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The aim of this study was to describe the effects of a 64.2 km ultra-trail on the biomarkers of muscle damage, inflammation and oxidative stress, and compare the results observed with an ECG and an echocardiogram, both performed before and after the race.Thirty-three ultra-trail volunteers (45.8 ± 8.7 years old) were enrolled in our study. Three blood tests were drawn from each runner, one just before (TPRE), one just after (TPOST) and the last 3 h after the end of the race (TPOST3h).All the markers increased. The maximum concentrations observed were at TPOST3h and were significant (p < 0.001) for creatine kinase, creatine kinase isoform MB, high-sensitivity C-reactive protein, uric acid and for the ratio of reduced glutathione to oxidised glutathione. However, in the case of myoglobin, high-sensitive troponin T, N-terminal pro-brain natriuretic peptide, oxidised glutathione, myeloperoxidase, cystatin C and creatinine, the most significant increases were at TPOST (p < 0.001). Modifications were observed in the medical imaging using echocardiography such as reduction of left ventricule end-sytolic and diastolic volumes and left ventricular global longitudinal strain. ECG showed electrical criteria for left ventricular hypertrophy and incomplete right bundle branch block after the race.Endurance races cause significant physiological stress to the body that can be measured by the increase of different biomarkers. From a laboratory perspective, it is important to take into account the possible exercise performed previous to the testing to avoid a misinterpretation of the results. From a training perspective, due to these increases in biomarkers, it is recommended that runners wait at least 72 h after an ultra-trail before subsequent training. In addition a transient impairment of ventricular function due to dehydration were observed.

The prevalence of pathologies associated with musical playing are high among professional musicians. While hearing injuries appear to be the most commonly disorder, instrumentalists are also prone to numerous neurological and musculoskeletal problems. Despite the increasing number of recent clinical studies, an appropriate identification of these problems by health practitioners remains difficult and the implementation of an adequate treatment is almost inexistent in a population of musicians with several disorders affecting the ability to play their instrument.Les pathologies en lien avec la pratique musicale sont fréquentes dans une population de musiciens professionnels. Alors que les lésions auditives restent peut-être les seules connues du grand public, les musiciens sont aussi sujets à de nombreux troubles neurologiques et musculo-squelettiques. Malgré une augmentation récente des études cliniques, l’identification de ces troubles par les praticiens de la santé reste difficile et la mise en place de traitement est presque inexistante dans une population de musiciens présentant de nombreux troubles interférant avec la pratique de leur instrument.

Amyotrophic lateral sclerosis (ALS) is an incurable disease characterized by muscle atrophy leading to complete paralysis. Once diagnosed, the average life expectancy is three to five years. In this context, palliative and end-of-life care are essential, as well as the development of cognitive and/or psychological therapies to improve the quality of life of patients. In this context, we conducted a review of the pertinent literature about psychological and cognitive interventions in end-of-life support for ALS patients. We identified 504 references out of which only four studies met our inclusion criteria. Two studies focused on dignity therapy, one study on the delay between the diagnosis and the start of psychological care in a specialized centre, and one case-report on psychological therapy combined with a computer-assisted communication system. The results of these studies, although very limited, suggest that psychological interventions may improve the management and quality of life of end-of-life ALS patients. Further studies should investigate the impact of psychological support adapted to ALS, using, for example, computer-assisted communication allowing to implement these interventions in a larger number of patients and over the long term.La sclérose latérale amyotrophique (SLA) est une maladie neurogénérative qui se caractérise notamment par une amyotrophie progressive évoluant jusqu’à la paralysie complète du patient dont l’espérance de vie est, en moyenne, de trois à cinq ans. Les soins palliatifs et le développement de thérapies pour améliorer la qualité de vie des patients sont essentiels. Dans ce cadre, nous avons réalisé une revue de la littérature portant sur les interventions psychologiques et cognitives dans la prise en charge des patients atteins de SLA en fin de vie. Nous avons identifié 504 références dont quatre rapportant des études qui répondaient aux critères d’inclusion. Deux études portaient sur la thérapie de la dignité, une sur la rapidité d’une prise en charge psychologique dans un centre spécialisé et un rapport de cas concernait une prise en charge psychologique combinée à un système de communication assistée par ordinateur. Les résultats de ces quatre études, bien que limités, suggèrent que les interventions psychologiques pourraient améliorer la qualité de vie des patients en fin de vie. De nouvelles recherches devraient être menées pour investiguer l’impact d’une prise en charge psychologique adaptée à la SLA en utilisant, par exemple, une communication assistée afin d’implémenter ces interventions sur un plus grand nombre de patients et sur le long terme.

We report the case of a 63-year old patient admitted in the intensive care unit for 25 days because of a severe SARS-CoV-2 pneumonia. With diverse symptoms of critical illness polyneuropathy the patient has been taken care of in a rehabilitation centre. Ankylosis and joint motion limitation led to a more extensive imaging assessment. The later showed advanced periarticular heterotopic calcification in both hips and in right shoulder. Although hypothesis about this complication's physiopathology remains unclear, early identification would allow a better management. It is the first time heterotopic ossification involving three large joints is reported after a SARS-CoV-2 infection.Nous rapportons le cas d’un patient de 63 ans admis dans une unité de soins intensifs durant 25 jours suite à pneumopathie à SARS-CoV-2 sévère. Le patient a présenté un tableau clinique de polyneuropathie des soins intensifs et a été pris en charge dans un centre de rééducation. L’ankylose et la limitation articulaire des hanches du patient ont conduit à compléter le bilan radiologique montrant d’importantes calcifications hétérotopiques périarticulaires des deux hanches et de l’épaule droite. Bien que les hypothèses physiopathologiques de cette complication restent incertaines, l’identification précoce a permis d’introduire une prise en charge adaptée. C’est la première observation d’ossification hétérotopique associée à une infection à SARS-Cov-2 impliquant trois grandes articulations chez un même patient.

Plantar fasciitis is the most common cause of talalgia in adult. It can affect a variety of individuals and its etiology is still unknown. Several factors are probably involved (repeated micro-traumatisms excessive tension, chronic inflammation…). In plantar fasciitis bone exostosis can be observed. The latter may also result into a functional incapacity due to major pain and therefore has a major impact on the quality of life. Several treatments with different efficacy are proposed to the patient. The role of radiotherapy is very limited, even if it's more frequently applied in Germany. The main goals of this article are to evaluate the place of the radiotherapy in the therapeutic approach, to confirm its efficacy and to assess the associated risks.La fasciite plantaire est la cause la plus fréquente de talalgie chez l’adulte. Elle affecte une population hétérogène et son étiologie reste inconnue, même s’il existe probablement une origine multi-factorielle (contraintes répétées, tension excessive, inflammation chronique…). La talalgie peut être associée à une exostose osseuse ou éperon calcanéen inférieur. Elle peut être source d’incapacité fonctionnelle en raison de douleurs importantes associées qui peuvent entraîner une altération majeure de la qualité de vie. De multiples traitements peuvent être proposés aux patients. La radiothérapie a une place très restreinte dans l’arsenal thérapeutique, même si elle est plus fréquemment utilisée chez nos voisins germaniques. Notre article a pour but de discuter de la place de la radiothérapie dans le schéma thérapeutique, d’en confirmer l’efficacité et d’en évaluer les risques associés.

The number of people with cancer is constantly increasing. Thanks to new screening techniques and treatment protocols, the number of survivors is also increasing. However, treatments cause some undesirable side effects that usually persist over time. The level of physical activity of these patients tends to decrease with the diagnosis of cancer and does not usually increase before the end of the treatments or even beyond. However, physical activity is beneficial not only in terms of preventing the progression or recurrence of the disease but also in the fight against side effects related to the disease and its treatments. There are various physical activity recommendations for cancer survivors that will be developed in this article. The project «Sport après cancer. Citoyen sportif, j'agis pour ma santé», developed by the University and the University Hospital of Liège, aims to promote adapted physical activity after cancer, creating a link between outpatient rehabilitation in a hospital setting and the practice of physical activity in a sporting and associative context.Le nombre de personnes atteintes d’un cancer est en augmentation constante. Grâce aux nouvelles techniques de dépistage et protocoles de traitement, le nombre de survivants est, lui aussi, en progression. Cependant, les traitements contre le cancer entraînent certains effets secondaires indésirables qui persistent généralement dans le temps. Le niveau d’activité physique de ces patients a tendance à diminuer dès l’annonce du diagnostic du cancer et n’augmente généralement pas avant la fin des traitements, voire bien au-delà. Pourtant, l’activité physique est bénéfique, non seulement en termes de prévention face à la progression ou à la récidive, mais également pour lutter contre les effets secondaires liés à la maladie et à ses traitements. Il existe diverses recommandations en matière de pratique d’activité physique pour les sujets ayant survécu au cancer qui seront développées dans cet article. Le projet «Sport après cancer. Citoyen sportif, j’agis pour ma santé», développé par le CHU et l’Université de Liège, a pour but de promouvoir l’activité physique adaptée après un cancer, en créant un lien entre la réadaptation ambulatoire en milieu hospitalier et la pratique d’activité physique dans un contexte sportif et associatif.

Androgenic alopecia is a genetically determined and leads to a progressive hair loss of the vertex, affecting both men and women. It is related to an important psychological and social distress. Medical therapies include topical minoxidil, oral 5?-reductase inhibitors and oestroprogestative drugs with anti-androgen effects for women. The surgical option is autograft hair transplantation. Recently, phototherapy with low-level energy lasers became available. All these treatments may present adverse effects and their effectiveness is questionable. Subcutaneous injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment. The methodology, the possible mechanisms of action and some initial clinical results of this treatment are presented.L’alopécie androgéno-génétique se manifeste par une perte progressive des cheveux du sommet du cuir chevelu, touchant aussi bien l’homme que la femme. Ses impacts sociaux et psychologiques négatifs sont souvent très importants. Elle peut se traiter par des médicaments (minoxidil topique, inhibiteurs de la 5?-réductase per os, oestroprogestatifs à visée anti-androgénique chez la femme), par des techniques chirurgicales d’autogreffes capillaires, ou encore, par photothérapie avec des lasers de basse énergie. Tous ces traitements ne sont pas dénués d’effets indésirables et leur efficacité n’est pas constante. Les injections sous-cutanées de plasma riche en plaquettes autologue dans le cuir chevelu peuvent constituer un traitement efficace de l’alopécie androgéno-génétique, en monothérapie ou comme adjuvant. Les modalités techniques, les modes d’action potentiels et les principaux résultats cliniques obtenus à ce jour sont présentés.

2020 will be remembered as the year of SARS-CoV-2 pandemic which confined most of the world's population at home. Rehabilitation units will have to face specific challenges to protect the vulnerable in-patients. Moreover, they must prepare for post-COVID-19 patients who might suffer from illness consequences or present a post intensive care syndrome secondary to the increased ICU length of stay. The purpose of this paper is to highlight the deficiencies of post-COVID-19 patients and suggest a decision algorithm to best match their needs.L’année 2020 restera marquée par la pandémie de SARS-CoV-2, originaire de Chine, qui a confiné une grande partie de la population mondiale. Les services de médecine physique et rééducation fonctionnelle ont dû adopter des mesures spécifiques afin de limiter la contagion de leurs patients, appartenant à la population à risque. Ils se préparent également à l’accueil et à la prise en charge des patients post-COVID-19 présentant des séquelles secondaires à l’infection ou à l’hospitalisation prolongée en réanimation, responsable d’un syndrome post-soins intensifs. L’objectif de cet article est de dégager les différentes pathologies auxquelles les médecins rééducateurs seront confrontés et de proposer un algorithme décisionnel pour orienter la prise en charge rééducative.

