In this article, a study of novel screen-printed electrodes bulk-modified with five potential bismuth precursor compounds (bismuth citrate, bismuth titanate, bismuth oxide, bismuth aluminate and bismuth zirconate) is presented for the determination of Cd(II) and Pb(II) by anodic stripping voltammetry. During the electrolytic deposition step, the precursor was reduced and served as the source of bismuth. Different key parameters were investigated in detail such as the nature of the bismuth precursor compound, the precursor content in the carbon ink, the polarisation range of the sensors, the supporting electrolyte, the stripping waveform, the deposition time, the deposition potential and the long-term stability of the sensors under continuous use. Using bismuth citrate as the precursor, the limit of detection was 0.9 μg L−1 for Pb(II) and 1.1 μg L−1 for Cd(II). The reproducibility on the same sensor (expressed as % relative standard deviation, (n = 8)) was 5.4% for Pb(II) and 7.2% for Cd(II) at the 20 μg L−1 level. Finally, the sensors were applied to the determination of Cd(II) and Pb(II) in water samples.

Introduction. - Dural carotid-cavernous fistulas are rare and require multidisciplinary management. Today there is no consensus on treatment, even though embolization is currently the first-line treatment. We present the cases of ten patients with a dural carotid-cavernous fistula diagnosed between 1989 and 2004 in order to compare the therapeutic choices used to treat dural carotid-cavernous fistulas in the late 1980s and mid-1990s to the therapeutic strategy currently favored.Patients and methods. - The ten patients, with a mean age of 65.9 years, were seven women and three men. They had an ophthalmologic examination and the diagnosis was angiographically confirmed. Treatments were either noninvasive (such as decoagulation and/or carotid-jugular or ocular compression) or embolization. A combination of these different treatment modalities was provided for several patients.Results. - The main symptoms were arterialized conjunctival veins, proptosis, diminished visual acuity, chemosis, elevated intraocular pressure, and diplopia. Of the seven patients who only had noninvasive treatment (embolization not possible), three remained stable, three showed partial improvement, and the last one was clinically cured. As for the three patients treated with embolization (prior or not), this treatment led to a dramatic clinical improvement for one patient, a clinical cure for the second, and a complete cure in the remaining patient.Conclusion. - Prior embolization when possible appears to be an effective and safe treatment for dural carotid-cavernous fistulas. Nonetheless, noninvasive treatment options, particularly compressions, remain an important therapeutic alternative. (C) 2009 Elsevier Masson SAS. All rights reserved.

PURPOSE:To describe transvenous embolization in four patients with indirect dural carotid cavernous fistulas (CCFs) via the inferior petrosal sinus (IPS) or superior ophthalmic vein (SOV), and their clinical outcomes. METHODS:The CCF approach was performed after retrograde venous catheterization from the femoral vein to the cavernous sinus via the IPS (n=1) or SOV (n=3). SOV catheterization was possible without surgical intervention. All patients presented initially with typical clinical signs of CCF. Patients treated via the SOV presented with thrombosis of the IPS. RESULTS:Catheterization and embolization were successful in all patients, with complete angiographic occlusion of the fistula. No early or late complications occurred. All patients presented with favorable clinical outcomes and complete recovery of ocular symptoms. CONCLUSION:Retrograde transvenous embolization of CCF via the IPS, or SOV if the IPS is thrombosed, is a safe procedure with a good clinical outcome.

Illustrer les lésions oculo-orbitaires traumatiques en TDM hélicoïdale afin de connaître leur sémiologie, leur prise en charge thérapeutique et leur degré d’urgence. Après un rappel de l’anatomie oculo-orbitaire, 20 observations sont présentées afin d’illustrer les lésions traumatiques de l’orbite et leur impact sur la prise en charge thérapeutique. Dans un contexte de traumatisme crânio-facial, la TDM hélicoïdale des orbites est l’examen de choix pour effectuer le bilan lésionnel. Toute suspicion de corps étranger intra-oculaire, toute atteinte de la fonction visuelle et toute suspicion d’incarcération musculaire nécessite une TDM hélicoïdale en urgence pour une prise en charge thérapeutique la plus rapide possible. Nous présentons des atteintes du globe oculaire (contusion, plaie sclérale, corps étranger), des parois osseuses et les lésions associées du nerf optique, des muscles oculo-moteurs et de la graisse péri-orbitaire. Pour chaque lésion, nous discutons l’impact des résultats de l’imagerie sur la prise en charge thérapeutique. Un traumatisme de l’orbite doit être exploré en TDM hélicoïdale avec des reconstructions axiales, coronales et para-sagittales obliques dans le plan du nerf optique afin de préciser les lésions susceptibles de menacer l’acuité visuelle et la mobilité oculaire qui peuvent imposer un traitement en urgence.

