A novel method for quantification of cefazolin local tissue concentration in blood, fat, synovium, and bone marrow using liquid chromatography - mass spectrometry.

To be effective, the concentration of antibiotic used must exceed the minimum inhibitory concentration (MIC) against infecting organisms at and in the surgical site. Few studies follow antibiotic levels for tissues that are manipulated during surgery. The aim of this work was to develop and validate a novel LC-MS method as well as an efficient extraction technique for the quantification of cefazolin in local tissues and whole blood. This method uses the same efficient extraction method across multiple tissue types affected by orthopedic surgery: blood, fat, synovium, and bone marrow. The ability to quantify cefazolin in these tissues will help identify surgical techniques and antibiotic dosing protocols that better protect patients from infection. The internal standard, 13C2,15N-cefazolin, co-elutes with cefazolin, and was used in calibration curves and tissue extracts as well as for cefazolin recovery and matrix effects. The protocol was rigorously tested, including measurements of reproducibility and calibration curve quality. The recovery of the extraction method ranges from 94% to 113% across all sample types. There is little to no matrix effect on cefazolin signal (98-120%). The developed method was used to determine cefazolin concentrations in tissues of 10 patients undergoing a total knee replacement. Cefazolin blood concentrations were approximately 500 times higher than in adipose, synovium, and bone marrow tissues. This clinical data shows that although the minimum inhibitory concentration is largely surpassed in blood, the concentration of cefazolin in fat, synovium, and bone marrow could be insufficient during a knee replacement. This method of cefazolin quantification will help surgeons optimize antibiotic concentrations in the local tissues during knee replacement surgery and potentially reduce serious post-surgical infections.

Digital health technology for remote care in response to the COVID-19 pandemic: a scoping review.

COVID-19 pandemic has forced the emergency deployment of digital health technology (DHT) to provide remote care. DHT is a promising option to enable telehealth, and, by the same token, it contributes to the implementation of social distance measures. The objective of this scoping review is to investigate existing DHT solutions that have been put in place to enable remote care in response to the COVID-19 pandemic. Structured literature searches were performed in Medline (Ovid), Scopus and CINAHL with Full Text (EBSCOhost), with a mix of keywords and controlled vocabulary unique to each database. The librarian utilized the search strategy on respiratory pandemics created in April 2020 for Medline (Ovid) by Canadian Agency for Drugs and Technology in Health (CADTH). An additional search for grey literature was performed including pre-prints and reports in Google Advanced, LitCovid and MedRx. Two independent reviewers assessed the articles retrieved from the databases (n=131) based on pre-established inclusion criteria and included six articles. Analysis of the results revealed six different types of DHT, including 5 dedicated to telemedicine and one used to track activity of people who were confined to their homes. The results showed positive health-related outcomes and user behavior outcomes. This review revealed that there is limited literature on the use of DHT to enable remote care in response to a pandemic and therefore calls for more documentation of the ongoing deployment of DHTs to support patient safety and the delivery of quality care during the COVID-19 pandemic and beyond.

[Self-evaluation of conization indications since the introduction of the French colposcopy and cervico-vaginal pathology quality charter in 2 colposcopy centers]. / Auto-évaluation des indications de conisation depuis l'instauration de la charte de qualité en colposcopie et pathologie cervico-vaginale.

OBJECTIVES: Analyze the efficiency of the implementation of the colposcopy and cervico-vaginal pathology quality charter. The question was to determine whether the criteria of more than 70% of excisional conizations containing CIN2+ lesions (cervical intraepithelial neoplasia 2 or 3 or carcinoma in situ) had been reached and demonstrate a reduction of the conization rate is possible. METHODS: An epidemiological descriptive, retrospective and multicenter study was performed in "Nord Franche-Comté Hospitals" (Belfort and Montbéliard, France) during the period from November 2013 to January 2015. Inclusion criteria were patients over 25 years undergoing cervical excisions for diagnostic and/or therapeutic purposes after Pap smear screening followed by colposcopically directed biopsies. The files were selected from a data collection and studied using the computerized patient record. RESULTS: In total, 116 conizations were performed: 103 by four French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) members and 13 by four SFCPCV non-members. The overall result of the primary outcome showed 53% of CIN2+ lesions found in cervical conization specimens, which can be broken down to 55% for the group of SFCPCV members and to 38% for the group of SFCPCV non-members. The statistical analysis indicates a significant difference (P=0.02) in the percentage of CIN2+ lesions discovered on the surgical specimen for the group of SFCPCV members. CONCLUSIONS: This self-evaluation shows that it is essential to be a SFCPCV member and to adhere to the charter. By complying with the charter and associating the new National Cancer Institute recommendations (December 2016), it is possible to reduce the conization rate and even to surpass the target of more than 70% of excisional conizations containing CIN2+ lesions.

