Oncogenic osteomalacia induced by a sinonasal tumour: case report and review.

BACKGROUND: Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome characterized by hypophosphatemia and overexpression of a phosphaturic agent, fibroblast growth factor 23 (FGF23). OOM is associated with a variety of mesenchymal tumours referred to as phosphaturic mesenchymal tumours. Head and neck regions are concerned in 5-10% of cases. METHODS AND RESULTS: We report the case of a 42-year-old female with OOM caused by a hemangiopericytoma of the left ethmoid sinus. The period between first symptoms and surgical excision of the lesion was approximately 5 years. We also conducted a PubMed-based search to identify all cases of OOM related to sinonasal tumour. Twenty eight cases in the sinonasal area were reported in the literature. CONCLUSION: OOM is an important diagnosis because resection of the causative tumour results in cure of the disease.

[Fronto-ethmoidal fibrous dysplasia: a case-report]. / Dysplasie fibreuse fronto-ethmoïdale: a propos d'un cas.

OBJECTIVES: Fibrous dysplasia is a congenital bone disease, where normal bone is replaced by a fibrous-like tissue with immature osteogenesis. The cephalic extremity is affected in one out of three cases. The aim of this study was to describe a case of fibrous dysplasia and review workup and management of this pathology. MATERIAL AND METHODS: We reviewed relevant publications using the Medline database and presented a case of isolated paranasal sinus fibrous dysplasia to illustrate this disease. RESULTS: The clinical onset was headache and left palpebral oedema in a twelve-year old. Imaging showed a left fronto-ethmoidal bone lesion with epidural empyema. No other radiological anomaly or phosphor-calcic disorder was present. The clinical course was positive using intravenous antibiotics, with a two-year follow-up. DISCUSSION: Fibrous dysplasia is diagnosed using CT-scan, without the need for histologic confirmation in most cases. Initial workup includes axial skeleton X-rays and hormonal dosages. The efficiency of biphosphonates drugs has significally reduced the number of surgical procedures. CONCLUSIONS: Fibrous dysplasia is often a multifocal disease and should be treated medically first. Management requires a multi-disciplinary team.

Necrotic adenoids in post-transplant lymphoproliferative disorders.

PROBLEM: Post-transplant lymphoproliferative disorders (PTLD) are a potentially fatal complication after solid organ transplantation. The majority of cases are associated with Epstein Barr virus infection (EBV). The first manifestations of PTLD are frequently observed in the ENT area with adenoidal and/or tonsillar enlargement. METHODOLOGY: We present the case of a 12-year old girl with a total nasal obstruction and tonsillitis five months after a kidney transplantation for bilateral congenital kidney hypoplasia. RESULTS: The EBV genome was detected by polymerase reaction three months after surgery. Fiberoptic examination revealed an obstructive necrotic mass in the naso-pharynx. The anatomic-pathologic analysis revealed necrotic adenoids. CONCLUSIONS: Necrotic tonsillitis is common. Necrosis of the adenoids, although rarer, can also occur and explains the important respiratory distress. Since two thirds of PTLD patients present with clinical symptoms in the ENT area, the otorhinolaryngologist should be aware of this complication.

[Treatment of severe proximal humeral fractures by proximal nailing (Telegraph). A prospective preliminary study]. / Traitement des fractures complexes de l'humérus proximal par enclouage verrouillé (Telegraph). Résultats d'une étude prospective préliminaire.

Treatment of complex fractures of the proximal humerus is still controversial. This prospective study was designed to evaluate the results of open reduction and proximal nailing in complex fractures of the proximal humerus. Fifteen patients aged 39 to 83 years (average: 59 years) presenting severely displaced fractures of the proximal humerus were observed after open reduction and fixation by proximal nailing (Telegraph) combined with screwing and/or osteosuture of the tuberosities. The patients were evaluated at one year clinically and radiologically. The Constant score, DASH score and Simple Shoulder Test were calculated. Complementarily, patients were submitted to an isokinetic test. At one year follow-up, the average range of motion was 85 degrees (40 degrees-170 degrees) for elevation, 82 degrees (40 degrees-170 degrees) for abduction, L3 for internal rotation and 34 degrees (10-60 degrees) for external rotation. The average visual analog score was 3 points (0-8 points). The Constant score varied from 17 to 92 points (average: 48 points). Isokinetic evaluation showed mostly a strength deficit in abduction even for patients presenting an excellent result. Functional results were related to the quality of the surgical reduction but also to patients' collaboration. Various treatment methods for complex fracture of the proximal humerus are reported in the literature. When a nearly anatomical reduction is achieved, the here-described method of open reduction and proximal nailing permits to obtain good functional results in most patients. This option should be considered for young patients and even in the elderly where results are comparable to that obtained with hemiarthroplasty in the same condition.

Pyocolpos in an elderly woman.

BACKGROUND: Pyocolpos, an uncommon accumulation of pus in the vagina, has not been previously reported in an elderly woman. CASE: A 76-year-old woman was hospitalised with post-menopausal bleeding and fever. Pelvic examination revealed an obstructed vagina. A gadolinium MRI showed pyocolpos. After surgical drainage, the patient rapidly recovered. CONCLUSION: Pyocolpos in elderly woman may appear spontaneously without any history of gynaecologic cancer or trauma.