Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg最新文献

Purpose of the study: To evaluate the efficacy of fractionated stereotactic reirradiation with CyberKnife (CK) performed in 6 patients with high grade gliomas treated in Luxembourg with local recurrence (LR).

Patients and methods: Between 04.2014 and 06.2016, 6 patients with multiform grade IV gliomas LR were reirradiated with CK (protocol CNER re-RT CFB 1), as reirradiation. The mean time between primary radiotherapy and local recurrence (LR) is 14.1 months [4 - 38]. CK is performed with a dose of 36 Gy in 6 fractions (5 cases) and 30 Gy in 3 fractions (1 case) Results : LR after CK (progression free survival) is 3.4 months [2 - 7] (5 cases assessment). Mean survival after CK is 12 months [3 - 22] (3 cases assessment). Mean survival after initial diagnosis is 37 months [17 - 58] (3 cases assessment). No toxicity is noticed (4 cases assessment). Time to first progression after primary treatment is a strong predictor for survival. Fractionated stereotactic reirradiation with CK is well tolerated and effective (survival) in patients with LR high grade gliomas. In accordance with these results, the CFB Conseil Scientifique recommends a new paradigm for MRI follow-up high grade gliomas. After first line treatment, an MRI has to be performed every 3 months, to identify LR earlier, and to offer the patients a way of salvage with CK option, in order to increase his chances of better survival.

Wernicke’s encephalopathy (WE) is a very rare complication of surgicalintervention, especially among patients with no liver dysfunction and no history ofalcohol abuse. In a surgical setting, Wernicke’s syndrome was mostly associatedwith abdominal surgery (bariatric, e.g. gastric bypass, splenectomy) but there areno papers in the literature dealing with such a complication among spine patients.

The majority of fractures of the anterior pelvic ring is treated non-operatively. However, a number of patients do not get pain free and cannot be mobilized. Since the supra-acetabular external fixator is associated with significant complications we developed an alternative technique based on recent anatomical studies. This article is a clinical feasibility study to evaluate a novel stabilization technique for fractures of the anterior pelvic ring in the elderly patient. This technique obtains rapid pain reduction and early ambulation in this group of patients.

We present a case of intraparenchymal radioinduced cyst of the brain observed in our department. It is a rare and relatively benign pathology which is usually treated conservatively or by surgery. We emphasize long-term imaging follow up in patients treated by radiosurgery, which can lead to the demonstration of multiple adverse events such as tumefactive cyst formation.

With the world further aging, geriatric medicine clearly became a necessity: in the 21th century many more people reach older ages by means of continued medical success in expanding lifespan. 150 years ago life expectancy was between 30 to 40 years, but today close to 800 million people are 60 yeas old or more. During the last century aging has been associated with decline and decay, but gradually more people lived ably and healthily in older ages. The expansion in life expectancy has become a synchronism of quality of life: the average 65 year old today is much healthier, physically and mentally fitter, than the average 50 year old 150 years ago, when Alois Alzheimer war born, a period when most nowadays existing geriatric institutions were envisioned and progressively realized over time. Today we strongly believe that a healthy life and, equally, the quality of life of the very old people can be extended with presently existing medical knowledge, based on research, environmental and behavioural changes, by postponing the onset and progression of fatal and disabling diseases and disorders. But very soon ethical considerations concerning all kinds of medical and technological solutions available to maintain or even improve the mental and physical functioning of dependant elderly people will engage our society when deciding how and at what moment in time to make the best decisions and allocate resources. Geriatric medicine will be further challenged by competing and demanding medical and economic needs, when marshalling resources to meet the growing demands of our society for improving care for the very old and often demented adult.

