a 60 years old man living in south-west Tunisian. The main clinical sign is a severe functional legs disability. Radiographic examination has shown a diffused osteocondensation, with cervical spine degenerative discopathy, a pelvis bilateral osteoarthritis and an interosseous membrane ossification of forearms and legs. The skeletal fluorosis diagnosis has been confirmed by high serum and urinary fluoride levels.

[Oculomotor muscles involvement revealing dermatomyositis in a patient with rheumatoid arthritis]. / Atteinte des muscles oculomoteurs révélant une dermatomyosite chez une patiente ayant une polyarthrite rhumatoïde.

INTRODUCTION: Oculomotor muscles (OMM) involvement in dermatomyositis (DM) and in rheumatoid arthritis (RA) is unusual. The DM always leads to OMM inflammation, whereas the RA particularly leads to tenosynovitis of the superior oblique muscle referred to as the Brown syndrome. OBSERVATION: The patient is a 43-year-old woman who gives a 17-year-history of severe seropositive RA with bilateral coxite. She was hospitalized for acute painful proptosis. The clinical examination revealed an orbital erythema and a muscular rhizomelic weakness. The muscular enzymes were increased. The orbital CT revealed in the right side, an enlargement of the superior rectus muscle that was enhanced after intravenous injection, which is compatible with myositis involvement. The muscular biopsy practiced at the level of the calf showed the specific histological signs of the DM. This orbital involvement was resolved with a high dose of corticosteroids. CONCLUSION: Our observation has the specificity of associating RA with DM with an involvement of the superior rectus muscle, which is due to the DM rather than the RA.

[Rheumatoid nodule and complete heart block: diagnosis by transesophageal echocardiography]. / Nodule rhumatoïde responsable d'un bloc auriculoventriculaire complet: diagnostic par l'échocardiographie transoesophagienne.

We report a case of 48 years old women with a 8 years history of rheumatoid arthritis and severe articular deformation treated during the last 6 months by prednisone (5 mg daily) and chloroquine (200 mg daily), admitted in the emergency room because of syncope. The electrocardiogram showed a complete atrioventricular block. Transesophageal echocardiography was performed and revealed an hyperechogenic mass (6 x 2.5 mm) in the interventricular septum probably related to a fibrous rheumatoid nodule. This potentially explain the atrioventricular block by infiltration of the conduction pathways. A permanent double chamber pacemaker was inserted. The chloroquine, another factor of conduction disturbances was not incriminated in this case. The conduction disturbances should be systematically detected in case of severe rheumatoid arthritis. Therefore, every patient must be submitted to a transthoracic echocardiography. Transesophageal echocardiography may be helpful to detect rheumatoid nodule.

[Septic arthritis of posterior lumbar facet joint]. / Arthrite septique interapophysaire postérieure lombaire.

Septic arthritis of the posterior lumbar joints is extremely rare. The clinical picture of this unusual site of infection can easily lead to confusion with spondylodiscitis which is more common. We report a case of a 50-year-old woman with Staphylococcus aureus septic arthritis of the left L5-S1 lumbar facet joint. CT scan was helpful to establish the diagnosis and to guide the percutaneous needle biopsy.

[Scapular exostosis complicated by bursitis. Apropos of a case]. / Exostose scapulaire compliquée de bursite. A propos d'un cas.

We present one case of bursa formation secondary to a scapular osteochondroma. This rare condition can simulate, clinically and radiologically, a sarcomatous transformation. CT scan is helpful to demonstrate the scapular osteochondroma and the adjacent bursa.

[Diagnosis of extruded herniated disks]. / Diagnostic des hernies discales exclues.

In a patient with disk herniation it is often difficult to establish that the disk is free in the spinal canal. A retrospective medical record study comparing 65 cases of free herniated disk (FHD) confirmed upon surgery and 65 cases of disk protrusion (DP) demonstrated that FHD was more common in young male blue collar workers, especially those who worked in the sitting position. No clinical findings were diagnostic of FHD although the straight-leg raising test was positive at smaller angles than in disk protrusion. In this study, sensitivity and specificity of CT scan for the diagnosis of FHD were 75% and 80%, respectively. CT scan findings suggestive of FHD included a free disk fragment, found in 22.5% of cases, and an acute connecting angle. Saccoradiculography was more sensitive but less specific than CT scan in this study. In FDH, migration was common and ragged hernia contours were seen on the saccoradiculography images.

[Association of cheiroarthropathy and Dupuytren's disease in diabetes mellitus]. / Association de la cheiroarthropathie et de la maladie de Dupuytren dans le diabète sucré.

Prospective study of 280 diabetic adults and 100 control show an association of limited joint mobility (LJM) with Dupuytren's contracture (DC) in 37 diabetic and no one of control case. In 80 diabetic with LJM, DC is found in 46.25 p. cent against 21 p. cent in 200 diabetic without LJM (p less than 0.00003). LJM and DC are significantly related to diabetic retinopathy and neuropathy. Their coexistence in diabetic patients, reported by other authors may be related to diffuse alteration of diabetic connective tissue.

[Autochthonous Behçet's disease. Apropos of 73 cases]. / La maladie de Behçet autochtone. A propos de 73 cas.

A multicenter study of Behçet's disease in France confirms the male predominance (62 p. cent), the mean age of onset in the 4th decade, the frequent muco-cutaneous, ocular, articular manifestations (94 p. cent), the skin hypersensitivity (68 p. cent). The forms with arthralgia predominate; the knees are especially affected; arthritis has a favorable course; the para-articular forms are infrequent and in 4 cases, are associated with ankylosing spondylarthritis. HLA B5 is found in 47 p. cent of the cases. HLA-B12 in 22 p. cent. HLA-B5 is associated with eye involvement in 62 p. cent of the cases, HLA-B12 is associated with skin involvement in 67 p. cent of the cases. The effectiveness of colchicine and, at a lesser degree, of steroids, is confirmed.