Cutaneous mammary loxoscelism: An unknown cause of breast inflammation: A case report and review of the literature.

Envenomation due to a Loxosceles spider bite is a rare event in France and no case concerning the breast has yet been reported. We report the case of a 48-year-old woman who presented at Saint-Etienne University Hospital with a pulsatile pain in her left breast two days after feeling a fleeting bite. An abscess was diagnosed and antibiotics were prescribed. A few days later, a necrotic zone appeared around the areola and 75 percent of the surrounding skin was inflamed. The patient reported a persistent fever and a burning pain in her breast. Loxoscelism was finally concluded and surgical debridement was undertaken, followed by supervised wound therapy and local skin care. Complete healing was achieved after 4 weeks of treatment. The diagnosis of loxoscelism is generally presumptive, as the bite is usually painless and the spider rarely captured. Its diagnosis should be considered when an abscess responds poorly to antibiotics.

vNOTEsHC : Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopic for large uteri: study protocol for a multicentre randomised controlled trial.

Background: In France, 62,000 hysterectomies are performed per year, 70% of which are benign. The choice of approach (laparotomy, laparoscopy or vaginal route) is particularly important in the case of large uterus (> 280g) which are associated with a higher risk of complications. The current data are not sufficient to favour one or other approach. A new medical device, the vNOTES (Natural Vaginal Orifice Transluminal Endoscopy System), offers the advantage of both laparoscopic and vaginal route for pelvic surgery. Objectives: To demonstrate the superiority in terms of intraoperative and postoperative complications of the use of a natural orifice transluminal endoscopic hysterectomy system (vNOTES) versus laparoscopic hysterectomy for benign pathologies on estimated large volume uteri (>280g). Materials and Methods: A randomised, double-blind, superiority trial will be performed at five hospital centres. Women with benign uterine pathology requiring hysterectomy and with a large uterus (> 280g) will be randomised to receive either laparoscopic or vNOTES hysterectomy. Main outcome measures: The primary outcome will be the occurrence of intraoperative and postoperative complications within 6 weeks of surgery. Secondary outcomes will be conversion during surgery, duration of surgery and hospitalisation, postoperative pain, postoperative complications, resumption of sexual life and satisfaction with the surgical team. Results: 248 women will be randomised. Conclusion: This trial will provide a better understanding of the approach to large uteri optimise the care of these thousands of women undergoing hysterectomy. What's new?: This trial will evaluate the vNotes for large uteri.

Surgical treatment of displaced acetabular fractures: report of 13 clinical cases.

BACKGROUND AND AIM OF THE WORK: Displaced acetabular fractures are complex lesions which may cause severe consequences if not appropriately treated. The results are linked to the quality of the articular reduction. Anatomical reduction, through surgical treatment with rigid internal fixation, should be considered to obtain an early mobilization, reduce long term osteoarthritis evolution and make the acetabular cavity suitable to eventually recive a total hip prosthesis. The aim of this study is to evaluate functional and radiographic outcome of patients with displaced acetabular fractures surgically treated. METHODS: Between 2005 and 2011, 29 displaced acetabular fracures were treated with open reduction and internal fixation. This study highlight our results in 13 patients with a mean follow-up of 29,5 months (range 5,5-66,3). Clinical evaluation was done according to the Harris hip score, while the radiological criteria were those of Kellgren-Lawrence. The associated injuries and complications were evaluated. RESULTS: At the latest follow-up the radiological results, based on the Kellgren-Lawrence grading scale, showed 3 patients with a I grade of osteoarthritis, 5 with a II grade, 3 with a III grade and 2 with a IV grade. The average Harris hip score was 77 (range 37-100). Postoperative complications included avascular necrosis of the femoral head in 3 patients and heterotopic ossification in 2 patients. CONCLUSIONS: This study confirm that open reduction and internal fixation in displaced acetabular fractures represents the best treatment able to lead to a satisfactory functional outcome. Moreover, it posticipates long-term arthrosis and eventually makes easier the implant of total hip prosthesis. (www.actabiomedica.it).