to investigate the questionnaires used in French-speaking Belgian spine multidisciplinary rehabilitation centers for patients with low back pain and to propose a minimal core set of questionnaires based on the results of our survey and on the (inter)national guidelines.the spine centers offering the 36 two-hour sessions defined by the Belgian national Institute for Health and disability insurance were invited to provide their battery of questionnaires.among the 37 identified and contacted centers, 21 participated in our survey. Results pointed out the use of questionnaires assessing pain intensity, disability, anxiety/depression and kinesiophobia in most centers as well as a huge heterogeneity regarding the questionnaires (and even the version of the questionnaire) reported and the non-systematic use of questionnaires recommended by the guidelines.taking into account the results of this survey, the present article proposes a minimal core set of questionnaires meeting the guidelines, which would make it possible to harmonize the assessments in the different centers and would facilitate the realization of multicenter studies.Objectifs : examiner les questionnaires utilisés dans les centres francophones belges de revalidation multidisciplinaire du rachis pour la prise en charge des patients lombalgiques et proposer une batterie de questionnaires minimale basée sur les résultats de cette étude et sur les recommandations (inter)nationales. Matériel et méthodes : les centres proposant le programme de 36 séances de 2 heures défini dans la nomenclature de l’INAMI (Institut National d’Assurance Maladie Invalidité), ont été invités à nous fournir leur batterie de questionnaires. Résultats : parmi les 37 centres identifiés et contactés, 21 ont participé à l’enquête. Si celle-ci met en évidence l’utilisation de questionnaires évaluant l’intensité de la douleur, l’incapacité fonctionnelle, l’anxiété/dépression et la kinésiophobie dans les différents centres, elle révèle également une grande hétérogénéité en termes de questionnaires (et même de version du questionnaire) utilisés et la non-utilisation systématique des questionnaires recommandés par les guides de pratique clinique. Conclusion : compte tenu des résultats de l’enquête, cet article propose une batterie minimale de questionnaires répondant aux guidelines, qui permettrait d’harmoniser les évaluations dans les différents centres et faciliterait la réalisation d’études multicentriques.

When acute arthralgia is associated with focal osteoporosis and reversible epiphyseal edema, all three spontaneously resolving without sequelae in a few months, it is then called transient focal osteoporosis. Well known at the hip, this pathology may be expressed at other joints and have a migratory character. In this case report, the patient presented himself with migrating transient focal osteoporosis that successively undertook, over one year, various anatomical zones within the same knee and then reached the contralateral knee. The evolution was characterized by a healing without sequelae after discharge and analgesic treatment.Lorsqu’une arthralgie aiguë est associée à une ostéoporose focale et à un oedème épiphysaire réversible, tout trois spontanément résolutifs sur le plan clinique et iconographique sans séquelles en quelques mois, la pathologie est alors nommée ostéoporose régionale transitoire. Bien connue à hauteur de la hanche, elle peut s’exprimer au niveau d’autres articulations, préférentiellement portantes des membres inférieurs et posséder un caractère migratoire. Dans ce rapport de cas, le patient a présenté une ostéoporose focale transitoire migrante touchant successivement, sur une année, diverses zones anatomiques au sein d’un même genou pour atteindre ensuite le genou controlatéral. L’évolution s’est caractérisée par une guérison sans séquelles après décharge et traitement antalgique.

We report a rare type of stress fracture in a young athlete, great hope of belgian table tennis. Although this type of fracture is not rare in the broad sense of the term, a stress fracture located at the distal femoral physeal is exceptional. Such a complication must be quickly detected because of growth disorders and impact on sports performances that this may cause. On the basis of an anamnesis and detailed clinical observations, we describe the physiopathology as well as the diagnostic and therapeutic management of this pathology.Nous présentons un type rare de fracture de fatigue chez un jeune sportif, grand espoir du tennis de table belge. Bien que ce type de fracture ne soit pas rare au sens large du terme, une fracture de fatigue située au niveau du cartilage de croissance fémoral distal est exceptionnelle. Cette complication doit être rapidement détectée vu les troubles de croissance et l’impact sur les performances sportives que cela peut engendrer. A partir d’une anamnèse et d’observations cliniques minutieuses, nous décrivons la physiopathologie ainsi que la prise en charge diagnostique et thérapeutique de cette pathologie.

