Endométriose des voies urinaires (aspects IRM avec corrélations chirurgicales et histopathologiques)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Evaluation fonctionnelle des modifications hémodynamiques intra-hépatiques en échographie-Doppler avec injection de produit de contraste chez des volontaires sains

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Successful Treatment of Saksenaea sp. Osteomyelitis by Conservative Surgery and Intradiaphyseal Incorporation of Amphotericin B Cement Beads

International audienceOsteoarticular mucormycosis cases are quite rare and challenging infections that are mostly due to direct inoculation during traumatic injury among immu-nocompetent patients. Classic management includes a combination of aggressive surgical debridement, which may lead to amputation, and long-term systemic lipo-somal amphotericin B therapy. This article describes the successful treatment of Sak-senaea sp. osteomyelitis in a patient with diabetes mellitus, using a combination of systemic antifungal therapy and conservative surgery with insertion of amphotericin-impregnated cement beads. KEYWORDS Mucorales, amphotericin B, antifungal agents, osteomyelitis M ucorales osteomyelitis still presents diagnostic and therapeutic challenges and is associated with high mortality rates despite a combined therapeutic strategy involving antifungal treatment and surgery (1). Members of the order Mucorales are present in soil and plant debris and could be responsible for osteoarticular mucormy-cosis as a consequence of contamination through disrupted cutaneous barriers after traumatic injury (2). Surgical management is classically aggressive and complicated, with poor functional outcomes or even amputation. We report the first successful conservative orthopedic treatment of Saksenaea sp. osteomyelitis in a patient with diabetes mellitus, using in situ amphotericin-impregnated cement beads in combination with systemic posaconazole therapy. A 63-year-old man was admitted for a painful and swollen right ankle. He had well-controlled diabetes mellitus, hypertension, and degenerative arthritis. He lived in France and had never travelled overseas. Seven years earlier, he had suffered ankle trauma due to a rockfall and developed a necrotic subcutaneous abscess and a diaphyseal periosteal reaction seen on X-ray films. He underwent surgical drainage of the abscess; the sample cultures remained sterile and the surgical wound outcome was marked by a purple painless cutaneous infiltration. Seven years after the first operation, the patient's ankle became painful again and a bone biopsy was performed, which revealed no microorganisms in cultures. Empirical broad-spectrum antibiotherapy was initiated, without efficacy. Lower leg pain, erythema, and edema worsened and a satellite, 4-cm, right inguinal area of lymphadenopathy appeared. The patient was afebrile and had moderate biological inflammatory syndrome (C-reactive protein level, 50 mg/liter). Magnetic resonance imaging (MRI) showed decreased signal intensity on Citation Parize P, Mamez A-C, Garcia-Hermoso D, Dumaine V, Poirée S, Kauffmann-Lacroix C, Jullien V, Lortholary O, Lanternier F. 2019. Successful treatment of Saksenaea sp. osteomyelitis by conservative surgery and intradiaphyseal incorporation of amphotericin B cement beads

Last Generation Triazoles for Imported Eumycetoma in Eleven Consecutive Adults

the French Mycosis Study GroupInternational audienceBackground: Optimal management of eumycetoma, a severely debilitating chronic progressive fungal infection of skin, disseminating to bone and viscera, remains challenging. Especially, optimal antifungal treatment and duration are ill defined.Methodology/Principal Findings: We conducted a monocentric retrospective study of 11 imported cases of eumycetoma treated by voriconazole or posaconazole for at least 6 months. Response to treatment was assessed through evolution of clinical and magnetic resonance imaging (MRI). (1→3) ß-D-glucan (BG) and positron emission tomography using [18F] fluorodeoxyglucose (PET/CT) results were also assessed. Identified species were Fusarium solani complex (n = 3); Madurella mycetomatis, (n = 3), and Exophiala jeanselmei, (n = 1). Moreover, two coelomycetes and one phaeohyphomycetes strains without species identification were retrieved. Serum BG and PET/CT were abnormal in 7/8 and 6/6 patients tested, respectively. Patients received last generation azoles for a mean duration of 25.9±18 months. Complete response (major clinical and MRI improvement) was observed in 5/11 patients, partial response (minor MRI improvement or stable MRI findings) in 5 and failure (MRI evidence of disease progression) in one, with a 73±39 [6–132] months mean follow-up. Relapse occurred in 2 patients after treatment discontinuation. Optimal outcome was associated with fungal species, initiation of last generation triazole therapy (<65 months since first symptoms), negative serum BG and PET/CT normalization.Conclusions/Significance: MRI, PET/CT and serum BG appear as promising tools to assess optimal time of antifungal treatment for eumycetoma

Efficacy and safety of thalidomide in patients with inflammatory manifestations of chronic granulomatous disease: A retrospective case series.

International audienc

Major MRI Response in patient 2.

<p>Major MRI response in Patient 2 with disappearance of periachillean tissular infiltration and of talus bone edema. Slight talus contrast enhancement persistance on T1 Gado Fat Sat sequence.</p

Treatment and outcome characteristics of eleven patients with eumycetoma.

<p>B: Bone involvement; CPK: creatinine phosphokinase; CR: Complete Response; D: drainage; I: inflammation; ITZ: itraconazole; J: Joint involvement; KTZ: ketoconazole; M: Muscle involvement; Node involvement; P: pain; PCZ: posaconazole; PF: Primary failure; PR: Partial Response; R: relapse; S: soft tissue involvement; SUV: Standard Uptake Value; V: Visceral involvement; VCZ: voriconazole.</p><p>* Patient 8 only had one post last generation triazole treatment dosage of BG so that evolution couldn’t be assessed.</p><p>Treatment and outcome characteristics of eleven patients with eumycetoma.</p

Organ involvement in patients 4 and 5.

<p>Lumbar tumefaction with draining sinuses (A). Black grains drainage (B). Paraspinal abdominal eumycetoma extension on abdomen MRI LAVA sequence (C) and lung extension on lung CT scanner (D) in patient 5. Clinical (E) second and third metatarsal destruction on 3D reconstruction CT (F) of foot. Foot mycetoma aspect on Axial T1 Fat Sat Gadolinium MRI (G) and PET/CT (H) in patient 4.</p

Major MRI and PET/CT responses in Patient 9.

<p>Left foot T1 Fat Sat Gadolinium enhanced MRI (A): Disappearance of periachillean tissular infiltration with the dot in the circle pattern, talus bone edema disappearance and slight talus contrast enhancement persistence. Disappearance of talus and tarsal hypermetabolism on left foot PET/CT (B).</p

Nocardia Arthritis

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