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Resume Objectif de l’etude Analyse retrospective des resultats obtenus chez 52 enfants irradies pour un medulloblastome. Patients et methodes Entre 1974 et 2012, 52 enfants âges en moyenne de 6 ans et demi (11 mois a 17 ans et demi) ont ete operes puis irradies au centre de lutte contre le cancer de Strasbourg pour un medulloblastome. Pour 44 d’entre eux, la strategie therapeutique a comporte de la chimiotherapie. Resultats Apres un suivi en moyenne de 106,6 mois (7 mois–446 mois), 13 rechutes et 24 deces ont ete observes. Les taux de survie globale a 5 et 10 ans etaient respectivement de 62 % et 57 %, ceux de survie sans recidive a 5 et 10 ans de 80 % et 63 %. L’analyse unifactorielle a retrouve les facteurs pronostiques suivants : l’existence d’un residu postoperatoire, la positivite du liquide cephalorachidien, le statut metastatique et le medulloblastome de haut risque. En analyse multifactorielle, la positivite du liquide cephalorachidien etait le seul facteur defavorable. Conclusion Ces resultats confirment les taux de survie obtenus par une prise en charge classique associant chirurgie puis irradiation. La rarete de la pathologie et l’insuffisance des resultats necessitent la mise en place de protocoles internationaux.

Resume Objectif de l’etude Analyse retrospective des resultats obtenus chez 21 adultes pris en charge pour un medulloblastome. Patients et methodes Entre 1978 et 2011, 21 adultes âges en moyenne de 31 ans (18,3–50) ont ete operes puis irradies (n = 20) au centre de lutte contre le cancer de Strasbourg pour un medulloblastome. Pour 12 patients, la strategie therapeutique a comporte de la chimiotherapie. Resultats Avec une surveillance en moyenne de 122 mois (19–423), six rechutes et sept deces ont ete observes. Les taux de survie globale a 5 ans et a 10 ans etaient de 89,4 ± 7,1 % pour les deux. Les taux de survie sans recidive a 5 ans et a 10 ans etaient respectivement de 79,6 ± 9,2 % et 85,7 ± 7,6 % et 60,6 ± 17,7 %. Conclusion Ce rapport d’experience permet de souligner l’importance pour ce type de pathologie rare de la mise en place d’essais prospectifs multicentriques et d’une prise en charge multidisciplinaire en milieu specialise.

Resume L’appendice caudal est une malformation exceptionnelle qui a toujours suscite de l’interet. Nous presentons le cas d’une decouverte antenatale d’une anomalie du rachis fœtal compatible avec un appendice caudal. Le bilan d’imagerie objectivait une extension de cette malformation superficielle a la moelle epiniere. La prise en charge obstetricale etait sans particularite. L’enfant a ete operee a 2 mois de vie. Les diagnostics differentiels sont le spina bifida, le teratome sacro-coccygien et le kyste du sinus pilonidal. L’appendice caudal est un des marqueurs de dysraphisme spinal, au meme titre qu’une touffe de poils ou qu’un hemangiome. Le risque est le syndrome de moelle attachee avec les complications neurologiques qu’il peut entrainer.

