Varus malalignment of the lower limb increases the risk of femoral neck fracture: A biomechanical study using a finite element method.

INTRODUCTION: The understanding of the stresses and strains and their dependence on loading direction caused by an axial deformity is very important for understanding the mechanism of femural neck fractures. The hypothesis of this study is that lower limb malalignment is correlated with a substantial stress variation on the upper end of the femur. The purpose of this biomechanical trial using the finite element method is to determine the effect of the loading direction on the proximal femur regarding the malalignment of the lower limb, and also enlighten the relation between the lower limb alignment and the risk of a femoral neck fracture. METHODS: Ten segmentations of CT scans were considered. An axial compression load was applied to the femoral head to digitally simulate the physiological configuration in neutral position as well as in different axial positions in varus/valgus alignment. RESULTS: The stress at the proximal femur changes as the varus _valgus angle does. It can be observed the smaller absolute stress at angle 10° (valgus) and the higher absolute stress at angle -10° (varus). The mean maximum von Mises stress value was 14.1 (SD=±3.48) MPa for 0°, while the mean maximum von Mises stress value was 17.96 MPa (SD=4.87) for -10° in varus. The fracture risk indicator of the proximal femoral epiphyses changes inversely with angle direction. The FRI was the highest at -10° and the lowest at 10°. CONCLUSION: Based on the biomechanical findings and the fracture risk indicator determined in this preliminary study, varus malalignment increases the risk of femoral neck fracture. Consideration of other parameters such as bone mineral density and morphological parameters should also help to plan preventive medical strategy in the elderly.

Adenolipoma of the skin.

Adenolipoma of the skin (ALS) is an uncommon histological variant of lipoma, characterized by the presence of normal eccrine sweat glands inside the fat proliferation. A 32-year-old woman presented to our department with a slow-growing, painless subcutaneous soft tumour located on the upper part of the right thigh. Microscopically, there was lobulated adipose tissue proliferation with well-differentiated eccrine glands and ducts in the periphery and centre of the nodule. These features were suggestive of ALS. ALS is a rare microscopic variant of cutaneous lipoma having similar clinical features to lipoma. The most frequent locations of this tumour are thighs (as in our patient), shoulders, chest and arms. Histologically, the tumour is composed of lobulated adipose tissue with larger and more prominent lobules than those in normal subcutaneous adipose tissue. A well-developed capsule may also be identified. Eccrine glands and ducts, without proliferative changes, are well-differentiated within the adipose tissue. Differential diagnosis of adenolipoma includes the common lipoma and its variants, skin tag and other hamartomatous lesions, such as nevus lipomatosus superficialis, and the lipomatous variant of eccrine angiomatous hamartoma.

[Parotid mucormycosis: A new case and review of the literature]. / Mucormycose parotidienne : une nouvelle observation et revue de la littérature.

INTRODUCTION: Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. The authors report the case of cervical mucormycoses with a particularly favorable evolution in diabetic woman. REPORT: A 54-year-old woman, type 2 diabetic, had presented a left lateral cervical mass. The diagnosis was confirmed by histological examination. She was treated with Amphotericin B with favorable evolution. CONCLUSION: The mucormycose is a rare infection. The treatment is medical and surgical. The prognosis is severe with an overall mortality rate of 40%.

Femoral parosteal osteosarcoma 18 years after its discovery: a case report.

Osteosarcomas are a heterogeneous group of tumors with diverse anatomical, clinical, and progressional characteristics. Parosteal osteosarcoma, or juxtacortical osteosarcoma, is a rare form of osteosarcoma that develops at the bone surface, but has a better prognosis than other conventional osteosarcomas. We report the observation of a 22-year-old female patient whose initial presentation was an enormous tumefaction of the knee that had been progressing for 10 years. The biopsy concluded in PO of the lower third of the femur. Staging was negative. The tumor had reached an enormous size and required amputation of the left lower extremity. A custom external prosthesis was manufactured to get her back to walking. Eight years after surgery, no local recurrence or metastasis has been detected. Parosteal osteosarcoma is a rare form of osteosarcoma with very slow progression (in spite of the particularly dramatic presentation in our observation), with an excellent prognosis and very rare metastasis.

[Primary cutaneous extraskeletal Ewing's sarcoma]. / Sarcome d'Ewing à localisation cutanée primitive.

BACKGROUND: Cutaneous extraskeletal Ewing's sarcoma is rare, being seen principally in children. We report a case of cutaneous sarcoma in the sole of the foot in a child. CASE REPORT: A 9-year-old child with no medical history of note was presenting a skin tumor for 3 months on the heel of the right foot. This tumor was burgeoning and painful and measured 3.5 cm in diameter; it was ulcerative at the surface and covered with a crust. Histological and immunohistochemical examinations confirmed the diagnosis of Ewing's sarcoma. Staging examinations proved negative and the patient underwent polychemotherapy, resulting in complete regression of the tumor. COMMENTS: Until 1998, 37 cases of cutaneous and subcutaneous Ewing's sarcoma were reported, being seen in 21 girls and 16 boys. Mean age at diagnosis was 15 years and mean tumor size was 3 cm (range: 1 to 12 cm). The tumors were observed throughout the body, being seen in the sole of the foot in 2 cases. Confirmation of the diagnosis was made by histological examination (malignant proliferation of small round cells in the dermis), immunohistochemical examination (CD99+) and cytogenetic analysis (translocation between chromosomes 22 and 11). The prognosis for cutaneous Ewing's sarcoma appears more favorable than that of Ewing's sarcoma in bone. Of the 37 patients treated, 7 had metastases and 2 presented relapse. Treatment for cutaneous Ewing's sarcoma, though not codified, consists of polychemotherapy associated with surgery and/or radiotherapy.

