Carte routière du département de la Dordogne : comprenant les routes royales, les routes départementales les chemins vicinaux de grande communication classés par le Conseil général / Dressée par A. Bardon Géog[rap]he des Ponts et Ch[aus]sées

Échelle(s) : [ca 1:200 000], échelle de 0,01 pour 2000 mètres

Extra-articular knee resection for a secondary chondrosarcoma evolving from an isolated enchondroma of the distal femur: A case report.

Introduction: Enchondromas are among the most current benign bone tumours. Malignant degeneration is extremely rare (<1%) and generally presents as a low grade chondrosarcoma. For localized grade 1 lesions, the treatment of choice is curettage. Wide excision and reconstruction is generally not necessary, unless locally advanced or more aggressive behaviour is suspected at presentation. Case report: A healthy 72 yo male presented with pain and recurrent knee joint effusion. X-rays show a classical central distal metaphyseal enchondroma of the femur associated with subtle osteolysis of the lateral condyle. MRI confirms the presence of a locally aggressive chondromatous lesion based in a classical enchondroma. Core needle biopsy revealed a grade 1 chondrosarcoma, which was in contrast to the radiological aggressiveness of the lesion. Total body CT-scan did not reveal metastatic disease. A wide resection was planned, as a high-grade lesion and joint contamination was suspected. We performed an extra-articular knee resection and reconstruction with a hinged modular total knee megaprosthesis. The definitive histology was grade 1 chondrosarcoma, the surgical margins were wide. The evolution was favourable and the patient was able to perform all his activities of daily living independently without pain at 6 weeks postop. Knee flexion reached 90°. The oncologic screening at 18 months did not show local or distant recurrence. Conclusion: Joints near a benign tumour that suddenly become symptomatic or present an effusion might indicate a malignant transformation. Wide resection and prosthetic reconstruction remains an effective treatment option even in low grade cartilaginous lesions if (1) the adjacent joint is contaminated, or (2) joint-sparing surgery would result in a severe functional impairment of the limb.

Ordonnance de M. le comte de Sainte Maure, premier écuyer commandant la grande écurie du Roi, bailli et capitaine des chasses de la varenne des Tuileries, pont de S. Cloud, plaine de S. Denis, portant règlement général sur le fait des chasses

[Acte. 1719-08-21. Paris]

Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): results of a multidisciplinary international expert panel-EPACT II

Introduction: High-grade evidence is lacking for most therapeutic decisions in Crohn's disease. Appropriateness criteria were developed for upper gastro-intestinal, extra-intestinal manifestations and drug safety during conception, pregnancy and breastfeeding in patients with Crohn's disease, to assist the physician in clinical decision making. Methods: The European Panel on the Appropriateness of Crohn's Disease Therapy (EPACT II), a multidisciplinary international European expert panel, rated clinical scenarios based on evidence from the published literature and panelists' own clinical expertise. Median ratings (on a 9-point scale) were stratified into three categories: appropriate (7-9), uncertain (4-6 with or without disagreement) and inappropriate (1-3). Experts were also asked to rank appropriate medications by priority. Results: Proton pump inhibitors, steroids, azathioprine/6-mercaptopurine and infliximab are appropriate for upper gastro-duodenal Crohn's disease; for stenosis, endoscopic balloon dilation is the first-tine therapy, although surgery is also appropriate. Ursodeoxycholic acid is the only appropriate treatment for primary sclerosing cholangitis. Infliximab is appropriate for Pyoderma gangrenosum, ankylosing spondylitis and uveitis, steroids for Pyoderma gangrenosum and ankylosing spondylitis, adalimumab for Pyoderma gangrenosum and ankylosing spondylitis, cyclosporine-A/tacrolimus for Pyoderma gangrenosum. Mesalamine, sulfasalazine, prednisone, azathioprine/6-mercaptopurine, ciprofloxacin, and probiotics, may be administered safety during pregnancy or for patients wishing to conceive, with the exception that mate patients considering conception should avoid sulfasalazine. Metronidazol is considered safe in the 2nd and 3rd trimesters whereas infliximab is rated safe in the 1st trimester but uncertain in the 2nd and 3rd trimesters. Methotrexate is always contraindicated at conception, during pregnancy or during breastfeeding, due to its known teratogenicity. Mesalamine, prednisone, probiotics and infliximab are considered safe during breastfeeding. Conclusion: EPACT II recommendations are freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

VOLUMES RELIES du Cabinet des titres : recherches de noblesse, armoriaux, preuves, histoires généalogiques. « Catalogue des noms, surnoms et armes des pages qui ont été receus dans la Grande-Escurie du Roy, depuis l'an 1667, sur les preuves faites par M. d'Hozier ; ledit catalogue commencé en 1685, » jusqu'en 1689.

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