Aspect pseudotumoral d’une tuberculose sacrée

Isolated tuberculosis of the sacrum in a 43-year-old woman manifested as functional impairment of the right lower limb. Sacral tuberculosis is rare in patients with no history of tuberculosis. Another unusual feature was the tumor-like aspect of the lesion, with diffuse, ill-defined osteolysis of a large part of the sacrum and extension to the presacral soft tissues responsible for rectal displacement.     

Spoliations sanguines liées aux prélèvements en réanimation. Étude préliminaire

ObjectiveTo assess the volume of blood samples withdrawn for laboratory testing in intensive care unit (ICU) patients and to determine the influence of the resulting blood loss on transfusion requirements in patients staying in the ICU for more than seven days.Study designProspective clinical open study.PatientsFifty patients treated in the ICU over the 3-month study period, neither admitted for a systematic postoperative monitoring, nor experiencing bleeding or haemolysis.MethodsFor each patient the following data were obtained: duration of ICU stay, volume of the daily withdrawn blood, the concentration of haemoglobin (Hb) at the time of ICU admission, ICU discharge and before each transfusion, volume of transfused blood.ResultsA mean volume of 62 ± 29 mL·d⁻¹ of blood was taken. It decreased from 85 ± 6 mL on admission day, to 66 ± 6 mL after seven days and 60 ± 8 mL after 14 days. About 27% of the withdrawn blood was rejected (initial blood reflowing through cannula and connection tube). Twenty-one patients (42%) had a length of stay greater than 7 days. In this population, a first group (13/21) was given transfusions of packed red cells during their hospitalisation and a second group (8/21) was not transfused. The mean volume of blood taken per day (67 ± 21 mL·d⁻¹ vs 55±15 mL·d⁻¹) and the total volume (1,204 ± 810 mL vs 810 ± 389 mL) were not significantly higher in the transfused group. Conversely, the mean haemoglobin concentration on ICU admission (97 ± 22 g·L⁻¹ vs 136 ± 26 g·L⁻¹) was significantly lower (P= 0.001) in the transfused patients.ConclusionBlood losses from blood withdrawal for laboratory tests are important and in agreement with the results of other reports. It is generally accepted that iatrogenic blood loss of this magnitude can cause anaemia if repeated over a prolonged period. Conversely, our data suggest that blood sampling does not contribute significantly to anaemia and transfusion requirements in patients with a prolonged ICU stay.     

L’électrostimulation des racines sacrées dans le traitement de l’incontinence anale

Functional deficits of the striated anal sphincteric muscles without any apparent gross defect often result in a lack of ability to postpone defecation by intention or in faecal incontinence in response to increased intra-abdominal or intrarectal pressure. We applied electrostimulation to the sacral spinal nerves to increase function of the striated muscles of the anal sphincter. Of three patients followed for six months, two-gained full continence and one improved from gross incontinence to minor soiling. Closure pressure of the anal canal increased in all. Preliminary data indicate that anal closure pressure increases with of the stimulation. Continuous stimulation of sacral spinal nerves can help some patients with faecal incontinence. It may be possible to promote continence with intermittent stimulation.     

Symposium Medtronic: traitement de l’incontinence fécale avec la neuromodulation sacrée: environnement fran?ais: neuromodulation sacrée: indications et mise en pratique

Résumé / Abstract

Symposium Medtronic: traitement de l’incontinence fécale avec la neuromodulation sacrée: environnement fran?ais: neuromodulation sacrée: indications et mise en pratique     

Manipulations cervicales et principe de précaution

Cervical spine manipulation and the precautionary principle. Cervical manipulations can cause severe neurological complications, which are both exceedingly rare and generally unpredictable. To meet the requirements of the principles of prevention and precaution, we believe the number of cervical manipulations should be reduced. To this end, we suggest that five recommendations developed by consensus be followed: unwanted effects, however minor, of previous manipulation should be looked for routinely and taken as absolute contraindications to further manipulation; a thorough physical examination, including a neurological evaluation, should be performed prior to manipulation; all known contraindications and indications should be followed; manipulation should be performed only by physicians experienced in this technique; and special caution should be exercised when performing first-line cervical manipulation.