Expandable Intravertebral Implant in Cancer-Related Vertebral Compression Fractures: A Retrospective Review of 36 Implantations.

The purpose of this retrospective review was to evaluate SpineJack implantation in cancer-related vertebral compression fractures in 13 consecutive patients (mean age, 62.8 years ± 18.8). A total of 36 devices were inserted at 20 levels (13 [65%] lumbar and 7 [35%] thoracic vertebrae), with a mean Spinal Instability Neoplastic Score of 9.1 ± 2.1. Vertebral height restoration was observed in 10 levels (50%), with a mean height restoration of 5.6 mm ± 2.2 (interquartile range [IQR], 4-7.5). A total of 6 cement leakages were observed in 3 (23%) patients without clinical consequences. No severe adverse events were observed. One adjacent fracture occurred. Average pain scores on the visual analog scale significantly improved from 5.5 ± 1.8 (IQR, 4-7) preoperatively to 1.5 ± 2.2 (IQR, 0-3.3) at 1 month (P < .01) and to 1.5 ± 1.3 (IQR, 0.3-2.8) at 6 months (P < .01). In this small cohort, SpineJack offered pain relief in cancer-related fractures without an observed increase in adverse events.

Ergonomics in Interventional Radiology: Awareness Is Mandatory.

Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.

Percutaneous Image-Guided Vertebral Fixation in Cancer-Related Vertebral Compression Fractures: A Case Series Study.

Background and objectives: Cancer-related vertebral compression fractures (VCF) may cause debilitating back pain and instability, affecting the quality of life of cancer patients. To further drive cement deposition during vertebroplasty, the aims of this restrospective case series study were to report the feasibility, safety and short term efficacy (≤6 months) of percutaneous vertebral fixation in cancer-related vertebral compression fractures using various intravertebral implants. Methods: All consecutive cancer patients treated with percutaneous vertebral fixation for VCF were retrospectively included. Various devices were inserted percutaneously under image guidance and filled by cement. Descriptive statistics were used and a matched paired analysis of pain scores was performed to assess for changes following interventions. Results: A total of 18 consecutive patients (12 women (66.6%) and 6 men (33.3%); mean age 59.7 ± 15.5 years) were included. A total of 42 devices were inserted in 8 thoracic and 16 lumbar vertebrae. Visual analogue scale measurement significantly improved from 5.6 ± 1.8 preoperatively to 1.5 ± 1.7 at 1 week (p < 0.01) and to 1.5 ± 1.3 at 6 months (p < 0.01). No severe adverse events were observed, but three adjacent fractures occurred between 1 week and 5 months after implantation. Conclusions: Percutaneous vertebral fixation of cancer-related VCF is feasible and safe and allows pain relief.

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture.

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients' quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

[Meningitis after spinal anesthesia]. / Méningites après rachianesthésie.

BACKGROUND: Meningitis is a rare complication after spinal anesthesia. aim: We report 4 cases of meningitis occurred after spinal anesthesia. OBSERVATIONS: These meningitis were diagnosed during tow months and with 3 different operators. The first symptoms appeared 4 to 6 hours after surgery and were represented especially by headaches and fever. Cyto-chimic analysis of cerebrospinal fluid (CSF) indicates bacterial meningitis but soluble antigens and culture were negative. Evolution was favorable in all cases under or without antibiotics. The exactly cause of these meningitis remained unknown and an insufficient asepsis was the principle risk factor found in all cases. CONCLUSION: Prevention of this risk consists on hygienic rules and perfect skin disinfection.

[Evaluation of a protocol of spinal anesthesia for cesarean section in a Tunisian maternity unit: hemodynamic repercussions and risk factors for hypotension]. / Evaluation d'un protocole de rachianesthésie pour césarienne dans une maternité Tunisienne : Répercussions hémodynamiques et facteurs de risque d'hypotension.

AIM: To evaluate hemodynamic repercussion of a protocol of spinal anesthesia (SA) for cesarean and release the predictive factors of maternal arterial hypotension post spinal anesthesia. METHODS: We included parturients proposed for Cesarean under SA. They were not included the women of statute ASA > II, preeclamptics, eclamptics and/or having counter-indications of SA. We excluded the cases where there were technical difficulties at the time of the realization of SA, a failure or a complication of this SA. We injected 10 Mg of bupivacaïne 0.5% isobar, 10 µg of fentanyl and 100 µg of morphine. The data were collected before the realization of SA (anthropometric parameters; antecedents; basic systolic and diastolic blood pressures (BSBP and DSBP) and basic heart rate (BHR)) and after SA (systolic and diastolic blood pressure (SBP and DBP), heart rate (HR); occurred or not of a sympathetic block (falls of the SBP of more than 20% of its basic value or a SBP<90 mm Hg); the time of installation of the sympathetic block and the duration of hypotension. RESULTS: The full number of parturients included was 1016 among whom 16 were excluded. Only 1000 parturients finished the study and were divided into 2 groups (group 1: 500 emergency cesarean and group 2: 500 elective cesarean). The incidence of the sympathetic block was of 44.2% as a whole and this block was significantly more frequent in group 2 (p=0.0001). There was a significant relation between the incidence of a sympathetic block and the advanced age of the parturient (p=0.0001), the important weight (p=0.047), high ASA statute (p=0.0001), the presence of hypertension (p=0.0001), diabetes (p=0.001) or cesarean (p=0.00015) in the antecedents and the low BSBP (p=0.015). CONCLUSION: In spite of the beneficial effect of the reduction in the amounts of local anesthetic in the SA, the sympathetic block remains frequent after SA for Cesarean. Thus, it is essential to detect the high risk women of occurred of sympathetic block after SA, and to propose strategies of prevention, monitoring and management for this population.

