Isolated lesser trochanter fracture in adults: an early indicator of tumor infiltration.

We report on a case of isolated lesser trochanter fracture, without associated trauma, secondary to pulmonary adenocarcinoma metastasis. Treatment consisted in resection-reconstruction by megaprosthesis. This form of isolated fracture is rare, and results from infiltration of the trochanteric area by a malignant tumoral process, which is usually metastatic.

Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas.

Data for patients with bone metastases (BMs) of differentiated thyroid carcinoma (DTC) were retrospectively studied to identify factors associated with survival. We especially studied the impact of therapies. Among the 1977 patients followed for DTC in our department from 1958 to 1999, 109 (77 females and 32 males; age range, 20--87 yr) presented BMS: All patients except 1 underwent total thyroidectomy, followed by radioiodine therapy (> or =3.7 gigabecquerels) in 95 cases. Survival rates at 5 and 10 yr were 41% and 15%, respectively. Univariate analyses indicated that a young age at BM discovery (P < 0.005) and the discovery of BM as a revealing symptom of DTC (P < 0.05) were features significantly associated with improved survival as well as radioiodine therapy (P < 10(-4)) and BM complete surgery (P < 0.02). Using multivariate analysis, the detection of BMs as a revealing symptom of thyroid carcinoma (P < 0.0005), the absence of metastasis appearance in other organs than bones during the follow-up (P < 0.03), the cumulative dose of radioiodine therapy (P < 0.0001), and complete BM surgery in young patients (P < 0.04) appeared as independent prognostic features associated with an improved survival.

Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports.

Vertebral hemangiomas can cause acute spinal cord compression either after a minor trauma or during the last 3 months of pregnancy. Failure to recognize the lesion can lead to potentially serious treatment delays. An emergency MRI scan usually establishes the diagnosis of vertebral hemangioma responsible for spinal cord compression requiring laminectomy. We report two cases showing that posterior fixation should be considered: in our experience it prevents vertebral collapse during the interval preceding secondary vertebroplasty, which, if performed, provides highly significant pain relief.

Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases.

STUDY DESIGN: The utility of the Tokuhashi score was assessed in a retrospective study in 71 patients with vertebral metastases. OBJECTIVES: To study the importance of the site of the primary tumor as a parameter in the preoperative prognostic Tokuhashi score. SUMMARY OF BACKGROUND DATA: A preoperative score composed of six parameters, each rated from zero to two, has been proposed by Tokuhashi for the prognostic assessment of patients with metastases to the spine. METHODS: Seventy-one patients with vertebral metastases were studied. There were 34 cases of thyroid cancer metastases, 28 cases of renal cancer metastases, and nine cases of metastases of unknown origin. In each patient, a local and a systemic tumor search were performed. Patients were divided into groups based on the primary site of the tumor, and each group was analyzed separately. RESULTS: In cases of vertebral metastases of thyroid cancers, surgery to excise single metastases was found to provide good results, as was palliative surgery of multiple metastases. Vertebral metastases of renal tumors were rarely single, and the results of palliative surgery were less satisfactory. Vertebral metastases of unknown primary tumors had a poor outcome, regardless of whether surgery was excisional or palliative. The median survival period in patients with metastases of unknown primary tumors was significantly shorter than that in patients with renal or thyroid cancer metastases. CONCLUSION: The Tokuhashi preoperative score is successful as a prognostic tool. However, it attributes the same one-point rating to metastases of renal cancer and to those of unknown primary tumors. In the case of metastases of unknown primary tumors, this rating is too high and should be reduced to 0.

Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating spinal metastases that result in pain or instability. MATERIALS AND METHODS: Thirty-seven patients (20 men, 17 women; aged 33-86 years) underwent 52 percutaneous injections of surgical cement into a vertebra (vertebroplasty) with fluoroscopic guidance in 40 procedures. Vertebroplasty was performed for analgesia in 29 procedures, stabilization of the vertebral column in five procedures, and both in six procedures. RESULTS: Twenty-four of the 33 procedures performed for analgesia that were evaluated resulted in clear improvement; seven, moderate improvement; and two, no improvement. Improvement was stable in 73% of patients at 6 months. In the procedure performed for stabilization, no displacement of treated vertebrae was observed (mean follow-up, 13 months). Three patients had transient radiculopathy due to cement extrusion, and two patients had transient difficulty in swallowing. CONCLUSION: Vertebroplasty of metastases is a minimally invasive procedure that provides immediate and long-term pain relief and contributes to spinal stabilization.

[Spinal metastases of thyroid origin. Apropos of a series of 37 cases]. / Métastases rachidiennes d'origine thyroïdienne. A propos d'une série de 37 cas.

PURPOSE OF THE STUDY: Define a specific therapeutic for spinal metastasis from thyroidal origin. MATERIAL: A retrospective series of 37 patients treated between January 1978 and January 1993 was made. The sex ratio was 29 women for 8 men with an average age of 59.5. The prevalent histology has a vesicular type (19 cases which represents 51 per cent). The metastasis are mostly found at the dorsal level (48.6). METHODS: The different parameters analysed for this study of 37 patients were: invaded segment of the vertebra (anterior, middle, posterior or total), Tokuhashi score, epiduritis extent, patient age, histological type and iodiosensibility. RESULTS: Out of 37 patients, 3 were lost for follow-up, 7 metastasis were treated carcinologically ("en bloc" resection). 30 were treated palliatively depending on the clinical symptoms: neurological, mechanical, or pain. The osseous metastasis exists in 56 per cent of the cases at the time the primitive neoplasy was discovered, and their presence burdens the final prognostic. 21 patients died with an average survival of 21 months, 13 patients survived with a mean follow-up of 50 months, 50 per cent of the patients had a vertebra totally involved with only 13 patients with neurological signs (4 Frankel A, 3 Frankel B, 4 Frankel C and 2 Frankel D). DISCUSSION: The analysis of the results shows that the pejorative criteria in case of vertebral metastasis of thyroidal cancer are the score of Tokuhashi inferior to 7, the whole affected vertebra, the epiduritis on 3 levels, the age of the patient superior to 65 and the idiosensibility of the metastase. The surgery do called carcinological gives very good results with 5 surviving patients out of 7. CONCLUSION: When reading this study it seems that, in front of vertebral metastasis from thyroidal origin, we should choose the most radical therapeutic attitude as much as possible. This strategy finds its justification by the fact that the thyroidal cancer spreads out slowly giving a survivorship superior to 12 months in case of metastatic vertebral affection. The importance of the tumoral reduction is connected with the efficiency of the iodiotherapy (for differentiated histological types). This is a considerable adjuvant treatment for this kind of cancer.

[An unusual dislocation of the elbow: convergent dislocation]. / Une luxation du coude exceptionnelle: la luxation convergente.

A case of dislocation of the elbow, combining convergent dislocation of the proximal radio-ulnar joint with posterior dislocation of the ulno-humeral joint was reported. This particular combination has not, to the knowledge of the authors, been reported previously. Diagnosis was based on anterioposterior X ray of the joint associated with a clinical finding of a loss of supination following reduction of the ulno-humeral joint. This unusual lesion has to be recognised for a missed diagnosis may lead to compromise of the result in the long term.