Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur.

PURPOSE: To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur. MATERIALS AND METHODS: The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years±13 (SD) (range: 35-82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score≥8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay. RESULTS: No patients treated with RPOC had a fracture during a mean follow-up time of 382 days±274 (SD) (range: 11-815 days). RPOC was performed under general (n=10) or locoregional (n=2) anesthesia. The average duration of the procedure was 95min±17 (SD) (range: 73-121min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4days ±3 (SD) (range: 2-10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n=7), VAS score decreased from 6.8±1.2 (SD) (range: 5-9) before treatment, to 2.3±1.1 (SD) (range: 1-4) one month later. CONCLUSION: Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.

Thrombocytopenia due to hypersplenism in oncological disease: partial splenic embolization during palliative treatment.

Hypersplenism is excess activity of the spleen, resulting in peripheral pancytopenia that predominates in platelet cell lines. Pancytopenia can be limited by reducing the volume of the functional spleen. However, in patients in very poor general condition, a splenectomy may not be possible, due to the risks of surgery and postoperative infection. Another therapeutic alternative in these patients is to reduce the volume of the spleen by super selective percutaneous splenic embolization. We report three cases of peripheral thrombocytopenia due to hypersplenism with a platelet count between 60,000 and 80,000/mm(3), which made it impossible to continue or start a chemotherapy protocol in these patients. For these patients, super selective partial embolization of the splenic parenchyma, with uncharged microspheres (250 microns) quickly resulted in a platelet count above 150,000/mm(3) so that chemotherapy could be continued or initiated.

[Rheumatoid arthritis and meningeal nodules]. / Polyarthrite rhumatoïde et nodules méningés.

INTRODUCTION: Rheumatoid nodules are possible extra-articular manifestations of rheumatoid arthritis. These lesions are mainly located in subcutaneous tissues but may also rarely affect deep organs, exceptionally the meninges. CASE REPORT: We report herein a case of meningeal nodules observed in a 52-year-old man with rheumatoid arthritis who underwent brain MRI to explore an acute visual impairment. Subsequent MRIs showed similar new lesions contrasting with total regression of the initially observed lesions. The final control brain MRI performed four years after the onset of the ocular symptoms disclosed total involution of all the extra-axial nodular lesions, a course highly suggestive of meningeal rheumatoid nodules. CONCLUSION: During the follow-up period of this case, the patient was treated with methotrexate at doses too low to cross the blood brain barrier. Consequently, it is most likely that the meningeal lesions developed during the natural course of the disease. Despite the non-specific features of the first imaging findings, the radiological changes observed over time were consistent with the final diagnosis of rheumatoid nodules.