[Guidelines for rehabilitation management of non-neurological urinary incontinence in women]. / Recommandations pour la prise en charge rééducative de l'incontinence urinaire non neurologique de la femme.

Pelvic floor rehabilitation is prescribed as first-line treatment for women with stress urinary incontinence, particularly in cases of urinary incontinence with no first-degree uterine prolapse, with poor-quality perineal testing results or inverted perineal command. Prescription of 15 sessions should suffice to evaluate the possibilities of improving the incontinence. The sessions can be continued if the patient feels she is progressing but has not reached sufficient results. With no progression despite properly conducted rehabilitation, the question of whether to continue the physical therapy arises. Currently, therapists determine the number of sessions. They are better apt to know whether sessions should be pursued and should relay a report to the prescribing physician. This type of rehabilitation is within the domain of physical therapists. Midwives can be responsible for postpartum rehabilitation. On the other hand, the importance of the patient's role in the results and their maintenance is well known. Occasionally a few sessions some time after the initial sessions can serve to verify the acquisitions and motivate the patient in her personal contribution to this rehabilitation. The work of the physical therapist cannot be substituted with Keat-type home electrostimulation. The physical therapist plays an important role in the overall management of this condition. Currently, in absence of demonstrated efficacy, self-administration of electrostimulation is not recommended. In urge incontinence, the rehabilitation approach will be used concomitantly with prescription of anticholergics with behavioral therapy and bladder biofeedback work. In addition, low-frequency electrostimulation can be done during the session. Starting with 10-12 sessions is sufficient. In all cases, rehabilitation should take a multidisciplinary approach and be integrated into a medical and/or surgical management plan.

[Guidelines for the palliative treatment of non-neurological urinary incontinence in women]. / Recommandations pour le traitement palliatif de l'incontinence urinaire non neurologique de la femme.

Absorbant products have greatly improved over the past few years in terms of both efficacy and comfort, but the problem of cost for patients persists. They can only be used for short periods of time while waiting for effective curative treatment or over longer periods if no other management option is possible. The model chosen must be adapted to the amount of leakage and the patient's shape. Many nonabsorbant palliative treatments have been reported, often with small series. They can be grouped into three types: extra-urethral occlusive devices, intra-urethral obstructive devices, and intravaginal support devices. The use of a pessary or other vaginal devices can be proposed, in particular with associated prolapse, which can be used when leakage is very occasional (sport, etc.) or in women who cannot have any other treatment.

[Synthesis of the guidelines for the treatment of non-neurological urinary incontinence in women]. / Synthèse des recommandations pour le traitement de l'incontinence urinaire féminine non neurologique.

The last two decades have brought about new medical and surgical treatments revolutionizing care for non-neurological urinary incontinence in women. Many studies, often randomized prospective studies with sufficient follow-up, have validated the therapeutic choices and shown them not to be part of a fad or marketing pressures. The French Association of Urology (L'Association Française d'Urologie), through its Committee on Women's Urology and Pelviperineology (Comité d'Urologie et de Pelvipérinéologie de la Femme), proposes its recommendations. These were established by an expert group of specialists (urologists, gynecologists, and physical therapists), based on a review of the literature but taking into account the daily practices in academic and private practice settings. Between evidence-based medicine and reality in the field, these recommendations attempt to propose realistic and applicable strategies.

[Intraorbital dermoid cyst: case report]. / Kyste dermoïde intraorbitaire: un cas.

Dermoid cysts account for 3-4 % of primary orbital tumors. The intraorbital location is relatively rare. The authors report a case of a 12-year-old male with an intraorbital dermoid cyst revealed by progressive right proptosis. The imaging aspects (CT scan and MRI) were consistent with intraconic dermoid cyst. The tumor was extirpated via a subfrontal approach. Histopathologic examination confirmed the diagnosis of dermoid cyst. The authors discuss the clinical symptoms, radiological aspects, and management.

[Neurosurgical management of paraplegia complicating Pott's disease: a six-case study]. / Prise en charge neurochirurgicale de la paraplégie tuberculeuse : à propos de six cas.

Tuberculosis is a rare disease in economically developed countries. Paraplegia is one of its severe complications, occurring in cases of spondylodiscitis with compressive epiduritis and/or pathological fracture of vertebral bodies with subacute kyphosis. Six patients aged 15-75 years were treated in our department from May 2005 to April 2006 by the same operator (L.N.) for paraplegia complicating Pott's disease. Patients' neurologic function at admission and their outcomes three and 12 months after surgery were graded using the Frankel classification. MRI showed a single lesion in five cases and skip lesions in one case. Standard antituberculosis chemotherapy was started immediately within the first week of admission in five patients following a 12-month regimen. Principles of surgical treatment were ventral spinal cord decompression (with or without dorsal stage procedure), immediate grafting, correction of subacute spinal deformity and instrumentation in all cases. The diagnosis of Mycobacterium tuberculosis was confirmed by laboratory investigations in four cases and by histopathological examination in all cases. One patient who had undergone prior isolated laminectomy performed by an on call team presented neurological deterioration and progressive kyphosis. Neurological outcome improved in five patients. Four of them were able to walk unaided within the first three months after surgery. No perioperative complication occurred. In paraplegia complicating vertebral tuberculosis, overall neurological outcome appeared to be good in case of delayed emergency surgical management combined with antituberculosis chemotherapy.

[Cervicomanubrial route for the ventral upper thoracic spine: technical note about six cases]. / Abord ventral transcervicomanubrial du rachis thoracique supérieur: note technique à propos de six cas.

Ventrolateral cervicotomy provides a narrowed working space for surgical management of upper thoracic spine. We report our experience about ventral upper thoracic spinal cord decompression with reconstruction and plating via the cervicomanubrial route. Six patients (24 to 75 years old) were operated on by the same operator (LN) by cervicomanubriotomy from 2002 to 2007 for upper thoracic spinal cord compression (one case of Pott's disease, three cases of metastases, one fracture, one invasive hemangio-epithelioma), with a good outcome in five patients. Lesions were located from the cervicothoracic junction down to the fourth thoracic vertebra (T4). In all cases, anterior spinal cord decompression, strut graft reconstruction (iliac bone in two cases, cement in four cases) and osteosynthesis were performed. In two cases, a second stage posterior decompression with fixation was performed. The approach begins by a left sided anterior cervicotomy, medial to the sternocleidomastoid muscle and lateral to the trachea and esophagus, associated with division of the infrahyoid muscles close to their insertion at the upper thoracic outlet followed by osteotomy of the manubrium sterni. Then, division of the thyropericardic fascia and thymus, control of the brachiocephalic vein, control of the thoracic lymphatic duct and the horizontal thoracic aorta are performed. The ventral part of fifth cervical vertebra body down to T4 is then exposed between the left primitive carotid artery laterally, the esophagus medially and the thoracic aorta caudally. Compared to total sternotomy without or with clavicle resection, cervicomanubriotomy seems to be a less aggressive, safe and reliable procedure.

[Lymphocytis meningitis: Listeria monocytogenes is a potential risk in a immunocompetent child]. / Méningite lymphocytaire: Listeria monocytogenes, une étiologie à ne pas négliger chez l'enfant immunocompétent.

UNLABELLED: Meningoencephalitis due to Listeria monocytogenes is a rare and serious form of brainstem infection in childhood. OBSERVATION: We report the case of a 7 year-old girl presenting lymphocytic meningitis with a high CRP level. Parenteral antibiotics combining ceftriaxone and vancomycine led initially to clinical improvement. Ten days later, secondary brainstem inflammation with hydrocephalus appeared and led to the detection of L. monocytogenes during external ventricular bypass. CONCLUSION: This observation of paediatric lymphocytic meningoencephalitis suggests a prescription of amoxicillin in association with first line antibiotics, particularly when an important inflammatory syndrome exists, immunocompetent children included.

[Abdominal management of rectocele and elytrocele: place of the laparoscopic approach]. / Traitement des rectocèles et des élytrocèles par voie abdominale: apport de la laparoscopie.

AIM OF THE STUDY: To report the results of abdominal promontory rectopexy and douglassectomy in the management of rectocele and enterocele. PATIENTS AND METHODS: Between 1992 and 2002, 72 patients were operated by one colorectal surgeon. Laparotomy was used in 37 cases between 1992 and 2001 and the laparoscopic approach in 35 cases from 1995 to 2002. Promontory rectal fixation required only one mesh secured between the anterolateral right side of the rectum and the lumbosacral ligament. The same mesh was used to fix the vagina or the cervix. Combined therapeutic or prophylactic urinary interventions are frequent in the series. RESULTS: The follow-up was more than one year in 63 patients with a mean value of 58 months with no patient lost. Recurrence of posterior vaginal prolapse was noted in only two cases. Dyschesia and urinary incontinence were improved respectively in 80 and 70% of the cases and a significant improvement in anal incontinence was observed in 95% of the patients. CONCLUSION: The abdominal way allows a suitable treatment in patients with advanced stage rectocele and enterocele and evidence of pelvic organ prolapse. The laparoscopic approach is superior in terms of morbidity and functional results.

[Tophaceous gout of the cervical spine, causing cord compression. Case report and review of the literature]. / Compression médullaire cervicale par tophus goutteux. Revue de la littérature à propos d'un cas.

