Case report of bone mastocytosis: total hip arthroplasty for osteoarthritis and open reduction for condylar fracture of the knee.

A 72-year-old woman was admitted in 1984 for painful protrusive osteoarthritis of the left hip diagnosed as systemic mastocytosis with bone lesions and clinical features of intestinal malabsorption but no clinical skin lesion. The total hip replacement, refused in a first step because of the bone pathology, was carried out two years later. Signs of loosening appeared after one year. In 1990, following a traumatic bicondylar fracture of the left knee, an osteosynthesis was carried out. Ten days later, a shaft pathologic fracture of the femur above the osteosynthesis plate implied another open reduction. Two and a half years later, the patient is able to walk short distances, using walking sticks, and lives at home receiving social assistance.

[Confronted with mono-arthritis: which tests?]. / Face à une monoarthrite: quelles investigations?

A monoarthritis may correspond to a localized inflammatory process or to the onset of rheumatoid disease that may later on spread over few or several of the other joints. In this article the different diagnostic and therapeutic steps to approach monoarthritis are presented. One of the first investigations consists in an analysis of the synovial fluid. It should take place before any therapeutic step is initiated and may allow to diagnose a microcrystalline or a septic arthritis. By means of a literature review monoarthritis is described as a disease, whose cause remains often undisclosed inspite of intensive investigations, whose further course, however, is often favorable.

[The pitfalls of cruralgia]. / Les pièges de la cruralgie.

Crural neuralgia can initially present as an involvement of the hip joint. We studied some clinical factors helpful for the diagnosis, which is sometimes difficult.

[Inaugural rachialgia in polyradiculoneuritis or meningoradiculitis]. / Rachialgies inaugurales lors de polyradiculonévrites ou de méningo-radiculites.

Meningoradiculitis or polyradiculoneuritis can manifest itself as a back pain of inflammatory nature. Two case reports give us information about the characteristics of a back pain at the onset of a neurological disease.

[Duration of rehabilitation and fate of patients with cerebral infarction]. / Durée de la rééducation et devenir des patients souffrant d'infarctus cérébraux.

We studied 61 patients with a first stroke, admitted in our rehabilitation center. Functional evolution is usually good, 84% of patients are able to return at home, after a mean of 4.6 months of rehabilitation. Age, sex, severity of the initial deficit, shoulder-hand syndrome, etiology and localisation of stroke are the factors which determine the functional recovery and duration of hospitalisation.

[Rheumatoid arthritis: what do patients do with our prescriptions?]. / Polyarthrite rhumatoïde: que font les patients de nos prescriptions?

This study encompassing a sample of 103 out-patients with chronic polyarthritis revealed that only 71.6% of the patients showed good compliance with the prescribed medication. A relatively large cohort (61%) used paramedical treatments. Factors influencing compliance-behavior, in particular attitude to paramedical methods are investigated.

[Ankylosing vertebral hyperostosis and pulmonary function]. / Hyperostose vertébrale ankylosante et fonction pulmonaire.

Ankylosing vertebral hyperostosis (HVA) or diffuse idiopathic skeletal hyperostosis (DISH) is a disease often seen in the middle-aged and elderly, frequently in patients older than 70 years (10.1% in men, 6.8% in women). Enthesal ossifications can occur at any site of tendinous or ligamentous insertion. The spine is commonly involved. The characteristic appearance is the presence of thick bony bridges between vertebral bodies of the right side of thoracic spine. Many authors, especially Fischer and Stecher, have described hyperostosis of the rib at the costo-vertebral articulation. In our study, 52 patients were examined. The physical examination consisted essentially in pulmonary function and measurement of thoracic and spinal mobility. In spite of severe ankylosing vertebral hyperostosis, which evokes important ossification of the costo-vertebral articulation, we couldn't demonstrate any change in pulmonary function.

[Superior gluteal nerve entrapment neuropathy]. / Mononeuropathie d'enclavement du nerf fessier supérieur.

We observed two female patients suffering from chronic gluteal pain of mechanical origin, without paresthesia. In the first case, the muscular pain was associated with weakness of hip abduction and with tenderness of the middle gluteal muscle. An electromyography, a principal examination, confirmed a diagnosis of entrapment of the superior gluteal nerve in one case and of the distal branch in the other. The proposed treatment, as in the case of neuropathic entrapment of the median nerve at the wrist, consists of a local infiltration of corticosteroids. If the symptoms persist, surgical intervention to free the nerve is indicated. For our first patient the clinical and electromyography cure has been completed. The neuropathy by chronic compression of a nerve in the gluteal area seems to be rare, but one has to consider further investigations in the case of chronic gluteal pain.

Hypothyroidism presenting as destructive arthropathy of the fingers.

A patient presenting with destructive arthropathy of the proximal interphalangeal (PIP) joints of the hands is described. She was initially believed to have rheumatoid arthritis but non-steroidal anti-inflammatory drugs were of no help. The patient was subsequently found to have hypothyroidism and erosive osteoarthritis of the fingers. Joint swelling, pain and stiffness responded dramatically to thyroid hormone substitution. The PIP joint spaces reappeared on the radiographs within 9 months. This case suggest that hypothyroidism may induce destructive arthropathy of the finger joints. As thyroxine replacement may reverse the rheumatic complaints, hypothyroidism should be considered in the differential diagnosis of a destructive arthropathy of unclear aetiology.

[Acute myelo-monocytic leukemia with collagenous medullary fibrosis and osteosclerotic lesions]. / Leucémie aiguë myélo-monocytaire avec fibrose médullaire collagène et lésions ostéocondensantes.

A case of acute myelo-monocytic leukemia (M4) in a 75 year old man with multiple osteosclerotic lesions is reported. Bone metastases were clinically and radiologically suspected. A surgical bone marrow biopsy at the iliac crest revealed a massive infiltrate of blasts with medullary fibrosis, large areas of osteosclerosis and foci of necrosis. Osteosclerosis is rarely observed during acute leukemias in adults. Differential diagnosis with acute myelofibrosis is discussed.