Ultrasonography and detection of subclinical joints and tendons involvements in Systemic Lupus erythematosus (SLE) patients: A cross-sectional multicenter study

Objectives

The aims of this study in SLE population were (1) to describe ultrasonography (US) joint abnormalities, (2) to estimate the reliability of clinical swollen joint count (C-SJC) and SLEDAI (C-SLEDAI) versus US-SJC and US-SLEDAI scores, (3) to highlight specific patterns of lupus patients with Power Doppler (PD) abnormalities.

Lower trapezius transfer with semitendinosus tendon augmentation

Background

Lower trapezius transfer can restore external rotation in brachial plexus palsies. In some cuff tear arthropathies, there is lack of active external rotation with a preservation of forward elevation. We evaluated the clinical outcomes of a lower trapezius transfer extended with a semitendinosus tendon and fixed to the insertion of the infraspinatus via arthroscopy.

Methods

Between 2013 and 2016, we operated on 14 patients (8 men, 6 women; mean age of 62 years, range: 50–70) to reconstruct irreparable posterosuperior rotator cuff tear. A vertical incision of 6 cm following the medial border of the spine was made to harvest the lower trapezius in extension with the semitendinosus tendon. The extension band of the lower trapezius was fixed laterally via arthroscopy on the great tuberosity at the level of the insertion of the infraspinatus. The proximal stump of this extension band was then fixed medially into the muscle of the lower trapezius with the arm in maximum external rotation. Outcomes were evaluated with the Constant–Murley score, simple shoulder test (SST), and subjective shoulder value (SSV).

Results

Over a mean follow-up of 24 months (range: 12–36 months), the gain in external rotation with the arm at the side was 24° and 40° in 90° of abduction. The Constant–Murley score improved from 35 to 60 points, the SST from 3.5 to 7.5, the SSV from 30 to 60%, and the pain decreased from 7 to 2 (visual analogue scale, 0–10). Both the lag sign and hornblower sign were negative after this transfer. There were two cases of hematomas, and one was revised because of infection.

Conclusion

Lower trapezius transfer is a therapeutic option for irreparable posterosuperior cuff tears with a lack of active external rotation and a good subscapularis. Patients can expect improvements in pain and in active external rotation without any loss of active anterior elevation.

     

Epidemiological profile of burns in children in central and southern Tunisia: A 67-case series

Introduction

Burns are among the most frequent injuries in children. They are a major cause of morbidity and mortality in low- and middle-income countries. This study aimed to describe the epidemiological aspects of burns in this environment and to propose preventive measures.

Accident vasculaire cérébral ischémique : une complication rare du kyste hydatique du foie

Hydatid cyst of the liver (HCL) is a widespread disease in North African countries. We report the case of a 39-year-old patient who was admitted in our intensive care unit because of anaphylactic shock due to a cracked HCL fortuitously discovered. This accident was also complicated by an ischemic stroke witch underline mechanisms are discussed.     

Unilateral permanent loss of vision after nefopam administration

Acute glaucoma angle closure is a rare complication of anaesthesia and multimodal analgesia. However it is a medical emergency, hence any delay in its treatment may have catastrophic consequences. We present a case of postoperative glaucoma, which had evolved to permanent blindness. We also reviewed the French pharmacovigilance database between 1996 and 2006 and found four other cases of acute glaucoma angle closure in postoperative period possibly related to the administration of nefopam.