We present the case of a 74-year-old patient with long-standing gout who developed C4-C5 tophaceous gout causing cord compression. The patient had undergone 4 years earlier for a disco-osteophytic cord compression (anterior C4-C5 and C5-C6 discectomy). When admitted, the patient presented quadriparesia which had developed during the previous week in association with acute tophaceous gout on the knees, and the metarsophalangeal articulations, in the context of a bronchial infection. The diagnosis of spondylodiscitis was initially retained because of the clinical features of severe infection and the radiological data (C4-C5 cord compression, with anterior epidural lesions in MRI). The intervention allowed decompression and pathological diagnosis of tophaceous gout. Spinal gout is well-known, and very rarely responsible for cord compression: only 15 cases of cervical gout have been described in the literature. Radiological findings are not specific, and treatment is surgical in the event of medullar compression despite medical treatment.

[Dermoid cyst of the lateral ventricle associated with ethmoidal dermal sinus. Report of a case]. / Kyste dermoïde des ventricules latéraux associé à un sinus dermique ethmoïdal. A propos d'un cas.

We report a case of a ventricular dermoid cyst associated with a dermal sinus connected with the ethmoidal cells in a patient who developed rapid symptoms of raised intracranial pressure. Computed tomography showed a cystic mass in the right lateral ventricle with a hydrolipidic image in the left frontal horn of the ventricle and associated hydrocephalus. Magnetic resonance imaging showed a heterogeneous T1 hyperintense mass with a fistulous tract communicating with the ethmoid cells. A cerebrospinal fluid ventriculo-peritoneal shunt was initially established, which required further revision. A right sided transventricular approach was undertaken in a second stage, allowing resection of a dermoid cyst. Obliteration of the dermal sinus tract was obtained using pericranial duraplasty. Clinical and imaging features are discussed. The need for total resection including the tumor capsule and occlusion of the fistula are emphasized if recurrence and infection are to be prevented.

[Krouamania causing an acute subdural hematoma of arterial origin]. / Hématome sous-dural aigu d'origine artériolaire et krouamanie.

We report a case of arteriolar subdural hematoma caused by Jedba assimilated to Krouamania. We discuss the pathophysiological mechanism of subdural bleeding, the clinical symptoms, the characteristics of such hematomas and the therapeutical management.

[Intra-orbital dacryops. Report of a case]. / Dacryops intra-orbitaire. A propos d'un cas.

We report a case of intra-orbital Dacryops in a 7-year-old child. The presenting sign was progressive exophtalmus. The patient was operated via a lateral approach allowing total removal of the cyst without recurrence after one year. The clinical, radiological (CT Scan and MRI) and therapeutical aspects are discussed.

[Trauma-induced arterial aneurysm in childhood. Report of a case and review of the literature]. / Anévrisme post-traumatique de l'enfant. A propos d'un cas, revue de la littérature.

We report a case of calloso-marginal artery aneurysm in a 3 year old child, revealed 3 weeks after a craniocerebral trauma with frontal embarrure, by a sudden subarachnoidal hemorrhage syndrome with loss of consciousness and coma. The CT scan confirmed the subarachnoid hemorrhage in all the basal cisterns, with an interhemispheric subdural hematoma. The carotid angiography showed a right calloso-marginal aneurysm. The child has been operated (coagulation of the artery and excision of the false aneurysm. We studied the mechanism of pediatric post-traumatic aneurysm, the histological and clinical presentation emphasizing the necessity of a complete neuroradiological exploration when new neurological symptoms develop after head trauma. Neurosurgical and/or endovascular neuroradiological treatment is mandatory.

[Chronic subdural hematoma in utero. Case report with literature review]. / Hématome sous-dural chronique in utero. A propos d'un cas, revue de la littérature.

We present a case of chronic subdural hematoma diagnosed in utero by ultrasonography, and MRI at 31 weeks gestation. No cause of usual intracranial hemorrhage was found. There was no trauma. The child was operated after induced vaginal delivery at 37 weeks gestation, with good results and normal neuropsychological development after one year. We discuss the symptomatology and the therapeutic attitude in such cases.

[Elaboration and validation of a specific quality of life questionnaire for urination urgency in women]. / Elaboration et validation d'un questionnaire qualité de vie spécifique de l'impériosité mictionnelle chez la femme.

