Common fibular nerve palsy due to fabella compression: An illustrative case report.

BACKGROUND: The fabella is a sesamoid bone situated in the tendon of the lateral head of the gastrocnemius muscle behind the lateral femoral condyle. Common fibular nerve injury may occur anywhere on its course and the most common etiology remains compression at the level of the head of the fibula. Compression by a fabella is a very unusual cause of common fibular nerve palsy and only few case reports are described in the literature. We present here an illustrative case. CASE DESCRIPTION: A 50-year-old female patient presented with a left drop-foot evolving for two weeks without pain or sensory deficit. Clinical examination revealed a paresis of the left foot dorsiflexors muscles (3/5). A compressive neuropathy of the common fibular nerve at the level of the fibula head was demonstrated by nerve conduction studies. Ultrasound of the left knee revealed nerve compression by a fabella. Early decompressive surgery was performed and the fabella was excised. We noticed an almost complete recovery probably due to early treatment (4+/5 two months after surgery). CONCLUSIONS: Common fibular nerve palsy related to fabella compression is very uncommon. Good clinical outcome has been described at 1-2 years with an early work-up and a prompt surgical decompression.

Multiple subpial transections and magnetic resonance imaging.

INTRODUCTION: Multiple subpial transection (MST) has been applied to the treatment of refractory epilepsy when epileptogenic zone involves eloquent areas since 1989. However, there is a lack of data evaluating the effect of this surgical technique on the cortex as measured by Magnetic Resonance Imaging (MRI). PATIENTS AND METHODS: Ten consecutive patients (3F/7M, average age: 18.5 years) were operated on using radiating MST (average: 39; min: 19, max: 61) alone (n=3) or associated with another technique (n=7). Seven patients underwent a post-operative 3.0T MRI while 3 had a 1.5T MRI. Three patients had an early post-operative MRI and 7 a late MRI, among which 3 previously had an intraoperative MRI. RESULTS: The MR sequences that allowed the best assessment of MST-induced changes were T2 and T2*. The traces of MST are more visible on late MRI. These discrete non-complicated stigmas of MST were observed in all 10 studied patients: on the intraoperative MRI they are seen as micro-hemorrhagic spots (hypo-T2), on the early postoperative MRI as a discreet and limited cortical edema whether associated or not with micro-hemorrhagic spots and on the late MRI as liquid micro-cavities (hyper-T2) surrounded with a fine border of hemosiderin. CONCLUSIONS: MST-induced cerebral lesions are best visualized in T2-sequences, mainly on the late postoperatively MRIs. On all the MRI examinations in this study, the MST are only associated with limited modifications of the treated cortical regions.

Myelopathy secondary to a spinal cord compression induced by C2 nerve tumors during head rotation.

INTRODUCTION: It is well known that nerve root tumors developing in the spinal canal can be responsible for spinal cord compression leading to myelopathy and neurological deficits. We report the case of a patient with bilateral C2 neurofibromas presenting with a myelopathy of the upper cervical spine with no spinal cord compression on standard magnetic resonance imaging. The spinal cord compression occurred between the cervical neurofibromas only during head rotation. CASE REPORT: A patient with bilateral neurofibromas of the C2 nerve roots showed a progressive neurological deterioration with an intramedullary MRI hypersignal without visible compression. Only an additional MRI carried-out with the head in rotation demonstrated the tumoral dynamic compression. A review of the literature showed that only two similar cases had previously been reported. The largest C2 tumor was completely removed uneventfully. CONCLUSION: Dynamic compression of the spinal cord in patients with bilateral C2 nerve root tumors must be routinely investigated even if the standard MRI shows no compression.

Recurrent acute subdural bleeding as a rare complication of a hemorrhagic non malignant meningioma.

We report the case of a 66-year-old male patient who presented acute and sub-acute subdural hematomas complicating a grade I meningioma. In the absence of trauma, detection of a subdural hematoma necessitates an etiologic research, in particular the exclusion of a vascular anomaly or a tumour. Subdural bleeding as a complication of a non malignant meningioma is a very rare and threatening situation and requires prompt surgical removal of the tumor.

[The value of combining multiple screwed plates in humeral shaft fractures]. / De l'intérêt à synthéser par plaque vissée bon nombre de fractures de la diaphyse humérale. A propos de 246 synthèses.

The authors have reviewed 246 fresh fractures of the shaft of the humerus treated by primary plating over a period of 22 years. It has been customary to treat the majority of fractures of the shaft of the humerus by conservative means, with use of open reduction and fixation by a plate for complicated fractures with associated injuries, or in cases of nonunion. Over the period of review the authors have gradually increasing their use of primary plating as opposed to the traditional methods. They fell that the reliability of union, together with the early mobilisation and return of the arm to normal function, favours the use of this method. Their opinion is based on a careful analysis of their results.

Fresnel diffraction and the fractional-order Fourier transform.

Fractional-order Fourier transforms are adapted to the mathematical expression of Fresnel diffraction, just as the standard Fourier transform is adapted to Fraunhofer diffraction. The continuity of fractional Fourier transforms with respect to their orders corresponds to the continuity of wave propagation, and their composition is in accordance with the Huygens principle.

[The Herbert screw in pseudoarthrosis of the carpal scaphoid]. / Le vissage d'Herbert dans les pseudarthroses du scaphoïde carpien.

For nearly three years, the authors have ensured scaphoid union by fixation with a double thread T.J. Herbert's screw. In these 25 cases a cancellous bone graft was used to fill the defect which would have left shortening of the scaphoid Twenty-two of the 25 cases, obtained rapid union, and 20 had a good or very good clinical result. One doubtful union and two cases of non-union occurred. One of these non-unions required revision. The main advantage of this procedure is to allow early mobilization of the wrist. This early is very appreciated by the patients who were immobilized several months by conservative treatment for their initial fracture.

[A rare complication of anticoagulants: hemoperitoneum caused by gallbladder rupture. Review of the literature apropos of a case]. / Un accident rare des anticoagulants: l'hémopéritoine par rupture vésiculaire. Revue de la littérature à propos d'un cas.

A 78 year old woman presented with a hemoperitoneum due to vesicular rupture, a rare event since only 45 similar cases have been reported and only 2 of these, as with the present case, were on anticoagulants. This clearly illustrates the extreme rarity of the accident involving a treatment that is being used with increasing frequency. Diagnosis was never made before laparotomy, and the outcome was fatal in 20 of these 46 patients, mortality being higher before progress in intensive care and in patients over 50 years.

[Gangrenous cholecystitis without lithiasis. A report on a case diagnosed by simple radiography of the abdomen (author's transl)]. / Cholécystite gangréneuse non lithiasique. A propos d'un cas diagnostiqué sur les radiographies d'abdomen sans préparation.

The authors report a case of gangrenous cholecystitis without lithiasis but with secondary infection of the gallbladder by anaerobic germs. Pre-operative diagnosis was possible from simple x-rays of the abdomen which demonstrated an obvious fluid level in the gallbladder, and by parietography. An immediate cholecystectomy was performed. Bacteriological examination of the bile confirmed the presence of Clostridium perfringens. The main bile duct appeared normal and the bile in the common bile duct was sterile. Convalescence was uneventful with antibiotic cover, in spite of the age and condition of the patient. Gangrenous cholecystitis occurs more frequently without gallbladder stones in humans. Clinical signs are not specific but simple x-rays of the abdomen are pathognomonic and enable pre-operative diagnosis to be made. Urgent cholecystectomy appears to be the ideal treatment. This affection has a high mortality and early operation is therefore justified.