B Acad Nat Med Paris
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B Acad Nat Med Paris · Jun 2005
Review[Spinal cord trauma: epidemiology and pre-hospital management].
In France, about 2000 people suffer spinal cord injuries each year. Most patients are young men involved in road accidents and most have cervical lesions. Emergency pre-hospital care is crucial, as the lesions are potentially life-threatening and can have devastating functional consequences. ⋯ The initial neurological examination is extremely important. Initial medical care should target an average systolic blood pressure above 80 mmHg, ensure adequate ventilation, maintain the body temperature over 36 degrees C, and control hyperglycemia. The patient should be transported rapidly to a specialized spinal trauma unit.
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Four diseases presenting mainly as intermittent bouts of inflammatory symptoms have been clinically and genetically characterized. At the head of this group is familial Mediterranean fever, which affects thousands of patients of Mediterranean ancestry. The other three entities are the tumor necrosis factor receptor superfamily 1A-associated periodic fever syndrome (TRAPS) with a dominant mode of inheritance; hyperimmunoglobulinemia D and periodic fever syndrome (HIDS); and the most recently recognized entity, which includes Muckle Wells syndrome, familial cold urticaria, and the chronic infantile neurological cutaneous and articular (CINCA) syndrome. Proper diagnosis of these entities is needed to begin specific clinical and therapeutic management.
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B Acad Nat Med Paris · Jun 2005
Review[Traumatic lesions of the spinal cord. Management in the hospital: the orthopedic surgeon's point of view].
Initial presurgical management of spinal injuries with spinal cord damage includes cardiorespiratory intensive care, a precise neurologic examination, and a complete radiological work-up with simple films, computed tomography, and also magnetic resonance imaging if there is a conflict between the imaging results and clinical findings. The structural lesion can then be staged, using a reproducible system with prognostic value for instability. Reduction, decompression and stabilization are the three main objectives of orthopedic management. ⋯ Spinal cord injuries in children pose two specific problems: that of spinal cord damage with no visible bony lesions; and that of subsequent spinal deformities (scoliosis, hypokyphosis, or hyperlordosis). The most common spinal cord injuries in the elderly involve hyperextension in patients with cervical canal stenosis. The incidence of spinal damage, with or without spinal cord involvement, is increasing Instability being rare in such cases, the primary objectives of surgery are usually decompression and repair.