1
|
Zendeoui A, Gharbi MA, Nefiss M, Ezzine MH, Tborbi A, Bouzidi R. Primary extrahepatic hydatid cyst of the thigh, an unusual presentation of sciatica: A case report of a diagnostic challenge. Int J Surg Case Rep 2024; 117:109545. [PMID: 38518474 PMCID: PMC10973717 DOI: 10.1016/j.ijscr.2024.109545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Sciatica, a condition characterized by pain along the sciatic nerve distribution, is commonly associated with nerve compression or irritation. However, its etiology can vary, including rare non-spinal causes such as hydatid cysts. We present a case of hydatid cyst in the thigh causing sciatica-like symptoms, highlighting the diagnostic challenges and management approach. CASE PRESENTATION A 40-year-old patient with a history of pulmonary tuberculosis presented with persistent lumbosciatic pain despite conservative treatment. Physical examination revealed left sciatica without spinal abnormalities. MRI revealed a hydatid cyst in the thigh, causing nerve irritation. Surgical resection of the cyst was performed, achieving symptom resolution. DISCUSSION Hydatid cysts in skeletal muscles are rare, with atypical presentations complicating diagnosis. Localization in the thigh, particularly the biceps femoris muscle, is uncommon. Diagnostic modalities include imaging and serological tests, while treatment involves surgical excision and postoperative albendazole therapy. CONCLUSION Recognition of rare presentations like thigh hydatid cysts causing sciatica-like symptoms is crucial for timely diagnosis and management. This case emphasizes the importance of considering unusual etiologies in refractory sciatica cases and underscores the complexity of medical diagnosis. Increased awareness among healthcare providers can lead to improved patient outcomes and prevent diagnostic delays.
Collapse
Affiliation(s)
| | | | - Mouadh Nefiss
- Orthopaedic Department, Mongi Slim Hospital, Tunisia
| | | | - Anis Tborbi
- Orthopaedic Department, Mongi Slim Hospital, Tunisia
| | - Ramzi Bouzidi
- Orthopaedic Department, Mongi Slim Hospital, Tunisia
| |
Collapse
|
2
|
Gharbi MA, Limaiem F, Romdhane KB, Tebourbi A, Bouzidi R, Nefiss M. Uncommon Thigh Mass in Neurofibromatosis Type 1: Unveiling Aggressive Epithelioid Sarcoma. Eur J Case Rep Intern Med 2024; 11:004432. [PMID: 38584901 PMCID: PMC10997394 DOI: 10.12890/2024_004432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background Patients with neurofibromatosis type I (NF1) have an increased risk of developing soft-tissue sarcomas, particularly those related to the nervous system. Epithelioid sarcoma (ES) is an exceptionally rare subtype of soft-tissue sarcoma, with limited knowledge about its clinical presentation and optimal management in NF1. This report aims to provide insights into the characteristics and outcomes of ES in NF1 patients. Case description A 37-year-old man with a history of NF1 presented with a progressively worsening mass on his right inner thigh. An MRI scan revealed a well-defined tissue mass originating from the adductor magnus muscle, later confirmed as ES through histopathology and immunohistochemistry. Considering poor local and general prognosis, the multidisciplinary team recommended salvage hip disarticulation, however the patient refused and opted for palliative marginal resection to reduce the tumour size. The patient's condition declined rapidly, and he succumbed six days after the surgery. Conclusion This case highlights the rarity of ES in NF1 patients and underscores the potential for malignant tumour development in this population. Further research is needed to improve our understanding and management of sarcomas in the context of NF1. LEARNING POINTS Patients with neurofibromatosis type 1 or von Recklinghausen's disease have a higher risk than those with other types of neurofibromatosis of developing benign or malignant soft-tissue tumours especially related to the nervous system.Epithelioid sarcoma is an extremely rare subtype of soft-tissue sarcoma and is exceptionally associated with neurofibromatosis type 1.A multidisciplinary approach remains essential in the diagnosis, management, and treatment of soft-tissue sarcomas in patients with neurofibromatosis type 1.
