Saint-Martin-de-Ré, France
Saint-Martin-de-Ré, France

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Rade F.,Trousseau Hospital | Bretagnol F.,Foch Hospital | Auguste M.,Trousseau Hospital | Di Guisto C.,Trousseau Hospital | And 2 more authors.
British Journal of Surgery | Year: 2014

Background: Laparoscopic peritoneal lavage has been proposed for generalized peritonitis from perforated diverticulitis to avoid a stoma. Reports of its feasibility and safety are promising. This study aimed to establish determinants of failure to enable improved selection of patients for this approach.Methods: The study included all patients with perforated sigmoid diverticulitis who underwent emergency laparoscopic peritoneal lavage from January 2000 to December 2013. Factors predicting failure of laparoscopic treatment were analysed from data collected retrospectively.Results: For patients undergoing emergency sigmoid resection (72 of 361), mortality and morbidity rates were 13 and 35 per cent respectively. In all, 71 patients had laparoscopic lavage, with mortality and morbidity rates of 6 and 28 per cent respectively. Reintervention was necessary in 11 patients (15 per cent) for unresolved sepsis. Age 80 years or more, American Society of Anesthesiologists grade III or above, and immunosuppression were associated with reintervention.Conclusion: Elderly patients and those with immunosuppression or severe systemic co-morbidity are at risk of reintervention after laparoscopic lavage. © 2014 Crown copyright.


Griffin S.J.,Necker Hospital for Sick Children | Margaryan M.,University of Lorraine | Archambaud F.,University Hospital of Bicetre | Sergent-Alaoui A.,Trousseau Hospital | Lottmann H.B.,Necker Hospital for Sick Children
Journal of Urology | Year: 2010

Purpose: This retrospective study was designed to assess the impact of shock wave lithotripsy on the pediatric kidney using pretreatment and posttreatment 99mtechnetium dimercapto-succinic acid renal scintigram. Materials and Methods: A total of 182 patients 5 months to 19.8 years old (mean 5.3 years) were treated for renal calculi with shock wave lithotripsy during a 20-year period. Pretreatment evaluation included clinical assessment, urine culture, renal ultrasound and plain abdominal radiograph with or without excretory urogram. Dimercapto-succinic acid scintigram was performed before and 6 months after completion of treatment in 94 patients (52%). Results: Patients underwent 1 to 4 sessions of shock wave lithotripsy per kidney with at least 1 month between treatments. Median number of shocks delivered per session was 3,000 (IQR 2,601 to 3,005). No new scars were observed on any posttreatment dimercapto-succinic acid scan. Regarding renal function, patients fell into 1 of 4 groups. Group 1 (66 patients, 70%) had normal function on dimercapto-succinic acid scan before and after treatment, group 2 (18, 19%) had decreased function in the affected kidney on pretreatment scan with no change after treatment, group 3 (2, 2%) had impaired function in the treated kidney that was transient (1) or permanent (1) and group 4 (7, 7%) had improved function in the treated kidney. Conclusions: Shock wave lithotripsy is an effective treatment for renal calculi in children. Renal parenchymal trauma associated with extracorporeal shock wave lithotripsy does not seem to cause long-term alterations in renal function or development of permanent renal scars in children. © 2010 American Urological Association Education and Research, Inc.


Dorval E.,Trousseau Hospital | Rey J.-F.,Institute Arnault Tzanck | Soufflet C.,Astrazeneca | Halling K.,Astrazeneca | Barthelemy P.,Astrazeneca
BMC Gastroenterology | Year: 2011

