Contribution of spinal cord biopsy to diagnosis of aquaporin-4 antibody positive neuromyelitis optica spectrum disorder.

Longitudinally extensive transverse myelitis is characteristic but not pathognomonic for neuromyelitis optica spectrum disorders (NMOSDs) and may mimic local tumors. In this retrospective study based on a cohort of 175 NMOSD patients we identified seven patients who initially presented with a longitudinally extensive spinal cord lesion and underwent spinal cord biopsy due to magnetic resonance imaging (MRI)-suspected malignancies. Remarkably, routine neuropathology was inconclusive and did not guide the diagnostic process to anti-aquaporin-4 (AQP4)-seropositive NMOSD. Serious postoperative complications occurred in 5/7 patients and persisted during follow-up in 2/7 patients (29%). Considering these sequelae, AQP4-antibody testing should be mandatory in patients with inconclusive longitudinally extensive spinal cord lesions prior to biopsy.

[Acute organophosphorus pesticide poisoning and cholinesterases activities]. / Intoxication aiguë au pesticide organophosphoré et activités des cholinestérases.

Suicides attempts with an organophosphate pesticide still occur in Brittany, an agricultural French area. The acute poisoning due to this nerve agent, responsible for the inhibition of the cholinesterases enzymes, is severe and can be fatal. The diagnosis is based on the decrease of cholinesterases activity, an assay which has been performed because of the patient context. The measurement of butyrylcholinesterases activity in emergency guarantees an appropriate and rapid management of the patient in order to rapidly regenerate cholinesterases. Even if the decrease level of butyrylcholinesterases activity does not give a significant prognostic value, its follow-up with time indicates the efficacy of the treatment and the gradual remission. In routine the measurement of acetylcholinesterase activity is more useful for the biological follow-up of subjects exposed to organophosphate phytosanitary compounds.

Anatomic exposures for vascular injuries.

The exposure of vascular injuries is contingent on knowledge of anatomy and the limitations and boundaries for proximal and distal control of each artery. In this article, these are conveniently organized into arteries of the neck, of the chest, of the abdomen, and of the extremities. In addition, the interface between the neck and chest, and the chest and the abdomen provide particular challenges because of the need to expose two body regions frequently. The anatomy, the points of proximal and distal control, the details of exposure, and the key maneuvers required to expose particular arteries are reviewed.

Incidental laparoscopic appendectomy for acute right lower quadrant abdominal pain. Its time has come.

BACKGROUND: Removing the normal appendix when operating for suspected acute appendicitis is the standard of care. The use of laparoscopy should not alter this practice. METHODS: Retrospective review of 72 patients found to have grossly normal appendices while undergoing laparoscopy for suspected appendicitis. Twenty-eight patients underwent diagnostic laparoscopy (DL) alone while 44 patients underwent diagnostic laparoscopy with incidental laparoscopic appendectomy (ILA). RESULTS: There was no difference in length of hospitalization (DL = 44 h, ILA = 43 h, p = 0.49) or morbidity (DL = 11%, ILA = 5%, p = 0.37). One patient required appendectomy 11 days after diagnostic laparoscopy for recurrent acute right lower quadrant abdominal pain. Five percent of resected appendices (2/44) demonstrated acute inflammation upon pathologic review. CONCLUSIONS: Laparoscopic removal of the normal appendix produces no added morbidity or increase in length of hospitalization as compared to diagnostic laparoscopy. It demonstrates cost effectiveness by preventing missed and future appendicitis. Incidental laparoscopic appendectomy is the preferred treatment option.