Se considera que todo bazo palpable es patológico. La esplenomegalia puede ser asintomática o manifestarse a través de un dolor abdominal de tipo pesadez en el hipocondrio izquierdo. Una esplenomegalia voluminosa puede complicarse con infarto, hematoma subcapsular o, incluso, ruptura del bazo. La pancitopenia puede asociarse a esplenomegalia, sin prejuzgar la causa, por secuestro de los elementos formes de la sangre o por hemodilución. El enfoque diagnóstico incluye elementos clínicos (fiebre, signos de hipertensión portal, adenopatías), biológicos (hemograma completo [HC] con frotis sanguíneo, pruebas de función hepática, serologías víricas, hemocultivos) y exploraciones complementarias morfológicas (ecografía abdominal con Doppler, endoscopia esofagogastroduodenal en busca de várices esofágicas, tomografía computarizada [TC] toracoabdominopélvica en busca de adenopatías). Las principales etiologías son la hipertensión portal, la infiltración reactiva en un contexto infeccioso y las hemopatías malignas. Hay que pensar, en un segundo tiempo, en las hemopatías benignas (hemoglobinopatías, anemia hemolítica), las conectivitis y las enfermedades por sobrecarga.

Purpose: Surgical planning of depth electrode implantation in stereo-electro-encephalography (SEEG) routinely uses magnetic resonance imaging (MRI) alone. Accurate visualization of arteries and veins in the vicinity of the electrode is essential to plan a safe trajectory to presumably reduce the risk of intracranial bleeding. The goal of this study was to compare multidetector row computerized tomographic angiography (MDCTA) with MRI for the visualization of vessels along each planned trajectory in patients who undergo SEEG.Materials and methods: Ten consecutive patients who were scheduled to undergo SEEG procedure were included. T1-weighted gadolinium-chelate enhanced MR sequence, stereotactic MDCT and MDCTA were performed after fixation of Leksell's frame. For each of the 106 planned stereotactic trajectories, the number of vessels in a 4.0 mm diameter circle around the trajectory from the dura mater to the target that were visible on MDCTA were compared to that of visible vessels in the same areas on MRI.Results: Ten vessels (10/106; 9.4%) were seen on MRI and 66 (66/106; 62.3%) on MDCTA (P < 0.0001). All vessels visible on MRI were visible on MDCTA. The difference in number of visible vessels between the two techniques remained significant for the different lobes (i.e., frontal lobe, temporal lobe and parieto-occipital lobe).Conclusion: MDCTA enabled visualization of more vessels than MRI based SEEG. MDCTA may help neurosurgeons better define the trajectory of the electrode and reduce the risk of intracranial bleeding. (C) 2016 Published by Elsevier Masson SAS on behalf of the Editions francaises de radiologie.

Background Bilateral subthalamic nucleus (STN) stimulation is used to alleviate Parkinson's disease (PD) motor symptoms. Recently, it has been shown that this therapeutic also increased gut cholinergic contractions. We therefore investigated the effect of STN stimulation on esophageal motility in an interventional randomized study. Methods Sixteen humans PD patients (4 women, 12 men; age: 62.4 +/- 9.3-years old) who underwent STN stimulation for at least 6 months were randomly evaluated with either stimulator turned OFF then ON, or inversely. Esophageal high resolution manometry was performed at the end of each ON and OFF period, with a 5 min resting period followed by ten swallows of 5 mL. Key Results During the ON, an increase in the distal contractility index was found (OFF: 1750 +/- 629 vs ON: 2171 +/- 755 mmHg/cm/s; p = 0.03), with no difference in the distal front velocity. A decrease in the integrative relaxation pressure of the lower esophageal sphincter (LES) was noted (OFF: 11.1 +/- 1.8 mmHg vs ON: 7.2 +/- 1.8 mmHg; p < 0.05) in ON. The LES resting pressure remained unchanged during the two periods. This resulted in a decrease in the intrabolus pressure (p = 0.03). No difference was observed for the upper esophageal sphincter, nor the pharyngeal contraction amplitude and velocity. Conclusions (sic) Inferences In conclusion, STN stimulation in PD patients increased esophageal body contractions and enhanced the LES opening. This suggests that the nigrostriatal-striatonigral loop is involved in the control of esophageal motility.

Background. - Patients with brain metastasis (BM) from renal cell carcinoma (RCC) have a poorly known prognosis due to the rarity of this disease. The aim of our study was to assess the outcome of patients with a BM due to RCC, and to determine the predictive factors for survival.Methods. - Consecutive patients who underwent treatment between 1997 and 2012 were identified retrospectively from a database (n=28, median age of 57.8 years, sex ratio M/F: 3.7). Main criteria collected concerned survival time. Other data collected were relative to initial histology, clinical findings at the time of BM diagnosis (diagnosis circumstances, KPS), radiological findings and BM characteristics (number, size and localization), treatment of BM (including surgery, stereotactic radiosurgery [SRS], systemic treatments, whole brain radiotherapy [WBRT]) and the outcome of surgery if performed. Statistical analysis of survival was performed using the Kaplan-Meier method.Results. - Median survival was 133 months, 1-year survival was 60.2%, 2-year survival was 16.4%. Univariate analysis showed the existence of intracranial hypertension (P = 0.01), other systemic metastasis (P = 0.049), the absence of deep metastasis (P = 0.03) which are all linked to shorter survival. Age, KPS, initial histology of RCC, number, size, localization, and hemorrhage in BM were not correlated to survival. The median survival in the surgical resection group was 25.3 months versus 8.6 months (P = 0.02). The main criteria for the selection of the surgical group were a single BM (P = 0.04), and superficial metastasis (P = 0.02).Conclusions. - Three predictive factors for longer survival in BMRCC were the absence of intracranial hypertension, the absence of acute metastasis and the absence of extracranial metastasis. Surgical removal, when possible, seems to benefit patient survival. (c) 2014 Elsevier Masson SAS. All rights reserved.

L’empyème intracrânien est une complication fréquente des affections ORL (oto-rhino-laryngologie). Les empyèmes intracrâniens, n’ont fait l’objet que de peu de travaux ces dernières années au Sénégal. Malgré les nouvelles techniques d’imagerie, cette affection pose encore des problèmes diagnostiques, thérapeutiques et de suivi dans nos régions. Cet article rapporte notre expérience confrontée à une revue de la littérature, en mettant l’accent sur les aspects épidémiologiques, les difficultés diagnostique et thérapeutique, et le pronostic.Il s’agit d’une étude rétrospective, réalisée de janvier 2008 à décembre 2011 portant sur 100 observations cliniques. Le diagnostic était posé grâce au scanner cérébral. Le traitement était à 21 % médical exclusif et à 79 % combiné à la chirurgie. La durée du traitement était de 4 à 8 semaines. La surveillance clinique et scannographique était de 12 mois.L’empyème représentait 44,4 % des suppurations collectées intracrâniennes. L’âge moyen était de 21 ans. La porte d’entrée était 35 % ORL, 10 % méningitique et 25 % inconnue. Le siège était 57 % sous-dural, 22 % extra-dural et 10 % inter-hémisphérique. L’empyème était associé à un abcès dans 7 cas. Un cas était situé dans la fosse cérébrale postérieure. L’évolution était favorable dans 78 %, 12,5 % ont présenté des séquelles neurologiques, 11 % sont décédés et 3 % ont présenté une récidive.La fréquence des empyèmes intracrâniens reste encore très élevée au Sénégal. Les difficultés de prise en charge du point de vue diagnostique, thérapeutique et économique font toute la gravité de cette affection. Malgré ces aléas, un schéma thérapeutique bien conduit et précoce est la seule garantie d’une réduction de la morbi-mortalité de cette affection qui touche particulièrement le sujet jeune.Intracranial empyema is a frequent complication of ear-nose-throat (ENT)infections. Limited studies have been carried-out on cerebral empyema during recent years in Senegal. Despite new imaging techniques, diagnostic and therapeutic problems as well as outcome still remain in our regions. We report our experience compared to that of the literature. The study focused on epidemiological aspects, difficulties in diagnosis and treatment as well as prognosis of this condition.This was a retrospective study conducted from January 2008 to December 2011 of 100 clinical cases. Diagnosis was made based on contrast CT-scan. Twenty-one percent of patients received medical treatment alone, while 79% underwent surgery. The duration of the treatment varied from 4 to 8 weeks. The follow-up was clinical and radiological with a mean follow-up time of 12 months.Cerebral empyema represented 44.4 % of all intracranial suppuration cases and the mean age was 21 years. The etiology was ENT in 35%, meningitis 10%, unknown 25%. Localization was sub-dural in 57%, extra-dural in 22%, inter-hemispheric in 10% of the cases. Empyema was associated with an abscess in 7 cases. One case was located in the posterior fossa. The evolution was favorable in 78% of the cases and in 12.5% some neurologic sequelae were observed. Eleven patients died and 3% of the patients had recurrences.The frequency of intracranial empyema is still high in Senegal. Difficulties in diagnosis, therapeutics and low economic incomes account for the gravity of intracranial empyema. In spite of these risks, early stage and effective treatment is necessary to reduce the morbi-mortality, especially in young aged children.

Spinal cord stimulation (SCS) has been demonstrated to be an effective treatment for postoperative persistent leg pain after spine surgery, but treatment of the back pain component remains much more difficult, as it comprises mixed neuropathic and mechanical pain mechanisms. Moreover, these patients could present damaged tissues at the site of SCS lead implantation as a result of previous spine surgery. It can therefore be logically assumed that minimizing the surgical invasiveness of SCS implantation would be beneficial for these patients. Several studies have demonstrated the value of Minimal Access Spine Technologies (MAST) in spine surgery, but only a few case reports have been published concerning the use of MAST techniques for SCS. Therefore, we were prompted to conduct a second ESTIMET ancillary study to prospectively analyse the potential impact and benefits of MAST technique during SCS lead implantation versus an open surgical approach.This is a multicentre, comparative, ancillary study conducted in 61 patients among the 115 enrolled patients ESTIMET study. One arm comprises patients undergoing multicolumn lead implantation via a Conventional Open Approach (COA) and the other arm comprises patients implanted by a MAST approach. Patients will be followed for 12 months after lead implantation. The following data will be collected: elevation of muscle enzymes (serum CPK), scar size, blood loss, infection rate, operating time and global, leg, back and scar NPRS.The first patient of this ancillary study was enrolled on 21 May 2012 and recruitment has now been achieved. Primary endpoint findings are expected to be available in 2015.Minimally invasive techniques have now been used for spine surgery for the past 12 years, and could also be useful in the context of SCS lead implantation, especially in patients with chronic back pain prior to implantation.La stimulation médullaire épidurale (SME) a démontré son efficacité dans le traitement des radiculalgies chroniques postopératoires. Cependant, le traitement de la composante lombaire reste beaucoup plus difficile car premièrement celle-ci présente des mécanismes douloureux mixtes, neuropathiques et mécaniques, et deuxièmement ces patients peuvent présenter des lésions tissulaires au niveau du site pressenti pour l’implantation de l’électrode, résultant de chirurgies rachidiennes antérieures. On peut donc logiquement supposer que le fait de minimiser le caractère invasif de l’implantation de la SME pourrait être bénéfique pour ces patients. Plusieurs études ont démontré l’intérêt des techniques mini-invasives (MAST) dans les chirurgies du rachis, mais seuls quelques cas ont été publiés concernant l’utilisation des techniques MAST pour la SME. Nous avons décidé de mener une seconde étude ancillaire ESTIMET afin d’analyser l’impact et les avantages potentiels de la technique MAST lors de l’implantation d’électrode de SME par rapport à une approche chirurgicale à ciel ouvert.Il s’agit d’une étude ancillaire multicentrique, comparative réalisée chez 61 patients parmi les 115 patients inclus dans l’étude ESTIMET. Un bras comprend des patients implantés d’une électrode multi-colonnes par une approche conventionnelle à ciel ouvert et l’autre bras comprend des patients implantés par une approche MAST. Les patients seront suivis pendant 12 mois après l’implantation de l’électrode. Les données suivantes seront collectées : élévation des enzymes musculaires (CPK sérique), taille de la cicatrice, perte sanguine, taux d’infection, temps opératoire et EVN radiculaire, lombaire et cicatricielle.Le premier patient de cette étude ancillaire a été inclus le 21 mai 2012. Le recrutement est maintenant finalisé. Les résultats finaux devraient être disponibles d’ici début 2015.Les techniques de chirurgie mini-invasive sont maintenant utilisées depuis plus de 12 ans en chirurgie rachidienne. Leur intérêt semble réel pour l’implantation d’électrodes de stimulation médullaire multi-colonnes, en limitant probablement le traumatisme opératoire chez ces patients, dont le dos est fragilisé. Ceci nécessite d’être confirmé par des études randomisées.

