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Solitary fibrous tumors (SFTs) of the spine are exceedingly rare tumors of mesenchymal origin. Most spinal SFTs arise from the thoracic spine, followed by cervical spine, and last lumbar spine with only 6 cases reported in literature. SFTs represent a wide range of neoplasms, ranging from benign to malignant. These tumors can develop a late recurrence, even after a decade or more of initial presentation, requiring long-term follow-up. We present a case of recurrent SFT of the lumbar spine with vertebral body involvement, presenting more than a decade after initial resection. It was initially misdiagnosed as a paraganglioma. To the best of our knowledge, there have been only 3 previous cases reporting SFT with vertebral body involvement.

B. Vallet *, Y. Blanloeil , B. Cholley , G. Orliaguet , S. Pierre , B. Tavernier a a Pole d’anesthesie reanimation, hopital Huriez, CHRU de Lille, rue Polonovski, 59037 Lille cedex, France b Service d’anesthesie-reanimation chirurgicale, hopital G.-et-R.-Laennec, CHU de Nantes, 44093 Nantes cedex 1, France c Service d’anesthesie-reanimation, hopital europeen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France d Service d’anesthesie-reanimation, hopital universitaire Necker–Enfants-Malades, universite Paris Descartes, Assistance publique–Hopitaux de Paris, 149, rue de Sevres, 75743 Paris cedex 15, France e Institut Claudius-Regaud, 20–24, rue du Pont-Saint-Pierre, 31052 Toulouse Cedex, France

Background In 2008, in France, 222 patients died because they did not receive the graft they expected. The main objective of this study was to determine the attitude of private practice physicians concerning organ donation. Methods A postal questionnaire was sent to all private practice office-based physicians in the Nord-Pas de Calais region. This questionnaire was elaborated with a panel of physicians and sociologists. It was sent with the monthly journal of the regional union of private physicians of June 2008. Results Two hundred and seventy eight questionnaires were returned. One hundred and thirty four (48.2%) respondents declared they knew what the regulations about organ donation were. The majority of respondents approved organ donation. Information to patients was provided during visits by 34.53% (96) of practitioners. For those who were knowledgeable about regulations, 50.75% of them talked about organ donation. Physicians who had already had experience with organ donation were more inclined to talk about it with other patients. The practitioners described three actions they felt could have a positive influence on family acceptance: providing information before death, talking about organ donation in an appropriate sensitive way, and relying on the confidence established by a solid patient-physician relationship. Conclusion Almost 90% of private physicians who responded to the survey were in favor of organ donation but only 34.5% delivered information and discussed the issue with their patients. The physicians coped with the topics more easily when they had experienced cases and when they were informed about existing regulations. A specific educational program on the current regulations and how to interact with patients on this subject during a visit could be a first answer to the problem and would be welcomed by practitioners.

To assess the difficulty in both laryngoscopy and tracheal intubation related to goitre and to identify factors predictive of difficult intubation due to this condition.Prospective observational.We used the Intubation Difficulty Scale (IDS) in 80 consecutive patients with large goitre (defined by the inability to palpate the cricoid cartilage, the presence of endothoracic goitre, tracheal deviation of more than 1cm or tracheal stenosis on the chest x-ray) and 77 control patients.Cormack grades 3-4 were more frequent at initial laryngoscopy in patients with goitre (23/80 vs. 9/77; p0.05), but the difference was no longer significant after application of an external laryngeal pressure (8/80 vs. 5/77). IDS scores (median [25th-75th percentiles]) were higher in the goitre group (1 [0 - 4]) than in the control group (0 [0 - 1]; p=0.001), corresponding to an increase in slightly difficult intubation (IDS 1-5: 36/80 vs. 15/77; p0.05). However, incidence of moderate to major difficulty in intubation (IDS5: 8/80 vs. 7/77) as well as time to completion of intubation were similar in both groups. Tracheal stenosis (or =30%) and reduced mouth opening (4.4cm) were the only significant predictors of increased difficulty in intubation in patients with a goitre.Large goitres are usually associated with slight difficulty in intubation only. Increased difficulty should be expected when severe tracheal stenosis is present on chest x-ray, especially when associated with a reduced mouth opening.

Resume La noradrenaline est le medicament recommande en premiere intention dans les consensus nationaux et internationaux pour le traitement hemodynamique du choc septique, parallelement au remplissage vasculaire. Cependant, aucune recommandation n’encadre le sevrage en noradrenaline qui suit necessairement cette prise en charge hemodynamique. Or, les proprietes pharmacodynamiques justifiant l’utilisation de la noradrenaline au cours du choc septique, a savoir vasoconstriction veineuse et arterielle, permettent de « normaliser » rapidement l’hemodynamique macrocirculatoire au prix potentiel d’une malperfusion regionale et/ou microcirculatoire, d’autant plus que le remplissage n’aura pas ete optimise. Le sevrage en noradrenaline, qui « relâche » la contrainte exercee sur la circulation veineuse, constitue donc une etape pendant laquelle tout defaut de remplissage initial ou secondaire peut se reveler. Les rares etudes disponibles sur le sujet montrent que le mode de sevrage habituel en noradrenaline est arbitraire et prolonge inutilement son utilisation potentiellement deletere. Le sevrage en noradrenaline pourrait se concevoir comme une epreuve fonctionnelle hemodynamique au cours de laquelle serait evaluee la precharge-dependance, demasquant un eventuel besoin en remplissage permettant de poursuivre et accelerer le sevrage ou, au contraire, un etat de « noradrenaline dependance » a respecter mais a reevaluer regulierement. De telles epreuves de sevrage pourraient etre envisagees precocement dans la prise en charge hemodynamique du choc septique, lors de toute stabilisation hemodynamique apparente, afin de prevenir ou eviter d’aggraver des troubles de perfusion regionales et microcirculatoires. Ainsi, l’enjeu du sevrage de la noradrenaline pourrait prendre une nouvelle dimension et meriter plus d’attention.

Hospital information system manages patient's hospitalization information across different applications and databases. As statistics are performed with difficulties on these different databases, the university hospital of Lille developed an anesthesia data warehouse. This common structure stores data related to anesthesia procedures and patient hospital stay. In that way, the joint analysis on intervention's events and patient's outcome is possible. However, data quality remains one of the main issues in this kind of project. Indeed, errors in patient identifier result in difficulties to link data between the different sources. This problem will be approached in the next phase of the project.

Resume Il est important d'identifier des criteres cliniques ou biologiques predictifs de l'efficacite du remplissage volemique (RV). Le contexte clinique (trauma, hemorragie, sepsis) peut constituer un element decisionnel majeur. Parmi les signes cliniques, les manœuvres d'orthostatisme sont les signes les plus sensibles d'une reponse positive au RV. La realisation d'une epreuve de remplissage vasculaire constitue un test diagnostique qui lorsqu'il est couple a la mesure de son effet sur le volume d'ejection systolique ou le debit cardiaque, permet de distinguer les patients repondeurs des patients non repondeurs. Chez le malade de reanimation, le lever de jambe passif reproduit les effets hemodynamiques d'une expansion volemique et son effet sur les variations de pression arterielle pulsee possede une bonne valeur predictive de l'efficacite du RV. Les anomalies biologiques les plus couramment observees sont l'insuffisance renale fonctionnelle et l'hyperlactacidemie. En pratique, lorsque l'indication du remplissage vasculaire est portee sur la reunion de criteres clinicobiologiques usuels, dans un contexte d'insuffisance circulatoire aigue, le pourcentage de patients repondeurs varie entre 40 et 72 % en fonction des etudes publiees.

Resume La chirurgie dentaire militaire regroupe des formes multiples, originales et habituellement meconnues d’exercice ou la culture de la polyvalence, de l’efficacite et du professionnalisme peut s’exprimer. Si l’idee de la creation d’un corps de chirurgiens-dentistes de carriere au sein des armees francaises est ancienne, sa realisation effective ne date que de l’an 2000. Permise par la professionnalisation des armees, elle est en fait le fruit d’une longue evolution qui depasse le milieu militaire et s’integre dans la reconnaissance progressive et generale de notre profession au sein du monde medical. Son organisation repose avant tout sur une sectorisation geographique s’affranchissant de l’opposition unite/hopital et permettant a tous les chirurgiens-dentistes d’exercer au plus pres des forces et a leur profit. Les synergies avec le monde civil dans les soins quotidiens, au decours des actions de formation continue ou dans les activites de recherche concourent a maintenir le lien Armee-Nation. L’integration des praticiens de reserve dans toutes les activites militaires procede de cette logique. Disposant de moyens de qualite, robustes, regulierement entretenus et aux normes de securite et d’hygiene, les praticiens peuvent se consacrer a leur raison d’etre : participer, a cote de leurs camarades medecins et en collaboration avec eux, a obtenir et a maintenir le meilleur etat de sante possible des ressortissants de la defense. Parfaitement integres, polyvalents et disponibles, les chirurgiens-dentistes militaires accompagnent nos soldats partout ou ils se trouvent. Leurs roles a l’etranger, en plus du soutien des forces armees francaises ou alliees, incluent bien souvent des missions a vocation humanitaire, illustrant les devises de nos ecoles « pro patria et humanitate » et « mari transve mare hominibus semper prodesse ».

Resumen Las particularidades de la anestesia y reanimacion en la cirugia de las glandulas suprarrenales se relacionan esencialmente con las alteraciones de la secrecion endocrina y su brusca correccion por la exeresis (tumores secretantes); en ocasiones tambien pueden estar vinculadas con la amplitud de la diseccion quirurgica (corticosuprarrenalomas). Los progresos realizados en el ambito de las estrategias diagnosticas y terapeuticas han permitido reducir la mortalidad y la morbilidad perioperatorias, asi como racionalizar y simplificar el tratamiento integral de los pacientes. La generalizacion del acceso laparoscopico en la mayoria de estos tumores es una de las modificaciones mas importantes de los ultimos diez anos. En este capitulo se describen las principales caracteristicas del tratamiento anestesico pre, intra y postoperatorio, en particular en presencia de hipercortisolismo, hiperaldosteronismo o secrecion anormal de catecolaminas.

Exact diagonalizations are used to study the structure of the many-particle wavefunction in quantum dots containing up to six electrons. We are able to provide quantitative information on the correlated electron–vortex state that forms at strong magnetic fields and find that the electron–vortex distances scale as the square of the filling factor.

The aim of this study was to verify whether a relationship exists between neuroleptic malignant syndrome (NMS) and anaesthetic-induced malignant hyperthermia (MH) or not. The in vitro halothane-caffeine tests were performed on muscle tissue obtained from 32 patients with documented NMS episodes. The diagnosis of NMS relied on Levenson's criteria. The results, expressed in accordance with the criteria of the European MH Group, defined 29 subjects as MH non-susceptible. Three patients were classified as MH equivocal. These findings demonstrate the lack of any link between NMS and MH. Therefore, patients with a history of NMS are not likely to be at risk of developing MH and special measures against MH are not required for anaesthesia in these patients.