C1-C2 Injury: Factors influencing mortality, outcome, and fracture healing.

BACKGROUND: C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS: A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS: A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS: C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.

[Lower urinary tract dysfunction in normal pressure hydrocephalus: Review of the literature]. / Troubles vésico-sphinctériens dans l'hydrocéphalie à pression normale : revue de la littérature.

INTRODUCTION: Lower urinary tract dysfunction in normal pressure hydrocephalus has received little attention from the scientific community. The aim of this review article was to discuss diagnostic and therapeutic options for these patients. SOURCES: A literature review of MedLine publications on urinary incontinence in normal pressure hydrocephalus was conducted. The following keywords were used: "hydrocephalus, normal pressure" and "bladder dysfunction" or "urinary incontinence" or "overactive bladder" or "urinary bladder, neurogenic". Prospective and retrospective studies as well as previous reviews were analyzed. RESULTS: Urinary symptoms in normal pressure hydrocephalus are mainly represented by overactive bladder, which is a significant burden for the concerned patients. Isolated overactive bladder is more frequent (64%) than urinary incontinence (57%). Detrusor overactivity is seen in 95.2% of the cases. Neuro-surgery is efficient on urinary symptoms for 61.5% of the patients. Bladder recovery after surgery relates with increased mid-cingulate perfusion, probably linked with a functional restoration of the mid-cingulate that normally inhibits the micturition reflex. Medical options, added or not to surgery, include anticholinergic drugs unable to pass through the blood-brain barrier, Transcutaneous Electrical Nerve Stimulation and sacral neuromodulation. CONCLUSION: There is actually an insufficient concern about urinary symptoms in normal pressure hydrocephalus. This article highlights the importance of a harmonization of neuro-urological practices in the pre-therapeutic evaluation of patients suffering from normal pressure hydrocephalus.

Evaluación nutricional de personas con VIH/SIDA / Nutritional status of people living with HIV-AIDS

Introduction: At present, the relationship between diet, nutrition and HIV infection has been demonstrated. The scientific community recognizes that knowledge and nutritional care can help maintain health and reduce the effects of the infection. Objective: To assess the nutritional status of people living with HIV-AIDS treated in out-patient clinics of Plaza County. Subjects and Methods: A descriptive cross-sectional study in 87 people infected with HIV (66 males and 21 females). Fifty four asymptomatic infected people and 33 AIDS patients were studied. Nutritional assessment consisted of anthropometric measurements: weight, height, triceps skinfold and arm circumference to calculate the body mass index, and fat and arm muscle area; dietary assessment with frequency questionnaires and food consumption by food groups; measurement of biochemical parameters: hemoglobin, triglycerides, blood sugar and cholesterol. Values were compared with the Student t test and Spearman correlation. Results: The largest group was asymptomatic male between 30-49 years. Few cases of anemia were detected. Hypertriglyceridemia and discrete reductions in fat reserves were predominant. Half of people with AIDS presented bad eating habits. More than half presented sufficient level of knowledge and attitude. Conclusion: It is necessary to increase the attitude of these patients in relation to the care of their nutrition.

Está demostrada la relación entre la alimentación, la nutrición y la infección por VIH. La comunidad científica reconoce que los conocimientos y el cuidado nutricional pueden contribuir a mantener la salud y a disminuir los efectos de la infección. Objetivo: Evaluar el estado nutricional de las personas con VIH-sida atendidas en la consulta de descentralización del municipio Plaza. Sujetos y Métodos: Se realizó un estudio descriptivo transversal en 87 personas infectados con el VIH, 66 del sexo masculino y 21 femenino. 54 portadores asintomáticos del virus y 33 pacientes sida. La evaluación nutricional consistió en mediciones antropométricas: peso, talla, pliegue tricipital, circunferencia braquial para calcular el índice de masa muscular, área grasa y muscular del brazo; evaluación dietética con encuestas de frecuencia de consumo de alimentos y por grupo de alimentos; medición de parámetros bioquímicos: hemoglobina, triglicéridos, glicemia y colesterol. Se comparó con la prueba t de Student así como correlación de Spearman entre indicadores. Resultados: Predominaron los asintomáticos masculinos entre 30-49 años. Se detectaron pocos casos de anemia. Predominó la hipertrigliceridemia y disminuciones discretas de las reservas de grasas. La mitad de personas con sida presentó comportamiento alimentario inadecuado. Más de la mitad presentó nivel de conocimientos y actitud suficiente. Conclusión: Es necesario incrementar la actitud de estos pacientes en relación al cuidado de su nutrición.