Collapse
Affiliation(s)
- Mohamed A. Gharbi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
- Department of Orthopaedic and Trauma Surgery, Mongi Slim Marsa University Hospital Centre, Tunis, Tunisia
| | - Faten Limaiem
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
- Pathology Department, Mongi Slim Marsa University Hospital Centre, Tunis, Tunisia
| | | | - Anis Tebourbi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
- Department of Orthopaedic and Trauma Surgery, Mongi Slim Marsa University Hospital Centre, Tunis, Tunisia
| | - Ramzi Bouzidi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
- Department of Orthopaedic and Trauma Surgery, Mongi Slim Marsa University Hospital Centre, Tunis, Tunisia
| | - Mouadh Nefiss
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
- Department of Orthopaedic and Trauma Surgery, Mongi Slim Marsa University Hospital Centre, Tunis, Tunisia
| |
Collapse
|
3
|
Limaiem F, Gharbi MA, Bouzidi R. An unusual cause of inguinal swelling: Primary synovial osteochondromatosis. Clin Case Rep 2024; 12:e8637. [PMID: 38444919 PMCID: PMC10912080 DOI: 10.1002/ccr3.8637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
Inguinal swelling should raise suspicion for hip joint osteochondromatosis. Early recognition, accurate diagnosis, and prompt surgical intervention are essential for optimizing patient outcomes.
Collapse
Affiliation(s)
- Faten Limaiem
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Pathology DepartmentMongi Slim HospitalLa MarsaTunisia
| | - Mohamed Amine Gharbi
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of Orthopedic SurgeryMongi Slim Hospital La MarsaLa MarsaTunisia
| | - Ramzi Bouzidi
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of Orthopedic SurgeryMongi Slim Hospital La MarsaLa MarsaTunisia
| |
Collapse
|
4
|
Zendeoui A, Nefiss M, Bousrih A, Tborbi A, Bouzidi R, Ezzaouia K. Solitary bone plasmacytoma of the axis, a rare and challenging case with good outcomes. Int J Surg Case Rep 2024; 114:109176. [PMID: 38128293 PMCID: PMC10800741 DOI: 10.1016/j.ijscr.2023.109176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Plasmacytoma is a rare hematological malignancy with a more favorable prognosis than multiple myeloma. This case report focuses on a unique solitary bone plasmacytoma (SBP) at the craniovertebral junction (CVJ), managed through surgery and radiotherapy. CASE PRESENTATION A 50-year-old patient presented with four months of worsening neck pain and cervicobrachial neuralgia. Despite treatment and physiotherapy, symptoms persisted. Clinical examination revealed neck stiffness, with no motor or sensory deficits. Radiographs and MRI showed an infiltrating axis lesion without instability signs. A CT-guided biopsy yielded inconclusive results. To address instability and establish a diagnosis, a curettage biopsy of the C2 posterior arch was performed, followed by occipito-C4 fusion using an iliac crest graft. Histological examination confirmed SBP. Adjuvant radiotherapy and chemotherapy were administered. At four-year follow-up, there was no multiple myeloma progression, but limited neck mobility were reported, with stable fusion observed on imaging. DISCUSSION Solitary bone plasmacytoma primarily affects the axial skeleton, with rare upper cervical spine involvement. Diagnostic criteria include histological confirmation, normal bone marrow analysis, unremarkable imaging (except for the primary lesion), and absence of end-organ damage related to lymphoplasmacytic proliferative disorders. Clinical presentation is nonspecific, and MRI is valuable for soft tissue assessment. Radiotherapy is the primary treatment, with surgery reserved for specific indications. CONCLUSION Solitary bone plasmacytoma is a rare condition with a favorable prognosis when promptly managed. This case underscores the importance of early diagnosis and treatment to prevent recurrence or multiple myeloma progression. A multidisciplinary approach, including surgery when necessary, is crucial for optimal outcomes.
