[A collaborative project to improve emergency room admissions through codesign]. / Un projet collaboratif d'amélioration de l'admission aux urgences par le codesign.

Design is a project approach that is gradually opening up in the hospital sector with the ambition of contributing to the improvement of hospitality for the benefit of patients and caregivers. This is the challenge taken up by the University Hospital of Montpellier (34) by creating an experimental project that integrates design practices in the emergency room.

[Do scoliotic patients need increased orthodontic treatment? A comparative study on 104 cases]. / Les patients scoliotiques ont-ils un besoin de traitement orthodontique augmenté ? Une étude comparative sur 104 cas.

INTRODUCTION: The diagnosis of scoliosis during orthodontic treatment is often attributed to orthodontic treatment, which may be a simple confounding factor. Do scoliotic patients require increased orthodontic treatment? Is the extent of their need for orthodontic treatment correlated with the severity of their scoliosis? MATERIAL AND METHOD: The authors conducted a comparative multicenter epidemiological study between a group of patients with a proven diagnosis of scoliosis objectified by the Cobb angle and a control group recruited from the general population. The endpoint was the Index Of Orthodontic Treatment Need (IOTN). The calculation of the number of subjects was made a priori. A statistical significance threshold of 5% was used for the statistical analysis. RESULTS: In this study, 104 patients were included: 36 patients (10 boys, 26 girls) with an average age of 12.1 years (+/-2.3 years) in the scoliosis group (mean Cobb angle = 21°) versus 69 patients (20 boys, 49 girls) with an average age of 12 years (+/-2.7 years) in the control group. Patients with scoliosis have a significantly higher need for orthodontic treatment than the general population. The study did not correlate the severity of scoliosis with the increased need for orthodontic treatment. DISCUSSION: Thus, the diagnosis of scoliosis during orthodontic treatment should not systematically result in the removal of the orthodontic appliance over-hastily held responsible for the scoliotic condition.

Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid "Lewis Santy".

BACKGROUND AND STUDY AIMS: Esophagogastric anastomosis (EGA) has a high risk of leakage. Based upon our experience in endoscopic gastrojejunal anastomosis using LAS, the aim of this study was to verify the technical feasibility and the safety of performing an EGA using a hybrid approach (endoscopic and surgical). MATERIALS AND METHODS: A pilot prospective study was performed on 8 survival pigs. The procedure was carried out in 2 stages: (i) surgical step consisting of an esogastrectomy by laparotomy with separated suture of the esophagus and stomach; (ii) endoscopic esophagogastric anastomosis using the LAS. The first 2 pigs allowed for the setting of the 2 steps procedure, and 6 were included in the study for assessing the efficacy and safety of the procedure with a 3-week survival course. The primary endpoint was morbidity and mortality. RESULTS: All procedures were successfull. The mean operative time was 98 minutes, with a mean endoscopic time of 46 minutes. Three early deaths occurred within the first weeks, unrelated to the LAS anastomosis. At 3 weeks, endoscopic assessment followed by necropsy demonstrated the right position and the endoscopic removability of the stent with good patency of the esophagogastric anastomosis, without leakage of the endoscopic suture. Pathological examination confirmed the patency of the anastomosis with fusion of mucosal and muscle layers. CONCLUSION: Endoscopic esophagogastric anastomosis with LAS is feasible and reproducible, without anastomotic leakage. It could be a new alternative to perform safe anastomoses, as part of a hybrid approach (surgical and endoscopic).

Erratum: Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid "Lewis Santy".

[This corrects the article DOI: 10.1055/s-0043-106577.].

Effectiveness of pure argon for renal transplant preservation in a preclinical pig model of heterotopic autotransplantation.

BACKGROUND: In kidney transplantation, the conditions of organ preservation following removal influence function recovery. Current static preservation procedures are generally based on immersion in a cold-storage solution used under atmospheric air (approximately 78 kPa N2, 21 kPa O2, 1 kPa Ar). Research on static cold-preservation solutions has stalled, and modifying the gas composition of the storage medium for improving preservation was considered. Organoprotective strategies successfully used noble gases and we addressed here the effects of argon and xenon on graft preservation in an established preclinical pig model of autotransplantation. METHODS: The preservation solution Celsior saturated with pure argon (Argon-Celsior) or xenon (Xenon-Celsior) at atmospheric pressure was tested versus Celsior saturated with atmospheric air (Air-Celsior). The left kidney was removed, and Air-Celsior (n = 8 pigs), Argon-Celsior (n = 8) or Xenon-Celsior (n = 6) was used at 4 °C to flush and store the transplant for 30 h, a duration that induced ischemic injury in our model when Air-Celsior was used. Heterotopic autotransplantation and contralateral nephrectomy were performed. Animals were followed for 21 days. RESULTS: The use of Argon-Celsior vs. Air-Celsior: (1) improved function recovery as monitored via creatinine clearance, the fraction of excreted sodium and tubulopathy duration; (2) enabled diuresis recovery 2-3 days earlier; (3) improved survival (7/8 vs. 3/8 pigs survived at postoperative day-21); (4) decreased tubular necrosis, interstitial fibrosis, apoptosis and inflammation, and preserved tissue structures as observed after the natural death/euthanasia; (5) stimulated plasma antioxidant defences during the days following transplantation as shown by monitoring the "reduced ascorbic acid/thiobarbituric acid reactive substances" ratio and Hsp27 expression; (6) limited the inflammatory response as shown by expression of TNF-alpha, IL1-beta and IL6 as observed after the natural death/euthanasia. Conversely, Xenon-Celsior was detrimental, no animal surviving by day-8 in a context where functional recovery, renal tissue properties and the antioxidant and inflammation responses were significantly altered. Thus, the positive effects of argon were not attributable to the noble gases as a group. CONCLUSIONS: The saturation of Celsior with argon improved early functional recovery, graft quality and survival. Manipulating the gas composition of a preservation medium constitutes therefore a promising approach to improve preservation.

Prospective randomized comparison of endoscopic submucosal tunnel dissection and conventional submucosal dissection in the resection of superficial esophageal/gastric lesions in a living porcine model.

BACKGROUND AND STUDY AIMS: To assess experimentally endoscopic submucosal tunnel dissection (ESTD) as an alternative technique of endoscopic submucosal resection. PATIENTS AND METHODS: This was a prospective, randomized, comparative experimental animal study carried out over a period of 9 months at the surgical research and teaching center of Aix-Marseille University, France. Virtual esophageal and gastric lesions measuring 3 cm in diameter were resected in pigs weighing 25 to 30 kg. The primary aim was to evaluate ESTD's efficacy compared with endoscopic submucosal dissection (ESD). The secondary aims were to determine complication rates as well as to assess procedure time and procedure speed, histologic quality of the resected specimen, and procedure cost. RESULTS: Eighteen procedures (9 ESD and 9 ESTD) were performed in nine pigs. The technical success rate was 88.9 % for both techniques, with one single failure in each. The en bloc resection rate was 100 % for ESTD and 88.9 % for ESD (one failure). The complication rate (22 %) and median procedure time were similar but dissection speed was quicker with ESTD in the esophagus (P = 0.03). Median procedure cost (728 Euros for ESD and ESTD) did not differ. On histologic examination, the lateral margins were healthy in 100 % of ESTD and in 88.9 % of ESD (P = 0.49). Deep resection margins were of better quality in ESTD (median submucosal thickness: 1307.1 µm vs. 884.7 µm; P = 0.039). CONCLUSIONS: ESTD is feasible and safe but not superior in the treatment of superficial esophageal/gastric lesions in porcine models compared with ESD. Nevertheless it provides a better quality histologic specimen.

Gastrojejunal anastomosis using a tissue-apposing stent: a safety and feasibility study in live pigs.

