Uptake of household disinfection kits as an additional measure in response to a cholera outbreak in urban areas of Haiti.

Médecins Sans Frontières-Operational Centre Amsterdam piloted the distribution of household disinfection kits (HDKs) and health promotion sessions for cholera prevention in households of patients admitted to their cholera treatment centres in Carrefour, Port au Prince, Haiti, between December 2010 and February 2011. We conducted a follow-up survey with 208 recipient households to determine the uptake and use of the kits and understanding of the health promotion messages. In 61% of surveyed households, a caregiver had been the recipient of the HDK and 57.7% of households had received the HDKs after the discharge of the patient. Among surveyed households, 97.6% stated they had used the contents of the HDK after receiving it, with 75% of these reporting using five or more items, with the two most popular items being chlorine and soap. A significant (p < 0.05) increase in self-reported use items in the HDK was observed in households that received kits after 24 January 2011 when the education messages were strengthened. To our knowledge, this is the first time it has been demonstrated that during a large-scale cholera outbreak, the distribution of simple kits, with readily available cleaning products and materials, combined with health promotion is easy, feasible, and valued by the target population.

[Intracranial Rosai-Dorfman disease mimicking multiple meningiomas]. / Une maladie de Rosai-Dorfman intracrânienne mimant des meningiomes multiples.

A 38 years-old man, who had olfactive schwannoma totally removed, with favorable clinical evolution and no radiological recurrence, suffered from headache and frontal syndrome, seven years after surgery. MRI of the brain showed multiple extra-axial lesions, disseminated, mimicking multiple meningiomas. The surgical strategy consisted in primary removal of the most symptomatic lesion. Histopathological examination after immunohistochemical tests permitted the definitive diagnosis of Rosai-Dorfman disease of the central nervous system. Evolution was still favorable 6 months after surgical removal of the whole lesions.

[Treatment of grade 0 intracranial aneurysms: Retrospective study of 79 cases]. / Traitement des anévrismes intracrâniens grade 0 : étude rétrospective portant sur 79 patients.

AIM: Without precise international recommendations, despite the advances of the ISUAA study, the superiority of microsurgery or endovascular treatment for unruptured intracranial aneurysm (UIA) over the natural history of this disease has not been proved. In this context, the authors evaluate their experience with the aim of assessing the results and risks of the different therapeutics and comparing them with the natural risk of this disease. MATERIAL AND METHOD: From January 1993 to July 2000, 79 patients harboring 110 UIAs were treated. These patients were divided retrospectively into two groups. Group A included 45 operated patients. Group B included 37 patients treated with endovascular coiling. The therapeutic choice was not randomized and was approved by a multidisciplinary neurovascular staff. RESULTS: The two populations were homogeneous in terms of age and sex. In group A, 12 patients presented early complications (26.6 %), with one death. In group B, 15.6 % of the patients presented an ischemic complication. After 1 year of follow-up, morbidity was 11.4 % in group A and 4.8 % for group B. Angiography found a partial recanalization in 12.5 % of the operated patients and in 33 % of the patients treated with endovascular coiling. DISCUSSION: Many factors are involved in the therapeutic decision: UIA location and size and individual risks. Progress in both surgery and interventional neuroradiology has led to good results conforming with the data reported in the literature but does not demonstrate the superiority of one technique over another.

Cerebral microdialysis and P(ti)O2 for neuro-monitoring before decompressive craniectomy.

We report the case of a young patient with post-traumatic, intractable, intracranial hypertension leading to craniectomy. This intracranial hypertension was preceded by focal signs of ischemia diagnosed through P(ti)O2 monitoring and cerebral microdialysis, and occurred a few hours prior to a decrease in cerebral perfusion pressure below 60 mmHg. The neurological outcome was satisfactory with a Glasgow Outcome Scale of 4 at 3 months. We discuss the potential interest of such neuro-monitoring to determine the optimal time for performing a craniectomy.

[Traumatic spondylolisthesis of the axis: arguments in favor of surgical management after analysis of 8 patients]. / Spondylolisthesis traumatique de C2. Indications chirurgicales après analyse de 8 cas opérés par voie antérieure.