Collapse
Affiliation(s)
| | - Mouadh Nefiss
- Orthopaedic department, Mongi Slim Hospital, Tunisia
| | - Anis Bousrih
- Orthopaedic department, Mongi Slim Hospital, Tunisia
| | - Anis Tborbi
- Orthopaedic department, Mongi Slim Hospital, Tunisia
| | - Ramzi Bouzidi
- Orthopaedic department, Mongi Slim Hospital, Tunisia
| | | |
Collapse
|
5
|
Gharbi MA, Zendeoui A, Tborbi A, Bouzidi R, Ezzaouia K, Nefiss M. Conservative surgical management of surface osteosarcoma using 3D printing technology: An unusual case report and literature review. Int J Surg Case Rep 2023; 113:109086. [PMID: 38007866 PMCID: PMC10746854 DOI: 10.1016/j.ijscr.2023.109086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Surface osteosarcoma, a rare variant of osteosarcoma, poses unique challenges in diagnosis and treatment. This report discusses the application of 3D printing technology in the surgical management of a complex case involving a 27-year-old female patient with surface osteosarcoma in the proximal tibia. CASE PRESENTATION A 27-year-old female patient presented with a progressively growing mass on her right knee, initially misdiagnosed as a benign bone tumor. Over five years, the lesion expanded from a well-corticated metaphyseal-epiphyseal outgrowth on the proximal tibia to involve the anterior tibial tuberosity. Radiological and histological evaluations confirmed well-differentiated paraosteal surface osteosarcoma. A multidisciplinary team opted for a conservative surgical approach, including resection of the anterior tibial tuberosity and patellar tendon. Precision was enhanced through 3D printing technology, which provided custom cutting guides. The reconstruction involved non-vascularized peroneus and iliac crest bone grafts. CLINICAL DISCUSSION Accurate differentiation from benign lesions presents challenges. Achieving surgical resection with clear margins is pivotal for favourable outcomes, particularly in young patients. Chemotherapy yields limited benefits in low-grade surface osteosarcomas. Functional prognosis hinges on effective post-resection reconstruction. 3D printing technology facilitates meticulous surgical planning and guidance, enhancing the success of conservative surgical interventions. CONCLUSION This case underscores the significance of a multidisciplinary approach, accurate diagnosis, and the integration of 3D printing technology in managing surface osteosarcomas. Conservative surgical resection, guided by precise planning and reconstruction, is critical for preserving functionality. Continued research and the adoption of innovative techniques hold promise for improving the quality of life and functional outcomes of individuals grappling with musculoskeletal tumors.
Collapse
Affiliation(s)
- Mohamed Amine Gharbi
- Department of Orthopedic and Trauma Surgery, Mongi Slim Marsa University Hospital Center, Tunis, Tunisia
| | - Ahmed Zendeoui
- Department of Orthopedic and Trauma Surgery, Mongi Slim Marsa University Hospital Center, Tunis, Tunisia.
| | - Anis Tborbi
- Department of Orthopedic and Trauma Surgery, Mongi Slim Marsa University Hospital Center, Tunis, Tunisia
| | - Ramzi Bouzidi
- Department of Orthopedic and Trauma Surgery, Mongi Slim Marsa University Hospital Center, Tunis, Tunisia
| | - Khelil Ezzaouia
- Department of Orthopedic and Trauma Surgery, Mongi Slim Marsa University Hospital Center, Tunis, Tunisia
| | - Mouadh Nefiss
- Department of Orthopedic and Trauma Surgery, Mongi Slim Marsa University Hospital Center, Tunis, Tunisia
| |
Collapse
|
6
|
Gharbi MA, Chahed HE, Slama SB, Teborbi A, Bouzidi R, Nefiss M. One-stage combined approach en bloc vertebrectomy for primary Ewing's sarcoma of mobile spine in an adult patient: 3 years following aggressive surgery for a rare entity. Clin Case Rep 2023; 11:e8170. [PMID: 38028076 PMCID: PMC10651980 DOI: 10.1002/ccr3.8170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Currently, there is no consensus on the optimal management of nonmetastatic Ewing's sarcoma of the mobile spine. However, associated to chemotherapy, aggressive surgery with en bloc wide resection seems to improve local control and survival. Abstract Primary Ewing's sarcoma (EWS) of non-sacral spine is extremely rare, especially in middle-age. Therapeutic strategy aims: to large tumor resection, to provide spine stability and to avoid recurrence through chemo and radiotherapy. We report a case of thoracic spine EWS in an adult treated by combined approach en bloc vertebrectomy.
