Hôpitaux Iris Sud

ABSTRACTPlacental mesenchymal dysplasia (PMD) has to be evoked as a diagnosis when an unusual cystic appearing placenta is noticed on prenatal scans. The pathway to diagnosis is challenging since it includes trophoblastic disease with a concrete neoplastic risk for the mother and PMD with a high rate of associated feto‐maternal complications.

The growing threat of antimicrobial resistance (AMR) is a critical issue for both civilians and the military. With each successive conflict, pathogens become more resistant, making the management of infections in casualties increasingly challenging. To better understand the scope and characteristics of conflict-related AMR, a comprehensive literature search was conducted in the PubMed database in April 2025, using defined search terms related to war casualties and antimicrobial resistance. We screened and included 117 relevant publications, comprising original research articles, reviews, case series, case reports, editorials, and commentaries, published in English or French, with no date restriction. This narrative review synthesizes current evidence on multidrug-resistant bacteria most commonly isolated from war casualties, their associated resistance mechanisms, and the microbiological diagnostic tools available at various levels of the military continuum of care (Roles 1-4). It also presents strategies for preventing cross-contamination and infection in resource-limited combat settings and provides practical, field-adapted recommendations for clinicians, from first responders to specialized care providers, aiming to improve infection management in armed conflict zones and mitigate the spread of AMR.

Abstract Purpose: This study quantifies the reproducibility of soft tissue laxity and gap measurements under manual stress, and implant positioning planning using the imageless ROSA® robotic system, by comparing a senior high-volume surgeon with a low-volume resident. Methods: In this single-center prospective study, 17 patients undergoing robotic-assisted total knee arthroplasty were evaluated. Intra- and inter-operator variability was assessed by recording intraoperative measurements and planning outcomes using a standardized protocol for functional alignment (FA). Results: Good-to-excellent reproducibility in soft tissue and gap assessments is demonstrated by both intra- and inter-operator measurements. Minor differences in planning parameters—including stylus height, femoral implant flexion, and the distal femoral cut—are observed, likely due to subjective high-volume surgeon adjustments. Conclusion: High reproducibility in soft tissue measurements and surgical planning across surgeons with different experience levels is shown by the ROSA® robotic system, while flexibility for individualized surgical strategies is retained.

This study is a comment on the non-effectiveness of fluoroscopy-guided manual lymph drainage using ICG as part of decongestive lymphatic therapy on the superficial lymphatic architecture in patients with breast cancer-related lymphoedema in a randomized controlled trial, and the demonstration of one toxicity of indocyanine green on the lymphatic system [...].

The end of childhood and adolescence are two critical periods. Patients' immaturity in making decisions can lead to irreversible health consequences. The use of social media exposing children to a wide variety of content may result in dangerous behavior. This has been seen with the emergence of many challenges such as the "Eraser Challenge," "Salt Ice Challenge," and "Benadryl Challenge." Here, we describe two cases of dermatologic lesions linked to social media challenges.

A cryptoglandular abscess, which can result in a perianal abscess and fistula, is caused by an anal gland infection. An anal fistula occurs in 40–66% of perianal abscesses. The

Bilateral reversed cortico-medullary differentiation is rarely observed on fetal or neonatal renal ultrasound and is therefore a diagnostic challenge. Our purpose was to widen the differential diagnoses of fetal and neonatal nephropathies introducing reversed cortico-medullary differentiation as a clue either on obstetric US or during follow-up of hyperechoic kidneys in order to improve the management of such rare clinical situations. We retrospectively reviewed the US images of 11 patients showing bilateral reversed cortico-medullary differentiation on prenatal examination or in which this pattern developed postnatally in the follow-up of fetal hyperechoic kidneys. For each patient, a precise diagnosis was established either on clinical assessment or, when available, on histological or genetic findings. Six fetuses displayed bilateral reversed cortico-medullary differentiation on obstetric examination, and the pattern persisted throughout pregnancy. In the five other fetuses, the kidneys appeared initially homogeneously hyperechoic; this evolved into reversed cortico-medullary differentiation during the third trimester in two cases and shortly after birth in three cases. Two pregnancies were terminated because of estimated poor prognosis. In the nine surviving neonates, four died of renal failure in the post-natal period. The clinical evolution was more favorable in the remaining five newborns. Six different diagnoses were established in patients presenting with a reversed cortico-medullary differentiation renal pattern. This finding was associated with poor outcome in six cases. An acute prenatal diagnosis of reversed cortico-medullary differentiation improves pre- and postnatal work-up and guides counseling and genetic testing.

Ribosomal RNA contains many posttranscriptionally modified nucleosides, particularly in the functional parts of the ribosome. The distribution of these modifications varies from one organism to another. In Bacillus subtilis, the model organism for Gram-positive bacteria, mass spectrometry experiments revealed the presence of 7-methylguanosine (m7G) at position 2574 of the 23S rRNA, which lies in the A-site of the peptidyl transferase center of the large ribosomal subunit. Testing several m7G methyltransferase candidates allowed us to identify the RlmQ enzyme, encoded by the ywbD open reading frame, as the MTase responsible for this modification. The enzyme methylates free RNA and not ribosomal 50S or 70S particles, suggesting that modification occurs in the early steps of ribosome biogenesis.

Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed-12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.

Résumé Approximativement 204 000 femmes par an en Europe souffrent d’un syndrome de stress post-traumatique (SSPT) postnatal. Il est estimé que 20 à 48 % des femmes répondent partiellement à des critères de stress posttraumatique à l’issue de leur accouchement. En impactant le noyau familial, cette pathologie représente un enjeu de santé publique périnatal. À ce jour, en Belgique, cette problématique n’est que faiblement documentée dans les recherches et les guidelines. L’objet de cet article est de présenter l’intérêt d’une approche transdisciplinaire dans un itinéraire clinique pour la gestion des SSPT postnatal.