[Primitive renal synovial sarcoma: a cystic tumor in young patients]. / Synovialosarcome primitif rénal: une tumeur kystique chez des patients jeunes.

INTRODUCTION: The study of the clinical, histological and immunohistochemical aspects of three kidney tumors corresponding to synovial sarcomas operated on in our center over three years. PATIENTS AND METHOD: Three patients aged between 27 and 33 had an enlarged nephrectomy for kidney tumors corresponding to a histological examination of a synovial sarcoma. The tumors were symptomatic in 100% of cases with back pain and spontaneous rupture. Size varied from 5 to 13cm. The radiological aspect was a cystic tumor (BosniakIV) in two cases and in the other a spontaneous perirenal hematoma. Two were in the right kidney and one in the left kidney. The parts were analyzed after fixation. Immunohistochemical coloration and an analysis in molecular biology by RT-PCR of fusion transcripts were carried out. RESULTS: One patient died because of local development and metastasis 24 months after an enlarged nephrectomy associated with radio chemotherapy (Maidprotocol). Two patients were in total remission after an average of 25 months following the same treatment. The histology found a mesenchymal fusocellular monotone proliferation corresponding to a sarcoma. In all three cases, it was a biphasic form with plaques of fusiform cells and epithelial cells. The immunohistochemical study shows a positivity of the contingent epithelial and fusiform. The muscular markers were negative. A study in molecular biology of the fusion transcript allowed for the finding of a translocation (X;18) in all three cases. CONCLUSION: Primitive synovial sarcoma of the kidney occured in young patients. The translocation (X;18) is pathognomonic of the diagnosis. The prognosis is bleak despite complete excision, radiotherapy and chemotherapy.

[Value of percutaneous biopsy for solid renal tumours less than 4 cm in diameter based on a series of 53 cases]. / Biopsie percutanée pour tumeurs rénales solides de moins de 4cm : intérêt ? A propos de 53 cas.

OBJECTIVE: To evaluate the reliability and clinical value of percutaneous biopsy in the diagnosis of small solid renal tumours (less or equal to 4 cm). MATERIAL: Fifty-three patients underwent biopsy for solid renal tumour less than 4 cm in diameter (mean age: 61 years). The mean diameter was 2.57 cm. The mean number of biopsy cores was 1.93. A histological correlation between biopsy and resection specimen was performed on the 32 operated patients. RESULTS: Biopsy allowed a precise histological diagnosis in 77% of cases: 9/53 benign tumours (17%), 32/53 cancers (60%); 12 biopsies were uninterpretable (normal renal tissue in six cases; necrotic or disrupted tissue in six cases). Management was modified in 13/53 cases (25%): eight benign tumours, three cases of normal renal tissue and two inconclusive cases were followed with no radiological signs of progression. Surgical resection was performed in 32 patients: two tumours were benign; 27 tumours were malignant; three specimens comprised normal renal tissue. For all positive biopsies with a diagnosis of malignant tumour, the Fuhrman grade was correctly evaluated by biopsy in 60% of cases. One false-negative biopsy was observed. For the 41 evaluable biopsies, the sensitivity and specificity were 96 and 100%, respectively. CONCLUSION: In this series, biopsy was a reliable examination in this indication with good sensitivity. The absence of cancer on biopsy did not formally exclude neoplasm. If no tumour (benign or malignant) is observed on the examination, a repeat biopsy or surgical resection should be considered.

A simple suture shuttle in rotator cuff repairs: a technical note.

In rotator cuff repairs, it is often necessary to pass 2 tails of 2 sutures through 1 transosseous hole to maximize the number of sutures per hole. We report on a simple technique with a double-loop suture thread that allows the passing of more than 1 suture limb through the same hole. This simple device, the simple suture shuttle, used in cuff repairs in combination with the modified Mason-Allen suture technique, significantly reduces the difficulty of passing more than 1 suture tail through a single bone tunnel. By reducing the number of bone tunnels, the weakening of a bone that might not be very strong is kept to a minimum. The Simple Suture Shuttle can also be used to pass more sutures through a given number of transosseous holes.

[Long term results of treatment of malleolar fractures (author's transl)]. / Résultats à long terme du traitement des fractures malléolaires.

116 malleolar fractures were reviewed after an average follow up of 8 years. 93 had been treated surgically. The results were similar after conservative or surgical treatment - 51% good, 29% satisfactory, 20% poor. 31% of cases were not completely reduced (28% after surgical treatment), 37% had post traumatic arthrosis (34% after surgical treatment). Arthrosis appeared especially in poorly reduced fractures but was usually well tolerated. The indications for surgery are discussed. The severity of fractures situated at a high level in the fibula (type C of Weber) is stressed.