[Spontaneous streptococcal arthritis of the pubic symphysis]. / Arthrites septiques spontanées à streptocoques de la symphyse pubienne.

Septic arthritis of the pubic symphysis is uncommon, and usually occurs in patients with predisposing conditions (female incontinence surgery, sports). Staphylococcus aureus and Pseudomonas aeruginosa are the main bacteria responsible of these infections. Streptococcal infections of the pubic symphysis are uncommon. We report three cases of streptococcal infections of the pubic symphysis that occurred in the absence of predisposing condition such as surgery or endocarditis. The diagnosis of septic arthritis was difficult, particularly in one patient who underwent an orchidopexy for a suspected of spermatic cord torsion before diagnosis was corrected. All three patients had a favourable outcome after an antibiotic treatment combining amoxicillin and rifampicin. Septic arthritis of the pubic symphysis should be suspected in patients with sudden groin pain, pubic tenderness and fever to avoid traumatic treatments and useless investigations.

[Charcot's disease of the lumbosacral joint in spinal cord injury: a case report]. / Arthropathie neurogène de la charnière lombosacrée chez un paraplégique : à propos d'un cas.

OBJECTIVE: Comment on spinal damage in Charcot's disease. OBSERVATION: We report on a paraplegic patient with T9 spinal cord injury who developed destructive arthropathy of the lumbosacral joint. DISCUSSION: Charcot's disease occurs sporadically during the progression of certain chronic neurological diseases. It affects the limbs and the spine, where it causes major disc and vertebral damage. In cases of spinal cord injury, Charcot's disease must be considered when faced with the appearance of spinal deformity or the aggravation of neurological symptoms. Treatment of Charcot's disease requires spinal osteosynthesis for the relief of neurological compression and the re-establishment of spinal stability.

[Quality of life and scales measuring]. / La qualité de vie et ses mesures.

SCOPE: To present a review of the concept and the measurement of quality of life. CURRENT SITUATION AND SALIENT POINTS: The concept of quality of life was developed in the seventies aiming to complete the medical evaluation. It appeared with improvement of disease prognosis, medical evaluation and the development of patient autonomy of patients. The methodology used to construct quality of life scales is presented. Problems raised by adaptation of instruments for use in other culture are briefly discussed. PERSPECTIVES: These scales are now used in clinical research, medical economic studies and day-to-day practice. However, ethical issues surrounding these measures persist.

[Asymptomatic blunt vertebral artery injury after cervical spine nonpenetrating trauma]. / Thrombose asymptomatique de l'artère vertébrale au cours des traumatismes fermés du rachis cervical.

OBJECTIVE: To show the possibility of vertebral injury after cervical spine trauma. METHOD: We observed 2 cases of asymptomatic thrombosis of the vertebral artery after cervical fracture. DISCUSSION: Thrombosis of the vertebral artery is acute in 20% of cases of cervical trauma. It may be asymptomatic. Magnetic resonance angiography is the best noninvasive investigation for such cases to systematically detect the complication. Treatment with anticoagulants or antiaggregants should be initiated.

[Acute low back pain induced by calcifying nucleopathy]. / Lombalgie aiguë révélant la résorption d'une nucléopathie calcifiante.

INTRODUCTION: The nucleopathy calcifying of the inter vertebral disk is mostly asymptomatic. CASE RECORD: We report a cave miming a spondylodiscit. DISCUSSION: Although idiopatic in most case, it is necessary to look for a calcifying metabolic disease. The treatment base on the immobilization of the spine and non steroidal anti inflammatory medications.

[Nonsurgical treatment of tennis elbow]. / Les traitements non chirurgicaux de la tendinopathie des épicondyliens.

OBJECTIVE: To review the literature on nonsurgical treatment of tennis elbow. METHODS: We searched Medline for all randomized controlled trials (RCTs), controlled clinical trials (CCTs) and literature reviews published from 1966 to December 2003 on nonsurgical treatment of tennis elbow. We used the keys words controlled clinical trial, tennis elbow on lateral epicondylitis, and treatment. We found 46 reports of RCTs and CCTs on 14 nonsurgical treatments and 11 literature reviews. RESULTS: Corticosteroid injection is the best treatment option for the short term. However, beneficial effects persisted only for a short time, and the long-term outcome could be poor. For the long term, physiotherapy (pulsed ultrasound, deep friction massage and exercise programme) was the best option but was not significantly different from the "wait-and-see" approach. Some support is offered for the use of topical nonsteroid anti-inflammatory drugs, at least for the short term. There is insufficient evidence to support or refute the use of acupuncture, extracorporeal shock wave therapy, manipulation, orthoses, low-energy laser, glycosaminoglycan polysulfate injection, botulinum toxin injection, or topical nitric oxide application. CONCLUSION: Further trials, with use of appropriate methods and adequate sample sizes, are needed before conclusions can be drawn about the effects of many of the treatments for tennis elbow and their ability to change the condition's natural course.

[Crowned dens syndrome: three new cases]. / Syndrome de la dent couronnée : à propos de trois nouveaux cas.

