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.
The Official Positions of the International Society for Clinical Densitometry: Acquisition of Dual-Energy X-Ray Absorptiometry Body Composition and Considerations Regarding Analysis and Repeatability of Measures
Hangartner T.N.,Wright State University |
Warner S.,Perceptive Informatics |
Braillon P.,HOpital Femme Mere Enfant |
Jankowski L.,Illinois Bone and Joint Institute LLC |
Shepherd J.,University of California at San Francisco
Journal of Clinical Densitometry | Year: 2013
In preparation for the International Society for Clinical Densitometry Position Development Conference of 2013 in Tampa, Florida, Task Force 2 was created as 1 of 3 task forces in the area of body composition assessment by dual-energy X-ray absorptiometry (DXA). The assignment was to review the literature, summarize the relevant findings, and formulate positions covering (1) accuracy and precision assessment, (2) acquisition of DXA body composition measures in patients, and (3) considerations regarding analysis and repeatability of measures. There were 6 primary questions proposed to the task force by the International Society for Clinical Densitometry board and expert panel. Based on a series of systematic reviews, 14 new positions were developed, which are intended to augment and define good clinical practice in quantitative assessment of body composition by DXA. © 2013 The International Society for Clinical Densitometry.
Guerin J.-F.,Hopital Femme Mere Enfant
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2011
The development of egg banks is subject to the mastery of oocyte freezing. The technique known as "slow freezing", which worked well with the embryos in the mid-1980s, is not very efficient when it comes to eggs. However, the vitrification technique, whose principle has long been known but which really developed only in recent years, gives excellent results when applied to the oocytes. Very recent data confirm the superiority of vitrification over slow freezing, and show that pregnancy rates after ICSI are as good as when using "fresh" oocytes. The new bioethics law of July 7, 2011 finally allowed the vitrification of oocytes in France, and thus allows to consider the establishment of oocyte banks, which will benefit to the "egg donation" activity: relief of the procedure, with no more need of synchronization "donor-recipient", better guarantees of confidentiality and anonymity, easier collaboration with centers unauthorized for the practice of gamete donation. However, one should consider the potential abuses with changing demands "for convenience": inevitable societal change or circumvention of requests that should be reserved for medical indications?
Marec-Berard P.,IHOP |
Chotel F.,Hopital Femme Mere Enfant |
Claude L.,Center Leon Berard
Bulletin du Cancer | Year: 2010
Ewing tumours are characterised as tumours consisting of small, blue, round malignant cells that may exhibit varying degrees of neural differentiation. Most of them arise in bony sites, and they represent the second commonest primary osseous malignancy in and adolescence and young adults. During the past 30 years, chemotherapy has increased survival from less than 5% to 65-70% in localized tumours and to 25-30% in primary metastatic tumours. Surgery is a major tool, whereas advances in imaging techniques have improved treatment indication and optimization. Radiotherapy remains useful, either alone or in addition to surgery, and new techniques (conformational RT and IMRT) will reduce short-term toxic effects. However, long-term toxic effects are also of major concern. Clinical and biological prognostic factors has been clearly identified and should guide the therapeutic choice for these patients. The metastatic Ewing tumours are of extremely poor prognosis, and impose the development of new therapeutic agents. This article is a review of the data available in 2009 concerning Ewing's sarcoma either as biologic aspects or as therapeutic aspects. ©John Libbey Eurotext.
Harmatz P.R.,Childrens Hospital |
Garcia P.,Hospital Pediatrico Of Coimbra |
Guffon N.,Hopital Femme Mere Enfant |
Randolph L.M.,Childrens Hospital Los Angeles |
And 4 more authors.
Journal of Inherited Metabolic Disease | Year: 2014
Objective: To evaluate the efficacy and safety of two dose levels of galsulfase (Naglazyme®) in infants with MPS VI. Study design: This was a phase 4, multicenter, multinational, open-label, two-dose level study. Subjects were randomized 1:1 to receive weekly infusions of 1.0 or 2.0 mg/kg of galsulfase for a minimum of 52 weeks. Progression of skeletal dysplasia was determined by monitoring physical appearance, radiographic changes, and growth. Urinary glycosaminoglycan (GAG) levels, gross and fine motor function, cardiac function, vision, hearing, and health resource utilization were evaluated. Safety assessments were performed. Results: Four infants (aged 3.3-12.7 months) participated in the study. Galsulfase was well tolerated at 1.0 and 2.0 mg/kg/week dose levels with no drug-related serious adverse events. Two subjects experienced a total of four possible treatment-related adverse events which were all considered mild. Length and weight remained within age-expected norms. Skeletal abnormalities continued to progress in all subjects. High baseline urinary GAG levels (mean: 870 μg/mg creatinine) decreased by approximately 70 %; these reduced levels were maintained (mean: 220 μg/mg creatinine at week 52) despite the development of anti-galsulfase antibodies. Hearing, cardiac function, hepatosplenomegaly, and facial dysmorphism stabilized or improved, but corneal clouding progressed. There was no clear difference in safety or efficacy between the two doses. Conclusions: Galsulfase at two dose levels was safe and well tolerated in infants. Normal growth was maintained but skeletal abnormalities continued to progress. Urinary GAG levels decreased with treatment. Early initiation of galsulfase may prevent or slow progression of some disease manifestations. © 2013 The Author(s).
