Spitzoid melanoma of the finger: a case report.

BACKGROUND: Melanoma is the most malignant skin tumor, with a high metastatic potential. Spitzoid melanoma is a subtype of melanoma requiring rapid management and extensive tumor resection. We have set the goal to recognize anatomical peculiarities and difficulties diagnoses posed by this type of tumor, as well as to recognize the management modalities, especially the surgical one, of malignant spitzoid melanoma. CASE PRESENTATION: A 25-year-old Tunisian male patient had consulted for nodular lesion of the right index, evolving for 4 years. A malignant tumor was strongly suspected, then confirmed as a melanoma by a biopsy excision. Initially, the excision was incomplete in depth, suggesting a complementary surgery, but the patient refused it; 3 years later, the patient again consulted after the appearance of an axillary lymphadenopathy and worsening of the skin lesion. A supplement of tumor removal with lymph node biopsy were performed. It was decided to perform an amputation of the second ray and the first commissure with cheiroplasty, reconstructing a four-finger hand. An homolateral axillary cleaning was performed at the same time. The postoperative result is considered esthetically and functionally satisfying. The evolution was marked by the appearance of pulmonary metastases, requiring adjuvant chemotherapy. A regression of the nodule under the mammary skin and total disappearance of axillary nodes have been marked; but the patient's condition rapidly deteriorated, and he died after a 2-month decline. CONCLUSION: Spitzoid melanoma is exceptional, posing difficulties in diagnostics, and it should not be underestimated, considering that it may involve the vital prognosis. Knowledge of this rare form of melanoma is important to avoid misdiagnosis, which delays diagnosis and subsequent therapy.

[Retrospective study of 50 cases of tibial pilon fractures in adults at the Department of Orthopedics of the University Hospital Center Habib Bourguiba, Sfax, Tunisia]. / Etude rétrospective de 50 cas de fractures du pilon tibial chez l'adulte dans le Département d'Orthopédie, Centre Hospitalier Universitaire Habib Bourguiba de Sfax, Tunisie.

Tibial pilon fractures are polymorphic fractures posing therapeutic and prognostic challenges. The purpose of this study is to examine the epidemiological profile of these fractures and to assess our findings from an anatomical and functional point of view. We collected data fom 50 medical records of patients treated for tibial pilon fractures and monitored over the period 2004-2013 at the Orthopedic-Trauma Department of the Habib Bourguiba University Hospital in Sfax. Functional outcomes were assessed using the Ankle-Hindfoot score. Radiological findings were used to determine fracture healing. Treatment was based on internal osteosynthesis in 30 cases, external fixation in 11 cases and on a combination of both techniques in 9 cases. At the end of this study, functional outcomes were good and very good in 36 cases. Thirty cases of fracture healing were reported, with 18 cases of vicious callus and two cases of pseudosteoarthritis. Therapeutic management of tibial pilon fractures is difficult in some cases. Solid osteosynthesis with anatomical reduction is the only therapeutic option to secure a satisfactory functional outcome.

Infection of a tophaceous nodule of the wirst and hand.

Tophaceous gout occurs years after recurrent attacks of acute inflammatory arthritis. The urate deposits are incriminated in the inflammatory process; however, their infection is exceptional. We report the observation of an infected gouty tophus of the pinky and the wrist of a 40-year-old man, presented as an excruciating inflammatory pain with buff-yellow swelling of the fifth right finger and wrist in a febrile context. As a matter of fact, the evolution was favourable after surgical excision and antibiotic therapy. The infection of a tophus is an exceptional complication of the gout. In daily practice, this diagnosis is really a difficult challenge for the clinician. The systematic bacteriological examination of the tophi with cutaneous fistulation is necessary to introduce prematurely an adapted treatment.

Scurvy: When it is a Forgotten Illness the Surgery Makes the Diagnosis.

BACKGROUND: Unlike most of animal species, human beings lack the enzymatic process for the conversion of glucose to ascorbic acid (vitaminC), and therefore getting the vitamin from food sources is essential. The association of the various signs caused by a deficiency of vitamin C is called scurvy or Barlow's disease, an easily treatable disease but can be fatal. It is rare in the developed countries and even economically underdeveloped societies in which the basic diet is already rich in ascorbate. METHODS: We describe here the case of a 4-year-old girl with cerebral palsy, in whom diagnosis concerns were oriented for osteomyelitis, based upon clinical presentation, ultrasonic and magnetic resonance imaging, led to a surgery revealing subperiosteal hematomas that argues in favor of scurvy. RESULTS: After vitamin C therapy, the symptoms are gone and the general condition of the patient improved despite persistent radiological signs. CONCLUSION: Recent studies of sporadic cases report a high incidence of scurvy in children with autism or psychomotor retardation and the fact that musculoskeletal manifestations are more common. The mosaics of the symptoms of scurvy are varied and include dermatological, dental, bone and systemic manifestations, making it a forgotten and misdiagnosed illness. A heightened awareness is needed to avoid an unnecessary surgery, unnecessary tests and procedures and to be able to start treatment for a potentially fatal but easily curable disease.