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About 30 cases of fibrous dysplasia associated with one or more myxomas (Mazabraud's syndrome) have been reported since 1926. We report a new case in a woman with polyostotic fibrous dysplasia and a myxoma in the left femoral muscle. She also had a history of precocious sexual development and café au lait spots, two manifestations whose association with polyostotic fibrous dysplasia defines McCune-Albright syndrome.

Background: Divergent results have been obtained in studies of bone mineral density in patients under oral vitamin K antagonists., Objective: To gather prospective data on bone mineral density and bone metabolism in 70 aortic valve replacement patients., Study Design: 49 patients who had been under oral vitamin K antagonists for at least one year after implantation of a mechanical aortic valve were compared with 21 recipients of a tissue aortic valve that did not require anticoagulant therapy. The following investigations were done in all patients: (1) dual-energy X-ray absorptiometry measurement of bone mineral density at the lumbar spine and femoral neck; (2) roentgenograms of the spine and pelvis; (3) serum assays of calcium, phosphate, creatinine, alkaline phosphatase, osteocalcin, 25-OH-vitamin D3, and parathyroid hormone., Results: The two groups were comparable regarding age and sex ratio. No differences were found in lumbar or femoral neck bone mineral density even after adjustment for age and sex. A trend toward an increase in bone mineral density at both sites with increasing duration of vitamin K antagonist therapy was demonstrated. The only bone turnover marker difference between the two groups was a significantly lower serum osteocalcin level in the group under vitamin K antagonist therapy (P < 0.0001)., Conclusions: Long-term vitamin K antagonist therapy does not affect bone mineral density at the lumbar spine or femoral neck and also fails to modify bone turnover markers, with the exception of osteocalcin.

Primary hyperparathyroidism causes excessive bone resorption with a decrease in bone mineral density. Fractures of the vertebras and appendicular bones, however, seem uncommon, even in the long term. We report three patients who presented with bone insufficiency fractures as the inaugural symptom of primary hyperparathyroidism. The three patients were women, aged 62, 65 and 86 years, respectively, who presented with fractures of the medial tibial plateau, femoral neck of femoral neck and tarsus. Laboratory tests showed hypercalcemia, hypophosphatemia and elevated parathyroid hormone levels. Apart from confusion in the 86-year-old patient, there were no clinical manifestations. A bone biopsy obtained in one patient showed increased resorption parameters with no loss of bone trabecular volume; the two other patients underwent absorptiometry, which disclosed a marked decrease in bone mineral density at the spine and femoral neck. There were no risk factors for osteopenia apart from advanced age and female gender. A parathyroid adenoma was removed surgically in all three cases. Vitamin D deficiency was a concomitant abnormality that probably exacerbated the adverse effects of hyperparathyroidism on the skeleton.

We report six cases of insufficiency fractures of the medial femoral condyle responsible for severe mechanical pain in the medial knee compartment in the absence of any identifiable precipitating factor. Suggestive changes were seen on initial roentgenograms in only one case, whereas increased radionuclide uptake was a consistent finding on the bone scan. The diagnosis was established only by magnetic resonance imaging in five cases. All six patients were women and four were older than 75 years. Two patients had a history of osteoporotic fractures, one had laboratory test evidence of osteomalacia and one had recurrent insufficiency fractures mistakenly ascribed for several years to migratory transient osteoporosis. Bone density was subnormal in five of the six patients. Rest and standard analgesics consistently ensured a favorable outcome within three to four weeks. To our knowledge there have been no previous reports of stress fractures of the medial femoral condyle. These lesions may be underdiagnosed since they are easily mistaken for primary osteonecrosis in the absence of magnetic resonance imaging. Primary osteonecrosis of the femoral condyle shares several features with insufficiency fractures, including predominance in elderly women with factors responsible for mechanical stress (varum, obesity, trivial trauma), mechanical pain, and increased radionuclide uptake. Because some cases of primary osteonecrosis may be secondary to undiagnosed stress-related microfractures, early diagnosis and elimination of weight bearing are essential.

Histologic and biochemical anomalies of muscle mitochondria were identified in four patients with predominantly rhizomelic myalgia clinically suggestive of an inflammatory disease but inconsistent biologic evidence of inflammation. This clinical pattern was initially suggestive of atypical polymyalgia rheumatica and could not be ascribed to any other disease. To explain this combination of anomalies, several hypotheses can be put forward, including coincidence, aging, and nonspecific mitochondrial anomalies resulting from immunologic or inflammatory disease. The speculation that these patients have an autonomous syndrome cannot be outruled but should be considered with caution. A therapeutic trial with coenzyme Q is under way.

