Efficacy of trabectedin in metastatic solitary fibrous tumor

Solitary fibrous tumor is a rare tumor type and has an unpredictable course. Local recurrence rate varies between 9 and 19%, and rate of metastatic involvement between 0 and 36 %. It is characterized by a typical architecture and immuno-histochemistry tests. The most important prognostic factor is the complete resection of primary tumor. Treatment of recurrences is not clearly established. If a solitary fibrous tumor is too advanced to allow surgical resection, radiotherapy and chemotherapy may be used. The most often used drugs are doxorubicine and\or ifosfamide. We report the case of man with metastatic solitary fibrous tumor treated with trabectedin, administered at a dose of 1.5 mg/m² every 3 weeks. After 3 cycles, metastases had significantly decreased. Recurrence of the disease was demonstrated 8 months after the start of trabectedin. This case shows that trabectedin is a possible treatment option

Bacterial contamination of the hospital environment during wound dressing change.

International audienceINTRODUCTION: The hospital environment plays a role in the cross-transmission of multidrug-resistant bacteria. The aim of this study was to evaluate the bacterial contamination of the hospital environment during chronic wound dressing change. PATIENTS AND METHODS: This study was performed from July 2010 to May 2011. Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae were counted in environmental samples (air and surfaces) that were obtained in the rooms of patients with wounds colonized (cases, n=9) or not (controls, n=15) during or not during wound dressing change. Bacterial contamination was compared to that found in the rooms of patients without colonized wounds. RESULTS: The environment was frequently contaminated during wound dressing change (38% of the sampled series were positive). In comparison, the contamination was less frequent in the environment of patients with colonized wounds when the wounds were not being dressed (14.3%) and in controls (3.8%). S. aureus was the most frequent species identified in positive samples. DISCUSSION: These results suggest that previously recommended measures such as hand hygiene after contact with the environment and wearing a mask are justified. Moreover, other measures should be suggested, in particular cleaning the room before and after dressing change of colonized wounds. LEVEL OF EVIDENCE: Level III: case control study

Functional and radiographic evaluation of the treatment of traumatic bone loss of the hand using the Masquelet technique

IF 0.308 (2017)International audienceThis study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. There were 13 cases of open fracture of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and the injuries were covered when necessary. To address the bone loss, the first step of the induced-membrane technique involved placing a cement spacer (polymethylmethacrylate [PMMA]) without antibiotics in the defect. During the second step, the cement spacer was removed and replaced by autologous cancellous bone graft. The graft was placed within the biological tube left empty after removal of the cement. For each patient, bone union was assessed with radiographs and/or CT scan. Failure was defined as nonunion at 1year. In 16 patients, the fractures had healed after 4months (1.5-12months) on average. Two failures were noted (one nonunion treated using a PIP prosthesis and one case of delayed union). Mobility of the fingers, evaluated using the Total Active Motion (TAM) was 145° (75°-270°). The Kapandji score reached 8 for the thumb. Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization