Femoral neuralgia due to degenerative spinal disease. A retrospective clinical and radio-anatomical study of one hundred cases.

We report a study of 100 patients admitted to the Grenoble Regional Teaching Hospital between July 1985 and February 1994 for femoral neuralgia due to degenerative spinal disease. A herniated disk resulting in nerve root impingement was found in 79 patients (83 herniated disks) and lumbar spinal stenosis in 21. The level of nerve root compromise was L2-L3 in eight cases, L3-L4 in 35 cases, and L4-L5 in 40 cases. Herniated disks were divided into several groups based on their location with regard to the intervertebral foramen: posterolateral herniations were entirely contained within the spinal canal (n = 12; 14.5%), whereas far lateral, or foraminal, herniations (n = 71; 85.5%) involved the intervertebral foramen. Twenty-nine foraminal herniations (34.9%) had a component located within the spinal canal (medioforaminal herniations), 33 (39.8%) were entirely contained within the foramen (pure foraminal herniations), and nine (10.8%) were located lateral to the foramen (lateroforaminal herniations). As compared with posterolateral herniations, foraminal herniations were associated with shorter symptom duration at admission (p < 0.05), a greater likelihood of nocturnal exacerbation of pain (p < 0.001) and of a positive femoral stretch test (p < 0.01), and failure of the pain to worsen during Valsalva maneuvers (p < 0.01).

[Hypophosphatemic vitamin D resistant osteomalacia with parathyroid adenoma (author's transl)]. / Ostéomalacie hypophosphorémique vitamino-résistante avec adénome parathyroïdien.

The authors report a new case of parathyroid adenoma associated with hypophosphatemic vitamin D resistant osteomalacia. These troubles were simultaneously found. Major and isolated phosphate tubular loss was improved neither by parathyroidectomy nor vitamin D or 25 OHD therapy. On the contrary 25 OHD associated with oral phosphate intake was clinically, radiologically and histologically efficient. The actual pathogenic concepts about this affection are reviewed.

[Sideroblastic anemia in a multiple myeloma treated by melphalan (author's transl)]. / Anémie réfractaire au cours d'un myélome multiple traité par melphalan.

A case of sideroblastic anemia arised in multiple myeloma is related. Eighteen cases of literature are studied. This evolution usually appears in old and remitted myeloma. The pathogeny of the sideroblastic anemia is unknown, and possibly related to leukemia complicating multiple myeloma.

[Supra trochlear femoral erosions. Their relations with gonarthrosis and chondrocalcinosis (author's transl)]. / L'érosion fémorale sus-trochléenne. Les rapports avec la gonarthrose et la chondrocalcinose articulaire.

Studying one hundred cases of simple gonarthrosis we found only one supra trochlear femoral erosion (STFE). Such a lesion was discovered in 14 cases among 150 chondrocalcinosis with arthrosic lesions. The cases involving STFE trend to a commun marked chondro-osteolytic evolution. The caracteristic patella sizes show clearly that STFE is not in relation with en anomaly of patella (patella alta...). The upper osteophyte of the patella presents only a minor importance in the formation of STFE. This STFE formation begins probably with a progressive chondro-osteolysis of patella and trochlea. Then, appears a progressive nipping between the upper point of patella and the supra trochlear femoral bone.

[The synovial membrane in articular chondrocalcinosis. Clinico-pathological data]. / La membrane synoviale dans la chondrocalcinose articulaire. Données anatomocliniques.

The study of 25 samples of synovial membrane taken from 118 subjects with articular chondrocalcinosis makes it possible to identify three histological aspects : the complete forms showing a crystalline deposit of calcium pyrophosphate of variable volume and alterations of an inflammatory or degenerative type ; incomplete forms showing no calcium deposit, but in which one can observe two sorts of modifications : forms of chondroid metamorphism or inflammatory stigmatas causing an indeterminate chronic synovitis ; finally, forms of superficial fibrosis of the chorion are sometimes encountered. In all, the synovial membrane in articular chodrocalcinosis is often little different from an arthrosic or senile one. However, the presence of crystalline deposits rich in calcium and phosphorous and varying in size can, in the face of certain articular manifestations of uncertain cause, point to the existence of an articular chondrocalcinosis.

[The hemarthroses of articular chondrocalcinosis]. / Les hémarthroses de la chondrocalcinose articulaire

Spontaneous haemarthrosis may occur during the evolution of articular chondrocalcinosis. It occurs mainly in older women and involves the knee in particular. The disorder may recur in the same or in different joints. A study of 11 case histories and counts of red blood corpuscles in samples of synovial fluid confirm that bleeding occurs more readily in chondrocalcinosis than in arthrosis alone. The proposed mechanism of haemarthrosis is only a hypothesis, but it is possible to imagine the onset of microcrystalline flow in a joint that is senile and affected by arthrosis. It is suspected that repeated haemarthrosis favours an oseolytic evolution in certain cases of chondrocalcinosis.

[Radiculomedullary compressions by osteosarcoma and by giant cell tumor of the spine occurring in Paget's disease]. / Compressions radiculo-médullaires par ostéosarcome et par tumeur a cellules géantes du rachis sur maladies de Paget

Two complications of Paget's disease are presented : they include an osteogenic sarcoma and a giant-cell tumour (GCT) of the lumbar spine with a radiculo-medullary compression syndrome. The rarity of sarcomatous degeneration of the spine affected by Paget's disease is emphasized and also the unusual character of the spinal GCT which develop in the presence of Paget's disease. As in the present case, it is often difficult to confirm the benign or malignant character of a GCT and the principal criteria of this classification are discussed.