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Le Touquet – Paris-Plage, France

Cherqaoui B.,French Institute of Health and Medical Research | Rouel N.,French Institute of Health and Medical Research | Auvrignon A.,Hopital dEnfants Armand Trousseau | Defachelles A.-S.,Center Oscar Lambret | And 3 more authors.
Transfusion | Year: 2014

Background Apheresis is a major challenge in peripheral stem cell collection from low-weight children with cancer. Comparisons between the new apheresis device Optia (TerumoBCT) and the earlier COBE Spectra (CaridianBCT) have been performed in adults but not in low-weight children. The objective was to compare the performance of these two devices in small children. Study Design and Methods In this retrospective study, all patients were reviewed weighing less than 15 kg undergoing stem cell collection using the Optia device between April 2011 and April 2012. They were paired on weight in a 3:1 ratio with patients whose cells had been collected with the COBE Spectra since 2006. Results Six patients were treated with the Optia and were matched with 18 patients treated with the Spectra. No side effects occurred. Collection efficiency (CE) was similar between the two groups (50% vs. 47%), but CD34 cell blood clearance was lower with the Optia (0.4 mL/min/kg vs. 0.6 mL/min/kg, p < 0.01). Platelet (PLT) loss and hemoglobin (Hb) loss were significantly reduced with the Optia (respectively, 32% vs. 54%, p < 0.01; and 1.4 g/dL vs. 2.9 g/dL, p < 0.01). Apheresis duration was increased with the Optia (159 min vs. 134 min, p < 0.05). The cell product harvested with the Optia had a lower volume and lower hematocrit, but similar white blood cell and PLT content. Conclusion Compared with the Spectra, the Optia allows similar CE with a reduced PLT and Hb loss but with a longer duration. © 2013 American Association of Blood Banks. Source

Siffroi J.-P.,Hopital dEnfants Armand Trousseau
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2015

By allowing oligozoospermic and even azoospermic men to conceive, ICSI has completely changed the prognosis of male infertility, leading eventually to the paradoxical hereditary transmission of genetic infertility factors. Patients with Klinefelter's syndrome, who were previously considered as sterile and eligible only for gamete donation, can now father by using sperm retrieved after testicular biopsy and ICSI. The high percentage of successful biopsies in these patients suggests a 47,XXY/46,XY mosaicism in many of them, thus explaining why most of their spermatozoa have a chromosomally balanced content. In men carrying a structural chromosome rearrangement like a translocation, it is now feasible to determine which sort of sperm cells have the highest probability to contain a balanced karyotype. Such a selection process is compatible with further assisted reproductive techniques and their use will certainly lead to a significant increase in successful ICSI attempts, with or without PGD, in affected couples. Despite the large number of genes involved in spermatogenesis, determination of the genic causes of male infertility is in progress thanks to the new techniques of genome analysis like array-CGH or NGS. Source

Garel C.,Hopital dEnfants Armand Trousseau | Moutard M.-L.,AP HP
Fetal Diagnosis and Therapy | Year: 2014

The purpose of this article is to discuss some common cerebral lesions that may be detected during prenatal screening: corpus callosum dysgenesis, absent septum pellucidum, localized parenchymal ischemic-hemorrhagic lesions, megacisterna magna, Blake's pouch cyst, posterior fossa arachnoid cyst and Dandy-Walker malformation. For each cerebral defect, the main imaging findings are reminded, certain differential diagnoses are discussed and prenatal diagnostic accuracy is analyzed with emphasis on uncertainties encountered during analysis of ultrasound or magnetic resonance images. Detecting cerebral lesions in fetuses requires rapid counseling by neuropediatricians. Keeping in mind that the prenatal diagnostic accuracy is not 100%, the neuropediatricians have to answer the parents' questions regarding the outcome of the unborn child as well as the risk of recurrence for future pregnancies. This article is based on the authors' large experience in both prenatal imaging and neurocounseling. The frequently asked questions are set up. Answers are provided, underscoring the importance of an appropriate description of the cerebral defect, and therefore the pivotal role of prenatal imaging. However, prenatal neurocounseling remains challenging and the parents must be aware of uncertainties regarding both diagnostic accuracy and prognostic evaluation. © 2014 S. Karger AG, Basel. Source

Cauchemez S.,Institute Pasteur Paris | Besnard M.,French Polynesia Hospital Center | Bompard P.,Bureau de veille sanitaire | Dub T.,Institute Pasteur Paris | And 10 more authors.
The Lancet | Year: 2016

Background The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified. Methods We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk. Findings The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62-70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0-8) per 10000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34-191) per 10000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data. Interpretation Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus. Funding Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS. © 2016 Elsevier Ltd. Source

Garel C.,Hopital dEnfants Armand Trousseau
Pediatric Radiology | Year: 2010

Posterior fossa (PF) malformations are commonly observed during prenatal screening. Their understanding requires knowledge of the main steps of PF development and knowledge of normal patterns in US and MR imaging. The vast majority of PF malformations can be strongly suspected by acquiring a midline sagittal slice and a transverse slice and by systematically scrutinizing the elements of the PF: cerebellar vermis, hemispheres, brainstem, fourth ventricle, PF fluid spaces and tentorium. Analysis of cerebellar echogenicity and biometry is also useful. This review explains how to approach the diagnosis of the main PF malformations by performing these two slices and answering six key questions about the elements of the PF. The main imaging characteristics of PF malformations are also reviewed. © Springer-Verlag 2010. Source

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