Neonatal septicemia is the most important cause of neonatal mortality. A wide variety of bacteria both aerobic and anaerobic can cause neonatal sepsis. Genus Pantoea is a member of Enterobacteriaceae family that inhabits plants, soil and water and rarely causes human infections, however, Pantoea dispersa has not been reported as a causative organism for neonatal sepsis. We hereby report two neonates with early onset sepsis caused by Pantoea dispersa. Early detection and appropriate antibiotic therapy can improve overall outcome of this rare infection in neonates.

Objectives. - Based on a cohort of patients treated on distal middle cerebral artery (MCA) aneurysm by microsurgical approach, the objectives were to assess the following: the postoperative functional outcome, study the causes of early neurological deterioration and to determine the predictive factors of favourable outcome.Patients and methods. - From a neurovascular prospective database, this retrospective longitudinal study included all the patients treated for cerebral aneurysm located on the distal segment of the MCA over two decades (January 1990-December 2011). The patients were all treated by microsurgical clipping exclusion. Any aneurysm was associated to infectious angiopathy. Data were retrieved from the patient's medical charts. The outcome was analysed twice: during the immediate postoperative period and at 6 months according to the modified Rankin scale. The relative risk was estimated for each variable and the prognostic factors were assessed using a multivariate logistic regression model (P < 0.05).Results. - Twenty-eight patients, mean age 40 +/- 13.3 years (median: 43 years; range 6-70 years) were divided into the ruptured group (n = 20) and unruptured group (n 8). In the ruptured group, the initial clinical status was good (WFNS I-III) in 12 patients (60%) and poor in eight (40%) with an intracerebral haematoma (ICH) in 11(55%). For both groups, the aneurysm location on the distal MCA decreased at a rate from 64.8% of the insular segment to 25% of the opercular then 10.7% to the cortical. During the hospital stay, neurological deterioration occurred in 16 patients (57.2%). The diagnosed causes were cerebral ischaemia in 10(35.6%), initial ICH in three (10.7%), hydrocephalus in two (7.1%) and epilepsy in one (7.1%). At 6 months, a favourable outcome (mRS 0-2) was observed in 19 patients (68.1%), a definitive morbidity in seven (24.9%) and death in two (7.2%). Based on the prognostic factors, only the absence of immediate postoperative neurological deterioration was identified as significant for a favourable outcome.Conclusion. - These rare cerebral aneurysms resulted in a high proportion of poor initial status related to a frequent ICH. Cerebral ischaemia was a major cause of the immediate neurological deterioration and the absence of immediate neurological deterioration was the single identified prognostic factor. (C) 2013 Elsevier Masson SAS. All rights reserved.

Background and purpose. - The endoscopic third ventriculostomy (ETV) has become the treatment of choice for managing non-communicating hydrocephalus. The aim of this study was to evaluate the efficacy and the morbi-mortality of this procedure and its long-term outcome.Patients and methods. - This retrospective study involved 82 consecutive patients treated for non-communicating hydrocephalus by ETV, in a single centre, between June 1999 and November 2008. The main criterion of efficacy was clinical improvement with shunt independence. The secondary criteria were the ventricular size (third and lateral ventricles) outcome and the procedural morbidity and mortality. In order to determine the predictive factors of dysfunction, a uni- and multivariate analysis was conducted.Results. - Divided in two groups, the overall success rate was 65.4% in the paediatric group (n =26) and 83.9% in the adult group (n = 56), after respectively a mean follow-up of 59.1 +/- 36.7 and 49.3 +/- 27.7 months. A procedural complication occurred in 5 patients (6.1%), with no procedure-related death. The predictive factors of ETV failure were an infectious aetiology and an age less than 16. Changes in ventricular size and success rate were independent.Conclusions. - ETV is an effective procedure at long-term for the management of non-communicating hydrocephalus with low morbidity. Therefore, it should be considered as first-line treatment. Cerebrospinal meningitis infection and young age both expose patients to possible dysfunction. (C) 2013 Elsevier Masson SAS. All rights reserved.