Urgent micturition interferes with the quality of life (QoL) of women suffering from this symptom. In order to evaluate this disturbance of quality of life and the benefits of treatment, a self-administered questionnaire, specific to the disorders of urgent micturition in women, was developed from a pre-existing scale (Measurement of Urinary Handicap, MUH). The following developmental methodology was adopted: Generation of a first instrument from the patient's descriptions collected by a multidisciplinary group of clinicians: formulation of questions, regrouping of questions into dimensions, choice of reference period and modalities of response. Content validation and test of comprehension in 20 patients. Transverse pilot study (98 patients) designed to reduce the number of questions and analyse the internal reliability and clinical validity. Reproducibility study. The final questionnaire comprises 24 items grouped into 5 dimensions: activities (8 items), emotional repercussions (5), self-image (5), sleep (3), well-being (3). The relevance of regrouping of the questions in their dimension and of calculation of a global score was confirmed by a principal component analysis and multifactorial analysis. The internal reliability and reproducibility of the scores were satisfactory, with a Cronbach alpha of > 0.70 and an intraclass correlation coefficient > 0.80, respectively. The clinical validity of the questionnaire was verified: the QoL scores of patients became significantly lower as the symptoms became more severe. A specific, reliable and clinically valid questionnaire, expressed in the form of a global score and a profile, was able to be developed. The profile of patients suffering from urgent micturition reflects the repercussions of the disease on the major and specific domains of their QoL. This questionnaire presents the required properties to be used in clinical trials designed to evaluate the effects of treatments on the patients' QoL, as a complement to classical clinical evaluations.

[Cerebral venous thrombosis in the Ile de la Réunion. A series of 20 patients]. / Thromboses veineuses cérébrales à l'Ile de La Réunion. Une série de 20 patients.

Twenty cases of cerebral venous thrombosis (CVT) are reported. A significant majority of patients were young women receiving oral contraceptives. In the puerperium CVT were frequent and delayed; the number of septic lateral sinus thrombosis was the same as in the occidental countries. The clinical picture was not specific, and idiopathic intracranial hypertension or pseudotumor cerebri were not frequent. Focal signs were the most frequent clinical manifestations. The clinical course, of deep CVT was not as severe as previously reported. Due to the lack of MRI, only CT scan was performed for all patients. More than 50% showed direct signs of CVT (cord sign and delta sign). The diagnosis of CVT was confirmed by cerebral angiography. Early systematic treatment by heparin was used with neither appearance nor aggravation of hemorrhagic infarcts being observed. The outcome was favorable in 60% of the cases, except for venous hemorrhagic infarction.

[Intracavernous invagination of pituitary macro-adenomas]. / L'invagination intra-caverneuse des macro-adénomes hypophysaires.

Depending on authors, intra-cavernous invasion by a pituitary adenoma is found in 9% to 40% of cases. In the light of our own experience, we think that such an invasion is probably much less frequent than usually evoked on CT-scan and MRI. In our study, it was confirmed in only one case over 125 (0.80%), though radiological data suspected an intra-cavernous invasion 17 times. An anatomical study on 20 cadavers showed that 30% of normal pituitary glands present with a lateral expansion into one or both cavernous sinuses (CS). These natural invaginations were already evoked by Harris and Rhoton in 1976. They can resemble an intra-cavernous extension or invasion on MRI views, moreover when an adenoma increases the volume of this expansion, and in the absence of any rupture of the medial wall of the CS. The medial wall of the CS is, in fact, constituted by a dural pouch which close-fits the pituitary gland and its expansions; it invaginates more or less in the CS, depending on the importance of the pituitary lateral expansion. In case of a large adenoma, the finger-glove lateral distension of the pouch disappears progressively during the tumoral removal. Finally the dura returns to its normal place back, at the end of the procedure. This concept of invagination of the CS medial wall, as opposed to that of invasion and therefore of rupture of the dural plane, explains the wide range of figures concerning the frequency of intracavernous invasion by pituitary adenomas, in the literature. These figures are all the more variable as there is no absolute criteria of intra-cavernous invasion on CT-scan nor MRI views. In the same way, no clinical criteria can be retained to assume the existence of such an invasion. So, an ophthalmoplegia seems to be usually linked to a compression of occulomotors nerves; it recovers in a large majority of cases, after the adenoma is removed. In conclusion we emphasize the necessity of interpreting with great care radiological imaging when it evokes' a possible intra-cavernous invasion of a pituitary adenoma. The indication of an eventual radiotherapy should be retained with as much care as possible, since complete removal of an adenoma and its lateral expansion(s) is almost always feasible through a trans-sphenoidal route.

[Exacerbation of myasthenia gravis by pefloxacin]. / Aggravation d'une myasthénie sous péfloxacine.

Pefloxacine 800 mg single dose was given as routine treatment after a cystomanometric examination to a 45-year-old woman with a 30-month history of generalized myasthenia gravis. One hour after, the patient developed exacerbation of myasthenia gravis with bilateral ptosis and an increased generalized weakness. She experienced a rapid improvement during the next 8 hours and physical examination returned to normal within one day. No additional factors which might have contributed to the exacerbation of myasthenia gravis were found. The report of exacerbation of myasthenia gravis with other antibiotic belonging to the group of fluoroquinolones (ciprofloxacin, norfloxacin and ofloxacin) prompt us to recommend caution with the use of all fluoroquinolones in myasthenic patients.