Skeletal features of primary hyperoxaluria type 1, revisited

PURPOSE

The purpose of this study was to describe the skeletal manifestations of primary hyperoxaluria type 1 (PH1), the most common of the primary hyperoxalurias.

METHODS

We clinically and radiographically reviewed 12 consecutive patients diagnosed with PH1, aged between 2 and 17 years. All patients had evidence of some type of renal involvement, 4 of whom were at end-stage renal disease (ESRD) and were under dialysis.

RESULTS

The main symptom was skeletal pain and was present only in the 4 severely involved patients and appeared during the second year of dialysis. The 2 most severely involved patients had evidence of pathological fractures. Radiological signs were present in patients with or without symptoms. These radiological signs were of two distinct types: those almost specific of oxalosis, such as dense and radiolucent metaphyseal bands and vertebral osteocondensations, which are found mainly in the severely involved individuals, and those less specific, such as signs of renal osteodystrophy, which are also found in less severely involved patients. Interestingly, our study revealed the presence of spondylolysis in 25% of cases. This latter finding is unique and has not previously been reported in the literature.

CONCLUSIONS

The skeletal manifestations of PH1 include specific and less specific radiological signs, with some patients being asymptomatic, and others presenting with bone pain and pathological fractures, as well as spondylolysis.

[Adolescent bicipitoradial bursitis: a rare disease that can simulate a malignant tumor]

Bicipitoradial bursitis is a rare condition: we found 36 cases reported in the literature, none in children. The main manifestation is a painful tumefaction. We report a case observed in an adolescent whose magnetic resonance imaging findings were compatible with a malignant tumor. Surgical biopsy enabled the correct diagnosis of inflammatory synovium without signs of malignancy compatible with bicipitoradial bursitis. Complete cure was achieved without resection.

Pediatric cervical spine instability

Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.

Atlantoaxial rotatory fixation owing to neck burn

The purpose of this paper is to present a case of severe atlantoaxial rotatory fixation owing to a previously unreported etiology, and to discuss its pathogenesis and management. Conservative measures were unable to prevent progression, thus requiring surgical intervention.

A newly recognized autosomal recessive syndrome with short stature and oculo-skeletal involvement

This report describes a young girl and her cousin presenting with postnatal short stature, strabismus, photophobia, retinitis pigmentosa, short neck, rhizomelic shortening of the long bones, short and slightly bowed humeri with prominent deltoid tuberosities, short and wide ribs and clavicles, dorso-lumbar scoliosis, biconcave vertebral bodies of the thoraco-lumbar spine, and narrowed lumbar canal. In addition, in the girl there were amelogenesis imperfecta of the hypomaturation type, and the radiographs showed short distal ulnae, sloping epiphyses of the radii, short femoral necks, and slightly flat uncovered femoral heads. The children's parents are first cousins. Differential diagnoses are discussed and the possibility of a newly recognized oculo-skeletal syndrome is raised.

The risk of neuro-orthopaedic malformations following in-vitro fertilization

The purpose of this study was to assess the risk of neuro-orthopaedic malformations after in-vitro fertilization. We compared the prevalence of neuro-orthopaedic malformations in two groups of pregnancies conceived either naturally or by in-vitro fertilization, and used multivariate analysis to study the impact of each variable. The results showed a prevalence of 0.89% neuro-orthopaedic malformations in the in-vitro fertilization cohort and 0.32% in the natural conception cohort. The three times greater risk of malformations in the in-vitro fertilization cohort was reduced after adjustment to other variables. We concluded that the increased risk of neuro-orthopaedic malformations after in-vitro fertilization is not due to the technique itself but rather to factors associated with it.

[Linear scleroderma and foot deformity in children]

Linear scleroderma is a subtype of localized scleroderma generally observed in children, and may produce secondary bone and joint deformities. Its localization at the foot or ankle is rarely reported. A complete review of the literature reveals 21 cases of foot or ankle deformity due to linear scleroderma to which we add one case. The clinical and radiological aspects of the deformity, its pathogenesis, histological findings as well as orthopaedic management are presented and discussed.