Background: Physicians may be unaware of the severity and extent of gastroesophageal reflux disease (GERD) in their patients. The aim of this study was to evaluate patient-physician agreement concerning proton pump inhibitor (PPI) treatment.Methods: 1818 French primary-care physicians and 5174 adult patients with GERD who were taking PPIs answered questions regarding symptoms and treatment satisfaction. Patient-physician agreement was scored using the Kappa (κ) method.Results: There was moderate patient-physician agreement for PPI treatment satisfaction (κ = 0.60), PPI prescription adherence (κ = 0.57) and use of over-the-counter gastrointestinal medications (κ = 0.44-0.51). Patient satisfaction with PPI therapy and PPI treatment adherence rates were both ~90%. There was poor patient-physician agreement concerning PPI therapy expectations (κ = 0.22-0.33). Residual reflux symptoms occurred in 61% of patients. Physicians underestimated residual symptom severity compared with their patients (κ = 0.43-0.47), though there was good agreement regarding the presence (κ = 0.62-0.78) and frequency (κ = 0.61-0.66) of these symptoms and their effect on patients' daily life (κ = 0.64).Conclusions: Patient-physician agreement regarding PPI therapy for GERD was moderate or good for the presence of residual symptoms and moderate for treatment satisfaction, but poor for treatment expectations. PPI treatment resulted in high satisfaction rates, but residual symptoms were fairly common and their severity was underestimated by physicians. © 2011 Dorval et al; licensee BioMed Central Ltd.


Leroy F.,French Institute of Health and Medical Research | Cai Q.,East China Normal University | Bogart S.L.,Yerkes National Primate Research Center | Dubois J.,French Institute of Health and Medical Research | And 17 more authors.
Proceedings of the National Academy of Sciences of the United States of America | Year: 2015

Identifying potentially unique features of the human cerebral cortex is a first step to understanding how evolution has shaped the brain in our species. By analyzing MR images obtained from 177 humans and 73 chimpanzees, we observed a human-specific asymmetry in the superior temporal sulcus at the heart of the communication regions and which we have named the "superior temporal asymmetrical pit" (STAP). This 45-mm-long segment ventral to Heschl's gyrus is deeper in the right hemisphere than in the left in 95% of typical human subjects, from infanthood till adulthood, and is present, irrespective of handedness, language lateralization, and sex although it is greater in males than in females. The STAP also is seen in several groups of atypical subjects including persons with situs inversus, autistic spectrum disorder, Turner syndrome, and corpus callosum agenesis. It is explained in part by the larger number of sulcal interruptions in the left than in the right hemisphere. Its early presence in the infants of this study as well as in fetuses and premature infants suggests a strong genetic influence. Because this asymmetry is barely visible in chimpanzees, we recommend the STAP region during midgestation as an important phenotype to investigate asymmetrical variations of gene expression among the primate lineage. This genetic target may provide important insights regarding the evolution of the crucial cognitive abilities sustained by this sulcus in our species, namely communication and social cognition.


Cassuto N.G.,Art Unit | Hazout A.,Art Unit | Bouret D.,Art Unit | Balet R.,Bleuets Hospital | And 3 more authors.
Reproductive BioMedicine Online | Year: 2014

Consistent evidence from meta-analysis has linked assisted conception by IVF, and particularly intracytoplasmic sperm injection (ICSI), with an increased risk of major birth defects. To compare the risk of major malformations of children born after standard ICSI and after intracytoplasmic injection of morphologically selected spermatozoa (IMSI), a prospective population-based study was conducted from 2005 to 2010. ICSI and IMSI were performed in only one assisted reproduction unit according to its classification of spermatozoa and using fresh semen. Medical data and follow up during 2 years of 1028 infants were collected. Major malformations were identified and classified by an external independent physician. The two groups were similar concerning the parents' age, treatment, number of oocytes recovered, days of transfer, gestational age and birthweight. However, major malformations were significantly lower with IMSI (6/450, 1.33%) versus ICSI (22/578, 3.80%; adjusted odds ratio 0.35, 95% confidence interval 0.14-0.87, P = 0.014), mainly affecting boys (adjusted odds ratio 2.84, 95% confidence interval 1.24-6.53, P = 0.009). In conclusion, the significantly decreased risk of major birth defects associated with IMSI remained decreased after multivariate adjustment and highlights the beneficial effect of sperm selection before ICSI. The aim of this study was to compare the birth defects in children born after intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected sperm injection (IMSI). We conducted a prospective population-based study from 2005 to 2010. Medical data and follow up at 2 years of age for 1028 infants were collected. We show that the major malformations were significantly lower in the IMSI group versus the ICSI group, and they mainly affected the boys. We found less abnormality when abnormal spermatozoa, according to the Cassuto Barak classification, were deselected at high magnification and not injected. In conclusion, the significantly decreased risk of major birth defects associated with IMSI remained decreased after multivariate adjustment and highlights the beneficial effect of spermatozoon selection before ICSI.


