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Functional positioning in robotic medial unicompartmental knee arthroplasty: a step-by-step technique
No full textInternational audienceUnicompartmental knee arthroplasty (UKA) compared to total knee arthroplasty, offers several benefits, though it is associated with a higher revision rate, primarily due to suboptimal implant positioning. Recent advances in robotic-assisted techniques have contributed to more personalized and reproducible procedures. Functional Positioning (FP), a three-dimensional alignment concept, introduces a tailored approach based on a surgical technique that is both effective and reproducible. This article presents a step-by-step surgical technique for medial UKA using FP principles in combination with an image-based robotic system. The technique ensures accurate preoperative planning, real-time intraoperative adjustments, and precise component placement. The key steps of this surgical technique include achieving congruent contact points between the femur and tibia under load across the full range of motion, positioning the implant based on the compliance of the medial soft tissues, planning for a targeted laxity that results in an “eagle-wing” appearance, and the use of robotic tools to map cartilage for optimal resurfacing. Future studies will help refine FP strategies and further optimize outcomes in these patients
Benign prostate hyperplasia over 150 cm3: Should we perform an endoscopic enucleation of the prostate or robotic-assisted simple prostatectomy?
No full textInternational audienceIntroduction: Benign prostatic hyperplasia (BPH) is a prevalent condition in ageing men, often resulting in significant lower urinary tract symptoms (LUTS) that impact quality of life. For patients with huge prostate volumes (> 150 mL), surgical management presents challenges. Traditionally, open simple prostatectomy (OSP) was the gold standard; however, minimally invasive approaches such as robotic-assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP), especially holmium laser enucleation of the prostate (HoLEP), offer similar or superior outcomes with reduced morbidity.Methods: This review analyzed studies comparing the perioperative, functional, and complication outcomes of RASP and HoLEP in treating very large prostates (> 150 mL). A comprehensive literature search was performed to evaluate evidence on surgical efficacy, complication rates, and recovery profiles.Results: Both RASP and HoLEP demonstrated excellent perioperative outcomes, with HoLEP providing reduced operative time and hospital stays. HoLEP also showed lower blood loss and a reduced need for transfusions, while RASP offered advantages in terms of precision and surgeon control, especially for anatomically complex cases. Functional outcomes, including improvement in urinary flow and symptom scores, were comparable between the two techniques. However, complications such as transient incontinence were more commonly reported with HoLEP.Conclusion: Both RASP and HoLEP are effective and safe for the management of very large prostates. HoLEP offers significant advantages in perioperative recovery and reduced morbidity, whereas RASP provides excellent outcomes in complex cases requiring precise dissection. The choice between these techniques should be guided by patientspecific factors and surgical expertise. Future studies should focus on long-term functional outcomes to refine surgical recommendations further
Analgesia considerations in orthopaedic surgery: the role of magnesium sulfate infusions
No full textInternational audienceOrthopaedic surgical operations are associated with significant post-operative pain, often managed with opioids, which carry risks of adverse effects and dependency. Magnesium sulfate, a NMDA receptor antagonist with analgesic and muscle relaxant properties, has emerged as a potential adjunct to improve pain control and reduce opioid consumption in orthopaedic procedures. Current evidence supports magnesium sulfate as a valuable adjunct in orthopaedic pain management, particularly in reducing opioid consumption and enhancing muscle relaxation. However, heterogeneity in study design, administration protocols, and patient populations warrants cautious interpretation. Monitoring for side effects such as hypotension and respiratory depression remains essential. Further high-quality, standardized trials are needed to optimize dosing strategies and confirm long-term benefits
Efficacy and safety of azacitidine for VEXAS syndrome: a large-scale retrospective study from the FRENVEX group
