Mis-diagnosed giant ovarian cyst and ventriculoperitoneal shunt malfunction.

Abdominal pseudocysts are common complications of ventriculoperitoneal shunt (VPS). We report the case of a 37-year-old woman treated by VPS for congenital obstructive hydrocephalus, who presented shunt dysfunction related to a voluminous abdominal cyst initially diagnosed as cerebrospinal fluid pseudocyst. The cyst was drained and the VPS was removed after endoscopic third ventriculocisternostomy (ETV). A few months later, a large new abdominal cyst appeared and was operated on. Diagnosis was rectified as massive ovarian mucinous cystadenoma. In any intra-abdominal cyst, differential diagnoses need considering to avoid mis-diagnosis in shunted patients, especially if the cyst is very large. The etiology of the hydrocephalus should also be investigated in case of shunt dysfunction. Even in case of longstanding shunt, ETV can be an alternative to shunt revision surgery in obstructive hydrocephalus, enabling VPS withdrawal and treatment of the hydrocephalus.

[Systemic treatments of the vasospasm]. / Traitements systémiques du vasospasme.

Cerebral vasospasm, a recognized complication of aneurysmal subarachnoid haemorrhage, can lead to delayed ischaemic neurological deficit, and death. The systematic administration of nimodipine confers a modest but real benefit against delayed ischaemic damage. When vasospasm occurs, triple-H therapy (hypervolaemia, hypertension, and haemodilution) has long been advocated in order to increase flow, but its usefulness remains unclear. Cardiac output optimization using inotropic drugs might also be considered in selected patients. In practice, only correction of volume depletion and induced hypertension (after aneurysm has been secured) can be recommended. In addition, according to phase II randomized trials, promising new treatments for vasospasm or its ischaemic complications include magnesium sulfate, the selective endothelin A-receptor antagonist clazosentan, and statins. The simple and safe profile of prophylactic use of statins appears particularly attractive. However, all these potential candidates need further validation through (on-going) clinical phase III trials.

[Follow-up study of head-injured children]. / Devenir de l'enfant traumatisé crânien.

The authors reviewed in a retrospective study 61 cases of severely head injury children who where admitted in the rehabilitation centre to evaluate the outcome 1 and 5 years after the brain injury. Neurologic and neuropsychologic status of children was assessed ad admission, 1 and 5 years later. Duration on intubation and age at time of head trauma were the worst functional prognosis.

[Recombinant hirudin in neurosurgery]. / Hirudine recombinante en neurochirurgie.

We report the case of a 70-year-old woman with paraplegia resulting from spinal cord compression secondary to an epidural haematoma. Because of an arrhythmia, a mitral valve replacement and the high risk of venous thrombosis, an anticoagulant treatment was introduced postoperatively. The patient having previously developed an type II heparin-induced thrombocytopaenia, a treatment by lepirudine was established successfully.

[Role of the regulation in the management of patients with severe head injuries]. / Rôle de la régulation dans la prise en charge du traumatisé crânien grave.

The regulator of the emergency medical ambulance service is involved in the various steps of the initial management of severe head trauma patients: handling calls, basic life support, prehospital advance life support, transport and hospital admission. The management is rapid (helicopter transports) coherent and adapted (adherence to the guidelines for severe head injury), and considers of local difficulties (geographical, possibility of admission to trauma centres), with the aim of improving the outcome of severely head-injured patients.

Enhanced levels of radiation-induced G2 phase delay in ataxia telangiectasia heterozygotes.

Ataxia telangiectasia (AT) is a multiform genetic disease characterized by immunodeficiency, cerebellar abnormalities, and cancer predisposition. Heterozygotes also have an increased risk of developing several different cancers. It has been estimated that as many as 18% of all patients with breast cancer, the cancer most clearly associated with AT heterozygotes, may be carriers of the AT gene. We describe an assay for AT heterozygotes that relies on the previous observation that cells from AT homozygotes show a greater and more prolonged radiation-induced accumulation in the G2 phase of the cell cycle than do normal controls. We showed that all 6 A-T heterozygotes show a greater extent of G2 phase delay at different times postirradiation than do controls. The degree of accumulation was less than that observed in AT homozygotes. Only two of 22 controls showed overlap with heterozygotes at 18 hours postirradiation, and that number was reduced to one at the 24-hour point. As a group, AT heterozygotes were intermediate between controls and AT homozygotes at both time points after irradiation. This assay is relatively simple and reliable and can be performed in any laboratory with access to both Epstein-Barr virus (EBV) for transformation of lymphocytes and a fluorescence-activated cell analyzer.

Normal inhibition of DNA synthesis following gamma-irradiation of radiosensitive cell lines from patients with Down's syndrome and Alzheimer's disease.

Inhibition of DNA synthesis was studied in gamma-irradiated lymphoblastoid cells from patients with Alzheimer's disease and Down's syndrome. A normal biphasic pattern of inhibition was observed over a dose range of 0-4 krad of gamma-rays in all of the cell lines. 3 out of 4 Down's and all the Alzheimer's cell lines were shown to be hypersensitive to ionizing radiation based on induced chromosomal aberrations. Increased G2 phase delay, comparable to that occurring in ataxia-telangiectasia cells, was observed for some of the cell lines, after exposure to gamma-rays. Contrary to other data in the literature these results demonstrate that radioresistant DNA synthesis is not an intrinsic feature of all disorders characterized by radiosensitivity.