PERM syndrome sévère mimant un tétanos

We report the case of a 55-year-old man without significant medical history admitted to the ICU for a progressive paralysis mimicking life-threatening tetanus. Evolution with classical tetanus treatment was negative, with the need for ventilator support and worsening condition being life threatening. Uncommon evolution revealed a rare glycin antibody-associated hyperekplexia (progressive encephalomyelitis with rigidity syndrome). Patient dramatically improved with immunosuppressive therapy including plasmatic exchanges, cyclophasmid and high dose corticoid infusions. Intensivists should be aware of this very rare syndrome whose treatment is the opposite of tetanus while presentation is very close. Optimal and treatment could lead to prolonged survival.     

Syndrome du canal carpien et poignet à ressaut révélant un fibrome de la gaine des fléchisseurs

The tendinous sheath fibroma (TSF) is a rare benign tumor, exceptionally responsible for carpal tunnel syndrome and “trigger” wrist: we found this association less than ten times in the English and French literature. We report the case of a 63-year-old right-handed carpenter who featured a triggering phenomenon of the right wrist during the flexion-extension movements and compression of the median nerve at the carpal tunnel, secondary to a TSF of the flexor digitorum superficialis. The diagnosis was suspected at the sonography and MRI, the tumor was excised and proven histologically to be a TSF. One year later, the patient remained free of symptoms.     

Acrométastases de la main et du pied compliquant un cancer mammaire

Hands and feet acrometastases are rarely observed. The authors report a case of bone metastasis to the left thumb and the right second metatarsal bone in a 37-year-old woman with breast carcinoma. Through this case report, mechanisms of such metastases are reviewed.     

Dilataciones congénitas de la vía biliar

Congenital dilations of the biliary tract are a group of rare conditions, commonly associated with the presence of an abnormality at the junction of the common bile duct and pancreatic duct, which may lead to the reflux of pancreatic juice within the biliary tree. The main clinical symptoms are, abdominal pain, cholangitis and acute pancreatitis, and the most serious complication is malignant degeneration. The treatment of choice is cholecystectomy and complete excision of the bile duct from its bifurcation to its intra-pancreatic segment.     

Ostéochondromatose pseudotumorale de la hanche chez un joueur de football

Pseudotumoral osteochondromatosis of the hip in a sockerplayer. The authors present a case of pseudotumoral osteochondromatosis of the hip, interresting by his clinical and radiological features. They discuss the incidence of the sport in the pathogenesis of the loose bodies and the magnetic resonance findings.     

Rupture de rate intra-abdominale révélée par un hémothorax

We report a case of a 17-year-old patient with an haemothorax related to an intra-abdominal spleen rupture. The nature of this haemothorax is unusual and the problem is how to obtain the etiology in this case. The spleen was in intra-abdominal position on all radiological examinations and was the source of bleeding. Therefore, laparotomy is the only convenient therapy.     

Lesiones iatrogénicas de la vía biliar

Bile duct injuries can be caused by different reasons, with Iatrogenic Bile Duct Injuries (IBDI) being the most common factor. IBDI is a complex situation produced in apparently healthy patients and is associated with a high rate of morbidity and a low rate of mortality. A multidisciplinary approach between surgeons, radiologist and endoscopist offers the best chances for an initial diagnosis, therapeutic options, management and follow up of complications for the patient. The aim of this review is to describe the current medical literature with reference to IBDI, and discuss our therapeutic algorithm.