Gelatin implant in the treatment of open-angle glaucoma: Safety and efficacy in real-life conditions.

OBJECTIVE: To evaluate the safety and efficacy of the Xen® implant for the treatment of open-angle glaucoma. MATERIAL AND METHOD: Retrospective study including patients who received the Xen® implant between January 2019 and December 2020 in a university hospital. Demographic and medical data were collected using DxCare® software. The primary endpoint was a 20% reduction in intraocular pressure (IOP) at 12 months according to Société Française du Glaucome (SFG) recommendations. The secondary endpoints were decrease in glaucoma medications and incidence of adverse events. RESULTS: Fifty-three patients (65 eyes) were included (sex ratio 0.65, age 75.38±7.31 years). IOP decreased by 18.51% from 17.86±4.22mmHg to 14.55±2.66mmHg (P<0.05). The number of glaucoma medications was 2.16±1.01 preoperatively vs 0.49±0.94 postoperatively (P<0.05). Adverse events included 8 malpositionings, 3 of which required reoperation, 1 case of increased IOP resolved by trabeculectomy, 1 case of venous ischemia treated by photocoagulation, 3 choroidal detachments and 3 corneal ulcers. Needling was required for 18 eyes. CONCLUSION: At 12 months, the IOP was lower than previously reported in the literature (14.55 vs 15.90mmHg, P<0.05), probably due to a lower preoperative IOP. The number of postoperative medications was similar to the literature (0.49 vs 0.40, P=0.51), as was the frequency of needling (27.69% vs 32.00%, P=0.36). The frequency of malpositioning was higher (12.31% vs 7.70%, P<0.05), probably due to the management of complicated patients. The efficacy of Xen® was in line with recommendations. It would be interesting to compare the efficacy of Xen® with trabeculectomy.

[A philosophy of survival in the time of the pandemic]. / Une philosophie de la survie au temps de la pandémie.

In medical practice, the concept of survival is reduced to a quantitative approach related to the patient's sameness. A philosophical refoundation of this concept, within the framework of the current contributions of the Covid-19 pandemic narratives and of Ricœurian hermeneutics, allows the development of survival-ipse. This is the hyperbolic force of refiguration of the living-dead human being. This excess of survival is, within the illness and the pandemic, the source of health and not its effect. The role of care is to constantly reactivate it.

Surgical approach of isolated fracture of the anterior wall of the frontal sinus: The upper eyelid incision.

Fractures of the frontal sinus are classified according to the topography (anterior wall, posterior wall or both), the displacement, and the presence of associated lesions (wound, nasofrontal duct injury, rhinorrhea). Isolated fractures of the anterior wall require surgical management, if the displacement is over 4 mm, to restore the forehead symmetry, to maintain the sinus ventilation and to avoid long-term complications (sinusitis, mucocele, meningitis…). Coronal incision is commonly performed but less invasive techniques are more and more used. We describe a technique of reduction and fixation of isolated anterior wall fractures by upper eyelid incision, allowing a good exposure of the lower portion of the frontal sinus, with a limited scar.

Predictors of trabecular bone score in school children.

UNLABELLED: Trabecular bone score (TBS) is a DXA-based tool that assesses bone texture and reflects microarchitecture. It has been shown to independently predict the risk of osteoporotic fracture in the elderly. In this study, we investigated the determinants of TBS in adolescents. INTRODUCTION: TBS is a gray-level textural measurement derived from lumbar spine DXA images. It appears to be an index of bone microarchitecture that provides skeletal information additional to the standard BMD measurement and clinical risk factors. Our objectives were to characterize the relationship between TBS and both age and pubertal stages and identify other predictors in adolescents. METHODS: We assessed TBS by reanalyzing spine DXA scan images obtained from 170 boys and 168 girls, age range 10-17 years, gathered at study entry and at 1 year, using TBS software. The results are from post hoc analyses obtained using data gathered from a prospective randomized vitamin D trial. Predictors of TBS were assessed using t test or Pearson's correlation and adjusted using regression analyses, as applicable. RESULTS: The mean age of the study population was 13.2 ± 2.1 years, similar between boys and girls. Age, height, weight, sun exposure, spine BMC and BMD, body BMC and BMD, and lean and fat mass are all significantly correlated with TBS at baseline (r = 0.20-0.75, p < 0.035). Correlations mostly noted in late-pubertal stages. However, after adjustment for BMC, age remained an independent predictor only in girls. CONCLUSIONS: In univariate exploratory analyses, age and pubertal stages were determinants of TBS in adolescents. Studies to investigate predictors of TBS and to investigate its value as a prognostic tool of bone fragility in the pediatric population are needed.

