[Coxalgia]. / Comment j'explore une coxalgie.

Coxalgia is one of the most common painful complaints in orthopedic surgery. The management of a "traumatic" hip is relatively well codified, however atraumatic coxalgia is more difficult to diagnose and explore. The history and a well-conducted clinical examination are essential for the management of coxalgia. The diagnosis is already well oriented by a simple X-ray and the presence or absence of inflammatory signs on the blood test. This article aims to provide a guideline for the diagnostic approach to coxalgia.

La coxalgie est une des plaintes douloureuses les plus fréquentes en chirurgie orthopédique. La prise en charge d'une hanche «traumatique¼ est relativement bien codifiée, par contre les coxalgies atraumatiques sont plus difficiles à diagnostiquer et explorer. L'anamnèse et un examen clinique bien conduit sont primordiaux pour la prise en charge de la coxalgie. Le diagnostic est déjà bien orienté par une simple radiographie et la présence ou non de signe inflammatoire à la prise de sang. Cet article vise à donner une ligne de conduite à la démarche diagnostique face à la coxalgie.

Efficacy of advanced pace-mapping technology for idiopathic premature ventricular complexes ablation.

PURPOSE: Catheter ablation is an effective treatment for premature ventricular complexes (PVCs). Activation mapping is accurate but requires PVCs at the time of the ablation. Pace-mapping correlation (PMC) is a supplemental tool recently developed as an integrated module for an electro-anatomical mapping platform. Our study sought to investigate whether pace-mapping technology provides similar ablation results in patients with low versus high idiopathic PVC burden at the time of ablation and the relationship between sites with the highest PMC and the earliest local activation time (LAT). METHODS: A total of 59 consecutive patients undergoing catheter ablation for idiopathic PVCs were enrolled. Twelve out of 59 patients (20%) were classified in the low PVC burden group (defined as < 2 PVCs/min) and 47/59 (80%) in the high PVC burden group. RESULTS: The most common origin of PVCs was the right ventricular outflow tract (RVOT) followed by aortic cusps, coronary sinus, parahisian region, and aorto-mitral continuity. Procedural and 1-month success rate were 95 and 87% respectively. PVC burden at the time of ablation did not influence the success rate. The median distance between the earliest LAT points and the highest PMC points was 6.4 (4.9-10.6) mm. CONCLUSIONS: Pace-mapping correlation is useful and accurate in localizing the origin of idiopathic PVCs irrespective of the initial PVC burden. It provides optimal ablation results when combined with LAT. Success rate at mid-term follow-up is higher when the origin of PVCs is located in the RVOT as compared to other locations.