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Flachskampf F.A.,Uppsala University | Wouters P.F.,Ghent University | Edvardsen T.,University of Oslo | Evangelista A.,University of Barcelona | And 5 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2014

With this document, we update the recommendations for transoesophageal echocardiography (TOE) of the European Association of Cardiovascular Imaging. The document focusses on the areas of interventional TOE, in particular transcatheter aortic, mitral, and left atrial appendage interventions, as well as on the role of TOE in infective endocarditis, adult congenital heart disease, and aortic disease. © The Author 2014.


PubMed | Montpellier University, Hopital Timone, University of Nantes, Bordeaux University Hospital Center and 10 more.
Type: | Journal: Multiple sclerosis (Houndmills, Basingstoke, England) | Year: 2016

To evaluate the effectiveness and tolerance of mycophenolate mofetil (MMF) as a first-line treatment in neuromyelitis optica spectrum disorder (NMOSD).In all, 67 NMOSD patients treated by MMF as first-line therapy, from the NOMADMUS cohort were included. A total of 65 fulfilled 2015 NMOSD criteria, and 5 were myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) positive. Effectiveness was evaluated on percentage of patients continuing MMF, percentage of patients free of relapse, pre- and post-treatment change in the annualized relapse rate (ARR), and Expanded Disability Status Scale (EDSS).Among 67 patients, 40 (59.7%) continued treatment till last follow-up. A total of 33 (49.3%) were relapse-free. The median ARR decreased from one pre-treatment to zero post-treatment. Of 53 patients with complete EDSS data, the score improved or stabilized in 44 (83%; p<0.05). Effectiveness was observed in aquaporin-4 (AQP4)-IgG (57.8% continued treatment, 46.7% relapse-free), MOG-IgG (3/5 continued treatment, 4/5 relapse-free), and seronegative NMOSD (64.7% continued treatment, 61.3% relapse-free). In 16 patients with associated steroids, 13 (81.2%) continued MMF till last follow-up versus 15 of 28 (53.6%) in the non-steroid group. Nine patients discontinued treatment for tolerability purpose.MMF showed effectiveness and good tolerability as a first-line therapy in NMOSD, whatever the AQP4-IgG status. Concomitant use of oral steroids at start could limit the risk of treatment failure.


Costa J.-M.,Laboratoire Cerba | David M.,HCL Inc | Bouvattier-Morel C.,Center Hospitalier Of Bicetre | Baumann C.,Unite de Genetique Clinique C.B. | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Prenatal dexamethasone (DEX) treatment has been proposed since 1984 to prevent genital virilization in girls with congenital adrenal hyperplasia (CAH). DEX is effective in CAH females if initiated before the sixth week of gestation, but its safety in children treated in utero remains controversial regarding cognitive functions. Objective: To avoid prenatal DEX in males and initiate DEX in due time in CAH females, we proposed in 2002 a protocol for fetal sex determination in the maternal serum (SRY test). Design and Setting:Weconducted a retrospective study of themanagementof 258 fetuses in the period 2002 through 2011 in pregnancies managed in referent medical centers with an institutional practice. Patients: A total of 258 fetuses at risk of CAH (134 males and 124 females) were included. Intervention: DEX was offered after informed consent to pregnant women. Main Outcome Measure: The sensitivity of an early SRY test was evaluated after data collection. Results: The SRY test is sensitive from 4 weeks and 5 days of gestation. It avoided prenatal DEX in 68% of males, and this percentage increased over the years. DEX was maintained until prenatal diagnosis in non-CAH females. Virilization was prevented in 12 CAH girls treated at the latest at 6 weeks gestation and minimized in 3 girls treated between 6 and 7 weeks gestation. Maternal tolerance was correct. No fetal malformations were noted in the 154 children treated in utero. Conclusions: The SRY test is reliable to avoid prenatal DEX in males, but its application must be improved. Prenatal DEX should be maintained to prevent virilization and traumatic surgery in CAH girls after informed consent and information provided to families about the benefit to risk ratio in limiting hyperandrogenism during fetal life. Our large multicentric French cohort has helped to better assess the risks previously reported. Copyright © 2014 by the Endocrine Society.


Wazaefi Y.,Aix - Marseille University | Gaudy-Marqueste C.,Hopital Timone | Avril M.-F.,University of Paris Descartes | Malvehy J.,Hospital Clinic of Barcelona | And 8 more authors.
Journal of Investigative Dermatology | Year: 2013

Although nevi are highly polymorphous, it has been suggested that each individual is characterized by only a few dominant patterns of nevi. Therefore, a nevus that does not fit in with these patterns, the "ugly duckling" nevus, is suspicious. Our objective was to study the intra-individual diversity of nevi, using human ability to build "perceived similarity clusters" (PSCs). Nine dermatologists had to cluster all the nevi of 80 patients into PSCs, at the clinical scale (CS) and at the dermoscopic scale (DS) (subset of 30 patients). Nine novices did the same in a subset of 11 patients. The experts identified a mean of 2.8 PSCs/patient at CS. Concordance was higher between experts than between novices at CS and at DS. Despite a trend for more PSCs at DS than at CS, the number of nevus patterns per patient remained low, regardless of the number of nevi. Inter-expert concordance permits a consensus representation of nevus diversity in each individual. Nevus diversity is limited in each patient and constitutes an individual reference system, which we can intuitively perceive. This reference is probably crucial for nevus analysis and melanoma detection and opens perspectives for computer-aided diagnostics. © 2013 The Society for Investigative Dermatology.