Percutaneous aortic valve replacement (TAVI) is one of the most innovative procedure in interventional cardiology. The Direct Flow Medical transcatheter aortic valve (DFM) is a new nonmetallic valve which allows perfect repositioning and valve retrieval prior to the final deployment. This study is a prospective non-randomized evaluation of the DFM system in the Luxembourg registry. The study focused on 15 patients who received between March 2013 and October 2013 a percutaneous aortic valve replacement by DFM prosthesis. All clinical and echocardiographic data have been collected prospectively. Fifteen inoperable patients with severe aortic stenosis were evaluated. The average age of our population was 83 +/- 4.16 years, mean STS score was 16%. 46% of patients were in NYHA class III and 33.3% in NYHA class IV. Mean ejection fraction was 59% +/- 12.7, the average mean gradient was 52.86 +/- 18.5 mm Hg and mean aortic orifie was 0.63 +/- 0.15 cm2. Procedural success rate was 100%. The mean trans- valvular gradient decreased from 52.86 +/- 18.5 mm Hg to 12 +/- 4.2 mm Hg (p < 0.001). The average hospital stay was 14 +/- 7.6 days. The non-fatal major event rate at one month was 33.3%. The mortality rate at one month was limited to 6.6%. These results allow us to confirm the efficacy and safety of the DFM valve.

AF might be a life threatening disease. Patients have been under oral antithrombotic treatment in order to avoid thrombotic events. Although this treatment proved to be effective in the last decades there was always the inconvenience of a regular blood control. In the last months NOACs have been flooding the market promising to be as effective as their older concurrents in certain circumstances and highlighting the fact that the control of INR has become obsolete. However, as there is no specific antidote up to date, NOACs might present a life threatening event in case of an intracerebral haemorrhage. The brain surgeons might find themselves in a difficult situation when they have to decide whether to operate on a patient with a compromised haemostasis or not. We present four patients who were treated with NOACs for AF. Three of them were admitted with intracerebral haemorrhage in our neurosurgical unit from January to October 2013. The fourth patient bled one week after stopping his treatment with NOAC. Furthermore we take a closer look to the existing literature and try to portray the issue from a neurosurgical point of view.

Background: Aerobic exercise capacity is considered as an independent prognostic factor for cardiovascular disease and mortality. It is usually expressed in maximal oxygen consumption (VO2(max)) or metabolic equivalent (MET) and is measured by spiroergometry or calculated by a regression formula based on maximal performance achieved. Obesity is associated with reduced physical performance and increased cardiovascular mortality. The aim of our study was to describe the ergometric and cardiovascular profile of patients of an obesity clinic, and to compare a direct measure of VO2(max) with an indirect by a regression formula and to.

Method: 131 consecutive patients of an obesity clinic (95 females, 36 males) aged 16-75 years participated. The VO2(max) was measured by spiro-ergometry on a treadmill and estimated by a regression formula on the basis of the speed and grade of the treadmill. We have determined the relationship between Body mass index (BMI), Waist Circumference (WC) and the parameters VO2(max)/kg, MET, Performance Relative for Age, Heart Rate Recovery one minute after maximal effort (HRR), VO2(max) relative to a theoretical normal body weight (corresponding to a BMI of 25 kg/m2 (VO2(max)Rel25)), blood pressure, at rest and 5 minutes after exercise, Framingham Score and C-reactive protein (CRP).

Results: For the different age groups the VO2(max)/kg was below normal values (mean -23.4%). Measured VO2(max) was 15.2% lower than estimated by the regression formula. After adjusting to age and to a theoretical upper-limit normal body weight (corresponding to a BMI of 25 kg/m2) VO2(max)/kg was 5-20% (mean value 15%) higher than the reference values. VO2(max)/kg and HRR were correlated with BMI, WC and Framingham Score. 40% of the patients were already treated for hypertension, 55% had elevated blood pressure measurements at rest and 52% after exercise.

Conclusions: Ergometric stress testing in obese subjects delivers important information that helps to evaluate the cardiovascular risk in this population and to provide individual recommendations for training therapy (e.g. training intensity, heart rate etc). Obese patients show a marked diminution of aerobic exercise capacity. In this population, the use of a standard regression formula to calculate VO2(max) leads to an overestimation of aerobic performance. The even higher than normal VO2(max) related to upper-normal body weight indicates that the reduced physical performance in obese patients is rather due to the overweight than to a pathological loss of muscle mass.

Mathematical models may be resorted to in an endeavor to predict the development of epidemics. The SIR model is one of the applications. Still too approximate, the use of statistics awaits more data in order to come closer to reality.