Borget I.,CNRS Gustave Roussy Institute |
Abramowitz L.,Bichat University Hospital |
Mathevet P.,Hopital Femme Mere Enfant
Vaccine | Year: 2011
Human papillomavirus (HPV) infection is associated with a range of diseases and cancers at different anatomical sites. In addition to its role as a necessary cause of cervical cancer, HPV is also associated with cancers of the vulva, vagina, anus, penis, head and neck. With the exception of cervical cancer, however, very few data are available on the economic burden of HPV-associated cancers. We assessed the annual costs associated with management of HPV-related cancers in France from the healthcare payers' perspective. We used data from studies that employed similar methodologies to estimate the costs during 2006 for cervical cancer, vulvar and vaginal cancers, anal cancer, and penile cancer, and during 2007 for head and neck cancers. Data on hospital-management costs for cancer were derived from the French national hospital database. The costs of outpatient care and daily allowance costs were estimated using data from the French National Institute of Cancer report for 2007. The costs for HPV-related cancers were estimated according to the percentage of each cancer type attributable to HPV infection. The estimated total costs associated with HPV-related cancers in France were €239.7 million. The overall costs in men were €107.2 million, driven mainly by head and neck cancers (€94.6 million). The total costs in women were €132.5 million, due mainly to invasive cervical cancer (€83.9 million). The costs associated with HPV-related cancers are important to consider when evaluating the overall benefits of HPV vaccination in males and females. © 2011 Elsevier Ltd.
Cagneaux M.,Pediatric and Fetal Imaging |
Paoli V.,Pediatric and Fetal Imaging |
Blanchard G.,Hopital Femme Mere Enfant |
Ville D.,Hopital Femme Mere Enfant |
Guibaud L.,Pediatric and Fetal Imaging
Pediatric Radiology | Year: 2013
A case of prenatal diagnosis of Sturge-Weber syndrome associated with polymicrogyria is reported. The diagnosis was based on a unique association with unilateral hemispheric gyriform calcification, focal hemispheric atrophy and white matter changes on prenatal imaging including ultrasound and MRI. Polymicrogyria, which is exceptionally associated with Sturge-Weber syndrome, is suggestive of and reinforces the hypothesis of early impairment of the cerebral microvasculature related to leptomeningeal angioma, which may lead to abnormal cerebral development as early as the second trimester of pregnancy. © 2013 Springer-Verlag Berlin Heidelberg.
Cassart M.,Erasme Hospital |
Avni F.E.,Erasme Hospital |
Guibaud L.,Hopital Femme Mere Enfant |
Molho M.,C.H.I Poissy St Germain en Laye |
And 2 more authors.
European Radiology | Year: 2011
Objective: To assess the potential role of MR imaging in the diagnosis of fetal liver iron overload. Methods: We reviewed seven cases of abnormal liver signal in fetuses referred to MR imaging in a context of suspected congenital infection (n∈=∈2), digestive tract anomalies (n∈=∈3) and hydrops fetalis (n∈=∈2). The average GA of the fetuses was 31 weeks. The antenatal diagnoses were compared with histological data (n∈=∈6) and postnatal work-up (n∈=∈1). Results: Magnetic resonance imaging demonstrated unexpected abnormal fetal liver signal suggestive of iron overload in all cases. The iron overload was confirmed on postnatal biopsy (n∈=∈2) and fetopathology (n∈=∈4). The final diagnosis was hepatic hemosiderosis (haemolytic anaemia (n∈=∈2) and syndromal anomalies (n∈=∈2)) and congenital haemochromatosis (n∈=∈3). In all cases, the liver appeared normal on US. Conclusions: Magnetic resonance is the only imaging technique able to demonstrate liver iron overload in utero. Yet, the study outlines the fundamental role of MR imaging in cases of congenital haemochromatosis. The antenatal diagnosis of such a condition may prompt ante-(in the case of recurrence) or neonatal treatment, which might improve the prognosis. © 2010 European Society of Radiology.
Breton A.L.,Hopital Edouard Herriot |
Lamblin G.,Hopital Femme Mere Enfant |
Pariset C.,University of Lyon |
Jullien D.,Hopital Edouard Herriot |
Jullien D.,University of Lyon
Dermatology | Year: 2014
Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported. © 2014 S. Karger AG, Basel.
Quartier P.,University of Paris Descartes |
Allantaz F.,Baylor Research Institute |
Cimaz R.,Hopital Femme Mere Enfant |
Pillet P.,Hopital Pellegrin Enfants |
And 15 more authors.
Annals of the Rheumatic Diseases | Year: 2011
Objectives: To assess the efficacy of the interleukin 1 receptor antagonist anakinra in systemic-onset juvenile idiopathic arthritis (SJIA). Methods: A multicentre, randomised, double-blind, placebo-controlled trial was conducted. The primary objective was to compare the efficacy of a 1-month treatment with anakinra (2 mg/kg subcutaneous daily, maximum 100 mg) with a placebo between two groups each with 12 patients with SJIA. Response was defined by a 30% improvement of the paediatric American College of Rheumatology criteria for JIA, resolution of systemic symptoms and a decrease of at least 50% of both C-reactive protein and erythrocyte sedimentation rate compared with baseline. After month 1 (M1), patients taking placebo were switched to anakinra. Secondary objectives included tolerance and efficacy assessment for 12 months, and analyses of treatment effect on blood gene expression profiling. Results: At M1, 8/12 responders were receiving anakinra and 1 responder receiving placebo (p=0.003). Ten patients from the placebo group switched to anakinra; nine were responders at M2. Between M1 and M12, six patients stopped treatment owing to an adverse event (n=2), lack of efficacy (n=2) or a disease flare (n=2). Blood gene expression profiling at enrolment and at 6 months' follow-up showed one set of dysregulated genes that reverted to normal values in the clinical responders and a different set, including interferon (IFN)-inducible genes, that was induced by anakinra. Conclusions: Anakinra treatment is effective in SJIA, at least in the short term. It is associated with normalisation of blood gene expression profiles in clinical responders and induces a de novo IFN signature. Trial Registration Number:NCT00339157.