Recurrent Legg-Calvé-Perthes disease revisited: fake or reality?

The objective of this study was to assess the course, the epidemiologic features and the prognosis of recurrent Legg-Calvé-Perthes disease. We reviewed seven reported cases and one personal case of recurrent Perthes' disease. In all cases, complete recovery from the previous episode was documented, and a thorough diagnostic work-up to rule out other diseases was undertaken. There were five boys. Age at onset ranged from 2 to 6 years. Five patients had bilateral involvement. Recurrence took place 1-5 years after complete healing of the initial one. Clinical and radiological pictures were similar to those found in primary Perthes' disease of the adolescent and consisted in a greater epiphyseal involvement. Recurrent Perthes' disease is very rare. We did not identify any risk factors for recurrence. A worse outcome is more closely related to an older age of the patient at recurrence than to recurrence itself.

Osteomyelitis of the rib due to Streptococcus pneumoniae: a very rare condition in children

Rib osteomyelitis is a rare disease. We present a previously unreported case of Streptococcus pneumoniae osteomyelitis of the rib. A 4-month-old-infant presented with fever, irritability and abdominal tenderness. Pericostal collection was discovered incidentally on ultrasound; it was first drained by needle aspiration and appropriate antibiotic therapy was given, with resolution of fever in 24 h, but recurrence of symptoms 4 days later, with swelling over the affected rib. Surgical drainage with resection of the infected portion of the rib were done followed by a prolonged course of intravenous and then oral antibiotics, without any recurrence at 6 months follow-up. A review of the pertinent literature was made. This case demonstrates that the spectrum of pathogens potentially responsible for rib osteomyelitis may be broader than previously reported. The management and outcome are similar to rib osteomyelitis due to any other bacteria.

Thermocoagulation percutanée scannoguidée de l’ostéome ostéoïde

PURPOSE OF THE STUDY

Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages.

MATERIAL AND METHODS

We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome.

RESULTS

Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients.

DISCUSSION AND CONCLUSION

This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.

[Results of long-term rehabilitation in the treatment of patellofemoral syndrome: retrospective study about 63 patients]

INTRODUCTION

Rehabilitation plays a primordial role in the treatment of the patellofemoral syndrome. We wanted to seek in a sample of population suffering from this problem, the factors favoring the occurrence of this syndrome, the rehabilitation result and the continuation of exercises.

PATIENTS AND METHODS

Prospective descriptive study on the rehabilitated patients in a questionnaire form divided in two parts. The first one seeks the information of the patient's file: demographical, social and professional data, risk factors, clinical assessment and imaging, medical treatment, immediate rehabilitation results. The second part seeks the long-term effect of rehabilitation, the perseverance to exercises and the resumption of professional and sports activities.

RESULTS

78 patients, feminine prevalence 59%; average age: 32.7 years (between 12 and 60 years). Occurrence favoring factors found: intensive sports 47.4%, profession presenting a risk 14%, traumatism 24.5%, hypermobility 30,7%.

ETIOLOGY

patellar instability 18/78, dysplasia 2, chondromalacia 14, femoropatellar osteoarthritis 4, non-marked 40. Previous treatment AINS: 45%, efficient in third of cases ; previous physical therapy 9/78 (50% failure). The evaluated results of short-term rehabilitation according to Ficat criteria, regardless of etiology, were satisfying (good or very good) in 77% of cases. Very good: 20.5 %; good: 56.5%; acceptable: 19.2% and bad 3.8%. At long term on 63 patients with an average recession of 18 months (6 months to 3 years) we had very good results: 22.2 %, good: 55.5%, acceptable 20.6% and bad 1.7%. Average duration of carry on of exercises: 4 months.

CONCLUSION

The functional rehabilitation has confirmed its efficiency in the treatment of young patients suffering from patellofemoral syndrome. The education, the life hygiene, the preparation to sports as well as carry on of exercises prevent recurrences.

