Search

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group.

This study aims to encapsulate the fungicide carbendazim using a biodegradable polymer (pectin). First, we have obtained calcium pectinate beads (CPG-Carb) by ionotropic gelation using calcium ions as a crosslinking agent. These beads were then coated with silica starting from tetraethoxysilane (TEOS), by a sol-gel process to form hybrid beads (CPG-Carb-SG). The morphology, composition and structure of both beads were characterized and the controlled release assays of the fungicide were studied in both water and soil columns. The encapsulation efficiency for CPG-Carb was slightly higher (75%) compared to CPG-Carb-SG (67%) due to carbendazim loss during the impregnation and condensation steps. The release rate in water and soil columns was about 4 times lower for CPG-Carb-SG than CPG-Carb demonstrating the efficiency of the silica coating to delay the release of carbendazim. Moreover, the release of CPG-Carb-SG is due to the erosion of the silica layer during the first two weeks. After this period, the silica layer was degraded, and the release is then controlled by the swelling of the organic part of the bead as observed for CPG-Carb. Finally, the biodegradability of the pectin, and the release profile make such systems promising candidates for sustained and economical pesticide delivery systems.

Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. The majority of infants are diagnosed after detection through newborn screening programs using thyroid-stimulating hormone (TSH) test. A rapid immunochromatographic lateral flow assay based on monoclonal antibodies (MAbs) colloidal gold nanoparticles was developed in a sandwich format for the detection of TSH. Two MAbs binding distinct TSH epitopes are used; one is conjugated to the detection reagent while the other is immobilized at the test line on the membrane. The colloidal gold was prepared by the reduction of gold salt coupled with MAbs and this optimal concentration was determined by spectrophotometry method. The sensitivity of our developed lateral flow immunoassay was determined using 5, 10, 15, 25 and 50 μUI/mL of TSH. The color intensity of the test line was directly proportional to the TSH concentration and the visual limit of detection was 10 μUI/mL. Twenty samples of umbilical cord serum were analyzed by the developed strips and the intensity of the signal was in agreement with the results obtained by the conventional radioimmunoassay method. The results suggest that this rapid test can be used in initial screening for congenital hypothyroidism especially in rural areas.

It is of interest to study the binding capacity of "3-[2-(2-Amino-1H-benzo[d]imidazol-1-yl)ethyl]-1,3-oxazolidin-2-one" (OXB2) with the active site of gamma-aminobutyric acid (GABA) located in the GABA type A receptor (GABAAR) in comparison with different GABAA subtypes. Optimal binding features were observed with the α2β2γ2 isoform (-8 kcal/mol). This is similar (-7.3 and -7.2 kcal/mol, respectively) for subtypes (α3β2γ2 and α1β2γ2). This implies that OXB2 binds preferentially to subtypes associated with anxiety (α2- and/or α3-containing receptors) linked molecules than with the subtype associated with sedation (α1-containing receptors). It is further noted that molecular dynamics simulation data of the complex (OXB2-GABAAR) shows adequate structural stability in aqueous environment. Moreover, relevant ADMET data is found adequate for further consideration.

Background Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-Cov-2, resulting in severe acute respiratory syndrome, with high potential of spreading and infecting humans worldwide. Since December 2019, when the virus was identified in humans, the literature on COVID-19 has grown exponentially and extrarespiratory symptoms including neurologic symptoms are increasingly highlighted. Methods Given the high and increasing number of publications reporting neurologic involvements of SARS-Cov-2, we thought that providing an update for neurologic complications of COVID-19 would be useful for physicians and especially young trainees in neurology and neurosurgery. Indeed, in this review we discuss several neurologic aspects reported in the literature to date including the evidence and pathways of neuroinvasion in COVID-19 and the main neurologic disorders reported in the literature to date, as well as future perspectives and the potential long-term consequence of current neuroinfection in COVID-19 patients. Results Currently, there is convincing evidence that SARS-CoV-2, the etiologic agent of COVID-19, can affect the nervous system, with damage and neurologic alterations. These neurologic disorders are grouped into several categories, ranging from nonspecific and moderate symptoms such as headache, myalgia, and hyposmia to severe symptoms including cerebrovascular disease and intracranial infections. Severe neurologic symptoms such as acute cerebrovascular disease occur only in a minority of patients with usual risk factors and are associated with poor outcome. However, most COVID-19 patients exhibit only minor or mild neurologic symptoms. Conclusions Management of COVID-19 patients should include early clinical, radiologic, and laboratory neurologic assessment, with a close follow-up, especially in severe forms. Future studies should assess late and long-term consequences of current COVID-19 patients with neurologic involvement.

