Rate of intravenous thrombolysis for acute ischaemic stroke in the North-of-France region and evolution over time.

The proportion of patients with ischaemic stroke treated by intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is an indicator of quality of stroke care. The objective of the study is to evaluate the rate of i.v. thrombolysis in the North-of-France region and its evolution over time. We determined the proportion of inhabitants treated by i.v. rt-PA in 2009-2010 (period A; 8 stroke units, no telemedicine) and 2012 (period B; population campaigns, 12 stroke units with telemedicine in 5). We used hospital registries from the 12 stroke units, and population-based data were collected in a subpopulation of 226,827 inhabitants (5.6% of the whole population). 1,563 inhabitants received i.v. rt-PA for stroke (period A: 835 in 24 months; period B: 728 in 12 months). Hospital and population data were similar. Annual rates of thrombolysis increased from 103 per million inhabitants [95% confidence interval (CI) 85-125] to 181 (95% CI 157-209; relative increase 76%, 95% CI 67-83%). This rate increased in 12 districts (significantly in 6), but the increase was greater in districts where new stroke units, telemedicine, or both were implemented. In conclusion, although the proportion of patients treated was already high in period A, there was still place for improvement. Implementation of new stroke units, extension of the telemedicine network and new population campaigns are necessary to improve the rate of thrombolysis in several areas, to ensure an equal access to treatment over the whole territory. The next step is now to determine whether this high rate of i.v. rt-PA delivery at the population level translates into clinical results.

Optical free-space board-to-board interconnect: options for optical pathways.

The optical free-space interconnect is becoming increasingly important because of its high intrinsic density and routing capabilities. This paper deals with a free-space board-to-board interconnect, based on light-emitting diode arrays as sources. The design of the optical pathway is discussed, and some design rules and simulation results are presented. Two basic options (a lens array and a single lens) are evaluated, and their performance, in terms of power transfer, cross talk, and uniformity, are analyzed.

Transalar sphenoidal encephalocele. Uncommon clinical and radiological findings.

A case of basal encephalocele protruding through a defect in the greater wing of the sphenoid bone is presented. The transalar type of encephalocele is uncommon and unclassified. This case, documented by computed tomography and magnetic resonance imaging, is unique in that it presented with trigeminal neuralgia and was associated with an angioma of the soft palate.

GaAs/AlGaAs multiple-quantum-well vertical optical modulators on glass using the epitaxial lift-off technique.

A GaAs/Al(0.30)Ga(0.70)As multiple-quantum-well vertical optical modulator has been grown on a GaAs substrate using the metal-organic vapor-phase epitaxy technique. This device was removed from the original substrate and placed on a glass carrier by means of epitaxial lift-off (ELO). Photocurrent measurements before and after the ELO show clear exciton absorption peaks and indicate the development of a Fabry-Perot cavity after ELO due to multiple reflections between the front and back of the ELO film. Transmission measurements show a maximal contrast ratio of 2.9 dB and an insertion loss of 2.8 dB at a wavelength of 831 nm.

Transalar sphenoidal meningoencephalocele associated with buccal angiomatosis. One case.

Basal encephaloceles are uncommon congenital malformations occurring with an estimated frequency of one case in 35,000 births. They are frequently occult since they protrude into the orbit, nasal cavity, nasopharynx or paranasal sinuses. Basal encephaloceles are divided into five anatomical types. We report a case of transsphenoidal encephalocele which differed from the classical type in that it protruded through a congenital defect in the greater wing of the sphenoid bone. This case had an unusual clinical presentation, being responsible for trigeminal neuralgia and associated with an angioma of the soft palate.

[Suboccipital Pott's disease]. / Mal de Pott sous-occipital.

A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis. The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass. CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels. Chest-X ray showed one tuberculous lesion at the right apex. The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive. An antituberculous trichemotherapy was started. After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar. Each one for a 5 month period. One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography. A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%). The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates. The removal of abscess is discussed.

[Indications for selective embolizations in maxillofacial pathology]. / Indications des embolisations sélectives en pathologie maxillo-faciale.

There has been remarkable progress in the therapy of maxillofacial disorders, mainly as a result of the development of Djinjian and Merland's techniques for the exploration and selective embolization of the region supplied by the external carotid artery. These methods facilitate management of bone and skin angiomas and help to resolve problems of therapeutic arteriography for orofacial tumors. Two particularly hypervascular types of tumor: nasopharyngeal angiofibroma and carotid glomus tumor, as well as the hemorrhagic complications of facial epitheliomas, are conditions in which extremely useful data is obtained. Post-traumatic arteriovenous fistula can be treated by introducing inflatable balloons that are releasable or linked to a catheter. Acute severe epistaxis following injury responds to emergency embolization of the external carotid artery branches.

[Neurinoma of the foramen laceratum (author's transl)]. / Les neurinomes du trou déchiré postérieur.

The clinical diagnosis of acoustic neuroma was suggested by the cochleovestibular symptomatology in a young woman who, was found indeed to have a neurinoma of the foramen laceratum. Such masquerading symptoms and signs are frequently reported (in one quarter of the cases) in these tumors, and probably partly explain their rarity, only 59 cases having been described. Tomography of the base of the skull appears as the main investigation leading to a correct diagnosis.

[Successive encephalic ischemic accidents in a young patient: Buerger's disease, buergerian syndrome, or juvenile atheroma? A report in clinical, angiographic, and anatomical findings in one case, compared to three other ones, in which a biopsy of the pulp of the toes was also performed (author's transl)]. / Accidents ischémiques encéphaliques successifs chez un sujet jeune: maladie de Buerger, syndrome buergerien ou athérome juvénile? A propos d'une observation clinique, angiographique et anatomique, comparée à trois autres avec étude de biopsie de pulpe d'orteil.

A man of 19 years of age was found to have a diffuse livedo, a quadruple asphyxic acrosyndrome, and dementia. Angiography confirmed the presence of distal ischemia with multiple circulatory blocks and a reduced distal network. The patient died at the age of 25 years and histopathological examinations of the vessels demonstrated obstructive atheromatous lesions in the medium sized and small arteries of the brain and viscera. By comparing these findings with those observed in three other cases, in which biopsy of the pulp of the toe was also performed, the hypothesis can be advanced that these juvenile encephalic ischemic accidents are caused by atheroma, which can be detected, at an early stage, by studying the distal arteries in the finger or toe pulp.

[Prognostic importance of the study of venous drainage in cerebral arteriovenous aneurysms]. / Intérêt pronostique de l'étude du drainage veineux des anévrysmes artério-veineux cérébraux.

The authors analysed in particular the venous drainage of 370 arteriovenous aneurysms operated during 20 years in neurosurgery at Lille's Hospital. If in many cases the study in details of the different arterious pedicles take an important place in the discussion of the indications and operative technics; in other cases a bad estimate of the interest of careful study of veins can be at the beginning of great disappointments. Also the authors insist on the necessary study of the venous system in totality by seeing after agenesia of some passages, the respective drainage of the angioma and the brain, the existence of a saturation venous phenomenon. The analysis in details of the anatomical and functional distribution of the venous drainage in these malformations can be taken into consideration in the operative decision. The analysis of results in ten preference observations suggest that it is an important element in the arteriovenous aneurisms' evolution and in the final prognostic.