Should we fear cement leakage during kyphoplasty in percutaneous traumatic spine surgery? A single experience with 76 consecutive cases.

OBJECTIVE: Although kyphoplasty is widely used to repair osteoporotic and pathologic vertebral fractures, balloon kyphoplasty and vertebral body stenting are new treatment options in cases of traumatic spinal injury. To our knowledge, there are no literature data on the incidence of cement leakage whereas these two percutaneous techniques are commonly used to repair non-pathologic fractures. The aim of this study was to evaluate and compare the clinical characteristics and the incidence of cement leakage associated with balloon kyphoplasty and vertebral body stenting in the percutaneous treatment of traumatic spinal injury. METHODS: A series of 76 consecutive kyphoplasties (50 with vertebral body stenting and 26 balloon kyphoplasties) were retrospectively reviewed. Preoperative and postoperative computed tomography scans were analyzed in order to detect cement leakage and grade it as minor, moderate or major. RESULTS: The overall leakage rate was 50%. None of the leakages gave rise to clinical symptoms. Although balloon kyphoplasty and vertebral body stenting did not differ in terms of the leakage rate, the latter technique was associated with a lower leakage volume. The Magerl type, fracture level and use of concomitant osteosynthesis did not appear to significantly influence the leakage rate. CONCLUSION: Vertebral body stenting can reduce the amount of cement leakage due to a better cohesion of the bone fragments after kyphosis correction and maintenance.

[Brown-Sequard syndrom complicating a C6 teardrop fracture associate with an occult vertebral artery dissection: case report]. / Syndrome de Brown-Séquard compliquant une fracture teardrop de C6 associée à une dissection d'une artère vertébrale asymptomatique : à propos d'un cas.

CASE REPORT: We report the case of a 27-year-old man, presenting a C6 tear-drop fracture associated to medullar contusion with a Brown-Sequard syndrome. An asymptomatic right vertebral artery dissection in its V2 portion was also discovered by the radiologic investigations. A surgical treatment and antiplatelet therapy were performed. The patient outcome was quite satisfactory.

[Subependymomas of lateral ventricle. Analysis of our series and review of literature]. / Les subépendymomes (astrocytomes subépendymaires) du ventricule latéral. Analyse de notre série et revue de la littérature.

Subependymoma is a benign lesion, slow-growing neoplasm, representing 0.2 to 0.7 % of intracranial tumors. They are often clinically silent, incidentally discovered at autopsy. These symptoms are related to big volume. They are attached to the septum pellucidum, leading to hydrocephalus by Monro foramen obstruction. Overall mean age at diagnosis is 39 years with more males than females. At CT-scan, subependymoma shows a slightly low attenuation compared to gray matter. There is no or mild enhancement following contrast injection. On MR T1-weighted imaging, subependymoma is isointense and hyperintense on MR T2-weighted imaging. Intramural calcifications and cystic components are noted in 20 to 30 % of patients. Peritumoral oedema is absent. Immunohistochemicals studies show intense positivity for S-100 and GFAP. The treatment is surgical with an excellent prognosis.

[Rare tumors of the lateral ventricle. Review of the literature]. / Les tumeurs rares du ventricule latéral. Revue de la littérature.

Metastases of lateral ventricle (LV) are attached to choroidal plexus. Primary source is cancer of kidney. Two thirds of patients are male. Oligodendrogliomas occur in young females. Signs of increased intracranial pressure are a constant feature. These tumors are found in anterior portion of the LV with severe enhancement and clumped calcifications. Treatment is surgical. Cavernomas have a preponderance of rapid growth with a bleeding revelation. Seizures are rare. Rebleeding is frequent and justifies a surgical treatment. Schwannomas are a rare entity in which the majority of patients are very young. MRI shows calcifications, cystic components and a strong enhancement. They are limited to sporadic cases, never associated with neurofibromatosis. Arachnoid cysts are located in the atrium and/or in the occipital horn. Patients are young (mean age < 40 years). MRI demonstrates an intracystic lesion with signal intensity similar to the CSF. Best treatment is an endoscopic fenestration. Epidermoid cysts occur in third decade. These pearly tumors appear isointense or a little hyperintense on T1-weighted imaging, very characteristic. They are enhanced after gadolinium injection and appear strongly hyperintense on T2-weighted imaging. An incomplete removal with a thorough long-term follow-up is necessary. Cavernomas of LV are hyperintense on T1- and T2-weighted imaging. They have a bleeding risk of 25 to 45%. Therefore, they must be operated.

[Anatomy of the periventricular white matter]. / Anatomie de la substance blanche périventriculaire.

The lateral ventricle (LV) has a deep position within the cerebral hemisphere. The LV is covered by white matter with important functional role in the dominant hemisphere. Lateral wall of the frontal horn is covered by the inferior occipitofrontal fasciculus (IOFF) and its roof by the corpus callosum (CC). The body of the LV has the same cranial relationship and is covered laterally by fibers of internal capsula and arcuate fasciculus; its lower part is in relationship with the body of the fornix. The atrium of the LV is covered by the arcuate fasciculus and its lower part is covered by the IOFF and optic radiations. The inferior horn or temporal horn is covered by optic radiations in depth of middle temporal gyrus (T2). The auditive radiations crossed the optic radiations at the level of the roof of the inferior horn.

[Bilateral failure of fusion between pedicles and body of C7]. / Défaut de fusion corporéo-pédiculaire bilatéral de C7.

We expose the case of a 48-year-old woman suffering of a chronic bilateral C7 radiculalgy and bilateral C7 failure of fusion between pedicles and body. According to spine embryogenesis we bring three hypothesis to explain this failure of fusion. Then we show that bilateral C6-C7 foraminal compression can arise from local cervical spine instability due to C7 and disk development abnormalities. The treatment proposed is dissectomy bone graft and anterior osteosynthesis leading to clinical and radiological good results. The patient went back to work after three months.

Non-traumatic pseudocyst of Glisson capsule complicating a ventriculoperitoneal shunt.

BACKGROUND: Cerebrospinal fluid pseudocysts in the peritoneal cavity following ventriculoperitoneal shunt are relatively uncommon. In these complications, perforation of solid organs is unusual. CASE DESCRIPTION: A case of subcapsular hepatic pseudocyst is described. A 48-year-old man treated by ventriculoperitoneal shunt presented with abdominal pain. Laboratory examinations revealed hepatic cytolysis. The CT-scan of the abdomen demonstrated a small ovoid non-enhanced cystic collection in the subcapsular area of hepatic segment V. Percutaneous hepatic fine-needle aspiration of the cyst guided by abdominal ultrasonography showed no abnormal findings. Peritoneal reimplantation at a different site was performed. The clinicopathological features of this entity are described and treatments are discussed. CONCLUSION: Reinsertion of the catheter at a different abdominal site is effective in non-infections cases. In contrast, a temporary external drainage with adequate antibiotic treatment followed by shunt reinsertion is necessary to treat a documented infection of CSF collections.

[Follicular dural lymphoma. Case report]. / Lymphome folliculaire méningé. A propos d'un cas.

A case of a meningeal B-cell lymphoma is described. A 48-year-old man presented with an episode of grand mal seizure following a brain injury. An initial diagnosis of extradural hematoma was made based on the results of the cerebral computerized tomography scan. Magnetic resonance images demonstrated an enhanced mass with a dural tail attached to the meningeal layer of the temporal bone, suggesting a meningioma "en plaque". The mass was surgically excised. Tumoral removal was subcomplete (Simpson 2). Operative inspection also suggested a meningioma, but histological analysis and electron microscopy revealed a grade IV follicular B-cell lymphoma. Biological studies were normal. An extensive workup found an external iliac adenopathy with several osseous locations on PET. The patient underwent chemotherapy and radiotherapy. Three years after the first symptoms appeared, the patient is alive and free of symptoms. The clinicopathological features and treatments were discussed.

Dynamical surface affinity of diphasic liquids as a probe of wettability of multimodal porous media.

We introduce a method for estimating the wettability of rock/oil/brine systems using noninvasive in situ nuclear magnetic relaxation dispersion. This technique scans over a large range of applied magnetic fields and yields unique information about the extent to which a fluid is dynamically correlated with a solid rock surface. Unlike conventional transverse relaxation studies, this approach is a direct probe of the dynamical surface affinity of fluids. To quantify these features we introduce a microscopic dynamical surface affinity index which measures the dynamical correlation (i.e., the microscopic wettability) between the diffusive fluid and the fixed paramagnetic relaxation sources at the pore surfaces. We apply this method to carbonate reservoir rocks which are known to hold about two thirds of the world's oil reserves. Although this nondestructive method concerns here an application to rocks, it could be generalized as an in situ liquid/surface affinity indicator for any multimodal porous medium including porous biological media.