Resume Introduction Notre strategie actuelle de developpement des activites de pharmacie clinique integre une priorisation dans les services de chirurgie. Les patients de ces services sont typiquement des patients a risque : transferts, prescripteurs multiples, modification des traitements medicamenteux frequente, classes pharmaco-therapeutiques a risque. Patients et methodes Trois activites de pharmacie clinique (conciliation a l’admission, analyse et optimisation pharmaceutique, participation a la visite des medecins) ont ete developpees en chirurgie orthopedique et en neurochirurgie. Les pharmaciens ont enregistre de facon prospective les donnees decrivant leurs activites : nombre de conciliations et de prescriptions analysees ainsi que temps necessaire a leur realisation. Les donnees concernant les interventions pharmaceutiques ont ete enregistrees sur la base ActIP ® . L’importance clinique des interventions a ete retrospectivement cotee par une equipe de 2 pharmaciens et de 2 medecins selon l’echelle de Hatoum et al. adaptee. Resultats Quatre mille cinq cent analyses pharmaceutiques et 248 conciliations ont ete menees. Cent cinquante-six interventions pharmaceutiques ont ete emises. Le taux d’acceptation moyen a ete de 80 %. Un total de 5,8 % des interventions pharmaceutiques ont ete cotees avec une importance clinique tres significative et 48,1 % avec une importance clinique au moins significative. Les activites developpees et leur documentation ont necessite un temps moyen quotidien pharmaceutique (pharmacien senior, interne et etudiant en pharmacie) d’environ 6 heures. Discussion et conclusion D’autres etudes, notamment comparatives et medico-economiques, devront etre menees pour appuyer les resultats presentes. Neanmoins, les indicateurs obtenus participeront a une meilleure lisibilite de l’importance clinique des activites realisees par les pharmaciens cliniciens et ceci particulierement au sein des services de chirurgie, tant par les prescripteurs que par les instances.

Resume La pharmacie clinique a ete developpee et evaluee dans differentes activites hospitalieres medicales. Les revues de la litterature effectuees dans ce domaine rapportent une plus value de cette discipline. Dans les services de chirurgie, consideres egalement comme a risque de survenue d’evenements iatrogenes, la realisation d’activites de pharmacie clinique doit pouvoir egalement contribuer a optimiser la prise en charge du patient. L’objectif de cette revue de la litterature est de determiner le profil des activites de pharmacie clinique developpees dans les services de chirurgie et d’identifier les indicateurs permettant leur evaluation. La recherche a ete effectuee sur la base de donnees Pubmed ® avec les mots cles suivants (2000–2013) : surgery , pharmacy , pharmacist , pharmaceutical care , impact et restreinte aux articles publies en francais ou en anglais. Les etudes traitant simultanement des domaines medicaux et chirurgicaux ont ete exclues et 21 articles ont ete retenus. Les activites de pharmacie clinique les plus frequemment developpees etaient l’historique medicamenteux et le suivi therapeutique des antibiotiques ou des anticoagulants. Deux types d’indicateurs ont ete identifies : des indicateurs d’activites (le nombre d’interventions pharmaceutiques, leur type et leur importance clinique ainsi que le taux d’acceptation et la charge de travail entrainee par les activites developpees) et des indicateurs d’impact concernant en majorite l’impact clinique et l’impact economique. Le developpement de la pharmacie clinique en chirurgie est documente et parait avoir, tout autant qu’en medecine, une plus value clinique et economique.

The purpose of this literature systematic review was the use of stereotactic radiotherapy in glioma. Research was performed in Medline/PubMed and associated references found in published articles without publication date limit. The quality of series is variable and many biases can be evidenced. Only two randomized trials have been published using stereotactic radiotherapy for up-front treatment. There is a lack of evidence of survival advantages to use this treatment at the time of diagnosis or relapse. There is also insufficient evidence regarding the benefice/harms in the use of stereotactic fractionated radiation therapy for patients with glioma. No recommendations can be enounced. Stereotactic irradiation as boost in primary diagnosed glioma or relapsed tumour is not associated with survival improvement. For relapsed patients, treatment needs to be discussed according to the other treatment options.