Collapse
Affiliation(s)
- Mohamed Amine Gharbi
- Department of Orthopedic and Trauma SurgeryMongi Slim Marsa University Hospital CenterTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Houssem Eddine Chahed
- Department of Orthopedic and Trauma SurgeryMongi Slim Marsa University Hospital CenterTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Sana Ben Slama
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of Anatomical PathologyMongi Slim Marsa University Hospital CenterTunisTunisia
| | - Anis Teborbi
- Department of Orthopedic and Trauma SurgeryMongi Slim Marsa University Hospital CenterTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Ramzi Bouzidi
- Department of Orthopedic and Trauma SurgeryMongi Slim Marsa University Hospital CenterTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Mouadh Nefiss
- Department of Orthopedic and Trauma SurgeryMongi Slim Marsa University Hospital CenterTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| |
Collapse
|
7
|
Limaiem F, Teborbi A, Bouzidi R. Primary giant hydatid cyst of the thigh: An unusual location. Clin Case Rep 2023; 11:e8056. [PMID: 37850058 PMCID: PMC10577154 DOI: 10.1002/ccr3.8056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
Key Clinical Message Primary hydatid cyst of the thigh is a rare condition requiring prompt recognition and accurate diagnosis for timely management and prevention of complications. Abstract Muscular hydatid cysts are rare, with a frequency ranging from 1% to 5% even in endemic areas. The clinical presentation of muscular hydatidosis is typically subtle and lacks specific features, frequently resulting in delayed diagnosis. Herein, the authors describe a case of a primary hydatid cyst located in the thigh.
Collapse
Affiliation(s)
- Faten Limaiem
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Pathology DepartmentMongi Slim HospitalMarsaTunisia
| | - Anis Teborbi
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of Orthopedic SurgeryMongi Slim HospitalMarsaTunisia
| | - Ramzi Bouzidi
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of Orthopedic SurgeryMongi Slim HospitalMarsaTunisia
| |
Collapse
|
8
|
Zendeoui A, Gharbi MA, Nafiss M, Ezzine MH, Bouzidi R, Tborbi A. Giant cell tumor of the tendon sheath of the toe: case report of an unusual localization. Int J Surg Case Rep 2022; 102:107797. [PMID: 36493712 PMCID: PMC9731858 DOI: 10.1016/j.ijscr.2022.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The purpose of this study is to highlight a rare entity of unusual location and to report our therapeutic attitude in this regard, while detailing the diagnostic criteria and therapeutic management. CASE PRESENTATION We describe the case of a 32 years old woman with a swelling of the big toe initially neglected by the patient, the evolution is marked by a discomfort when wearing shoes, it was a firm mass of 2 cm slightly painful without local inflammatory signs with bone lysis on radiography, The MRI showed an invasion of the flexor and extensor tendons of the hallux, our approach was a carcinological tumor exeresis and arthrodesis while preserving the toe since the pedicle was not invaded, the histological examination confirmed the diagnosis and the evolution is good without tumor recurrence. CLINICAL DISCUSSION A giant cell tumor of the tendon sheaths (GCTTC) usually presents as a firm slow growing mass, the radiological assessment shows bone erosions, an MRI for extension assessment and histological confirmation are mandatory, malignant degenerations are unusual but should always be investigated, treatment is based on the most complete surgical resection to avoid the risk of recurrence, adjuvant radiotherapy can be done in case of incomplete resection but it is a controversial subject. CONCLUSION GCTTC are benign tumors that may be locally malignant because of the invasion of noble structures, which makes their complete exeresis difficult. The diagnosis is based on clinical and radiological criteria and requires histological confirmation.
