Three different surgical positions on radiological outcomes in the proximal femoral nail: supine, lateral decubitus and traction table.

OBJECTIVE: While the proximal femoral nail (PFN) is deemed a successful therapeutic approach for intertrochanteric femoral fractures, medical professionals lack agreement as to the optimal surgical positioning. Our objective was to determine the radiological superiorities of three different surgical positions (supine, lateral decubitus, and traction table). PATIENTS AND METHODS: In this clinical study, 157 prospectively followed-up patients who were operated with PFN for intertrochanteric femur fractures between 2019 and 2022 were analyzed retrospectively. The demographic data of the patients, fracture type, preparation and surgery duration, recorded number of fluoroscopy shots, femoral neck quadrant of the lag screw, tip-apex distance, collodiaphyseal angle, and reduction quality were evaluated. RESULTS: Of the 157 patients evaluated in the study, 35 patients (22.3%) were operated in the supine position without traction table, 52 patients (33.1%) in the lateral decubitus position, and 70 patients (44.6%) in the supine position with a traction table. Significant differences were found between groups in terms of preparation duration (p<0.001) and number of fluoroscopy shots (p<0.001). Post-hoc analyses revealed that the preparation duration and the number of fluoroscopy shots were significantly lower in the supine position with manual traction. In radiological examinations, significant differences were found between the groups in all radiological parameters evaluated. Post-hoc analyses showed that the use of the traction table is associated with the lag screw quadrant (p<0.001), the reduction quality (p<0.001), the tip-apex distance (p=0.011), and the collodiaphyseal angle (p<0.001). CONCLUSIONS: Despite the disadvantages, such as prolonged preparation duration and increased fluoroscopy usage, the use of a traction table stands out in PFN due to superior radiological results, such as a more successful reduction quality, a more accurately positioned lag screw and ideal tip-apex distance, and collodiaphyseal angulation.

Evaluation of the intraocular pressure changes during micturition in patients with benign prostatic hyperplasia.

OBJECTIVE: To evaluate the effect of the Valsalva maneuver (VM) during micturition on intraocular pressure (IOP) in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: IOP were measured before and during micturition in uroflowmetry testing by Tonopen-Avia (Reichert Inc., NY, USA) in 35 eyes of 35 patients with BPH. International Prostate Symptoms Score (IPSS) questionnaire was used for quantification of BPH symptoms. The subjects were divided into two groups according to IPSS questionnaire: patients with low IPSS scores and patients with high IPSS scores. RESULTS: The mean IOP before and during micturition in patients with BPH were 15.26 ± 4.39 mmHg and 16.23 ± 4.43 mmHg, respectively (p = 0.047). When patients with BPH were assigned to two distinct groups according to the IPSS scores, IOP did not differ in patients with low IPSS scores (p = 0.590), whereas mean IOP was significantly higher in patients with high IPSS scores (p = 0.007). CONCLUSIONS: The Valsalva maneuver, performed during micturition, can lead to significant IOP increase in patients with BPH, particularly in advanced disease.

[Testosterone: a treatment for the prevention of cardiovascular disease]. / La testostérone: un traitement pour la prévention des maladies cardiovascutaires?

Testosterone treatment was largely prescribed and marketed as a potential therapy to treat symptoms of aging. Testosterone levels decrease progressively with aging and low testosterone levels were associated with an increase risk of cardiovascular events and death. Controversies persist whether this association is causal or mediated by confounders of the general health. Systematic screening of testosterone is not recommended in a check-up visit, but only in case of suggestive symptoms. Furthermore a recent meta-analysis and large prospective cohort studies have reported a concern regarding the safety of testosterone therapy and the associated risk of major cardiovascular events. The decision to prescribe testosterone should be made with the patient after evaluating the risks and benefits.

[Recommendations for management of dyslipidemia in 2014]. / Prise en charge des dyslipidémies en 2014.

Benefit of statin treatment is well established for secondary prevention. For primary prevention, good data exist to support use of statins in high-risk groups. Less data are available for intermediate risk group and very few patients at low risk have been included in clinical trials. In this context, an individual approach based on a risk stratification using PROCAM score adjusted for Switzerland is recommended. Lifestyle measures should be tried first. We also discuss the new American guidelines and their related controversies. Secondary causes and familiar forms of dyslipidemias, for which a risk assessment cannot be performed using risk scores (first cardiovascular event between age 20 and 60), should not be overlooked.

[PCSK9 inhibitors: emerging treatment to lower cholesterol?]. / Inhibiteurs de PCSK9: futur traitement pour baisser le cholestérol?

The achievement rate of recommended low-density lipoprotein cholesterol (LDL-C) targets of < 1.8 mmol/l for secondary prevention in very high risk patients is difficult. Observational studies reported that loss of function mutation of the PCS9 was associated with LDL-C decrease level and reduction of cardiovascular events. Monoclonal antibodies to PCSK9 (REGN727 and AMG 145, PSCK9 inhibitors) have been tested in clinical studies of phase I and II and showed LDL-C level reduction of 60-70% compared to placebo. This approach appears safe and well-tolerated. The PCSK9 inhibitors are now tested in large phase III clinical studies to assess the long-term safety and efficacy of this new promising approach.

[Should we perform a screening ECG among asymptomatic adults?]. / Faut-il faire des ECG de dépistage chez les adultes asymptomatiques?

The resting ECG is a safe, low cost and widely available in the clinical investigation of several cardiac symptoms. However, there is controversy regarding the use as a screening tool or routine cardiovascular (CV) risk assessment test among healthy asymptomatic adults. Two recent studies reported that ECG adds supplemental information in the estimation of coronary artery disease (CAD) risk in asymptomatic patients, especially in those with intermediate risk. However, we currently need more data on the impact of ECG on the prevention of clinical CV outcomes, especially in a randomized clinical trial, and on additional costs of testing and treatment. For the time being, routine ECG testing is not recommended for the prevention of CV events among healthy asymptomatic adults.

[Role of percutaneous coronary intervention in diabetic patients]. / Rôle de la revascularisation coronarienne chez le patient diabétique avec maladie coronarienne stable.

Clinical outcomes after revascularization, both for surgery and percutaneous coronary intervention (PCI), is significantly worse in diabetic patients compared with non-diabetic patients. While in acute coronary syndrome, PCI is favored because of the increased risk of surgery performed during ongoing infarction, in stable patients assessment of clinical factors, such as coronary anatomy and comorbidities should guide decision of the revascularization modality (e.g., surgical, PCI, or conservative). Surgery should be favored in patients with multivessel coronary disease and acceptable surgical risk. Overall, the threshold for surgery compared to PCI should be lower in diabetic patients compared with non-diabetic ones.

[Superficial vein thrombosis: what's new in the management?]. / Thrombose veineuse superficielle: quelles nouveautés dans la prise en charge?

Lower limbs superficial venous thrombosis (SVT) is a relatively frequent disease. Its prevalence among patients consulting their treating physician is estimated to be 10.8% among women and 4.9% among men. Up to 25% of at risk patients with isolated SVT present with a concomitant DVT. Ultrasound imaging may play a role in the management of these patients allowing precise diagnosis, determination of thrombus extension and presence of associated DVT. From data recently appeared in the literature treatment of SVT with prophylactic doses of fondaparinux may be proposed to at risk patients with isolated SVT.

[Development, implementation and practical use of a diagnostic score]. / Développement, implémentation et utilisation pratique d'un score diagnostique.

In recent years many clinical prediction rules (CPR) have been developed. Before a CPR can be used in clinical practice, different methodical steps are necessary, from the development of the score, the internal and external validation to the impact study. Before using a CPR in daily practice family doctors have to verify how the rules have been developed and whether this has been done in a population similar to the population in which they would use them. The aim of this paper is to describe the development of a CPR, and to discuss advantages and risks related to the use of CPR in order to help family doctors in their choice of scores for use in their daily practice.

Tumor-induced ileo-ileal invagination in adults.

We report two cases of ileo-ileal intussusception due to a lymphoma in a 25-year-old and a leiomyoma in a 35-year-old woman. Both were diagnosed by laparotomy. Intussusception is a rare condition in adults and is usually difficult to diagnose. In contrast to childhood, idiopathic intussusception is quite rare in adults. The etiology is usually an intestinal tumor. In adults treatment is always surgical.