Acide tranexamique intra articulaire sans drainage après prothèse totale du genou - Etude prospective, continue, contrôlée de 107 patients

92ème réunion annuelle de la SOFCOT, PARIS, FRANCE, 06-/11/2017 - 09/11/2017L'acide tranexamique diminue le saignement dans la prothèse totale du genou. La procédure d'administration varie et son retentissement fonctionnel est une notion peu évaluée. L'objectif de notre travail est de vérifier qu'une injection intra-articulaire d'Exacyl sans évacuation ni drainage est efficace sur le saignement et garantit un résultat fonctionnel satisfaisant en termes de douleurs et de mobilité, en l'absence de majoration des complications

Incidence and risk factors for bilateral proximal femoral fractures

BACKGROUND: Proximal femoral fractures (PFFs) are a public health issue due to their high frequency. The frequency of a second PFF on the other side is estimated at 10%. This estimation is controversial, however, and the risk factors have not been evaluated in a large population of French patients. The objective of this retrospective case-control study was to determine: (1) the incidence of second PFFs and (2) their risk factors.HYPOTHESIS: The incidence of second PFFs is >2% after 1 year and >5% after 3 years.MATERIAL AND METHODS: We conducted a case-control study in a population of consecutive patients managed surgically for PPF at the Lyon Sud Hospital between 2013 and 2014. We analysed the following clinical factors: age, sex, body mass index (BMI), institutionalisation, the Parker score, the American Society of Anesthesiologists score (ASA), comorbidities, and the use of psychoactive drugs.RESULTS: We included 474 PFFs (trochanter, n=240 and neck, n=234) of which 36 were bilateral. The contralateral fracture occurred within 1 year of the first fracture in 6/474 (1.3%) cases and within 3 years in all 36 cases (7.6%). The case-control study comprised 49 cases with bilateral PFF and 161 controls with no second hip fracture within 3 years. Risk factors for a second hip fracture were age older than 90 years (odds ratio [OR]=5.44; 95% confidence interval [95%CI], 112-2642 (p=0.002)) and a history of heart disease (OR, 2.18; 95%CI, 1.06-4.47 [p=0.03]). A Parker score?6 was protective (OR, 0.84; 95%CI,0.71-0.99 [p=0.03]). Mortality after 3 years was 42% (201/474), and 13% (63/474) of patients were lost to follow-up.DISCUSSION: Age older than 90 years, a Parker score below 6, and a history of heart disease are risk factors for a second PFF within 3 years after the first PFF.LEVEL OF EVIDENCE: III; case-control study

Outcomes and survival of a modern dual mobility cup and uncemented collared stem in displaced femoral neck fractures at a minimum 5-year follow-up

IntroductionThe choice of implant type for total hip replacement in the treatment of femoral neck fractures remains debated. Some authors advocate for the systematic use of cemented stems, while others do not use dual mobility first-line. We therefore conducted a retrospective study using a dual mobility cup (DMC) and an uncemented collared stem (UCS) in order to: (1) confirm the low dislocation rate in this indication, (2) assess other surgical complications, in particular periprosthetic fractures, (3) ensure that these benefits are maintained over time, at a minimum follow-up of 5 years and, (4) assess the rate of revision of the implants.HypothesisOur hypothesis was that the dual mobility dislocation rate for the treatment of femoral neck fractures was lower than for bipolar hemiarthroplasties or single mobility hip prostheses.Patients and methodsA retrospective study of 244 femoral neck fractures (242 patients) treated with DMC and UCS was conducted, between 2013 and 2014. The mean age was 83±10 years (60-104). The occurrence of dislocation, periprosthetic fracture, infection of the surgical site, loosening, reoperation and revision were investigated. The HOOS Joint Replacement (JR) score was collected. The cumulative incidence with mortality was used as a competing risk.ResultsThe mean follow-up was 6 years±0.5 (5-7). At the last follow-up, 108 patients (50%) had died. Twenty-three patients (9.5%) were lost to follow-up. One case of symptomatic aseptic loosening of DMC was observed. The cumulative incidence of dislocations and periprosthetic fractures at 5 years were 2% (95% CI: 0.9-5.4) and 3% (95% CI: 1.2-6), respectively. The 5-year cumulative incidence of surgical site infections was 3.5% (95% CI: 1.8-7). The cumulative incidence of reoperations at 5 years was 7% (95% CI: 4.5-11). The causes of reoperation were periprosthetic fracture (n=6), infection (n=8), postoperative hematoma (n=2) and cup malposition (n=2). The cumulative incidence of a revision at 5 years was 2.7% (95% CI: 1.2-6). The cumulative incidence of a surgical complication from any cause at 5 years was 9% (95% CI: 6.7-14.8). The mean HOOS JR score was 79±5 (52-92).DiscussionThe cumulative incidence of dislocation at 5 years is low and other surgical complications (including periprosthetic fractures) do not increase during this period for DMC associated with UCS, in femoral neck fractures. The use of this type of implant is reliable in the treatment of femoral neck fractures.Level of evidenceIV; retrospective study without control group

Relations génétiques entre la Ride d'Aves et le bassin arrière-arc de Grenade, Caraïbe orientale

International audienc

Unravelling the genetic relations between the Grenada Basin, the Aves Ridge, and the Lesser Antilles: a structural and stratigraphic analysis