But Cette etude a pour but de discuter les differentes indications therapeutiques permettant la prise en charge des hemangiomes orbitaires et palpebraux chez l’enfant. Materiel et methodes L’etude retrospective menee entre 2000 et 2006 sur 9 enfants (5 filles et 4 garcons), âges de 1 mois a 9 ans, a porte sur l’examen clinique, le bilan orthoptique, l’echographie oculo-orbitaire et l’imagerie neuroradiologique. Les differents types de tumeur ont ete analyses ainsi que les schemas therapeutiques employes : exerese chirurgicale, corticotherapie orale et injection intra-tumorale de corticoides. Resultats Trois patients ont ete operes, et leurs resultats sont discutes. Les injections intra-tumorales de corticoides ont montre une regression tumorale complete avec la disparition des symptomes. La corticotherapie par voie generale a entraine une regression, puis une reprise de croissance a la diminution ou a l’arret du traitement, necessitant une prise en charge secondaire par chirurgie ou corticotherapie intra-tumorale. Conclusion Il semble donc indique d’etablir des schemas therapeutiques adaptes a l’âge de l’enfant, a l’histologie tumorale, a la localisation, au retentissement clinique et fonctionnel afin d’offrir les meilleures chances de guerison, sachant que la chirurgie et la corticotherapie intra-tumorale representent les traitements de choix.

Retrospective analysis of the results of 52 children irradiated for a medulloblastoma.Between 1974 and 2012, 52 children with an average age of 6 years and a half (11 months-17 years and a half) were treated with surgery then with radiotherapy at the Comprehensive Cancer Centre of Strasbourg (France). For 44 children, the treatment consisted of a chemotherapy.After a mean follow-up of 106.6 months (7-446 months), 13 relapses and 24 deaths were observed. Overall survival at 5 years and 10 years were 62% and 57%, respectively. Disease-free survival at 5 years and 10 years were 80% and 63%, respectively. Univariate analysis found the following adverse prognostic factors: the existence of a postoperative residue, the positivity of the cerebrospinal fluid, the metastatic status and medulloblastoma of high-risk. Positivity of the cerebrospinal fluid remains a negative factor in multivariate analysis.These results confirm the survival rate obtained by a conventional approach (surgery then irradiation). Insufficiency of results and rarity of medulloblastoma require the establishment of international protocols.

Retrospective analysis of the results of 21 adults treated for medulloblastoma.Between 1978 and 2011, 21 adults with an average age of 31 years (18.3-50) were treated with surgery then with radiotherapy (n=20) at the Comprehensive Cancer Center of Strasbourg. For some (n=12), treatment consisted of chemotherapy.After a mean follow-up of 122 months (19-423), six relapses and seven deaths were observed. Overall survival at 5 years and 10 years was 89.4 ± 7.1% for both. Disease-free survival at 5 years and 10 years was 79.6 ± 9.2% and 85.7 ± 7.6% and 60.6 ± 17.7%, respectively.The rarity of medulloblastoma, especially in adults and these results confirm the necessity of international protocols.

A novel approach to conserving and augmenting parasitoids involves storing large numbers of parasitised hosts in massemergence devices After eclosing inside the device parasitoid adults which are generally smaller than their hosts are allowed to escape through a mesh screen while any unparasitised hosts remain trapped The goal of this study was to assess the potential of massemergence devices both for augmenting populations of the parasitoid Microctonus hyperodae and for manipulating its synchrony with its host the Argentine stem weevil Listronotus bonariensis The experiments demonstrated that a screen with a 900 micro;m by 900 micro;m mesh is appropriate to separate parasitoid adults from their hosts and that a device of very simple design could be effective However the survival of L bonariensis and M hyperodae was reduced by cool storage and food deprivation and further development is required to overcome these limitations

Occipital condyle fractures (OCF) are seldom described in children, with only 14 cases reported in the literature. We report the observation of a 13-year-old child in whom such a fracture was diagnosed. A review of the paediatric cases allowed us to identify the clinical features of OCF in children. The average age was found to be 10 years, and the causative traumatism was most often related to road traffic or sporting accidents with associated head injury. The level of consciousness was depressed in 67% of the cases, and in 53%, an injury to the cranial nerves, brain stem or high spinal cord was present. Neck pain with reduction of head mobility was reported in 27% of the cases. Treatment was generally conservative, i.e. a hard collar or halo vest for an average of 8 weeks. The course was favourable with respect to osseous consolidation, mobility and pain. On the other hand, the neurological deficits improved, but sequelae remained. Early diagnosis and treatment is mandatory since the secondary displacement of fractured fragments can injure the cranial nerves in a delayed fashion or even be fatal due to compression of the brain stem.

