ABSTRACT
BACKGROUND: Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE: To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS: Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION: Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
Subject(s)
Craniotomy/standards , Durapatite/standards , Plastic Surgery Procedures/methods , Prostheses and Implants/standards , Prosthesis Implantation/standards , Skull/surgery , Adult , Autografts/transplantation , Craniotomy/adverse effects , Craniotomy/methods , Durapatite/administration & dosage , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Prostheses and Implants/adverse effects , Prosthesis Implantation/adverse effects , Plastic Surgery Procedures/adverse effects , Reproducibility of ResultsABSTRACT
Pollen of Poaceae is among the most allergenic pollen in Europe with pollen of birch. It is therefore useful to elaborate models to help pollen allergy sufferers. The objective of this study was to construct forecast models that could predict the first day characterized by a certain level of allergic risk called here the Starting Date of the Allergic Risk (SDAR). Models result from four forecast methods (three summing and one multiple regression analysis) used in the literature. They were applied on Nancy and Strasbourg from 1988 to 2005 and were tested on 2006. Mean Absolute Error and Actual forecast ability test are the parameters used to choose best models, assess and compare their accuracy. It was found, on the whole, that all the models presented a good forecast accuracy which was equivalent. They were all reliable and were used in order to forecast the SDAR in 2006 with contrasting results in forecasting precision.
Subject(s)
Allergens/immunology , Models, Theoretical , Poaceae/immunology , Pollen/immunology , Environmental Monitoring/methods , Epidemiological Monitoring , Forecasting , France/epidemiology , Humans , Meteorological Concepts , Precipitating Factors , Predictive Value of Tests , Regression Analysis , Rhinitis, Allergic, Seasonal/epidemiologyABSTRACT
High levels of tissue-like plasminogen activator in cerebrospinal fluid reported in a patient with an intracerebral haemorrhage associated to cerebral metastasis of malignant melanoma could support the hypothesis of cerebral haemorrhage induced by tPA tumoral synthesis.
Subject(s)
Cerebral Ventricle Neoplasms/pathology , Intracranial Hemorrhages/etiology , Melanoma/pathology , Adult , Cerebral Ventricle Neoplasms/metabolism , Humans , Intracranial Hemorrhages/metabolism , Intracranial Hemorrhages/pathology , Male , Melanoma/metabolism , Tissue Plasminogen Activator/biosynthesis , Tissue Plasminogen Activator/cerebrospinal fluidABSTRACT
Few cases of pituitary adenoma with metastases have been reported. We report a case with histologically benign intracranial and cauda equina metastases. We compare it to the others in the literature.
Subject(s)
Adenoma/pathology , Brain Neoplasms/secondary , Magnetic Resonance Imaging , Pituitary Neoplasms/pathology , Adenoma/diagnosis , Brain Neoplasms/diagnosis , Humans , Male , Middle AgedABSTRACT
A patient with a mass lesion of Müllerian origin associated with a spinal dysraphism is reported. The mass lesion was a genuine uterine formation, and a hemorrhage arose from a functional endometrium. A spinal dysraphism was associated, including a low-lying conus medullaris, a subcutaneous lipoma, and a sinus between the cul-de-sac and the lipoma. This ectopic and mature tissue may be differentiated from teratoma and endometriosis.