Bilateral simultaneous metal inlay dissociation from the polyethylene liner of a metal-on-metal hip replacement.

INTRODUCTION: Hard-on-hard bearings for total hip replacement may require a modular acetabular inlay for which polyethylene is often used in a sandwich-type configuration. However, differences in the elastic modulus of the materials make fixation of this metal insert uncertain. The aim of this study is to report a case of bilateral separation of the metal insert from the polyethylene sandwich in a metal-on-metal bearings prosthesis. MATERIALS AND METHODS: A bilateral total hip arthroplasty was performed in two operations, four months apart, in a 53-year-old woman following a corticosteroid-induced osteonecrosis. The total hip replacement system included a cementless stem, and a press-fit hemispheric cup containing a polyethylene sandwich with a metallic insert (Sikomet). RESULTS: Three years later, the patient consulted because of abnormal noise in her right hip which appeared normal on conventional X-ray. Three months later she consulted again for persistent noise. Separation of the metal insert from the polyethylene sandwich was diagnosed and an acetabular revision was performed selecting a metal-on-polyethylene articulation system. The postoperative course, for this revision, was uneventful, but the patient returned with the similar symptoms in her left hip four months later, resulting in the same type of revision. During the revisions, osteolysis secondary to metallosis was diagnosed, requiring synovectomy and acetabular reconstruction with morcelized allograft impaction. The left side postoperative course included three dislocations in nine months which were conservatively treated and have not since recurred. DISCUSSION AND CONCLUSION: This is the first reported case recording an almost simultaneous bilateral dissociation of a hard-on-hard inlay from its polyethylene sandwich. This bilateral case suggests that the fixation of the metal insert inside the polyethylene was probably defective. This case is also a reminder that mechanical complications (separation, implant fracture) should be searched for in presence of any abnormal noise occurring after hard-on-hard bearings prosthetic implantation. This confirms the necessity of periodical follow-up of hip arthroplasties and the importance of knowing their radiological features. The low carbon content of the Sikomet bearing may have been the cause of this failure by increasing frictional torque on the bearing surface, causing metallosis which has already been described in the literature in this type of hip replacement system.

[Antenatal diagnosis of achondrogenesis. Two successive cases in the same family]. / Diagnostic anténatal de l'achondrogenèse. A propos de deux cas successifs dans une même fratrie.

Achondrogenesis is a rare case of fetal skeletal dysplasia. Achondrogenesis in lethal. That is a autosomal recessive fetal skeletal dysplasia. There is a very important dwarfism with extreme micromely, macrocephalia and brevity of chest. The authors enumerate the echographics, radiologics and histologics symptoms of this chondro-dysplasia. The authors comment rapidly the others diagnosis of lethal fetal skeletal dysplasia. Genetic consul is a necessity.

[The parathyroid risk in thyroid surgery. Argument against the early postoperative prescription of vitamin D. Experience with 729 thyroidectomies in 1988]. / Le risque parathyroïdien en chirurgie thyroïdienne. Plaidoyer contre la prescription post-opératoire précoce de vitamine D. Expérience de 729 thyroïdectomies en 1988.

729 consecutive patients underwent thyroidectomy in 1988 in the same institution, including 477 (68%) bilateral resections and 242 (33%) total thyroidectomies. An effort was made to see and save all 4 parathyroids and their blood supply. Early post-operative hypoparathyroidism was defined at day 5, by serum calcium less than 8 mg/dl. and serum phosphate less than 4 mg/dl or by serum calcium only if greater than 7.5 mg/dl. Patients afflicted with early hypoparathyroidism were given calcium tablets without any vit D for 1 year at most. Follow-up, checking serum Ca, P and i PIH was done on a 3 months basis during 1 year. Permanent hypoparathyroidism was defined by persistence of the above-mentioned criteria after 1 year, and eventually vit D was started. 27 patients (5.6% our of 477 bilateral thyroid resections) experienced early post-op hypoparathyroidism. Inciting factors were previous thyroid surgery (4), radioiodine treatment (2), modified neck dissection (2), sternal split with mediastinal node clearance (1), visualization of 1 parathyroid gland only (3 redo cases) and autotransplantation of more than 1 parathyroid (1 case). 1 patient was lost for follow-up. 25 others recovered a normal parathyroid function. 1 is permanently hypoparathyroid (1 redo case with other risk factors). Painstaking parathyroid dissection allows a 0% rate of permanent hypoparathyroidism after primary surgery, if vit D is not given in the early post-operative period. We suggest that avoidance of early vit D prescription in cases of early post-operative hypoparathyroidism, leading to mild sustained hypocalcemia, stimulates the spared parathyroid glands (including a possible 5th) and therefore allows full recovery of the parathyroid function.