Girard N.,Hopital Timone | Girard N.,Jean Moulin University Lyon 3 | Raybaud C.,University of Toronto
Magnetic Resonance Imaging Clinics of North America | Year: 2011

The immature brain is more prone to seize than the mature brain. Causes of seizure are multiple and affect different neuroimaging modalities. The most common associated diseases are hypoxia-ischemia, intracranial hemorrhage and cerebral infarction, central nervous system infections, and acute metabolic disturbances. Ultrasound (US) is not specific. Computed tomography (CT) carries the risk of irradiation and is not as productive as magnetic resonance (MR) imaging. MR imaging is the modality of choice; it is difficult to perform in a neonate, but it is more sensitive and versatile than US or CT, and is now widely used in specialized centers. © 2011.


Girard N.J.,Hopital Timone | Girard N.J.,French National Center for Scientific Research | Chaumoitre K.,Aix - Marseille University
Journal of Magnetic Resonance Imaging | Year: 2012

This work reviews magnetic resonance imaging in the developing human brain. It focuses on fetal brain imaged in vivo and in utero with complementary sections on abnormalities seen in clinical settings, and on potential of diffusion tensor imaging and of proton magnetic resonance spectroscopy. The main purposes are to illustrate the normal fetal developing brain and its abnormalities commonly encountered in utero, and to emphasize the potential role of adjunct techniques such as diffusion imaging and spectroscopy that may help elucidate fetal brain maturation and its abnormalities. © 2012 Wiley Periodicals, Inc.


Bittar F.,Aix - Marseille University | Cassagne C.,Aix - Marseille University | Bosdure E.,Hopital Timone | Stremler N.,Hopital Timone | And 5 more authors.
Emerging Infectious Diseases | Year: 2010

An increasing body of evidence indicates that nondiphtheria corynebacteria may be responsible for respiratory tract infections. We report an outbreak of Corynebacterium pseudodiphtheriticum infection in children with cystic fibrosis (CF). To identify 18 C. pseudodiphtheriticum strains isolated from 13 French children with CF, we used molecular methods (partial rpoB gene sequencing) and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry. Clinical symptoms were exhibited by 10 children (76.9%), including cough, rhinitis, and lung exacerbations. The results of MALDI-TOF identification matched perfectly with those obtained from molecular identification. Retrospective analysis of sputum specimens by using specific real-time PCR showed that ≈20% of children with CF were colonized with these bacteria, whereas children who did not have CF had negative test results. Our study reemphasizes the conclusion that correctly identifying bacteria at the species level facilitates detection of an outbreak of new or emerging infections in humans.


Vidal V.,Hopital Timone | Monnet O.,Hopital Timone | Jacquier A.,Hopital Timone | Bartoli J.-M.,Hopital Timone | Tropiano P.,Hopital Timone
Journal of Spinal Disorders and Techniques | Year: 2010

Background: One of the main difficulties in using an anterior retroperitoneal approach in prosthetic lumbar disk replacement surgery is the exposure of the anterior aspect of the spine because of the risk of hemorrhage because of vascular injury when the venous structures are mobilized. Purpose: The goal of our study was to use computed tomography (CT) to research for anatomic variations of the ileocaval drainage network, which were likely to complicate this type of procedure. Design: Prospective study. Patient sample: Ninety patients (48 males, 42 females) explored between July 2003 and February 2007. Outcome measures: Not applicable. Methods: All the patients had a CT scan before disk replacement surgery to treat degenerative lumbar disk disease by a microinvasive, anterior retroperitoneal approach. Results: Eighteen of 90 patients presented with variations in their iliocaval drainage network: 3 cases of double inferior vena cava, 1 case of duplication of the inferior vena cava, 5 cases of ectopic internal iliac veins, 9 cases of accessory iliac veins. Conclusions: Anatomical variations in the iliocaval venous drainage system are fairly frequent but easy to analyze by CT. Even if they have no functional impact, they must be analyzed and described because they can be of great interest in the preoperative workup for retroperitoneal lumbar surgery. © 2010 by Lippincott Williams & Wilkins.


PubMed | Hopital Timone
Type: Journal Article | Journal: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie | Year: 2014

Cystic lesions are common findings during prenatal ultrasonography but their prenatal and postnatal prognosis is difficult to establish because of some regress spontaneously. The purpose of this study was to identify putative criteria to predict regression of partially or completely cystic lesions detected by prenatal ultrasound.Prenatal ultrasound features of thoracic or abdominal cystic lesions were retrospectively analyzed. Ovarian and urological lesions were not included in this study.A total of 57 cystic lesions were studied. Of the 57 lesion, 36 lesions including 10 abdominal (43.5%) and 26 thoracic (76.5%) lesions required surgical resection. Of the 57 lesions, 10 persistent lesions after birth were only monitored. Eleven lesions including eight abdominal (34.7%) and three thoracic (8.8%) lesions regressed prenatally (p=0.02). Regressing abdominal lesions consistently presented as solitary lesions with a homogenous aspect. Only one abdominal lesion showed a multilobulated aspect. Two regressing thoracic lesions were purely cystic and one lesion presented a heterogeneous aspect.Regression of cystic lesions detected by prenatal ultrasound scan was more likely for lesions in abdominal (mainly adrenal or splenic lesions) than thoracic locations. The likelihood of regression was highest for purely cystic abdominal lesions.


PubMed | Hopital Timone
Type: Journal Article | Journal: Journal of magnetic resonance imaging : JMRI | Year: 2012

This work reviews magnetic resonance imaging in the developing human brain. It focuses on fetal brain imaged in vivo and in utero with complementary sections on abnormalities seen in clinical settings, and on potential of diffusion tensor imaging and of proton magnetic resonance spectroscopy. The main purposes are to illustrate the normal fetal developing brain and its abnormalities commonly encountered in utero, and to emphasize the potential role of adjunct techniques such as diffusion imaging and spectroscopy that may help elucidate fetal brain maturation and its abnormalities.

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