[Chronic headaches due to idiopathic cerebrospinal fluid hypotension treated with sphenopalatine ganglion block]. / Céphalées chroniques sur hypotension de liquide céphalorachidien idiopathique traitées par bloc sphénopalatin.

Sphenopalatine ganglion block (SPGB) is a well-known technique of anesthesia used for the treatment of many types of facial pain syndromes. Its utility in the treatment of headaches due to cerebrospinal fluid hypotension, caused by dural breach or not, seems established but the lack of strong studies proving its efficacy or its superiority compared to epidural blood patch doesn't allow it, for now, to be a part of the official treatment algorithm. We report the case of a patient presenting idiopathic cerebrospinal hypotension (Schaltenbrand syndrome) treated effectively with a sphenopalatine ganglion block using the intranasal approach.

Le bloc du ganglion sphénopalatin (BGSP) est une technique d'anesthésie connue de longue date et utilisée comme proposition de traitement dans de nombreux types de syndromes d'algie de la face. Son utilité dans le traitement des céphalées sur hypotension de liquide céphalorachidien, causées ou non par une brèche durale, semble établie. Cependant, l'absence d'études solides démontrant son efficacité ou sa supériorité par rapport au «blood patch¼ épidural ne permet pas, à l'heure actuelle, de lui donner une place précise dans l'algorithme de prise en charge. Nous rapportons le cas d'un patient présentant un syndrome d'hypotension intracrânienne idiopathique ou spontanée (syndrome de Schaltenbrand) ayant bénéficié d'un traitement efficace par bloc du ganglion sphénopalatin par voie intra-nasale.

[Current situation of breast reconstruction after breast cancer in Reunion Island]. / État des lieux de la reconstruction mammaire après cancer du sein sur l'Île de la Réunion en 2016.

OBJECTIVES: The aim of this study is to describe the current trends of breast reconstruction (BR) and breast oncoplasty (BO) for breast cancer patients in Reunion Island. METHODS: This is a multicenter retrospective descriptive study of all BR and BO surgeries in 2016. We studied the first stage of BR that corresponds to the choice of surgical technique. Patient's age, care center, technique and duration of surgery, complications and their risk factors were reviewed. Patient satisfaction was assessed using the modified BREAST-Q©. RESULTS: In 2016, BR rate over total mastectomy was 47.6% and BO rate was 6.3% over partial mastectomy. Among the 92 patients included, 25 immediate BR were performed (84% in private institution) and 44 delayed BR (67% in public hospital). Although prosthetic techniques were the most used, satisfaction seems to be better with autologous techniques. CONCLUSIONS: The ratio of BR is high in Reunion Island with a wide range of techniques but uneven practice. Conversely, BO's ratio is low and improvement is needed.

[Laparoscopic cervico-isthmic cerclage evaluation]. / Evaluation du cerclage isthmique par voie coelioscopique.

OBJECTIVE: The transabdominal cervico-isthmic cerclage could to be proposed in case of failure of vaginal cerclage, 2nd trimester fetal losses and cervical defects. The efficiency of the laparoscopic approach, more recently described, has to be demonstrated for the prevention of obstetrical accident. PATIENTS AND METHODS: This study is a retrospective monocentric evaluation of 14 laparoscopic cervico-isthmic cerclages performed with Benson modified technique before pregnancy between 2005 and 2007. Previous obstetrical accidents, etiology of cervical incompetence and patient outcome after cerclage were compared. RESULTS: Median age of the patients was 33.5 years; 93% had previous fetal losses or preterm delivery and 42.9% had failure of Mac Donald cerclages. The indication of laparoscopic cervico-isthmic cerclage was Mac Donald cerclage failure (six cases), and eight cases of anatomic incompatibility of Mac Donald cerclage. Mean duration of laparoscopic cervico-isthmic cerclage was 45 minutes. All patients were hospitalized on an outpatient basis. No operative complication was reported. Six women were pregnant after cerclage: five deliveries by caesarean section at term, and one first trimester foetal loss. DISCUSSION AND CONCLUSION: The cervico-isthmic cerclage can be easily performed by laparoscopy. The indications are strictly the same as cervico-isthmic cerclages by laparotomy. Increasing the number of term deliveries and the obstetrical outcome of these patients, the efficiency of the cervico-isthmic cerclage by laparoscopy is demonstrated.

Altitude, heart rate variability and aerobic capacities.

We analyzed the relationship between aerobic capacities and changes in heart rate variability (HRV) in Nordic-skiers during living high-training low (Hi-Lo). Eleven skiers trained for 18 days at 1200 m, sleeping at 1200 m (LL, n = 5) or in hypoxic rooms (HL, n = 6, 3 x 6 days at altitudes of 2500 - 3000 - 3500 m, 11 h . day (-1)). Measurements were performed before, during and two weeks after Hi-Lo. VO(2max), peak power output were not improved in HL nor in LL, whereas VO(2) and power at the respiratory compensation point (VO(2RCP) and PRCP) increased by 7.5 % and 5.0 % only in HL. Significant changes in HRV occurred only in LL, in the standing position, including a 30 % (p < 0.05) increase in resting heart rate (HR), a 50 % (p < 0.05) decrease in total spectral power (TP) and a 77 % (p < 0.05) decrease in high frequency activity (HF). When all the subjects were pooled, the changes in HRV in the supine position were correlated to the changes in aerobic capacities, i.e., HF, LF and TP were correlated to VO(2RCP) and HR, HF and TP were correlated to PRCP. This study confirms the relationship between HRV and changes in aerobic capacity, therefore highlighting the potential value of HRV for monitoring altitude training adaptations.

Anesthesia of a patient with an obstructing tracheal mass: a new way to manage the airway.

A case of upper airway obstruction due to thyroid tumor requiring surgery is presented. Successful establishment of an open tracheal airway was achieved by the insertion of an endotracheal stent and was followed 10 days later by tracheal resection and anastomosis.