Revue medicale suisse最新文献

The use of patellofemoral prostheses remains controversial, primarily due to the high failure rates of the first-generation implants. Latest-generation implants appear to be more promising, depending on the indication, implant design, and surgical techniques used. Robotic-assisted surgery offers new perspectives and enables promising outcomes while preserving bone stock, particularly in younger patients. The indication must integrate clinical and radiological criteria. Complications are mainly early, with residual anterior knee pain and maltracking. Later, the progression of femorotibial osteoarthritis predominates, while implant loosening and wear remain rare. Long-term studies are necessary to validate these results.

Soft tissue sarcomas are rare malignant tumors of mesenchymal origin, accounting for approximately 1 % of adult cancers. Their diagnostic and therapeutic complexity requires multidisciplinary management at specialized reference centers. Diagnosis relies on imaging, primarily MRI, as well as on anatomopathological and molecular analysis of a planned biopsy. Surgery with negative margins (R0) remains the standard treatment, often combined with neoadjuvant radiotherapy or chemotherapy, depending on the lesion's type, grade, and resectability. Systematic discussion within a multidisciplinary sarcoma tumor board optimizes the therapeutic strategy, reduces diagnostic errors, and improves both overall and functional patient outcomes.

Lyme carditis can occur a few weeks/months after the onset of Lyme disease and usually triggers an atrioventricular conduction block of variable degree. We report a 39-year-old man who presented with symptomatic complete atrioventricular block secondary to Lyme carditis. We decided to implant a traditional single chamber pacemaker using an unusual approach: the battery was fixed directly onto the skin. The patient was discharged with ceftriaxone IV during 2 weeks, clinical follow up and pacemaker interrogations twice a week. The complete heart block resolved after 2 weeks. After a normal 3 days ECG and exercise test, the pacemaker was removed without any complications after a total of 3 weeks.

Obesity, which is rapidly increasing worldwide, is a key factor in osteoarthritis due to mechanical overload of weight-bearing joints and systemic inflammation driven by pro-inflammatory mediators secreted by adipose tissue. This association has led to an increase in total hip and knee arthroplasties. Surgery significantly improves pain and function, but obese patients face higher risks of postoperative complications, especially in those with severe obesity, and often have poorer functional outcomes. Although preoperative weight loss is recommended, it is not consistently linked to reduced complications. A multidisciplinary approach focusing on nutritional status, weight stabilization, and rehabilitation is essential to optimize patient care.

Hepatic biliary cysts (HBCs) are benign cystic formations of the liver, often discovered incidentally on imaging. They are mainly classified as simple hepatic cysts (KHBS) and complex hepatic cysts (KHBC). Asymptomatic in the majority of cases, they become symptomatic when adjacent structures are compressed or when there is a complication with the cyst itself. Diagnosis is based on ultrasound, supplemented by CT scan and/or MRI to confirm the nature of the cyst and its relationship with surrounding organs. Asymptomatic forms do not require follow-up. In the case of complicated symptoms and/or cysts, multidisciplinary management is essential.