No full textInternational audienceVEXAS (Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic) syndrome is a severe monogenic disorder caused by somatic UBA1 mutations, characterized by inflammation, cytopenias and frequent association with myelodysplastic neoplasms (MDS). Steroid dependence is common, and targeted therapies have demonstrated limited efficacy. Azacitidine (AZA), a hypomethylating agent used in MDS, has shown potential in VEXAS but data remain limited. This multicenter retrospective study assessed AZA efficacy and safety in 88 genetically confirmed VEXAS patients from the FRENVEX (French VEXAS) group, 80% meeting WHO 2022 MDS criteria. Inflammatory response rates were 41% at 6 months and 54% at 12 months, regardless of MDS status. A total of 50 (61%) patients achieved inflammatory response, with 70% occurring at 6 months, suggesting a delayed median response. Among responders, relapse-free survival on AZA was 90% at 1 year and 85% at 5 years. Of the 12 responders who discontinued AZA, 9 relapsed after a median of 3.1 years (range: 0.4-5.6), with effective re-exposure in 4 of 5 patients. Hematological responses included red blood cell transfusion independence in 65% and platelet improvement in 77% of patients. Molecular response, defined as a ≥25% reduction in UBA1 variant allele frequency (VAF), was observed in 65% of patients, all of whom achieved inflammatory and hematological responses; and VAF dropped below 2% in 43% of cases. Infections (34%) and cytopenias (36%) were common, particularly during the first three cycles. This study establishes AZA as an effective therapy for VEXAS, improving inflammation, cytopenias, and UBA1 clonal burden, warranting larger prospective trials
Discarded intravenous medication in the ICU: the GAME-OVER multicenter prospective observational study
No full textInternational audienceBackground: Medication waste is a contributor to the healthcare environmental footprint and impacts ecosystems. Data on medication waste in the intensive care unit (ICU) are scarce, and therefore are essential to develop new sustainable strategies.Methods: The GAME-OVER French multicenter prospective observational study was conducted from November 2022 to March 2023, over a 24-h period of choice, at the discretion of each participating center. Adult ICUs were enrolled in the study on a voluntary basis and hospitalized patients who did not express opposition were included in the analysis. The primary endpoint was the percentage of discarded intravenous (IV) medication in the ICU, defined as the ratio of the discarded volume to the total volume of IV medication prepared. Secondary endpoints included identifying risk factors and main reasons for medication waste and estimating its related healthcare cost.Results: Among the 81 ICUs and the 1076 enrolled patients, 408.9 L of 130 IV medications were prepared. The discarded volume was 43.8 L, resulting in a 10.7% discarded IV medication (95% Confidence Interval (CI), 9.9-11.5). Number of daily admissions/discharges in the ICU, as admission for elective surgery, Sequential Organ Failure Assessment score ≥ 7, endotracheal intubation, renal replacement therapy and body mass index were independently associated with increased discarded IV medication. Ninety percent of pharmaceutical waste was attributed to 25 key drugs, with an estimated national annual cost of 2,737,163€.Conclusions: Discarded intravenous medication in the ICU is considerable and results in significant costs for the health care system, without obvious patient-centered value. Risk factors associated with medication waste were largely nonmodifiable, emphasizing the need for sustainable practices in patient care and resource management.</b
Syndrome des abcès aseptiques : un potentiel lien avec des maladies autoinflammatoires monogèniques
No full textInternational audienceIntroductionLe syndrome des abcès aseptiques (AAS) est une maladie rare, avec la plus grande série de patients recensée en France comprenant 71 cas. L’AAS est souvent associé à des pathologies telles que les dermatoses neutrophiliques (pyoderma gangrenosum, syndrome de Sweet)ou les maladies inflammatoires chroniques de l’intestin (MICI). Il partage certaines caractéristiques avec les maladies auto-inflammatoires, impliquant les cellules de l’immunité innée.Des variants du gène PSTPIP1 ont été rapportés dans des maladies liées à l’AAS, comme l’hidradénite suppurée. Des études ont exploré un lien potentiel entre le gène PSTPIP1 et l’AAS, mais aucune conclusion définitive n’a été établie quant à une origine monogénique dans l’étiologie de la maladie. La rareté de l’AAS, l’absence de cas familiaux et la variabilité phénotypique rendent difficile l’identification des gènes impliqués.L’objectif de notre étude était d’explorer une possible étiologie monogénique au développement des abcès aseptiques.Patients et méthodesNous avons inclus des patients français atteints d’AAS selon les critères définis par André et al. Un séquençage de l’exome a été réalisé et les variants rares d’intérêt dans des gènes associés à l’immunité ont été analysés.RésultatsDix patients ont été inclus, avec un âge moyen de 28,5 ± 10 ans, dont 50 % de femmes. Tous présentaient des abcès spléniques, avec des localisations supplémentaires au niveau du foie (n = 2) et de la peau (n = 3). Trois patients avaient une pathologie associée : maladie de Crohn (n = 1) et spondylarthrite ankylosante (n = 2). Les traitements comprenaient des corticoïdes (n = 9) et des immunosuppresseurs (n = 8). Des rechutes ont été observées chez 8 patients.Aucune mutation ponctuelle du gène PSTPIP1 n’a été identifiée chez les 10 patients. En revanche, un patient présentait un génotype pathogène compatible avec un déficit en mévalonate kinase (MKD). Un autre patient avait un variant hypomorphe probable dans le gène PLCG2, précédemment associé au phénotype APLAID chez un patient avec des abcès hépatiques stériles et un granulome hépatique nécrosant. Un troisième patient avec un AAS typique présentait un variant dans le gène NLRC4.ConclusionNos résultats préliminaires suggèrent que le syndrome des abcès aseptiques pourrait être associé à des maladies auto-inflammatoires monogéniques telles que le MKD ou l’APLAID. Il reste à déterminer si ces associations sont causales ou simplement contributives au phénotype de l’AAS
Evaluation of professional practices in the use of mexiletine for the management of childhood myotonia in French pediatric neuromuscular centers (MEXI-PEDI survey)
No full textInternational audienceBackground: Myotonia is the main feature of both myotonic dystrophy (DM) and non-dystrophic myotonia (NDM). It is felt as stiffness, pain, fatigue, and weakness. In France, mexiletine, a non-selective voltage-gated sodium channel blocker, is approved for the treatment of myotonia in adults with NDM, and it has a temporary recommendation for use in the symptomatic treatment of DM in adults. However, it is not currently licensed for treating myotonia in children due to the lack of studies on its use in pediatrics. This has meant heterogeneous practices in its utilization and has led to prescriber reluctance, which has jeopardized accessibility. We undertook a professional practice survey of French pediatric neuromuscular centers to determine their prescribing habits for mexiletine, assessing indications, doses, efficacy, and tolerance. Methods: One medical pediatric professional from each French pediatric neuromuscular center belonging to the national neuromuscular network (FILNEMUS) was invited to complete an anonymous questionnaire. Results: In total, 34 healthcare professionals responded. Of these, 16 had already treated a child for myotonia with mexiletine. Mexiletine was prescribed in one third of pediatric patients with NDM, but it was used in only 3% of DM type 1 patients and in no DM type 2 patients. Pre-treatment assessment always included a cardiac evaluation; however, the method of introduction (inpatient vs. outpatient basis), dosage adjustment, and efficacy evaluation ranged widely. More than half of the respondents reported a high efficacy of mexiletine in their patients; only three reported moderate adverse events (dyspepsia, loss of appetite, and asthenia). Conclusion: The findings of this first survey on mexiletine for pediatric myotonia in France lend support for the creation of future national guidelines
Endoscopic submucosal dissection for visible dysplasia in IBD: A nationwide multicenter cohort from the GETAID and the SFED
No full textInternational audienceBackground and aims: New techniques for endoscopic resection, including endoscopic submucosal dissection (ESD), have been developed to allow for en-bloc resection with very low recurrence rates and organ sparing in patients without inflammatory bowel disease (IBD). Data on ESD for the management of colorectal dysplasia in IBD patients are scarce. We aimed to evaluate the efficacy and safety of ESD for the treatment of IBD.Methods: We conducted a retrospective multicenter cohort study that evaluated consecutive ESD procedures in IBD patients with visible dysplasia from 20 French centers with ESD experience. Between June 2008 and March 2022, all IBD patients included in the local ESD databases and who underwent ESD for visible dysplasia proven on biopsy were included. All patients were included from the date ESD was performed, and endoscopic follow-up and surgical data were collected.Results: Among the 88 lesions resected in 82 patients (19 patients with Crohn's disease), 82% and 80% of patients had R0 and curative resection, respectively. Ten (12%) patients required surgery: 1 for complication, 3 for endoscopic failure, and 6 for noncurative resection. After a median follow-up of 20 (IQR 10.5-45) months, 4 patients experienced local recurrence, and 14 (17%) underwent surgery. Two patients died from cardiovascular issues during the follow-up. Factors associated with local recurrence were R1 resection, associated primary sclerosing cholangitis, a personal history of colorectal cancer, and active lesions at the ESD site.Conclusions: Endoscopic submucosal dissection is feasible for IBD patients with visible colorectal dysplasia and has an acceptable safety profile. These findings should be evaluated further in control trials
Real-Life Cefiderocol Use in Bone and Joint Infection: A French National Cohort
No full textInternational audienceBackground: Cefiderocol (CFD) is a novel siderophore cephalosporin developed for the treatment of infections involving multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections (1–3). For bone and joint infections (BJIs), the use of CFD is currently neither part of its market authorization nor recommended, and has not yet been assessed by large-scale studies.Objectives: To fill the scarcity of data regarding the use of CFD in BJIs, we aimed to describe patients’ and infection characteristics along with the outcomes of the infection.Methods: We conducted a retrospective observational multicenter study in 22 French centers from January 2019 to December 2023.Results: From January 2019 to December 2023, 45 patients were included. Patients were mainly males (73%) with a median age of 62 years (interquartile range [IQR] 29), and a median Charlson comorbidity index of 3. Implant-related infections (20) were the most prominent, accounting for 44% of the cases. Carbapenemase-producing GNB were involved in 74% of the cases (n = 17/23), among which Pseudomonas aeruginosa accounted for 38% of these cases. Most patients received 6 g of CFD per day. CFD was used in combination with an antibiotic in 40 out of 45 cases (89%). The median duration of CFD treatment was 34 days. Seven patients (16%) experienced side effects, mainly gastro-intestinal disorders, including three (7%) who induced treatment cessation. Infection control included surgery in 37 (82%) patients. Failures and deaths occurred, respectively, in 22 (49%) and 10 (22%) cases.Conclusions: Our results suggest that CFD may be an alternative in MDR-GNB infections with limited therapeutic options
Quelles pratiques pour un laboratoire de biologie médicale écoresponsable en 2025 ?
No full textInternational audienceIn the face of climate emergency, medical biology laboratories (MBLs) must reconcile diagnostic performance, innovation, and environmental sustainability. Playing a crucial role in patient diagnosis and follow-up, MBLs have a significant ecological footprint due to their high energy consumption, extensive use of plastics, and substantial waste production, including hazardous materials classified as carcinogenic, mutagenic, repro-toxic, or radioactive.While maintaining their essential contribution to healthcare and improving patient outcomes, this article provides an overview of concrete strategies and perspectives for reducing the environmental impact of MBLs. Through practical examples and evidence-based recommendations, we aim to raise awareness among medical biologists and equip them with the necessary tools to integrate ecological transition into their daily practices.Face à l'urgence climatique, les laboratoires de biologie médicale (LBM) sont confrontés à la nécessité de réconcilier performance diagnostique, innovation et durabilité environnementale. Les LBM, qui jouent un rôle crucial dans le diagnostic et le suivi des patients, génèrent une empreinte écologique significative due à leur consommation énergétique, à l'utilisation massive de plastiques et à la production importante de déchets dont certains sont classés cancérogènes, mutagenes, reprotoxiques et radioactifs.Toujours avec l'objectif de continuer à participer à l'activité de soins et d'améliorer la qualité de soins des patients, cet article propose un état des lieux des stratégies concrètes et perspectives de réduction de l'empreinte écologique des LBM. À travers des exemples pratiques et des recommandations fondées, nous visons à sensibiliser les biologistes médicaux et à les outiller pour engager une transition écologique dans leurs pratiques quotidiennes