Melki I.,Necker Hospital | Lambot K.,Necker Hospital | Jonard L.,Trousseau Hospital | Couloigner V.,Necker Hospital | And 11 more authors.
Pediatrics | Year: 2013

Germline mutations in the SLC29A3 gene result in a range of recessive, clinically related syndromes: H syndrome, pigmented hypertrichosis with insulin-dependent diabetes mellitus syndrome, Faisalabad histiocytosis, and sinus histiocytosis with massive lymphadenopathy. The main symptoms of these diseases are hyperpigmentation with hypertrichosis, sensorineural deafness, diabetes, short stature, uveitis, and Rosai-Dorfman like histiocytosis. Here, we report the case of an 11-month-old boy with early-onset, recurrent episodes of unprovoked fever lasting 7 to 10 days and associated with pericardial effusion, abdominal pain, diarrhea, and inflammation. Physical examination revealed hyperpigmentation with hypertrichosis, dysmorphic features, and spleen and liver enlargement. Failure to thrive, sensorineural deafness, retarded psychomotor development, and a Rosai-Dorfman like cheek lesion developed subsequently. The febrile episodes did not respond to tumor necrosis factor a antagonists and interleukin-1. Sequencing of the SLC29A3 gene revealed a homozygous missense mutation c.1088G>A (p.Arg363Gln). These observations suggest that a newly identified mutation in the SLC29A3 gene may be associated with an autoinflammatory disorder. Genetic defects in SLC29A3 should be considered in patients with autoinflammatory manifestations, recurrent febrile attacks, and 1 or more of the symptoms found in the broad spectrum of SLC29A3-related disorders (especially hyperpigmentation with hypertrichosis). Copyright © 2013 by the American Academy of Pediatrics.


Leroy S.,University of Oxford | Leroy S.,Trousseau Hospital | Vantalon S.,University of Western Brittany | Larakeb A.,Trousseau Hospital | And 2 more authors.
Radiology | Year: 2010

Purpose: To directly compare various renal ultrasonography(US) criteria for vesicoureteral reflux(VUR) with voiding cystography, the reference method, for diagnostic accuracy in helping to determine an intermediate strategy of screening children who require cystography. Materials and Methods: Institutional review board approval and parental consent were obtained for this prospective hospital-based cohort study involving children with urinary tract infections (UTIs). Renal length, ureteral dilatation, pelvic dilatation, and corticomedullary differentiation were analyzed and compared. One hundred seventeen patients(median age, 0.8 year; age range, 0.0-13.9 years) were included:46 (39%) boys(median age, 0.3 year; age range, 0.5-13.9 years) and 71 girls(median age, 1.2 years; age range, 0.0-11.5 years). A two-level logistic regression model was used to analyze data, and diagnostic accuracy calculations were performed. Results:Thirty-two(27%) children had all-grade VUR, and eight (7%) had VUR of grade 3 or higher. Only ureteral dilatation was significantly related to all-grade VUR(odds ratio [OR], 7.5; 95% confidence interval [CI]:1.0, 58.2; P = .05), with 25% sensitivity(95% CI:15%, 39%) and 88% specificity(95% CI:83%, 92%). Ureteral, pelvic, and urinary tract dilatations were significantly associated with VUR of grade 3 or higher, with ORs of 20.2(95% CI: 3.5, 118.2; P =.001), 13.7(95% CI:4.1, 46.0; P <.001), and 20.0(95% CI:4.4, 90.1; P <.001), respectively. The best compromise between sensitivity and specificity was achieved by using the ureteral dilatation criterion, which had 73% sensitivity(95% CI:43%, 90%) and 88% specificity (95% CI:84%, 92%) for high-grade VUR. Conclusion:Ureteral dilatation may yield the best accuracy for the US-based diagnosis of both all-grade and high-grade VUR. This US criterion, perhaps in combination with other predictors, might find a place in an evidence-based selective strategy for limiting cystography in children with UTIs. © RSNA, 2010.


