Assuntos
Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/cirurgia , Tuberculoma/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Antituberculosos/uso terapêutico , Terapia Combinada , Descompressão Cirúrgica , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Medula Espinal/patologia , Compressão da Medula Espinal/tratamento farmacológico , Neoplasias da Medula Espinal/diagnóstico , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculoma/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tuberculose da Coluna Vertebral/diagnósticoRESUMO
The authors present the French concept of a mobile neurosurgical unit (MNSU) as used to provide specific support to remote military medicosurgical units deployed in Africa, South America, Central Europe, and Afghanistan. From 2001 to 2009, 15 missions were performed, for 16 patients. All but 3 of these missions (those in Kosovo, French Guyana, and Afghanistan) concerned Africa. Eleven patients were French soldiers, 3 were civilians, and 2 were Djiboutian soldiers. The conditions that MNSUs were requested for included craniocerebral wounds (2 cases), closed head trauma (7 cases), spinal trauma (5 cases), and spontaneous intracranial hemorrhage (2 cases). In 5 of the 16 cases, neurosurgical treatment was provided on site. All French soldiers and 2 civilians were evacuated to France. The MNSU can be deployed for timely treatment when some delay in neurosurgical management is acceptable.
Assuntos
Ambulâncias/organização & administração , Medicina Militar/organização & administração , Neurocirurgia/organização & administração , Transporte de Pacientes/organização & administração , Adulto , Administração de Caso/organização & administração , Pré-Escolar , Traumatismos Craniocerebrais/cirurgia , França , Humanos , Masculino , Medicina Militar/métodos , Neurocirurgia/métodos , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Transporte de Pacientes/métodos , GuerraRESUMO
We report a case of associated vertebromedullary and ureteral lesions in a severely injured patient, a victim of a gunshot aggression in Africa. Urine extended from the ureteral fistula through the third lumbar vertebral body, blended with cerebrospinal fluid from the dural attrition, and flowed very slowly through the dorsal exit ballistic hole. This is to our knowledge the first such case described in the literature. Uro-computed tomography scan finally made the diagnosis of ureteral fistula after two neurosurgical procedures determined that initially presumed dural persistent fistula needed to be closed.