Une cause de difficulté de sevrage de la ventilation artificielle: la polyneuropathie de réanimation

Three cases of Critically Illness Polyneuropathy (CIP) are reported. The difficulty of weaning the patients from the ventilator, whereas sepsis and MOF had been successefully treated, was the main feature in the three cases. The diagnosis was established by electromyogram, showing a primary axonal denervation of peripheral nerve fibres, which was confirmed by a pathological study in one patient.     

Choix de la prothèse du genou en fonction de la perte de substance osseuse

Résumé Lors de la pose d'une prothèse totale du genou, un déficit osseux peut apparaître. Cette perte de substance osseuse peut se décomposer en une perte de substance réelle et une perte de substance virtuelle, suivant qu'il s'agit d'une véritable perte du stock osseux ou d'une fausse perte de substance, un vide, un espace, créé artificiellement par la correction d'une déformation extra-articulaire. Pour obtenir un alignement prothétique correct, il sera indispensable de compenser la totalité de ces pertes de substance osseuse, que nous appelons perte de substance globale. Or, si la correction d'une déviation du genou entrainée par une usure osseuse ne perturbe en rien l'équilibre ligamentaire, retrouvé facilement par le relâchement des ligaments rétractés (relâchements de normo-correction), le redressement d'une déformation pré-existante à l'arthrose va nécessiter des relâchements d'hypercorrection, modifiant considérablement la balance ligamentaire. Ainsi, suivant la part respective de ces deux composantes, réelle et virtuelle, la compensation de la perte de substance globale risque de perturber la cinématique du genou prothésé. Il nous apparaît donc que, selon les caractéristiques de la perte de substance osseuse, le choix de la prothèse mise en place se portera sur un modèle qui respecte les deux ligaments croisés, ou conserve le ligament croisé postérieur, ou au contraire sacrifie le pivot central, ou même, au besoin, protège ou remplace les ligaments latéraux.     

Consecuencias renales de la hipertensión intraabdominal en modelo porcino. Búsqueda de la técnica indirecta de elección de la medida de la presión intraabdominal

ObjectiveTo study the effects on the renal system in a porcine model of intraabdominal hypertension, and to determine the indirect technique of choice for determination of the intraabdominal pressure.Material and methods30 pigs were used divided in two groups according with increased intraabdominal pressure values (20 mm Hg and 30 mm Hg). In both groups pressures were registered 8 times, summing up to 3 hours, with a CO₂ insufflator. Three different measures of the intraabdominal pressure were taken: a direct transperitoneal measure, using a catheter of Jackson-Pratt connected to a pressure transducer, and two indirect measures, a transvesical by means of a Foley to manometer system, and a transgastric by introducing in the stomach a catheter connected to a pressure monitor with electronic hardware. Mean arterial pressure was calculated, along with the cardiac index, production of urine and serum creatinine.ResultsThere was a greater correlation between the transvesical and the transperitoneal intraabdominal pressures (R² = 0,95). Average transgastric intraabdominal pressure was inferior to the transperitoneal indicator in all taken measurements. The average arterial pressure descended in both groups, with earlier significant differences observed at 30 mm Hg (p < 0,020). Urine production was lower at 30 mm Hg compared with the 20 mm Hg group (9,63 ± 1,57 versus 3.26 ml ± 1,73). Serum creatinine increased in both groups being pathological at 30 mm Hg after 1 h 20 min, with existing differences between early pressures (p < 0,027).ConclusionsThis study revealed marked renal affectation with higher severity at 30 mmHg pressures. The transvesical technique showed a greater correlation with the direct measurement technique used, defining this as the method of choice for determination of intraabdominal pressure.     

Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature

Background and purposeParagangliomas of the cauda equina are rare tumors. The standard treatment is surgical resection. Our study aims to compare our clinical, radiological, prognostic data to the literature and to offer management and follow-up recommendations.MethodsIn this retrospective study, six patients with paraganglioma of the cauda equina region were treated. Symptoms included radicular nerve pain and low back pain with occasional sphincter dysfunction and motor deficit. MRI showed well-circumscribed lesions with homogeneous enhancement following gadolinium injection. Treatment involved complete surgical resection of the tumor under electrophysiological control. In addition to the characteristics of the tumor, we assessed operating results as well as postoperative morbidity and follow-up.ResultsAll patients had complete removal of the tumor, which required in most cases the resection of the carrying root. The intervention allowed a regression of the initial symptoms, with possible postoperative regressive sphincter disorders. Clinical and radiological follow-up (19 months on average), showed no tumor recurrence.ConclusionsThe reference treatment of these tumors is complete surgical resection, usually requiring the sacrifice of the carrying nerve root. Intra-operative nerve roots stimulation is recommended to reduce the risk of motor deficit linked to this radical treatment. A long-term clinical and radiological follow-up is recommended.     

Capacité de la biopsie de la prostate à prédire le score réel du cancer de la prostate?

ObjectiveTo evaluate the correlation between Gleason score at needle biopsy and prostatectomy specimen.Subjects and MethodsWe reviewed the records of 47 patients treated for prostate cancer by radical prostatectomy and the evaluation of the agreement was made according to the differentiation groups (well, moderately and poorly differentiated).ResultsThe concordance of the Gleason score was 70%, a sub-staging of 25.5%, and 4.2% for on-staging. For the positive predictive value (PPV), well differentiated group was 81.25% and 100% for moderately differentiated group. The Kappa concordance coefficient was 0.36 with a better concordance observed in the moderately differentiated group.ConclusionThe biopsy Gleason score imperfectly reflects the one of radical prostatectomy specimens. However, these limits of staging must be understood in the determination of therapeutic strategies.     

Conflit sous-acromial : influence de la morphologie de la voûte acromiocoracoïdienne sur la valeur fonctionnelle de l'épaule

Subacromial impingement: influence of coracoacromial arch geometry on shoulder function. Objective. To look for correlations between radiological coracoacromial arch geometry and shoulder function in patients with subacromial impingement syndrome. Patients and methods. During a prospective study of the efficacy of arthroscopic subacromial decompression, we evaluated the function of the treated and contralateral shoulders using Constant's functional score and confronted the results to several radiographic parameters reflecting coracoacromial arch geometry. Results. Constant's score values were low (42±15) because of pain and a low level of activity. Males had significantly higher scores than females. Constant's score was unaffected (P>0.05) by patient age, the side, the level of activity, or the duration of symptoms, but was significantly influenced by the orientation of the acromion with respect to the scapular spine and to the vertical scapular axis. The preoperative Constant's score was significantly higher in patients with a more horizontal acromion (P=0.01). A very tight correlation was found between the preoperative Constant's score and the angle between the acromion and scapular spine (P=0.0003). Conclusion. Based on our results, we defined an open and a closed coracoacromial arch geometry. Coracoacromial arch geometry is correlated with shoulder function syndrome and can assist in the interpretation of rotator cuff impingement.