Objective The aim of this study is to detail the background, training, and career of Dr. Georgette Kidess, the first and still the only female neurosurgeon in Palestine. In addition, we mention the obstacles that women face during their neurosurgical career and how to overcome them. Also, we discuss different methods to attract female medical students to neurosurgery. Methods Information was gathered only from direct face-to-face interviews with Dr. Kidess. Results Georgette Kidess was born on May 2, 1952, in Nablus, Palestine. She received the degree of Doctor of Medicine (M.D.) at Eberhard Karls Universitat, Tubingen, Germany in 1979. She worked as a neurosurgeon at the Hadassah EinKarem Hospital in Jerusalem and subsequently established the first neurosurgical department at the Ramallah Governmental Hospital in Ramallah in 1986. Thereafter, she has continued a career in private practice, currently at Saint Luke's Hospital, Nablus. Dr. Kidess played a major part in establishing neurosurgery in Palestine. She was among the founders of the Palestinian Neurosurgical Society in 2014. Conclusions In this article, we recount Dr. Kidess's contributions and achievements to neurosurgery in Palestine. Her commitment, persistence, and diligence enabled her to overcome great odds and become the first female neurosurgeon in Palestine. We hope that her story will inspire and open the doors for subsequent women to enter and enhance neurosurgery, especially in the Middle East.

Women in Neurosurgery (WIN) have come a long way and are making inroads in every neurosurgical subspecialty. There has been a worldwide increase in the number of female neurosurgeons both in the training and practice. Although this is a welcome trend, gender equality at work in terms of opportunities, promotions, and pay scales are yet to be attained. This is more apparent in the developing and underdeveloped nations. Barriers for a female neurosurgeon exist in every phase before entering residency, during training, and at workplace. In the neurosurgical specialty, only a few women are in chief academic and leadership positions, and this situation needs to improve. WIN should be motivated to pursue fellowships, sub-specialty training, research, and academic activities. Furthermore, men should come forward to mentor women, only then the gender debates will disappear and true excellence in neurosurgery can be attained. This article reviews the issues that are relevant in the present era focusing on the barriers faced by female neurosurgeons in the developing and underdeveloped countries and the possible solutions to achieve gender equality in neurosurgery. The authors also present the data from the World WIN Directory collected as a part of Asian Congress of Neurological Surgeons-WINS project 2019. These numbers are expected to grow as the WIN progress and add value to the neurosurgical community at large.

A 59-year-old female presented with severe headache and trouble of consciousness. The CT showed a subarachnoid hemorrhage FISHER IV with a hematoma of the right cerebellum. The angiography discovered a persistent left trigeminal artery associated with an aneurysm of the right posterior meningeal artery. The attempt of embolization failed and the patient suffered cerebral vasospasm and died. The persistence of a trigeminal artery is found in 0.1–0.6% of the population. It is the most frequent embryological carotid-vertebral anastomosis. It appears at the fifth week of development and disappears when the embryo reaches 5–7 mm. This embryological persistence is associated with numerous vascular abnormalities. The literature review showed the presence of those aneurysms in the trigeminal artery itself or the communicating artery. The association that we described is the first to our knowledge. Therefore, this association is particular and interesting to expose.

Pineal epidermoid and dermoid cysts are rare lesions of the pineal region. Only few cases were reported. Clinical presentation is similar to all lesions of the pineal region lesions. Imaging data is a good help for diagnosis. Surgical management is the principal therapeutic option of these cysts. Surgery is challenging because of the characteristics of the anatomical location and the histological nature of epidermoid and dermoid cysts. Particular complications related to these cysts are important to take into account during the management of these cysts.