Spinal MRI was performed in 9 multiple myeloma and 2 solitary plasmacytoma, using sagittal, T 1-weighted (TR: 350-550 ms/TE: 15-26 ms) and T 2-weighted (TR: 2,000-2,500 ms/TE: 60-120 ms) sequences, with additional gadolinium injection in 3 cases. MRI features were the following: 1) round, patchy lesions with low T 1 signal highlighted by gadolinium and bright T 2 signal were present in 10 of the 11 patients: all osteolytic lesions seen on plain X-rays corresponded to such lesions and biopsy performed in 4 cases showed massive marrow replacement by plasma cells. 2) overall marrow signal was dramatically decreased in 3 patients (2 of whom had a high tumoral mass). 3) extra-dural compression was present in 4 cases. 4) 25 vertebral compression fractures (10 of whom with a "benign" appearance) and focal fat deposition were seen. 5) postradiation treatment examination seemed predictive of the outcome in the 2 solitary plasmacytomas. MRI proved to be more sensitive than plain X-rays or bone scintigraphy. Number and size of focal tumor-like lesions did not correlate with the low marrow signal appearance. Both correlated poorly with overall tumoral mass but diffuse abnormalities were associated with rapidly fatal outcome in three cases. These features might reflect qualitative rather than quantitative patterns of the disease (nodular or diffuse macroscopic marrow replacement). These findings are in agreement with those of the few previous studies. MRI is valuable for spinal cord damage assessment. It appears less accurate in benign versus malignant vertebral compression fracture determination than it does in bone metastasis. Its prognostic value is still questionable.

Bone histomorphometry was carried out in 11 women, aged 53 to 80 (mean = 69.6), treated with fluoride for vertebral osteoporosis for more than 6 months and having suffered one or more stress fractures (1 to 4 sites, mean = 1.7 sites) during that time. Classical contraindications were complied with in all cases but 2 patients did not have any combined calcium supplement. In 6 cases, histomorphometry showed no sign (notably hyperosteoidosis) of the effects of fluoride on bone. Bone trabecular volume was markedly below the fracture threshold in 4 patients. This group refractory to fluoride included the two patients who had received no calcium supplement. In 5 cases, histomorphometry showed hyperosteoidosis of normal or low thickness, with a normal mineralisation rate, reflecting the effects of fluoride on bone. However, bone trabecular volume remained below the fracture threshold in all cases. In all 11 cases, bone structure studied in polarised light was lamellar and there was no increase in cortical porosity. These results suggest that the imputability to fluoride of peripheral bone accidents must be viewed very relatively (the persistence of an insufficient bone trabecular volume being the feature usually found) or, at any event, that its possible iatrogenic effect is not linked to bone remoulding abnormalities.

This study analyses the results of 30 surgical repairs of the rotator cuff. The basic problem was degenerative pathology in which medical treatment had been tried previously in all cases. The type of treatment was based upon preoperative evaluation and arthro-CT scan in particular. Results were invariably good, with regression of pain and recovery of activity. Muscle power was significantly correlated with the value of the tendon repaired, this being reflected overall by incomplete recovery.

Three new cases of neurological complication by osteoporotic compression are reported. They are: a medullar compression by compression of D12 in a 66 year old woman, a deficient cruralgia by compression of L1 in a 67 year old man, and another deficient cruralgia due to the compression of L3 and L4 in a 55 year old woman. The literature presents 16 cases of neurological compressions by vertebral compressions attributed to the osteoporosis: two in 1958, and the others as from 1987. The only recently recognized feature of these complications can be explained by the axiom according to which "there are no neurological complications in the course of osteoporotic compressions" and by the introduction of new diagnosis techniques. However, the critical analysis of the published cases enables us to retain only 11 indisputable cases which, with our three observations, allows us to define certain features: the osteoporosis does not have any particularity compared to the uncomplicated form; the dorsolumbar junction is preferentially affected; the neurological complication occurs progressively and belatedly; the usual mechanism is the recoil of one of posterior vertebral corners, different from the globally convex bulging of tumoral compressions: it could be an element of the differential diagnosis. The surgical treatment gives better results.

Twenty patients with "idiopathic" bone infarction were studied. There were 18 men and 2 women, age 30 to 69 years, at the time of the diagnosis (mean age = 49 years). Sixty-five lesions were recorded with a marked predominance to the lower extremities (77 p. cent are located around the knees) and to the metaphysis (only three pure diaphyseal lesions). Considered asymptomatic, these lesions were painful in 6 patients. They are multiple, and in this case symmetrical, in 12 patients (60 p. cent). X-Rays disclose the classic heterogeneous ball-like, smoke twirled or encapsulated calcifications. A periosteal thickening opposite the lesions was observed in 6 patients; this may be the only radiological sign. Finally, 18 of the 65 lesions were not visible on standard X-Rays, and obvious on MRI. The MRI aspect is characteristic and may be superposed on the basic lesions already described in the course of aseptic osteonecroses of the femoral head. This is, besides, the most sensitive test, snowing a larger number of more extended necroses than the other examinations. CT scanning as well as scintigraphy present a limited advantage. More than half of the patients also present epiphyseal aseptic osteonecroses, often multiple (55 sites for 13 patients), and often unrecognized. The etiological factors are in fact common to both of these diseases: steroid therapy, alcoholism, dyslipidemia, idiopathic forms. Among the possible causes, the literature mentions lupus erythematosus, renal transplant, cytosteatonecrosis, arteriopathies while there is no post-traumatic form. All of the characteristics of these bone infarctions determine a topographic form of the osteonecrotic disease.(ABSTRACT TRUNCATED AT 250 WORDS)