Synovial Chondromatosis of the Shoulder in Rheumatoid Arthritis: A Case Report and Brief Review of the Literature.

BACKGROUND: Synovial chondromatosis is an uncommon benign condition characterized by synovial membrane proliferation and metaplasia. Synovial chondromatosis cases in patients with rheumatoid arthritis have been reported. However, involvement of the glenohumeral joint is rare. CASE PRESENTATION: We herein report a case of a rare association of synovial chondromatosis involving the shoulder in a rheumatoid arthritis patient. The symptoms have improved with anti-tumor necrosis factor drugs. Consequently, there was no need for invasive therapy to treat synovial chondromatosis. CONCLUSION: Synovial chondromatosis can be aggressive and destructive. More trials are needed to establish a better clinical diagnostic strategy and pharmacological management.

Traumatic Floating Neural Arch of the Subaxial Cervical Spine: Case Report.

Bilateral traumatic pedicle fracture in the lower cervical spine is a very unusual lesion. Its association with bilateral facet dislocation has been reported once in the literature. We report a unique traumatic lesion considered as subaxial cervical floating neural arch with special emphasize on reduction maneuvers and surgical management. It was a case of bilateral C7 pedicle fracture with bilateral C6/C7 facet dislocation in a neurologically intact 70-year-old patient. Open posterior reduction with fixation followed by anterior fusion was performed with good functional and radiological outcomes at last follow up. The floating neural arch lesion is the combination of bilateral pedicle fracture and facet dislocation. The detection of such lesions imposes a two-stage surgery with open posterior reduction and anterior fusion.

Sciatica and femoral head osteonecrosis complicating a gluteal hydatid cyst: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease is an endemic echinococcal infestation in Tunisia. Only 4% of hydatid cysts are located in the muscle. The gluteal localization is a very rare entity. The present case illustrates a gluteal hydatid cyst resulting in sciatica and osteonecrosis of the femoral head, an exceptional entity. CASE PRESENTATION: A 49-year-old man of urban origin, with free medical history, presented to our outpatient clinic with left sciatica and mechanical hip pain, that have been ongoing for 2 years. Pelvic radiograph showed femoral head osteonecrosis and lytic lesions of the ischium. MRI scan identified an extra-articular vesicular cyst in the left gluteal region involving the gluteus maximus. It suggested the diagnosis of musculo-skeletal echinococcosis. The patient underwent surgery and intraoperative findings showed a gluteal vesicular cyst with direct compression of the sciatic nerve, it also revealed femoral head necrosis. The cyst was drained and the pericyst excised. Total hip arthroplasty was postponed and the patient received a course of anthelmintic chemotherapy. CLINICAL DISCUSSION: Muscular involvement of hydatid cysts is rare and seen only in 4% of cases. Neurological complications from sciatic nerve compression can present as sciatica, with a principal differential diagnosis of nerve root compression. Aseptic femoral head osteonecrosis, an exceptional complication of an extra-articular gluteal hydatid cyst, can result from three mechanisms: a direct mechanical compression, an ischemic process due to vessel obstruction or a cellular process mediated by osteoclasts. Treatment is based on surgical excision combined with anthelmintic chemotherapy, the latter reduces the number of live cysts and the risk of recurrence. CONCLUSION: Although gluteal cysts are extremely rare with different clinical symptoms, surgery associated with anthelmintic treatment has a good functional outcome.

Spinal Osteoid Osteoma Revealed by Radiculopathy: Case Report and Literature Review.

Osteoid osteoma (OO) is a benign tumor that usually occurs in long bones of young males. We report a rare case of spinal OO in a 25-year-old woman, revealed by a sciatica. Spinal radiographs and computed tomography scan were normal, although performed at 6 months of symptom evolution. On magnetic resonance imaging, however, an important edema of the right transverse process of L5 vertebrae was depicted but was inconclusive. The diagnosis of OO was finally retained on a second computed tomography scan with thinner slices focused on the edematous area. The patient had an en-bloc excision of the tumor with complete regression of symptoms. Due to the atypical clinical presentation and the absence of common findings in imaging, the diagnosis was delayed by 12 months. Radiculopathy caused by spinal OO is a rare condition with no more than 30 cases reported in the literature. In fact, spinal OO usually presents with inflammatory back pain or painful scoliosis. This case emphasizes the importance of early suspicion and diagnostic interventions in the detection and treatment of OO.