Lorette G.,University of Tours | Lorette G.,Trousseau Hospital | Machet M.-C.,University of Tours | Maruani A.,University of Tours
European Journal of Pediatrics | Year: 2013

A 4-year-old boy presented a translucent cyst on the left lateral side of the urethral meatus. The lesion was excised. Histological examination showed features of a cystic lesion within the dermis surrounded by a thin epithelium of columnar cells with a round apical pole. Immunohistochemical staining was positive for pan-cytokeratins (AE-1/AE-3) and negative for actin. These findings led to a diagnosis of urethral parameatal cyst. In conclusion: this entity is a rare congenital malformation and consists of a parameatal benign cyst occurring in prepubertal males. Treatment consists of complete resection of the cyst. © 2013 Springer-Verlag Berlin Heidelberg.


Barnerias C.,Necker Hospital | Saudubray J.-M.,Necker Hospital | Touati G.,Necker Hospital | De Lonlay P.,Necker Hospital | And 5 more authors.
Developmental Medicine and Child Neurology | Year: 2010

Aim: To describe the phenotype and genotype of pyruvate dehydrogenase complex (PDHc) deficiency. Method: Twenty-two participants with enzymologically and genetically confirmed PDHc deficiency were analysed for clinical and imaging features over a 15-year period. Results: Four groups were identified: (1) those with neonatal encephalopathy with lactic acidosis (one male, four females; diagnosis at birth); (2) those with non-progressive infantile encephalopathy (three males, three females; age at diagnosis 2-9mo); (3) those with Leigh syndrome (eight males; age at diagnosis 1-13mo); and (4) those with relapsing ataxia (three males; 18-30mo). Seventeen mutations involved PDHA1 (a hotspot was identified in exons 6, 7, and 8 in seven males with Leigh syndrome or recurrent ataxia). Mutations in the PDHX gene (five cases) were correlated with non-progressive encephalopathy and long-term survival in four cases. Interpretation: Two types of neurological involvement were identified. Abnormal prenatal brain development resulted in severe non-progressive encephalopathy with callosal agenesis, gyration anomalies, microcephaly with intrauterine growth retardation, or dysmorphia in both males and females (12 cases). Acute energy failure in infant life produced basal ganglia lesions with paroxysmal dystonia, neuropathic ataxia due to axonal transport dysfunction, or epilepsy only in males (11 cases). The ketogenic diet improved only paroxysmal dysfunction, providing an additional argument in favour of paroxysmal energy failure. © The Authors. Journal compilation © Mac Keith Press 2009.


Roman S.,Aix - Marseille University | Denoyelle F.,Trousseau Hospital | Farinetti A.,Aix - Marseille University | Garabedian E.-N.,Trousseau Hospital | Triglia J.-M.,Aix - Marseille University
International Journal of Pediatric Otorhinolaryngology | Year: 2012

Purpose: Active middle ear implant can be used in children and adolescents with congenital hearing loss. The authors report their experience with the semi implantable Medel Vibrant Soundbridge® (VSB) in the audiologic rehabilitation of such patients. Methods: In this retrospective study, audiological and surgical data of 10 children (10.5 ± 4 years) implanted with 12 VSB in 2 tertiary cares ENT Departments were analysed. Results: Two children with bilateral external auditory canal (EAC) atresia and mixed hearing loss (mean air conduction (AC) thresholds = 65. dB HL) were bilaterally implanted. Eight children presented with microtia associated with EAC atresia bilaterally (n= 3) and unilaterally (n= 5). All of them had a conductive hearing loss in the implanted ear (mean (AC) thresholds were 58.75. dB HL preoperatively). The Floating Mass Transducer was crimped on the long process of the incus (n= 8) or on the suprastructure of the stapes (n= 4). There were no intra- or postoperative surgical complications. All the children wore their implants after 5 weeks. Postoperative mean bone conduction (BC) thresholds were unchanged. The mean aided thresholds with VSB (four frequencies warble tones at 0.5, 1, 2 and 4. kHz) were 28. dB HL (±10). Word discrimination threshold in quiet conditions in free field with the VSB unilaterally activated was 50% at 38. dB SPL (±9). Conclusion: The results indicate that satisfaction of the children and their parents is very encouraging but surgeons should be cautious with this new approach in relation to the pinna reconstruction and to possible risks to inner ear and facial nerve. © 2012 Elsevier Ireland Ltd.

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