[Associated factors and sub-clinical myocardial dysfunction in obese patients with masked hypertension]. / L'hypertension artérielle masquée chez les obèses : facteurs associés et atteinte myocardique infraclinique.

INTRODUCTION: Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. METHODS: It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. RESULTS: A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. CONCLUSION: It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.

Well-differentiated extraskeletal chondrosarcoma: about a new case.

Extraskeletal chondrosarcoma is a rare malignant tumor. The well differentiated histological type, which is found primary in soft tissue, is extremely rare. This report  describes the case of a 58-year-old woman presented with a large palpable mass in the right buttock. Imaging studies revealed a well-defined soft tissue mass, with extensive calcification. A histological examination after surgical resection confirmed the diagnosis of well-differentiated extraosseous chondrosarcoma. The outcome was favorable, without recurrence or metastasis.

[Chronic kidney disease and myocardial infarction: epidemiological, clinical, therapeutic and prognostic characteristics (about 231 cases)]. / Insuffisance rénale chronique et infarctus de myocarde : particularités épidémiologiques, cliniques, thérapeutiques et pronostiques (à propos de 231 cas).

AIMS OF THE STUDY: To study the epidemiologic, clinical, therapeutic and prognostic characteristics of the myocardial infarction (MI) in patients with chronic kidney disease (CKD). To identify the impact of CKD in hospital, mid- and long-term survival after myocardial infarction. To determine the predictive factors of hospital and midterm MACCE in patients with CKD. PATIENTS AND METHODS: The study population was 231 patients with a myocardial infarction admitted alive from January 2005 to December 2006. The population was divided into two groups. Group 1: glomerular filtration rate (GFR) ≥60 ml/min: 112 patients; group 2: GFR<60 ml/min: 119 patients. RESULTS: Patients with CKD had more history of stroke and arterial hypertension. They had received less medical therapies and urgent reperfusion. In multivariate analysis, CKD was a predictive factor of hospital (P=0.016), at 6 months (P=0.003), at 1 year (P=0.004) and at 2 years MACCE (P=0,015). The predictive factors of hospital MACCE in group 2 were: use of vasopressors (P=0.001) and primary angioplasty (P=0.043). In patients with CKD, only surgical coronary revascularization was MACCE predictive factor (P=0.03). CONCLUSION: Baseline renal function is a powerful predictor of short- and long-term events after myocardial infarction. Our results confirm the need to include the renal function in the evaluation of the level of risk among patients admitted with acute myocardial infarction.

[Supraventricular tachycardia in infants]. / Les troubles du rythme supraventriculaires chez le nourrisson et l'enfant. À propos de six cas.

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.

[A rare localization of solitary plasmocytoma]. / Une localisation rare de plasmocytome solitaire.

INTRODUCTION: Solitary bone plasmocytoma is rare, characterized by malignant plasmocyte proliferation, derived from a sole B lymphocyte clone located on a bony segment without medullar invasion. It, above all, affects the thoracolumbar spine. Costal involvement is rarely described. CASE REPORT: The authors report the case of a 60-year-old man who complained of dyspnea, dry cough, and thoracic pain four months before admission. Thoracic imaging revealed a left apical tissue mass with osteolysis of the first rib. A transparietal biopsy of the mass was not helpful. Surgical biopsy concluded as to the diagnosis of costal plasmocytoma. All of the examinations carried out to search for other localizations were negative confirming the solitary nature of the tumor. The treatment consisted of complementary radiotherapy at a dose of 45Gy. The patient was in remission after eight months. CONCLUSION: Solitary costal plasmocytoma should be called to mind when confronted with a lytic tumor of the rib. The treatment is based on surgery and radiotherapy. The prognosis is dominated by the risk of progression to multiple myeloma.

[Supracondylar fractures of the humerus in children]. / Les lésions nerveuses dans les fractures supra-condyliennes de l'humérus chez l'enfant.

PURPOSE OF THE STUDY: The most frequent type of elbow fracture in children is by far the supracondylar fracture. This type of fracture also raises the greatest risk of nerve injury. We wanted to study the clinical and prognostic features of nerve injuries in children presen-ting supracondylar fractures of the humerus. MATERIAL AND METHODS: We analyzed the files of 55 children with nerve lesions identified among 1 180 files on supracondylar fractures in children. Most presented Lagrange and Ribault stage IV fractures. Nerve injuries involved the radial nerve (n=28), medial nerve (n=20), and ulnar nerve (n=7). The nerve injury was diagnosed before treatment in 32 children, and after treatment in 23. When nerve injury was identified before treatment, closed reduction had been used for eleven fractures and open reduction for 21. Nerve injury identified after treatment was found in eleven fractures after closed reduction and in 12 fractures after open reduction. RESULTS: When nerve injury was recognized at the initial examination, spontaneous nerve recovery was achieved in all cases, irrespective of the treatment modality, within a maximum of four months. When nerve injury was recognized after treatment, spontaneous nerve recovery was obtained in twenty cases. Time to recovery was longer. The three other cases required nerve exploration with neurolysis for two and a nerve graft for one. DISCUSSION: Nerve injury discovered after treatment is either caused by or aggravated by the treatment. Prognosis is less favorable than for injuries discovered at the initial examination. This highlights the importance of carefully searching for nerve deficit, even partial deficiency, in all children presenting a supracondylar fracture of the humerus. It also emphasizes the importance of care in obtaining bone reduction if the initial examination did not reveal any nerve deficit.

