Plaie du cœur après un traumatisme fermé du thorax

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open fracture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.     

Quel bilan morphologique demander devant un cancer du rectum ?

Management of rectal cancer needs pre therapeutic staging with endoluminal ultrasonography and pelvic MRI, which allow evaluation of size, localization and TN staging of the tumor. After neoadjuvant radiochemotherapy, a second pelvic MRI will be necessary to evaluate the tumor response, using different criteria as morphologic criteria, volumetric criteria and functional imaging. Overstaging is the main limitation, due to difficult to recognize tumor from fibrosis, and to recognize malignant from benign nodes. Metastatic evaluation is done with a thoracic and abdominal CTscan, completed by liver MRI if there are liver metastasis which could benefit of a surgical resection.     

Cas clinique leiomyosarcome du rein: A propos d’un cas

Le léiomyosarcome du rein est une tumeur rare. Les auteurs ont rapporté l’observation d’un homme agé de 45 ans, chez lequel le diagnostic d’une tumeur rétropéritoénale gauche a été posé lors de l’exploration de douleurs du flanc gauche associées à une altération de l’état général et ce par l’imagerie (Echographie et scanner abdominal). La laparotomie exploratrice avait conclu à une tumeur rénale gauche localement évoluée, une néphrectomie élargie a été réalisée et l’histologie était en faveur d’un léiomyosarcome rénal. Une récidive locale a été diagnostiquée après un recul de 6 mois. Après une nouvelle laparotomie, l’abstention était de mise devant le caractère évolué de la récidive. Le but de cette observation est double. Le premier, est la nécessité de faire un diagnostic précoce, afin d’intervenir sur une tumeur de petite taille, plus accessible à la chirurgie. Le second, est de discuter la place du traitement adjuvant, qui pourrait réduire le risque de récidive précoce.     

Acrométastase du pied révélant un cancer bronchique: à propos d’un cas

Foot bone acrometastasis, as the first manifestation of an occult primary malignant tumor, is rarely reported in the literature, and delayed or inappropriate diagnosis is frequent. We report a case of arcometastasis at the head of the first metatarsus revealing an occult lung adenocarcinoma.     

Kyste synovial intraosseux du capitatum : à propos d’un cas

Intraosseous cyst of the carpal bones is a rare cause of wrist pain. Few cases have been reported. We report a rare case of intraosseous ganglion cyst of the capitate, in a girl aged 16 who plain of chronic pain of the right wrist. The radiological assessment showed an osteolytic lesion with marginal sclerosis. The diagnosis was confirmed by histopathology and treatment consisted of curettage with autologous cancellous bone graft. At 8 months follow-up, the capitate is fully consolidated and the functional result is satisfactory.     

Luxation trans-scapholunaire antérieure du carpe. À propos d’un cas

Volar perilunar dislocations of the carpus are rare. They occur in young patients following a violent injury. Open reduction is often needed because of instability of the lesion. The authors report a case of volar transscaphoid perilunate fracture-dislocation treated surgically, with a satisfactory functional result after a follow-up of two and a half years.     

Une luxation antérieure du coude sans fracture péri-articulaire chez un adulte

In view of the comparative frequency of posterior dislocations of the elbow, it is rather remarkable that anterior dislocations of that joint should be among the rarest of injuries [1]. Our case is one of the first cases of anterior dislocation of the elbow without any periarticular fracture or pre-existing deformities around the elbow [2].     

Traitement d’un déficit congénital bilatéral de flexion du coude chez un enfant classé arthrogrypose

The authors report the case of a child presenting with bilateral upper limb arthrogryposis due to agenesis of the biceps. Physical examination revealed a bilateral deficit of active elbow flexion although passive flexion was possible. Echography confirmed bilateral biceps agenesis. The treatment was surgical, one side at a time. An ipsilateral pedicle latissimus dorsi muscle transfer was used to restore elbow function. The second procedure took place 7 months after the first. After each operation, the patient's limb was immobilised in plaster for 6 weeks before rehabilitation was commenced. Six months postoperatively, elbow flexion measured 100° on both sides. The functional sequelae at the donor site were negligible, apart from some persisting hypertrophic scars. Bilateral biceps brachii agenesis has not previously been reported in the literature. The surgical treatment undertaken enabled restoration of function with minimal sequelae.