[Interest hamstring flap in the coverage of ischial pressure sores]

The ischial pressure ulcer, a condition common in the paraplegic patient in a wheelchair, are deemed to be poor prognosis made frequent recurrences after surgery. We hope to show in this work the interest and superiority shreds hamstrings in their care compared with other surgical techniques. A series of 20 ischial pressure ulcer operated in our department over a period of eight years with a mean of four years is analyzed and compared with literature data The optimal rate of recurrence found in the literature is 20%. all of these results highlights the importance of choosing the cover and flap. Quality followed postoperatively. Different surgical techniques are discussed including: the gluteus maximums, slender, tensor fascia lata fasciocutaneous thigh flap, rectus femoris, vastus lateralis, rectus abdominis, the most complex cases and the most extreme indications are described as. The treatment of ischial pressure ulcer is heavy and requires a multidisciplinary team to improve prognosis

[Normal pressure hydrocephalus]

Normal pressure hydrocephalus [NPH] first described in 1965 by Hakim and Adams, and was considered idiopathic. However, in some cases an aetiology can be identified. We are going to focus on idiopathic NPH. Age usually over than 60 years, with slight male preponderance, clinically the triad contains gait disturbance that usually precedes other symptoms, dementia and urinary incontinence. The positive diagnostic is done by CT scan, MRI, lumbar puncture and other exams. But none has proven to be of adequate reliability. The selection of patients is based on clinical triad, CT scan and MRI, lumbar puncture and resistance to outflow of cerebrospinal fluid. The first diagnostic issue concerns other forms of hydrocephalus. The second is to exclude other types of dementia. And the third is to exclude other problems causing gait disturbance in the elderly such as parkinsonism, pain, polyneuropathy and myelopathy. In some cases, it is difficult to differentiate between NPH and degenerative dementia with cortico subcortical atrophy causing ventricular widening. Predictors of good response being mainly the short duration of disease symptoms, good response to CSF removal tests, and test of resistance to flow of CSF. The treatment is based on ventriculo-peritoneal shunt with programmable valve better than medium pressure one. Potential complications are subdural hematomas or hygroma, shunt infection, intraparechymal hemorrhage in the brain, seizures, shunt obstruction or disconnection. The most likely symptom improved with shunting is incontinence, then gait disturbance and lastly dementia. Many markers of good response have been determined but the results of published serials are still inhomogeneous