Collapse
|
9
|
Nefiss M, Abid H, Gharbi MA, Bouzidi R, Teborbi A. Bone metastases from renal cell carcinoma: 4 years after aggressive surgeries and anti‐angiogenic therapy. Clin Case Rep 2022; 10:e6599. [DOI: 10.1002/ccr3.6599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mouadh Nefiss
- Department of Orthopaedic Surgery Mongi Slim University Hospital La Marsa Tunisia
- Tunis El Manar University Tunis Tunisia
| | - Hichem Abid
- Department of Orthopaedic Surgery Mongi Slim University Hospital La Marsa Tunisia
- Tunis El Manar University Tunis Tunisia
| | - Mohamed Amine Gharbi
- Department of Orthopaedic Surgery Mongi Slim University Hospital La Marsa Tunisia
- Tunis El Manar University Tunis Tunisia
| | - Ramzi Bouzidi
- Department of Orthopaedic Surgery Mongi Slim University Hospital La Marsa Tunisia
- Tunis El Manar University Tunis Tunisia
| | - Anis Teborbi
- Department of Orthopaedic Surgery Mongi Slim University Hospital La Marsa Tunisia
- Tunis El Manar University Tunis Tunisia
| |
Collapse
|
10
|
Bouzidi R. What is going wrong in health research investment? post-pandemic lessons and the need for change. jidhealth 2020. [DOI: 10.47108/jidhealth.vol3.issspecial2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The emergence of a new dimension of consciousness after the COVID-19 pandemic might provide an opportunity to highlight gaps and inequalities in health research investment and to mobilize scientific and public opinion to change the way things are done. This analysis considers some lessons learned from the pandemic crisis concerning the priority of global health research, research in prevention and well-being, and international research cooperation. The question raised by these issues concerns the unfairness of health research funding, mainly dominated by the pharmaceutical and device industries. However, evidence shows that these companies shifted funding to late-phase clinical trials and away from innovation activity and global health priorities. On the other hand, public institutions continue to invest in basic science, with the majority of funds still focused on basic research and innovation. This direct relationship between industry and biomedical research disrupts the reliability of findings and biases the evidence. Several initiatives and efforts are shaping pathways towards health research independence from industry funding. We can propose the idea of industry funding without a direct relationship with researchers through a common pot managed by an independent international agency. Nevertheless, to promote publicly funded research, the scientific community must strengthen its position compared to industry-funded research through transparency and the scientific value of publications.
Collapse
|
11
|
Nefiss M, Tebourbi A, Ben Maatoug A, Bouzidi R. Femoral nerve paralysis complicating a post-traumatic iliopsoas haematoma. BMJ Case Rep 2018; 2018:bcr-2017-220446. [PMID: 29930178 DOI: 10.1136/bcr-2017-220446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. An 18-year-old student presented with complete paralysis of the knee extensors and a sensory deficit on the anterior side of the thigh 5 weeks after a sport accident. MRI of the lesser pelvis showed an iliopsoas haematoma. Surgical decompression was performed and recovery was complete at 6 months of follow-up.
Collapse
Affiliation(s)
- Mouadh Nefiss
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Anis Tebourbi
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Aymen Ben Maatoug
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Ramzi Bouzidi
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| |
Collapse
|
12
|
Tebourbi A, Hadhri K, Ben Salah M, Bouzidi R, Kooli M. Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review. ReconRev 2016. [DOI: 10.15438/rr.6.4.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Context:Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging.AimsTo report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature.MethodsWe report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapyResultsAt two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic looseningConclusionsBrucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.
Collapse
|
13
|
Zlitni M, Bouzidi R, Karray B, Mestiri M, Rajhi H, Kooli M. [Spinal hydatidosis: diagnostic and treatment]. Bull Acad Natl Med 2012; 196:485-495. [PMID: 23420964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hydatidosis is a parasitic disease due to Echinococcus granulosus. Spinal hytatidosis is the most common form, characterized by high morbidity and mortality. It is often diagnosed only when neurological complications occur, due to the long clinical latency and the non specific nature of symptoms. Standard radiography may show lacunar, areolar abnormalities separated by irregular walls without clear boundaries. Magnetic resonance imagery can reveal hydatic abcess presenting typical liquid abcess and locoregional extension. Laboratory methods are of little assistance to the diagnosis. Complete surgical excision of the lesions remains the only curative treatment, in the same way as for malignant tumors. Surgical eradication of hydatic lesions is difficult, however. Indeed, the surgeon is guided by the macroscopic aspect, but the bone may be infiltrated by microvesicles without clear boundaries. It is now recommended to accompany surgery by medical treatment based on albendazole. Rapid diagnosis and treatment of spinal hyatidosis may yield long-term remission or even cure, especially in localized forms.
