[Giant cell tumors of the distal end of the radius treated by resection-arthrodesis]

The distal end of the radius is one of the sites commonly affected by giant-cell tumor of bone; it poses problems of reconstruction after resection of the distal radius. The authors present a retrospective study of 5 giant cells tumors treated by resection-arthrodesis of the wrist. These tumors were seen in 3 men and 2 women. From the radiological point of view, all tumors were extensive and lytic lesions centered in the epiphysis and involving the metaphysis; the wrist joint was respected. From the histological point of view, the tumors were grade I in 3 cases and grade II in 2 cases. With a mean follow up of 8 years, the results were considered good in 3 cases, fair in 1 case and poor in 1 case. A high incidence of bone complications was noted: delayed union (up to 11 months) and fracture of the graft, which occurred in 3 patients.

Friedreich's ataxia with isolated vitamin E deficiency: a neuropathological study of a Tunisian patient

The neuropathological findings in a Tunisian patient with Friedreich's ataxia with vitamin E deficiency are reported. The main histological changes are: (1) spinal sensory system demyelination with neuronal atrophy, axonal spheroids and corpora amylacea; (2) neuronal lipofuscin accumulation in the third cortical layer of the cerebral cortex, thalamus, lateral geniculate body, twelfth and ambiguus nuclei, spinal horns and posterior root ganglia. Ultrastructurally, the lipopigments were of uniform granularity without lipid droplets.

[Intramuscular myxoma. Apropos of two cases]

The authors report two cases of rare localization of intra muscular myxoma: one in the buttock, and the other in the lumbar area. The first case, a 58 years old woman had a four month history of a mass in the buttock. Computed tomography revealed the presence of a solid tumor. Diagnosis was based on histological examination. After surgical treatment no recurrence was observed after fourteen months. The second case was a 54 years old woman who presented a sciatica with back pain and neurological signs. The symptoms didn't response to medical treatment. Computed tomography showed an enlarged and-cystic lumbar lesion extending to the first sacral hole, with bone erosion of L3 and L4 articular apophysis and spinous process. Needle biopsy and surgical excision of the tumor were performed. Total neurological recovery was observed and no recurrence was observed after three years. The authors reminded the characteristics of this rare and benign soft tissue tumor and specified the place of magnetic resonance imaging (MRI) to establish the diagnosis which was still confirmed by histological examination of an open biopsy. Clinical follow-up revealed exceptional recurrence and no metastasis.

Limb-girdle muscular dystrophy 2C: clinical aspects

The LGMD2C linked to chromosome 13q and related to a 35 KDa dystrophin-associated glycoprotein deficiency, is very similar to Duchenne muscular dystrophy with an autosomal recessive inheritance. It is characterized by a variability of the age of onset, the severity of the evolution and the severity of myopathic changes at the muscle biopsy. This variability was also present in the expression of the alpha-sarcoglycan between the same sibships and between different families.

[Tuberculosis of the trochanter. Apropos of 17 cases]

This paper presents a short study of 17 cases of tuberculosis of the greater trochanter seen during a period of 19 years at the National Orthopaedic Institute in Tunis. The onset of the infection is slow with patients presenting at a mean of 7 years after initial symptoms. The diagnosis is confirmed by biopsy and culture of the organism. Management is based on treatment with antituberculous drugs, although surgical excision of the lesion is sometimes required. Successful resolution of the symptoms is usually achieved unless the hip joint becomes involved. Our patients showed good results at a mean follow up of 5 1/2 years.

Osteoid osteoma of the acetabulum

Osteoid osteoma of the acetabulum can be expected to cause nonspecific symptoms of hip inflammation. In a sixteen year old girl, investigation by routine radiographs and a bone scan suggested a focus of inflammation with a nidus and sclerosis of the acetabulum and overgrowth of the head and neck of the femur. Removal of the lesion by an anterior approach with dislocation of the hip gave excellent results when seen after three years with a normal gait and normal hip motion.

The Mitroflow pericardial valve. First five years of follow-up evaluation

The first 5 years durability study on a substantial number of Mitroflow pericardial valves makes the substance of the present report. One hundred eighty-eight valves were implanted on 166 patients before December 1985: 149 patients were discharged and are recalled annually. Follow up is 99% complete. In October 1988, mean follow up was 3.5 years (3-5.5). Total patients times years is 582. Sixty-two percent of the patients are asymptomatic, 58% in sinus rhythm. Forty-seven percent do not receive any anticoagulant therapy. The linearized rates of thromboembolism (1.2% per patient-year) and endocarditis (0.17 per patient-yr) is minimal. Seven patients only had valve dysfunction requiring explantation (1.2% per patient-yr). At 5 years, freedom of structural deterioration is 95.2% +/- 2.1. Single cusp tear at a stent post is the most frequent lesion (86%) as calcifications are observed in three only (major in two, microscopical in one). Histology does not permit to ascertain whether the tear is due to tissue fatigue or abrasion. Moderate microscopic architectural disruption of the valvular tissue is observed. Composite indices of all valve mortality and morbidity show at 5 years a 89.7% +/- 2.9 freedom of events. These data, associated to the high mechanical and optimal clinical characteristics of the valve, published previously, confirm the satisfactory performances of the valve at 5 years.

[Jaundice and pregnancy. Apropos of 62 cases]

In this study, the authors have attempted to collect files of jaundice in pregnant women. 65 cases were included in this study, over a period of 4 years. Several etiologies of jaundice have been reported but viral hepatitis especially the non A, non B viral hepatitis remain the most frequent. The epidemiology, and the clinical and evolutive criteria of each disease are briefly summarized.