Rheumatologic manifestations of pachydermoperiostosis and preliminary experience with bisphosphonates.

OBJECTIVE: Pachydermoperiostosis is manifested by finger clubbing, hypertrophic skin changes, and periosteal bone formation. We describe 5 cases revealed primarily by their rheumatologic manifestations. Also reported are preliminary experiences on the use of intravenous pamidronate as a treatment. METHODS: This is a retrospective study including the analysis of clinical manifestations, laboratory results and morphological examinations gathered from patients' medical records. We evaluated efficacy of treatment with 1 mg/kg iv pamidronate in the 3 new cases. RESULTS: Before treatment with iv pamidronate, the patients' global assessment was poor (twice) and very poor (once). The physician's global assessment was poor in 3 patients. After treatment with iv pamidronate, 2 patients had significant improvement. Physician and patient global assessments were very good, good, and moderate. No side effects were observed. All biological variables were within normal ranges at 12 month followup visit. CONCLUSION: Pachydermoperiostosis must be recognized by the rheumatologist, since it can present symptomatically through articular manifestations. When conventional treatment modalities fail, iv pamidronate might be useful.

Long-term efficacy of percutaneous drill-biopsy under computed tomography guidance of osteoid osteomas of the hip and femur. A review of seven cases.

UNLABELLED: En bloc surgical excision of osteoid osteomas of the hip and femur is difficult because of problems with tumor boundary identification and the need to use internal fixation or bone grafting. We report our experience with seven cases treated by percutaneous drill-biopsy under computed tomography guidance. PATIENTS: Six adults and one child with a mean age of 22 years treated since 1995. All seven patients reported insomnia due to pain during a mean of 10 months, improved by aspirin or other nonsteroidal anti-inflammatory agents. The tumor was seen on plain radiographs in four cases and on computed tomography scans in all seven cases. Magnetic resonance imaging was diagnostic in only two cases. The tumor was in the femoral neck in four patients, in the acetabulum in one, in the proximal femur in one, and at the distal diaphyseal-metaphyseal junction of the femur in one. METHOD: A trephine was used to remove the tumor under computed tomography guidance during a short general anesthesia. RESULTS: No serious complications were recorded. Full weight bearing was allowed starting at the forty-eighth hour in six of the seven patients. Immediate pain relief and a full recovery were obtained in every case. Results were excellent in four patients and good in three after a follow-up of 14 to 44 months. CONCLUSION: Percutaneous drill-biopsy of osteoid osteomas is a valuable alternative to conventional surgery in patients with tumors at sites that are difficult to access. The technique allows early weight bearing and ensures a full recovery.

Arthritis, tenosynovitis, fasciitis, and bursitis due to sea urchin spines. A series of 12 cases in Réunion Island.

UNLABELLED: Arthritis, tenosynovitis, and bursitis due to sea urchin spine injuries have unique pathological features and run a chronic course until the spines are removed. Of the 40 cases of sea urchin spine-related clinical symptoms published to date, only 12 had osteoarticular symptoms. PATIENTS AND METHODS: We studied 12 cases with osteoarticular symptoms seen in Réunion Island from 1994 to 1998. There were nine cases of arthritis and one case each of tenosynovitis, fasciitis, and bursitis. The nine males and three females had an age range of 9 to 50 years. RESULTS: The injury was at the knee in six cases, the foot in three, and the hand in three. The time from injury to lesion development ranged from two days to two and a half months. Laboratory tests were normal apart from evidence of mild inflammation in three of the arthritis cases. The spine was visible on plain radiographs in eight cases. Histology was done in seven patients and consistently showed a typical foreign body granuloma. Removal of the spine with synovectomy was performed in 11 cases and consistently ensured a full recovery. DISCUSSION: The clinical manifestations and management in our patients were compared to those in earlier reports. The differential diagnosis of laboratory test, radiographic, and histologic findings is reviewed. Pathogenic hypotheses and the immunogenic effect of the protein sheath that surrounds sea urchin spines are discussed. CONCLUSION: The diagnosis of these frequently under-recognized lesions rests on a careful history and on converging histologic, radiologic, and clinical findings.

Contribution of magnetic resonance imaging to the diagnosis of extraskeletal Ewing's sarcoma.

A case of extraskeletal Ewing's sarcoma presenting as a large gluteal mass is reported. This is a rare tumor with a frequently grim prognosis. Although the definitive diagnosis requires histological examination, magnetic resonance imaging is useful for determining the location of the tumor, evaluating its spread, and eliminating skeletal Ewing's sarcoma by establishing the integrity of the neighboring bone marrow. The tumor is seen on T1-weighted images as low signal with heterogeneous postgadolinium enhancement. Signal intensity on T2-weighted images is variable. In the case reported here, combination chemotherapy with external beam radiation therapy was ineffective, and the patient died 12 months after the diagnosis.

[Joint osteoarthritis and rhizarthrosis]. / Arthroses digitales et rhizarthroses.

Articular joint disease frequently occurs in women during menopause. It mainly affects the terminal interphalangeal joints (and is responsible for the formation of small, hard nodules, known as Heberden's nodes) and the metacarpophalangeal joint the thumb (root arthrosis). Clinical diagnosis is not difficult and the disorders are often little troubling and considered only secondary in an overall functional context. However, they can change the quality of life of these patients, making many daily activities difficult to perform. They thus remain a common reason for outpatient visits, although their disfiguring nature is sometimes the main motivation of these patients.