Painful medial knee compartment syndrome in over-45 year-olds: I--medical or surgical management: a series of 174 patients.

INTRODUCTION: There is at present no consensus on the management of degenerative medial meniscus lesions in patients aged over 45 years without proven osteoarthritis, especially given that the causal relation between degenerative meniscal lesion and osteoarthritis remains controversial. A prospective multicenter non randomized study was therefore performed. The principal objective was to assess surgeons' practice in the management of degenerative medial meniscus lesions. The secondary objectives were to identify predictive and prognostic factors and to compare medical versus surgical attitudes so as to draw up an adapted treatment strategy. PATIENTS AND METHOD: One hundred and seventy-four patients were included between September 2008 and February 2010, and distributed between a surgical (n=104) and a medical group (n=70). Minimum follow-up was 6 months. Patient satisfaction and health-related quality of life on the SF-36 questionnaire were assessed at 6 months. RESULTS: No difference emerged between the surgical and medical groups. However, predictive factors for poor results were identified: overweight (p=0.005), cartilage lesions (p=0.035) and meniscus extrusion (p=0.006). DISCUSSION: Results clarified the relation between degenerative meniscus lesions and osteoarthritis, in terms of meniscal incompetence. Meniscal extrusion should be seen as an arthrogenic degenerative meniscus lesion. We recommend a management strategy based on terrain and imaging data (X-ray and MRI), with the aim of providing patient relief while conserving cartilage.

Lymphoma with regression after methotrexate withdrawal in a patient with rheumatoid arthritis. Role for the Epstein-Barr virus.

We report a new case of large T-cell lymphoma in a rheumatoid arthritis patient under low-dose methotrexate (cumulative dose: 750 mg). Serologic tests for the Epstein-Barr virus were positive, and the viral RNA was demonstrated in the lymphoma cells. As in a few other cases reported in the literature, the clinical and laboratory test abnormalities resolved promptly after methotrexate withdrawal without anticancer therapy. The patient was still in complete remission at last follow-up four years later.

[Decrease of the functional affinity of rheumatoid factors under the effect of tiopronin]. / Réduction de l'affinité fonctionnelle des facteurs rhumatoïdes sous l'effet de la tiopronine.

Sixteen rheumatoid arthritis patients were serologically examined, before and after a 2-month treatment with tiopronine (TP). The titer of agglutinating rheumatoid factor (RF) as well as the level of non-agglutinating RF were significantly reduced in serum and synovial fluid (SF). The functional affinity of the remaining RF was attenuated in serum (p less than 0.01) and SF (p less than 0.05). Conversely, the proportion of asialylated IgG was enhanced in serum (p less than 0.05) and SF (p less than 0.05). These findings would suggest that TP might restore the efficacity of sialyl transferase at the B lymphocyte level.

[Pituitary adenoma secreting somatotropic hormone. Gigantism and peripheral neuropathy. A case]. / Adénome hypophysaire sécrétant de l'hormone somatotrope. Gigantisme et neuropathie périphérique. Une observation.

Gigantism, an extremely rare condition, develops before puberty or in subjects in whom puberty is not yet completed. Hypersecretion of somatotropic hormone results in a tremendous surge in growth (our patient was 2.36 m tall). Among other clinical symptoms disabling peripheral neuropathy predominates and changes in nerve conduction velocity are not merely due to the increase in height. The increase in growth hormone concentrations combined with hypogonadotrophic hypogonadism with normal prolactinaemia is associated with peculiar cutaneous symptoms and with low levels of sex hormone-binding protein.

[Osteoid osteoma of the toes. Apropos of 2 cases]. / L'ostéome ostéoïde des orteils. A propos de deux cas.

Two patients presented with osteoid osteomas of the distal phalanx of a toe. A review of documented cases provided data on the characteristic features of these lesions. Diagnosis and treatment, in all cases, were ensured by excision biopsy, enabling a permanent cure to be obtained with a minimum of mutilation.

Salivary immunoglobulin determinations: their diagnostic value in Sjögren's syndrome.

Salivary immunoglobulins (IgA, IgG, IgM) determinations are performed on 74 patients with and without Sjögren's syndrome (SS). In normal subjects IgA is the only immunoglobulin detected in saliva by classical immunodiffusion methods. Correlations between the presence of IgG and/or IgM in saliva and other functional and objective clinical parameters and hsitological aspects of minor salivary glands are studied. In SS the prescence of IgG and/or IgM is in close relationship with "sialography index" which is the most reliable clinical investigation. These results point out that salivary immunoglobulins determinations constitute a simple and specific complementary test for SS diagnosis; they may allow the clinicians to observe the progress of the disease or to evaluate effectiveness of drugs.