Mini-percutaneous nephrolithotomy: Is smaller better for kidney stones in patients with neurogenic bladder?

INTRODUCTION: Patients with neurologic bladder are at an increased risk for urolithiasis, and currently, data on mini-percutaneous nephrolithotomy in this population are limited. Our objective was to compare mini (15F)-percutaneous nephrolithotomy, standard (24F)-PCNL and flexible ureteroscopy in terms of efficacy and safety in treatment of kidney stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: We conducted a retrospective monocentric study in our neuro-urological referral centre. All consecutive patients with NLUTD and a cumulative size of renal calculi greater than 15mm or 10mm in the lower calyx, who had extraction surgery between 2005 and 2020, were included. The primary endpoint was the one-session stone-free rate (SFR) at 3 months on a CT scan. The secondary endpoints were complication (Clavien-Dindo grading system), operative time, blood loss and length of hospital stay. RESULTS: We performed 76 standard PCNL (sPCNL), 46 flexible ureteroscopy lithotripsy (fURL) and 25 miniaturized PCNL (mPCNL). The one-session SFR was 37.5% for the mPCNL group, 38.2% for the sPCNL group and 37% for the fURL group with no significant difference between the three procedures (P=0.99). Early complications, blood loss and transfusion rates were lower in the mPCNL group than in the sPCNL group (P=0.047) and comparable to fURL group. The final SFRs after a second intervention for mPCNL, sPCNL and fURL were 48%, 61.8% and 63%, respectively (P=0.67). CONCLUSION: The efficacy of mPCNL in patients with NLUTD was not different from other techniques, but a significantly lower rate of complications than sPCNL was observed. LEVEL OF PROOF: 3.

Hand and wrist Osteo-articular bone defect: induced membrane technique indications.

Bone defect in the hand and wrist is the result of 3 main causes: traumatic, infectious or tumoral. Whatever the cause and possibility of emergency management, the site (hand or wrist) and anatomical location (articular or diaphyseal) guide the choice of surgical technique and timing. Functional sequelae do not vary, and the ultimate objective is not so much to fill a defect but to give a useful and accepted finger, hand or wrist.

[The evolution of phosphocalcic cement in phalangeal and metacarpal enchondromas. A retrospective study of 13 cases]. / Le devenir du ciment phosphocalcique dans les cures d'enchondromes des phalanges et métacarpiens. Une étude rétrospective de 13 cas.

Chondromas are the most frequent benign tumors of the skeleton. The surgical treatment of these tumors consists of curettage of the tumor, which may be associated with a filling of the defect. One of the filling techniques uses bone substitutes. The primary objective was to evaluate the resorption of phosphocalcic injectable cements and their evolution in bone sites. The secondary objectives were to evaluate the function of the finger and to look for a possible recurrence of the chondroma. We performed a bi-centric study and reviewed 13 patients with 14 phalanx or metacarpal chondromas operated on by phosphocalcic cement filling technique with a minimum follow-up of 2years. An X-ray at the longest follow-up was performed as well as a QDASH, a "finger score" and a measurement of the amplitudes. Cement disappearance was observed in 100% of 5 patients. An average of 30% of cement remained at the last follow-up (0-80%). The disappearance of cement was significantly inversely proportional to the time since the last radiograph (P<0.01). On average, total disappearance of cement was found at about 6years postoperatively. The mean QDASH score was 6.1 (0; 40.91). The mean finger score was 3 (0-24). The disappearance of the cement seems to occur in the medium term after its installation but does not predict the functional recovery and satisfaction of patients operated on for the cure of a chondroma of the hand.

[Osteosynthesis by intramedullary headless screw in digital fractures: A retrospective scannographic and anatomical study]. / Ostéosynthèse par vis centromédullaire sans tête dans les fractures digitales : une étude rétrospective scanographique et anatomique.

INTRODUCTION: Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique. MATERIAL AND METHOD: We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage. RESULTS: At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily. CONCLUSION: This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.

[The incidence of hand trauma the COVID-19 epidemic setting]. / L'incidence des traumatismes de la main dans le contexte épidémique COVID-19.

OBJECTIVES: In France, a lockdown was enforced from March 17 to May 11, 2020. It was renewed with different modalities from April 3 to May 3, 2021. Our objective was to compare the epidemiology of hand and wrist trauma injuries during these periods to a control period, with the hypothesis of a decreased incidence of hand and wrist trauma. METHODS: Patients consulting at a trauma emergency center of a university hospital labeled SOS-Mains were included during lockdowns, and were compared with a control group who consulted during an equivalent period in 2019. We retrospectively collected demographic and clinical data in relation to hand and wrist injuries. RESULTS: During lockdowns, there was an increase in these injuries relative to the total number of patients (from 16% to 22% and 18%). We found a decrease during the first lockdown in the number of fractures, amputations, burns, infections, injuries secondary to a work accident and isolated wounds but a significantly higher proportion of tendon and vasculonervous injuries in the first lockdown (12% vs. 4%). CONCLUSIONS: In first lockdown, the incidence of hand and wrist injuries decreased, but there was an increase in tendon and microsurgical injuries. This may be explained by the change in leisure activities. This underlines the importance of preventive measures concerning the risks related to some activities (use of sharp/motorized tools) in this context of health crisis.

Techniques to prevent symptomatic neuroma in digital amputations.