The ageing of the population in good health or without severe morbidity expose them to the occurrence of a subarachnoid hemorrhage (SAH) and requires effective management. Currently, the pertinence of cerebral aneurysm treatment by clipping or coiling is accepted for patients in the 8th or 9th decade of life, and the risk of postoperative morbidity induced by our therapeutic alternative must be carefully assessed. In these decades, the female/male sex ratio for aneurysmal SAH was greater in female who had a 1.6 times higher ratio than in male. The initial clinical status did not appear worse with age despite the frequent severity of bleeding observed on CT scan probably due to the large subarachnoid space. The aneurysm distribution and size were similar to those classically reported in the global population. The endovascular (EV) coiling appears as the first option with a favorable outcome rate estimated at 48% to 63%. Nevertheless, the benefit of EV coiling compared to microsurgical clipping for treatment of ruptured aneurysm in the elderly has not been demonstrated in a large randomized study. This is the reason why the vascular section of the French Society of Neurosurgery developed a prospective and randomized study of the aneurysmal SAH (PHRC 2007-042/HP) on the elderly patients.

We report the case of a 59-year-old woman admitted for a sudden headache due to a subarachnoid haemorrhage. On CT scan, the clots predominated into the posterior fossa without high-density in the sylvian or interhemispheric fissures. The vertebral angiography revealed a dural arteriovenous fistula at the foramen magnum associated to an aneurysm of the cervical anterior spinal artery. Due to the high rebleeding risk of a dural shunt, we proposed curative treatment using microsurgical interruption of the intradural draining vein. On the postoperative angiography at 15-day follow-up, the 2 malformations were corrected and the outcome at 6 months was excellent. Based on the literature, we assess this exceptional association and suggest its possible management.Une femme de 59 ans est admise en urgence pour une céphalée soudaine liée à une hémorragie sous-arachnoïdienne. Sur la tomodensitométrie cranio-encéphalique sans injection, l’hyperdensité prédominait dans la fosse postérieure au niveau de la jonction craniocervicale. L’artériographie vertébrale révélait une fistuledurale artério-veineuse alimentée par une branche méningée provenant de l’artère vertébrale gauche lors de la traversée durale, la veine efférente dilatée se dirigeait vers le haut en péribulbaire puis pré-protubérantiel. En outre, lors des clichés réalisés à l’injection lente du produit de contraste, un anévrisme fusiforme du segment cervical de l’artère spinale antérieure était diagnostiqué. Un traitement de la fistule artério-veineuse était réalisé par approche sous-occipitale microchirurgicale permettant une interruption par clip de la veine dilatée variqueuse. Sur l’angiographie de contrôle à 15 jours, les 2 malformations étaient complètement exclues. À 6 mois, la patiente a repris la totalité de ces activités socioprofessionnelles.