Percutaneous radiofrequency coagulation of osteoid osteoma in children and adolescents

The purpose of this paper was to evaluate the effectiveness of percutaneous radiofrequency ablation of osteoid osteoma in children and adolescents. Twenty-three patients aged 4.5-19.5 years were retrospectively reviewed. All patients with lower limb lesions were able to bear full weight on their operated limb immediately after the procedure, and to resume their daily activities within 24-48 h. Pain disappeared immediately after surgery in 21 cases, and in lower limb lesions the gait was back to normal after an average of 5 days. No septic or neurovascular complications were observed. At an average follow-up of 3.5 years, all the patients including two cases of initial failure were free of pain and had a normal gait. Clinical healing was confirmed by computed tomography and bone scan performed in 12 cases. This precise and minimally invasive method is safe, effective and associated with reduced health care resources. It could be recommended as the treatment of choice for osteoid osteoma of the limbs in children and adolescents.

[Bernese periacetabular osteotomy for the treatment of the degenerative dysplasic hip]

PURPOSE OF THE STUDY

Appropriate management of degenerative joint disease in patients with dysplasic hips is a controversial issue. Non-surgical treatment is generally insufficient to achieve good long-term results and, in young patients, indications for total hip replacement, arthrodesis, or salvage procedures (Chiari, bone block) are limited. The most physiological option is to re-orient the acetabulum to cover the femoral head with a sufficient amount of joint cartilage. Several types of redirection osteotomy have been described. In the present work, we assess the clinical and radiological outcome after Ganz periacetabular osteotomy in patients with dysplastic hips who developed degenerative joints. We searched for factors influencing outcome.

MATERIAL AND METHODS

This retrospective analysis was conducted in 57 patients with hip dysplasia who had undergone 64 peri-acetabular osteotomies for joint degeneration. Mean age at surgery was 31 years. The preoperative diagnosis was primary osteochondritis of the hip in 9 patients. The Merle d'Aubigné scores and VCE, VCA, HTE angles on standard x-rays were obtained before surgery and at last follow-up. The Tönnis grade for the severity of the joint degeneration was determined. In 19 patients, inter-trochanteric femoral osteotomy was performed to improve joint congruency in addition to peri-acetabular osteotomy. Clinical and radiological results were assessed at a mean follow-up of 3.5 years (range 2-6 years). The effects of age, cause of dysplasia, surgical history of the hip, severity of joint degeneration, association with femoral osteotomy, and learning curve were studied. Complications were recorded.

RESULTS

On the average, the Merle d'Aubigné score improved from 13 points preoperatively to 16.5 points at last follow-up. Limping was observed for a longer period after surgery in patients who had an associated inter-trochanteric osteotomy. At last follow-up, the overall score was lower in grade 3 hips than in grade 1 and 2 hips. Serious complications were observed in the first 15 patients. There was no statistical relationship between age at surgery or surgical history of the hip and final outcome. Comparing the preoperative x-rays with those obtained at last follow-up demonstrated an improvement in the mean value for VCE (2 degrees preoperatively to 25 degrees at last follow-up), VCA (- 6 degrees to 39.5 degrees ), and HTE (25 degrees to 15 degrees ). Radiologically, the severity of joints degeneration was improved or remained unchanged in 83% of the hips (especially for grade 1 and 2 hips).

DISCUSSION

In our hands, peri-acetabular osteotomy has provided good results, especially in terms of improved function and control of joint degeneration. Although this procedure is basically indicated for young patients with hip dysplasia free of joint degeneration, it would also be a useful alternative for those who have developed only moderately extensive joint degeneration (Tönnis grades 1 and 2) and a moderately excentric femoral head. Success in these patients depends on surgical experience, correct indications, and careful attention to technical details. Nevertheless, complications are not exceptional and the learning curve may be long. In our series, the main factor predictive of outcome was the Tönnis grade of joint degeneration.

Is MRI effective in detecting intraarticular abnormalities of the injured knee?

BACKGROUND DATA

Magnetic resonance imaging (MRI) is widely used for the diagnosis of intraarticular anomalies of the knee. Its reliability is controversial mainly in the pediatric population, and its results may vary from one center to the other. The purpose of this study was to assess the validity of MRI in detecting intraarticular abnormalities in patients who sustained an injury of their knee, by comparing its findings to those of arthroscopy.