The occurrence of a symptomatic neuroma on a digital amputation stump, whether traumatic or not, is a frequent complication that affects the patient's quality of life. The objective of this study was to analyze the complications inherent to the various techniques used to manage the nerves when performing digital amputation. We compared different surgical nerve management techniques to determine if one technique is more effective than another in preventing neuroma occurrence. We reviewed 105 patients over a 5-year period. A DN4 score greater than 4 and the modified Tinel test (percussion) showing a trigger zone allowed us to clinically diagnose symptomatic neuroma-related pain. We found 23 symptomatic neuromas out of 131 digital amputations. Twelve neuromas were found when the nerves had been neglected (12/33), eight were found in nerves treated by stripping (8/60), three when nerves were treated by stripping and thermal ablation (3/18). No neuroma was found in the five cases of centrocentral union of the two proper palmar digital nerves, in the 5 nerves buried in the bone or in the 9 nerves subjected to thermal ablation only. Management of the nerve is essential for the prevention of neuromas in digital amputations. New techniques such as bone burial and centrocentral union of the two stumps appear to be particularly effective.

[Outpatient breast cancer surgery: Patient satisfaction study and the role of the attending physician]. / La chirurgie ambulatoire du cancer du sein : étude de satisfaction des patientes et place du médecin traitant.

OBJECTIVES: To evaluate the satisfaction of patients with breast cancer treated surgically in an outpatient setting and the role of the attending physician. METHODS: This prospective satisfaction study focused on patients who had a breast cancer surgery as an outpatient procedure, between February and October 2018, at the CHU and Clinique Mutualiste chirurgicale de Saint-Étienne, Loire, France. The data were collected via a satisfaction survey, which was given to the patients during the postoperative visit. RESULTS: One hundred and four patients were included. The most frequent surgery was partial mastectomy with sentinel lymph node (63.5%). On overall breast cancer surgery, 47.6% were performed on an outpatient basis. Ninety-seven percent of the patients were satisfied, 96.9% would have recommended this procedure to a friend and 47% could resume their daily activities as early as the second day. Among the patients, 16.2% would have preferred to stay on day more in hospital after the surgery. This preference was related to the complexity (P=0.035) and duration of the surgery (P=0.025), fatigue (P=0.03) and feeling of isolation (P=0.016). Among the patients, 25.5% saw their doctor for organic, psychological, administrative, monitoring and informational issues. CONCLUSIONS: Outpatient breast cancer surgery seems safe and qualitative. Standardized procedures, relevant information about the outpatient procedure and specificities of this type of care, as well as the transmission of information with the attending physician are the keys to success.

Elaboration of a nomogram to predict non sentinel node status in breast cancer patients with positive sentinel node, intra-operatively assessed with one step nucleic acid amplification method.

BACKGROUNDS: Tumor-positive sentinel node(SLN) biopsy results in a risk of nonsentinel node metastases in case of micro and macro metastases ranging from 20 to 50 %, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. Thus, the development of a mathematical model for predicting patient-specific risk of non sentinel node(NSLN) metastases is strongly warranted. METHODS: The following parameters were recorded: CLINICAL: hospital, age, medical record number Bio-pathological: tumor (T) size, grading (G), multifocality, histological type, LVI, ER-PR status, HER-2, ki67, molecular classification (luminal A, luminal B, HER2 like, triple negative) Sentinel and nonsentinel lymph node related: number of removed SLNs, number of positive and negative SLNs, copy number of positive sentinel nodes, ratio: number of positive SLNs to number of removed SLNs, number of removed and number of positive nodes after ALND. A total of 2460 patients have been included in the database. All the patients have been provided by the authors of this paper. RESULTS: Multivariate logistic regression analysis demonstrated that only the number of a CK19 mRNA copies (p < 0.0001), T size (p < 0.0001) and LVI (p < 0.0001) were associated with NSN metastases. The discrimination of the model, quantified with the area under the receiver operating characteristics curve, was 0.71 (95 %, C.I. 0.69-0.73), thus confirming a good level of reliability. CONCLUSIONS: The nomogram may be employed by the surgeon as a decision making tool on whether to perform an intraoperative axillary lymph node dissection on breast cancer patients with SLN positive. The large population employed and the standardized method of measuring the value of CK19 mRNA copies are appropiate prerequisites for a reliable nomogram.

Expression of an estrogen-induced breast cancer-associated protein (pS2) in benign and malignant human ovarian cysts.

BACKGROUND: In human mammary tumors, pS2 expression is directly controlled by estrogens and restricted to a subclass of breast carcinomas. In addition, recent studies have suggested that this gene is expressed in both the invasive and preinvasive forms of breast cancer. EXPERIMENTAL DESIGN: pS2 gene expression was investigated in benign and malignant ovary tumors and whenever possible, pS2 expression was also studied in cells collected from cystadenoma fluids. In several cases, particularly with cells from cystadenoma fluids, the limited amount of material available prevented the used of the traditional RNA detection methods such slot/dot blots or Northern blots. Therefore, a rapid and sensitive polymerase chain reaction assay of pS2 expression has been developed and used in this study. RESULTS: In human ovarian tumors, data obtained show that pS2 transcripts and proteins are present in all mucinous cystadenomas studied and at a lower frequency in endometrioid cystadenomas. Quantitation of the CA 19-9 mucin concentration in ovarian fluids indicate that pS2 expression is always associated with high mucin concentrations, but mucin-positive and pS2-negative samples are also frequently observed. CONCLUSIONS: These data suggest that pS2 expression is restricted to subclasses of human ovarian cystadenomas.