[Sexual disorders among spinal cord injury patients]. / Troubles sexuels chez les patients atteints de lésions médullaires.

OBJECTIVE: Spinal cord injury (SCI) can alter to varying degrees patients' sexuality. The goals of this study were to evaluate sexual dysfunctions (SD) among a sample of Tunisian patients with SCI and to determine the associated factors. METHODS: A cross-sectional descriptive study was conducted on a sample of 30 patients with SCI. Sexuality was evaluated by : Male Sexual Quotient (MSQ) and Sexual Health Inventory for Men (SHIM). Other parameters were collected : sociodemographic, clinical, functional capacity, psychological profile and quality of life (QoL) (Short-Form 36 SF36). RESULTS: The mean age was 41±9.6 years (23-56). The frequency of SD in this study was 69.2 %. The most affected items in the MSQ (76 %) were erection, orgasm, seduction and performance. The SD were associated with alteration of SF36 domains. We noted positive correlations on the one hand between the MSQ score and the role physical (RP) and general health (GH) sub scores of SF36 and on the other hand between the SHIM and the sub scores RP, mental and physical component score (MCS and PCS). The MSQ score was negatively correlated with the HAD score. No other associations were noted. CONCLUSION: Our study showed a high frequency of SD in SCI patients including Tunisians. SD were mainly associated with impaired QOL and the anxio-depressive profile. The absence of other associations could be explained mainly by the peculiarity of our culture which still considers sexuality and SD as a taboo and secondary subject.

Osteolytic clear cell meningioma of the petrous bone occurring 36 years after posterior cranial fossa irradiation: Case report.

OBJECTIVE AND IMPORTANCE: While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. CLINICAL PRESENTATION: A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. INTERVENTION: As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. CONCLUSIONS: To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration.

Editor's Choice - Minimizing Radiation Exposure During Endovascular Procedures: Basic Knowledge, Literature Review, and Reporting Standards.

CONTEXT: Endovascular procedures, requiring X-ray guidance, are commonly performed in vascular surgery. X-ray exposure is associated with biological risks for both patients and physicians. Medical X-ray use must follow "as low as reasonably achievable" (ALARA) principles, which aim at using the lowest radiation exposure to achieve a procedure safely. This is underlined by European and international recommendations that also suggest that adequate theoretical and practical training is mandatory during the initial education of physicians. However, the content of this education and professional practices vary widely from one country to another. OBJECTIVE: This review aims to summarize the basic knowledge required for vascular surgeons on X-ray physics and image production. METHODS: A panel of endovascular therapists (vascular surgeons and radiologists) and physicists dedicated to X-rays was gathered. International recommendations were summarized. A literature review was performed via MEDLINE to identify studies reporting dosages of common endovascular procedures. RESULTS: The different mechanisms inducing biological risks, and the associated potential effects on health, are described. Details on dose metrics are provided and a common nomenclature to measure, estimate, and report dose is proposed in order to perform accurate comparisons between publications and practices. Key points of the European and international legislation regarding medical X-ray use are summarized, and radiation protection basics for patients and staff, are detailed. Finally, a literature review is proposed for physicians to evaluate their practice. CONCLUSIONS: Today's trainees will be highly exposed to radiation throughout their practice. It is thus compulsory that they undergo dedicated radiation education during their initial training, and regular refresher sessions later. In daily practice, focus on dose reduction and monitoring of patient and staff exposure are mandatory.

Embolization of peripheral high-flow arteriovenous malformations with Onyx.

PURPOSE: The aim of this study was to report our experience in embolization of high flow peripheral arteriovenous malformations (AVMs) with Onyx. MATERIAL AND METHODS: Nineteen patients (10 men, 9 women) with peripheral high-flow AVMs who were treated with arteruial embolization using Onyx were retrospectively included. AVMs were located in the head and neck (6), extremities (5), chest (2), kidney (2), uterus (2), pelvis (1) and parietal (1). In 13 patients, embolization was done using Onyx only. One patient underwent embolization by direct puncture, the others by transarterial approach. Embolization was performed in one or multiple sessions (up to 5). A total of 28 sessions were performed. Follow-up was performed with a delay between 10 and 34 months. RESULTS: Technical success was achieved in all patients. Complete devascularization was obtained in 12 patients. Surgical excision was performed in 9 patients. Non-target Onyx embolization was not observed. One patient developed stroke. In 1 patient microcatheter fracture occured. One patient presented severe pain and bradycardia during the procedure that disappeared shortly after. One patient had persistent but less frequent epistaxis after embolization. Another patient had persistent pain without improvement. One patient was lost to follow-up. Other patients were free of symptoms on follow-up. CONCLUSIONS: Embolization with Onyx® is an interesting option for management of peripheral high-flow AVMs either preoperatively or as a single treatment.

Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations.

PURPOSE: The purpose of this study was to evaluate the effectiveness of ethylene vinyl alcohol copolymer (Onyx) as a single embolic agent for percutaneous arterial treatment of hemorrhage due to uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: Twelve women (mean age, 33 years) with metrorrhagia due to uterine AVMs who were treated by percutaneous arterial embolization using Onyx as a single embolic agent were retrospectively included. The diagnosis of uterine AVM was suggested by pelvic ultrasound and/or magnetic resonance imaging findings and further confirmed by angiography. Clinical files and angiographic examinations were reviewed for angiographic findings, technical and clinical success, procedure complication and further pregnancies. Clinical success was defined by absence of metrorrhagia at 1 month following embolization. RESULTS: Sixteen arterial embolization procedures were performed. Angiographically, 6 women had high flow AVM and 6 had low flow AVM. The rate of technical and clinical success was 92% (11/12 patients). One woman with early repeat hemorrhage underwent two embolization procedures and further hysterectomy. No severe complications were observed after embolization. Three women (3/12; 25%) became pregnant following embolization including one full term pregnancy. CONCLUSION: In women with metrorrhagia due to AVM, arterial embolization with Onyx is effective and safe. Additional research is needed to confirm the possibility of future pregnancy after Onyx embolization.

Congenital neuroblastoma presenting with paraplegia following spinal puncture in a neonate. Case report and review of the literature.

Neuroblastoma is the most common intraspinal solid tumor of childhood. Neurological deterioration due to an intratumoral hemorrhage following a spinal puncture is extremely rare. We report on the case of a 23-day-old neonate who was admitted to our institution for the onset of a paraplegia following a diagnostic lumbar puncture. The MRI showed an epidural tumor with massive intratumoral hemorrhage. Operatively and with histologic confirmation, the mass was determined to be a neuroblastoma. Following surgery, neurological function improved.

Preclinical study on an animal model of a new non-adhesive cyanoacrylate (Purefill®) for arterial embolization.

PURPOSE: The goal of this study was to assess the distal dispersion, the adhesion strength to catheter, the vascular toxicity and the ability in excluding embolized vessels using Purefill® (α-hexil-cyanoacrylate) as embolic material, which is a new high purity cyanoacrylate and compare these results with those obtained with N-butyl-2-cyanoacrylate (Histoacryl®) and a mixture of N-butyl-2-cyanoacrylate and methacryloxysulfolane. MATERIAL AND METHODS: In six pigs, the right rete mirabile (RM) and right renal arteries were embolized with α-hexil-cyanoacrylate, and the left rete mirabile and left renal artery were embolized with N-butyl-2-cyanoacrylate and N-butyl-2-cyanoacrylate+Methacryloxysulfolane for comparison. One minute after glue injection through the microcatheter, displacements of the kidney and the pharyngeal artery were measured on angiographic images, before exercising any traction and during catheter pulling, when the forces were maximal. Displacement was measured in terms of distance (mm) with respect to renal pedicles and in terms of angle (°) with respect to the rete. After acute embolization (4 pigs) or three-month follow-up (2 pigs), the kidneys and the RM were removed and further analysed using computed tomography and histopathological examination. RESULTS: Similar short and long-term embolic efficacies were observed with the three glues. The mean displacement distances of renal pedicles were 2.6mm for α-hexil-cyanoacrylate, 22.6mm for N-butyl-2-cyanoacrylate and 19.8mm for N-butyl-2-cyanoacrylate+Methacryloxysulfolane (P=0.021). The mean angles of displacement of the ascending pharyngeal arteries were for 12.2° for α-hexil-cyanoacrylate, 23.5° for N-butyl-2-cyanoacrylate and 30° for N-butyl-2-cyanoacrylate+Methacryloxysulfolane (P=0.070). Histopathologically, findings were similar for the three glues, immediately and 90 days after embolization. CONCLUSION: α-hexil-cyanoacrylate has occlusive efficacy in the short and long term similar to those of N-butyl-2-cyanoacrylate and N-butyl-2-cyanoacrylate+Methacryloxysulfolane. In addition, histopathological changes are similar with the three glues immediately or 90 days after embolization. Conversely, α-hexil-cyanoacrylate results in a reduced angle and distance of displacement compared to the other two glues, assumably reflecting a limited adhesive strength.

