The effects of drainage with a Redon versus a conventional drain on postoperative pain and blood loss after valve replacements.

AIM: The aim of this study was to assess the influence of drainage with a Redon drain versus a conventional drain on postoperative pain and blood loss after valve replacements. METHODS: After approval by the local Ethics Committee and written informed consent, 30 patients, 20-60 years of age, scheduled for first elective valve replacement were included. After standardized anaesthetic regimens, cardiopulmonary bypass and coagulation therapy procedures and at the end of the operation, the patients were randomly assigned to 1 of 2 groups: (GI, n=15): drainage with 4 Redon drains; (GII, n=15): drainage with 2 conventional drains. Postoperative pain intensity at rest (VAS-R), during coughing and mobilization (VAS-M) in bed was independently evaluated using a visual analogue scale (VAS 100 mm) at 6 hourly intervals until 48 h after admission to the ICU (Ho). All patients received 2 g of paracetamol after obtaining the VAS score (8 g/24 h). No other analgesic agents were used. All patients were submitted to 2D echocardiography to verify the presence of pericardial effusion 24 h after surgery. Values are expressed as means. Pearson's chi squared and ANOVA (for repeated measurements) were used for statistical analysis. P<0.05 was considered significant. RESULTS: There was no statistically significant difference in the mean postoperative VAS-R and VAS-M, and in the mean postoperative total blood drainage 822.3 ml in GI, versus 704.3 ml in GII. Non pericardial effusion was found, and we did not see side-effects in any of the patients. CONCLUSIONS: We have shown that drainage with a Redon drains versus a conventional drain does not influence postoperative pain intensity and blood loss after valve replacements.

[Ectopic prolactinoma of the sphenoidal sinus: case report]. / Prolactinome ectopique du sinus sphénoïdal.

A 34-year-old woman was hospitalized for exploration of amenorrhea and galactorrhea. She had experienced primary sterility, diagnosed 11 years earlier. Endocrine tests demonstrated hyperprolactinemia (serum prolactin 594 ng/ml). Magnetic resonance imaging (MRI) showed a soft tissue mass located within the posterior part of the sphenoidal sinus. The pituitary gland appeared normal. Medical treatment with bromocriptine was unsuccessful. Transsphenoidal tumor resection was performed. Histology reported adenoma, which was consistent with prolactin-producing tumor demonstrated by immunohistochemical staining for prolactin. Because of the persistence of hyperprolactinemia related to an intra-sphenoidal tumor remnant, bromocriptine (15 mg/d) was initiated. Menses ensued and prolactin level declined (49 ng/ml). One year later, the tumor remnant had disappeared on the MRI and the patient became pregnant. Ectopic adenomas of the sphenoidal sinus are of particular interest due to the diagnostic difficulties encountered. Nevertheless, the nature of the lesion can be determined from the endocrine manifestations. Some of these tumors respond to medical treatment, similar to intra sellar tumors. Surgery remains however the only means of obtaining definitive diagnosis and cure.

[Thoracic aortic aneurysm complicating pseudo-coarctation]. / Anévrisme de l'aorte thoracique compliquant une pseudo-coarctation.

INTRODUCTION: The aneurysm of the descending aorta complicating a pseudocoarctation, itself due to a congenital elongation with kinking of the aorta is a rare entity. OBSERVATION: We report a case of aortic aneurysm discovered in a 72 years old woman without notable antecedents, which was referred for recurrent bronchitis. The X-ray showed a calcified opacity of the upper mediastinum, 5 cm of large. A thoracic CT-scan evoked the presence of a circulating sacciform aneurysm with calcified walls, developing on the final part of the aortic arch, which was with abnormally ascending way going up to the cervico-thoracic orifice and carrying out an aspect of aortic kinking. The assessment was complemented by a RMI as well as an aortic opacification. A thoracic scintigraphy showed an hypoperfusion of the left lung. The remainder of the cardiac assessment was normal. The patient was operated under femoro-femoral extracorporeal circulation through a left posterolateral thoracotomy of the 4th intercostal space. The examination showed a 7 cm diameter calcified aneurysm of the descending thoracic aorta complicating a tight stenosis in connection with an elongation and a kinking. The upper section of the aorta was shifted towards the pleural dome. The aortic section above aneurism was of normal size whereas the lower section was dilated. The aneurism was excised and a prosthetic graft was carried out. The surgery follow-up was marked by an hemodynamic stability, without neurological deficit. A ventilatory assistance was necessary during 5 days. Currently with 8 months follow-up, the patient goes well. COMMENTS: A prosthetic replacement in front of this type of aneurism is legitimate given the risk of the occurrence of complications secondary to the pseudocoarctation (arterial hypertension, aortic insufficiency) or to the aneurism itself, dissection or compression of vicinity (pulmonary artery).

[Trans-ethmoid encephaloceles]. / Les céphalocèles transethmoïdales.

We report two cases of ethmoidal cephaloceles. Ethmoidal cephaloceles are very rare and most commonly present with recurrent episodes of meningitis or sometimes as a nasal mass. Diagnosis is made at MR and CT. Such imaging studies should be obtained in patients with recurrent meningitis or patients with polypoid nasal lesions prior to biopsy.

