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Abdel M.P.,Mayo Medical School | Oussedik S.,University College London | Parratte S.,Aix - Marseille University | Lustig S.,Lyon University Hospital Center | Haddad F.S.,22 Buckingham Street
Bone and Joint Journal | Year: 2014

Substantial healthcare resources have been devoted to computer navigation and patientspecific instrumentation systems that improve the reproducibility with which neutral mechanical alignment can be achieved following total knee replacement (TKR). This choice of alignment is based on the long-held tenet that the alignment of the limb post-operatively should be within 3° of a neutral mechanical axis. Several recent studies have demonstrated no significant difference in survivorship when comparing well aligned versus malaligned TKRs. Our aim was to review the anatomical alignment of the knee, the historical and contemporary data on a neutral mechanical axis in TKR, and the feasibility of kinematicallyaligned TKRs. Review of the literature suggests that a neutral mechanical axis remains the optimal guide to alignment. © 2014 The British Editorial Society of Bone & Joint Surgery. Source

Hebuterne X.,University of Nice Sophia Antipolis | Lemarie E.,Pneumology | Michallet M.,Lyon University Hospital Center | De Montreuil C.B.,Nantes University Hospital Center | And 2 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2014

Background and Aims: The aim of this study was to evaluate on 1 day the prevalence of malnutrition in different types of cancer and the use of nutrition support in patients with cancer. Methods: A 1-day prevalence survey was carried out in 154 French hospital wards. Malnutrition was defined as a body mass index (BMI) <18.5 in patients <75 years old or <21 in patients ≥75 years old and/or body weight loss >10% since disease onset. Oral food intake was measured using a visual analog scale. Results: Nutrition status was collected for 1903 patients (1109 men and 794 women, 59.3 ± 13.2 years). Cancer was local in 25%, regional in 31%, and metastatic in 44% of patients. Performance status was 0 or 1 in 49.8%, 2 in 23.7%, 3 or 4 in 19.6% and not available in 6.5% of patients. Overall, 39% of patients were malnourished. The prevalence of malnutrition by disease site was as follows: head and neck, 48.9%; leukemia/lymphoma, 34.0%; lung, 45.3%; colon/rectum, 39.3%; esophagus and/or stomach, 60.2%; pancreas, 66.7%; breast, 20.5%; ovaries/uterus, 44.8%; and prostate, 13.9%. Regional cancer (odds ratio, 1.96; 95% confidence interval, 1.42-2.70), metastatic cancer (2.97; 2.14-4.12), previous chemotherapy (1.41; 1.05-1.89), and previous radiotherapy (1.53; 1.21-1.92) were associated with malnutrition. Only 28.4% of non-malnourished patients and 57.6% of malnourished patients received nutrition support. In all, 55% of patients stated that they were eating less than before the cancer, while 41.4% of patients stated that they had received nutrition counseling. Conclusions: The prevalence of malnutrition is high in patients with cancer, and systematic screening for and treatment of malnutrition is necessary. © 2013 American Society for Parenteral and Enteral Nutrition. Source

Mick G.,Lyon University Hospital Center | Hans G.,University of Antwerp
Journal of Clinical Gerontology and Geriatrics | Year: 2013

Herpes zoster (HZ; shingles) is a viral disease characterized by a painful unilateral rash involving one or two adjacent dermatomes. HZ results from reactivation of the varicella zoster virus (VZV) acquired during chickenpox. Following this primary VZV infection, the virus establishes latency in sensory nerve ganglia, until it reactivates decades later. The rash usually heals within 2-4 weeks, but some individuals experience residual neuropathic pain, known as postherpetic neuralgia (PHN), for months or even years, which can seriously impact their quality of life. We reviewed the epidemiological data for PHN in Europe since 2000 after the introduction of antiviral drugs. The overall lifetime risk for HZ was 23-30% and increased to 50% in those >80 years old. Defining PHN as pain persisting 3 months after rash onset, between 10% and 30% of patients with HZ developed PHN; this increased to 60-70% in those age ≥60 years. Some trials have reported that antiviral agents given soon after rash onset may prevent PHN. Vaccination programs with a zoster vaccine have been shown to prevent PHN, particularly in older patients. The various definitions used for PHN in different studies make it difficult to acquire a meaningful measurement of the true burden of PHN. In addition, comparisons between various studies and the prevalence and incidence data from different countries are difficult, because of this heterogeneity. This article provides a balanced overview of the important clinical and epidemiological studies carried out with respect to the definition, prevention, and treatment of this debilitating condition. Copyright © 2013, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan LLC. All rights reserved. Source

Mick G.,Lyon University Hospital Center | Mick G.,Pain Unit | Correa-Illanes G.,Hospital del Trabajador | Correa-Illanes G.,University of Chile
Current Medical Research and Opinion | Year: 2012

Background: The topical 5 lidocaine medicated plaster is recommended as first-line treatment for localized peripheral neuropathic pain. Scope: In order to provide an overview of the efficacy and safety of the lidocaine plaster in the treatment of different neuropathic pain conditions, all efficacy and safety studies (randomized, controlled, or open-label with well described methodology), case reports, and pharmacological studies on the lidocaine plaster retrieved from a PubMed literature research (1960-March 2012) plus additional references identified from retrieved articles were included. Findings: The lidocaine plaster is efficacious in the treatment of neuropathic pain symptoms associated with previous herpes zoster infection. Results from a large open-label controlled study suggest that the lidocaine plaster could be at least as effective as systemic pregabalin in the treatment of postherpetic neuralgia and painful diabetic polyneuropathy. Open-label studies indicate efficacy in the treatment of other localized neuropathic pain conditions, such as painful idiopathic sensory polyneuropathy, complex regional pain syndrome, carpal tunnel syndrome sequelae, postsurgical and posttraumatic pain. Quality of life markedly improved in a variety of neuropathic pain conditions and long-term treatment provided sustained relief in patients with neuropathic pain who are responsive to lidocaine plaster. The lidocaine plaster is usually well tolerated. The risk of systemic adverse events and pharmacokinetic interactions with concomitant medication is minimal owing to low systemic exposure. Conclusions: Treatment of several, primarily neuropathic and mixed-pain conditions with the 5 lidocaine medicated plaster was found efficacious and safe. Further controlled studies, in particular where only small open-label studies or case reports are available, should be considered. © 2012 Informa UK Ltd. All rights reserved. Source

Lustig S.,Lyon University Hospital Center
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Patellofemoral arthroplasty remains controversial, primarily due to the high failure rates reported with early implants. Several case series have been published over the years, which describe the results with various first- and second-generation implants. The purpose of this work was to summarize results published up to now and identify common themes for implants, surgical techniques, and indications. First-generation resurfacing implants had relatively high failure rates in the medium term. Second-generation implants, with femoral cuts based on TKA designs, have yielded more promising medium-term results. The surgical indications are quite specific and must be chosen carefully to minimize poor results. Short-term complications are generally related to patellar maltracking, while long-term complications are generally related to progression of osteoarthritis in the tibiofemoral joint. Implant loosening and polyethylene wear are rare. Overall, recent improvements in implant design and surgical techniques have resulted in better short- and medium-term results. But more work is required to assess the long-term outcomes of modern implant designs. © 2013 Elsevier Masson SAS. Source

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