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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.

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.

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 5 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.

Lecompte J.-F.,Hopital Timone | Hery G.,Hopital Timone | Guys J.-M.,Hopital Timone | De Lagausie P.,Hopital Timone
European Journal of Pediatric Surgery | Year: 2014

Abstract Purpose 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. Methods Prenatal ultrasound features of thoracic or abdominal cystic lesions were retrospectively analyzed. Ovarian and urological lesions were not included in this study. Results 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. Conclusion 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. © 2014 Georg Thieme Verlag KG.

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