Enhanced recovery after surgery, esophagectomy, prehabilitation

Yannick Deswysen Published in the journal : February 2021 Category : Chirurgie oeso-gastrique

The Enhanced Recovery After Surgery (ERAS®) program constitutes a real improvement in perioperative care. This evidence-based concept has been proven to reduce the impact of surgery on the patient, thereby decreasing potential complications. The beneficial effects have been demonstrated in different clinical situations, although they are particularly relevant for patients with multiple co-morbidities undergoing major surgery. The ERAS is, therefore, fully applicable to esophageal surgery.

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2020 innovations in orthopedic surgery and traumatology

Xavier Libouton*, Nathalie Pireau*, Robin Evrard*, Emmanuel Thienpont*, Daniel Morcillo, Loic Thoreau, Maïte Van Cauter, Vincent Druez, Jean-Emile Dubuc, Maxime Bonnelance, Nadia Irda, Ludovic Kaminski, Simon Vandergugten, Alin Sirbu, Karim Tribak, Dan Pu Published in the journal : February 2021 Category : Chirurgie orthopédique et traumatologie

Four themes were emphasized in the year 2020, including new perspectives in knee arthroplasty surgery, contribution of 3D metal printing in developing implants for sarcoma surgery, usefulness of lateralization of the rotation center in reverse prosthetic shoulder surgery, and, lastly, contribution of microsurgery in bone defects. Nevertheless, 20% of patients still experience an unsatisfactory outcome following knee arthroplasty. Advances in tribology and implant fixation have rendered it possible to deviate from a purely mechanical approach and develop new resurfacing strategies that respect the patient's native anatomy. These advances are aimed at a kinematic alignment that is capable of recreating the natural joint movement with its ligament balance. This has resulted in developing personalized implants and ultra-precise positioning techniques, which are assisted by navigation and robot.

In oncological surgery, certain tumor resections are associated with difficult reconstructions, especially within the pelvis, as these resections are accompanied by a high rate of complications and mechanical failures. Metal 3D printing technology has rendered it possible to design porous titanium implants, which basically mirror the substance loss. Their stable fixation can already been anticipated at the design stage, thereby facilitating the reconstruction process and offering lasting mechanical perspectives. The performance of a reverse shoulder arthroplasty, which is indicated in osteoarthritis associated with a cuff tear, results in a medialization of the glenohumeral rotation center. This medialization results in a conflict with the scapula and progressive loosening of joint replacement. Metallic augmentation or bone grafting techniques enable lateralization of the rotation center, thereby preventing these complications.

Finally, when facing vast bone-tissue defects with a significant functional impact, the use of autologous vascularized grafts of different types represents a surgical solution that is still constantly evolving, including the recent contribution of super microsurgery.

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Virtual reality training after suffering from a vascular cerebral accident

Gauthier Everard, Charlotte Pietteur, Gaëtan Stoquart, Thierry Lejeune Published in the journal : February 2021 Category : Médecine Physique et Réadaptation

After stroke, patients may present with motor and cognitive impairments that lead to a reduced quality of life. Rehabilitation therefore represents a major challenge for these patients. Recently, new emerging technologies have contributed to intensifying the rehabilitation program, including virtual reality. Virtual reality allows for providing real-time feedbacks, promoting the use of the affected limb, and including specific and varied exercises. Moreover, combined with serious games, virtual reality adds a motivating and playful feature to the rehabilitation program. Results of these last years should encourage the implementation of virtual reality as a therapy complement.

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2020 innovations in metabolic fatty liver disease, hepatocellular carcinoma, cholestatic pruritus, encephalopathy, and inflammatory bowel diseases

Nicolas Lanthier, Ivan Borbath, Géraldine Dahlqvist, Bénédicte Delire, Olivier Dewit Published in the journal : February 2021 Category : Hépato-gastroentérologie