Based on a cohort of patients treated on distal middle cerebral artery (MCA) aneurysm by microsurgical approach, the objectives were to assess the following: the postoperative functional outcome, study the causes of early neurological deterioration and to determine the predictive factors of favourable outcome.From a neurovascular prospective database, this retrospective longitudinal study included all the patients treated for cerebral aneurysm located on the distal segment of the MCA over two decades (January 1990–December 2011). The patients were all treated by microsurgical clipping exclusion. Any aneurysm was associated to infectious angiopathy. Data were retrieved from the patient's medical charts. The outcome was analysed twice: during the immediate postoperative period and at 6 months according to the modified Rankin scale. The relative risk was estimated for each variable and the prognostic factors were assessed using a multivariate logistic regression model (P < 0.05).Twenty-eight patients, mean age 40 ± 13.3 years (median: 43 years; range 6–70 years) were divided into the ruptured group (n = 20) and unruptured group (n = 8). In the ruptured group, the initial clinical status was good (WFNS I–III) in 12 patients (60%) and poor in eight (40%) with an intracerebral haematoma (ICH) in 11 (55%). For both groups, the aneurysm location on the distal MCA decreased at a rate from 64.8% of the insular segment to 25% of the opercular then 10.7% to the cortical. During the hospital stay, neurological deterioration occurred in 16 patients (57.2%). The diagnosed causes were cerebral ischaemia in 10 (35.6%), initial ICH in three (10.7%), hydrocephalus in two (7.1%) and epilepsy in one (7.1%). At 6 months, a favourable outcome (mRS 0–2) was observed in 19 patients (68.1%), a definitive morbidity in seven (24.9%) and death in two (7.2%). Based on the prognostic factors, only the absence of immediate postoperative neurological deterioration was identified as significant for a favourable outcome.These rare cerebral aneurysms resulted in a high proportion of poor initial status related to a frequent ICH. Cerebral ischaemia was a major cause of the immediate neurological deterioration and the absence of immediate neurological deterioration was the single identified prognostic factor.Les anévrismes distaux de l’artère cérébrale moyenne (ACM), rares, posent des questions spécifiques liés à leur topographie. L’objectif du travail était d’évaluer dans une cohorte consécutive de patients, le devenir fonctionnel postopératoire, les causes de la détérioration neurologique précoce et déterminer les facteurs prédictifs d’une évolution favorable.Cette étude longitudinale, rétrospective, concernait tous les patients traités d’anévrisme implantés au-delà de la bifurcation majeure – distaux – de l’ACM durant deux décennies (janvier 1990–décembre 2011). Tous les patients ont été traités par exclusion microchirurgicale. Les données étaient extraites des dossiers médicaux identifiés à partir d’un registre constitué prospectivement. L’évolution était analysée en période immédiate et à six mois selon les critères de la classification modifiée de Rankin. Le risque relatif était estimé pour chaque variable et les facteurs pronostiques à l’aide d’une analyse par régression logistique ordinale.La cohorte composé de 28 patients (âge moyen : 40 ± 13,3 ans, médiane : 43 ans, extrêmes : 6–70 ans) était divisée en un groupe rompu (n = 20) et non rompu (n = 8). Dans le groupe rompu, la présentation clinique initiale était WFNS I–III chez 12 patients (60 %) et WFNS IV–V chez huit (40 %) ; un hématome intracérébral associé était diagnostiqué chez 11 patients (55 %). La topographie des anévrismes distaux de la cohorte était le segment insulaire pour 64,8 % des anévrismes, le segment operculaire pour 25 % et le segment cortical pour 10,7 %. Durant l’hospitalisation, une détérioration neurologique survenait chez 16 patients (57,2 %). Les étiologies étaient une ischémie cérébrale chez dix patients (35,6 %), l’hématome cérébral initial chez trois (10,7 %), une hydrocéphalie chez deux (7,1 %) et une épilepsie chez un (7,1 %). À six mois, une évolution favorable (Rankin 0–2) était observé chez 19 patients (68,1 %), une morbidité chez sept (24,9 %) et un décès chez deux (7,2 %). L’unique facteur pronostique indépendant d’une évolution favorable était l’absence de détérioration neurologique postopératoire immédiate.Ces patients avec anévrisme rompu de topographie distale sur l’ACM présentent une haute proportion d’état clinique défavorable initial liée à la fréquence des hématomes cérébraux associés. Ces anévrismes par leur topographie distale sont traités de manière prépondérante par exclusion microchirurgicale faisant parfois appel à des techniques de neuronavigation. L’ischémie cérébrale, sur ces artères de petit calibre, est à haut risque recommandant actuellement l’utilisation de procédures de contrôle peropératoire.

