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.
Sudour H.,Center Oscar Lambret |
Audry G.,Hopital dEnfants Armand Trousseau |
Schleimacher G.,University Pierre and Marie Curie |
Patte C.,Institute Gustave Roussy |
And 2 more authors.
Pediatric Blood and Cancer | Year: 2012
Background: The treatment of bilateral Wilms tumors (WT) requires multimodality therapy with individualized decision to ensure cure while preserving as much renal parenchyma as possible. Procedure: We analyzed the clinical records of 49 children with bilateral WT treated in France between 1993 and 2001, according to the SIOP-93 guidelines (individual treatment program: Treatment was continued as long as there was imaging evidence of tumor regression). Pathology reports, duration of preoperative chemotherapy and surgical records were also reviewed. Overall Survival (OS) and Event-Free Survival (EFS) rates were studied and relationships between possible prognostic factors and survival were assessed. Results: Imaging studies revealed bilateral involvement in 98% of the cases. Whatever the response to preoperative chemotherapy, the mean duration of neoadjuvant chemotherapy was 80 days (Q1-Q3: 47-89 days). Forty-eight children underwent nephron sparing surgery (NSS) at least for one kidney and 19 for both. Five-year EFS and OS rates were, respectively, 83.4 and 89.5%. Only the most advanced stages were shown to affect OS (P=0.03). At study endpoint, end-stage renal disease (ESRD) was reported in seven children, associated with a predisposing phenotype in three. Conclusions: Results of this study demonstrate a favorable outcome of patients with bilateral WT receiving an individual treatment program. With a tailored approach to treatment according to the tumor response, 77% of our patients were operated before the third month of preoperative chemotherapy. In spite of good survival, 14% of our patients have ESRD. © 2012 Wiley Periodicals, Inc.
PubMed | Hopital dEnfants Armand Trousseau, Service de Neurologie pediatrique, University of Geneva, Pediatric Neurology and Geneva Childrens Hospital
Type: Case Reports | Journal: Neuropediatrics | Year: 2016
Severe fetal ventriculomegaly is generally associated with poor prognosis in terms of survival and neurodevelopment outcome. As such, many parents opt to terminate the pregnancy independently of a known etiology. We report here the case of a female fetus with severe progressive ventriculomegaly due to the unexpected presence of bilateral nodular periventricular heterotopias visualized on MRI of a fetal brain. Reaching a structural diagnosis was perceived as a relief for the parents and the pregnancy was continued. Neurodevelopment assessment at 3 years of age is normal with no epilepsy.
Guillemette-Artur P.,Center Hospitalier Of Polynesie Francaise |
Besnard M.,Center Hospitalier Of Polynesie Francaise |
Eyrolle-Guignot D.,Center Hospitalier Of Polynesie Francaise |
Jouannic J.-M.,University Pierre and Marie Curie |
Garel C.,Hopital d'Enfants Armand Trousseau
Pediatric Radiology | Year: 2016
Background: An outbreak of Zika virus was observed in French Polynesia in 2013–2014. Maternal Zika virus infection has been associated with fetal microcephaly and severe cerebral damage. Objective: To analyze the MRI cerebral findings in fetuses with intrauterine Zika virus infection. Materials and methods: We retrospectively analyzed prospectively collected data. Inclusion criteria comprised cases with (1) estimated conception date between June 2013 and May 2014, (2) available US and MRI scans revealing severe fetal brain lesions and (3) positive polymerase chain reaction for Zika virus in the amniotic fluid. We recorded pregnancy history of Zika virus infection and analyzed US and MRI scans. Results: Three out of 12 cases of severe cerebral lesions fulfilled all inclusion criteria. History of maternal Zika virus infection had been documented in two cases. Calcifications and ventriculomegaly were present at US in all cases. MRI showed micrencephaly (n = 3), low cerebellar biometry (n = 2), occipital subependymal pseudocysts (n = 2), polymicrogyria with laminar necrosis and opercular dysplasia (n = 3), absent (n = 1) or hypoplastic (n = 1) corpus callosum and hypoplastic brainstem (n = 1). Conclusion: Severe cerebral damage was observed in our series, with indirect findings suggesting that the germinal matrix is the principal target for Zika virus. The lesions are very similar to severe forms of congenital cytomegalovirus and lymphocytic choriomeningitis virus infections. © 2016, Springer-Verlag Berlin Heidelberg.
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.
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.
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.
Garel C.,Hopital dEnfants Armand Trousseau |
Fallet-Bianco C.,Service de Neuropathologie |
Guibaud L.,Imagerie Pediatrique et Foetale
Journal of Child Neurology | Year: 2011
The cerebellum undergoes a protracted development, making it particularly vulnerable to a broad spectrum of developmental events. Acquired destructive and hemorrhagic insults may also occur. The main steps of cerebellar development are reviewed. The normal imaging patterns of the cerebellum in prenatal ultrasound and magnetic resonance imaging (MRI) are described with emphasis on the limitations of these modalities. Because of confusion in the literature regarding the terminology used for cerebellar malformations, some terms (agenesis, hypoplasia, dysplasia, and atrophy) are clarified. Three main pathologic settings are considered and the main diagnoses that can be suggested are described: retrocerebellar fluid enlargement with normal or abnormal biometry (Dandy-Walker malformation, Blake pouch cyst, vermian agenesis), partially or globally decreased cerebellar biometry (cerebellar hypoplasia, agenesis, rhombencephalosynapsis, ischemic and/or hemorrhagic damage), partially or globally abnormal cerebellar echogenicity (ischemic and/or hemorrhagic damage, cerebellar dysplasia, capillary telangiectasia). The appropriate timing for performing MRI is also discussed. © SAGE Publications 2011.
Blondiaux E.,Hopital dEnfants Armand Trousseau |
Garel C.,Hopital dEnfants Armand Trousseau
Acta Radiologica | Year: 2013
The purpose of this article is to analyze the advantages and limitations of prenatal ultrasonography (US) and magnetic resonance imaging (MRI) in the evaluation of the fetal brain. These imaging modalities should not be seen as competitive but rather as complementary. There are wide variations in the world regarding screening policies, technology, skills, and legislation about termination of pregnancy, and these variations markedly impact on the way of using prenatal imaging. According to the contribution expected from each technique and to local working conditions, one should choose the most appropriate imaging modality on a case-by-case basis. The advantages and limitations of US and MRI in the setting of fetal brain imaging are displayed. Different anatomical regions (midline, ventricles, subependymal area, cerebral parenchyma, pericerebral space, posterior fossa) and pathological conditions are analyzed and illustrated in order to compare the respective contribution of each technique. An accurate prenatal diagnosis of cerebral abnormalities is of utmost importance for prenatal counseling.
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.