We herein present several relevant developments in the hepato-gastroenterology field during the year 2020. An expert consensus has resulted in a clearer nomenclature for “non-alcoholic” fatty liver disease, which is now referred to as "metabolic" liver disease and clearly defined using positive criteria. In fibrosing steatohepatitis, lanifibranor, which is a triple agonist of the three isoforms of the peroxisome proliferator-activated receptor (PPAR α, δ, γ), has demonstrated clear superiority over placebo in terms of disease resolution, fibrosis regression, and metabolic profile improvement. For patients with advanced hepatocellular carcinoma, the combined approach of atezolizumab (anti-programmed death-ligand 1 [anti-PD-L1]) and bevacizumab (anti–vascular endothelial growth factor [anti-VEGF) is a huge improvement and sets a new standard treatment in first-line. In cholestatic pruritus cases, fibrates are deemed to exert beneficial effects on the symptoms. Rifaximin, a broad-spectrum and, poorly absorbed antibiotic, has been demonstrated to be effective for preventing hepatic encephalopathy. This agent is now reimbursed when given in combination with lactulose. For inflammatory bowel diseases, ustekinumab (anti-interleukin [IL]12-IL23) is also now reimbursed in ulcerative colitis cases, and infliximab (anti-tumor necrosis factor [TNF]) as well as vedolizumab (anti-integrin) can be administered subcutaneously. Lastly, inflammatory bowel disease patients were proven not to exhibit any increased risk of coronavirus infection or developing severe COVID-19. In spite of their immunosuppressive therapy, these patients can (and should) benefit from the currently available vaccines.

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Innovations 2020 in hemostasis and thrombosis

Cédric Hermans, Amandine Hansenne, Catherine Lambert Published in the journal : February 2021 Category : Hémostase – Thrombose

The year 2020 was rich in developments and innovations in the field of thrombotic and hemorrhagic disorders. With respect to both its complex physiopathology and its multifaceted antithrombotic treatment, the coagulopathy linked to COVID-19 has aroused major interest that is far from being exhausted. Direct oral anticoagulants (DOACs) continue to be developed and validated, particularly in cancer-related venous thromboembolic diseases and for managing heparin-induced thrombocytopenia. The data on the DOAC use in early pregnancy appear reassuring. While these agents should indeed be avoided during pregnancy, the available data do not justify voluntary pregnancy termination as based on DOAC exposure alone. Mortality in catastrophic anti-phospholipid syndrome (CAPS) is likely to be significantly reduced when two antibodies, consisting of eculizumab and rituximab, are incorporated into the treatment regimen. As regards congenital hemophilia, the publication of new international recommendations by the World Federation of Hemophilia has attracted a great deal of attention, as have new therapeutic advances, including the validation of an ultra-long half-life FVIII concentrate (BIV001). Emicizumab is a bispecific antibody mimicking the action of FVIII that appears to be very promising. In addition to this drug’s use in managing congenital hemophilia A, it is also indicated in managing acquired hemophilia A.

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2020 innovations in the field of hematopoietic stem cell transplantation

Raphaël Lattenist, MD, Xavier Poiré, MD, PhD Published in the journal : February 2021 Category : Hematology/Oncology

The 2020 annual meeting of the American Society of Hematology (ASH) provided us with several contributions to the field of hematopoietic stem cell transplantation (HSCT). Post-transplant cyclophosphamide (PTCy) occupied a prominent place on the stage. This modality of graft-versus-host disease (GvHD) prophylaxis, which was initially developed in the haploidentical HSCT setting, was associated with major benefits so that its use tended to spread across other donor types. PTCy appears to be particularly invested with the benefit of improving outcomes in HSCT from mismatched unrelated donors (MMUD). This appears to be of great usefulness for patients from underserved ethnicities that lack a matched donor. Likewise, management of chronic graft-versus-host disease (cGvHD) had its share of improvement with the result presentation of the REACH3 study. Notably, in this study, ruxolitinib was compared to the best available therapy. The approach of reduced intensity conditioning (RIC) for myeloid malignancies similarly received some attention with a boost to supporting its use for higher-risk myelodysplastic syndrome (MDS), including the elderly. Finally, we present a Phase 1 study, which was designed to improve its efficacy in high-risk myeloid malignancies by adding venetoclax .

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What is the progress made in pediatric cardiology in 2020?

Jelena Hubrechts, Madeline Barbier, Coralie De Bruyne, Sylvie Lommaert, Mieke Roggen, Laetitia Vanhoutte, Christophe Vô, Stéphane Moniotte Published in the journal : February 2021 Category : Cardiologie pédiatrique

Despite the worldwide health crisis, different advances were made in pediatric cardiology in 2020. This paper discusses six different topics, the first being related to the ongoing pandemic and the last one being a review of the last two decades’ advances made in this field.