Endemic insular and coastal Tunisian date palm genetic diversity.

The breeding of crop species relies on the valorisation of ancestral or wild varieties to enrich the cultivated germplasm. The Tunisian date palm genetic patrimony is being threatened by diversity loss and global climate change. We have conducted a genetic study to evaluate the potential of spontaneous coastal resources to improve the currently exploited Tunisian date palm genetic pool. Eighteen microsatellite loci of Phoenix dactylifera L. were used to compare the genetic diversity of coastal accessions from Kerkennah, Djerba, Gabès and continental date palm accessions from Tozeur. A collection of 105 date palms from the four regions was analysed. This study has provided us with an extensive understanding of the local genetic diversity and its distribution. The coastal date palm genotypes exhibit a high and specific genetic diversity. These genotypes are certainly an untapped reservoir of agronomically important genes to improve cultivated germplasm in continental date palm.

Direct estimation of cardiac biventricular volumes with an adapted Bayesian formulation.

Accurate estimation of the ventricular volumes is essential to the assessment of global cardiac functions. The existing estimation methods are mostly restricted to the left ventricle (LV), and often require segmentation which is challenging and computationally expensive. This paper proposes to estimate the volumes of both LV and right ventricle (RV) jointly with an efficient segmentation-free method. The proposed method employs an adapted Bayesian formulation. It introduces a novel likelihood function to exploit multiple appearance features, and a novel prior probability model to incorporate the area correlation between LV and RV cavities. The method is validated on a comprehensive dataset containing 56 clinical subjects (3360 images in total). The experimental results demonstrate that the estimated biventricular volumes are highly correlated to their independent ground truth. As a result, the proposed method enables a direct, efficient, and accurate assessment of global cardiac functions.

Comparative study of perdialytic volemia variability in chronic dialysis patients between acetate- free biofiltration and bicarbonate hemodialysis.

We have developed since 1994 a new hemodialysis (HD) technique called acetate biofiltration 84% (AFB 84%) that is characterized by the absence of acetate in the dialysate and the complete correction of buffer balance by post- dilutional infusion of bicarbonate- based replacement solution. Our study aimed to compare the variability of perdialytic volemia [net ultrafiltration (UF) rate, total UF, Δweight (T4- T0)] during AFB 84% and bicarbonate dialysis (BD) for stable chronic hemodynamic patients. This was a prospective crossover study carried out on 14 patients for a total of 168 HD sessions (84 AFB 84% and 84 BD). Optical measurement of hemoglobin (Hb) concentration was incorporated into the dialysis monitor to allow the study of the relative blood volume. For both techniques, Hb measured by Hemoscan® correlated well with the laboratory measurements. Moreover, the comparison of the averages of the different indicators of the perdialytic volemia did not disclose any significant statistical differences. Nevertheless, the comparison of the variability of perdialytic volemia between both techniques showed less Δ volemia (T4- T0) during the AFB 84% than the BD (- 7.909% for BD and - 6.960% for ABF 84%, P = 0.0036). We conclude that the absence of acetate and maintaining an optimal osmolarity at the origin of a better plasma refilling rate are key factors that make AFB 84% a technique assuring a better perdialyitic hemodynamic tolerance in comparison with BD in chronic HD patients.

Effective level set image segmentation with a kernel induced data term.

This study investigates level set multiphase image segmentation by kernel mapping and piecewise constant modeling of the image data thereof. A kernel function maps implicitly the original data into data of a higher dimension so that the piecewise constant model becomes applicable. This leads to a flexible and effective alternative to complex modeling of the image data. The method uses an active curve objective functional with two terms: an original term which evaluates the deviation of the mapped image data within each segmentation region from the piecewise constant model and a classic length regularization term for smooth region boundaries. Functional minimization is carried out by iterations of two consecutive steps: 1) minimization with respect to the segmentation by curve evolution via Euler-Lagrange descent equations and 2) minimization with respect to the regions parameters via fixed point iterations. Using a common kernel function, this step amounts to a mean shift parameter update. We verified the effectiveness of the method by a quantitative and comparative performance evaluation over a large number of experiments on synthetic images, as well as experiments with a variety of real images such as medical, satellite, and natural images, as well as motion maps.