BACKGROUND AND STUDY AIMS: Various techniques using surgical and natural orifice transluminal endoscopic surgery (NOTES) have been evaluated to create a gastrojejunal bypass. The aim of the current study was to determine the safety, feasibility, and efficacy of a new technique using a pure endoscopic approach and tissue-apposing stent placement for gastrojejunal anastomosis (GJA). MATERIALS AND METHODS: This was a prospective, experimental study on six live pigs weighing 20 - 45  kg. Endoscopies were performed using a double-channel gastroscope, and included the creation of a GJA using a tissue-apposing, fully covered, self-expanding metallic stent. Antibiotic therapy was continued for 7 days after the procedure, and food was gradually reintroduced from Day 3. Changes in weight following the procedure were compared with a control group of age-matched animals. Anastomosis functionality was confirmed by endoscopy at 3 weeks (before the animals were euthanized), and during histopathological analysis. The primary outcomes were morbidity and mortality at 3 weeks. Secondary outcomes were technical feasibility, procedure time, and patency of the GJA. RESULTS: The procedures were performed successfully in all animals. The mean procedure time was 26  ±  6.7 minutes (range 15 - 32 minutes). One case of stent migration occurred during the procedure; the stent was successfully replaced using the same procedure. All animals were alive after 3 weeks. The mean weight gain during follow-up was 0.85  ±  2.56  kg (range - 2 to + 2  kg) compared with 5.2  ±  1.6  kg (range 3 - 7  kg) in control animals (P = 0.007). At necropsy, the stents were still in place in all animals, without evidence of peritonitis. Histopathology confirmed permeable anastomoses with continuity of the mucosa and mucosa muscle layers. CONCLUSIONS: GJA with a tissue-apposing stent is safe, feasible, and reproducible without anastomotic leakage in a porcine model using a pure endoscopic approach and standard endoscopic equipment.

Gastrojejunal Anastomosis Exclusively Using the "NOTES" Technique in Live Pigs: A Feasibility and Reliability Study.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) could reduce procedure-associated morbidity and mortality. The aim of this study was to determine the feasibility of performing a simple model of gastrojejunal anastomosis in a living porcine model exclusively using NOTES. METHODS: It was a prospective experimental animal study concerning pigs weighing between 25 and 30 kg. Endoscopies were performed using a double-channel gastroscope. A preliminary phase allowed for the development of the technique on 3 animals that were immediately euthanized. The experimental phase included the implementation of a gastrojejunal anastomosis in 9 animals. Antibiotic therapy was continued for 7 days with gradual feeding. Surviving animals were euthanized after 3 weeks. Anastomosis permeability in each animal was confirmed by opacification, endoscopy, and histopathological analysis. The main outcome measurements were the feasibility and animal survival at 3 weeks postsurgery. RESULTS: The entire procedure was performed on 9 animals (4 males and 5 females). Anastomosis required 4.7 ± 1.2 stitches (range 4-7). The average total length of the procedure was 143 ± 50.8 minutes (range 87-225 minutes). One bleeding, 2 suture dehiscences, and a poor stomach incision were the immediate complications endoscopically resolved. At 3 weeks, 5 animals had survived. Three animals died as a result of anastomotic leakage confirmed at necropsy and histopathology. In the surviving animals, histology confirmed permeable anastomoses with collagen scar tissue and continuity of the mucosa and mucosa muscle layers. CONCLUSION: Successful gastrojejunal anastomosis by NOTES is technically feasible but is subject to a learning curve.

A specific closed percutaneous technique for reduction of Jeffery type II lesion.

Open reduction is commonly recommended in Jeffery type II fractures. Attempts to reduce these fractures percutaneously were reported as unsafe and unreliable. We revisited this technique and used a specific percutaneous reduction that turned out to be successful in two cases. Instead of lifting the radial head as described in leverage maneuver, we use a pushing-back procedure to reduce the fracture. The maneuver aims at suppressing the capitellum interposition between the head fragment and the metaphysis by reproducing the reversed trajectory of trauma. This reduction is made possible because of the posterior periosteal attachment of the radial head. A few weeks after the procedure, the two patients remained painless, recovered a complete range of motion in prono-supination and returned to sports. In these two cases, the procedure used led to a prompt recovery and provided a much better outcome than described with the classic open approach.

Interobserver reliability in the interpretation of radiologic signs in Legg-Calvé-Perthes disease.

An accurate interpretation of radiographs is crucial in determining therapeutic choices in Legg-Calvé-Perthes disease. The aim of this study was to measure the interobserver reliability of a group of surgeons in this condition. Twenty-three radiographs were shown to nine pediatric orthopedic surgeons at nine different medical centers. Differences in coding between members of the group was assessed using a two-way random factor analysis of variance. Reliability was excellent for the Catterall classification [intraclass correlation coefficient (ICC) = 0.94], and good for the stage of disease and Head at Risk signs (ICC ranging from 0.74 to 0.85) except for lateral subluxation, whose reliability is fair (ICC = 0.68). Analysis of results shows that lateral subluxation should be expressed in a quantitative measurement rather than a binary answer. The reliability of Gage's sign would be improved if multiple definitions did not exist in the literature. In experienced hands, Catterall's classification can be used with reliability. Difficulties are still noted in separating group II frorm group III.