Conception de prothèse visible en IRM pour la prise en charge chirurgicale des prolapsus génitaux et des hernies abdominales

National audienc

Conception of an anti-infectious and MRI visible mesh used for pelvic organs prolapse and abdominal hernias surgery

International audienceLa pose chirurgicale de prothèses afin de pallier les descentes d'organes de la zone pelvienne ou pariétale est une opération de plus en plus fréquente et requière l'implantation de plus de 1 200 000 dispositifs médicaux annuellement. Or, les cas de complications et de réinterventions chirurgicales restent très élevés, principalement dus aux infections associées à une réponse inflammatoire importante, ainsi qu'aux érosions, expositions et migrations des prothèses. Ces travaux présentent différentes stratégies permettant d'apporter des propriétés de résistance à l'infection et de suivi postopératoire à l'aide d'une visibilité en IRM à des treillis. Pour cela, un enrobage de polymères dégradables (polyesters) piégeant des antibiotiques est créé à l'aide d'un aérographe autour des filaments des treillis tout en conservant leurs aspects morphologiques et leurs propriétés mécaniques. Cet enrobage temporaire permet une libération prolongée de principes actifs inhibant l'adhésion bactérienne, la formation de biofilm et la prolifération bactérienne périprothétique pendant plus de trois jours in vitro. Parallèlement, des polymères contenant des agents de contraste greffés sur leur squelette carboné ont été utilisés comme agent d'enrobage, afin d'apporter des propriétés de visibilité en IRM aux treillis. In vitro, ces treillis enrobés induisent un signal significatif en IRM expérimentale (7 Tesla) et présentent une très bonne stabilité de l'agent de contraste, quelle que soit la technique de stérilisation employée. Surgical operations for soft tissue reinforcement (i.e. pelvic organs prolapse or abdominal hernias) are common procedures and require annually at least 1,200,000 of prostheses. Unfortunately, postoperatory complications and reinterventions are still important, mainly due to infection, inflammation, erosion, exposition or meshes migration. We present here several strategies to bring to meshes anti-infective resistance and clinical follow-up capability through an MRI visible material. A coating of the mesh by degradable polymers (polyesters) trapping antibiotics was created using an airbrushing technique, without modifying dramatically the morphology and the mechanical properties of the meshes. This temporary drug reservoir-coating allows a sustained release of the drugs and hamper in vitro bacterial contamination and biofilm formation on the meshes, associated to a large periprosthetic microorganism growth inhibition for a minimum of three days. Simultaneously, magnetic resonance contras

Recommendations of the European Board for the Specialty Cardiology (EBSC) for education and training in basis cardiology in Europe

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Cranberry capsules to prevent nosocomial urinary tract bacteriuria after pelvic surgery: a randomised controlled trial

International audienceOBJECTIVE:To evaluate whether cranberries are able to prevent postoperative urinary bacteriuria in patients undergoing pelvic surgery and receiving transurethral catheterisation.DESIGN:Randomised, double-blind, placebo-controlled trial.SETTINGS:French tertiary Care centre, University Hospital.POPULATION:A total of 272 women undergoing pelvic surgery aged 18 or older.METHODS:Participants undergoing pelvic surgery were randomised to 36 mg cranberry (proanthocyanidins, PAC) or placebo once daily for 10 days. Statistical analysis was performed by a chi-square test.MAIN OUTCOME MEASURES:The primary and secondary outcomes were postoperative bacteriuria, defined by a positive urine culture, within the first 15 and 40 days, respectively.RESULTS:Two hundred and fifty-five participants received the intended treatment: 132 (51.8%) received PAC and 123 (48.2%) received placebo. There were no significant differences in baseline demographics, intra-operative characteristics or duration and type of catheterisation between the two groups. PAC prophylaxis did not reduce the risk of bacteriuria treatment within 15 days of surgery [27% bacteriuria with PAC compared with 25% bacteriuria with placebo: relative risk 1.05, 95% CI 0.78-1.4, P = 0.763). The same result was observed on day 40. Bacteriuria occurred more often in older women with increased length of catheterisation.CONCLUSION:Immediate postoperative prophylaxis with PAC does not reduce the risk of postoperative bacteriuria in patients receiving short-term transurethral catheterisation after pelvic surgery.TWEETABLE ABSTRACT:PAC prophylaxis does not reduce the risk of postoperative bacteriuria in patients undergoing pelvic surgery