Caudal appendage is a rare malformation which has since ever been interesting. We present the case of a girl in which a caudal appendage was discovered before birth. A throughout checking found an extension from this abnormality to the cordal spine. The baby is operated when 2months old. Differential diagnosis are spina bifida, teratoma and pilonidal sinus. Caudal appendage is one of the typical cutaneous finding with underlying spinal dysraphism, such as hair tuft or pigmented macule. The risk is a tethered cord syndrome that can lead to severe complication. The treatment is either surgery or expectation.

Our current development strategy integrates clinical pharmacy activities prioritized in surgical services. Patients in these services are typically risk patients: transfers, multiple prescribers, frequent medication change, pharmacotherapeutic risk classes.Three clinical pharmacy activities (admission reconciliation, pharmaceutical analysis, participation doctors round) have been developed in orthopaedic surgery and neurosurgery. Pharmacists prospectively recorded data describing their activities: number of reconciliations and analyzed requirements and time required to achieve them. Data on pharmaceutical interventions were recorded on the basis ActIP®. The clinical significance of interventions was retrospectively rated by a team of two pharmacists and two physicians on the scale adapted Hatoum et al.Four thousand five hundred pharmaceutical analysis and 248 reconciliations were conducted. One hundred and fifty-six pharmaceutical interventions were issued. The average acceptance rate was 80%. A total of 5.8% of pharmaceutical interventions have been listed with a very significant clinical importance and 48.1% with at least significant clinical importance. The activities and documentation required pharmaceutical average daily time (senior pharmacist, resident and external pharmacist) about 6 hours.Other studies, including comparative and medico-economic, must be conducted to support these results. Nevertheless, the indicators obtained attend a better readability of the clinical importance of the activities performed by clinical pharmacists and this particularly in surgical services, both by prescribers and authorities.

Resume Les medulloblastomes sont des tumeurs cerebelleuses appartenant au groupe des tumeurs primitives neuro-ectodermiques ( primitive neuroectodermal tumours [PNET]) du systeme nerveux central. Il s’agit de la tumeur maligne cerebrale la plus frequente de l’enfant. Ce sont des tumeurs rares et heterogenes dans leurs caracteristiques et dans la population touchee. Cela justifie la mise en place d’essais prospectifs multicentriques et une prise en charge multidisciplinaire en milieu specialise. Les strategies therapeutiques historiques reposent sur des groupes de risque bases sur des donnees cliniques, radiologiques et chirurgicales. Ces strategies s’appuient sur des associations de chirurgie, radiotherapie et chimiotherapie. Des donnees histologiques ont ensuite ete ajoutees a la stratification du risque. Enfin, les connaissances moleculaires plus recentes affinent encore ces groupes pronostiques. Ainsi peut-on esperer, alleger le traitement des groupes de bon pronostic, ameliorer le pronostic des medulloblastomes de haut risque et developper de nouvelles approches therapeutiques.

Resume La position ventrale pour la chirurgie de la fosse posterieure et de la jonction cervicocrânienne est progressivement adoptee par l'ensemble des services de neurochirurgie. Nous analysons les raisons de cette evolution et precisons ensuite ses indications en milieu neurochirurgical. L'expose des precautions a prendre pour un positionnement correct du patient permet ensuite d'en detailler les avantages tant pour l'equipe neurochirurgicale que pour celle d'anesthesie-reanimation. Les references ont ete choisies a partir d'une recherche Medline couvrant la litterature de 1991 a 1997, du Year Book of Neurology and Neurosurgery de 1980 a 1996, et des principales revues neurochirurgicales parues dans la meme periode.

