2019 innovations in orthopaedic surgery and traumatology

Xavier Libouton, Nathalie Pireau, Simon Vandergugten, Vincent Cunin, Jean-Emile Dubuc, Philippe Mahaudens, Nadia Irda, Maïte Van Cauter, Ludovic Kaminski, Karim Tribak, Dan Putineanu, David Mathieu, Daniel Morcillo, Loic Thoreau, Alin Sirbu, Vincent D Published in the journal : February 2020 Category : Chirurgie orthopédique et traumatologie

The year 2019 has provided us three major themes: the contribution of 3D imaging in the planning of shoulder replacements, joint reconstruction of the elbow by mirrored osteoarticular graft, and finally scoliosis surgery by modulation of growth, without vertebral fusion. Shoulder disease is one of the most common conditions involving the musculoskeletal system, affecting about half of the patients with musculoskeletal complaints. Gleno-humeral osteoarthritis, whatever its etiology, may justify prosthetic replacement. However, the fate of these implants does not attain the survival rates of prosthetic hip and knee implants. The severity of bone loss, particularly within the scapula, and the difficulty of precisely orientating implants both account for a large part of common and too early failures. Planning surgery using planning software from 3D reconstruction scans can anticipate these problems and enable us to establish an appropriate surgical strategy.

The fate of elbow replacements remains limited over time, especially in the young and active subject. Using osteochondral reconstruction allows us to postpone arthroplasty for several years. The need for perfect joint congruence is currently made possible via mirror planning from the healthy joint and selection of the most appropriate allograft based on scanner imaging. Surgery is made possible by the surgeon's provision of cutting guides for the injured joint and allograft, ensuring accurate correction, in accordance with preoperative planning.

Scoliosis mainly affects a young population, tending to worsen with growth. Until now, surgery has been aimed at restoring the spine’s sagittal balance by fusion of the bony segments to prevent further deformation. This strategy has implemented constraints on the spine segments left free of instrumentation and bone fusion with potentially secondary discoradicular pathologies at these levels. The concept of using residual spine growth to correct deformation has recently been introduced. Rather than permanently fusing the column, the material is positioned to slow the growth on the curvature’s convex side and let the concave side continue to grow and correct the deformation. This is growth modulation. In this configuration, the column is no longer blocked and retains its flexibility.

Read more

2019 innovations in cardiothoracic surgery

Emiliano Navarra, Valérie Lacroix Published in the journal : February 2020 Category : Chirurgie cardio-thoracique

Minimally-invasive cardiothoracic surgery has been developed to reduce the invasiveness related to conventional cardiothoracic approaches. Robotic technologies, which are among the latest advances in minimally-invasive approaches, have been introduced to improve the operative surgical vision. This objective is achieved by means of extremely performant 3D cameras and full immersion set, enabling an extremely fine dexterity and wider degree of freedom. Using robotic technology, there is an improved comfort for the surgeon owing to improved console ergonomy, in comparison with other minimally-invasive techniques. Concerning thoracic surgery, robotic technologies are currently used to perform lung, lymph nodes, and mediastinal tumor resections.

Read more

Recommendations of the European Society of Cardiology for diagnosis and management of chronic coronary disease

Agnès Pasquet Published in the journal : February 2020 Category : Cardiology

Coronary artery disease is one of the most prevalent diseases in cardiology, and patient care requires adapted treatment.

The new guidelines of the European Society of Cardiology regarding coronary artery disease present coronary artery disease as a continuum and propose a new protocol for its diagnosis or antithrombotic therapy

Read more

Staphylococcal scalded skin syndrome in a 13-year-old teenager

Marylou Lefèvre, Audrey Bulinck, Pierre-Paul Roquet-Gravy Published in the journal : January 2020 Category : Dermatology

Staphylococcal scaled skin syndrome (SSSS) is an exfoliating skin disease that predominantly affects newborns and young children. This infectious exanthema, characterized by superficial epidermis detachment, is due to Staphylococcus aureus infection excreting exfoliative toxins A and/or B. This case report illustrates the clinical signs of SSSS characterized by an erythrodermic and blistering skin rash with erythematous and oozing lesions in friction areas. The diagnosis of SSSS was clinically established. A positive evolution was observed under intravenous antibiotic treatment with flucloxacillin and clindamycin associated with movicol®, local care, and hydro-electric re-equilibration. We have addressed the physiopathology and differential diagnosis of SSSS, highlighting the relevance of early diagnosis.

Then, we have discussed guidelines about the treatment/management, and particularly the benefits of combining clindamycin and an osmotic laxative, infusion of fresh frozen plasma, or intravenous immunoglobulins in case of antibiotic resistance.

