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Genève, Switzerland

Duthon V.B.,Hopitaux Universitaires Of Geneva
Orthopaedics and Traumatology: Surgery and Research | Year: 2015

Inaugural traumatic patellar dislocation is most often due to trauma sustained during physical or sports activity. Two-thirds of acute patellar dislocations occur in young active patients (less than 20years old). Non-contact knee sprain in flexion and valgus is the leading mechanism in patellar dislocation, accounting for as many as 93% of all cases. The strong displacement of the patella tears the medial stabilizing structures, and notably the medial patellofemoral ligament (MPFL), which is almost always injured in acute patellar dislocation, most frequently at its femoral attachment. Lateral patellar glide can be assessed with the knee in extension or 20° flexion. Displacement by more than 50% of the patellar width is considered abnormal and may induce apprehension. Plain X-ray and CT are mandatory to diagnose bony risk factors for patellar dislocation, such as trochlear dysplasia or increased tibial tubercle-trochlear groove distance (TT-TG), and plan correction. MRI gives information on cartilage and capsulo-ligamentous status for treatment planning: free bodies or osteochondral fracture have to be treated surgically. If patellar dislocation occurs in an anatomically normal knee and osteochondral fracture is ruled out on MRI, non-operative treatment is usually recommended. © 2014 Elsevier Masson SAS.

Van Beers B.E.,Hopitaux Universitaires Paris Nord Val Of Seine | Pastor C.M.,Hopitaux Universitaires Of Geneva | Hussain H.K.,University of Michigan
Journal of Hepatology | Year: 2012

Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA, Primovist® in Europe and Eovist® in the USA) is a liver-specific magnetic resonance imaging contrast agent that has up to 50% hepatobiliary excretion in the normal liver. After intravenous injection, Gd-EOB-DTPA distributes into the vascular and extravascular spaces during the arterial, portal venous and late dynamic phases, and progressively into the hepatocytes and bile ducts during the hepatobiliary phase. The hepatocyte uptake of Gd-EOB-DTPA mainly occurs via the organic anion transporter polypeptides OATP1B1 and B3 located at the sinusoidal membrane and biliary excretion via the multidrug resistance-associated proteins MRP2 at the canalicular membrane. Because of these characteristics, Gd-EOB-DTPA behaves similarly to non-specific gadolinium chelates during the dynamic phases, and adds substantial information during the hepatobiliary phase, improving the detection and characterization of focal liver lesions and diffuse liver disease. This information is particularly relevant for the detection of metastases, and for the detection and characterization of nodular lesions in liver cirrhosis, including early hepatocellular carcinomas. Finally, GD-EOB-DTPA-enhanced magnetic resonance imaging may provide quantitative assessment regarding liver perfusion and hepatocyte function in diffuse liver diseases. The full potential of GD-EOB-DTPA-enhanced magnetic resonance imaging has to be established further. It is already clear that GD-EOB-DTPA-enhanced magnetic resonance imaging provides anatomic and functional information in the setting of focal and diffuse liver disease that is unattainable with magnetic resonance imaging enhanced with non-specific contrast agents. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Van Delden C.,Hopitaux Universitaires Of Geneva
Current Opinion in Organ Transplantation | Year: 2014

PURPOSE OF REVIEW: The purpose of this study is to provide an overview of bacterial biliary tract infections in liver transplant recipients with a focus on pathogenesis and conservative treatment strategies. RECENT FINDINGS: The development of interventional endoscopic and radiologic interventions has improved the outcome of conservative treatments for bile tract strictures and bilomas. However, recent data show an important rise of infections with multidrug-resistant (MDR) pathogens in liver transplant recipients. SUMMARY: Both recurrent cholangitis and infected bilomas are bacterial biliary tract infections in liver transplant recipients responsible for significant morbidity and graft loss, which require a multidisciplinary approach. Risk factors for biliary tract strictures and bilomas formation have recently been identified. With the improved outcome of a conservative management including prolonged and/or recurrent antibiotic treatments, the risk of selecting resistant pathogens is increased. There is an urgent need to develop new strategies to reduce the risk of secondary infections by MDR isolates in liver transplant recipients. © 2014 Wolters Kluwer Health.

Shah D.,Hopitaux Universitaires Of Geneva
Expert Review of Medical Devices | Year: 2011

The advent of catheter ablation has revolutionized the treatment of supraventricular cardiac arrhythmias, including in the last few years, atrial fibrillation. The discovery of electrically active sleeves of atrial myocardium extending into the pulmonary veins has led to the development of pulmonary vein ostial ablation, with the aim of electrically isolating or 'walling-off the arrhythmogenic tissue. Despite different innovations, the most commonly used technique is the composite multiple-point ablation lesion created with a fundamentally simple radiofrequency energy-delivering ablation catheter. The high recurrence rate and low efficacy of current ablation procedures may be traced in large part to the inherent variability in individual lesion size with this technology. Arguably, real-time lesion monitoring, optimization and prediction are necessary to achieve significant improvements in efficacy and safety for catheter ablation of atrial fibrillation.

Charnay Y.,Hopitaux Universitaires Of Geneva | Leger L.,University of Lyon
Dialogues in Clinical Neuroscience | Year: 2010

Brain serotonergic circuitries interact with other neurotransmitter systems on a multitude of different molecular levels. In humans, as in other mammalian species, serotonin (5-HT) plays a modulatory role in almost every physiological function. Furthermore, serotonergic dysfunction is thought to be implicated in several psychiatric and neurodegenerative disorders. We describe the neuroanatomy and neurochemistry of brain serotonergic circuitries. The contribution of emergent in vivo imaging methods to the regional localization of binding site receptors and certain aspects of their functional connectivity in correlation to behavior is also discussed. 5-HT cell bodies, mainly localized in the raphe nuclei, send axons to almost every brain region. It is argued that the specificity of the local chemocommunication between 5-HT and other neuronal elements mainly depends on mechanisms regulating the extracellular concentration of 5-HT, the diversity of high-affinity membrane receptors, and their specific transduction modalities. © 2010 LLS SAS.

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