[Cervical spondylolysis : a rare fortuitous finding]. / Cas clinique. Spondylolyse cervicale : une découverte fortuite rare.

A young patient consulted in our physical and rehabilitation medicine department following the onset of pain on the scapula area and at the base of his right upper limb after carrying a heavy load. After a couple of weeks, the patient also developed cervical pain. Fortuitously, the cervical scanner displayed a right C6 spondylolysis. Further evaluation by bone scan confirmed that this lesion was not recent and so probably not the cause of the symptoms. Cervical isthmic spondylolysis is a rare condition, much more common at the lumbar level and often ignored at the cervical one. The etiology, pahophysiology, imaging and treatment options for this cervical pathology are discussed in this article.

Un jeune patient a consulté en médecine physique pour des douleurs aux niveaux de l'omoplate et de la racine du membre supérieur droit apparues suite au port d'une charge lourde. Après quelques semaines, le patient se plaignait également de cervicalgies. Un scanner du rachis cervical a objectivé fortuitement une spondylolyse C6 droite. Un bilan complémentaire par scintigraphie osseuse a révélé que la lésion était ancienne et qu'elle n'était probablement pas la cause de la symptomatologie. La lyse isthmique cervicale est une pathologie peu répandue. Très connue à l'étage lombaire, la spondylolyse est rare et souvent ignorée au niveau cervical. L'étiologie, la physiopathologie, l'imagerie et la prise en charge de cette pathologie cervicale sont discutées dans cet article.

[Clinical case of the month. Ulnar artery aneurysm in a roofer]. / Anévrisme de l'artère ulnaire chez un couvreur.

A case of ulnar artery aneurysm in an independent roofer is reported. It is a rare disease often associated with the Hammer Hypothenar Syndrome specifically found in manual workers and athletes exposed to repetitive palmar trauma.

[Single cervical metastasis of breast cancer]. / Métastase unique cervicale d'un cancer du sein.

We report a rare case of single cervical metastasis of breast cancer. Bone metastases are the most frequent in breast cancer. Early diagnosis combined with the new therapeutic advances have considerably improved the quality of life and increased the survival. Imaging plays a great role in the diagnosis, particularly scintigraphy and radiography, but sometimes also CT and MRI. The treatment is currently not standardized and it combines hormone therapy, chemotherapy, radiotherapy, and/or surgery.

Influence of premedication with alprazolam on the occurence of obstructive apneas. A prospective randomized double-blind study.

Postoperative development or worsening of obstructive sleep apnea is a potential complication of anesthesia. The objective of this study was to study the effects of a premedication with alprazolam on the occurrence of apneas during the immediate postoperative period. Fifty ASA 1 - 2 patients undergoing a colonoscopy were recruited. Patients with a history of obstructive sleep apnea (OSA) were excluded. Recruited patients were randomly assigned to one of two groups: in Group A, they received 0.5 mg of alprazolam orally one hour before the procedure; and in Group C, they received placebo. Anesthesia technique was identical in both groups. Patients were monitored during the first two postoperative hours to establish their AHI (apnea hypopnea index, the number of apneas and hypopneas per hour). Nine patients were excluded (4 in group A and 5 in group C) due to technical problems or refusal. Interestingly, premedication by alprazolam did not change intra-operative propofol requirements. During the first two postoperative hours, the AHI was significantly higher in group A than in group C (Group A: 20.33 ± 10.97 h-1, C: 9.63 ± 4.67 h-1). These apneas did not induce significant arterial oxygen desaturation, or mandibular instability. Our study demonstrates that a premedication with 0.5 mg of alprazolam doesn't modify intra-operative anesthetic requirements during colonoscopy, but is associated with a higher rate of obstructive apneas during at least three and a half hours after ingestion. No severe side effects were observed in our non-obese population. Our results must be confirmed on a larger scale.