Collapse
Affiliation(s)
- Mongi Zlitni
- L'Académie nationale de médecine, Chirurgie orthopédique Tunis, Tunisie.
| | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Mestiri M, Bouabdellah M, Bouzidi R, Kammoun S, Mnif N, Hawet S, Kooli M, Zlitni M. Giant cells tumor recurrence at the third lumbar vertebra. Orthop Traumatol Surg Res 2010; 96:905-9. [PMID: 20934931 DOI: 10.1016/j.otsr.2010.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 04/27/2010] [Accepted: 05/17/2010] [Indexed: 02/02/2023]
Abstract
Giant cell tumors (GCT) of the spine are rare. We report a case of (GCT) of the third lumbar vertebra revealed by left lumbar radiculopathic thigh pain in a 47 year old man. Imaging showed an osteolytic process invading the vertebral body, the posterior arch and compressing the dural sac left side. Neurological decompression was first performed including stabilization by an instrumented postero-lateral graft. A surgical biopsy was obtained at the same time to confirm the diagnosis. A secondary L2-L4 tumor curettage and graft procedure did not prevent, 5 years later, tumor recurrence. We believe that the simple tumor curettage is insufficient to prevent giant cell tumors recurrence.
Collapse
Affiliation(s)
- M Mestiri
- Department of Orthopaedic Surgery, Charles-Nicole Hospital, Tunis, Tunisia.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Bouabdellah M, Bouzidi R, Kammoun S, Mohamed F, Amara K, Chaabouni L, Kooli M, Zlitni M. [Pott's disease of the upper cervical spine (three cases and literature review)]. Tunis Med 2010; 88:847-850. [PMID: 21049417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Sub-occipital Pott's disease is rare, but dangerous. AIM To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease. METHODS We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007. RESULTS There were two women and one man (mean age at onset: 48 years). The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography (CT) (n=2) and MRI (n=1 and n=3). The diagnosis was confirmed histologically on a biopsy of the abscess (n=1), a bacteriological evidence (n=2) and retained thanks to argument presumption (n=3). The treatment was based on quadruple antituberculous chemotherapy with external traction (n=2 and n=3) associated with urgent surgery (n=1) because of the worsening of the neurological complications. The evolution was fatal (n=1) and positive (n=2 and n=3). CONCLUSION Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with traction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability.
Collapse
|
17
|
Bouabdellah M, Bouzidi R, Ghamgui A, Belkhadi A, Kooli M, Zlitni M. [A particular form of fracture separation of extra-pedicle-laminar body: value of tomodensitometry]. Tunis Med 2010; 88:619-620. [PMID: 20711973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
18
|
Gdoura F, Trigui M, Zribi W, Ellouze Z, Bouzidi R, Ayedi K, Keskes H. Pelvic bone hydatidosis. Orthop Traumatol Surg Res 2010; 96:85-9. [PMID: 20170864 DOI: 10.1016/j.rcot.2009.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Accepted: 04/08/2009] [Indexed: 02/02/2023]
Abstract
Bone hydatid disease is a rare pathology, characterized by its long clinical latency, the absence of radiological specificity as well as its challenging surgical treatment. We report an observation of pelvic bone hydatidosis in a 28-year-old patient, appearing with pain and stiffness of the hip as well as a degenerative aspect on the coxofemoral joint on X-ray. The treatment consisted of an extensive hemipelvectomy with femoro pelvic arthrodesis, completed by medical treatment. The functional result was excellent in spite of a break in the fixation material, which allowed a certain mobility at the proximal end of the femur. Hydatid disease of bone is infiltrating,diffuse, slow, and progressive, all characteristics explaining the often-delayed diagnosis. Medical imaging provides accurate analysis for planning a broad surgical resection. The quality of surgical resection is determined according to the risk of recurrence. Pelvic locations are particularly difficult to treat. After an enlarged and difficult surgical resection, reconstruction remains aleatory and poses many technical problems.
