Self-selecting fluid intake while maintaining high carbohydrate availability does not impair half-marathon performance.

We aimed to test the hypothesis that self-selecting fluid intake but maintaining high exogenous CHO availability (60 g/h) does not compromise half-marathon performance. 15 participants completed 3 half-marathons while drinking a 6% CHO solution to guidelines (DRINK) or a non-caloric solution in self-selected volumes when consuming 3×glucose (20 g) gels (G-GEL) or glucose-fructose (13 g glucose+7 g fructose) gels (GF-GEL) per hour. Fluid intake (DRINK: 1 557±182, G-GEL: 473±234, GF-GEL: 404±144 ml) and percent body mass loss (DRINK: - 0.8±0.9, G-GEL: - 2.0±0.6, GF-GEL: -2.3±1.1) were different (P<0.05) between conditions, though race time did not differ (DRINK: 110.6±14.4, G-GEL: 110.3±14.6, GF-GEL: 113.7±12.8 min). In G-GEL, there was a positive correlation (P<0.05) between body mass loss and race time. Plasma glucose was lower (P<0.05) in GF-GEL compared with other conditions, and total CHO oxidation (DRINK: 3.2±0.5, G-GEL: 3.0±0.4, GF-GEL: 2.6±0.4 g/min) was lower (P=0.06) in this trial. Self-selecting fluid intake but maintaining high CHO availability does not impair half-marathon performance. Additionally, consuming glucose-fructose mixtures in sub-optimal amounts reduces plasma glucose and total rates of CHO oxidation.

Histological changes and neural elements in the posterior cruciate ligament in osteoarthritic knees.

PURPOSE: To evaluate histological changes and neural elements in 100 posterior cruciate ligaments (PCLs) in patients with osteoarthritis. METHODS: 100 PCLs were obtained from a consecutive series of 46 women and 16 men aged 49 to 91 (mean, 67) years who underwent primary PCL-retaining total knee replacement for osteoarthritis. Histology was examined using conventional light microscopy. The PCLs were graded histologically in terms of parallel orientation of collagen fibres, mucoid degeneration, inflammation, and haemosiderin deposition. Histological changes were graded as normal, mild degeneration, moderate degeneration, and severe degeneration. The neural elements were assessed using immunohistochemical staining for S100 protein and neurofilaments. The histopathologist was blinded to the age, gender, and clinical and radiological grades of osteoarthritis. RESULTS: One specimen was excluded from analysis owing to inadequate tissue. In the remaining 99 specimens, histology was normal in 72, mildly degenerative in 4, moderately degenerative in 4, and severely degenerative in 15. 76 specimens were positive for S100 protein or neurofilament or both by immunohistochemical staining, indicating the presence of neural elements. CONCLUSION: Most knees with osteoarthritis present with viable PCLs. Retaining the PCL in total knee replacement is a good option for better kinematics, stability, and proprioception.

Fixed- versus mobile-bearing total knee arthroplasty in Indian patients.

PURPOSE: To compare the mid-term clinical outcomes in Indian patients after total knee arthroplasty (TKA) using a fixed- or mobile-bearing prosthesis. METHODS: 120 consecutive patients (50 men and 70 women) aged 55 to 76 (mean, 63) years who had arthritis of the knee with similar deformity and range of motion were randomised to undergo TKA using a fixed- or mobile-bearing prosthesis. Patients with mediolateral instability and infective arthritis were excluded. Knee Society knee and functional scores, range of motion, and the presence of flexion contracture were assessed. RESULTS: The mean follow-up duration was 3.5 (range, 1-4.6) years. The mid-term outcome of the 2 groups was comparable. One patient with a mobile-bearing prosthesis had recurrent dislocation at postoperative week 2, owing to iatrogenic medial collateral ligament injury. CONCLUSION: Long-term studies of both functional and radiological outcomes are needed to determine the indications for fixed- versus mobile-bearing prostheses.

[Dural carotid-cavernous fistulas: progression in therapeutic management from 1989 to 2004. A report of ten cases]. / Fistules carotido-caverneuses indirectes (durales): évolution de la prise en charge thérapeutique de 1989 à 2004. A propos de 10 cas.

INTRODUCTION: Dural carotid-cavernous fistulas are rare and require multidisciplinary management. Today there is no consensus on treatment, even though embolization is currently the first-line treatment. We present the cases of ten patients with a dural carotid-cavernous fistula diagnosed between 1989 and 2004 in order to compare the therapeutic choices used to treat dural carotid-cavernous fistulas in the late 1980s and mid-1990s to the therapeutic strategy currently favored. PATIENTS AND METHODS: The ten patients, with a mean age of 65.9 years, were seven women and three men. They had an ophthalmologic examination and the diagnosis was angiographically confirmed. Treatments were either noninvasive (such as decoagulation and/or carotid-jugular or ocular compression) or embolization. A combination of these different treatment modalities was provided for several patients. RESULTS: The main symptoms were arterialized conjunctival veins, proptosis, diminished visual acuity, chemosis, elevated intraocular pressure, and diplopia. Of the seven patients who only had noninvasive treatment (embolization not possible), three remained stable, three showed partial improvement, and the last one was clinically cured. As for the three patients treated with embolization (prior or not), this treatment led to a dramatic clinical improvement for one patient, a clinical cure for the second, and a complete cure in the remaining patient. CONCLUSION: Prior embolization when possible appears to be an effective and safe treatment for dural carotid-cavernous fistulas. Nonetheless, noninvasive treatment options, particularly compressions, remain an important therapeutic alternative.

Cavernous sinus fistula treated through the transvenous approach: report of four cases.

PURPOSE: To describe transvenous embolization in four patients with indirect dural carotid cavernous fistulas (CCFs) via the inferior petrosal sinus (IPS) or superior ophthalmic vein (SOV), and their clinical outcomes. METHODS: The CCF approach was performed after retrograde venous catheterization from the femoral vein to the cavernous sinus via the IPS (n=1) or SOV (n=3). SOV catheterization was possible without surgical intervention. All patients presented initially with typical clinical signs of CCF. Patients treated via the SOV presented with thrombosis of the IPS. RESULTS: Catheterization and embolization were successful in all patients, with complete angiographic occlusion of the fistula. No early or late complications occurred. All patients presented with favorable clinical outcomes and complete recovery of ocular symptoms. CONCLUSION: Retrograde transvenous embolization of CCF via the IPS, or SOV if the IPS is thrombosed, is a safe procedure with a good clinical outcome.

Bilateral spontaneous rupture of Achilles tendons: a case report.

Spontaneous bilateral rupture of Achilles tendon is rare. Rupture of the Achilles tendon has been described in patients on oral corticosteroid therapy. The sudden dorsiflexion of the plantar-flexed foot is the usual mechanism of injury. Spontaneous bilateral rupture is common in the degenerated tendon, which is often seen in patients with long-term corticosteroid therapy. This case is unusual because the patient has never taken steroids. We discuss the mechanism of injury and other probable causes.

A persistent pharyngohyostapedial artery: embryologic implications.

A 3-year-old child was examined because of otorrhagia. CT scans showed an unusual vessel, confirmed by angiography, related to a persistent pharyngohyostapedial artery. This embryonic persistent artery associated with the normal internal carotid artery would explain the "duplication" aspect of the internal carotid artery.

[Gadolinium and contrast medium MRI of the acoustic nerve in patients with meningeal neuritis and acoustico-facial syndrome]. / Imagerie en résonance magnétique avec Gadolinium et prise de contraste de la VIIIe paire au cours de méningo-névrites avec syndrome acoustico-facial.

Twelve cases of vestibular neuritis were investigated in gradient echo MRI with gadolinium. Only 3 severe cases associated with an acoustico facial syndrome (2 cases of herpes zoster oticus and one case after influenzae) demonstrated focal enhancement within the internal auditory canal on post contrast T1 weighted images. This enhancement involved at least 2 differents nerves. These 3 severe cases associating sensory neural hearing loss and facial palsy revealed a meningeal reaction after cerebrospinal fluid examination. The enhancement lasted a long time (up to 10 months) in one case of RAMSAY HUNT syndrome associated with a chronic lymphocytic leukemia. The MRI was able to confirm the anatomical reality of the vestibular neuritis and more precisely of the meningoneuritis and gave arguments for the theory of the polyneuropathy of Adour. Enhancement at MRI seems correlated with the severity of the affection (permanent vestibular areflexia in 3 cases and permanent hearing loss in 1 case).

[Benign vertebral osteoblastoma. Report of 6 cases]. / L'ostéoblastome bénin vertébral. A propos de 6 observations.

We present six cases of benign spinal osteoblastoma. This localization of this uncommon benign bone tumor occurring in young subjects is rare. The patients were explored with radiotomography, computed tomography, myelography and medullo-spinal angiography. These benign tumors may appear radiographically as pure bone lysis mimicking malignancy. The size of these tumors often leads to widening search for extension, particularly in recurrent, aggressive, multifocal forms which require wide resection, and sometimes total vertebrectomy. Medullo-spinal angiography can confirm the vascular involvement of the tumor nidus and is require to identify arteries supplying the spinal canal which would modify operative strategy.

Direct emergence of the dorsospinal artery from the aorta supplying the anterior spinal artery: report of two cases.

We report two cases of an isolated dorsospinal artery that emerged directly from the aorta to supply the anterior spinal artery, which in one case had another blood supply on the opposite side, in a lower position. It is important to identify this anatomic variant, otherwise spinal angiography might be incomplete, especially when the isolated dorsospinal artery supplies the anterior spinal artery.

[Role of hormonal exploration in avoiding of the failures of anterior pituitary gland surgery in Cushing disease]. / Rôle de l'exploration hormonale dans l'esquive des échecs de la chirurgie anté-hypophysaire de la maladie de Cushing.

Patients with Cushing's disease are not cured by transsphenoidal microsurgery in about 30% of the cases. Beside the problem of invasive macroadenomas, these failures are due either to diagnostic errors, or to very small microadenomas that could no be found. Positive diagnosis of hypercortisolism is quite straightforward and the problem is sensitivity rather than specificity. Primary adrenocortical hypercortisolism should not be mistaken. Depression-related hypercortisolism can be difficult to distinguish from Cushing disease: most cases are recognized after clinical story and CRF stimulation test. Ectopic ACTH secretion by a carcinoid tumor represents at least 8% of ACTH-dependant hypercortisolism. It cannot be reliably distinguished from corticotroph microadenoma by either classical dynamic tests or anterior pituitary imaging. However measurements of ACTH in the inferior petrosal sinus under basal condition and CRF stimulation allow the diagnosis of central or peripheral ACTH secretion with a quasi 100% sensitivity and specificity. In contrast this technique is of poor help for the diagnosis of lateralization of corticotroph microadenomas, for which it gives erroneous results in 25 to 50% of the cases. Rapid intraoperative measurement of ACTH in peripituitary blood seems a more reliable approach. In our series it gave correct results in 11 out of 12 cases. In 1995 hormonal exploration of Cushing disease should limit the failures of anterior pituitary surgery to the cases of invasive macroadenomas that cannot be completely removed.

[Intracranial dural fistula with spinal cord venous drainage. Apropos of 2 cases]. / Les fistules durales intracrâniennes a drainage veineux périmédullaire. A propos de deux observations.

The authors report 2 new cases of intracranial dural fistula draining into spinal veins. Comparisons with 19 other published cases showed that dural fistulae of the spine share common features with intracranial fistulae. The first case concerned a 78-year old woman presenting with a thoraco-lumbar myelopathy which proceeded by increasingly severe bouts and ended within 6 months in a flaccid sensorimotor paraplegia with urinary incontinence. Paraclinical examinations consisted of MRI, myelography and spinal as well as cerebral arteriography. MRI and thoraco-lumbar myelography displayed marks of dilated retrospinal vessels. Spinal arteriography showed no arteriovenous malformation, but the venous return of Adamkiewicz artery was not visible. Diagnosis was made by cerebral arteriography which demonstrated an intracranial arteriovenous fistula in the occipital region, draining into the posterior spinal vein. Treatment was endovascular and consisted of embolization by micro-coils, but clinical improvement was mediocre. Six months later, as the clinical picture was getting worse a second arteriography was performed. It showed recanalization of the fistula which was embolized again, using both coils and particles. No improvement in spinal cord deficit was observed. The second case was that of a 42-year old man presenting with paraparesis, tetrapyramidal syndrome, sensory deficit at T9, peribuccal dysaesthesias and genito-urinary sphincteral disorders, all gradually getting worse. The paraclinical exploration was the same as in the first case. MRI and myelography showed retrospinal vascular impressions. Spinal arteriography was normal, except for the lack of venous return of Adamkiewicz artery. Cerebral arteriography detected an intracranial dural arteriovenous fistula in the occipital region, draining into the anterior and posterior spinal veins. Treatment was surgical, consisting of exclusion of the arteriovenous fistula. Partial clinical improvement was noted. These two cases, compared with those of the literature, shared a number of features with spinal dural arteriovenous fistulae: they occur in middle-aged and predominantly male patients, and the clinical signs of ascending myelopathy are caused by the same physiopathological mechanism of spinal vein hyperpressure. Lesions of the medulla oblongata or the cervical spinal cord are found only in intracranial arteriovenous fistulae draining into spinal veins. Diagnosis is based on data provided by myelography (impressions of dilated and sinous vessels) and MRI (low-intensity perispinal signals, widening of the conus medullaris with high-intensity centrospinal signal); spinal cord angiography only shows a lack of venous return of Adamkiewicz artery without any other abnormality, whereas cerebral arteriography confirmed the diagnosis of intracranial dural arteriovenous fistula draining into spinal veins.

[Computed tomographic aspects of secondary cholesteatomas of the middle ear and petrous bone]. / Aspects tomodensitométriques des cholestéatomes secondaires de l'oreille moyenne et du rocher.

The authors present their experience of secondary cholesteatomas of the middle ear explored by computerized tomography (CT). Following a brief anatomicopathological description of secondary petrous bone cholesteatomas, and of the CT technique used for their exploration, they describe and illustrate the classical "bag-shaped" internal or external attical forms usually extended to the antrum and the mastoid process, and the less common locations often due to relapse or postoperative recurrences (anterior hypotympanic or posterior mastoidal). The holotympanic forms, usually due to "lamellar" cholesteatomas, create diagnostic problems with other opacities in the cavity, as also do certain forms that are evacuated spontaneously or by aspiration. One of the qualities of CT lies in the preoperative extension assessment. The lesion may extend towards the internal wall of the cavity (lateral semicircular canal, second portion of the facial nerve), towards the labyrinth to the petrosal apex and/or the geniculate ganglion, and above all towards the inferior labyrinth which might bring the cholesteatoma into contact with large vessels (e.g. jugular vein bulb for postero-inferior extensions, carotid canal for antero-inferior extensions). Extension into anfractuosities of the cavity walls (sinus tympani, subratubal fossette) must be systematically looked for in order to avoid postoperative recurrences.

[Endovascular treatment of iatrogenic false aneurysm in the right subclavian pit. Apropos of a case]. / Traitement endovasculaire d'un faux anévrysme iatrogène du creux sus-claviculaire droit. A propos d'un cas.

The authors report about one case of false aneurysm in the right subclavicular pit, which developed after iterative venous punctures in a 67-year-old woman. Surgery was excluded, and an endovascular treatment was decided, with an approach of the lesion by direct puncture in this case and the insertion of an inflatable balloon.