Over the last decade, Physical and Rehabilitation Medicine (PRM) is a medical specialty that has evolved considerably in the various fields that concern it : from the management of low back pain and lumbosciatalgia or osteoporosis in a multidisciplinary manner, through the use of new technologies in neuro-locomotor rehabilitation and robotisation in amputee patients for example, the development of regenerative medicine and prevention in sports traumatology and, finally, the progress of electrophysiology techniques for the diagnosis of small-fibre neuropathies. These various advances will be discussed in this article.Au cours de la dernière décennie, la Médecine Physique et Réadaptation (MPR) est une spécialité médicale qui a fortement évolué dans les différents domaines qui la concernent : de la prise en charge des lombalgies et lombosciatalgies ou encore de l’ostéoporose de manière pluridisciplinaire, en passant par l’utilisation des nouvelles technologies en rééducation neuro-locomotrice et de la robotisation en rééducation, chez les patients amputés par exemple, le développement de la médecine à vocation régénérative et la prévention en traumatologie du sport et, enfin, les progrès des techniques d’électrophysiologie pour le diagnostic des neuropathies à petites fibres. Ces différentes avancées seront abordées dans cet article.

Diabetes mellitus causes several micro- (nephropathy, neuropathy and retinopathy) and macro-vascular (coronary insufficiency, stroke, lower limb arteriopathy) complications. Some complications are less widely known, particularly the ones involving the musculoskeletal system. Even though diabetes is not specifically linked to these complications, it increases both their incidence and severity. The objective of this paper is to review the main musculoskeletal complications associated to diabetes. It describes the pathophysiology, symptomatology and treatments of these complications.Le diabète sucré entraîne toute une série de complications micro- (néphropathie, rétinopathie et neuropathie) et macro-vasculaires (coronopathie, accident vasculaire cérébral et artériopathie des membres inférieurs). Certaines complications sont moins connues, notamment celles qui touchent le système musculo-squelettique. Ces pathologies ne sont pas spécifiques du diabète, mais celui-ci en augmente fortement, non seulement, l’incidence, mais aussi la sévérité. Le but du présent article est de revoir les principales complications musculo-squelettiques que l’on peut rencontrer chez les personnes diabétiques, en décrire la physiopathologie, la symptomatologie et le traitement à préconiser.

Knee tendinopathies account for a large number of sports dropping, especially in sports requesting jumps and running. There is actually no consensus about the management of those injuries. Nevertheless, new therapies may offer possibilities to the non-responding ones. This review aims to actualise the treatment of knee tendinopathy, to discuss the most recent forms of treatment and their clinical use, limited by our current knowledge of the disease.Les tendinopathies de l’appareil extenseur du genou sont la cause d’un nombre important d’interruption d’activité dans le milieu sportif, particulièrement ceux impliquant les sauts et la course. Il n’existe pas encore de consensus clair sur la prise en charge de ces pathologies. Néanmoins, des approches nouvelles semblent offrir des possibilités de traitement de ces tendinopathies réfractaires. Cette revue de la littérature permet d’actualiser la prise en charge des tendinopathies et d’évoquer les traitements les plus récents et leurs implications cliniques dans les limites de nos connaissances de cette pathologie.

Cardiovascular diseases are responsible for many deaths in our western societies. Practice of sport activities can decrease their occurrence and improve the prognosis of the patients already affected. The practice of a sport, however, presents an increased cardiovascular risk during its realization (sudden death, myocardial infarction, etc.). An assessment of the risk of complication is necessary before allowing patients with ischemic heart disease to practice a sport activity. Sport activities in competitions are discouraged for most patients, but for the majority, recreational activities should be encouraged. A regular medical follow-up is necessary as well as a respect of instructions of good sport practice.Les maladies cardiovasculaires sont responsables de nombreux décès dans nos sociétés occidentales. La pratique d’une activité sportive permet de diminuer leur survenue et d’améliorer le pronostic des patients déjà atteints. La pratique d’un sport peut cependant être associée à un risque cardiovasculaire majoré lors de sa réalisation (mort subite, infarctus du myocarde, etc.). Une évaluation du risque des complications est nécessaire avant de permettre à un patient coronarien de pratiquer du sport. Les compétitions sportives sont déconseillées pour la plupart de ces patients, mais pour la grande majorité de ceux-ci, les activités de loisir doivent être encouragées. Un suivi médical régulier reste donc nécessaire, tout comme le respect des consignes des bonnes pratiques sportives.