OBJECTIVESub-Saharan Africa (SSA) represents 17% of the world’s land, 14% of the population, and 1% of the gross domestic product. Previous reports have indicated that 81/500 African neurosurgeons (16.2%) worked in SSA—i.e., 1 neurosurgeon per 6 million inhabitants. Over the past decades, efforts have been made to improve neurosurgery availability in SSA. In this study, the authors provide an update by means of the polling of neurosurgeons who trained in North Africa and went back to practice in SSA.METHODSNeurosurgeons who had full training at the World Federation of Neurosurgical Societies (WFNS) Rabat Training Center (RTC) over the past 16 years were polled with an 18-question survey focused on demographics, practice/case types, and operating room equipment availability.RESULTSData collected from all 21 (100%) WFNS RTC graduates showed that all neurosurgeons returned to work to SSA in 12 different countries, 90% working in low-income and 10% in lower-middle-income countries, defined by the World Bank as a Gross National Income per capita of ≤ US$995 and US$996–$3895, respectively. The cumulative population in the geographical areas in which they practice is 267 million, with a total of 102 neurosurgeons reported, resulting in 1 neurosurgeon per 2.62 million inhabitants. Upon return to SSA, WFNS RTC graduates were employed in public/private hospitals (62%), military hospitals (14.3%), academic centers (14.3%), and private practice (9.5%). The majority reported an even split between spine and cranial and between trauma and elective; 71% performed between 50 and more than 100 neurosurgical procedures/year. Equipment available varied across the cohort. A CT scanner was available to 86%, MRI to 38%, surgical microscope to 33%, endoscope to 19.1%, and neuronavigation to 0%. Three (14.3%) neurosurgeons had access to none of the above.CONCLUSIONSNeurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources and the need to continue expanding efforts in local neurosurgery training and continuing medical education. Focus on affordable and low-maintenance technology is needed.

The number of women in the medical field has increased in Africa over the last few decades, yet the underrepresentation of women within neurosurgery has been a recurrent theme. Of all surgical disciplines, neurosurgery is among the least equitable, and the rate of increase in female surgeons lags behind other surgical disciplines such as general surgery. This historical review provides an overview of the history of women in neurosurgery and their current status on the African continent. To the authors’ knowledge, this is the first article to provide such an overview.

Alors que cela a été réalisé chez de nombreuses autres espèces de mammifères, chez le dromadaire, l’évaluation du taux de cortisol a été très rarement décrite dans les fèces, et elle ne l’a jamais été dans les poils. L’objectif de cette étude a ainsi été de déterminer, chez cet animal, les taux de cortisol dans le sérum, les poils et les fèces, et leurs éventuelles corrélations. Les résultats ont montré que le taux de cortisol variait avec la saison et qu’il était significativement (p < 0,05) plus élevé en janvier qu’en mai/juin. Une corrélation positive entre les taux sériques et ceux déterminés dans les poils et les fèces a été notée. Cette corrélation indique que l’analyse du cortisol dans les poils et les fèces reflète l’activité de la corticosurrénale et pourrait être utilisée comme une méthode non-invasive pour évaluer le stress chez le dromadaire.

Slaughter stress responses were evaluated in the dromedary camel by analyzing hematocrit (Hct), neutrophil/lymphocyte ratio (NLR), hemolysis (H%), catalase activity (CATa) and plasma levels of cortisol (COR), triiodothyronine (T3), thyroxine (T4), glucose and malondialdehyde (MDA). Blood was collected during three different steps: at the arrival of the animals at the slaughterhouse just after unloading (step 1), at the end of a rest period of 16 to 20 hours (step 2) and finally during bleeding (step 3) after exposure to traditional slaughter stress. NLR, H%, MDA, glucose, COR, T3 and T4 measured at step 2 were significantly (P

In camel, 25-hydroxyvitamin D content, quality parameters and lipid oxidation in raw and cooked meat during ageing at cold, and relationship between these parameters were investigated. The pH value of the raw meat was significantly (P

To examine a possible control of reproductive seasonality by melatonin, continual-release subcutaneous melatonin implants were inserted 4.5 months before the natural breeding season (October–April) into female camels (Melatonin-treated group). The animals were exposed to an artificial long photoperiod (16L:8D) for 41 days prior to implant placement to facilitate receptivity to the short-day signal that is expected with melatonin implants. The treated and control groups (untreated females) were maintained separately under outdoor natural conditions. Ovarian follicular development was monitored in both groups by transrectal ultrasonography and by plasma estradiol-17β concentrations performed weekly for 8 weeks and then for 14 weeks following implant insertion. Plasma prolactin concentrations were determined at 45 and 15 days before and 0, 14, 28, 56, and 98 days after implant insertion. Plasma melatonin concentration was determined to validate response to the artificial long photoperiod and to verify the pattern of release from the implants. Results showed that the artificial long photoperiod induced a melatonin secretion peak of significantly (P

The effect of ageing was evaluated on quality parameters (pH, electrical conductivity (EC), osmolality, drip loss (DL) and cooking loss (CL)), proteins, fat and 25-hydroxyvitamin D (25-OH-D) total levels and antioxidant status (malondialdehyde (MDA) and catalase (CAT) activity) in meat of camels during storage at 4 ± 1 °C. Samples were taken from the brachial triceps muscle (triceps barchii) and were stored at 4 ± 1 °C for 10 d. Quality parameters, chemical composition and antioxidant status were assessed at 3 h and 24 h postslaughter and 5, 7 and 10 d postmortem during cold storage. CAT activity significantly decreased while osmolality, EC, DL, CL and MDA contents significantly increased, from the 5th or 7th postmortem day of cold storage of the camel meat. However, proteins, lipids and 25-OH-D total contents showed no significant differences during all period of ageing. In conclusion, in the dromedary camel, ageing time of triceps muscle influenced significantly its quality characteristics and antioxidant status from the 5th or 7th postmortem day of refrigerated storage, without any variation of proteins, fat and 25-OH-D contents.

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.

Background: Giant cavernous malformations of the central nervous system are quite rare. They are more common in children and may be misdiagnosed as other intracranial neoplasms. Here, we presented a very rare giant cavernous angioma mimicking a neoplastic temporal lobe lesion in an 18-month-old male. Case Description: An 18-month-old male presented with two initial seizures. Although the clinical examination was normal, the computed tomography (CT) scan showed a large left temporal mass (66 mm diameter) exerting significant mass effect and midline shift. The brain magnetic resonance (MR) imaging demonstrated a large left temporal heterogeneously enhancing lesion with significant perilesional edema and mass effect. The patient underwent gross total removal of the lesion that proved to be an intracranial cavernous angioma. Postoperatively, he did well, exhibiting no residual neurological deficit, and has remained lesion and seizure-free. Conclusion: This and 12 other cases in the literature focus on intracranial cavernous angiomas that could have been readily misdiagnosed as tumors. It confirms why obtaining appropriate preoperative MR and CT studies, followed by surgical intervention, is essential to confirm the correct underlying pathology and appropriately and optimally treat the patient.

Les traumatismes de l'etage anterieur de la base du crâne representent 15 a 20% des traumatismes crâniens en general. Ils menacent les structures neuro-encephaliques sus jacentes et sont tres souvent responsables de breches osteo-meningees exposant au risque infectieux. Notre travail a concerne 136 dossiers exploitables de traumatisme de l'etage anterieur de la base du crâne colliges sur une periode de 10 ans entre janvier 2003 et decembre 2012. Le diagnostic a ete suspecte devant les signes cliniques evocateurs (ecchymose peri-orbitaire, rhinorrhee…) et a ete confirme dans la plupart des cas par la TDM. Le traitement ideal est la fermeture chirurgicale de la breche en association aux moyens medicaux (vaccination, anti-epileptiques, mesures de reanimation…) Le moment ideal de la reparation est au-dela de la 72eme heure apres la diminution de l'oedeme cerebral en cas d'absence d'une lesion intracrânienne necessitant une intervention en urgence. Notre equipe ne pratiquant pas la voie endoscopique, l'abord frontal est souvent indique. Le pronostic depend des lesions cerebrales associees et surtout de la presence d'une breche dont le diagnostic et la reparation doivent etre les plus rapides et les plus precis possibles. Ainsi toute rhinorrhee post-traumatique necessite une exploration systematique, le timing ideal: c'est la disparition de l'oedeme cerebral pour faciliter l'exploration, ceci est en general possible a partir de la 72eme heure sauf dans les cas associes a une autre lesion intra crânienne necessitant une exploration en urgence.

Le siège intraventriculaire est une localisation rare des cavernomes de l'encéphale. Le quatrième ventricule est le moins concerné de toutes les localisations. Nous rapportons le cas d'une patiente âgée de 52 ans qui présente depuis 12 mois un syndrome d'hypertension intracrânienne et trouble de l’équilibre. Elle s'est présentée aux urgences avec un GCS à 14, nuque subraide, un syndrome cérébelleux statokinétique avec une acuité visuelle basse et un oedeme papillaire bilatéral. Une TDM cérébrale réalisée aux urgences a objectivé un hématome du 4ème ventricule avec hydrocéphalie active triventriculaire. Une dérivation ventriculaire interne a été réalisée en urgence avec une bonne évolution clinique post opératoire. Le bilan a été complété par une IRM cérébrale objectivant un processus du quatrième ventricule évoquant un cavernome. Un abord direct a été réalisé permettant une exérèse totale du cavernome siégeant au sein du quatrième ventricule. L'anatomo-pathologie a confirmée le diagnostic. A notre connaissance, il s'agit du 13ème cas rapporté dans la littérature. Les cavernomes intraventriculaires représentent 2,5-10% de tous les cavernomes dont 9% est au niveau 4ème ventricule. Les patients sont souvent admis aux urgences suite au saignement de cette malformation angiomateuse. Le diagnostic est rendu accessible par les différentes séquences de l'IRM. Le traitement est souvent chirurgical vu le risque de resaignement. Le pronostic dépend de l’état initial du patient et de l'infiltration du plancher du quatrième ventricule.

Intracranial epidermoid cysts are one of the rare tumors of all intracranial tumors. They represent 0,2 to 1% of intracranial tumors and 7 % of tumors in the cerebellopontine angle. The pineal region is exceptionally subject to such kind of tumor. Cushing was the first to report the pineal localization of the epidermoid cyst in 1928. Up to now, 85 cases of pineal epidermoid cyst were cited in the literature. We report a clinical case concerning a 45 years old man who presented an intracranial hypertension during 18 months. The clinical examination found a hemiparesis with a facial hypoesthesis. The MRI showed a process of the pineal region. The patient underwent a surgery with a large resection. The histological examination confirms the epidermoid cyst. Many approaches were described in the literature. The outcome is related to this localization.Key words: Pineal epidermoid cyst, intracranial tumor, cerebellopontine angle

La myélopathie cervicarthrosique est un syndrome clinique en relation avec la diminution des dimensions du canal rachidien, la cervicarthrose est l’étiologie principale après 50 ans. L'objectif du traitement est de rétablir les dimensions du canal rachidien cervical. Le choix de la technique chirurgicale sera guidé par l'analyse des signes cliniques, imageries, pré opératoire en fonction de laquelle sera pratiquée soit la voie antérieure, postérieure, ou exceptionnellement la voie combinée. Notre étude a pour but dans un premier temps d’évaluer à long terme les résultats cliniques et radiologiques de la chirurgie ensuite répondre à cette préoccupation: La lordose cervicale pré opératoire et postopératoire sont t-elles des facteurs de bon pronostic? Nous rapportons une étude rétrospective entre 2000 et 2013 portant sur 135 patients opérés dans notre formation et remplissant les critères inclusions. La collecte des données s'est faite en s'aidant du dossier médical des patients (échelle d'Association des orthopédistes Japonais), Imagerie (Radio, TDM, IRM), mesure de l'angle de courbure rachidienne en pré et postopératoire, ceci dans le but d’évaluer à long terme les résultats clinique et radiologique de la chirurgie. Ont été inclus dans notre étude 135 patients, 82 Hommes (60%), 53 femmes (40%) avec un âge moyen de 52 ans, ayant consulté pour des motifs divers (Névralgies cervicobrachiales, lourdeur des membres, troubles génito-sphinctériens). Soixante cinq patients (48%) ont bénéficié d'un abord antérieur (dissectomie, cloward, somatotomie médiane), 64 patients (47%) ont été opérés par voie postérieure (laminectomie de 1 à 3 niveaux) et 6 patients (5%) ont bénéficié d'un abord combiné dans un délai moyen de 3 mois devant la persistance des symptômes. Le niveau cervical le plus touché était C5C6 suivie de C4C5. L’évolution globale de nos patients était favorable dans 58% des cas, stationnaire dans 41% des cas et 1% d'aggravation. Soixante patients ayant présentés une amélioration en postopératoire avaient une courbure rachidienne en lordose, contre 17 patients en raideur et aucun patient en cyphose (p < 0.05). En définitive, la myélopathie est une pathologie fréquente dans la pratique neurochirurgicale, le diagnostic s'est beaucoup amélioré grâce à l'avènement de IRM, plusieurs voies d'abords sont utilisées en fonction des données cliniques et d'imageries, l’évolution reste favorable si la prise en charge est précoce avant l'apparition des déformations importantes de l'alignement sagittal du rachis.

Le siege intraventriculaire est une localisation rare des cavernomes de l'encephale. Le quatrieme ventricule est le moins concerne de toutes les localisations. Nous rapportons le cas d'une patiente âgee de 52 ans qui presente depuis 12 mois un syndrome d'hypertension intracrânienne et trouble de l'equilibre. Elle s'est presentee aux urgences avec un GCS a 14, nuque subraide, un syndrome cerebelleux statokinetique avec une acuite visuelle basse et un oedeme papillaire bilateral. Une TDM cerebrale realisee aux urgences a objective un hematome du 4eme ventricule avec hydrocephalie active triventriculaire. Une derivation ventriculaire interne a ete realisee en urgence avec une bonne evolution clinique post operatoire. Le bilan a ete complete par une IRM cerebrale objectivant un processus du quatrieme ventricule evoquant un cavernome. Un abord direct a ete realise permettant une exerese totale du cavernome siegeant au sein du quatrieme ventricule. L'anatomo-pathologie a confirmee le diagnostic. A notre connaissance, il s'agit du 13eme cas rapporte dans la litterature. Les cavernomes intraventriculaires representent 2,5-10% de tous les cavernomes dont 9% est au niveau 4eme ventricule. Les patients sont souvent admis aux urgences suite au saignement de cette malformation angiomateuse. Le diagnostic est rendu accessible par les differentes sequences de l'IRM. Le traitement est souvent chirurgical vu le risque de resaignement. Le pronostic depend de l'etat initial du patient et de l'infiltration du plancher du quatrieme ventricule. Key words : Cavernome, ventricule cerebraux, encephale

Les méningiomes intracrâniennes multiples sont définies comme la présence d'au moins deux méningiomes sur des sites intracrâniens différents et ceci en absence de neurofibromatose. C'est une tumeur rare dont la prévalence varie entre 1-10%. Le but de notre travail était de décrire les caractéristiques cliniques, radiologiques, histologiques d'une série de 4 patients porteurs de méningiome multiple et en déduire les facteurs de risques de survenue de cette pathologie. Préciser la qualité d'exérèse chirurgicale de la lésion selon la classification de Simpson. Rapporter les suites postopératoires ainsi que le suivie à long termes des patients afin de préciser leur qualité de vie. Il s'agit d'une étude rétrospective portant sur 4 cas de Méningiomes intracrâniens multiples sur 174 patients opérés pour méningiome au CHU Avicenne entre Janvier 2000 à Décembre 2013. En s'aidant des données cliniques, imageries, chirurgicales, histologiques mentionnée dans le dossier médical de chaque patient. Notre série est constitué de 4 patients (3 femmes pour 1 homme), d'un âge allant de 42-50 ans (moyenne d’âge= 45,5 ans). Nous avons identifié 21 méningiomes (17 en sus tentoriel et 4 en sous tentoriel), aucun cas de décès ni d'infection postopératoire dans notre échantillon. Le pronostic reste bon malgré le nombre de lésion nécessitant parfois plusieurs interventions chirurgicales.

A new strain of Penicillium cyclopium was found on mouldy Grenoble walnuts. From the culture filtrate, two new extracellular lipases (A- and B-lipase) were isolated and characterized. The mycelium contained one of the two forms of lipase (B-lipase). The specificity of the cell-bound lipase linked to the mycelium was then studied. The enzyme was specific to shortchain homogeneous triacylglycerols; it preferred to attack the o-position rather than the p-position, and showed stereospecificity on the sn-1 position.

Background: Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. Hereby, we report an unusual case of a temporal epidermoid cyst coexisting with an atypical meningioma. Case Presentation: A 37-year-old male presented with progressive symptoms of raised intracranial progression with progressive loss of vision without any neurological deficit. On admission, magnetic resonance imaging (MRI) revealed a right frontal lesion appearing hypointense T1, hyperintense T2 slightly enhanced after gadolinium and a second right temporal, isointense T1, hyperintense T2 non-enhancing lesion. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The whitish temporal lesion with the pearl appearance reminding of an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst. Conclusion: The simultaneous occurrence of primary intracranial tumors of different cell types is rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously.

L’hypercalcémie et l’hyperphosphatémie postprandiales, ainsi que l’absorption intestinale du calcium (Ca), ont été mesurées chez 12 chamelons. Les animaux ont été divisés en quatre groupes de trois individus. Les groupes 1 et 2 ont reçu une perfusion intraveineuse (IV) respectivement du fragment synthétique du peptide apparenté à l’hormone parathyroïdienne (PTHrP) et du solvant. Au début de la perfusion, les groupes 1 et 2 ont reçu par voie orale du lait artificiel. Les groupes 3 et 4 ont reçu des injections IV respectivement de 1α,25-dihydroxyvitamine D3 (1α,25(OH)2D3) et du solvant. A la dernière injection, les groupes 3 et 4 ont reçu par voie orale une solution de SrCl2. Le PTHrP a induit une élévation significative de l’hypercalcémie et de l’hyperphosphatémie postprandiales. Ce peptide n’a influencé ni le volume urinaire, ni l’excrétion rénale du Ca, alors qu’il a provoqué une augmentation de l’excrétion rénale du phosphore (P). La 1α,25(OH)2D3 a engendré une augmentation significative des taux plasmatiques du strontium (Sr), du Ca et du P. La 1α,25(OH)2D3 n’a induit d’effet significatif ni sur le volume urinaire, ni sur l’excrétion rénale du Ca, du P et du Sr. Au vu de ces résultats, le PTHrP et la 1α,25(OH)2D3 semblent jouer un rôle prépondérant dans la croissance osseuse chez le chamelon.

Les taux plasmatiques de calcium (Ca) et de phosphore inorganique (Pi) ainsi que la teneur du lait en ces mineraux ont ete mesures chez six chamelles en troisieme lactation apres administration intraveineuse de la [1alpha],25-dihydroxyvitamine D3 [1alpha],25-(OH)2D3]. Le traitement par ce steroide a induit une aug mentation significative (P < 0,05) de la calcemie et de la phosphatemie. Les valeurs de la calcemie et de la phosphatemie sont passees respectivement de 94,2 ± 4,1 et 54 ± 2,5 mg/l, avant la premiere injection du calcitriol (stade 0 h), a 108,1 ± 3,4 et 63,5 ± 2,4 mg/l, 24 h apres l'arret du traitement. La calcemie et la phosphatemie sont restees elevees jusqu'a la fin du test. L'injection intraveineuse de la [1alpha],25-(OH)2D3 a induit une augmentation significative (P < 0,05) de la concentration et de l'excretion du Ca et du Pi dans le lait. La concentration et l'excretion de Ca dans le lait recueilli par periodes de 12 h sont passees respectivement de 1 080 ± 30 mg/l et 1 100 ± 64 mg/12 h, au stade 0 h, a 1 218 ± 34 mg/l et 1 240 ± 57 mg/12 h, apres la deuxieme injection, alors que celles du Pi ont augmente respectivement de 732 ± 66 mg/l et 754 ± 61 mg/12 h, au stade 0 h, a 840 ± 38 mg/l et 890 ± 56 mg/12 h, apres la deuxieme injection. La teneur et l'excretion de Ca et de Pi dans le lait sont restees elevees (P < 0,05) jusqu'a 12 h apres l'arret du traitement. Ces resultats suggerent un effet de la [1alpha],25-(OH)2D3 au niveau mammaire chez la chamelle lactante, ce metabolite augmentant chez cette derniere la teneur du lait en Ca et en Pi sans aucune modification significative de la production laitiere. (Resume d'auteur)