During the SARS-CoV-2 pandemic, an unexpected high number of children were admitted, presenting with Kawasaki disease and coronary dilatation. Moreover, in 2021, a new clinical entity arose, which is referred to as multisystem inflammatory syndrome, which was temporarily associated to COVID-19 (MIS-C).This new clinical condition shared similarities with atypical Kawasaki disease, even though the patients’ median age tended to be higher, while a significant left ventricular dysfunction was mostly the prominent cardiac feature at the time of diagnosis. Treatment guidelines of Kawasaki disease were reviewed in the light of this recent outbreak of patients presenting with MIS-C.

Other topics that have been addressed in this paper are the routine use of angiotensin-converting enzyme inhibitors (ACEI) in patients with single ventricle, as well as that of pulmonary artery banding in infants and children with end-stage dilated cardiomyopathy, in addition to cardiac resynchronization therapy. Lastly, the use of physical exercise in Fontan patients has been discussed before ending with an historical overview of the major advances made in congenital heart disease.

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Recommendations of the European Society of Cardiology on management of patients with non-STEMI acute coronary syndrome

Agnès Pasquet, Frédéric Maes Published in the journal : February 2021 Category : Cardiology

These new European Society of Cardiology guidelines concern the management of patients with acute coronary syndrome presenting without persistent ST-segment elevation. The central role of performing an electrocardiogram and troponin assessment in the initial diagnosis is highlighted. A rapid use of high-sensitive troponin schema for ruling out acute myocardial infarction enables us to safely discharge patients without any acute syndrome. Performing fast troponin assessments within 2 hours or 24 hours of admission allows to screen patients for coronary angiography and percutaneous revascularization. Following coronary artery stent placement, anti-platelet or anticoagulant regimens should be carefully chosen so as to balance the bleeding risk against the ischemic or thrombotic risk. The different protocols are reviewed herein according to the patients’ clinical situation. Lastly, the comprehensive treatment of patients is presented.

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Acute hepatitis due to nasal cocaine use: clinical case report and literature review

Barbara Gauchet (1), Véronique Gerard (2), Hadrien Fourneau (3) Published in the journal : January 2021 Category : Emergency

We present the case report of a 28-year-old man admitted to the emergency department for acute hepatitis due to nasal cocaine use. Cocaine abuse is associated with a variety of acute medical complications. Acute hepatitis without other systemic disorders is a rare condition that may occur following cocaine use.

Based on a systematic review of the literature, this report seeks to discuss the clinical, biological, and histopathological features of this disease and its evolution, too. The clinical practice guidelines for managing acute hepatitis due to cocaine use will be discussed, as well.

This case provides us the opportunity to remember and explore the differential diagnosis of acute hepatitis and the usefulness of a precise anamnesis.

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Epidermal hamartoma type PENS («papular epidermal nevus with « skyline » basal cell layer»)

Marie Cuvelier (1*), Josette André (2), Didier Bessis (3), Pierre-Paul Roquet-Gravy (1), Audrey Bulinckx (1) Published in the journal : January 2021 Category : Dermatology

PENS hamartoma or “papular epidermal nevus with "skyline" basal cell layer” is a congenital epidermal hamartoma, which is characterized by specific histopathological features. We report a diagnosis of PENS hamartoma that was made in an 18-month-old girl.

Initially described by Torrelo et al. in 2011 (1), PENS hamartoma exhibits particular clinical features consisting of coalescent, verrucous, and light brown polygonal papules (2). The diagnosis is confirmed by histological examination, which, in the majority of cases, shows an alignment of epidermal basal cells and palissadic disposition of nuclei evoking a "skyline". In 2012, the term PENS Syndrome was retained, owing to new clinical descriptions associating light neurological abnormalities with these cutaneous lesions (2). PENS syndrome is a rare neuro-cutaneous syndrome, which involves one or more congenital epidermal hamartomas of PENS type, as well as non-specific neurological abnormalities (1-3). Neurological manifestations begin to occur during the first two years of life (1). A review of the literature identified 27 reported cases of PENS hamartomas (1-12), including some familial cases and other cases associated with neurological abnormalities (PENS syndrome). The physiopathology of PENS hamartoma and PENS syndrome remains unclear, whereas several hypotheses have been advanced (7).

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