INTRODUCTION: Crowned dens syndrome is due to a microcrystalline infringement (hydroxyapatite or calcium pyrophosphate) of the retro-odontoidal ligament of atlas, often leading to the erroneous diagnosis of meningitis or spondylitis. We report on three new cases diagnosed from 1996 to 1999. EXEGESIS: The patients complained of cervicalgies, headaches or fever. The initially evoked diagnoses were meningitis, spondylodiscitis or endocarditis. Clinical exam found meningism and an inflammatory syndrome in all patients. Analysis of the cerebro-spinal fluid realised in two cases was normal. The diagnosis of crowned dens syndrome was assessed in two cases by cervical CT scan of C1/C2. In the third case, chondrocalcinosis of a wrist allowed this diagnosis. We report a probably non fortuitous case of crowned dens syndrome associated with genetic hemochromatosis. A non steroidal anti-inflammatory treatment allowed a dramatic regression of clinical symptoms. CONCLUSION: This entity should be better known; it can mimick numerous diagnosis and be responsible for fever in the long course.

[Inhibitors of TNFalpha]. / Les inhibiteurs du TNFalpha.

INTRODUCTION: TNFalpha inhibitors etanercept and infliximab, are a new and very exciting drugs. Etanercept is administered subcutaneously, and infliximab by intravenous perfusions. EXEGESIS: They are indicated in severely rheumatoid arthritis resistant to treatment with methotrexate, and in Crohn's disease refractory to immunosuppressive agents. Their safety profile is good, but the risk of infections is increased. CONCLUSION: Their indication in other inflammatory diseases need further studies.

[Bone mineral density in patients with chronic lung diseases]. / Etude de la densité minérale osseuse chez des patients insuffisants respiratoires chroniques.

PURPOSE: We evaluated bone mineral density and phosphorus calcium status in patients with chronic lung diseases. PATIENTS AND METHODS: A prospective study was conducted in 58 patients (43 men and 15 women, mean age 44 years, age range 16-68 years) who were classed in three groups: chronic obstructive diseases (25 patients), cystic fibrosis (19 patients), and other lung diseases (14 patients). Fifteen percent of the patients were receiving corticosteroid therapy. Bone mineral density of the lumbar spin and the femoral neck was measured. RESULTS: Serum calcium, phosphate, creatinine, osteocalcin and parathyroid hormone were normal. The 25-hydroxyvitamin D (normal=9-40 ng/ml) level was in the lower limits of normal (12 ng/ml) and was severely decreased in 12 patients (<7 ng/ml). CONCLUSION: Chronic lung disease can lead to osteoporosis. Corticosteroids, low vitamin D level, sedentary lifestyle, smoking, and in cystic fibrosis nutritional deficiencies, delayed puberty and hypogonadism are risk factors. Bone density must be measured in order to prevent and treat osteoporosis.

Primary lymphoma of bone: a prospective study of 28 cases.

PURPOSE: To conduct a prospective study of primary lymphoma of bone (PLB) comparatively with extraskeletal non-Hodgkin's lymphomas (ESNHLs) and secondary lymphoma of bone (SLB). PATIENTS AND METHODS: The 28 cases of PLB, 2932 cases of ESNHL, and 219 cases of SLB included between April 1, 1993, and October 1, 1997, in a treatment protocol for NHL developed by the Adult Lymphoma Study Group, were studied prospectively. RESULTS: Of the 28 PLB patients, 17 were men and 11 women; median age was 48 years (range, 18-69). The disease was monostotic in 17 cases (involving the peripheral skeleton in 14) and polyostotic in nine cases. The proportion of patients younger than 60 years was 86% in the PLB group, 59% in the ESNHL group, and 55% in the SLB group. The Ann Arbor stage distribution (I-II/III-IV) was as follows: 54%/46% in the PLB group, 50%/50% in the ESNHL group, and 20%/80% in the SLB group. Performance status was 0 or 1 in 100% of the PLB patients, 50% of the ESNHL patients, and 20% of the SLB patients. The phenotype was B in 89% of the PLBs and 85% of the ESNHLs and SLBs. In the PLB group, 54% of patients had diffuse large cell tumors and 11% diffuse mixed tumors; in the ESNHL group, 39% had diffuse large cell, 13% diffuse mixed, and 8% diffuse immunoblastic tumors; and in the SLB group, 45% had diffuse large cell, 10% diffuse mixed, and 12% diffuse immunoblastic tumors. A complete or partial response to induction therapy was noted in 86% of PLB patients, 84% of ESNHL patients, and 78% of SLB patients. Overall five-year survival was 65% in the PLB group, 50% in the ESNHL group, and 40% in the SLB group. DISCUSSION: Survival was better in the PLB group. Further studies are needed to determine the effect of radiation therapy at completion of the treatment protocol and to look for prognostic factors associated with bone involvement.

[The value and limits of Palmaz's prosthesis in the treatment of tracheobronchial stenosis]. / Intérêts et limites de la prothèse de Palmaz dans le traitement des sténoses trachéobronchiques.

