Two level Anterior Lumbar Interbody Fusion (ALIF) in a patient with a rare vascular malformation, a duplication of the inferior vena cava.

BACKGROUND: Anterior Lumbar Interbody Fusion is now a well-established procedure to treat degenerative lumbar disease. This approach has its own risks and each spine surgeon must understand the pitfalls that can be encountered when dealing with an anatomy variation of the vessels in order to be able to perform the safest possible procedure. CASE DESCRIPTION: We report the case of a 48 years old man with a rare vascular anatomy variation undergoing a two-levels L4-L5 and L5-S1 ALIF procedure through a right-sided retroperitoneal approach. The preoperative imaging planning revealed a duplication of the Inferior Vena Cava (IVC) located on each side of the aorta. CONCLUSION: Preoperative Imaging evaluation and a detailed knowledge of the anatomy is the key of a safe and successful procedure as any variation can complicate the anterior approach. We believe that teaming up with a vascular surgeon for junior surgeons during the first anterior procedures and especially in the context of anatomical variation is recommended.

The 'ins' and 'outs' of intermediate filament organization.

A major function shared by several types of cytoplasmic intermediate filaments (IFs) is to stabilize cellular architecture against the mechanical forces it is subjected to. As for other fibrous cytoskeletal arrays, a crucial determinant of this function is the spatial organization of IFs in the cytoplasm. However, very few crossbridging proteins are specific for IFs - most IF-associated proteins known to exert a structural role act to tether IFs to other major cytoskeletal elements, such as F-actin, microtubules or adhesion complexes. In addition, IFs are endowed with the ability to participate in their own organization. This intriguing property is probably connected to the unusual degree of sequence diversity and sequence-specific regulation that characterize IF genes and their proteins. This dependence upon a combination of extrinsic and intrinsic determinants contributes to distinguish IFs from other fibrous cytoskeletal polymers and is key to their function.

The nonhelical tail domain of keratin 14 promotes filament bundling and enhances the mechanical properties of keratin intermediate filaments in vitro.

Keratin filaments arise from the copolymerization of type I and II sequences, and form a pancytoplasmic network that provides vital mechanical support to epithelial cells. Keratins 5 and 14 are expressed as a pair in basal cells of stratified epithelia, where they occur as bundled arrays of filaments. In vitro, bundles of K5-K14 filaments can be induced in the absence of cross-linkers, and exhibit enhanced resistance to mechanical strain. This property is not exhibited by copolymers of K5 and tailless K14, in which the nonhelical tail domain has been removed, or copolymers of K5 and K19, a type I keratin featuring a short tail domain. The purified K14 tail domain binds keratin filaments in vitro with specificity (kD approximately 2 microM). When transiently expressed in cultured cells, the K14 tail domain associates with endogenous keratin filaments. Utilization of the K14 tail domain as a bait in a yeast two-hybrid screen pulls out type I keratin sequences from a skin cDNA library. These data suggest that the tail domain of K14 contributes to the ability of K5-K14 filaments to self-organize into large bundles showing enhanced mechanical resilience in vitro.

Cytoskeleton: missing links found?

The quest for the function of BPAG1, a major hemidesmosomal protein of skin keratinocytes, has led to the discovery of a group of protein isoforms derived from the same genomic locus that are involved in organizing and integrating cytoskeletal networks in sensory neurons.

Acute isodense subdural hematoma on computed tomography scan--diagnostic and therapeutic trap: a case report.

BACKGROUND: Post-traumatic acute subdural hematomas generally appear hyperdense on a computed tomography scan. In the hyperacute stage, a subdural hematoma in rare cases appears heterogeneous with isodense images. This can pose a diagnostic problem and compromise patient care. Here we report a case of an isodense subdural hematoma and its management. CASE PRESENTATION: We report the case of a 59-year-old white European man who had a serious head injury with an acute subdural hematoma. The trauma was also responsible for blood loss and hemostasis disorders. A cerebral computed tomography scan revealed an isodense subdural hematoma. Our intervention confirmed that it was an acute hematoma. CONCLUSIONS: This unusual isodense appearance is due to anemia. It can be the cause of misdiagnosis and incorrect treatment choices.

[Interferon alpha-2a treatment of 26 patients with chronic non-A non-B hepatitis. Predictive factors of response]. / Traitement par l'interféron alpha-2a de 26 cas d'hépatites chroniques non A-non B. Etude des facteurs prédictifs de réponse.

The type and predicting factors of response to alpha interferon therapy have been studied in 26 patients with chronic non-A non-B hepatitis. Interferon was administered three times weekly during 6 months at a dose of 3 millions units/day. Eleven patients (42 percent) had serum alanine aminotransferase levels below 1.5 times the upper limit of normal range at the end of treatment. Only eight (31 percent) patients had persistent normalization of seric alanine aminotransferase value, 6 months after the end of the interferon treatment. The main factors involved in the response to therapy were age, apparent duration of the disease, and mode of contamination: patients who responded to interferon were younger, had a shorter duration of hepatitis and a parenterally transmitted disease.

[Spontaneous esophageal perforation. Radiological diagnosis]. / Perforation oesophagienne spontanée. Diagnostic radiologique.

Esophageal perforations are rare and usually occur after instrumentation. We relate here a case unsuspected spontaneous esophageal perforation. Computed chest tomography firstly showed signs of mediastinal abscess. Secondary barium meal confirmed the diagnosis.

[Listeria monocytogenes liver abscess. In a diabetic patient]. / Abcès du foie à Listeria monocytogenes. Chez une malade diabétique.

Most liver abscesses are caused by Enterobacteriaceae, sometimes associated with anaerobes. Listeriosis is an exceptional cause of liver abscess, usually in a context of disseminated infections. We report the case of a diabetic woman who had liver abscess due to Listeria monocytogenes. The organism was isolated after guided needle aspiration, and there was no other site of infection. The course of the disease gradually moved towards recovery under an antibiotic therapy that was based on sensitivity tests. A search for immunodeficiency proved negative. A review of the literature showed that the rare cases of listerial liver abscess share a common factor, diabetes mellitus, the importance of which has not yet been noticed.

[Portal hypertension: a rare cause of hematuria]. / L'hypertension portale: une cause rare d'hématurie.

A patient with undiagnosed cirrhosis presented with massive haematuria 16 years after augmentation colonoplasty. Portal hypertension (PHT) was responsible for a portocaval collateral circulation with vesical varices detected by low pressure endoscopy performed between episodes of haematuria. A very similar case was published in 1991. Surgical haemostatis with partial or total resection of the colonoplasty was only temporarily effective in our patient, who subsequently underwent liver transplantation due to repeated episodes of hepatic encephalopathy. No recurrence of haematuria was observed six years after the diversion. This rare cause of haematuria must be considered in view of the widespread use of intestinal conduits in urology: a dozen cases have been reported after transileal cutaneous ureterostomy, occurring an average of 3 years after the operation. Direct treatment of the varices, either by surgical devascularisation or resection or be endoscopic laser sclerosis or coagulation, is only temporarily effective. Treatment of the PHT appears to be the most effective measure in the long term: beta-blockers administered in the absence of episodes of haematuria or portal by-pass surgery in the case of failure.

[Orbital tumors. Neurosurgical activity]. / Tumeurs orbitaires. Activité neurochirurgicale.

In this chapter, we report the results of orbital tumor management in a few neurosurgical departments and compare it to a Paris neurosurgical department that has developed a close relation with an ophthalmological department. These departments' activity is quite low, treating mainly sphenoorbital meningiomas. Other tumor groups are unequally and sporadically managed.