[N-acetylcysteine in septic shock]. / La N-acétylcysteine dans le choc septique.

AIM: To focus on the various studies evaluating the effects of Nacetylcysteine in septic shock METHODS: Main references obtained from the medical database Medline using the keywords: N-acetylcysteine; septic shock, free radicals. RESULTS: Septic shock remains the leading cause of mortality in intensive care units. The progressive knowledge of the pathophysiology of septic shock, underline the production of free radicals and their cellular and microcirculatory effects. The Nacetylcysteine used mainly in paracetamol poisoning, has properties to control free radicals. The explosion of free radicals in septic shock has led to multiple studies assessing the role of N-acetylcysteine as an anti radical, and for its anti inflammatory action. CONCLUSION: NAC seems to play an important role in septic shock to control free radicals and the inflammatory response. But these results remain contradictory. Some larger and more standardized studies should allow to evaluate the actual effects of NAC in septic shock.

Prevention and transplantation in chronic kidney disease: what is achievable in emerging countries? Meeting report: Bamako meeting December 4-6, 2008.

Experts from all continents discussed the present and future of nephrology and transplantation medicine in emerging countries during a 3-day conference, supported by the World Health Organization, the International Society of Nephrology, the Transplantation Society-Global Alliance for Transplantation and the Ministry of Health of the Republic of Mali. This conference was held in Bamako, Mali on December 4-6, 2008, and focused on prevention and treatment of chronic kidney disease in emerging countries. Apart from delivering high-quality medical and scientific knowledge, the meeting was mainly a call to action for emerging countries to start chronic kidney disease prevention and screening programs, develop end-stage renal disease registries and start or further elaborate transplantation programs. International as well as regional collaborations need to be stimulated and strengthened in order to allow emerging countries to acquire the information, technology, experience and skills necessary to achieve these ambitious goals.

[The prophylaxis of the thromboembolic disease in the head trauma]. / Thromboprophylaxie des traumatises crâniens.

BACKGROUND: The prophylaxis of the thromboembolic disease in the severe head trauma remains a controversy. AIM: In this study, we are interested to the determination of under groups of patients for whom the advantages of the prophylaxis of the thromboembolic disease (TED) are higher than its disadvantages. METHODS: We proceeded to a retrospective study based on patient medical records ranging from March 2003 until March 2004, enrolling 56 consecutive patients. The data collected related to the age, the gender, past medical history, the type of trauma, results of the initial CT scan, the treatment, appearance or not of the thromboembolic disease and its prophylaxis therapy. RESULTS: The average age was of 36 ± 19 years. 76.8% did not have significant past medical history. All the patients profited from an elastic compression stocking. The LMWH were used among 15 patients victim of severe head trauma associated with other injuries and 72 hours after stabilization of hemorrhagic attacks. A thromboembolic disease diagnosis was based clinical or biological assumptions. Among 56 patients, 4 of them showed a TED with an incidence of 7.1 including 3 DVT and one case of pulmonary embolism. The 4 patients sustain severe multiple trauma; 3 of them received an early anti-coagulation therapy. In the group of patients with TED, the OMEGA scores and IGS are high; all of them are multiple traumatized patients with shock requiring a blood transfusion in 75 of the cases. Only the blood transfusion is correlated at the risk of TED, statistically established. CONCLUSION: The risk to develop a thromboembolic complication in the traumatic patients with head injury is high particularly in case of associated muscleskeletal injuries. Elastic compression technique is not always effective but considered as an interesting alternative to the pharmacological prevention of thrombosis. The use of the anticoagulants therapy must be careful. It is contra-indicated in case of cerebral haemorrhage in progress and must be considered upon individual case of each patient.

Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes.

BACKGROUND: Spinal anaesthesia for caesarean section exposes to high incidence of arterial hypotension which can result in maternal and neonatal morbidity. We hypothesized that the reduction of this dose from 10 mg to 7.5 mg would minimize hypotension without altering pain relief. METHODS: In this double-blind prospective study, 80 ASA1 women scheduled for elective caesarean section were randomized into two groups A and B receiving respectively 10 and 7.5 mg of isobaric bupivacaine both with 25 microg of fentanyl and 100 microg of morphine in spinal anaesthesia. Intravenous ephedrine was administered for each episode of hypotension. We recorded sensory and motor block, intraoperative pain, nausea and vomiting. In postanaesthesia care unit, sensory and motor recoveries were measured and maternal satisfaction rate was assessed. RESULTS: In group A, a larger dose of ephedrine was needed (32 +/- 23 vs 19 +/- 16 mg; p = 0.004). Incidence of sensory block above T4 (52 vs 10%; p < 0.001), nausea (52 vs 22%; p = 0.005) and vomiting (25 vs 8%; p = 0.03) were all higher than in group B. Arterial hypotension was less frequent in group B (68 vs 88%; p = 0.03). The time required for recovery to T10 sensory level and motor regression were shorter than in group A (p < 0.001) and the satisfaction rate was higher than in group A (excellent and good in 90% vs 67%; p = 0.03). There was no difference in pain relief. CONCLUSION: A dose of 7.5 mg of isobaric bupivacaine reduced incidence of hypotension, nausea and vomiting and improved patient satisfaction.