Les complications des traitements du cancer de la prostate sont responsables d’une altération de la qualité de vie. Nous avons évalué la prévalence et le vécu par les patients des conséquences fonctionnelles sexuelles des traitements du cancer de la prostate.un auto-questionnaire rétrospectif a été adressé à tous les membres de l’Association nationale des malades du cancer de la prostate (Anamacap). Toutes les réponses reçues ont été analysées.226 questionnaires ont été analysés, l’âge moyen était de 67,3 ans, le suivi moyen de 58,1 mois. 110 patients ont eu une chirurgie seule, 29 une radio-hormonothérapie, 28 une irradiation seule et 49 des traitements combinés. Après le traitement du cancer de la prostate, une dysfonction érectile modérée à sévère a été rapportée par 75,2 % des patients ; une dysorgasmie était retrouvée dans 69 % des cas ; une orgasmurie dans 21 % des cas ; une diminution de taille de la verge dans 70 % des cas et une diminution de sensibilité du gland dans 59 % des cas. Chacune entraînait une gêne importante allant de 75 % à 90 % selon le symptôme. La prise d’IPDE5 n’a montré une efficacité que dans 25,6 % en prise quotidienne et 39 % à la demande.Les conséquences fonctionnelles des traitements du cancer de la prostate sont fréquentes, variées et imputent au premier plan la vie sexuelle. Il est nécessaire d’améliorer l’éducation thérapeutique et la prise en charge oncosexologique grâce aux associations de malade, afin de rétablir l’équilibre du couple.3.Complications of prostate cancer treatments are responsible of a lower quality of life. We evaluated the prevalence and the perceptions of sexual consequences of prostate cancer treatments.A retrospective self-administered questionnaire was sent to all the members of the Association Nationale des Malades du Cancer de la Prostate (ANAMACAP). All the answers were analyzed.226 questionnaires were analyzed, the average age was 67.3 years old, the average follow-up was 58.1 months. 110 patients had surgery only, 29 had hormone therapy plus radiotherapy, 28 had radiation therapy only and 49 had combined treatments. After the treatment of the prostate cancer, an erectile dysfunction was reported by 75.2% of the patients; an orgasmic dysfunction by 69%; a climacturia by 21%; a reduced penile length by 70% of them and a less sensitive glans by 59%. They were responsible of a lower quality of life for 75% to 90% of the patients depending on the symptom. A PDE5-inhibitor treatment was effective for only 25.6% of them when taken daily and for 39% on demand.Functional consequences of prostate cancer treatments are common, diverse and directly involved in the sexual life. It is necessary to improve therapeutical education and onco-sexology with the help of patients’ associations, to build a new balance in the couples.3.

In this study, rarefaction effects in pressure-driven gas flows in annular micro-channels are investigated. The influence of gas rarefaction, aspect ratio of the annulus, and surface accommodation coefficient on wall friction, mass flow rate, and thermal energy flow rate is studied. For this, the linearized Navier–Stokes–Fourier (NSF) and regularized 13-moment (R13) equations are solved analytically. The results are compared to available solutions of the Boltzmann equation to highlight the advantages of the R13 over the NSF equations in describing rarefaction effects in the process. Moreover, a second-order slip boundary condition is proposed to improve the accuracy of the classical NSF equations.

Background and purpose. - Long-term results of decompressive laminectomy in degenerative lumbar stenosis have been studied in only six prospective studies. The objective of our study was to evaluate the functional outcome at long term of patients after decompressive laminectomy in lumbar stenosis and to determine predictive factors of favorable outcome.Methods. - A prospective cohort data were collected by an independent observer five years after decompressive laminectomy for degenerative lumbar stenosis. The endpoint was the assessment of the Beaujon score for functional evaluation. The result was considered as favorable if the Beaujon score increased by at last five points' between the preoperative stage and at follow-up examination. Logistic regression was then performed with univariate and multivariate analysis to reveal predictive factors of good long-term outcome (P <= 0.05).Results. - The preoperative characteristic of our population (n = 98) was a mean age of 67.3 +/- 8.8 years, a low comorbidity (mean Charlson score = 2.8 +/- 1.5), overweight status (BMI = 29.4 +/- 6.3) and the mean Beaujon score was 9.3 +/- 3.1. At five years after surgery, the mean Beaujon score became 14.1 +/- 4.2. Favorable functional outcome concerned 45.9% of our series. The predictive factor of favorable outcome identified in the univariate analysis the neurological deficit (P = 0.05) and in the multivariate analysis the low comorbidity (P = 0.01).Conclusion. - The long-term results of surgical treatment of lumbar spinal stenosis were moderate with an improved outcome in 49.5% of cases in our study. The only independent factor to a favorable outcome was the low comorbidity. (C) 2012 Elsevier Masson SAS. All rights reserved: