[Diagnostic problems poses by stiff and painful scoliosis in children].
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Biomedical subjects
Publications and source records attributed to J Dubousset.
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The authors have observed 15 cases of progressive anterior vertebral fusion in patients involved with so-called Scheuermann's disease. The congenital origin of the lesion is discussed. The ossification was sometimes delayed and appeared only during the growth spurt.
The case reported concerns a 12 year-old girl, native of the Cameroons, hospitalized in France for the treatment of the most severe disseminated type of African histoplasmosis (Histoplasma duboisii). In addition to a severe infectious syndrome, the child presented with 3 associated typical involvements: diffuse lymphadenopathy, skin lesions consisting of nodules of the face and trunk and suppurative osteo-articular lesions with an impressive radiological appearance: extensive bone lysis and metaphyseal fractures, without any sign of bone reconstruction, even after several months of treatment. This is rare a disease, but one that should be recognized, especially in its onset localized form, in a patient presenting with infectious osteoarthritis with a torpid evolution leading to the diagnosis of tuberculous or pyogenic infection, or even of osteosarcoma. The disseminated lesions may be difficult to distinguish from the multifocal bone lesions of sickle-cell disease osteomyelitis.
By using a three-dimensional computed tomography (CT) scanner, we compared the anatomic features of the pelvis of three fetuses of same gestational age, one with a normal pelvis representing the reference model, one with classic bladder exstrophy, and one with cloacal exstrophy. The tomography slices were selected at the same levels for each case. Three angles expressing external opening of the pelvis were defined. Comparing normal and abnormal pelvises allowed definition of three criteria for the correction of the malformation: (a) the sum of the differential angles gives the amplitude of the correction needed; (b) a supraacetabular osteotomy appears to allow best closure of the pelvic ring; (c) only three slices of a CT scan are needed, which cannot be harmful, especially for neonates. Therefore, we believe that a CT scan of the pelvis should be performed whenever an osteotomy is planned in the surgical reconstruction of bladder and cloacal exstrophy.