Rhabdomyosarcome para vertebral : cause rare de compression medullaire

Le rhabdomyosarcome est la tumeur maligne mésenchymateuse la plus fréquente chez l’enfant. Il se voit essentiellement au niveau des extrémités et la sphère ORL. La localisation paravertébrale avec compression médullaire est beaucoup plus rare. Les auteurs rapportent un cas de rhabdomyosarcome paravertébral avec extension endocanalaire et compression médullaire. Il s’agit d’une fille âgée de 6 ans admise pour un tableau de compression médullaire. L’examen clinique retrouve une patiente paraplégique avec niveau sensitif T8, des réflexes ostéo-tendineux abolis et une contracture des muscles paravertébraux. L’IRM médullaire montre un processus tissulaire à point de départ musculaire paravertébral droit, de signal hétérogène avec extension intra-canalaire et compression médullaire. La patiente a eu une laminectomie avec biopsie chirurgicale. L’étude histologique a posé le diagnostic d’un rhabdomyosarcome alvéolaire. La patiente a été traitée par chimiothérapie suivie d’une radiothérapie. L’IRM de contrôle a montré une régression totale du processus tumoral. Après un recul d’une année, la patiente a présenté une récidive locale avec métastases pulmonaires. Malgré cette localisation rare, le rhabdomyosarcome doit être évoqué devant un processus paravertébral avec extension épidurale et compression médullaire chez l’enfant.Mots clés : Rhabdomyosarcome, IRM, compression médullaire

Les osteomes sinusiens a extension orbitaire a propos de trois cas

Introduction : L’ostéome des sinus paranasaux est une tumeur bénigne rare, dévolution lente et qui peut être responsable de complications ophtalmologiques, sinusiennes et endocrâniennes. Son traitement lorsqu’il s’impose, n’est que chirurgical.Observations : Nous rapportons les observations médicales de trois patients opérés dans le service d’ORL et de chirurgie cervico-faciale de l’hôpital 20 aout de Casablanca pour des ostéomes sinusiens a extension orbitaire. L’origine de l’ostéome était frontale dans 1 cas et ethmoïdal dans 2 cas. La tumeur était le plus souvent révélée par une exophtalmie d’apparition progressive associée ou non a des céphalées L’indication opératoire a été posée chez les trois malades. La voie d’abord a été transfaciale dans deux cas et bicoronale dans un cas. L’évolution a été favorable chez tous les patients.Conclusion : : l’ostéome sinusien est une néoformation osseuse bénigne dont le traitement est chirurgical dans les formes symptomatiques. La voie d’abord dépend de la localisation tumorale.Mots clés : Ostéome, Sinus paranasaux, Extension orbitaire, Traitement.Objective : The osteoma of paranasal sinuses is a rare benign tumour, slow devolution and which may be responsible for ocular, intracranial and sinus complications. The treatment when it is required, is that surgical.Case report : We report the medical observations of three patients operated in the ENT service and cervical-facial surgery in the Hospital 20 August of Casablanca for sinus osteomas with orbital extension. The origin of the osteoma was frontal in one case, ethmoid in two cases. The tumor was most often revealed by a gradual exophthalmia associated or not with headache. The operative indication has been raised in three patients. The incision was transfacial in two cases and bicoronale in one case. The evolution was favorable in all patients.Conclusion: the sinus osteomas is a benign bone neoformation with surgical treatment in symptomatic forms. The surgical approach depends on tumor location.Keyswords : Osteoma, Paranasal sinuses, Orbital Extension, Treatment

Population of Coconut Crab (Birgus latro) in Fam Island, Raja Ampat, Indonesia

This research was conducted inthe villages of Korwo Iba and Meos Ambower, Fam Islands Raja Ampat Regency, Southwest Papua Province, will be implemented within 3 years, namely 2020 to 2022. The purpose of this study was to evaluate the coconut crab population and its sex population (comparison of the number of male and female sexes), the relationship between body weight and length coconut crab carapace.This research uses descriptive quantitative and qualitative with the technique of reviewing the results of previous research journals. The data analysis used was the calculation of the relationship between length and weight of fish growth by Effendi 2002. The method of collecting morphometric data from a number of coconut crab samples. Based on the research results obtained,p.sThe population of coconut crabs decreased because the male coconut crab population was more dominant than the females, vegetation factors and the activity of local people who caught coconut crabs for trade or consumption. The relationship between carapace length and body weight of the coconut crab produces a value of b less than 3 (<3) which indicates a negative allometric, which means that the length gain is faster than the body weight gain

Managing central venous access during a health care crisis

10.1016/j.jvs.2020.06.112JOURNAL OF VASCULAR SURGERY7241184-

Managing central venous access during a health care crisis.

ObjectiveDuring the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic.MethodsWe conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19.ResultsParticipants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group).ConclusionsImplementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises

Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialtie

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries