Botulinum toxin and hyperhidrosis of the amputation stump in war amputees.

INTRODUCTION: Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment. AIM: This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis. METHODS: A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months. RESULTS: Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment. CONCLUSION: Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

A tale about an unusual cause of pygalgia in non-radiographic axial spondyloarthritis.

Schwannoma are tumors of Schwann cells of the peripheral nerve sheath. Sacral location is rarely reported especially in spondyloarthritis patients. Herein, we report a case of uncommon pygalgia in a 25-year-old man with history of a non-radiographic axial spondyloarthritis and in whom the diagnosis of sacral Schwannoma was established.

Hydatid disease of proximal femur treated using a mega prosthesis: A case report.

INTRODUCTION: Bone hydatidosis is a rare disease. It is characterised by discreet and nonspecific symptomatology that makes the diagnosis late and the treatment difficult to manage. PRESENTATION OF CASE: We report the case of a 29-year-old woman hospitalised for right hip pain with a lytic image well limited in the upper extremity of the right femur. We retained the diagnosis of a unicameral bone cyst which weakens the cortical bone. Osteosynthesis with a Gamma nailing was indicated to prevent fractures. At five years of follow up, the patient presented a pain recurrence. Radiographs showed almost a destruction of the upper extremity of the femur and a loosening of osteosynthesis material. Thus, we indicated the removal of the osteosynthesis material and a bone biopsy were performed. Histopathological examination leads to an osseous hydatid cyst diagnosis. We decide to carry out a carcinological resection and reconstruction with a mega prosthesis. The clinical results were excellent and no recurrence for three years follow-up. DISCUSSION: Bone hydatidosis is challenging to diagnose at an early stage, mainly when it simulates a bone cyst. Moreover, the consequence of a late or misdiagnosed bone hydatidosis is devastating. Because of its diffuse and infiltrative character, it gradually invades the whole bone, which makes it more complicated to manage. CONCLUSION: Bone hydatidosis is a rare disease that can simulate other pathologies like a bone cyst in our case. In these situations, the anamnesis has a primordial place to guide the diagnosis and investigations.

[Results of total knee arthroplasty on excessive genu varum superior to 20°]. / Résultats des prostheses totals du genou sur genou varum excessif supérieur à 20°.

BACKGROUND: Total knee arthroplasty on excessive genu varum is a more demanding technique and gives worst results than procedures on moderate deformations. It remains a subject of controversies due to the lack of consensus. The purpose of our study is to evaluate the results of total knee arthroplasty (TKA) on excessive genu varum (superior to 20°) by analyzing pre and post operative clinical and radiological parameters. METHODS: We reviewed retrospectively 40 TKA in 33 patients (seven patients operated bilaterally) performed for genu varum superior to 20° between 2004 and 2011. Pre and post operative evaluation of patients were done according to the International Knee Society score. RESULTS: The mean age of our patients was 67 years with a female predominance. Tricompartmental arthritis was the etiology in all cases. Pre operative IKS score and HKA angle were respectively 52,36 /200 points and 155,7°. The mean follow up was 4 years. Our results were generally satisfactory. The post operative IKS score was 155,36 points (mean joint score of 85.85 points and mean functional score of 69.26 Points) and the post operative HKA angle was 176,17°. Only 60° of patients had normal HKA angle. We noted aseptic loosening of the tibial component in 3 cases. CONCLUSION: TKA on excessive genu varum is more demanding technique. Pre operative planning after analyzing different clinical and radiological parameters is necessary to obtain a good functional outcome while minimizing the rate of complications.

An association of vertebral breast cancer metastasis and multiple myeloma, revealed by a spinal cord compression.

Authors describe the case of a patient with breast cancer and multiple myeloma as the second metachronous disease responsible for spinal cord compression. Synchronous occurrence of bone marrow breast cancer disease and multiple myeloma has not been described in the literature, as in this case. By presenting this case, we point to possible association between both diseases and the possible factors involved in the development of second malignant disease.