[Catheterization of the inferior petrosal sinus. Its role in the diagnosis of Cushing's syndrome. Experience with 23 explorations]. / Le cathétérisme des sinus pétreux inférieurs. Sa place dans le diagnostic du syndrome de Cushing. Expérience de 23 explorations.

Selective catheterization of the inferior petrosal sinus has been performed in 23 patients: 11 Cushing's disease, 5 lung carcinoid tumors whose diagnosis has been confirmed by surgery and 7 ACTH-dependent hypercortisolism whose final diagnosis has not yet been proved. The pituitary origin of hormone secretion is accepted if the central-to-peripheral ratio (C/PR) is equal or greater than 2 on basal values and/or during CRF test. On basal values, all subjects but one with confirmed pituitary lesions exhibited a C/PR > or = 2; the carcinoid tumors never exceeded the value of 1.3. After CRF injection, all the pituitary tumors showed an increase in C/PR; one patient with a lung carcinoid tumor (CRF-negative) showed a pituitary ACTH secretion (C/PR = 3.7). The localization of pituitary adenoma by the lateralization of hormone secretion is disappointing, except, perhaps, for very small extremely lateral adenomas. No accident occurred in our series, nor in the literature. This investigation seems the most reliable approach to prove the pituitary origin of hormonal hypersecretion. We recommend it to be performed in ACTH-dependent Cushing's syndrome when the secretory pattern is not typical and/or pituitary imaging is normal.

Three-dimensional reconstruction in routine computerized tomography of the skull and spine. Experience based on 161 cases.

Three-dimensional (3D) reconstruction in routine computerized tomography (CT) presupposes that the referring clinicians are motivated, software programs are of good quality, a second working console is available and manipulations are made by experienced persons. Maxillofacial surgery is the main, conventional indication, but the method is also used to plan the surgical treatment of craniofacial malformations and that of injuries and tumours. 3D reconstruction cannot replace a thorough analysis of the acquisition sections since its spatial definition is not as good as theirs. Without competing with pure research-work, a number of applications remain in the realm of speculative imaging, but it cannot be denied that 3D reconstruction has an interesting potential for teaching.

[Malformations of the bony labyrinth and deafness]. / Malformations du labyrinthe osseux et surdités.

17 new cases of malformation of the bony labyrinth detected radiologically (tomography, CT) and associated with perceptive or composite deafness are reported. 2 cases discovered in spontaneous or traumatic recurrent meningitis are described, as well as 1 case discovered after the occurrence of total deafness following stapedial surgery. The malformations were unilateral in 7 cases, bilateral in 10. Deafness was of the composite type in 6 cases. An associated malformation of the middle or external ear was noted in 4 cases. 5 cases were included in a context of multiple malformations, including 1 case of otobranchiorenal syndrome, 1 case of Apert's syndrome and 3 cases of craniostenosis. Referring to the classification given by Mrs Vignaud and Jardin, we have encountered 1 case of stage I malformation, 9 cases of stage II, pseudo-Mondini malformation, 1 case of stage III or true Mondini malformation, 1 case of stage IV malformation, 3 cases of malformation of the aqueduct of the vestibule, ie. stage V. We have also encountered 2 isolate cases of stenosis of the internal auditory canal. On the basis of these cases, we report a few physiopathogenetic hypotheses and various classifications currently described in the literature. We also list the various associated external and middle ear malformations and the multiple-malformation syndromes that are commonly described. Stress is laid on the fact that these malformations often go undetected in congenital deafness, as well as on the usual course of these types of deafness for which there is no medical or surgical treatment.

Apparently primary malignant melanoma of the cerebellopontine angle. One case.

We report a case of primary malignant melanoma of the cerebellopontine angle. This tumour showed RMI features that were totally different from those reported for secondary melanomas, and therefore its nature could not be suspected before surgery. Intracranial primary melanomas are so rare that no other published case is available for comparison, and our tentative explanations for the atypical RMI signals cannot be supported by evidence from the literature.