Clinical decision rules to distinguish between bacterial and aseptic meningitis.

BACKGROUND: Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations. AIMS: To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules. METHODS: All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been included in a retrospective cohort study. Sensitivity and specificity were calculated by applying each rule to the patients. The best rule was a priori defined as the one yielding 100% sensitivity for bacterial meningitis, the highest specificity, and the greatest simplicity for a bedside application. RESULTS: Among the 166 patients included, 20 had bacterial meningitis and 146 had aseptic meningitis. Although three rules achieved 100% sensitivity (95% CI 84-100), one had a significantly lower specificity (13%, 95% CI 8-19) than those of the other two rules (57%, 95% CI 48-65; and 66%, 95% CI 57-73), which were not statistically different. The ease of manual computation of the rule developed by Nigrovic et al (a simple list of five items: seizure, blood neutrophil count, cerebrospinal fluid (CSF) Gram stain, CSF protein, CSF neutrophil count) was higher than the one developed by Bonsu and Harper. CONCLUSION: On our population, the rule derived by Nigrovic et al had the best balance between accuracy and simplicity of manual computation and could help to avoid two thirds of unnecessary antibiotic treatments and hospitalisations.

[A long-term follow up of the shoulder in obstetrical brachial palsy]. / Suivi à long terme des épaules paralytiques obstétricales (à propos de 129 cas).

OBJECTIVES: To study shoulder impairment and disability caused by obstetrical brachial plexus palsy, their evolution under physical and surgical treatments, and the place of complementary explorations in persistent sequels. METHODS: From 1991 to 2000, 129 patients (66 M, 63 F) were included in a retrospective study. Impairment was assessed by muscle recovery (deltoid, biceps, external rotators) and shoulder passive motion. Disability was assessed by Mallet functional test. RESULTS: Full spontaneous recovery was noted in 20% of patients before the age of 3 months. Repair of the nerve lesion was undertaken in four children between the 18th and 24th months. Full recovery of deltoid and biceps was noted in three-fourth of whole cases before the 12th month, and of the external rotation in only 45% at this same age. Seventy-seven percent of patients showed stage >or= III of Mallet test (VI: 20%, IV: 32%; III: 25%) at a middle age of 3.5 years. A long-term follow-up showed an external rotation limited less than 20 degrees in 15 children. Investigation by RMN or Arthroscanner was realized for five patients, this reveals a deformation with subluxation of the humeral head in two cases. Ten children were operated (liberation of sub-scapula in nine cases associated to a tendinous transfer six times; humeral osteotomie in one case). This surgery has allowed the improvement of the functional state in all cases. CONCLUSION: After-effects in shoulder are frequent especially the limitation of external rotation, which can lead to a deformation, and subluxation of the humeral head. The authors insist on the importance to push investigations in case of limitation of the passive external rotation to improve the therapeutic choice.

[Management of posteriorly dislocated lenses: a report on 18 cases]. / Traitement des luxations postérieures du cristallin.

The posterior dislocation of the lens is a relatively frequent complication of ocular trauma. Treatment is medical, surgical and optical. The authors present a retrospective study of 18 patients (18 eyes) operated between January 1990 and December 1999 for a posterior dislocation of the lens. The age of the patients varied from 9 to 60 years, with a mean of 46 years. The etiology of the dislocation was an eye contusion in 15 cases and spontaneous dislocation in 3 cases. Vitrectomy was performed in all the patients, followed by extraction of the lens using one of two methods Results were good in both groups, with a final visual acuity better than 1/10 in 11 cases out of 18. Complications were substantially fewer than when using old techniques and included 4 cases of hypertonia, 3 cases of corneal edema, 2 cases of retinal detachment, and 1 case of macular edema. All of these complications were treated medically and/or surgically. The authors discuss the advantages and disadvantages of all lens extraction techniques and the benefits of the use of perfluorocarbon liquid in the treatment of the dislocated lens.

[Corneal lesions caused by caterpillar hairs: four case studies]. / Lésions cornéennes dues aux poils de chenille.

Caterpillar hairs disseminated by the wind can cause serious ocular problems in humans. We present 4 cases of corneal lesions caused by caterpillar hairs. Intense functional signs observed in exposed subjects should bring this diagnosis to mind. The severity of this affection is due to the possibility of intraocular migration, even many years after the first accident. Treatment consists of removing the caterpillar hair associated with an antibiotic and local anti-inflammatory treatment.

[Retinal detachment in the patient surgically treated for cataract]. / Decollement de retine chez l'operé de cataracte.

We report 95 cases of retinal detachment in patients aged from 17 to 82 years, aphakic (49 cases) and pseudophakic (46 cases). Risk factors are vitreous issue, inflammation, Yag capsulotomy, retinal predisposal lesions and secondary implantation. Surgery is not different from other retinal detachment. Anatomic result are successful in 66% of aphakic and in 70% of pseudophakic patients.

Chondromyxoid fibroma of the scapula : A case report.

Chondromyxoid fibroma of the scapula occurring in a 23 year old woman is of interest because of its unusual site and the extensive invasion of the soft tissues.