Collapse
Affiliation(s)
- F Gdoura
- Service de chirurgie orthopédique et traumatologique, faculté de médecine de Sfax, CHU Habib Bourguiba, route El-Aïn Km 0,5 CP, 3029 Sfax, Tunisie
| | | | | | | | | | | | | |
Collapse
|
19
|
Rajhi H, Bouzidi R, Ezzaouia K, Chammakhi R, Felfel M, Hamza R. [Osteoid osteoma of the coccyx: a case report]. ACTA ACUST UNITED AC 2006; 92:275-8. [PMID: 16910611 DOI: 10.1016/s0035-1040(06)75736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- H Rajhi
- Service d'Imagerie Médicale, EPS Charles-Nicolle, Tunis, Tunisie.
| | | | | | | | | | | |
Collapse
|
20
|
Bettaieb I, Zermani R, Karray M, Bouzidi R, Farah F, Rammeh S, Kourda N, Zlitni M, Ben Jilani S. [Low-grade central chondrosarcoma: difficult diagnosis in an adolescent girl]. ACTA ACUST UNITED AC 2006; 92:68-72. [PMID: 16609621 DOI: 10.1016/s0035-1040(06)75678-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Central chondrosarcoma of the tibia is exceptional, particularly in young patients. Low-grade tumors raise difficult problems for histological distinction with enchondroma. We report a case of grade 1 chondrosarcoma located in the upper portion of the tibia in a 17-year-old girl. After radical surgery, outcome was favorable with no recurrence or metastasis at three years follow-up. The distinction between low-grade central chondrosarcoma and enchondroma is one of the most difficult challenges in bone pathology. Clinical, radiographic and pathological data must be considered together to reach certain diagnosis.
Collapse
Affiliation(s)
- I Bettaieb
- Service d'Anatomie et Cytologie Pathologique, Service d'Orthopédie, Hôpital Charles-Nicolle, boulevard du 9-Avril, 1006 Tunis, Tunisie
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.
Collapse
Affiliation(s)
- M Karray
- Service d'orthopédie et de traumatologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006 Tunis Tunisie.
| | | | | | | | | | | | | |
Collapse
|
22
|
Karray M, Kooli M, Ezzaouia K, Bouzidi R, Mestiri M, Zlitni M. [Predictive criterions of unrecognized articular effraction after internal fixation of femoral neck fractures]. Tunis Med 2004; 82:827-36. [PMID: 15693476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
On the basis of a retrospective study comprising 91 cases of femoral neck fracture treated by DHS, unrecognized screw articular penetration was observed in 9 cases (9.9%). The coxa valga (Garden I) fractures are the most interested by this complication (7 cases out of 9). With a practical purpose and to avoid remarking each time complex measurements again we found that the distance "d" separating the end of the implant from subchondral bone calculated on antero posterior and lateral views and so the angle measured on the lateral view were two criteria significantly predictive of this technical error with respectively P: 0.005 and P: 0.0005. Thus during the surgical procedure taking these two measurements after the installation of the pin guide would allow attention on the risk incurred. In case of doubt, we have changed the way of this pin before resorting to drilling and tapping.
Collapse
Affiliation(s)
- Maher Karray
- Service d'Orthopédie et de Traumatologie, Hôpital Charles Nicolle Tunis, Tunisie
| | | | | | | | | | | |
Collapse
|
23
|
Ezzaouia K, Bouzidi R, Lebib H, Cherif R, Mestiri M, Kooli M, Zlitni M. [Ender nailing of trochanteric fractures (report of 100 cases)]. Tunis Med 1999; 77:95-100. [PMID: 10333706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- K Ezzaouia
- Service d'orthopédie traumatologie de l'hôpital Charles Nicolle, Tunis
| | | | | | | | | | | | | |
Collapse
|
24
|
Bouzidi R, Zehi K, Bouguira A, Arroum A, Saadaoui F, Zouari M, Karray S, Zlitni M, Litaiem T, Douik M. [Conservative treatment of fractures of the femoral neck with vertical line in adults. Review of 153 cases]. Tunis Med 1997; 75:754-8. [PMID: 9507344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- R Bouzidi
- Institut National d'Orthopédie Mohamed Taieb Kassab, La Manouba
| | | | | | | | | | | | | | | | | | | |
Collapse
|