[Osteoporosis in tunisian major beta thalassemic patients a study of 64 pediatric cases]

Osteoporosis has been described extensively in adult thalassemics. Fewer studies have been reported in thalassemic children. Study the frequency and outcome of osteoporosis in Tunisian major beta thalassemic children and to identify principal clinical risk factors and biological characteristics of its occurrence. It's a prospective study enrolled between 1 January and 31 December 2008. 64 thalassemic major patients were evaluated. The study of bone mineral density was provided by X-ray photon. Osteoporosis was defined by Z score beta -2SD at lumbar [L1-L4] sites. 30 of patients studied [46.87 per cent] had a Z score beta 2-SD. Compared with non-osteoporotic patients we have identified as risk factors: the age of the patient [p = 0.001]. The number of transfusion [p = 0.002] and the increased of the annual consumption of blood [p = 0.02]. We found a larger number of growth retardation [p =0.004]. Iron overload was greater in the group of osteoporotic patients [p = 0.04]. The sex, age at diagnosis, the average of hemoglobin, the status of viral hepatitis B and C, the incidence of allo or auto-immunization, and thyroid status seem to have no influence the occurrence of osteoporosis in our study. The onset of osteoporosis is associated directly to higher transfusion requirements and age > 12 years

[ distal pedicled dorsal metacarpal flap, about 30 cases]

The distal pedicled dorsal metacarpal flap based on a retrograde bloody supply harvested from the dorsum of the hand, its vascularisation is provided by proximal dorsal cutaneous branches of the digital collateral arteries through the rich anastomotic arterial network of the web space. This flap is useful in reconstructing defects on the dorsal and palmed aspect of the digits. The authors present 30 clinical cases to describe the anatomical basis, the operatory techniques, the advantages and inconvenients of this new flap

[Juvenile Sapho a two cases reports]

The acronym Sapho syndrome [for synovitis, acne, pustulosis, hyperostosis, osteitis] is a rare entity, particulary in pediatric patients. A 15 year-old and 19 year-old adolescents, with severe acne history, presented inflammatory buttock pain associated to lumbar pain in the first case and sternal pain in the second. Radiographic exploration demonstrated bilateral sacro-iliitis associated to sterno-clavicle arthritis in the second case. Diagnosis of Sapho syndrome was retained. Satisfactory improvement was caused by corticosteroids in the first case and non steroidal anti-inflammatory drugs in the second. Sapho syndrome is rare disease with unknown origin. Non steroidal anti-inflammatory drugs are the treatment of choice, as they are usually both effective and well tolerated

[Association of Castleman's disease and Hodgkin lymphoma a case report]

Castelman's disease is an atypical lymphoid proliferation presenting in two different types [localized or multicentric]. The localized form has a better prognosis and a surgical treatment may confer a long remission. Authors report the case of a 43-years-old man who consulted for distal arthralgia and cervical lymphadenopathies. Cervical neck dissection permits a clinical remission during 4 years. The patient reconsulted in 2004 for cervical, axillary and medastinal nodes. Biopsy concluded to an association of Castelman disease and Hodgkin Lymphoma in its nodular sclerosis form. The patient was successfully treated with chimiotherapy. Two years later, he remains asymptomatic with no sign of relapse

Sciatica as a rare symptom of recurrent uterine carcinoma. About four cases and literature review

The occurrence of inflammatory sciatica needs a special attention because it is often related to malignant, infectious or inflammatory affections. However, rare pelvic affections and especially gynecological conditions can also cause sciatic pain. We report four observations of sciatic neuropathy caused by compression of the sacral plexus by metastases of uterine carcinoma. A literature revue is also undertaken to emphasize on the importance of recent complementary exams for the etiological diagnosis of sciatica