Senhance 3-mm robot-assisted surgery: experience on first 14 patients in France.

The objective of this article is to present our experience with the 3-mm instruments using the Senhance surgical robotic system in gynecological and abdominal surgery from July to December 2017 by a retrospective observational study. All patients who underwent a robot-assisted 3-mm laparoscopic procedure with the Senhance surgical robotic system were enrolled. Two separate populations were involved: nine female gynecological patients and five digestive surgery patients. Five cholecystectomies, three annexectomies, four ovarian cystectomies, one myomectomy and one endometriotic nodule resection were performed. For the gynecological cases, the median time spent at the console was 37 min (12-77), while the total duration of the intervention was 81.33 min. All the interventions were performed on an outpatient basis. There were no postoperative complications. The average visual analog scale for pain (VAS) was 2.11 (± 1.91) on D0. For the abdominal surgery cases, the median time was 39 min (21-64). The average total duration of the intervention was 87.4 min (± 36.82). One of the five interventions was performed on an outpatient basis. There was one laparoscopy conversion. No postoperative complications in the 2 weeks following the operation. There are few 3-mm instruments available with the Senhance surgical robotic system, which limits the number of interventions. However, it is possible to perform gynecological interventions with 3-mm instruments on an outpatient basis in complete safety. It is possible to perform cholecystectomies by pairing the use of 3-mm and 5-mm instruments. The recent arrival of new 3-mm instruments will enable a wider range of surgical indications.

Can the osteosynthesis with locking plates be a better treatment for unstable fractures of the proximal humerus?

PURPOSE: The purpose of this study is to review our experience with proximal humeral locking plates, including complications, functional outcomes, strength recovery and predictors of successful treatment. METHODS: Seventy unstable proximal humeral fractures were treated with open reduction internal fixation (ORIF) with the use of locking proximal humerus plate. At an average follow-up of 31 months, the clinical and subjective outcomes were evaluated, and complication was analysed. RESULTS: The average Constant score was 72. The mean disabilities of the arm, shoulder and hand score was 23. The average range of motion was as follows: mean range of anterior elevation and abduction 120°-150°; external rotation in abduction 64° and in adduction 44°; and internal rotation T12. CONCLUSION: On the basis of the overall functional and clinical outcome obtained, it is possible to suggest that the ORIF of the proximal humerus fractures using locking plate represents a helpful option that can lead to a good clinical and functional outcome even in the most complex fractures.

[Single-dose intraincisional levobupivacaine infiltration in caesarean postoperative analgesia: a placebo-controlled double-blind randomized trial]. / Infiltration peropératoire de lévobupivacaïne après césariennes: étude randomisée en double insu contre placebo.

OBJECTIVES: The efficacy of single-dose intraincisional infiltration with levobupivacaine in postoperative analgesia and chronic pain after caesarean sections is unknown. STUDY: A placebo-controlled double-blind randomized trial. PATIENTS AND METHODS: After ethical approval, and written inform consent, 140 women scheduled for a caesarean section were randomly assigned and received 30mL of levobupivacaine 0.5% (L group) or saline (placebo-P group) into their wound. The primary endpoint was morphine consumption (using intravenous morphine patient-controlled analgesia) for the first 24h after surgery. At 1h to 48h, side effects, pain at rest and pain 2months later were recorded. RESULTS: All included patients had similar demographic and surgical characteristics. The morphine consumption was significantly lower in the L group at h6, h8 and h12 (considering both total intake and each request). At h4, the mean total morphine consumption was 25 (12) mg in the L group versus 31 (14) mg in the P group (P=0.05). Time until discharge and side effects including nausea-vomiting (14 vs 20%), wound scar complications (6 vs 8%) and chronic pain after 2months (25% in both groups complained of small pain, and 75% no pain) were similar between the two groups (P>0.05). CONCLUSION: Single-dose local infiltration of levobupivacaine 0.5% reduced opioid requirement at 12h, with no difference after 24h. www.clinicaltrials.com, number: NCT00621907.