Cavernous hemangioma of the skull and meningioma: association or coincidence?

Intraosseous cavernous hemangiomas of the skull are rare. Meningiomas are quite frequently encountered in a neurosurgical practice. The association between these two entities is nevertheless very uncommon. The authors present a case of a 72-year-old woman suffering from headache. The MRI showed a parietal meningioma with adjacent thick bone. The meningioma and the bone were removed. The histological examination confirmed the diagnosis of meningioma and revealed a cavernoma of the skull. The relationship between the lesions suggests more than a coincidental association. Several hypotheses are proposed to explain common causal connections.

Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: indications, advantages and limitations.

Onyx(®) is a remarkable liquid embolizing agent that may allow a well-trained operator to undertake challenging embolization procedures. In multiple interventional radiology indications, the physico-chemical properties of Onyx(®) allow safe embolization. The purpose of this article is to review the advantages and disadvantages of Onyx(®) and identify its main indications.

Selected kinematic characteristics of intercollegiate women triple jumpers.

Eight women triple jump finalists at the 1986 Big Ten Track and Field Championships and 10 women triple jump finalists at the 1986 National Track and Field Competition were filmed during competition. Among selected kinematic characteristics, the following high correlations (r greater than 0.70) were found: the distance of the hop phase correlated highly with the total jump distance; the horizontal position of the center of gravity of the body in relation to the support foot at takeoff correlated highly with the distance of the hop and the jump phases; the horizontal velocity into the step phase correlated highly with the total distance of the jump; the vertical velocity into the hop and step phases correlated highly with the respective phase distance; and there was an inverse correlation between the maximum height of the center of gravity during the flight phase of the step and the total distance. A significant difference was found between men and women triple jumpers in relation to the contribution of the step phase to the total distance of the jump (men, means = 29.5, SD = 1.46; women, means = 26.7, SD = 2.94; P less than 0.05). All remaining relationships among the kinematic variables studied were found to be not significant at P less than 0.05 or were less than r = 0.70. The phase ratios of current women triple jumpers were similar to ratios that have been reported for the novice athlete.

Epidemiology of tropical theileriosis (Theileria annulata infection of cattle) in an endemic region of Tunisia: characterisation of endemicity states.

A serological survey on tropical theileriosis was conducted on a sample of 54 farms in a region within the semi-arid bioclimatic zone of Tunisia. Screening of cattle sera at a dilution of 1/160 using the indirect immunofluorescent antibody test with the schizont antigen of Theileria annulata, revealed the presence of animals with positive sera in 92.15% of the sampled farms. The exposure of calves to infection in the first season was shown to be significantly lower than in older cattle. Three endemic situations were identified based on the serological profiles of herds and the incidence and age distribution of disease cases. Endemic stability was observed in farms showing a sero-prevalence of 100% in cattle of four theileriosis seasons or more and by the incidence of the highest disease levels in cattle at their second and third theileriosis season. High endemic instability was identified on the basis of low sero-prevalence rates and the occurrence of the highest disease incidence in cattle at fourth theileriosis season or more.

[Leishmania infantum MON-1: the only zymodeme isolated in canine leishmaniasis in Tunisia]. / Leishmania infantum MON-1: seul zymodème isolé chez les chiens leishmaniens en Tunisie.

Iso-enzymatic characterization of 19 Leishmania strains isolated from Tunisian dogs revealed that all correspond to Leishmania infantum MON-1. This confirms the role of dog as a reservoir of the commonest zymodeme responsible for human visceral leishmaniasis in the Mediterranean basin. However, and in spite of the high number of identifications, many zymodemes, mainly the dermotropic ones as Leishmania infantum MON-24, frequently reported in humans, had never been isolated from dogs. The study of their cultural characteristics may contribute to explain the particular iso-enzymatic profile of dogs strains.

Does ascorbic acid protect against vanadium neurotoxicity in different regions of rat brain?

