Hôpital de la Croix-Rousse

Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure. In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28. A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, -0.05 percentage points; 95% confidence interval [CI], -4.21 to 4.10; P = 0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, -5.93 percentage points; 95% CI, -11.78 to -0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group. Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28. (Funded by the French Ministry of Health and Fisher and Paykel Healthcare; SOHO ClinicalTrials.gov number, NCT04468126.).

Fluoropyrimidines, including 5-fluorouracil (5-FU) and capecitabine, remain foundational in the treatment of various cancers, despite their well-documented risk of cardiotoxicity. This study aimed to characterize cardiovascular events associated with fluoropyrimidine use, evaluate their management, and assess the prognostic impact of fluoropyrimidine reintroduction. We conducted a retrospective cohort study of patients admitted for cardiovascular events between January 2014 and October 2024 at Croix-Rousse and Lyon Sud University Hospitals (Hospices Civils de Lyon, France), who had received fluoropyrimidine-based chemotherapy within the preceding year. Among 141 patients, the most frequent cardiovascular events were coronary artery disease (30.5%), atrial fibrillation (28.4%), and heart failure (19.9%). Post-event, three primary therapeutic strategies were implemented in the follow-up cohort (n = 114): fluoropyrimidine reintroduction (n = 54, 38.3%), switch to alternative chemotherapy (n = 25, 17.7%), and transition to palliative care (n = 36, 25.5%). Recurrent cardiotoxicity after reintroduction occurred in eight patients (14.8%), with only one recurrent coronary event. At 2-year follow-up, overall survival tended to be higher in the reintroduction group compared to the group of patients switching to an alternative chemotherapy (HR = 1.77 [0.92-3.42]; p = 0.088) and to palliative care (HR = 8.31 [4.67-14.79]; p < 0.001). No significant increase in unplanned hospitalizations was observed in the reintroduction group compared to the alternative chemotherapy group (HR = 1.48 [0.83-2.66]; p = 0.185). Our findings suggest that fluoropyrimidine reintroduction-guided by multidisciplinary evaluation, cardiovascular management, and close monitoring-appears to have a favorable benefit/risk balance for selected patients.

We present a case of orbital recurrence of choroidal melanoma 14years post-evisceration. Initially misdiagnosed as trauma-related, the patient's condition progressed, leading to neovascular glaucoma and retinal detachment. Subsequent pain and complications prompted evisceration without a pathological evaluation. Fourteen years later, an orbital mass was identified, leading to an orbital exenteration. This case demonstrates the potential for long-term local-regional recurrence of choroidal melanoma and highlights the importance of thorough examination and pathological evaluation in cases of a painful, sightless eye to prevent delayed diagnoses and improve patient outcomes.

To describe a series of doxycycline-induced fixed drug eruptions (FDE) observed in sexual health clinics, in a context of increasing doxycycline use for sexually transmitted infection (STI) management and prophylaxis in France. We conducted a retrospective case series, combined with a doxycycline prescription audit and a sexual health clinician survey. Thirteen male patients (mean age: 32.5 years) were diagnosed with doxycycline-induced FDE. Most were MSM (men who have sex with men, 84.6%) and received doxycycline for STI treatment (92.3%). Lesions were mainly genital (85%) and often misdiagnosed as ulcerative STIs. Doxycycline prescriptions increased by 345% between 2018 and 2024. When performed, allergy workups confirmed the diagnosis in 60% of cases. The sharp rise in doxycycline use for STI prophylaxis coincides with the identification of multiple FDE cases. Enhanced dermatological awareness is needed within antimicrobial stewardship programs to ensure safer implementation of doxycycline-based prevention strategies.

Postoperative stiffness is a common and incapacitating complication after total knee arthroplasty (TKA), significantly impacting functional outcomes. Open arthrolysis remains a less-studied surgical option. The objective of this study was to assess the use and outcomes of open arthrolysis in post-TKA stiffness management. We hypothesised that open arthrolysis is the least frequently used technique. This was a retrospective multicentre study conducted as part of the 2024 SOFCOT symposium on post-TKA stiffness management, including 13 centres in France. Patients who underwent open arthrolysis for post-TKA stiffness between 2015 and 2019 were included. Demographic, radiographic, and clinical data were collected, and functional outcomes were evaluated using KOOS, Oxford, and JFS-12 scores preoperatively and postoperatively. Range of motion (ROM) was assessed and compared across different treatment modalities. Among 490 patients treated for post-TKA stiffness, 12 (2.4%) underwent open arthrolysis. The mean follow-up duration was sevenyears. Open arthrolysis patients were treated later than those undergoing manipulation under anaesthesia (28.1 vs. 7.2months, p = 0.001) and later than arthroscopic arthrolysis patients without statistical difference (9.9months, p = 0.216). Mean ROM improved by 27° postoperatively but remained lower than in other treatment groups (74° vs. 98°, p = 0.011). More than 90% of open arthrolysis patients reported dissatisfaction, compared to 26% for other techniques (p < 0.001). Open arthrolysis is rarely performed for post-TKA stiffness with higher patient dissatisfaction rates than other treatment modalities. These findings suggest that open arthrolysis may have a limited role in post-TKA stiffness management.