The use of endobronchial prosthesis may be indispensable to maintain patency of the airways. We report our experience using Palmaz's prosthesis in four patients. The results were satisfactory in one patient but we have been confronted with three failures and one grave complication. The failures were linked to unsuitable properties of this prosthesis which has led us limit its use whilst waiting for newer studies.

Concentrations of ceftriaxone (1,000 milligrams intravenously) in abdominal tissues during open prostatectomy.

Ceftriaxone concentrations in abdominal tissues were evaluated at different stages of open prostatectomy. Ceftriaxone was administered as antibiotic prophylaxis, and 15 consecutive patients were given a single dose of ceftriaxone (1,000 mg intravenously in 1 min) 30 min before surgery. Ceftriaxone concentrations in tissue were determined at three stages of the surgical procedure; upon the opening of the abdominal cavity, during the prostatectomy, and upon the closure of the abdominal cavity. Samples of the following tissues or sample were assayed: epiploic and abdominal-wall fat; Retzius' space, bladder, and prostate tissue; and urine. During the different stages of the surgical procedure, for all patients, and in the different tested tissues, ceftriaxone concentrations greater than or equal to the cutoff point (4 micrograms/g of tissue) were measured. The highest concentrations were obtained in the bladder (43 +/- 18 micrograms/g) and in the prostate (35 +/- 18 micrograms/g). In fatty tissues, concentrations were between 13 +/- 5 and 22 +/- 8 micrograms/g. All patients (15 of 15) had ceftriaxone levels in tissue greater than the MICs for the potential pathogens (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis). In conclusion, during open prostatectomy and after the use of a single dose of ceftriaxone (1,000 mg), high antibiotic levels were obtained throughout the surgical procedure in the tissues potentially involved in postoperative infection.

[Merkel cell carcinoma: primary cutaneous neuroendocrine tumor]. / Carcinome à cellules de Merkel: tumeur neuroendocrine cutanée primitive.

Merkel cell carcinoma is a neuroendocrine primitive tumor of the skin. We report a case who develops node and visceral metastasis, and dead. The clinical presentation, diagnosis, histology, immunocytochemistry, treatment and prognosis of this tumor will be discussed.

[Community acquired pneumonias in the region of Montpellier. Increase of pneumococci with reduced sensitivity to penicillins]. / Pneumonies communautaires dans la région de Montpellier. Augmentation des pneumocoques de sensibilité diminuée aux pénicillines.

OBJECTIVES: Bacteriological data indicate that there is an increased incidence of Streptococcus pneumoniae strains with an intermediate sensitivity to penicillin. The goals of the present study was i) to investigate the profile of sensitivity of Streptococcus pneumoniae isolated from patients with bacterial pneumonia in the area of Montpellier and ii) to compare this profile with the findings of the national center registry to better appreciate geographical specificity. METHODS: Fifty-six patients with bacterial pneumonia were enrolled into the study. From September 1989 to March 1994, we performed bacterial sampling including blood cultures, protected brushes and bronchoalveolar lavage specimens. We examined the antibiotic sensitivity of the germs which were isolated. All patients were followed using clinical and radiological criteria. RESULTS: A precise bacteriological diagnosis was established in 83.6% of the population. Streptococcus pneumoniae was found in 47.2% of the samples. In 19%, the strains displayed an intermediate sensitivity to penicillin. All patients recovered. CONCLUSION: We found a higher rate of resistance to penicillin in Montpellier than the common rate of the national reference center in France. The location of Montpellier closed to the Spanish border might, at least in part, explain this difference.

[A new cause of prolonged fever of unknown origin: progesterone substitution therapy]. / Une nouvelle cause de fièvre prolongée inexpliquée: les traitements progestatifs.

OBJECTIVES: Over the last 3 years, we examined 15 patients on progesterone substitution therapy who presented prolonged fever. Many explanations had been put forward before the diagnosis was suggested. We recall the thermogenic effect of progesterone. METHODS: Based on a retrospective analysis, we reported the clinical and biological features of 15 patients with prolonged fever due to progesterone substitution therapy and prospectively followed the temperature curves of 9 menopaused women who received substitution therapy for the first time. RESULTS: The 15 case reports were quite typical. Often onset occurred with an acute infectious episode. Following this episode, the patients continued to take their temperature and discovered persistent fever. The context was often one of anxiety-depression rich in functional symptomatology. Laboratory findings included a normal sedimentation rate in all patients. Several days after treatment withdrawal temperature returned to normal. The prospective study confirmed the thermogenetic effect of almost all progesterone substitution drugs. CONCLUSION: The thermogenic effect of natural progesterone is well known but it must be recalled that all progesterone agents with 5-beta metabolites have the same effect. Since metabolic clearance is long, the thermogenic effect may persist for several days after withdrawal.

[Pachydermodactyly: report of a case]. / La pachydermodactylie: une observation.

This 20 year old white patient complained of progressive thickening of his fingers over a period of four years. The second, third and fifth fingers of each hand indeed appeared podgy. The soft tissue on each side of the first phalanx was swollen, firm without adherence to the bone. The skin of the interdigital space was hyperpigmented and lichenified. This case illustrates the clinical and histologic features of digital fibromatosis which are discussed.