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Resume Objectifs. – Evaluer les resultats a long terme de la suture de la coiffe des rotateurs et chercher d’eventuels facteurs predictifs pre- et/ou peroperatoires. Patients et methodes. – Tous les patients ayant subi une suture de la coiffe des rotateurs, a ciel ouvert, pour une dechirure transfixiante entre 1990 et 1996 et ayant un recul d’au moins 4 ans ont ete contactes. La technique operatoire et la reeducation postoperatoire etaient standardisees. Certains facteurs (âge, sexe, cote dominant, douleurs, duree des symptomes, limitation de la mobilite active) ayant pu influencer le resultat final ont ete notes. Resultats. – Vingt-six hommes et 24 femmes sur un total de 56 patients ont ete retenus. L’âge moyen etait de 58,5 ans. La duree des symptomes etait en moyenne d’un an avec des extremes de 3 a 48 mois. Avant l’operation, l’antepulsion active etait en moyenne de 144°, l’abduction active de 135° et la rotation externe coude au corps de 39°. La taille de la dechirure, mesuree durant l’intervention, variait de 1 a 5 cm. Les patients ont estime avoir recupere le maximum de la force de l’epaule (75 % de la force anterieure a la dechirure) apres un delai moyen de 10 mois. Apres une evolution moyenne de 6 ans, une reduction significative des douleurs (de 2,18/3 a 0,98/3 ; p Conclusion. – Dans cette serie de patients, la suture de la coiffe des rotateurs a reduit l’intensite des douleurs. Le resultat definitif n’a ete atteint qu’apres un peu moins d’un an. La mobilite articulaire n’a ete amelioree que dans une minorite des cas.

Introduction Calcium pyrophosphate deposition (CPPD) may cause severe arthropathy, major joint destruction and treatment options are limited. The aim of this study was to test the therapeutic efficacy of methotrexate (MTX) in chronic or recurrent CPPD arthropathy. Methods Patients with CPPD arthropathy were randomized to receive either weekly subcutaneous injections of 15 mg/week of MTX or placebo (PBO) for three months, in a double-blind, crossover randomized controlled trial. Inclusion criteria comprised definite CPPD disease, recurrent arthritis or persistent polyarthritis, and an insufficient response to NSAIDs, glucocorticoids or colchicine. The primary outcome was an improvement in the disease activity scores based on 44 joints (DAS44). The analysis was performed on an intent-to-treat basis. Results We randomized 26 patients, and compared 25 treatment periods on MTX with 21 treatment periods on PBO. Baseline characteristics were balanced between the groups. The evolution of the DAS44 was not statistically significantly different between groups (median DAS44 decreased by −0.08 on MTX versus −0.13 on PBO, after three months, P = 0.44). Furthermore, pain levels remained stable in both groups (median change in VAS Pain −1 unit on MTX and 0 on PBO, P = 0.43), and none of the secondary outcomes was significantly different between the two groups. Minor adverse events (AE) did not differ in frequency between the groups, but the only serious AE occurred on MTX (bicytopenia). Conclusions The results of this trial with MTX in this older population with chronic or recurrent CPPD arthropathy suggest no strong effect of MTX on disease activity. Trial registration EudraCT No: 2007-003479-37. Registered 26 April 2008

A postmenopausal woman treated with diuretics for hypertension and who underwent surgery for a previous fibroadenoma of the left breast presented, in December 2003, with a sudden bloody discharge of the left nipple with local swelling, redness, and pain. Radiologic investigations revealed a well-delimited tumor under the areola. Needle aspiration disclosed many histiocytes but no bacteria. Despite improvement with antibiotics, the tumor was removed. Pathological examination shows features suggesting the tumor was a gouty tophus. Birefringent crystals were retrospectively found on the smears of the aspirated material. To our knowledge, only 3 similar cases have been reported in the literature.

Adalimumab is a frequently prescribed TNFalpha inhibitor for treatment of rheumatoid arthritis. We report on a patient who probably developed a Miller-Fisher syndrome after the second injection of adalimumab.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 7 novembre 2012

OBJECTIVES To evaluate the results of rotator cuff repair and to look for preoperative and/or intraoperative predictors of long-term outcomes. PATIENTS AND METHODS All patients who underwent open rotator cuff repair surgery for a full-thickness tear between 1990 and 1996 and who were subsequently followed-up for at least 4 years were contacted. The surgical technique and postoperative rehabilitation program were standardized. We recorded factors potentially associated with outcomes (age, sex, dominant hand, pain, symptom duration, and active range-of-motion limitation). RESULTS Of the 56 patients identified, 26 men and 24 women with a mean age of 58.52 years were included in the study. Mean symptom duration was 12 months (range, 3-48 months). Before surgery, mean active range of motion of the shoulder was 144.6 degrees for forward elevation, 135.2 degrees for abduction, and 39.4 degrees for lateral rotation with the elbow at the side. The size of the tear measured during surgery was 1-5 cm. Mean time to recovery of shoulder power (75% of the value before the tear) as assessed by the patients was 10 months. After a mean follow-up of 6 years, a significant reduction in pain was noted (from 2.18/3 to 0.98/3; P < 0.001), although two-thirds of the patients reported occasional pain. Six patients were dissatisfied. Range of motion had improved in one-fourth of the patients. Constant's score after surgery was 65/100. Persistent difficulty in taking objects down from high shelves was noted. None of the preoperative or intraoperative factors studied predicted the long-term outcomes. CONCLUSION In this series of patients, rotator cuff repair reduced pain severity. Nearly a year was needed to achieve the final result. Only a minority of patients experienced an improvement in range of motion.

Due to the increase of the immunocompromised population, mucosal and systemic infections caused by Candida glabrata, formerly known as Torulopsis glabrata, have shown a recent significant increase. We present a case of C. glabrata vertebral osteomyelitis which required repeated surgical therapy, a complete L2 and L3 corporectomy and more than one year of hospitalisation to complete healing. We compare this case to eight previously reported cases outlining the features of C. glabrata spinal osteomyelitis, including symptoms, diagnosis, treatment, evolution and outcome. According to the case presented and in review of the literature, we believe that in the absence of abscess and neurologic symptoms, medical treatment should be initiated with close clinical, laboratory and radiologic follow-up. An unfavorable evolution of these parameters should be an indication for aggressive and, if necessary, repeated surgical intervention in association with an antifungal treatment.