Consensus statement: recommendations for the management of metabolic bone disease in human immunodeficiency virus patients / Documento de consenso: Recomendaciones para el manejo de la enfermedad ósea metabólica en pacientes con virus de la inmunodeficiencia humana

"OBJECTIVE: To provide practical recommendations for the evaluation and treatment of metabolic bone disease in human immunodeficiency virus (HIV) patients. PARTICIPANTS: Members of scientific societies related to bone metabolism and HIV: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM), and Sociedad Española de Fractura Osteoporótica (SEFRAOS). METHODS: A systematic search was carried out in PubMed, and papers in English and Spanish with a publication date before 28 May 2013 were included. Recommendations were formulated according to GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) setting both their strength and the quality of supporting evidence. Working groups were established for each major part, and the final resulting document was later discussed in a face-to-face meeting. All the authors reviewed the final written document and agreed with its content. CONCLUSIONS: The document provides evidence-based practical recommendations on the detection and treatment of bone disease in HIV-infected patients"

"Objetivo Proporcionar unas recomendaciones prácticas para el manejo de la enfermedad metabólica ósea en pacientes con virus de la inmunodeficiencia humana (VIH). Participantes Miembros de diferentes sociedades científicas relacionadas con el metabolismo óseo y con la enfermedad VIH: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM) y Sociedad Española de Fractura Osteoporótica (SEFRAOS). Métodos Se realizó una búsqueda sistemática en PubMed de la evidencia disponible para cada aspecto, y se revisaron artículos escritos en inglés y en castellano con fecha de inclusión hasta 28 de mayo de 2013. Las recomendaciones se formularon según el sistema GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Los autores trabajaron por grupos en la formulación de cada apartado de las recomendaciones y posteriormente el documento global se discutió en una reunión conjunta. Todos los autores revisaron el documento escrito final y lo consensuaron. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y el tratamiento de la enfermedad metabólica ósea en pacientes con VIH"

Alpine cushion plants inhibit the loss of phylogenetic diversity in severe environments.

Biotic interactions can shape phylogenetic community structure (PCS). However, we do not know how the asymmetric effects of foundation species on communities extend to effects on PCS. We assessed PCS of alpine plant communities around the world, both within cushion plant foundation species and adjacent open ground, and compared the effects of foundation species and climate on alpha (within-microsite), beta (between open and cushion) and gamma (open and cushion combined) PCS. In the open, alpha PCS shifted from highly related to distantly related with increasing potential productivity. However, we found no relationship between gamma PCS and climate, due to divergence in phylogenetic composition between cushion and open sub-communities in severe environments, as demonstrated by increasing phylo-beta diversity. Thus, foundation species functioned as micro-refugia by facilitating less stress-tolerant lineages in severe environments, erasing a global productivity - phylogenetic diversity relationship that would go undetected without accounting for this important biotic interaction.

Impact of maternal veiling during pregnancy and socioeconomic status on offspring's musculoskeletal health.

UNLABELLED: The impact of maternal veiling during pregnancy and of socioeconomic status on offspring's bone mass was investigated in 326 healthy adolescents. Veiling during pregnancy was associated with decreased musculoskeletal parameters in the offspring boys, but not girls. SES was a significant predictor of bone mass in both genders. INTRODUCTION: This study investigates the effects of maternal veiling during pregnancy, a surrogate for low vitamin D level, and socioeconomic status (SES), a surrogate of nutritional status, on their offspring's bone mass at adolescence. METHODS: Three hundred and twenty-six healthy adolescents aged 13.1(2.0) years and their mothers were studied. The impact of maternal veiling on offspring's bone mass was evaluated through regression analyses. Outcome variables were bone mineral density (BMD) and content (BMC) at the spine, hip, and total body of the children. Predictors were maternal veiling during pregnancy and SES. Covariates were height, body composition, Tanner staging, calcium intake, vitamin D and exercise in children. RESULTS: In boys, adjusted analyses revealed that both maternal veiling during pregnancy and SES were significant predictors of bone mass, at multiple skeletal sites. In girls, SES but not maternal veiling during pregnancy was a significant predictor of bone mass at multiple sites. CONCLUSION: Maternal veiling during pregnancy was associated with decreased musculoskeletal parameters of boys, but not girls. SES was a significant predictor of bone mass in both genders. These findings may have profound implications on children's bone health.

Failure of multiple antivirals to affect high HHV-6 DNAaemia resulting from viral chromosomal integration in case of severe aplastic anaemia.

We report a fifty-year-old woman presenting with severe aplastic anaemia (SAA) and prolonged high Human Herpesvirus 6 (HHV6) variant A DNAeamia detected by quantitative PCR. Multiple antiviral treatments failed to affect the HHV6 DNAemia and subsequent immunosuppressive treatment reached only partial improvement as judged by bone marrow examinations. The patient remained dependent on thrombocyte transfusions and G-CSF treatment. After one year of steady high HHV6 DNA load in blood, viral chromosomal integration was proved by demonstrating the viral DNA in hair follicles. This condition appeared to be unconnected with, and to have no effect, on the original SAA.

[Complicated omental splenosis]. / Splénose épiploïque compliquée.

Splenosis results from autotransplantation of splenic tissue, usually after traumatic splenic rupture. The diagnosis is suggested by the history and the presence of multiple nodules on computed tomography. Selective splenic scintigraphy utilising heat denatured red blood cells confirm the diagnosis. Treatment is usually conservative with surgical excision reserved for complicated cases. We report a case of splenosis associated with phlegmon and infectious process, requiring surgical intervention.

Pleuropericardial cysts: treatment by videothoracoscopy.

Four cases of pleuropericardial cyst (three symptomatic, one in an unusual location) were treated by videothoracoscopy. Complete resection of the cyst was possible in all cases. The postoperative course was uneventful and patients were discharged on the 4th or 5th day. Pleuropericardial cysts account for 5 to 10% of all mediastinal tumors. Clinical latency and a benign course are characteristic features. In most cases, computed tomography (CT) confirms the diagnosis. When the cyst is symptomatic or the diagnosis is in doubt (atypical location, high density on CT scans), videothoracoscopy offers an alternative to transpleural puncture with evacuation or excision via thoracotomy.

Surgical management of pleuropulmonary tuberculosis.

To define the current indications for surgical management of pleuropulmonary tuberculosis and analyze the results of operative procedures, the records of 59 patients operated on between January 1987 and December 1993 were reviewed. Three patient categories were defined. Group I patients (n = 25) underwent operation for diagnostic purposes: solitary mediastinal node or mediastinal adenopathy associated with pulmonary lesions (n = 10), pulmonary infiltrates (n = 4), pulmonary nodules or masses (n = 10), or chronic pleurisy (n = 1). Postoperative mortality and morbidity rates in this group were both 4%. Group II patients (n = 18) underwent operation for active lesions: intrapulmonary cavity (n = 6), destroyed lung parenchyma (n = 6), or chronic loculated pleural effusion (n = 6). Postoperative morbidity and mortality rates were 16.6% and 5.5%, respectively. Group III patients (n = 16) underwent operation for a complication of therapy or for sequelae of previously "cured" tuberculosis: calcified pyothorax (n = 8), empyema (n = 2), fistulized nodes (n = 2), bronchiectasis (n = 3), or aspergilloma (n = 1). Morbidity and mortality rates in this group were 31.25% and 12.5%, respectively. Surgery continues to have both diagnostic and therapeutic indications for management of pleuropulmonary tuberculosis, despite the morbidity and mortality rates associated with operative procedures.

[Current surgical methods for the etiological diagnosis of mediastinal adenopathies]. / Méthodes chirurgicales actuelles pour le diagnostic étiologique des adénopathies médiastinales.

The aim of this work was to determine the role of video-thoracoscopy and mediastinoscopy for the diagnosis of lymph node enlargement in the mediastinum of unknown aetiology. From January 1992 to December 1993, 26 patients were seen for surgical biopsy of mediastinal lymph nodes. Relative localization and the requirement for an associated gesture determined the choice between axial mediastinoscopy, parasternal scopy and videothoracoscopy. Mediastinoscopy was performed for peritracheal or right hilar (Baréty) nodes and parasternal scopy for anterior mediastinal masses. Videothroacoscopy was performed when the lymph nodes were localized at the preceding sites or when an associated manoeuver was required. Mediastinoscopy was performed in 16 patients. Lymphorrea which subsided after 4 days occurred in one patient and the mean hospital stay was 2.6 days. Diagnosis was achieved in 15 cases. The delay from procedure to treatment was 11 days on the average. Parasternal scopy was used 3 times and gave the diagnosis in all cases. Videothoracoscopy was used for 7 patients including 2 cases with pulmonary biopsies. Diagnosis was established 7 times and the delay to treatment was 12 days. No diagnostic thoracotomie were performed during this period. When access to the mass to be biopsied is difficult with mediastinoscopy (aorto-pulmonary, subcarenal, triangular ligament) videothoracotomy can be useful. Post-operative follow-up is simple and a specific treatment can be instaured rapidly. Videothoracotomy should be an important supplementary method for mediastinoscopy and helping avoid thoracotomy.

[Video-assisted thoracic surgery: indications and limitations]. / Chirurgie thoracique vidéo-assistée: indications et limites.

From November 1990 to September 1992, 72 patients underwent a video-assisted thoracic surgery (VATS), 47 men and 25 women, of mean age 49 years. Video-assisted thoracic surgery was indicated for the following: 44 spontaneous pneumothorax, 6 benign tumors of the lung or the mediastinum, 4 pleural effusions, one broncho-pleural fistula and one sympathectomy; 17 diagnostic procedures (lung or mediastinal lymph-nodes biopsies). In one patient, it was necessary to associate a mini-thoracotomy and 5 patients went on to a formal thoracotomy. There was no mortality and the morbidity rate was 5.5%. Some conditions are required: one-lung ventilation, ability to convert to a formal thoracotomy at any moment. It is contra-indicated in cases of single lung or complete obliteration of the pleural space due to dense adhesions. The place of VATS is now well defined for the treatment of spontaneous pneumothorax. It is discussed for resection of pulmonary diseases depending on their size, location and histologic type.

[Oncological and functional results of direct colo-anal anastomosis after total resection of the rectum for cancer]. / Résultats carcinologiques et fonctionnels de l'anastomose colo-anale directe après exérèse totale du rectum pour cancer.

From january 1986 to december 1992, 71 patients underwent direct colo-anal anastomosis as described by Parks (CAA) after total rectal resection for carcinoma: 49 men and 22 women with a mean age of 64 years (range 37-82). In 67 cases, the indication was for adenocarcinoma of the mid and low rectum, and in 4 cases for carcinoma of the upper rectum associated with a low rectal benign tumour (6 Dukes A, 36 Dukes B, 21 Dukes C, 8 Dukes D). A diverting colostomy was constructed in all cases. One patient died from pulmonary embolism (mortality: 1.4%). Anastomotic leakage occurred in 6 cases (8.5%). None of these cases required reoperation and all colostomies have been closed. Local recurrence occurred in 12 cases (17%) 6 to 34 months after CAA, of whom 4 were treated by abdominoperineal resection. Eleven patients died from local recurrence (3 cases) or distant metastasis (8 cases). Actuarial survival at 1, 2, 3, 4 and 5 years was 92%, 88%, 78%, 75% and 69% respectively. From the functional point of view, one patient underwent abdomino-perineal resection for incontinence 3 years after CAA. All the other patients were fully continent, with a mean stool frequency of 2 per day, and good gas-stool discrimination. Twenty per cent of patients presented soiling, 20% with stool frequency, and 12% with urgency. Long term functional and oncological results make CAA a good alternative to abdomino-perineal resection for mid and low rectal carcinoma.

[Pleuro-pericardial cysts, treatment by video-assisted surgery]. / Kystes pleuro-péricardiques traitement par chirurgie vidéo-assistée.

Three cases of symptomatic pleuro-pericardic cysts were treated with video-assisted surgery. Complete exercises of the cysts was possible in all cases. The follow-up was uneventful and hospitalization was 4 to 5 days. Pleuro-pericardic cysts represent 5 to 10% of the mediastinal tumours. Clinical latency and a constantly benign course are characteristic features. In most cases, tomodensitometry confirms the diagnosis. The diagnosis may be uncertain only in symptomatic forms (atypical localization, high density on tomodensitometry). In these cases, video-assisted surgery is an interesting alternative to transparietal punction-evacuation or to exeresis via thoracotomy.

[Pancreatic-pleural fistula and cancer of the esophagus: single stage surgical treatment of both lesions]. / Fistule pancréatico-pleurale et cancer de l'oesophage: traitement chirurgical des deux affections en un seul temps opératoire.

To our knowledge, the association of a pancreatico-pleural fistula and an esophageal carcinoma has never been previously reported. We report the case of a 48 year old man, who presented with a squamous-cell carcinoma of the esophagus associated with a right pancreatico-pleural fistula. This association raises the problem of the surgical strategy. In our case, we chose to treat the two lesions during the same operation. We performed left pancreatectomy with splenectomy and an Ivor-Lewis procedure, with an uneventful post-operative course.

[Complicated solitary biliary cysts]. / Les kystes biliaires solitaires du foie compliqués.

With development of ultra sound, solitary hepatic cyst (SHC) appears as a common and benign affection. Complications can occur in 10 per cent of cases. We report here four cases of complicated SHC: vena caval obstruction, intracystic bleeding, rupture, intracystic infection. Those four patients were successfully treated by partial excision of the cyst in the first 3 cases, and by percutaneous drainage with CT scan guidance in the latter. Complications of SHC occur only in large cysts, with a diameter up to 8 cm. So, small SHC do not require any treatment, while large SHC must be treated to avoid complications. Percutaneous aspiration and direct injection of alcohol can lead to recurrence. Surgical therapy by partial excision is successful, with low rates of mortality and morbidity.