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Plouin-Gaudon I.,Center Hospitalier Of Valence | Bossard D.,Hopital Prive Jean Mermoz | Fuchsmann C.,University of Lyon | Ayari-Khalfallah S.,University of Lyon | Froehlich P.,University of Lyon
International Journal of Pediatric Otorhinolaryngology | Year: 2010

Objective: To compare the efficiency of diffusion-weighted MR imaging (MRI) vs. high resolution CT in predicting recurrent or residual cholesteatoma in children who underwent prior middle ear surgery. Design: Prospective study. Setting: Tertiary care university hospital. Patients: Seventeen patients (4 with 2 recurrences) aged 5-17 years (mean 11.4) previously surgically treated for a cholesteatoma of the middle ear, were included for follow-up with systematic CT scan and MRI, between 2005 and 2007. Methodology: CT scan was performed on a Siemens Somaton 64 (0.5/0.2 mm slices reformatted in 0.5/0.3 mm images), parallel and perpendicular to the lateral semi-circular canal for each ear (100 mm × 100 mm FOV). MRI was undertaken on a Siemens Avanto 1.5 T unit, with an adapted protocol for young children. Diagnosis of recurrent cholesteatoma was based on the evidence of a hyperintense image at B1000 on diffusion-weighted images. Results of CT scan and MRI were compared with operative diagnosis. Results: Nine patients had a positive MRI, among which 8 had cholesteatoma confirmed during revision surgery. In the 12 negative MRI cases, 5 were positive on revision surgery. None of these lesions was over 3 mm. Two of them were diagnosed on the CT scan. CT scan alone had a positive predictive value of 75%, and a negative predictive value of 58%. Conclusion: Diffusion-weighted MRI is associated with a high positive predictive value for the detection of recurrent cholesteatoma. CT scan remains the first choice imaging technique. In case of doubtful CT scan, diffusion-weighted MRI could confirm a recurrence or, when negative, avoid second-look surgery. © 2009 Elsevier Ireland Ltd. All rights reserved.

Plouin-Gaudon I.,Center Hospitalier Of Valence | Bossard D.,Hopital Prive Jean Mermoz | Ayari-Khalfallah S.,Hopital Femme Mere Enfant | Froehlich P.,Hopital Femme Mere Enfant
Archives of Otolaryngology - Head and Neck Surgery | Year: 2010

Objective: To evaluate the efficiency of diffusion-weighted magnetic resonance imaging (MRI) and highresolution computed tomographic (CT) scan coregistration in predicting and adequately locating primary or recurrent cholesteatoma in children. Design: Prospective study. Setting: Tertiary care university hospital. Patients: Ten patients aged 2 to 17 years (mean age, 8.5 years) with cholesteatoma of the middle ear, some of which were previously treated, were included for follow-up with systematic CT scanning and MRI between 2007 and 2008. Interventions: Computed tomographic scanning was performed on a Siemens Somaton 128 (0.5/0.2-mm slices reformatted in 0.5/0.3-mm images). Fine cuts were obtained parallel and perpendicular to the lateral semicircular canal in each ear (100x100-mm field of view). Magnetic resonance imaging was undertaken on a Siemens Avanto 1.5T unit, with a protocol adapted for young children. Diffusion-weighted imaging was acquired using a single-shot turbo spin-echo mode. To allow for diagnosis and localization of the cholesteatoma, CT and diffusion-weighted MRIs were fused for each case. Results: In 10 children, fusion technique allowed for correct diagnosis and precise localization (hypotympanum, epitympanum, mastoid recess, and attical space) as confirmed by subsequent standard surgery (positive predictive value, 100%). In 3 cases, the surgical approach was adequately determined from the fusion results. Lesion sizes on the CT-MRI fusion corresponded with perioperative findings. Conclusions: Recent developments in imaging techniques have made diffusion-weighted MRI more effective for detecting recurrent cholesteatoma. The major drawback of this technique, however, has been its poor anatomical and spatial discrimination. Fusion imaging using high-resolution CT and diffusion-weighted MRI appears to be a promising technique for both the diagnosis and precise localization of cholesteatomas. It provides useful information for surgical planning and, furthermore, is easy to use in pediatric cases. ©2010 American Medical Association. All rights reserved.

Chaby G.,University of Amiens | Senet P.,Paris West University Nanterre La Defense | Ganry O.,University of Amiens | Caudron A.,University of Amiens | And 7 more authors.
British Journal of Dermatology | Year: 2013

Background Some prognostic markers of venous leg ulcer (VLU) healing have been evaluated, mostly in retrospective studies. Objectives To identify which clinical characteristics, among those known as possible prognostic factors of VLU healing, and which VLU-associated sociodemographic and psychological factors, are associated with complete healing at week 24 (W24). Methods A prospective, multicentre, cohort study was conducted in 22 French dermatology departments between September 2003 and December 2007. The end point was comparison between healed and nonhealed VLUs at W24, for patient clinical and biological characteristics; psychological, cognitive and social assessments; affected leg inclusion characteristics; venous insufficiency treatment and percentage of initial wound area reduction during follow-up. Results In total, 104 VLUs in 104 patients were included; 94 were analysed. The mean VLU area and duration were 36·8 ± 55·5 cm2 and 24·8 ± 45·7 months, respectively. At W24, 41/94 VLUs were healed. Univariate analysis significantly associated complete healing with superficial venous surgery (P = 0·001), adherence to compression therapy at W4 (P = 0·03) and W24 (P = 0·01), ankle-joint ankylosis (P = 0·01) and mean percentage of VLU area reduction at W4 (P = 0·04). Multivariate analysis retained superficial venous surgery during follow-up [odds ratio (OR) 8·4, 95% confidence interval (CI) 1·9-48·2] and percentage reduction of the VLU area at W4 (OR 1·6, 95% CI 1·0-2·14) as being independently associated with healing. Conclusions These results indicate that complete healing of long-standing, large VLUs is independently associated with ablation of the incompetent superficial vein and percentage of wound area reduction after the first 4 weeks of treatment. What's already known about this topic? Despite advances in venous leg ulcer (VLU) management, the time to ulcer healing generally remains long. Some prognostic markers of healing have been evaluated, mostly in retrospective studies. What does this study add? In this prospective, multicentre, cohort study, complete healing of long-standing, large VLUs at 6 months was independently associated with ablation of the incompetent superficial vein and percentage of wound area reduction after the first 4 weeks of treatment. © 2013 British Association of Dermatologists.

Ouzzane A.,University of Lille Nord de France | Coloby P.,Center Hospitalier Rene Dubos | Mignard J.-P.,Service durologie | Allegre J.-P.,Center Hospitalier Of Valence | And 4 more authors.
Progres en Urologie | Year: 2011

Objectives: The aim of these recommendations is to help urologists to optimize prostate biopsy practice in order to improve diagnosis yield and to minimize associated morbidity. Methods: Online systematic literature search was performed on PubMed® until April2010. Regulation texts, published guidelines and results of recent urologists practice study, were taken into consideration. Level of evidence was assigned to each recommendation. Results: Patient information must be prior to the procedure and should be given through a medical exam by the physician performing the biopsies. The check for complication risk factors (allergic, infectious, hemorrhagic) had to be done preoperatively by the physician during the medical exam. The use of single systemic antibiotics is recommended and Quinolones are the drugs of choice (level of evidence 2). Biopsies should be performed on outpatient basis to assess the safety of the procedure. Transrectal route and ultrasound guidance are state-of-the-art. Local anaesthesia with peri-prostatic block is recommended (level of evidence 1). On baseline biopsies, extended 12-cores scheme should be performed. Urine retention and severe postbiopsies infections have been reported in less than 1% of cases. Optimal management of severe post-biopsies infections is based first on patient information and require hospital intravenous antibiotic therapy. Conclusion: To improve the sensitivity and to reduce the risk of complication, achievement of prostate biopsies should follow a standardized procedure. © 2010 Elsevier Masson SAS.

Recurrent fever of unknown origin is probably the most difficult to diagnose subtype of fever of unknown origin. It represents between 18 and 42% of the cases in large series of patients with fever of unknown origin. The limited literature data do not allow one to construct a diagnostic algorithm. However, the diagnostic strategy is different from classic fever of unknown origin. The spectrum of causative disorders is different from continuous fever with less infections and tumors. Among systemic inflammatory diseases, adult-onset Still's disease is the most common cause. More than 50% of the cases remain unexplained. Hereditary recurrent fevers, the prototype of autoinflammatory diseases, are now more easily discuss in a young adult. © 2014 Société nationale française de médecine interne (SNFMI).

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