Bilateral inferior petrosal sinus sampling (BIPSS) is the most reliable procedure for distinguishing Cushing's disease from ectopic ACTH secretion. However, it is less reliable at predicting the lateralization of the pituitary corticotroph microadenoma. We sought to determine whether this could be improved by taking into account the pattern of venous drainage and the precise location of the catheters. We retrospectively studied data from 86 patients who underwent BIPSS. Cushing's disease was predicted in 74 patients, of whom 69 underwent transsphenoidal surgery. Surgical cure was obtained in 65 patients, with identification of a corticotroph microadenoma in 58 cases. In 49 patients the location of the microadenoma predicted by the intersinus ACTH gradient could be compared with the pathologist's data. BIPSS accurately predicted the lateralization of the microadenoma in only 57% of these patients. Prediction was improved to 71% when both venograms and catheters were symmetric (35 patients). In this subgroup accuracy was 86% in patients with both catheters in the inferior petrosal sinuses compared with 50% in patients with both catheters in the cavernous sinuses (CS). Two transient sixth nerve palsies occurred during CS catheterization. Our data suggest that BIPSS results are much improved when venous drainage is symmetric. Catheterization of CS did not improve the results and was less safe.

Comment on Primary Localization of

A 3-year-old child was examined because of otorrhagia. CT scans showed an unusual vessel, confirmed by angiography, related to a persistent pharyngohyostapedial artery. This embryonic persistent artery associated with the normal internal carotid artery would explain the "duplication" aspect of the internal carotid artery.

We present six cases of benign spinal osteoblastoma. This localization of this uncommon benign bone tumor occurring in young subjects is rare. The patients were explored with radiotomography, computed tomography, myelography and medullo-spinal angiography. These benign tumors may appear radiographically as pure bone lysis mimicking malignancy. The size of these tumors often leads to widening search for extension, particularly in recurrent, aggressive, multifocal forms which require wide resection, and sometimes total vertebrectomy. Medullo-spinal angiography can confirm the vascular involvement of the tumor nidus and is require to identify arteries supplying the spinal canal which would modify operative strategy.

Twelve cases of vestibular neuritis were investigated in gradient echo MRI with gadolinium. Only 3 severe cases associated with an acoustico facial syndrome (2 cases of herpes zoster oticus and one case after influenzae) demonstrated focal enhancement within the internal auditory canal on post contrast T1 weighted images. This enhancement involved at least 2 differents nerves. These 3 severe cases associating sensory neural hearing loss and facial palsy revealed a meningeal reaction after cerebrospinal fluid examination. The enhancement lasted a long time (up to 10 months) in one case of RAMSAY HUNT syndrome associated with a chronic lymphocytic leukemia. The MRI was able to confirm the anatomical reality of the vestibular neuritis and more precisely of the meningoneuritis and gave arguments for the theory of the polyneuropathy of Adour. Enhancement at MRI seems correlated with the severity of the affection (permanent vestibular areflexia in 3 cases and permanent hearing loss in 1 case).

We present six cases of benign spinal osteoblastoma. This localization of this uncommon benign bone tumor occurring in young subjects is rare. The patients were explored with radiotomography, computed tomography, myelography and medullo-spinal angiography. These benign tumors may appear radiographically as pure bone lysis mimicking malignancy. The size of these tumors often leads to widening search for extension, particularly in recurrent, aggressive, multifocal forms which require wide resection, and sometimes total vertebrectomy. Medullo-spinal angiography can confirm the vascular involvement of the tumor nidus and is require to identify arteries supplying the spinal canal which would modify operative strategy.

We report two cases of an isolated dorsospinal artery that emerged directly from the aorta to supply the anterior spinal artery, which in one case had another blood supply on the opposite side, in a lower position. It is important to identify this anatomic variant, otherwise spinal angiography might be incomplete, especially when the isolated dorsospinal artery supplies the anterior spinal artery.

Patients with Cushing's disease are not cured by transsphenoidal microsurgery in about 30% of the cases. Beside the problem of invasive macroadenomas, these failures are due either to diagnostic errors, or to very small microadenomas that could no be found. Positive diagnosis of hypercortisolism is quite straightforward and the problem is sensitivity rather than specificity. Primary adrenocortical hypercortisolism should not be mistaken. Depression-related hypercortisolism can be difficult to distinguish from Cushing disease: most cases are recognized after clinical story and CRF stimulation test. Ectopic ACTH secretion by a carcinoid tumor represents at least 8% of ACTH-dependant hypercortisolism. It cannot be reliably distinguished from corticotroph microadenoma by either classical dynamic tests or anterior pituitary imaging. However measurements of ACTH in the inferior petrosal sinus under basal condition and CRF stimulation allow the diagnosis of central or peripheral ACTH secretion with a quasi 100% sensitivity and specificity. In contrast this technique is of poor help for the diagnosis of lateralization of corticotroph microadenomas, for which it gives erroneous results in 25 to 50% of the cases. Rapid intraoperative measurement of ACTH in peripituitary blood seems a more reliable approach. In our series it gave correct results in 11 out of 12 cases. In 1995 hormonal exploration of Cushing disease should limit the failures of anterior pituitary surgery to the cases of invasive macroadenomas that cannot be completely removed.