International audienceLocated in the southeastern Caribbean, the Grenada Basin is bounded to the east by the modern Lesser Antillesisland arc, to the west by the Aves Ridge, commonly interpreted as a Cretaceous-Paleocene extinct volcanic arc,and to the south by the transpressive plate boundary with South America. The Grenada Basin has long beenregarded as a classical back-arc basin until recent studies suggest alternative models, such as forearc openingor Wernicke-type simple shear. The genetic relations between the Grenada Basin and its adjacent arcs remaintherefore controversial. Our analysis of seismic reflection and refraction data acquired during the GARANTIcruise (May-June 2017 onboard R/V L’Atalante) sheds light on basement nature and topography, depositionalhistory and deformation of the sedimentary infill, including vertical motions, of the Lesser Antilles back-arc area.Correlations with well logs located on the northern Venezuelan shelf, DSDP sites on the Aves Ridge, and IODPsites off the west coast of Martinique Island, also provide chronostratigraphic constraints.Seismic lines across the Grenada Basin reveal a significant asymmetry: the basement deepens from 5 to 10km southeastwards while flat-lying sediment units thicken from 2 to 7 km. A 6.5 to 7 km thick oceanic crustunderlies the southeastern half of the basin over a width of about 80 km. The Grenada Basin comprises threemajor depositional sequences defined by unconformities and/or changes in the seismic facies, from bottom to top:- Sequence 1: undifferentiated Eocene sediments represented by strong reflectors that drape the acoustic basement,as well as syntectonic deposits.- Sequence 2: Oligocene to Middle Miocene distal turbidites, probably originating from the Orinoco River thatflowed from the south into the Grenada Basin at that time. Sequence 2 lies unconformably over Sequence 1.- Sequence 3: Late Miocene to Recent arc-derived turbidites and pelagic sedimentation, with little detri-tal input from South America, due to the emplacement of the eastward drainage of the Orinoco River southof the northern Venezuelan coastal range during Middle Miocene. Sequence 3 lies unconformably over Sequence 2.Since the oldest syntectonic sediments date from the Eocene, the last tectonic event that shaped the present-daybasement topography dates back from the Eocene. Given the horizontality of Sequences 2 and 3 within the basinand along the Aves Ridge, no differential vertical motions occurred between the Grenada Basin and the AvesRidge since then. This raises questions about the subsidence mechanisms that led to the current depth of theoceanic crust in the southeastern Grenada Basin. By contrast, reflectors in Sequences 2 and 3 are bent upwardsalong the Lesser Antilles slope, reflecting the uplift of the Neogene Lesser Antilles arc. These observations will beintegrated in a future model for the evolution of the Lesser Antilles back-arc area, as part of the ANR GAARAntiproject

LES PLUS BEAUX TEXTES DE LOURDES

Comprend : REVUE MARIE / Paul CLAUDEL ; Jean MARCHAT - REVUE MARIE / Joseph FOLLIET ; Julien BERTHEAU - VoYAGE A LOURDES / Alexix CARREL ; Julien BERTHEAU - LES FOULES DE LOURDES / K. HUYSMANS ; Jean MARCHAT - LES MARGES DE LA PRIERE / Daniel ROPS ; Maurice ESCANDE - LES GEORGIQUES CHRETIENNES / Francis JAMMES ; Jean MARCHAT - LOURDES, VILLESAINTE / Louis MERCIER ; Maurice ESCANDE - BERNADETTE / Marcelle AUCLAIR ; Françoise ROSAY - ALLOCUTION A RADIO VATICAN DU 23 FEVRIER 1957 / Son Exc. Mgr THEAS - EXTRAIT DE L'ENCYCLIQUE DU 2 JUILLET 1957 / S.S. le Pape PIE XII ; Maurice ESCANDEBnF-Partenariats, Collection sonore - BelieveContient une table des matière

Population pharmacokinetics of daptomycin in patients with bone and joint infection: minimal effect of rifampicin co-administration and confirmation of a sex difference

International audienceBackground Daptomycin is increasingly used in the treatment of bone and joint infection (BJI), but its pharmacokinetics (PK) and dosage requirements have not been thoroughly investigated in this indication. Daptomycin may be co-administered with rifampicin, which raises questions about a potential drug interaction. Objectives To investigate the population PK and dosage requirements of daptomycin in patients with BJI, and examine the influence of rifampicin co-administration. Methods A population approach was used to analyse PK data from patients who received daptomycin in our regional reference for BJI. We examined the influence of available covariates, including rifampicin co-administration on daptomycin PK. Simulations performed with the final model investigated the influence of dosages and covariates on PTA for both efficacy and safety. Results A total of 1303 daptomycin concentrations from 183 patients were analysed. A two-compartment model best described the data. Significant intra-individual variability was observed. Daptomycin clearance was influenced by renal function and sex, with females having a 26% lower typical clearance than males. Central volume of distribution (V1) was influenced by body weight, age, sex and rifampicin co-administration. Typical V1 was 11% lower in patients who were co-administered rifampicin. In PK/PD simulations, sex influenced the probability of AUC24/MIC target attainment, while rifampicin had a marginal effect. Conclusions A daptomycin dosage of 8 mg/kg/24 h in women and 10 mg/kg/24 h in men should optimize efficacy but may lead to excessive trough concentrations in many patients, especially in women. Therapeutic drug monitoring appears necessary for precision dosing of daptomycin