Surgical management of cervical radiculomedullary arterial aneurysm with subarachnoid haemorrhage: a case report.

The aim of this paper was to report an unusual case of a 30-year-old woman admitted to the emergency department for a subarachnoid spinal haemorrhage. Clinical presentation was typical and the initial CT-scan did not show any intracranial lesions. Diagnosis was then confirmed by a full-spinal MRI that revealed a cervical radiculomedullary artery aneurysm. The diagnosis was also confirmed by an arteriography that showed a left C6 radiculomedullary artery aneurysm. Surgical management was performed and included a direct approach of the vascular lesion using an anterolateral cervicotomy and occlusion of the parent vessel. Histological examination confirmed the typical aspect of the aneurysm. The postoperative course was uneventful and the patient was discharged from hospital at day 15. This type of vascular lesion is very uncommon and requires a prompt diagnosis. Initial MRI can confirm the presence of a subarachnoid haemorrhage related to the aneurysm, which can be also visualized by an arteriography. Management of these vascular disorders requires a multidisciplinary specialized spine-team and is commonly performed using a direct surgical approach.

[Unilateral hydrocephalus secondary to a brain temporal abscess treated by endoscopic septotomy: a case report]. / Hydrocéphalie unilatérale secondaire à un abcès temporal traitée par septotomie endoscopique: à propos d'un cas.

Hydrocephalus is a rare complication of brain abscess, due to either the mass effect on the ventricular system or to the rupture of the abscess in the ventricles. We report here the case of 44-year-old man who was operated on for a temporal lobe abscess of pulmonary origin who presented 6 weeks later with obstructive hydrocephalus secondary to a likely choroid plexus thrombophlebitis. This patient was treated successfully with an endoscopic septotomy. In light of the pertinent literature, we discuss the pathophysiological and management aspects of this unusual entity.

[Percutaneous pedicle screw fixation and kyphoplasty for management of thoracolumbar burst fractures]. / Traitement des fractures de type burst de la charnière thoracolombaire par kyphoplastie et ostéosynthèse percutanée.

OBJECTIVE: To evaluate outcome and potential advantages of a percutaneous posterior approach to burst fractures of the thoraco-lumbar junction without neurological complications by means of a technique combining balloon kyphoplasty and percutaneous pedicule screw fixation. METHODS: In this preliminary study patients who suffered traumatic of the thoraco-lumbar junction presented a Magerl type A3 fracture. The mean age of the patients was 64 years (54-78 years). All had a normal neurological examination. A combined technique using balloon kyphoplasty, that allows restoration of the vertebral height and fixation by means of cement injection with percutaneous osteosynthesis was performed as a minimal invasive alternative treatment. Mean follow-up (plain radiograph and CT scan, pain assessment) was 12 months (range 5-14 months). RESULTS: All patients experienced an early pain relief, successfully mobilized on day 1 after surgery and discharged after a mean stay of 4.5 days. Immediately postoperatively the mean vertebral height restoration was 11.5% and the reduction of the kyphotic angle was 9 degrees. Those results were maintained over the complete follow-up period. Only one patient required analgesic treatment with weak opioids (step II of the WHO pain ladder) 3 months after surgery. CONCLUSIONS: The treatment of burst fractures of the thoraco-lumbar junction with no neurological complication by associating minimally invasive techniques results in good fracture reduction and stabilisation. The main advantage of this approach is to shorten the hospital stay.

[Family planning, what's new?]. / Quoi de neuf en matière de contraception?

Women rely on complete and precise information given by doctors and family planning consultants for choosing a suitable contraceptive. Available hormonal contraceptives in Switzerland are presented. Personal and family history are essential for evaluating medical contraindications to combined hormonal methods. Combined pills, vaginal hormonal rings and combined patches share the same contraceptive effects, contraindications and overall cardiovascular risks. Prescribers should prefer second generation pills because of lower risks of venous thromboembolic disease. Non oral methods are generally associated with improved compliance and in the case of vaginal rings, with fewer side effects. Progestogen only contraceptives (pills, implants and intrauterine devices) can be used in patients with known intolerance and/or contraindications to estrogens.

[Use of aromatase inhibitors in infertile women]. / Utilisation des inhibiteurs de l'aromatase dans la prise en charge des femmes infertiles.

Aromatase inhibitors (AI) block the last enzymatic step of estrogen production, the aromatization of the A-cycle of aromatizable androgens and particularly, androstenedione (D4) and testosterone (T). Molecules designed for interfering with aromatase activity have existed for many years. Yet the activity of products of the aminogluthetimide era was too unspecific and these substances carried too many side effects for being used clinically. Today, however, 3rd generation AIs have become available that are highly specific and essentially devoid of side effects. These molecules have recently been approved for treating breast cancer in post-menopausal women, either in advanced forms, or as part of adjuvant therapy. In women whose ovaries are active, a temporary inhibition of E2 production will activate gonadotropins and in turn, stimulate follicular growth. In cancer patients, this property precludes the use of AIs in women whose ovaries are still active, unless gonadotropins are blocked. In infertile patients, this property of AIs has been put to play for inducing ovulation. AIs have been used both in women who do not ovulate but whose hypothalamo-pituitary-gonadal (HPG) axis is active (oligo-anovulators of PCOD type) and in those who ovulate regularly but in whom multiple ovulation is sought for treating infertility or as part of IVF. Like CC, AIs are not usable in women whose gonadotropins are suppressed, as in the case of hypothalamic amenorrhea. The sum of data available on the use of AI for inducing ovulation remains however meager to this date and is mainly constituted of pilot and non-randomized trials. Yet mounting evidence tends to support AIs' advantages over CC for induction of ovulation. Hence, we think that these drugs will play a key role for the induction of ovulation in the future.