Transvenous approach to intracranial dural arteriovenous fistula (Cognard v): a treatment option. A case report.

The endovascular technique is the gold standard treatment in dural arteriovenous fistulas. Due to the limited number of series published it is difficult to create rigid guidelines in terms of the best endovascular treatment approach. Treatment must be tailored to each particular case, but it is important to keep in mind that the possibility of treating a type V dAVF by the transvenous approach should not be discarded. In selected cases the transvenous approach may be helpful to increase the chance of success in the endovascular treatment of type V dAVF. We describe a patient in whom the first arterial treatment failed to achieve occlusion of the fistulous point with the glue. Clinical symptoms improved due to the diminished flow at the fistula after the first embolization but as soon as collateral arteries were recruited by the fistula, spinal cord venous drainage impairment led to symptoms recurrence. Transvenous access allowed us to close the fistula completely in one only session with a complete disappearance of the pathologically inverted perimedullary venous flow.

Sistemas de enfermedades profesionales en España y Francia: conocimientos y opinión de las personas implicadas / Occupational disease systems in Spain and France: knowledge and opinion of the persons involved

Las enfermedades profesionales afectan a numerosos trabajadores y tienen un importante impacto socioeconómico. Sin embargo, dentro de la unión europea existen diferencias muy considerables entre los sistemas aplicados por los distintos estados miembros. El presente trabajo examina pormenorizadamente las diferencias entre los sistemas español y francés y evalúa los conocimientos al respecto de trabajadores que han padecido una enfermedad profesional, de médicos del trabajo y de la atención primaria, de empresarios y delegados de prevención y/o de miembros de los comités de seguridad y salud, y examina sus opiniones acerca del procedimiento de declaración de una enfermedad profesional y de quién debe declararla

Occupational diseases affect a large number of workers and have a considerable socioeconomic impact. However, within the European union quite considerable differences do exist between the systems applied by the various member states. The present paper examines in detail the differences between the French and Spanish systems and assesses the level of knowledge of workers who have suffered an occupational disease, of occupational health and primary health care physicians, employers, prevention delegates and/or members of the occupational safety and health committees, and examines their opinions regard-ing the procedure for the declaration of an occupational disease and regarding who should perform such a declaration

[Prevalence of impairments and social inequalities]. / Prévalence des déficiences et disparités sociales.

BACKGROUND: Population ageing and longer duration of the working career could increase the prevalence of impairments and disabilities whereas there have been few data to help prevention and care. This study aimed at describing the prevalence of various types of impairments and assessing their social inequalities in the Lorraine population (north-eastern France). METHODS: The sample included 6.214 subjects aged 15 or more from 8.000 households randomly selected in the Lorraine population. A mailed questionnaire including socio-demographical characteristics, job, and various types of impairments was used. The data were analysed with the chi2 independence test, the adjusted odds ratio (OR) and the Mantel-Haenszel test. RESULTS: The prevalence of at least one impairment was 30% in both sexes. It varied from about 20% for subjects aged less than 40 years to about 60% for the subjects aged 70 years or more. It was higher in men than in women among the individuals aged more than 50 years (OR adjusted on age: 1.22, 95% CI: 1.04-1.44). The impairments were generally multiple for the subjects aged over 50. The prevalence of at least one impairment was higher for workmen (OR adjusted on age: 2.11, 95% CI: 1.68-2.66), farmers, craftsmen, traders and heads of firms (OR adjusted on age: 1.60, 95% CI: 1.17-2.18) and for employees (OR adjusted on age: 1.62, 95% CI: 1.29-2.03) in comparison with executives, intellectual professionals and teachers. For workmen a higher prevalence was observed for all types of impairments: intellectual and psychological functions, language, hearing, vision, visceral functions, and skeleton and posture. Farmers, craftsmen, traders, heads of firms and employees showed an excess for most types of impairments. Social inequalities were significant for various age groups during their period of occupational activity, but not after retirement. Unemployed people also had an excess of impairments. CONCLUSION: The prevalence of impairments strongly increased with advancing age. Marked inequalities were observed between various socio-occupational categories. Men were more affected than the women over 50 years of age. Impairments represent a health index which is useful for prevention to reduce their causes and consequences.

Influence of temperature on embolisation with cyanoacrylate.

SUMMARY: We evaluated the influence of temperature on the viscosity of mixtures with different histoacrylllipiodol concentrations and on injection control, to test the radiological visualization of these mixtures. A viscosimeter was used to measure the viscosity of different histoacryl and lip iodol combinations at various temperatures. After introduction of these blends into the polyethylene tubes, their radiological densities were evaluated by means of CT and DSA. Viscosity was found to be directly proportional to the percentage of lipiodol and inversely proportional to the temperature. By digital subtraction, the mixtures were still visible when the percentage of histoacryl reached 90%. Warming histoacryl and lipiodol mixtures to a temperature that is close to 40 degrees C decreases the mixture's viscosity significantly and makes the injection easier to manage. Tantalum and tungsten powders do not necessarly have to be added to visualize mixtures containing less than 90% histoacryl.

[Atypical algodystrophy of the knee: apropos 2 partial cases]. / Algodistrofia atípica de rodilla: a propósito de dos casos con forma parcial.

Algodystrophy is a common entity which may present in many clinical contexts. Its early diagnosis and therapy are of great prognostic interest. Apart from the typical complete forms there are some other atypical forms, such as partial knee algodystrophy, of difficult diagnosis. Its inclusion in the differential diagnosis of gonalgia occurring in patients attended under many medical specialties is therefore necessary. Two atypical cases of knee algodystrophy in its partial form are reported. One of these cases relapsed at the heterolateral knee after 18 months of the initial presentation; this second episode was also a partial form, a fact which we have not seen reported. The reported cases are here discussed and the scarce literature is reviewed, commenting on the difficulty of the early diagnosis compared with other entities which may mimic the clinical picture, radiological and scanning features of algodystrophy, such as aseptic osteonecrosis or stress fracture. The diagnostic algorithm is discussed, pointing to the usefulness of magnetic resonance (MR) in difficult cases to rule out other entities which would entail different therapeutic modalities.