Biomedical subjects
Publications and source records attributed to A Sautet.
The different lesions of the glenoid labrum are described. They may involve the antero-inferior, the posterior or the superior (SLAP lesions) part of the labrum. CT-arthrography is the gold standard imaging modality in this field of shoulder abnormalities.
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Primary leiomyosarcoma of bone is rare. Herein we describe 3 cases with immunohistochemical study. All 3 cases were positive for smooth muscle actin and/or desmin. None was positive for cytokeratin. Differential diagnosis includes metastatic spindle cell carcinoma, other sarcoma (fibrosarcoma, malignant fibrous histiocytoma) and metastatic extra-osseous leiomyosarcoma, mostly from uterus or digestive tract.
A 47 years-old man presented an atraumatic, spontaneous index flexor tendons rupture. This patient has been treated two years ago for a pulmonary tuberculosis. At surgery, the flexor tendons were infiltrated by a granuloma. Histologic examination was compatible with tuberculosis sequelae. According to literature review, this is the second reported case of a tendon rupture due to tuberculosis granuloma.
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Intra-osseous ganglia are among the more frequent causes of cystic lesions of the carpus and may be responsible for diffuse pain, possibly be related to biological activity of the lesions, or when the ganglia opens into the adjacent joint. A CT-scan is useful to determine their exact location and the presence of a cortical defect. Although not this feature is completely established, they seem to arise de "novo" from the bone although their fluid content is reminiscent of those of soft-tissue ganglia. Surgical curettage with bone grafting is only indicated when pain persists despite a period of rest.
17 patients with haemophilia have been treated for a neurological deficit of the upper limb. Four of the five entrapment neuropathies have been operated upon, and only two patients recovered completely. Only two of the 12 patients with a compartment syndrome have been operated upon, and only two had sequelae. Clotting factor replacement is always indicated as primary treatment. Surgical release is indicated if the condition fails to improve. Late treatment was responsible for incomplete recovery, whatever the cause of the nerve compression.
PURPOSE: To determine whether dynamic contrast material-enhanced magnetic resonance (MR) imaging can help differentiate between malignant and benign mediastinal lymph nodes (MLNs) in bronchogenic carcinoma. MATERIALS AND METHODS: Nine patients with biopsy-proved lung carcinoma underwent dynamic contrast-enhanced MR imaging before undergoing thoracic surgery. MR studies included spin-echo, electrocardiographically gated axial and coronal sequences and transaxial gradient-echo breath-hold sequences, which were performed after administration of a bolus of gadoterate meglumine. The enhancement curves were established on the basis of mean signal intensities from regions of interest at the level of tumor and the enlarged MLN. MR images were compared with pathologic specimens obtained at surgical resection. RESULTS: Metastatic MLNs exhibited their peak enhancement at 60-80 seconds, with a slow decrease until 6 minutes. Granulomatous and anthracotic lymph nodes displayed a slight enhancement, with no peak within 6 minutes (P < .01). CONCLUSION: Dynamic contrast-enhanced MR images may provide informative data about the nature of enlarged MLNs in the preoperative assessment of lung carcinoma. Further studies are needed to investigate its usefulness in clinical practice.
Kaposi's sarcoma is very common in patients with AIDS. Usually, skin lesions are associated with various visceral involvements. A homosexual patient with AIDS presented with cough and dyspnea, which were followed months later by hemoptysis. He had no skin lesions or endobronchial Kaposi's sarcoma at any time. His chest radiograph showed only an irregular solitary nodule. It exhibited very slow development over time. Surgery was performed, and this solitary nodule proved to be pulmonary Kaposi's sarcoma. Pulmonary Kaposi was the sole manifestation of this associated AIDS sarcoma. This very unusual case report of pulmonary Kaposi sarcoma indicates that this diagnosis should be considered in patients with AIDS presenting with a solitary pulmonary nodule.
We did a retrospective review of 32 patients who had undergone acute treatment for acromioclavicular joint dislocation (mean follow-up period 46 months) and 24 patients who had undergone surgery for chronic joint dislocation (mean follow-up period 51 months). All patients had a ligamentoplasty performed using the coracoacromial ligament. With the shoulder functional score described by Patte, we obtained 81% satisfactory results for the patients who underwent acute treatment and 79% satisfactory results for those who underwent late treatment. Because results in both groups were similar, we now treat only the more severe form of acute dislocation with surgery. Delayed surgery is indicated in those patients who have an unsatisfactory result after functional treatment.
In the last 10 years we have found impingement of the coracoid process on the rotator interval in 12 patients (14 shoulders). Seven of these patients were women and 5 were men; the average patient age was 48.5 years. One patient had a calcified coracohumeral ligament, another patient had an anterior tear of a repaired deltoid flap, and a third had an aberrant pectoralis minor tendon inserted into the rotator interval. Eleven patients had a weak rotator interval, and in 4 cases the rotator interval had a small tear. We closed the rotator interval in all 12 patients. We also performed a coracoidoplasty in 5 of the patients. The condition of all shoulders improved clinically after operation; the average follow-up was 4.2 years. Three patients (4 shoulders) still had moderate pain, and 7 patients (9 shoulders) lacked strength. Internal rotation was the only shoulder movement that remained limited. Although impingement seemed obvious during surgery, experimental studies have reported contradictory findings.
The availability of multidisciplinary care for rheumatoid arthritis is still limited. The Raoul Dufy Program offered by the Saint-Antoine Teaching Hospital in Paris provides one-on-one personalized care in a day hospital setting as an adjunct to conventional medical follow-up. Listening and providing information and education are major objectives of the nurse, rheumatologist and physical therapist participating in the program. The team also includes a social worker, a surgeon, a dietician, a podiatrist and a psychologist, who intervene as needed. Seventy patients attended the program between December 1993 and September 1995 and were asked to complete a baseline and a three-month questionnaire designed to evaluate the effects of the program in terms of new therapeutic interventions, patient knowledge and quality of life. The patient knowledge score increased significantly (P < 0.0001). Many therapeutic interventions were initiated after program attendance, especially in the fields of podiatry, psychology and physical therapy. However, the quality of life score failed to improve. These results and the substantial patient demand for appointments are encouraging. Further work is needed on the methodology of multidisciplinary care evaluation. Coping strategy evaluation tools may allow to identify some of the specific benefits provided by the multidisciplinary approach.