BACKGROUND AND PURPOSE: The purpose of this report is to assess the efficacy of primary surgical stabilization in the management of traumatic C2 spondylolisthesis. MATERIAL AND METHODS: Eight patients including 5 men and 3 women (mean age, 44 years) were treated surgically for traumatic spondylolisthesis of the axis. Three patients presented permanent neurological deficit. The indication for operative treatment included fracture instability and association with either neurological deficit or multiple trauma. External immobilization was attempted and failed in two patients. In all cases the procedure was performed by the anterior route and consisted of surgical fixation with C2/C3 discectomy, intersomatic graft placement, and bone fusion. RESULTS: Using the Effendi and Levine classification, fractures were classified as type I in 2 cases, type II in 3, type IIa in 2, and type III in 1. The two patients with severe tetraparesis presented spinal cord contusion at the C2/C3 disk level. Postoperative radiography demonstrated C2/C3 fusion in all patients. No surgical complications were observed. The average hospital stay was 4.5 days. CONCLUSION: Surgical stabilization by C2-C3 fusion via the anterior route is effective for management of all types of traumatic C2 spondylolisthesis. It achieves immediate stability. We recommend its use as a primary intervention not only for unstable lesions but also for lesions associated with neurological deficits or multiple trauma. A major benefit is to facilitate nursing care and patient rehabilitation.

[Intradiploic epidermoid cyst: diagnosis by ultrasonography and MRI]. / Kyste épidermoïde intradiploïque: diagnostic par échographie et IRM.

Epidermoïd cysts are well documented. Whenever possible, surgery is always necessary. Intradiploic epidermoïd cyst are uncommon, especially in the occipital bone. Ultrasonography (US) may be useful and used instead of radiographs. As demonstrated in intracranial forms, diffusion-weighted MR Imaging (MRI) sequence can be useful for the diagnosis of epidermoid tumors and postoperative assessment of residual tumor. We propose to illustrate the usefulness of US and MRI in depicting an intradiploic epidermoïd cyst in a 27-year-old woman.

Cavernous hemangioma of the sphenoid sinus: case report and review of the literature.

BACKGROUND: Few cases of paranasal sinus cavernous hemangiomas have been reported in the literature. We report the first case of cavernous hemangioma of the sphenoid sinus and discuss therapeutic considerations and differential diagnosis. CASE DESCRIPTION: A case of sphenoid sinus tumor in a 67-year-old woman is reported. The initial symptoms were a horizontal diplopia, a left facial dysesthesia, and a recent history of unusual headache. Physical examination revealed a left VIth nerve paresis. A CT scan was performed showing a hypodense homogeneous mass in the sphenoid sinus that was not enhanced after administration of contrast medium. MR study demonstrated on T1-weighted image an isointense nonenhancing homogeneous mass filling the sphenoid sinus. On T2-weighted images the tumor mass displayed a mild hyperintense signal. The patient was operated on via a transsphenoidal approach with total removal of the tumor. Pathological findings were consistent with a nonosseous cavernous hemangioma. MR imaging performed 5 years later was still normal. CONCLUSION: The clinicoradiological and pathological features of this entity are described, and the literature reviewed.

[Ewing's sarcoma of the soft tissues: apropos of 3 cases and review of the literature]. / Sarcome d'Ewing des parties molles: à propos de 3 cas et revue de la littérature.

Three cases of extraosseous Ewing sarcoma are reported. This pathology of the young adult is very rare as shown by the review of the literature. Clinical or imaging (CT or MRI) findings are non-specific and diagnosis is based on histology. Nonetheless, this diagnosis should be considered in all patients with primary soft tissue tumors.

[Blue nevus of the scalp associated with a meningeal melanocytoma]. / Naevus bleu en plaque du cuir chevelu associé à un mélanocytome méningé.

INTRODUCTION: Headache opposite to a blue nevus of the scalp can reveal intra cranial melanotic lesions. CASE REPORT: A 25-year-old man caucasian was admitted to hospital for a first generalized tonic-clonic seizure. For six months, he has had episodic frontal-temporal right headache opposite to a blue pigmentary cutaneous congenital lesion in frontal territory (histology confirmed benign blue nevus). Neurologic examination noted a right congenital hereditary ophtalmoplegia. Cerebral MRI showed a right rolandic tumor with diffuse leptomeninge infiltration. This patient was operated of a meningeal melanocytoma with leptomeninges melanosis. DISCUSSION: The apparition of headache related to a blue nevus must lead to realize a cerebral MRI to look for a neuroectodermic hamartoma: melanotic tumor (in particular melanoma), or leptomeninges melanosis with high potential of degeneration. Meningeal melanocytoma is a rare benign spinal or intra cranial melanotic tumor.

[Malignant primary intrathoracic histiocytofibroma]. / Histiocytofibrome malin primitif intrathoracique.

Malignant primary intrathoracic fibrous histiocytoma (MFH) is a rare tumour: since it was first described in 1979, hardly more than 80 cases have been published. We present a large MFH which had started in the pleura and was intrathoracic. The tumour was typical, being comprised of malignant fibroblastic and histiocytoid cells in storiform arrangement. It was revealed by spinal bone metastases which multiplied over the whole skeleton in spite of chemotherapy. The patient died of cerebral metastasis developed 8 months after the onset of the disease. The cases found in the literature are gathered together and commented.