[Sciatica due to unusual causes: Tarlov cysts and nerve roots anomalies]. / Lombosciatique de causes inhabituelles: kystes de Tarlov et anomalies des racines nerveuses.

Tarlov cysts and nerve roots anomalies usually involve lumbosacral roots and are often asymptomatic. MRI has enabled recognition of many conditions that used to be missed by CT or myelography investigations performed for back and leg pain. However, even without additional compressive impingement (disc hernia, spondylolisthesis or lumbar canal stenosis) these anomalies can be responsible for sciatica, motor deficit and bladder sphincter dysfunction. Tarlov cysts are perinervous dilatations of the dorsal root ganglion. CT and especially MRI can reveal these cysts and their precise relations with the neighboring structures. Delayed filling of the cysts can be visualized on the myelogram. MRI is more sensitive than CT myelography for a positive diagnosis of nerve root anomalies, a differential diagnosis with disc hernia and classification of these anomalies. Surgical treatment is indicated for symptomatic Tarlov cysts and nerve root anomalies resistant to conservative treatment. Better outcome is observed in patients with an additional compressive impingement component. We report two cases of sciatica: one caused by Tarlov cysts diagnosed by MRI and the other by nerve root anomalies diagnosed by CT myelography. In both cases, conservative treatment was undertaken. The clinical, radiological and therapeutic aspects of these disorders are discussed.

[Multifocal tuberculous dactylitis: a case report]. / Dactylite tuberculeuse multifocale : à propos d'un cas.

INTRODUCTION: Tuberculous dactylitis (TD) is a rare disorder. It is the source of a diagnostic hardship as it is difficult to distinguish from other lesions. We report an unusual case with multiple affected sites both in hands and the right big toe. CASE REPORT: A 42-year-old female initially presented with two painful tumefactions affecting the left third finger and the right middle finger. These tumefactions had been present for two months. Conventional radiography and computed tomography of the hand revealed soft tissue swelling with bone expansion and cortical destruction in the proximal, middle and distal phalanx of the third finger, the proximal phalanx of the middle finger in the left hand, the proximal and middle phalanx of the middle finger of the right hand. Bone scintigraphy showed additionally infraradiologic localisation in the proximal phalanx of the first right toe. Pathology examination of a biopsy specimen revealed granulomatous osteitis with caseous necrosis. Antituberculosis treatment led to initial clinical remission followed by a recurrence and lesion spreading due to bacteria resistance. The second line treatment with Rifampicine, Ciprofloxacine, Ethambutol and Clarithromycine induced favorable outcome. CONCLUSION: Tuberculosis dactylitis is well tolerated for a long time leading to a late diagnosis which may favour its spreading. Antituberculosis treatment is effective but the functional outcome depends on early diagnosis.

[Cervical myelopathy revealing bone fluorosis]. / Myélopathie cervicale révélant une fluorose osseuse.

Bone fluorosis is a rare metabolic disease characterized by massive bone fixation of fluorine. It is seen endemically around phosphate mines in North Africa. Neurologic complications, such as medullar compression may rarely reveal the disease. We report a case of cervical myelopathy due to bone fluorosis causing tetraparesis. Medullar compression was caused by posterior vertebral ligament calcification. Diagnosis was based on the characteristic radiologic aspect, and confirmed by the dosage of serum and urine levels of fluorine. Cervical laminectomy resulted in significant pain improvement, despite persistent motor deficit.

[Paramedical staff knowledge and practice related to the blood transfusion safety]. / Connaissances et pratiques du personnel soignant en matière de sécurité transfusionnelle.

Blood transfusion is a complex activity, involving many actors. It is a high risk activity which couldn't be controlled without the use of specific methods. Health care workers beliefs and organisational factors are two major issues for the blood transfusion safety. Our study objectives were to describe the paramedical staff's knowledge and practice regarding blood transfusion safety and to identify factors that are related to them. We carried out a cross sectional study. The information was gathered by using a questionnaire. The latter was developed by foreign teams and adapted to the local context. Two outcome measures were used: the knowledge and practice score and the proportion of true answers. The study showed that only 15% of the interviewed persons have had a score less than 30 (scale range from 0 to 100), i.e. only 15% have had appropriate knowledge and practice with no negative consequences for the patient safety. 13.8% of the study population provided right answers related to the biologic exams required before red cells transfusion and 34% for the abnormal reaction circumstances. These results underscores the importance of strategies improving the quality and the safety of blood transfusion, i.e. the continuous medical education, implementing a blood transfusion information system and the use of transfusion practice guidelines.

[Oculomotor muscles involvement revealing dermatomyositis in a patient with rheumatoid arthritis]. / Atteinte des muscles oculomoteurs révélant une dermatomyosite chez une patiente ayant une polyarthrite rhumatoïde.

INTRODUCTION: Oculomotor muscles (OMM) involvement in dermatomyositis (DM) and in rheumatoid arthritis (RA) is unusual. The DM always leads to OMM inflammation, whereas the RA particularly leads to tenosynovitis of the superior oblique muscle referred to as the Brown syndrome. OBSERVATION: The patient is a 43-year-old woman who gives a 17-year-history of severe seropositive RA with bilateral coxite. She was hospitalized for acute painful proptosis. The clinical examination revealed an orbital erythema and a muscular rhizomelic weakness. The muscular enzymes were increased. The orbital CT revealed in the right side, an enlargement of the superior rectus muscle that was enhanced after intravenous injection, which is compatible with myositis involvement. The muscular biopsy practiced at the level of the calf showed the specific histological signs of the DM. This orbital involvement was resolved with a high dose of corticosteroids. CONCLUSION: Our observation has the specificity of associating RA with DM with an involvement of the superior rectus muscle, which is due to the DM rather than the RA.

[Tubercular abscess of the psoas without associated spinal involvement. A case report]. / Abcès tuberculeux du psoas sans atteinte rachidienne associée. A propos d'un cas.

INTRODUCTION: Tuberculous psoas abscess outside of locoregional causes is uncommon and can cause a problem of differential diagnosis. EXEGESIS: We report a case of unilateral tuberculous abscess of the psoas which first clinical and radiological features presented like a retroperitoneal tumor. Exploration laparotomy discovered a bulky abscess of the left psoas muscle. Bacteriologic and histologic evaluation confirmed the tuberculous origin. Radiological study of the spine did not show any signs of spondylodiscitis. Under antituberculosis treatment a crural collection occurred and a surgical drainage was performed. Five years later, there was a recurrence of a crural collection which responded well to antituberculosis treatment. CONCLUSION: Tuberculous psoas abscess is usually secondary to spinal involvement, more uncommonly to digestive, urologic or genital tuberculosis. Primary abscess was rarely described and the pathogenesis remains unclear. Psoas contamination is supposed to be hematogenous or lymphatic in origin. Ultrasonography and computed tomography (CT) transformed the diagnosis and the therapeutic approach by percutaneous puncture and drainage.

Behçet syndrome with ankylosing spondylitis.

Two HLA B27-positive patients with concomitant Behçet syndrome and ankylosing spondylitis are reported. The relevant literature is reviewed and the meaning of this combination discussed.