المؤلفون: Géraldine Bart, Benoit Le Goff, Laurie Charret, Grégoire Cormier, David Boutoille, Emmanuelle Dernis, Christelle Darrieutort-Laffite, Emmanuel Hoppe

المصدر: Journal of Antimicrobial Chemotherapy. 76:3029-3032

مصطلحات موضوعية: Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Bursitis, medicine.drug_class, Olecranon, 030106 microbiology, Antibiotics, medicine.disease_cause, Septic bursitis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Antibiotic therapy, Elbow Joint, medicine, Humans, Pharmacology (medical), Olecranon Process, Pharmacology, 030222 orthopedics, Streptococcus, business.industry, Bacterial Infections, Middle Aged, medicine.disease, Comorbidity, Anti-Bacterial Agents, Infectious Diseases, medicine.anatomical_structure, Cellulitis, Female, business

الوصف: Background No current guidelines are available for managing septic bursitis (SB). Objectives To describe the clinical characteristics and management of olecranon and prepatellar SB in five French tertiary care centres. Methods This is a retrospective observational multicentre study. SB was diagnosed on the basis of positive cultures of bursal aspirate. In the absence of positive bursal fluid, the diagnosis came from typical clinical presentation, exclusion of other causes of bursitis and favourable response to antibiotic therapy. Results We included 272 patients (median age of 53 years, 85.3% male and 22.8% with at least one comorbidity). A microorganism was identified in 184 patients (67.6%), from bursal fluids in all but 4. We identified staphylococci in 135 samples (73.4%), streptococci in 35 (19%) and 10 (5.5%) were polymicrobial, while 43/223 bursal samples remained sterile (19.3%). Forty-nine patients (18%) were managed without bursal fluid analysis. Antibiotic treatment was initially administered IV in 41% and this route was preferred in case of fever (P = 0.003) or extensive cellulitis (P = 0.002). Seventy-one (26%) patients were treated surgically. A low failure rate was observed (n = 16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted Conclusions Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. The success rate was equivalent in the non-surgical and the surgical management groups. However, a treatment duration of

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dafaeae5cf13b4a9e6db087760bf84c9Test
https://doi.org/10.1093/jac/dkab265Test

المؤلفون: Benoit Le Goff, Jean-David Albert, Nicolas Dumoulin, Guillaume Coiffier, Grégoire Cormier, Stéphane Varin, Christelle Darrieutort-Laffite

المصدر: The American journal of sports medicine. 49(4)

مصطلحات موضوعية: medicine.medical_specialty, Percutaneous, Physical Therapy, Sports Therapy and Rehabilitation, law.invention, 03 medical and health sciences, Rotator Cuff, 0302 clinical medicine, Randomized controlled trial, law, Shoulder Pain, Post-hoc analysis, medicine, Effective treatment, Humans, Orthopedics and Sports Medicine, Rotator cuff, Calcific tendinopathy, Therapeutic Irrigation, Ultrasonography, Interventional, 030203 arthritis & rheumatology, 030222 orthopedics, business.industry, Calcific tendinitis, medicine.disease, Ultrasound guided, Surgery, medicine.anatomical_structure, Treatment Outcome, Case-Control Studies, Tendinopathy, business

الوصف: Background: Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. Purpose: To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. Study Design: Case-control study; Level of evidence, 3. Methods: This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients’ clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score Results: Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. Conclusion: Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e855bca0fe1586773a1e4c6ad4a64346Test
https://pubmed.ncbi.nlm.nih.gov/33719606Test

المؤلفون: Stéphane Varin, Grégoire Cormier, Lucie Planche, Benoit Le Goff, Guillaume Coiffier, Jean-David Albert, Christelle Darrieutort-Laffite, Yves Maugars

المصدر: Annals of the Rheumatic Diseases. 78:837-843

مصطلحات موضوعية: Adult, Male, Visual analogue scale, medicine.medical_treatment, Immunology, Equivalence Trials as Topic, Punctures, Methylprednisolone, General Biochemistry, Genetics and Molecular Biology, Injections, Intra-Articular, Rotator Cuff, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Tendinitis, Shoulder Pain, Humans, Immunology and Allergy, Medicine, Therapeutic Irrigation, Glucocorticoids, Saline, Ultrasonography, Interventional, Pain Measurement, 030203 arthritis & rheumatology, Pain, Postoperative, 030222 orthopedics, Dry needling, business.industry, Calcinosis, Calcific tendinitis, Middle Aged, medicine.disease, Acute Pain, Treatment Outcome, Anesthesia, Tendinopathy, Female, Saline Solution, Subacromial bursa, business, Follow-Up Studies, medicine.drug, Calcification

الوصف: ObjectiveSteroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL.MethodsThis was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0–100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up.ResultsThe estimated mean difference in the first week’s maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups.ConclusionNon-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption.Trial registration numberNTC02403856.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dcece3babe2a404951bc62970e939b9fTest
https://doi.org/10.1136/annrheumdis-2018-214971Test

المؤلفون: Christelle Darrieutort-Laffite, Louis J. Soslowsky, Benoit Le Goff

المصدر: International Journal of Molecular Sciences
International Journal of Molecular Sciences, Vol 21, Iss 7000, p 7000 (2020)

مصطلحات موضوعية: ultrasound-guided injections, Percutaneous, Angiogenesis Inhibitors, Review, Bioinformatics, Achilles Tendon, Catalysis, lcsh:Chemistry, Inorganic Chemistry, 03 medical and health sciences, 0302 clinical medicine, In vivo, stem cells, Adrenal Cortex Hormones, medicine, Animals, Humans, Physical and Theoretical Chemistry, lcsh:QH301-705.5, Molecular Biology, dry needling, Spectroscopy, 030222 orthopedics, Dry needling, Achilles tendinopathy, business.industry, Platelet-Rich Plasma, Organic Chemistry, Soft tissue, 030229 sport sciences, General Medicine, medicine.disease, Computer Science Applications, Tendon, Clinical trial, Disease Models, Animal, medicine.anatomical_structure, lcsh:Biology (General), lcsh:QD1-999, Platelet-rich plasma, Chronic Disease, Tendinopathy, business, Stem Cell Transplantation

الوصف: Achilles tendinopathy (AT) is a common problem, especially in people of working age, as well as in the elderly. Although the pathogenesis of tendinopathy is better known, therapeutic management of AT remains challenging. Various percutaneous treatments have been applied to tendon lesions: e.g., injectable treatments, platelet-rich plasma (PRP), corticosteroids, stem cells, MMP inhibitors, and anti-angiogenic agents), as well as percutaneous procedures without any injection (percutaneous soft tissue release and dry needling). In this review, we will describe and comment on data about the molecular and structural effects of these treatments obtained in vitro and in vivo and report their efficacy in clinical trials. Local treatments have some impact on neovascularization, inflammation or tissue remodeling in animal models, but evidence from clinical trials remains too weak to establish an accurate management plan, and further studies will be necessary to evaluate their value.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::463958f51d286bc34afd0598f3abc569Test
http://europepmc.org/articles/PMC7582801Test

المؤلفون: Benoit Le Goff, Christelle Darrieutort-Laffite

المصدر: Revue du Rhumatisme Monographies. 85:102-107

مصطلحات موضوعية: 030203 arthritis & rheumatology, 030222 orthopedics, 03 medical and health sciences, 0302 clinical medicine, Rheumatology

الوصف: Resume Les tendinopathies calcifiantes sont une cause frequence de douleurs d’epaule volontiers chroniques et invalidantes. Differentes options therapeutiques s’offrent a nous pour prendre en charge ces patients. Dans cette revue, les moyens et options strategiques dans cette pathologie sont discutes et permettent de degager certaines notions. Le traitement par kinesitherapie et anti-inflammatoires non steroidiens peut etre tente en premiere intention puisque le caractere symptomatique de la calcification peut etre un marqueur de l’evolution vers la resorption. Cependant, la duree necessaire a la disparition spontanee des symptomes peut etre longue et difficilement previsible. Ensuite, environ un tiers des patients pourront repondre sur le long terme a une infiltration de la bourse sous-acromio-deltoidienne, les autres recidivant souvent lorsque l’effet de la corticotherapie locale s’attenue. C’est a ce stade qu’une intensification du traitement peu se discuter. Les donnees actuelles semblent favoriser la ponction-lavage-fragmentation (PFL) de la calcification aux ondes de chocs. Cette derniere permet de maniere plus rapide et frequente la disparition de la calcification et de la douleur. Cette affirmation est a temperer au vu de la qualite et quantite de donnees disponibles. Le guidage de la PFL se fait maintenant sous echographie et avec une technique a une aiguille qui est equivalente au lavage a 2 aiguilles. Enfin, la chirurgie est clairement indiquee en cas d’echec d’une prise en charge medicale complete, n’ayant jamais montre sa superiorite par rapport aux autres therapeutiques.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::43ef06a26461f367d4ef6f86fbd2a11fTest
https://doi.org/10.1016/j.monrhu.2018.01.002Test

المؤلفون: Jean-Denis Laredo, Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Yves Maugars

المصدر: Revue du Rhumatisme. 84:486-491

مصطلحات موضوعية: 030222 orthopedics, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, 030217 neurology & neurosurgery

الوصف: Resume Objectif Realiser une synthese d’articles abordant le role de l’etirement radiculaire dans la physiopathologie de la radiculopathie. Methodes Revue d’articles pertinents sur ce theme disponibles dans la base de donnees PubMed. Resultats Une etude microscopique peroperatoire de patients presentant une sciatique a revele dans tous les cas une adherence de la hernie a la dure-mere des racines nerveuses. Lors du test d’elevation de la jambe tendue ( Straight leg raising [SLR], manœuvre de Lasegue), l’adherence des tissus periradiculaires limite le deplacement de la racine nerveuse, et des modifications ischemiques transitoires dans la racine provoquees par l’etirement perturbent temporairement la conduction. Les racines rachidiennes sont plus fragiles que les nerfs peripheriques, et d’autres contraintes mecaniques que la compression radiculaire peuvent provoquer une radiculopathie, en particulier si elles alterent egalement le flux sanguin intraradiculaire ou la fonction des villosites arachnoidiennes, etroitement liees aux veines radiculaires. Ainsi, l’arachnoidite (disparition de la graisse peridurale autour du sac dural) et la fibrose epidurale postoperatoire peuvent favoriser une sciatique, notamment chez des patients dont le tronc sciatique adhere egalement au muscle piriforme ou obturateur interne. De fait, l’etirement radiculaire est fortement accru par une adherence a deux niveaux. Conclusions L’exces de traction des racines nerveuses n’etant pas visible a l’imagerie, nombre de medecins ont perdu l’habitude de prendre en consideration les changements microscopiques et physiologiques, alors que dans plus de 10 % des sciatiques, la compression des racines nerveuses n’apparait pas sur l’IRM lombaire. Rappelons que si la compression de la racine d’un nerf spinal implique un etirement radiculaire, l’inverse n’est pas vrai : il arrive que des racines soient etirees sans qu’aucune compression ne soit visible.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::378caaa758bdf838eeb4b4affd44e688Test
https://doi.org/10.1016/j.rhum.2017.04.006Test