[Spinal cord compression caused by extramedullary hematopoiesis foci in the course of thalassemia]. / Compression médullaire par des foyers d'hématopoïèse extra médullaire au cours de la thalassémie.

BACKGROUND: Extramedullary haematopoiesis is a physiological response to chronic anemia, observed frequently during homozygous thalassemia. It is usually asymptomatic but can be manifested by compression of adjacent organs, particularly the spinal cord. CASE REPORT: A 44-year-old woman diagnosed with thalassaemia intermedia, was admitted for difficulties to walk and sphincter disturbances. Neurologic examination suggested spinal cord compression, which is confirmed by dorso-lumbar resonance magnetic imaging. The histology obtained by laminectomy led to the diagnosis of extramedullary hematopoiesis related to thalassemia. A radiotherapy enabled with good outcome. DISCUSSION: Spinal cord compressions by extramedullary hematopoiesis during thalassemia are uncommon (75 cases in the literature) but can induce severe sequelae if the diagnostic is not rapidly obtained. Magnetic resonance imaging is the gold standard allowing precise diagnosis and spreading of extramedullary hematopoiesis. Radiotherapy and more recently hydroxyurea are the first line treatment. CONCLUSION: This observation recalls that extramedullary hematopoiesis is a differential diagnostic of spinal cord compression in patients with thalassemia. A screening of paravertebral localization of extramedullary hematopoiesis should be performed in high risk thalassemic patients.

[An unusual tumor of the larynx: malignant fibrous histiocytoma. Apropos of a case. Review of the literature]. / Une tumeur exceptionnelle du larynx: l'histiocytome fibreux malin. A propos d'une observation et revue de la littérature.

On the basis of one case, the authors report about an exceptional tumor of the larynx: malignant fibrous histiocytoma. This tumor, belonging to the soft-tissue sarcomas, usually develops in the limbs. The histological diagnosis is still difficult, in spite of the help provided by immunocytochemistry and fine structural analysis. A histological grading associated to other deciding prognostic factors, such as the size and depth of the tumor and the quality of exeresis, would demonstrate a prognostic correlation. The evolution is characterized by frequent local recurrence and metastases. The treatment is mainly surgical, with as extensive an exeresis as possible at once. Radiation therapy and chemotherapy, though often associated, have not decisively proven their value.

[Variations in the calcaneo-fibular ligament (lig. calcaneofibulare). Application to the kinematics of the ankle]. / Variations du ligament calcaneo-fibulaire (lig. calcaneofibulare). Applications à la cinématique de la cheville.

The authors observe variations in the calcaneo-fibular ligament because this ligament controls two articulations, the talo-crural and the subtalar. This study is based on the dissection of the ankle of 20 specimens. The calcaneo-fibular ligament is reinforced by the ventral and lateral talo-calcaneus ligaments with variations. 3 types of disposition have been described. Type A: A lateral talo-calcaneal ligament reinforces the calcaneo-fibular ligament. These two ligaments are divergent on the proximal, medial, or distal part. Type B: There is an independent lateral talo-calcaneal ligament forward of the calcaneo-fibular ligament. Type C: A ventral talo-calcaneal ligament is observed, parallel to the interosseous ligament. The authors consider the consequences of variation in the lateral ligaments of the ankle for the functioning of the tibio-tarsal articulation, the subtalar articulation and the astragalo-scaphoid articulation in order to propose specific radiographic examination of the kinematics of the ankle.

Anatomic basis of a superior approach to the acetabulum with osteotomy of the ala of the ilium.

This study demonstrates the importance of a superior approach to acetabulum with intrapelvic osteotomy of the iliac ala in certain fractures of the acetabulum. This study is based on the dissection of 15 formolized and 5 frozen subjects, the surgical treatment of 17 acetabular fractures, and the performances of 2 Chiari-type osteotomies and 2 Salter-type osteotomies. We investigated the gluteus medius muscle and its pedicle in relation to the iliac ala. Landmarks for the osteotomy lines and the gluteal pedicles are defined in terms of the requirements of different surgical approaches. The superior approach for acetabular fractures was made using a skin incision of Smith-Petersen type. The underlying principle is the performance of an intrapelvic osteotomy of the iliac ala, the anterosuperior part of the ala being tilted outward and backward and pedicled on the gluteal muscles. This provides intra- and extrapelvic exposure of the acetabular walls. The advantages and drawbacks of this route of approach in surgery of the pelvic girdle are discussed in terms of the types of fracture treated and tumoral locations. The anatomic findings are illustrated from traumatology and tumoralpathology. This approach seems particularly suitable for acetabular fractures interrupting the pelvic ring.

[Study of the vascular segmentation of the spleen]. / Contribution à l'étude de la segmentation vasculaire de la rate (lien).

An experimental study of the spleen segmentary vascularisation was conducted by the "injection-corrosion" technique. Most often was found the well known existence of two lobes, each being divided into two segments, separated by asvascular planes. However we stress the possibility of deviation from this schema, either by the existence of supernumerary polar arteries, or by anomalies in the distribution of segmental arteries.