The spine has been the subject of extensive clinical research since it is the source of many painful complaints. However, there is little scientific evidence concerning the therapeutic proposals. During the course of life, the intervertebral disc degenerates, which over time diminishes its damping capacity and facilitates the expulsion of the nucleus pulposus through the annulus fibrosus. The degeneration of the intervertebral disc (DDI) is the origin of some back pain and various specific treatments have been developed. These include the infiltration at the center of the intervertebral disc of plasma rich platelet (PRP), composed of multiple growth factors which act on the disc degeneration. This treatment is recent and less invasive than surgery. Preliminary results seem promising. However, many gray areas and several parameters remained to be clarified. In an attempt to do this, a literature review was conducted based on bibliographic databases Pubmed, Medline and Scopus

The pathophysiological mechanisms of tendinopathies integrate various intrinsic and extrinsic factors. Classic "passive" therapeutics have a limited action. Because of a better pathophysiological understanding of tendinopathies, more recent treatments (injections of various compounds, infiltrations of platelet-rich plasma, stem cells) would lead to a long-term healing. In case of failure of conservative managements and depending on the anatomical site, a surgical approach may be considered.

Classic "passive" therapeutics (anti-inflammatory drugs, infiltrations of corticosteroids...) of tendinopathies, which are used relatively empirically, reduce pain and inflammation, without fundamentally changing the tendon structure. The eccentric rehabilitation has been applied to chronic tendinopathies, not only due to the failure of conventional therapies but also due to a better pathophysiological understanding of tendinopathies. Various studies underscore the effectiveness of eccentric rehabilitation which, after 20-30 sessions, leads to healing and especially prevents the risk of chronicity. Shockwave therapy, amending the tendinous structure, would lead to a long term healing.

The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is frequently unrecognized and may lead to misdiagnosis and delayed treatment. We report the case of a 77 year old patient complaining of symptoms of an anterior tarsal tunnel syndrome with neuropathic pain located at the dorsal part of the foot, without any sensorimotor loss. The ENMG was in favour of a motor impairment of the deep peroneal nerve. MRI exploration of the ankle showed a millimetric bony overgrowth of the upper pole of the navicular bone, irritative to the deep peroneal nerve. Infiltration at overgrowth of the navicular provided a partial and temporary decrease in pain symptoms. Surgical nerve decompression was then considered.

Platelets contain growth factors released during their degranulation following activation. These growth factors promote tissue remodeling, wound healing and angiogenesis. Currently, the clinical effect of Platelet-Rich Plasma (PRP) is still discussed, or even controversial. Our researches have assessed the effectiveness of PRP on the healing of animal tendons and human beings suffering from chronic jumper's knee.

Jumper's knee is a frequent chronic overuse syndrome of the proximal part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. The aim of this study was to clarify the possible efficacy of one injection of Platelet-rich plasma (PRP) in cases of rebel jumper's knees.Twenty patients with chronic proximal patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10-point visual analogic scale of pain, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COMTEC®, Fresenius-Kabi, Bad Homburg, Germany). Six millilitres of PRP were injected without local anesthetic. One week after infiltration, patients started a standardized sub-maximal eccentric reeducation.During daily activities pain significantly decreased with time. At functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration.This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve symptoms of chronic jumper's knee in patients non-responsive to classical conservative treatments.

We report the case of a patient presenting with an akineto-rigid syndrome of the left hemibody whose etiological exploration by magnetic resonance imaging showed the presence of a cavernoma located in the right lenticular region. The interest of this situation is to establish if there is a pathophysiological link between such symptoms and the lesion revealed by the MRI.

A case of ulnar artery aneurysm in an independent roofer is reported. It is a rare disease often associated with the Hammer Hypothenar Syndrome specifically found in manual workers and athletes exposed to repetitive palmar trauma.

This case report is concerned with a 30 year old patient diagnosed with pigmented villonodular synovitis (PVNS) in the knee. The patient underwent an orthopedic surgical operation to remove the lesions. PVNS is a rare proliferative disorder, mostly benign and affecting the knee; its aetiology remains unclear. It represents a medical challenge because of non-specific symptoms that delay the diagnosis with a very high rate of recurrence. MRI imaging is necessary to explore the lesions, but the final diagnosis can only be made after anatomopathologic analysis of the excised lesions. When multiple lesions are present, the treatment consists of their excision by arthrotomy, or by arthroscopy if the disease is localized.

We report a rare case of single cervical metastasis of breast cancer. Bone metastases are the most frequent in breast cancer. Early diagnosis combined with the new therapeutic advances have considerably improved the quality of life and increased the survival. Imaging plays a great role in the diagnosis, particularly scintigraphy and radiography, but sometimes also CT and MRI. The treatment is currently not standardized and it combines hormone therapy, chemotherapy, radiotherapy, and/or surgery.

F-waves result from the discharge of the motoneurons following their antidromic activation. The F-wave appears, as an indirect (the F-wave latency decreases when the stimulation site moves away from the muscular detection) and late response (occurring after the M response). In practice, the most useful parameter is the F-wave minimal latency, provided that at least seven distinct F-waves are evoked. When the analysis is relative either to the controlateral side, or to a former examination, this parameter is one of most sensitive in electroneuromyography. F-wave evocation implies conduction along the entire peripheral nervous system, and particularly its proximal part, which is not investigated by nervous trunks conduction velocity studies. Thus, F wave study is the most useful in plexopathies and polyradiculonevritis. In the early phase of Guillain-Barré syndrome, their absence may be the unique sign indicative of proximal conduction blocks.

We report the case of a young boy who had had multiple bone fractures (more than 10) since the age of 19 months. The father had the same clinical history. The clinical examination was normal for his age except blue sclera. The bone densitometry showed a severe osteoporosis for his age. Biological exam swere correct. The genetic exploration revealed mutation of COL1A2 gene. With this clinical history, the diagnosis of Osteogenesis imperfecta (OI) was retained. OI is a hereditary dystrophy with abnormal synthesis or metabolism of collagen with, often, mutation of COL1A1 or COL1A2 genes. There are 7 different forms. We consider the possible differential diagnoses. The goal of any treatment is to promote bone remineralisation and to decrease the fracture frequency. The treatment includes calcium and vitamin D, and in the presence of some precise criteria, biphosphonate therapy.

Auto-immune diseases represent the 3rd cause of morbidity after cardiovascular and oncologic diseases. They often occur in young subjects. Their presence is not synonymous of disease and must be associated to clinical signs to be pathological. However, their discovery can require a complement of investigations and the possibility of a follow-up because some auto-antibodies are predictive of disease. This paper is concerned with the main autoantibodies that can be picked out at the laboratory of immunology. Some technical explanations and INAMI rules are explained too.

We report a case of hypothyroid myopathy, or Hoffmann syndrome, in a 31-year-old man who presented to the emergency department with asthenia, muscular pain, cramps, and joint pain. Tests revealed increased creatine phosphokinase level (8102 U/L) and severe hypothyroidism (content of T4=3.8 pg/ml, T3=1.3 pg/ml, and thyrotropin stimulating hormone150 microU/ml). Other causes of myopathy were excluded by anamnestic investigation and paraclinical exam. Treatment was begun with thyroid hormones (from 75 to 175 microg) and good clinical evolution was rapid. The pathophysiology of hypothyroid myopathy, clinical aspects and pathologic anatomic elements are described. The exact etiology of hypothyroidism must be known because some pathologic features are benign and treatment can have good results, whereas others, such as cancer, have worse prognosis.