[Eclampsia in the late postpartum. Contribution of x-ray computed tomography and magnetic resonance imaging]. / Eclampsie du post-partum tardif. Apport du scanner X et de l'imagerie par résonance magnétique.

A 28-year-old woman developed late post-partum eclampsia. CT scan showed focal cortical hypodensities and diffuse and bilateral hypodensity of the hemispheric white matter. These lesions were hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences. The CT and MRI abnormalities resolved completely within a few weeks. These changes are similar to those which occur with the more common prepartum eclampsia.

[Is measurement of body temperature by infrared tympanic thermometry reproducible?]. / La mesure de la température corporelle par thermomètre tympanique infrarouge est-elle reproductible?

OBJECTIVE: To assess the reliability of body temperature estimated by infrared tympanic thermometry. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: 71 patients in a neurosurgical intensive care unit. 393 triplets of measurements were performed: right ear, left ear and right ear again. RESULTS: Limits of agreements are [-1, +1 degree C] between both ears, and [-0.6, +0.7 degree C] for two consecutive measurements in the right ear. The Bland and Altman diagram show that most of the points responsible for the lack of accuracy are between 36 and 37 degrees C. CONCLUSION: These values give an estimation of the technique's accuracy. In our point of view, such a reproducibility is adequate for daily clinical practice. The accuracy of infrared tympanic thermometry with the First Temp Genius seems reasonable for the clinical practice when the temperature is over 37 degrees C.

[Functional neurosurgery for epilepsy]. / La chirurgie fonctionnelle de l'épilepsie.

Introduced at the end of the last century, epilepsy surgery is indicated in patients with intractable partial seizures and based on the resection of the epileptogenic cerebral tissue from which ictal discharges originate. Palliative procedures include seizure spread pathways interruption (callosotomy, multiple subpial transections) and chronic stimulation of the vagus nerve. Complete preoperative investigations including seizure observation, clinical tests, video-EEG, MRI and functional MRI, and PET-scan are performed in order to identify the epileptogenic zone. In difficult cases, invasive seizure monitoring through depth electrode implantation (SEEG) is performed. Resections for temporal lobe seizures are associated with favorable outcome: 60 to 90% of patients will be seizure-free after surgery. A less favorable outcome is observed after extra-temporal resections: 40 to 60% seizure-free patients. A better outcome is observed after surgery for epilepsy associated with an image-defined lesion, most often a tumor, rather than for cryptogenic epilepsy. Tumors associated with chronic partial epilepsy are indolent, most of them are dysembryoplastic neuroepithelial tumors (DNET). Outcome after palliative procedures are more variable, depending on the etiology of epilepsy.

[Neurosurgery with a CO2 laser. Evaluation of 61 operations]. / Neurochirurgie au laser CO2. Bilan de 61 interventions.

The authors present the results of their over two years experience with CO2 Laser neurosurgical unit. They explicit the indications and the technical data followed during intra-cranial (N = 44), intra-spinal (N = 12) and intra-orbital (N = 5) procedures. Meningiomas, neurinomas and adenomas are the best indications for tumoral CO2 Laser neurosurgery. In other respects sterilization and cranialization of aeric sinuses are simplified by the use of CO2 Laser: it assures vaporization of the mucosa and carbonization of the walls more easily than an electric coagulator. At last the use of CO2 Laser for dissection and removal of intra-orbital tumors is quite demonstrative. Thus owing to its physical and thermical qualities CO2 Laser is often a very useful, sometimes irreplaceable, apparatus: provided that its indications are precise and rigorous.

[Terson's syndrome and intraocular complications in meningeal hemorrhages (26 cases)]. / Syndrome de Terson et complications intra-oculaires dans les hémorragies méningées (26 cas).

The Terson syndrome was described in the early 1900's as the association of an intra-vitreous humor bleeding and a subarachnoidal hemorrhage (SAH). The high jeopardy of blindness of such a syndrome emphasizes the importance of evaluating as soon as possible the presence of blood in the posterior chamber of patients presenting with a SAH. 250 patients admitted in the Neurosurgical Department of Ste Anne Hospital with a SAH were evaluated between January 1984 and February 1990. 26 had an intra-ocular hemorrhage (10.5%). In those cases the mortality rate was not increased (15.4%) but the morbidity rate was higher (42%). Concerning the intra-ocular bleeding, 4 patients underwent a vitrectomy (2 had a complementary photocoagulation). Only one patient had a visual sequela (partial decrease of visual acuity). These data emphasize the visual risk which has to be considered; a specific treatment (vitrectomy and/or photocoagulation) must be performed as quickly as possible so as to save the vision. In some particular instances, the ophthalmological treatment might even be necessary before the intracranial procedure itself.

[A man with spontaneous pain in shoulders and hips]. / Een man met spontane pijnklachten van heupen en schouders.

A 19-year-old man presented with spontaneous pain in both hips and shoulders. X-ray of the pelvis showed osteopenia throughout the pelvis and a late stadium of coxarthrosis. MRI showed osteonecrosis on both sides in the femur head and acetabulum as well as both humerus heads. Glucocorticoids may induce osteonecrosis.

A CT scan score for the assessment of lung disease in children with common variable immunodeficiency disorders.

BACKGROUND: The prevalence and severity of structural lung disease in children with common variable immunodeficiency (CVID) disorders is not well known, and a dedicated CT scanning protocol and CT scan scoring system have not been described in this category. METHODS: This was a cohort study of 54 children (34 CVID, 20 CVID-like disorder) in a stable condition who underwent volumetric inspiratory and end-expiratory CT scans. Scans were scored for airway abnormalities, interstitial and parenchymal lung disease, and lymphadenopathy using a newly developed CT scan scoring system. Scores were normalized to a 0% to 100% scale. Observer agreement was assessed using an intraclass correlation coefficient (Ri). Prevalence and severity of CT scan abnormalities were calculated. RESULTS: Structural lung disease was common (85%-93%), but usually mild as reflected in the relatively low scores (bronchiectasis score 2.8% +/- 6.4%). Moderate-to-severe bronchiectasis was found in three (5%) patients. Expiratory air trapping was the most common finding, found in 71% to 80%, but often in a mild form; application of a cut off level of > 10% reduced its prevalence to 33% to 38%. In 9% to 15% of all patients, air trapping was the only abnormality. Multiple lung nodules were seen in 24% to 25% and could disappear after corticosteroid treatment. Observer agreement was moderate (Ri 0.6-0.79) to good (Ri > 0.8) for all items and the composite scores, except airway wall thickening. CONCLUSION: In children with CVID disorders, mild structural lung disease is common. Expiratory CT scans show the most frequent abnormality, air trapping. The occurrence of (silent) lung disease progression and the clinical impact of CT scans require further investigations.

Difficult endotracheal intubation as a result of penetrating cranio-facial injury by an arrow.

UNLABELLED: Penetrating injury of the face and airway may make endotracheal intubation difficult or impossible. We report the case of a patient who attempted to commit suicide with a crossbow. Surgery under general anesthesia was required to remove the arrow. The oral intubation route was impossible, and a fiberoptic nasal intubation under local anesthesia was performed. IMPLICATIONS: We report a case of a 42-yr-old patient who underwent surgery for a penetrating craniofacial injury caused by an arrow. Because of the median vertical trajectory of the arrow (from the chin to the frontal skull), only the right nasal approach was accessible for endotracheal intubation. Fiberoptic nasal intubation and securing the airway under local anesthesia are described.