[Digital tuberculous revealed by trauma]. / Une tuberculose digitale révélée par un traumatisme.

Tuberculous dactylitis is an uncommon condition which is particularly difficult to differentiate from other lesions, particularly tumors. Diagnosis must be confirmed by histology and/or bacteriology studies. We report the case of a 64-year-old diabetic woman who consulted for a painful tumefaction on her fourth finger of the left hand which had developed after minimal trauma. The x-ray of the hand visualized multiple bony defects involving the second phalanx of the fourth finger and a fracture. Pathology examination of a biopsy specimen revealed granulomatous osteitis with typical caseous necrosis. The clinical signs and radiographic images resolved after anti-tuberculosis treatment.

[Tubo-ovarian actinomycosis ruptured in the sigmoid colon]. / Actinomycose tubo-ovarienne pseudotumorale fistulisée au côlon.

Actinomyces is an anaerobic, gram-positive bacteria saprophyte of the oral cavity, lungs, genital and gastro-intestinal tracts. Tubo-ovarian infection is rare. The authors report a case of tubo-ovarian abscess, due to actinomyces ruptured in the sigmoid and diagnosed in a 30-year-old woman using an intra-uterine device for more than 5 years. After salpingo-oophorectomy and partial sigmoid resection, pathology confirmed the diagnosis.

[Sarcoid-like necrotizing granulomatosis. A case report]. / La granulomatose nécrosante sarcoïdosique. A propos d'une observation.

Necrotizing sarcoid granulomatosis is a rare granulomatous pulmonary angeitis that was first described by Liebow in 1973. We report the case of a 36-year-old woman who was admitted for exploration of chest pain, cough and fever at 39 degrees which had progressed for more than 2 months. Chest X-ray showed several inconstant pulmonary opacities. The physical examination, the radiographic and endoscopic aspects were non-specific. The diagnosis was made only by open lung biopsy which showed histological findings of necrotizing sarcoid granulomatosis. The opacities disappeared with no recurrence spontaneously at one year.

[Placental metastasis of breast cancer]. / Métastase placentaire d'un cancer du sein.

The authors report an unusual case of extensive placental micrometastases of breast carcinoma occurring in a 43 years-old woman, seen at 31 weeks gestation with metastatic disease. A female infant was delivered by caesarean section. Physical examination of the newborn was normal. The mother rapidly died of metastatic disease. Placental metastases from maternal tumours are rarely reported in the literature. The diagnosis is made by histologic examination. Placental metastases are associated with bad prognosis for the mother. The foetus is usually free of tumours when the metastases are limited to the intervillous space.

[Mesenchymatous chondrosarcoma of the superior maxillary bone. A case report]. / Chondrosarcome mésenchymateux de l'os maxillaire supérieur. A propos d'un cas.

The authors report a new case of mesenchymal chondrosarcoma (MCS), occurring in the upper jaw bone of a 19 year-old woman. Radiographic picture in the bone shows an aggressive osteolytic tumor suspect of malignancy. An incisional biopsy was practiced and the histologic examination has confirmed the diagnosis of MCS. Treatment have consisted of a large resection of maxilla with additional irradiation therapy. The postoperative course was marked by recurrence of the lesion one year later.

[Buschke-Loewenstein giant condyloma in the perianal region with inguinal invasion: a case report]. / Condylome géant de Buschke-Loewenstein de la région périanale avec envahissement inguinal: a propos d'un cas.

The giant condyloma acuminatum of the perianal region is a tumor characterised by its large size with the propensity to infiltrate into deeper tissues, contrasting with a microscopically benign pattern. The evolution after malignant transformation of condyloma and lymph node invasion is rare. However it is exceptionally observed a lymph node invasion of microscopically benign condyloma acuminatum. The authors report a case of microscopically benign giant condyloma acuminatum of the perianal region associated with inguinal invasion, discovered in a 47 year-old man. Treatment consists in extensive surgery of the tumor and inguinal nodes, followed by a radiation therapy.

[Polymorphous low-grade adenocarcinoma of the accessory salivary glands--a case report]. / Adénocarcinome polymorphe de faible malignité des glandes salivaires accessoires--une observation.

A case of polymorphous low-grade adenocarcinoma of minor salivary gland is reported. This tumor was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms (pleomorphic adenomas) or salivary malignant conditions (malignant pleomorphic adenomas, adenoid cystic carcinomas, papillary adenocarcinomas and adenocarcinoma not otherwise stated). This neoplasm, with few exceptions, originates in minor salivary gland tissues of the palates or buccal mucosa. It is characteristically slow to enlarge. Clinical reports show the neoplasm present for many years before diagnosis. The tumor have a variety of morphological patterns, a cytological uniformity and an infiltration into adjacent structures. The treatment is a wide local excision. Recurrences and lymph node metastases are rare.