Post-traumatic liponecrosis. Apropos of a clinical case

Localized post-trauma liponecrosis, also called lipoatrophy, is a benign disease with no functional consequences but does cause important aesthetic problems. Diagnosis is often missed. Necrosis of the adipocytes occurs after direct trauma and absorption of the haematoma. It is important to search for favouring factors and order the necessary examinations. The therapeutic strategy is presented.     

Atrophic thyroiditis: an unusual course of a Basedow-like variation of Hashimoto disease. Apropos of a case

This case concerns a 27-year-old man with a very high level of anti-thyroid antibody and pretibial elephantiasis myxedema which developed progressively over several years following subtotal thyroidectomy for < hashitoxicosis >. Complementary resection of the thyroid stump was performed ; under microscopic examination this stump presented an aspect of atrophic thyroiditis. This unusual development towards atrophic thyroiditis raises the problem of the relations between the various forms autoimmune thyroiditis.     

Tracheobronchopathia osteochondroplastica . Apropos a case

We present one case of osteochondroplastic tracheobronchopathy in a patient with right laterocervical tumoration as a manifestation of a normofunctional nodular goiter detected in a thyroid morphofunctional study, and tracheal stenosis secondary both to the goiter and the tracheobronchial process. The coincidence of these two processes, probably fortuitous, has never been described before.     

Pigmented basal cell carcinoma of the eyelid. Apropos of a clinical case

A clinico-pathologic case of a 83-year-old female patient with a deeply pigmented inferior lid tumor is reported. The histopathological study of the tumor demonstrated a pigmented basal cell carcinoma. Numerous different tumors may affect the eyelids, melanocytic or not in nature. True melanomas are infrequent compared with the numerous other pigmented tumors, which always need a histological analysis.     

Multiple pilomatricoma. Apropos of a case

Pilomatricoma is a benign, solitary tumor. The histopathologic findings of viable basaloid cells in the periphery, shadow cells in the central part and foci of calcification are characteristic of pilomatricoma. The microscopic aspect of multiple pilomatricomas was not different from solitary pilomatricomas. Though, some consider them as a pathognomonic sign of myotonic dystrophy. Complete surgical excision is the best management.     

Pseudocystic ureteritis. Apropos of a case

The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.     

Odontoid bone. Apropos of a case

Reporting a clinical observation, the authors emphasize upon the extreme scarceness of this variety of so called "congenital" pseudarthrosis of the odontoid process. The congenital origin, due to a lack of fusion, or the acquired one by avascular necrosis following a trauma is explained. The diagnosis may be clinical, consisting either on a vertebral syndrome occurring in childhood, or on a neurological syndrome in the adult age. It is mainly radiological : A scanner investigation is presented here. Owing to the potential neurological severity of the disease, the posterior fusion has to be recommanded.     

Diagnostic and therapeutic management of ethylene glycol poisoning. Importance of crystalluria. Apropos of a case

During the course of a case of ethylene glycol poisoning with ensuing oliguric renal failure despite early dialysis, we show the importance of early diagnosis of this intoxication in underlined. Characteristics of ethylene glycol poisoning are: metabolic acidosis with anion gap (without lactic acidosis or keto-acidosis) and high plasma osmolarity. Awaiting the result of blood and urinary toxic values, crystalluria, by typical needle monohydrate calcium oxalate crystals finding, evokes the diagnosis and permits to start a specific treatment. This treatment is based on: principles of intensive care, ethanol administration (or 4-methyl-pyrazole now available), also thiamine and pyridoxine administration and finally, dialysis therapy. We can hope, with early and intensive management of this poisoning, to prevent the renal failure, principal complication of ethylene glycol ingestion, which can lead to chronic renal failure. Therefore, crystalluria, an easy and specific diagnosis technic, is of great interest.     

Corono-radicular amputation of mandibular molars: indication, technic and prosthetic utilization. Apropos of a clinical case

Lesions to the radicular bifurcation generally entail the removal of the tooth in question. This leads to the need to create a prosthetic bridge to compensate for the absence of the extracted tooth. This solution is not readily accepted by the patient who wishes to avoid involving other teeth. In these cases rhizectomy and the execution of an inlay on an adjacent tooth may satisfy the patient and resolve the clinical symptoms. The authors report a case of rhizectomy and prosthetic reconstruction of a tooth using inlay.     

Secreting retroperitoneal paraganglioma. Apropos of a case

A case of secreting, asymptomatic retroperitoneal paraganglioma is presented. Paragangliomas are rare neuroendocrine tumors and the malignant behaviour, higher than pheochromocytomas, is based on metastases or local recurrence. The treatment is complete surgical excision. Radiotherapy and chemotherapy may be used for palliation of symptoms.     

Postoperative ptosis: etiopathogenesis, clinical analysis, and therapeutic management. Apropos of a series of 43 cases

PURPOSE: Acquired postoperative ptosis (PP) are difficult to situate in the current classification of ptosis. Assessement of the mechanisms, the clinical features and the possible treatments of these PP would suggest a new classification of ptosis. MATERIAL AND METHODS: Among 260 cases of surgically corrected ptosis, 43 cases of PP (16.5%) were detected and analyzed. RESULTS: Forty cases of PP were eligible for this study. Their responsible mechanisms were aponeurotic (57.5%), mixed (aponeurotic and/or myogenic and/or neurogenic) (27.5%) and myogenic (15%). PP was assessed in most cases as being mild (77.5%) and the levator's muscle contraction was most often mildly impaired (77.5%). In these cases, surgical procedure was performed: levator aponeurosis disinsertion repair (85%), Fasanella-Servat procedure (2.5%), frontalis sling (2.5%) and other surgical procedure with synthetic materials (10%). Postoperative complications included 1 case of persistent lid edema and 4 cases of spontaneous suture rupture. Six patients (15%) were secondarily reoperated: 2 for overcorrection (5%) and 4 for undercorrection (10%). The general outcome was good in 90% of cases, insufficient in 5% of cases and unsatisfactory in 5% of cases. CONCLUSION: This study confirms the previously described features of the PP: onset after anterior surgery procedures of usually moderate ptosis, induced by an aponeurotic defect mechanism in most cases. The treatment was exclusively surgical: anterior reinsertion of the levator aponeurosis. For better management, we suggest a new ptosis classification: aponeurotic, myogenic, neurogenic and mixed (aponeurotic and/or myogenic and/or neurogenic) and false or pseudo-ptosis.