Hôpital Kirchberg

Kirschner wires are still widely used for osteosynthesis in orthopedics and trauma surgery. Breaking of this material and migration into the lung parenchyma is a complication that has been occasionally described. We report a case of a patient who presented at our clinic with left thoracic discomfort and an intermittent non-productive cough. Chest X-ray showed a broken clavicular pin with the distal half inside the left chest. The pin was extracted from the lung parenchyma using a left 3-port video-assisted thoracoscopic approach. A literature review suggests that all intrathoracically migrated material should be removed, because of the risk of further migration and harm to the heart or major broncho-vascular structures. A minimally invasive approach should be considered whenever anatomy, clinical presentation and location of the material allows this.

peer reviewed

IntroductionIncisional hernia (IH) is a prevalent and potentially dangerous complication of abdominal surgery, especially in high-risk groups. Mesh reinforcement of the abdominal wall has been studied as a potential intervention to prevent IHs. Randomised controlled trials (RCTs) have demonstrated that prophylactic mesh reinforcement after abdominal surgery, in general, is effective and safe. In patients with abdominal aortic aneurysm (AAA), prophylactic mesh reinforcement after open repair has not yet been recommended in official guidelines, because of relatively small sample sizes in individual trials. Furthermore, the identification of subgroups that benefit most from prophylactic mesh placement requires larger patient numbers. Our primary aim is to evaluate the efficacy and effectiveness of the use of a prophylactic mesh after open AAA surgery to prevent IH by performing an individual patient data meta-analysis (IPDMA). Secondary aims include the evaluation of postoperative complications, pain and quality of life, and the identification of potential subgroups that benefit most from prophylactic mesh reinforcement.Methods and analysisWe will conduct a systematic review to identify RCTs that study prophylactic mesh placement after open AAA surgery. Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase, Web of Science Core Collection and Google Scholar will be searched from the date of inception onwards. RCTs must directly compare primary sutured closure with mesh closure in adult patients who undergo open AAA surgery. Lead authors of eligible studies will be asked to share individual participant data (IPD). The risk of bias (ROB) for each included study will be assessed using the Cochrane ROB tool. An IPDMA will be performed to evaluate the efficacy, with the IH rate as the primary outcome. Any signs of heterogeneity will be evaluated by Forest plots. Time-to-event analyses are performed using Cox regression analysis to evaluate risk factors.Ethics and disseminationNo new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publications in peer-reviewed journals and summaries posted online.PROSPERO registration numberCRD42022347881.

Thoracic outlet syndrome (TOS) is a rare and heterogeneous syndrome secondary to a compression of the neurovascular bundle in the thoracic outlet area. Muscle hypertrophy is recognized to induce vascular or neurogenic compression, especially in sports involving upper-arm solicitation. Athletes represent a distinctive population because of a specific management due to an ambitious objective, which is returning to high-level competition. We evaluated the scientific literature available for the management of TOS in athletes. Article research extended to March 2021 without other restriction concerning the date of articles publication. The search was performed independently by two assessors. A first preselection based on the article titles was produced, regarding their availability in English or French and a second preselection was produced after reading the abstracts. In case of doubt, a third assessor’s advice was asked. Case reports were selected only if the sport involved was documented, as well as the level of practice. Cohorts were included if data about the number and the sport level of athletes were detailed. Seventy-eight articles were selected including 40 case reports, 10 clinical studies and 28 reviews of literature. Baseball pitchers seem to be highly at risk of developing a TOS. The surgical management appears particularly frequent in this specific population. The prognosis of TOS in athletes seems to be better than in the general population, possibly due to their better physical condition and their younger age. Some studies showed interesting and encouraging results concerning return to previous sport level. Literature shows a strong link between TOS and certain sports. Unfortunately, this syndrome still lacks rigorous diagnostic criteria and management guidelines for athletes.

Puisque la médiation se trouve au cœur de la dynamique adolescente, l’art-thérapie apparaît comme un moyen privilégié de prise en charge de l’adolescent, notamment lors de séances groupales. Des séances de médiation peuvent revêtir la fonction de rites de passage, permettant à la fois le développement social et l’émergence d’une personnalité en train de se construire. Le moratoire identitaire lié à cet âge apparaît souvent comme une période dont il est difficile de sortir sans aide, tout comme il est compliqué d’accéder à la réalisation identitaire. Ainsi, alors que la quête identitaire malmène les psychés de ces jeunes, l’art-thérapie se place dans une position étayante dans les changements biologiques, cognitifs et sociaux. Le thérapeute se doit de comprendre la souffrance lorsqu’elle s’exprime, en particulier dans les créations artistiques, et de permettre l’établissement d’une bonne alliance thérapeutique, en respectant le code mis en œuvre par l’adolescent. C’est pour cela que l’art-thérapie apporte toute sa contribution, en complément du langage, dans sa dimension communicative, dans son aide à l’élaboration psychique, dans son soutien à l’imagination et à l’autonomie. Elle se présente également comme lien entre le monde interne et la réalité extérieure, et offre la possibilité de permettre une écriture de soi, une trace dans le groupe de soin, mais aussi une trace de son passage de l’enfance à l’âge adulte.