OBJECTIVE: Ascorbic acid is a powerful antioxidant and protects against lipid peroxidation in cerebral membrane. The objective of the study was to investigate protective effects of ascorbic acid on lipid peroxidative damage and perturbation of enzymes, glucose-6-phosphate dehydrogenase (G6PDH) and acetylcholinesterase (AChE) in discrete regions of rat brain after vanadium exposure. METHODS: This study was carried out at Al-Arab Medical University, Benghazi, Libya, from 1995 to 1996. To investigate the effect of this vitamin on vanadium neurotoxicity in brain, adult rats were injected with L-ascorbic acid (1.0 g/kg body weight) and elemental vanadium (2.5 mg/kg body weight) alone or concomitantly for 8 consecutive days by the intraperitoneal route. RESULTS: Vanadium intoxication significantly enhanced the occurrence of lipid peroxidation in discrete regions of rat brain. The increase in lipid peroxidation was inhibited by ascorbic acid treatment. On the other hand, ascorbic acid content was higher, but the activity of G6PDH and AChE was significantly inhibited in discrete regions of rat brain after vanadium neurotoxicity. Interestingly, however, co-administration (L-ascorbic acid + vanadium) reversed the levels of ascorbic acid together with the activity of G6PDH and AChE towards normal values. The neurohistopathology showed that vanadium is involved in an interaction with myelin and deleterious effect of metal resulted in edema and marked vacuolation of white matter or segmental de-myelinantion in the hypothalamus region of rat brain. Ascorbic treatment, however, did not show any effect on histopathological changes. CONCLUSION: These results suggested that vanadium neurotoxicity initiated lipid peroxidative damage and interferes with enzymes, G6PDH and AChE, in rat brain. These events may lead to sensorimotor dysfunctions and axonal degeneration. On the other hand, ascorbic acid therein reduced the toxicity of vanadium.

[Evaluation of two DNA probes specific for Leishmania infantum in the diagnosis of canine leishmaniasis]. / Evaluation de deux sondes ADN spécifiques de Leishmania infantum dans le diagnostic de la leishmaniose canine.

This study reports on the evaluation of two L. infantum specific DNA probes for the diagnosis of canine leishmaniasis. The probes presented very satisfying performances in terms of specificity (100%) and predictive value of the positive result (100%). However, their sensitivity (35.3%) and the clinical complexity of canine infections render their use difficult in epidemiological surveys of visceral leishmaniasis aiming at measuring the prevalence of the dog infection by L. infantum. The sensitivity of these tools has improved (66.7%) when dogs presenting patent leishmaniasis were considered. Such probes constitute appropriate tools to confirm suspected cases of leishmaniasis. Unlike the classical parasitological and serological tools, this kind of tools allows a concomitant detection and identification of the causative agent. Therefore, despite their low sensitivity, these probes can still be of importance in epidemiological investigations.

Techniques to reduce radiation and contrast volume during EVAR.

There is a large variability observed in the literature regarding radiation exposure and contrast volume injection during endovascular aortic repair (EVAR). Reducing both in order to decrease their respective toxicities must be a priority for the endovascular therapist. Radiation dose reduction requires a strict application of the "as low as reasonably achievable" principles. Firstly, all X-ray system settings should be defaulted to low dose, and fluoroscopic time reduced as much as possible. Digital subtraction angiography runs should be replaced by recorded fluoroscopy runs when possible. Magnification should be avoided, whereas collimation should be systematic to minimize scatter radiation and focus only on the area of interest. Advanced imaging modes can also contribute to dose reduction. For instance, image fusion can facilitate endovascular navigation, and allow table and C-arm positioning without fluoroscopy. In our experience, routine use of image fusion during EVAR significantly reduces both radiation exposure and contrast volumes during complex EVAR. To make these imaging modes useable in real life settings, the X-ray system should be fully controlled by the operator from table side. Reducing iodinated contrast volume, while maintaining image quality, can also be achieved through the use of automated contrast injectors. Additionally, alternative contrast agents, like carbon dioxide (CO2) and gadolinium, have also been evaluated and can be used in specific cases. Contrast-enhanced ultrasound and intravascular ultrasonography are currently developed as potential alternatives to both iodinated contrast use and X-ray during EVAR. Lastly, specific education and training of operators in radiation protection are essential.

[Temporal lobe epilepsy due to an intracranial meningocele in a patient with neurofibromatosis type 1]. / Épilepsie temporale symptomatique d'une méningocèle intracrânienne chez une patiente atteinte de neurofibromatose de type 1.

Epilepsy has been rarely reported in patients with neurofibromatosis type 1 (formally known as von Recklinghausen disease), which may occur in 3 to 6% of cases. This condition is generally related to neuronal migration anomalies or cortical malformations. We report a case of temporal epilepsy secondary to temporal meningocele due to sphenoidal dysplasia in a patient who presented with neurofibromatosis type 1 and also discuss this association.