‘Ganglions’

The ganglion cyst is the commonest soft-tissue swelling in the hand and wrist. It is a fibrous swelling that arises near a joint or tendon sheath, and contains clear mucinous fluid. The exact pathogenesis of the ganglion is unknown, although various theories quote anatomical and physiological evidence to support them. Ganglia can occur near any joint in the body, although they are encountered most commonly in the wrist and hand. They can present in a diverse number of ways. In cases of diagnostic uncertainty, they can be investigated by imaging techniques. If a ganglion is symptomatic, it should be treated by conservative means initially including aspiration. Steroids have no place in their management. If this strategy fails, then excision is required, it should be radical to minimise the risk of recurrence. Further research into the pathophysiology may allow improvement in treatment.     

‘STAB AND SPLIT’: A ‘BLOODLESS’ AND ‘SCARLESS’ SKIN INCISION TECHNIQUE FOR MINOR SURGERY

The ‘stab and split’ skin incision technique was applied to children requiring minor surgery. A small stab incision was made on a skin crease and split open with mosquito forceps. After the surgical procedure was completed, the wound was closed in layers with a subcuticular suture to the skin. In all cases, splitting caused virtually no blood loss because subcutaneous veins were left intact, and the wounds healed well, especially in infants. ‘Stab and split’ is an effective alternative incision technique for minor surgery in younger children.     

L’hypercalciurieHypercalciuria.

Hypercalciuria is a biological syndrome defined as excretion in the urine of more than 0.1 mmol/kg/24 hours of calcium in the absence of dietary restrictions. A number of endocrine, renal, and bone diseases can cause hypercalciuria. Urinary calcium excretion is substantially influenced by the intakes of calcium, sodium, protein, carbohydrates, alcohol, and potassium, so that a poorly balanced diet can result in hypercalciuria. Recently, there has been a burst of interest in molecular studies of rare lithiasis syndromes, all of which are due to mutations in the ClCN5 chlorine channel gene. Mutations affecting the calcium-sensitive receptor (CaSR) have been identified in other forms of hypercalciuria. Idiopathic hypercalciuria is defined as hypercalciuria that persists after correction of dietary imbalances and has no detectable cause. The classification suggested by Pak (class I, class II, class III, and “renal” hypercalciuria) is controversial and of little assistance in clinical practice. Three mechanisms can be incriminated in idiopathic hypercalciuria: increased intestinal absorption of calcium, defective reabsorption of calcium by the renal tubule, and increased bone resorption. Overexpression of the vitamin D receptor and a deficiency in renal tubule enzymes may be involved also. Bone mineral density is moderately decreased in idiopathic hypercalciuria, particularly of the renal type. The risk of vertebral fracture seems increased, however. Overproduction of calcitriol and of cytokines that stimulate bone resorption have been incriminated in the bone loss. Treatment of the cause is essential in secondary hypercalciuria (dietary advice, treatment of an underlying disease…). A diet low in sodium and meat and containing no more than 800 mg of calcium per day has been advocated in idiopathic hypercalciuria. Hydrochlorothiaide therapy is warranted in patients with osteopenia and an inadequate response to dietary therapy.     

Boxer’s pericardium

A 65-year-old retired professional boxer presented with progressively worsening shortness of breath, peripheral oedema and mild abdominal swelling over a period of 6 months. His only past medical history was hypertension. Subsequent investigations revealed chylous ascites, pericardial constriction and bilateral chylothorax. He had uneventful pericardectomy, and post-operatively the chylothorax resolved only after administration of octreotide for 10 days. The histopathological features of fibrosis, haemosiderin deposition in the pericardium and abundant haemosiderin-laden macrophages are consistent with chronic resolving haemopericardium. These findings suggested that the cause of pericardial constriction was repeated chest trauma from boxing.     

Diagnostic d’une spondylarthropathie lors d’un syndrome de Sweet

The association of Sweet's syndrome and Crohn 's disease is rare. We report a new case of a such association. A 5 year-old woman developed a diarrhea, fever, and skin lesions consistent with a presumptive diagnosis of Sweet's syndrome. Crohn 's disease was also diagnosed. Oral prednisone, associated with mesalazine, effected improvement of both cutaneous lesions and bowel disease. The ten cases of the literature and ours show that Sweet's syndrome may occur during an acute phase of Crohn's disease. Most of the time, Crohn's disease has already been diagnosed. However, this was not so with our patient, wherein lies the originality of our case. A general corticotherapy is the prefered course of treatment.

Comparaison de deux échelles de qualité de vie, l’une générique et l’autre spécifique, dans l’évaluation de l’efficacité d’un traitement thermal global dans l’arthrose du genou

Objectifs. – Notre étude a eu pour buts d’étudier l’efficacité à court terme du traitement thermal sur la qualité de vie des patients atteints d’arthrose du genou et d’analyser les différences et les corrélations entre les résultats obtenues avec deux échelles de qualité de vie, l’une générique et l’autre spécifique des affections rhumatismales.Patients et méthodes. – Nous avons sélectionné par randomisation 50 patients atteints de gonarthrose, qui ont bénéficié d’un programme de traitement thermal de type global et polyvalent pendant une durée de 21 jours. Les résultats chez les 46 patients ayant terminé l’étude ont été évalués avec les échelles de qualité de vie SF-36 (générique) et AIMS2 (spécifique).Résultats. – Une amélioration statistiquement significative a été observée dans tous les domaines du SF-36. Tous les domaines de l’AIMS2 se sont aussi améliorés, mais cette amélioration n’était significative que pour la moitié d’entre eux. Il existait une corrélation significative des domaines correspondants entre les deux échelles, à l’exception des domaines d’activité physique.Conclusion. – Un traitement thermal global, polyvalent, semble améliorer, à court terme, la qualité de vie des patients atteints d’une gonarthrose.Objectives. – To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis.Patients and Methods. – Fifty patients with knee osteoarthritis were randomly recruited. They underwent a comprehensive spa therapy program for 21 days. Forty-six patients completed the study. The results were evaluated with SF-36 and AIMS2.Results. – Statistically significant improvement was observed in all subscales of SF-36. All subscales of AIMS2 improved too, but only half of them were significant. Correlation between matching subscales of each test was also significant, except physical activity.Conclusion. – Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term.