Spinal metastases of bronchopulmonary cancer: Role of spinal surgery and value of prognostic scores (Modified Tokuhashi and Tomita).

INTRODUCTION: Bone metastasis is frequent in bronchopulmonary cancer. We report a series of 52 patients, and analyze indications and the efficacy of surgery. MATERIALS AND METHODS: We retrospectively studied the records of 52 patients operated on for spinal metastases of bronchopulmonary cancer over a 6-year period from January 2009 to December 2014 in the neurosurgery department of the North Hospital of Marseille, France. RESULTS: Mean age was 63.6years; with a sex ratio of 3:1 (M:F). Spinal pain associated with vertebral fracture and spinal cord compression was the most frequent clinical presentation (59.6%). SINS score was≥7 in 78.9% of cases. Karnofski Performance Status was average in 67.4% of cases. Predicted survival beyond 12months was zero according to the modified Tokuhashi score. The surgical indication was essentially palliative. Evolution showed regression of pain in 84.6% of cases, and stabilization and improvement in motor deficit in 80.6%. Median postoperative survival was 16months. CONCLUSION: Our results highlight the interest of surgery for pain relief, spinal stabilization and improvement in neurological function in patients with spinal metastases of bronchopulmonary cancer, and the unreliability of predictive survival scores.

Cranial reconstruction after a post-craniotomy empyema.

This article presents a case report of a cranioplasty performed after a post-craniotomy empyema with osteitis. The skull reconstruction was performed using a bioceramic implant and a combined muscular free flap of latissimus dorsi and serratus anterior. This procedure not only provided coverage of a wide skull defect but also allowed the filling of the intracranial dead space. Clinically, we observed an improvement of the patient's preoperative neurological status with a near-complete correction of her right hemiparaesis and phasic disorders. Eight months after the cranioplasty, (1) no recurrence of infection was noticed; (2) no distortion of the skull was noticeable and (3) the patient again experienced a normal social life. Using computed tomography (CT) scan images, we observed a re-expansion of the left cerebral hemisphere without any dead space or extradural collection. The only observable sequelae were a temporoparietal alopecia (10 cm x 4 cm) and a winging of the scapula, induced by the skin graft and the removal of the lower-third of the serratus anterior muscle, respectively. The use of a muscular free flap associated with a customised biomaterial allows a single-stage reconstruction of extensive skull defect (120 cm(2)) in a previously infected area.

[Epidural intracranial hematomas: practical issues revealed by management of 100 recent cases]. / Hématomes intra-crâniens extra-duraux: à propos de 100 cas récents. Notre expérience et considérations pratiques.

We present a retrospective study on the management of 100 patients who presented epidural hematoma over a four-year period. Our goal was to provide an update on management of this injury. Computed tomography was performed because of the clinical presentation. Results provided information on the type of injury and appropriate treatment. A three-phase clinical progression was observed in only 6% of the patients. Despite state-of-the-art management, mortality remained high in these brain-injured patients (21%). No progress appears to have been achieved in the last ten years. This paradoxical fact probably results from the enhanced severity observed in our patients, who often suffered from associated intracranial injuries as well as multiple trauma (thoracic, abdominal trauma). Analysis study of the results confirms an improvement in mortality among patients with isolated epidural hematoma (6.6%), but great concern remains about the high mortality among patients with associated intracranial lesions (33.3%) or multiple trauma (32%).

[Subperiosteal hematoma of the orbit. Three cases]. / Hématome sub-périosté de l'orbite.

Orbital subdural hematoma should be considered in victims of head and face trauma with signs of exophthalmia. Early diagnosis and treatment, consisting of decompression, is mandatory to avoid long-term functional complications.

[Extradural hematoma of the posterior fossa]. / Hématome extradural de la fosse postérieure.

Extradural hematoma of the posterior fossa (EDHPF) is considered to be a rare complication of head injuries. In early reports, diagnosis was made only at the time of autopsy. Today, CT scanning prompts early diagnosis leading to better outcome. We report 20 consecutive patients observed over the last ten years who underwent surgery for EDHPF. This localization was found in 14,3% of all trauma patients operated for extradural hematoma. In our experience, EDHPF occurs in young adults with a clear male predominance. Vehicle accidents are the most frequent mechanism of injury. The main clinical presentation is subacute onset of signs (50% of our cases). Postoperative outcome was favorable in 19 of our patients (95%). We propose mandatory CT scanning that may have to be repeated as needed, to prevent delay in diagnosis and decision for surgery. Surgical removal of the EDHPF must be carried out as soon as possible as this is the only way to reduce morbidity and mortality.

[Tuberculous abscess of the cerebellum. Apropos of a case]. / Abcès tuberculeux du cervelet. A propos d'un cas.

A 22-year-old Asian man developed intracranial hypertension with a 38 degrees C fever. Two months earlier, he had undergone surgery and medical treatment for tuberculous otomastoiditis and pulmonary tuberculosis. The CT scan revealed multiple tuberculous abscesses of the cerebellum. Histological, microbiological and biological proof of diagnosis was obtained. We advocate surgical treatment of intracranial tuberculous abscesses associated with antituberculosis chemotherapy for 18 months. The earlier the treatment, the better the prognosis. This pathology must be kept in mind when treating patients from countries with a high endemic rate of tuberculosis and suffering from immunodeficiency syndrome.

Decollements epiphysaires traumatiques chez les adolescents congolais : a propos de 15 cas

Les auteurs analysent 15 cas de decollements epiphysaires traumatiques chez des adolescents congolais (age moyen 16 ans et 9 mois). La population atteinte est essentiellement masculine; a la suite; dans 60 pour cent des cas d'un accident de football. Les lesions concernent l'extremite distale du femur dans 80 pour cent des cas. Le traitement realise; chirurgical dans 75 pour cent des cas; a conduit a 14 bons et tres bons resultats (93 pour cent). Ces lesions survenant en fin de croissance; sont d'un bon pronostic

[Results of an open fixation treatment of 131 fractures of the femoral diaphyses in a Congolese hospital setting]. / Résultats du traitement à foyer ouvert de 131 fractures de la diaphyse fémorale en milieu hospitalier Congolais.

From 1987 to 1991, 196 fractures of the femoral diaphysis were treated at the University Hospital Center of Brazzaville. A retrospective perusal of the files of these patients produced 131 analyzable cases, all treated by open osteosynthesis using either screw-attached plates (n = 84) or nails (n = 47). The overall infection rate was 5.4% (7/131). This rate was 5.9% (5/84) using screw-attached plates and 4.2% (2/47) using nails, i.e. only slightly higher than in the literature. Bone fixation was successful in 90% of cases. Mechanical complications (11.4%) were due mainly to technical errors during the initial fixation. With a follow-up of 3 years, analysis according to the criteria of GENESTE showed that open osteosynthesis of fractures of the femoral diaphysis in an African orthopedic department led to 90% of good (32%) and excellent (58%) results. In this African series, the main problem was the initial fixation.

[Open fractures caused by gunshot in civilian practice. Apropos of 31 cases]. / Fractures ouvertes par armes à feu en pratique civile. A propos de 31 cas.

The authors report their experience of the treatment of 31 gunshot open fractures in civilian practice. The fractures, comminuted in two thirds of cases, were produced by various fire-arms. Two vascular injuries were observed. Conservative treatment was performed in 80% of cases. 13 septic complications were observed (6 superficial and 7 deep infections). The were also 7 cases of delayed union, 3 mal unions and 7 cases of joint stiffness. To improve the prognosis of these lesions, the authors emphasize that surgeons must be familiar with ballistic wounds and carry out an early initial and appropriate treatment.