[Primary intraosseous meningioma of the vault]. / Méningiome intra-osseux primitif de la voûte.

Primitive intra-osseous meningioma is a rare benign tumor. We report a case with a temporal localization and antro-attical extension into the petrous bone.

[Ultrasonography of acute osteomyelitis of the long bones in children. Diagnostic and prognostic value]. / Echographie des ostéomyélites aiguës des os longs chez l'enfant. Valeur diagnostique et pronostique.

Between 1991 and 1994, ultrasonography was used to investigate 90 consecutive children with acute osteomyelitis. Ultrasonographic findings were analyzed taking into account the time elapsed from first symptoms. Outcome in 47 children who were treated and followed for at least 6 months was also studied. Deep soft tissue swelling adjacent to the affected bone was found to be an early but nonspecific sign which persisted all along the course of the disease. Periosteal elevation smaller than 3 mm, secondary to exsudation or septic fluid, confirmed the disease in earliest stage and was the most frequent ultrasonographic sign in first three days of disease. Treated at that stage, total resolution was obtained in 66% of patients and stabilization, in 34% of cases, without any evolution toward chronicity. Acute osteomyelitis with subperiosteal abscess progressed toward stabilization in 66% of cases and toward chronic osteomyelitis in 8% of cases. 32% of subperiosteal abscess were ruptured; in such situation, progression to chronicity was observed in 26% of patients. Since ultrasonography has been used in our institution for the diagnosis of acute osteomyelitis, the rate of evolution to chronicity spectacularly dropped from 63% to 11%. The main advantage of ultrasonography is an earlier detection of subperiosteal collection that indicates surgical drainage without any delay.

[Ultrasonography in the diagnostic approach of septic arthritis]. / L'échographie dans l'approache diagnostique des arthrites septiques.

PURPOSE OF THE STUDY: Septic arthritis is frequent in Tunisia and is responsible for orthopedic sequela. The purpose of this study was to establish the indication and the viability of ultrasound scanning in the early diagnosis of septic arthritis. MATERIAL AND METHODS: 82 patients were explored by ultrasonography for suspected septic arthritis. Mean age was 7 years (range 2 months to 37 years). All sonographic studies were performed using a 7.5 MHZ transducer. 52 patients were surgically treated or had joint aspiration. Only 39 patients had septic arthritis. The hip and the knee were the most frequent localisation (respectively 20 and 12 cases). RESULTS: Statistical analysis showed that the ultrasound scanning in the diagnosis of joint effusion had a sensitivity of 93.4 per cent and a specificity of 100 per cent. Matter floating within the joint effusion was noted in 50 per cent of septic arthritis. These changes were not found in other arthritis. The thickness of synovialis and joint capsule was not specific of septic arthritis. In hip septic arthritis (51 per cent of localisation) the mean width of the anterior synovial recess was 11.7 mm (5-20 mm). In the asymptomatic opposite hip, the mean width was 3.6 mm (2.6-5 mm). Cortical irregularities had suggested osteomyelitis of femoral neck in osteoarthritis of the hip in 4 cases. Subperiosteal abscess of the femoral neck was directly visualized in another patient. DISCUSSION AND CONCLUSION: Our expense highlights that sonography may be a useful tool in the management of patient with suspect septic arthritis. Sonography allows early diagnosis of joint effusion with high accuracy. Hyperechoic or mixed aspects of the fluid joint suggest septic origin.

[Septic thrombosis of the cavernous sinus complicating malignant staphylococcal infection of the face]. / La thrombose septique des sinus caverneux compliquant la staphylococcie maligne de la face.

Septic thrombosis of the cavernous sinuses most commonly follows staphylococcal infections of the middle third of the face. Orbital symptoms are constant. We report six cases diagnosed only by CT. At present, MR imaging is the diagnostic procedure of choice. Its findings are thought to reflect the septic nature of the thrombosis.

[Thoraco-abdominal digestive duplication]. / Duplication digestive thoraco-abdominale.

The authors report a case of a thoraco-abdominal duplication of the foregut, observed in a 10-year old boy. Thoraco-abdominal duplication is an expression of notochordodysraphia, as it is frequently associated with vertebral malformations. Barium meal, ultrasonography and CT-Scan should provide a preoperative diagnosis. One-stage total excision in a single stage is mandatory in order to treat the symptoms and avoid the risks of further progression.

[Intrathoracic hydatid cyst. Contribution of tomodensitometry. Apropos of 25 cases]. / Hydatidose intrathoracique. Apport de la tomodensitométrie. A propos de 25 observations.

Twenty-five cases of thoracic hydatic disease, studied by CT since 1982, are reviewed. Fifteen patients were Maghrebin, 10 were native. The lungs were interested 22 times, the mediastinum 3 times and the heart only once. Complications of hydatic disease were present 8 times. We compare contribution of CT to the other diagnosis criterious. Our results show the accuracy of CT for the diagnosis of non complicated cyst and the lack of specificity for complicated cysts.