[Osteoid osteoma of the coccyx: a case report]

The spine is a rare localization of osteoid osteoma and the coccyx even more exceptional. We report a case of osteoid osteoma of the coccyx in a young man who consulted for sacrococcygeal pain partially relieved with salicylates. Computed tomography of the region demonstrated a typical osteoid osteoma lesion. CT-guided localization enabled complete resection of the nidus as demonstrated by the CT of the operative specimen Pathology confirmed the diagnosis of osteoid osteoma. Outcome has been quite favorable at two years.

[Melitococcal psoas abscesses: study of three cases and review of the literature]

Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.

[Vertebral actinomycosis with spinal cord compression. A case report]

INTRODUCTION

Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual.

EXEGESIS

We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up.

CONCLUSION

Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.

Hydatid cyst of bone: diagnosis and treatment

Osseous hydatidosis is a rare occurrence of hydatid disease. Anatomoclinical changes are, however, peculiar to this localization. From the anatomopathologic standpoint, this localization marks the torpid, insidious progression of the parasite into bone tissue, leading to an immediate diffuse, extensive, invasion process, so complete surgical eradication is rarely possible. From the clinical standpoint, whatever the localization may be, we are surprised by the latency of this affection, the patient being treated at an advanced stage, when radiologic lesions are already extensive, and the complications, especially in the spinal area, are severe. Owing to the poor biologic findings, the diagnosis of osseous hydatidosis is still primarily based on roentgenographic findings. Sometimes, however, the diagnosis is established only after surgery. Treatment of osseous hydatidosis is closer to oncologic therapy than to the usual surgical treatment of visceral hydatid cysts. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion.

[Early and late hospital mortality in myocardial infarction. Causes and prognostic factors. Apropos of 140 cases]

The purpose of this work is to study the causes of early and late in-hospital mortality of myocardial infarction, to define elements of prognosis and to attempt to prevent the fatal outcome of the coronary disease. This study concerns 107 men and 33 women, between the ages of 30 and 83 years (mean age 62.8 years). The total mortality is 12% (early: 6.5%, late: 5.5%. 66% of the patients are over 60 and 45% present 3 or more coronary risks factors. The clinical picture is characterized by frequent initial complications (84% of the cases), dominated by hemodynamic failure. The infarction is most of the time located anteriorly (56.6% of the cases). Primary cardiogenic shock represents the main cause of early mortality (55.3%). A recurrent infarction represents 75% of the causes of late deaths. Tri-vessels involvement and alteration of the ventricular function are noted in 9 out of 14 coronary arteriograms. Prognosis factors are proposed to differentiate high risk patients requiring an early coronary arteriogram in view of a specific medical and/or surgical treatment. The best signs of a poor prognosis are: tri-vessels involvement and alteration of the ventricular function.