<b><span style="font-family:Verdana;">Introduction: </span></b>Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs ...<b><span style="font-family:Verdana;">Introduction: </span></b>Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs by isolated headache, following post spinal puncture headache (PSPH). We report a case of cerebral venous thrombosis complicating PSPH, following <span>a spinal</span> anesthesia. <b><span>Observation:</span></b><span> A 23-year-old man was admitted to the emergency room for</span> PSPH appeared 6 hours after a spinal <span>aesthesia</span> for removal of osteosynthesis equipment from the<span style="font-family:Verdana;"></span><span style="font-family:;" "=""> right tibial plateau. The headache was <span>fronto</span>-occipital, relieved by lying down. Six days later, <span>headache</span> became permanent, not relieved by morphine, associated with vomiting. The neurological examination was normal. Brain magnetic resonance Magnetic venography showed superior sagittal sinus and right transverse sinus thrombosis. After administration of low molecular weight heparin at curative dose, and warfarin under INR control, the evolution was marked by a rapid regression of headaches on the same day. After a 1-year <span>setback,</span> the patient was asymptomatic. <b>Conclusion:</b> CVT is a rare complication of spinal anesthesia and potentially severe if diagnosed lately. Urgent brain imaging must be performed for any atypical headache or the onset of neurological disorders so as not to misunderstand cerebral vein thrombosis. Controlling the spine anesthesia would reduce the inadvertent perforation of the dura-mother that would lead to CVT complicating post spinal puncture headaches.</span>展开更多
Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar...Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Phylloid sarcomas are rare. There is not enough data...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Phylloid sarcomas are rare. There is not enough data to codify the management. </span><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> The objective was to study the clinical and therapeutic aspects and the fate of patients after a follow-up of at least 4 years. Thus contributing to the limited body of knowledge on these tumors. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> a retrospective analysis of the files from 2013 to 2017 was carried out and patients were followed up until 2021at Hassan II Hospital. Epidemiological, clinical and therapeutic aspects were studied. Survival was calculated using the Kaplan-Meier method. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We collected 12 charts of patients treated for phyllodeal sarcoma from 2013 to 2017. The median age was 43 years. The circumstance of discovery was marked by the presence of nodule in all patients. The coupled echo-mammography examination classified the nodules, ACR 4 in 7 patients and ACR 3 in 3 and ACR 5 in 2 patients. Histological examination revealed a phylloid sarcoma in 11 patients and a borderline phylloid tumor in 1 patient. All patients had radical surgery with positive margins in 2 patients, 16.66%. One patient had revision surgery. Histological examination of the surgical specimens showed phylloid sarcoma on all specimens. All patients had adjuvant radiotherapy with doses of 50 Gy in 25 fractions of 2 Gy and a boost of 10 Gy was done in one patient. The median spread of radiotherapy was 37 days. Grade 1 and 2 skin toxicities were noted in 5 and 3 patients respectively. The median time from surgery to radiotherapy was 2.95 months. 3 patients relapsed after 13.6 months of follow-up. The recurrence-free survival at 1 and 3 years was 83% and 75% respectively. Overall survival at 3 and 5 years was 83% and 75% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> This is a rare entity which requires randomized trials to codify its manage</span><span style="font-family:Verdana;">ment. It would seem that the multidisciplinary approach, associating surgery</span><span style="font-family:Verdana;"> ± radiotherapy, is a good option.</span></span></span></span>展开更多
文摘<b><span style="font-family:Verdana;">Introduction: </span></b>Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs by isolated headache, following post spinal puncture headache (PSPH). We report a case of cerebral venous thrombosis complicating PSPH, following <span>a spinal</span> anesthesia. <b><span>Observation:</span></b><span> A 23-year-old man was admitted to the emergency room for</span> PSPH appeared 6 hours after a spinal <span>aesthesia</span> for removal of osteosynthesis equipment from the<span style="font-family:Verdana;"></span><span style="font-family:;" "=""> right tibial plateau. The headache was <span>fronto</span>-occipital, relieved by lying down. Six days later, <span>headache</span> became permanent, not relieved by morphine, associated with vomiting. The neurological examination was normal. Brain magnetic resonance Magnetic venography showed superior sagittal sinus and right transverse sinus thrombosis. After administration of low molecular weight heparin at curative dose, and warfarin under INR control, the evolution was marked by a rapid regression of headaches on the same day. After a 1-year <span>setback,</span> the patient was asymptomatic. <b>Conclusion:</b> CVT is a rare complication of spinal anesthesia and potentially severe if diagnosed lately. Urgent brain imaging must be performed for any atypical headache or the onset of neurological disorders so as not to misunderstand cerebral vein thrombosis. Controlling the spine anesthesia would reduce the inadvertent perforation of the dura-mother that would lead to CVT complicating post spinal puncture headaches.</span>
文摘Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Phylloid sarcomas are rare. There is not enough data to codify the management. </span><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> The objective was to study the clinical and therapeutic aspects and the fate of patients after a follow-up of at least 4 years. Thus contributing to the limited body of knowledge on these tumors. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> a retrospective analysis of the files from 2013 to 2017 was carried out and patients were followed up until 2021at Hassan II Hospital. Epidemiological, clinical and therapeutic aspects were studied. Survival was calculated using the Kaplan-Meier method. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We collected 12 charts of patients treated for phyllodeal sarcoma from 2013 to 2017. The median age was 43 years. The circumstance of discovery was marked by the presence of nodule in all patients. The coupled echo-mammography examination classified the nodules, ACR 4 in 7 patients and ACR 3 in 3 and ACR 5 in 2 patients. Histological examination revealed a phylloid sarcoma in 11 patients and a borderline phylloid tumor in 1 patient. All patients had radical surgery with positive margins in 2 patients, 16.66%. One patient had revision surgery. Histological examination of the surgical specimens showed phylloid sarcoma on all specimens. All patients had adjuvant radiotherapy with doses of 50 Gy in 25 fractions of 2 Gy and a boost of 10 Gy was done in one patient. The median spread of radiotherapy was 37 days. Grade 1 and 2 skin toxicities were noted in 5 and 3 patients respectively. The median time from surgery to radiotherapy was 2.95 months. 3 patients relapsed after 13.6 months of follow-up. The recurrence-free survival at 1 and 3 years was 83% and 75% respectively. Overall survival at 3 and 5 years was 83% and 75% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> This is a rare entity which requires randomized trials to codify its manage</span><span style="font-family:Verdana;">ment. It would seem that the multidisciplinary approach, associating surgery</span><span style="font-family:Verdana;"> ± radiotherapy, is a good option.</span></span></span></span>