MATERIAL AND METHODS

Two hundred and seventeen traumatic knees underwent MRI followed by arthroscopy. Findings of MRI and arthroscopy were statistically compared.

RESULTS

Accuracy of MRI was 95.39% and 99.08% for anterior and posterior cruciate ligament ruptures respectively, 85.25% and 90.78% for medial and lateral meniscal tears respectively, and 91.24% for injury of the articular cartilage. There was not a significant difference between the pediatric and the adult populations, except for a greater sensitivity to detect lateral meniscal tears and a better specificity and accuracy to identify chondral lesions in the first group. Variability between centers was significant for the diagnosis of chondral defects.

CONCLUSION

The good MRI reliability in detecting intraarticular abnormalities as demonstrated in this report, underlines its importance in the assessment of the injured knee before arthroscopy.

Popliteal cyst in a patient with total knee arthroplasty: a case report and review of the literature

We report a case of total knee arthroplasty (TKA) failure presenting initially as a large popliteal cyst without bony destruction in a 66-year-old woman. A foreign body gigantocellular inflammatory reaction against polyethylene wear particles was found on histology. The size of the cyst and the absence of bony destruction can be due to an exclusive early intramuscular granulomatous reaction. Progressive loosening of the femoral component and narrowing of the joint space heralded the TKA failure.

Comparative study of five polycyclic aromatic hydrocarbon degrading bacterial strains isolated from contaminated soils

Five polycyclic aromatic hydrocarbon (PAH) degrading bacterial strains, Pseudomonas putida 34, Pseudomonas fluorescens 62, Pseudomonas aeruginosa 57, Sphingomonas sp. strain 107, and the unidentified strain PL1, were isolated from two contaminated soils and characterized for specific features regarding PAH degradation. Degradation efficiency was determined by the rapidity to form clearing zones around colonies when sprayed with different PAH solutions and the growth in liquid medium with different PAHs as sole source of carbon and energy. The presence of plasmids, the production of biosurfactants, the effect of salicylate on PAH degradation, the transformation of indole to indigo indicating the presence of an aromatic ring dioxygenase activity, and the hybridization with the SphAb prove representing a sequence highly homologous to the naphthalene dioxygenase ferredoxin gene nahAb were examined. The most efficient strain in terms of substrate specificity and rapidity to degrade different PAHs was Sphingomonas sp. strain 107, followed by strain PL1 and P. aeruginosa 57. The less efficient strains were P. putida 34 and P. fluorescens 62. Each strain transformed indole to indigo, except strain PL1. Biosurfactants were produced by P. aeruginosa 57 and P. putida 34, and a bioemulsifier was produced by Sphingomonas sp. strain 107. The presence of salicylate in solid medium has accelerated the formation of clearing zones and the transformation of indole by Sphingomonas sp. strain 107 and P. aeruginosa 57 colonies. Plasmids were found in Sphingomonas sp. strain 107 and strain PL1. The SphAb probe hybridized with DNA extracted from each strain. However, hybridization signals were detected only in the plasmidic fraction of Sphingomonas sp. strain 107 and strain PL1. Using a polymerase chain reaction (PCR) approach, we determined that several genes encoding enzymes involved in the upper catabolic pathway of naphthalene were present in each strain. Sequencing of PCR DNA fragments revealed that, for all the five strains, these genes are highly homologous with respective genes found in the pah, dox, and nah operons, and are arranged in a polycistronic operon. Results suggest that these genes are ordered in the five selected strains like the pah, nah, and dox operons.

Renal transplantation in multiple myeloma. Case report and review of the literature

A patient with end-stage renal disease and known benign monoclonal gammopathy underwent kidney transplantation at Westchester County Medical Center, Valhalla, NY. After surgery, during routine follow-up, the patient had laboratory evidence of frank multiple myeloma. However, she did not show any clinical signs or symptoms of the disease. Four years later, the patient is asymptomatic and continues to have stable renal function. As a result of our experience, and that of others, we support transplantation as a viable option for patients with multiple myeloma.