Key Words

Staphylococcal scaled skin syndrome (SSSS), exfoliative skin disease, adolescent, bullous, exfoliative toxins, clindamycin

Read more

Acute interstitial nephritis under pembrolizumab treatment

Romain Dury, Valentin Van Den Bossche, Kim Vanderheyde, Sophie Jossart Published in the journal : January 2020 Category : Pneumology

Pembrolizumab is a humanized monoclonal antibody targeting the PD-1 receptor expressed on the surface of cytotoxic T lymphocytes. Along with other specific antibodies, it belongs to the class of immune checkpoint inhibitors (ICI). Its use as monotherapy is particularly indicated in the first-line treatment of metastatic non-small-cell lung cancers (NSCLC) without oncogenic addition (ALK or EGFR mutations) and expressing the PD-L1 receptor at ≥50% on the surface of tumor cells, corresponding to a high tumor proportion score (TPS score), which has shown predictive of a better response to treatment (1) (2) (3). We have presented herein the case of a patient with a pembrolizumab-treated NSCLC complicated by acute interstitial nephritis (AIN) under pembrolizumab immunotherapy. Permanent discontinuation of pembrolizumab and treatment with intravenous corticosteroids enables us to gradually normalize the patient's renal function.

Nephritis is one of the rare potential undesirable effects associated with immunotherapy.

New toxicity profiles associated with immune checkpoint inhibitors require the reporting of any symptoms or biological abnormalities dedected during their use in order to initiate prompt management of these immunotherapy-related undesirable effects.

Key Words

Immunotherapy, acute interstitial nephritis, pembrolizumab, undesirable effects

Read more

Geriatrics , the rise of a “young” discipline

Thibaud De Blauwe Published in the journal : January 2020 Category : Geriatry

Long before our time, the Egyptians, Greeks, and medieval scholars were already interested in the pathologies and other illnesses related to old age. In addition to a brief summary of the history of geriatrics, this article offers a reflection on the origin of this young discipline. Geriatrics took off quite rapidly, proposing innovations in the care of frail elderly patients and their relatives, creation of a care program, partnerships, as well as the integration of multidisciplinarity and interdisciplinarity. Many areas are still evolving, such as sarcopenia, frailty, or care of elderly patients within the emergency room, as well as optimization of elderly patient care at the hospital.

Read more

Child and youth abuse, let's talk about it!

Maya Drachman, Emmanuel de Becker Published in the journal : January 2020 Category : Psychiatrie infanto-juvénile

Child and youth abuse is a societal as well as medical issue. Over time, its management has changed. As a physician, it is essential to recognize the clinical signs and know how to think and act in case of concern and suspicion. When a child describes acts of abuse, the physician must do everything in his power to provide him with help, while being bound by professional secrecy. The physician can break this secret in case of imminent, serious, and urgent risk endangering the child's life. Nowadays, it is known that child abuse has consequences for the adults of tomorrow and is associated with increased physical and psychological problems.

We propose guidelines for the care of abused children, taking into account the particularity of the Belgian system.

Read more

Side effects of multiple myeloma treatments

Sarah Bailly, Sarah Amat, Catherine Percy, Thomas Gérard, Laurane Lallemand, Aline Munting, Marie-Christiane Vekemans Published in the journal : January 2020 Category : Hematology/Oncology

The prolonged use of new drugs such as proteasome inhibitors, immunomodulators, and monoclonal antibodies in the treatment of multiple myeloma is associated with adverse side effects that represent a daily challenge for physicians. We propose a series of recommendations based on clinical cases.

Read more

New Type 2 diabetes treatments: cardiovascular safety/benefit and neproprotection

Martin Buysschaert, Benoit Buysschaert, Isabelle Paris, José Luis Medina, Michael Bergman, Vanessa Preumont Published in the journal : January 2020 Category : Diabétologie

Diabetic nephropathy is currently the leading cause of chronic end-stage renal disease, along with its clinical consequences. Its prevention implies multidisciplinary management based on strict control of blood glucose from diabetes onset, in addition to blood pressure control, primarily using ACE-I inhibitors or sartans. Recent clinical trials have demonstrated the cardiovascular security/benefits as well as nephroprotective effects of new classes of antihyperglycemic agents (DDP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors), in addition to their well-established antihyperglycemic effects.

This paper aims to review the state of the art of diabetes-related cardiovascular and renal complication management.




Read more

Combined utilization of peridural thoracic anesthesia und intravenous lidocain in preventing autonomic hyperreflexia in the peri-operative period

Audrey Foaleng Published in the journal : December 2019 Category : Anesthésie

A 50-year-old man with a complete medullary section at the old C6-C7 level and suspicion of autonomic hyperreflexia (HA) was assumed to benefit from cystectomy with Bricker-type non-continent urinary diversion. In addition to general anesthesia, thoracic epidural analgesia and intravenous lidocaine were used to prevent HA during the operative period, facilitating postoperative rehabilitation. The patient remained stable throughout the procedure, without any major problems postoperatively. Oral feeding was started on Day 3. The article describes the benefits of epidural analgesia and intravenous lidocaine for managing patients at risk for HA.

Read more