Medulloblastoma are cerebellar tumours belonging to the group of primitive neuroectodermal tumours (PNET) and are the most common malignant brain tumours of childhood. These tumours are rare and heterogeneous, requiring some multicentric prospective studies and multidisciplinary care. The classical therapeutic approaches are based on clinical, radiological and surgical data. They involve surgery, radiation therapy and chemotherapy. Some histological features were added to characterize risk. More recently, molecular knowledge has allowed to devise risk-adapted strategies and helped to define groups with good outcome and reduce long-term sequelae, improve the prognostic of high-risk medulloblastoma and develop new therapeutic tools.

Clinical pharmacy has been developed and evaluated in various medical hospital activities. Reviews conducted in this area reported a higher value of this discipline. In surgical services, evenly adverse drug events may occur, so clinical pharmacy activities must also help to optimize the management of drug's patient. The objectives of this literature review is to determine the profile of clinical pharmacy activities developed in surgical services and identify indicators. The research was conducted on Pubmed(®) database with the following keywords (2000-2013), "surgery", "pharmacy", "pharmacist", "pharmaceutical care", "impact" and limited to French or English papers. Studies dealing on simultaneously medical and surgical areas were excluded. Twenty-one papers were selected. The most frequently developed clinical pharmacy activities were history and therapeutic drug monitoring (antibiotics or anticoagulants). Two types of indicators were identified: activity indicators with the number of pharmaceutical interventions, their description and clinical signification, the acceptance rate and workload. Impact indicators were mostly clinical and economic impacts. The development of clinical pharmacy related to surgical patients is documented and appears to have, as for medical patients, a clinical and economical value.

To assess the contribution of ictal SPECT to the definition of the epileptogenic zone (EZ) prior to surgery in focal drug-resistant epilepsies, we investigated the effect of the timing of injection and seizure semiology on patterns of perfusion and cerebral blood flow changes (CBF) beyond the EZ. In the rat model of amygdala-kindled seizures, we measured CBF changes with the quantitative [(14)C]-iodoantipyrine autoradiographic method during secondary generalized (SGS, n=26 fully-kindled rats) and focal seizures (FS, n=19 partially kindled rats), according to sequential timing of injection with respect to seizure onset. During SGS, the correct lateralization and rough localization of the focus within limbic structures was only possible at the early ictal and post-ictal times, in between we observed widespread rCBF increases. The switch from hyper to hypoperfusion occurred at the time of late ictal injection. The accurate localization of the EZ was obtained in the study of the more subtle FS (stage 0). At stage 1 of the kindling, there was already a remote widespread spreading of hyperperfusion. In patients surgically cured from a mesio-temporal lobe epilepsy (mean post-operative follow-up: 66 months), we retrospectively studied 26 pairs of ictal and interictal pre-operative SPECTs, classified in 3 groups according to the progression of ictal semiology. Using visual analysis of subtracted SPECTs (SISCOM) and group comparisons with a control group (using SPM), we observed more widespread combined hyper and hypoperfusion with the increasing complexity of seizures. In simple partial seizures, the SISCOM analysis allowed a correct localization of the focus in 4/8 patients, whereas the SPM analysis failed to detect significant changes, due to individual variation, spatial normalization and small magnitude of CBF changes. In complex partial seizures with automatisms, SISCOM and SPM analysis showed antero-mesial temporal hyperperfusion (overlapping the EZ), extending to the insula, basal ganglia, and thalamus in the group of patients having dystonic posturing (DP group) in addition to automatisms. Ictal hypoperfusion involved pre-frontal and parietal regions, the anterior and posterior cingulate gyri, to a greater extent in the DP group. In both human and animals studies, we observed a correlation between the extent of composite patterns of hyper/hypoperfusion and the severity of seizures, and the recruitment of remote sub-cortical structures. Hypoperfused areas belong to neural networks involved in perceptual decision making and motor planning, whose transient disruption could support purposeless actions, i.e. motor automatisms.