[Intra-articular analgesia after arthroscopy of the knee]

In 33 patients the authors compared two protocols for postoperative analgesia after elective arthroscopy of the knee. One group (n = 11) received plain bupivacaine 0.25% by intra-articular administration. Another group (n = 11) received by the same route a mixture of bupivacaine 0.25% with fentanyl 50 micrograms. The last group (placebo group: n = 11) received the same volume of saline. The combination of bupivacaine with fentanyl reduced postoperative pain more effectively than plain bupivacaine and the analgesic effect was still present 9 hours after the arthroscopy.

The value and limitations of L-arginine infusion on glomerular and tubular function in the ischemic/reperfused kidney

PURPOSE

The nitric oxide precursor, L-arginine, has been shown to have a salutary effect on ischemia and reperfusion injury in skeletal muscle, skin, and intestines. Because L-arginine also increases renal blood flow, glomerular filtration, and urine flow in experimental animals with normal renal function, we postulated that L-arginine may also improve renal function after renal ischemic injury.

METHODS

Eighteen adult New Zealand white rabbits weighing 3 to 3.5 kg were subjected to bilateral normothermic renal ischemia by clamping both renal pedicles for 1 hour followed by 2 hours of reperfusion. The animals were randomized into three groups: group I (control, n = 6) received no additional treatment; group II (pretreatment, n = 6) received systemic intravenous L-arginine at 150 mg/kg over 20 minutes before induction of ischemia; group III (posttreatment, n = 6) received systemic intravenous L-arginine at 150 mg/kg over 20 minutes from the onset of reperfusion. Urine flow, creatinine clearance (CCR), fractional excretion of sodium (FENa), and renal failure index (RFI) were calculated before ischemia and 2 hours after reperfusion, by use of standard formulas. The changes of the various renal parameters were compared among the three groups.

RESULTS

Bilateral normothermic renal ischemia for 1 hour produced a significant deterioration of glomerular filtration as evidenced by a CCR decrease from 11.1 +/- 1.8 to 2.49 +/- 0.9 ml/min (p < 0.01), FENa increase from 2.9% +/- 1.0% to 20.8% +/- 1.5% (p < 0.01) and RFI increase from 4.0 +/- 1.3 to 28.8 +/- 2.6 (p < 0.01). Pretreatment with L-arginine (group II) minimized the deleterious effects caused by ischemia on glomerular filtration (CCR of 2.49 +/- 0.9 ml/min in group I vs 4.95 +/- 2.5 ml/min in group II, p < 0.05) and tubular function (FENa of 20.8% +/- 1.5% in group I vs 13.0% +/- 5.6% in group II and RFI of 28.8 +/- 2.6 in group I vs 18.6 +/- 8.0 in group II, p < 0.05). Infusion of L-arginine at the onset of reperfusion (group III) produced a significant diuretic effect (urine flow from 32.6 +/- 13.4 ml/hr in group I to 63.3 +/- 18.8 ml/hr in group III, p < 0.05) and also minimized glomerular damage (CCR from 2.49 +/- 0.9 ml/min in group I to 4.80 +/- 1.2 ml/min in group III, p < 0.05); however, no beneficial effect was observed on tubular function.

CONCLUSION

Induction of nitric oxide production by systemic L-arginine infusion can best preserve glomerular and tubular function in the ischemic/reperfused kidney when given before the ischemic insult.

Compound tibial fractures with bone loss treated by the Ilizarov technique

We report our experience of the use of the Ilizarov technique to treat nine patients with severe compound tibial fractures. The mean defect in bone was 6.3 cm, and four cases were infected. All nine patients had satisfactory union and function without the use of bone grafts or antibiotics. The Ilizarov technique was very satisfactory; there were no major complications.

[Lamellar coxitis. Apropos of 30 cases]

The authors have studied 30 cases of acute necrosis of articular cartilage complicating slipped capital femoral epiphysis. They recall the main features of this condition: stiffness and narrowing of the joint space. They analyse the importance of the degree of slipping and of the type of treatment in the aetiology of this complication. Weight bearing should be suppressed as early as possible, for a long period of time. However early signs of degenerative arthrosis were found in most of the hips.