[Primary brain stem hemorrhage: retrospective study of 25 cases]. / Hémorragies spontanées du tronc cérébral: étude rétrospective de 25 observations.

INTRODUCTION: We report a retrospective series of 25 cases of brain stem hemorrhage. METHODS: Cases of spontaneous hemorrhage of the brain stem which were observed from 1990 to 2000 in a department of neurology were reviewed. Etiological factors, CT scan at admission, clinical signs and the course of the disease were analyzed retrospectively. RESULTS: There were 25 patients, 14 male and 11 female aged from 24 to 91. Fifteen hematomas were related to hypertension, four to coagulation disorders and two to a vascular malformation. The hemorrhage was located in the pons in 22 cases and in the midbrain in three cases. The death rate directly related to the hemorrhage was 14/25 (12 early and two delayed deaths). Prognosis factors were the size of the hemorrhage, a ventricular bleeding, disorders of consciousness and pupillary abnormalities on admission, the need for mechanical ventilation. CONCLUSION: In brain stem hemorrhage, the size of the hematoma is a more important prognosis factor than age or etiological factors.

Rapid quantitative procalcitonin measurement to diagnose nosocomial infections in newborn infants.

BACKGROUND AND OBJECTIVE: Serum procalcitonin (PCT) monitoring may help clinicians to manage nosocomial infections in neonates. This study investigated the diagnostic value of a new, rapid method to measure PCT and sought to determine the best cut-off value. METHODS: This monocentric, prospective study included all newborn infants with clinical suspicion of infection in a neonatal intensive care unit. Rapid, automated PCT measurements were performed on blood samples obtained for C-reactive protein (CRP) measurement. Negative and positive predictive values, sensitivity and specificity were calculated. Logistic regression analysis determined the best cut-off value to obtain a negative predictive value of PCT that was at least 15% above that of CRP. RESULTS: Between June 2005 and May 2006, 73 newborn infants with a median (Q25-Q75) gestational age of 28 (26-30) weeks and a birth weight of 995 (720-1350) g were included. Thirty (41%) were infected. The best PCT cut-off value was 0.6 ng/ml, which provided a negative predictive value of 100%. The sensitivity, specificity and positive predictive value were 100%, 65%, and 67%, respectively, for PCT at the 0.6 ng/ml cut-off value. CONCLUSION: Rapid measurement of PCT could help to rule out nosocomial infection in newborn infants hospitalised in intensive care units.

Delayed primary closure using Silastic vessel loops and skin staples: description of the technique and case reports.

The use of Silastic vessel loops and skin staples for closure of surgical wounds, with or without tissue loss, is a relatively simple technique that can be done at the patient's bedside or in an office setting, using local anesthesia. The vessel loops are tightened or additional staples are placed, as required, until the skin edges are approximated. In a variety of wounds, use of Silastic vessel loops eliminates the need for skin grafting or secondary wound closure and minimizes the morbidity associated with these procedures.