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Abdallah W, Spaggiari E, Brisset S, Dard R, Attié Bitach T, Bault JP, Quibel T. Prenatal Diagnosis of Primrose Syndrome. J Ultrasound Med 2024; 43:411-414. [PMID: 37929614 DOI: 10.1002/jum.16354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
Primrose syndrome is a very rare congenital malformation. Symptoms of this disorder may appear during childhood, but the diagnosis is identified in adulthood in the majority of cases. The prenatal diagnosis of Primrose syndrome is not developed in the literature. We present herein a case series of 3 cases with characteristic sonographic features. A dysmorphic metopic suture, downslanting palpebral fissures, a wide forehead, and agenesis of corpus callosum are the main signs. A missense mutation in ZBTB20 identified in whole exome sequencing can confirm the prenatal diagnosis of Primrose syndrome.
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Affiliation(s)
- Wael Abdallah
- Department of Obstetrics and Maternal-Fetal Medicine, CHI Poissy St Germain-en-Laye, Poissy, France
| | - Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - Sophie Brisset
- Service de génétique, Centre hospitalier de Versailles, Paris, France
| | - Rodolphe Dard
- Genetics Department, CHI Poissy St Germain-en-Laye, Poissy, France
| | - Tania Attié Bitach
- Médecine génomique des Maladies rares, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Jean Philippe Bault
- Department of Obstetrics and Maternal-Fetal Medicine, CHI Poissy St Germain-en-Laye, Poissy, France
| | - Thibault Quibel
- Department of Obstetrics and Maternal-Fetal Medicine, CHI Poissy St Germain-en-Laye, Poissy, France
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2
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Gougis P, Grandal B, Jochum F, Bihan K, Coussy F, Barraud S, Asselain B, Dumas E, Sebbag C, Hotton J, Spaggiari E, Pierga JY, Savarino R, Laas E, Spano JP, Reyal F, Hamy AS. Treatments During Pregnancy Targeting ERBB2 and Outcomes of Pregnant Individuals and Newborns. JAMA Netw Open 2023; 6:e2339934. [PMID: 37883083 PMCID: PMC10603505 DOI: 10.1001/jamanetworkopen.2023.39934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
Importance Targeted therapies directed against ERBB2 are the cornerstone of medical treatment for ERBB2-positive breast cancers but are contraindicated during pregnancy. Objectives To describe the association of exposure to anti-ERBB2 agents during pregnancy with pregnancy and fetal or newborn outcomes, and to compare the risk and types of adverse outcomes reported more frequently in this context than after exposure to other anticancer agents. Design, Setting, and Participants For this case-control study, All reports with a pregnancy-related condition and an antineoplastic agent (Anatomical Therapeutic Chemical classification group L01) registered in the World Health Organization international pharmacovigilance database VigiBase up to June 26, 2022, were extracted. All reports with a pregnancy, an antineoplastic treatment during pregnancy, and a cancer were retained. Reports with anticancer agents prescribed for nononcologic purposes were not included. Exposure The exposure group was defined as reports that mention anti-ERBB2 agents compared with exposure to other anticancer agents. Main Outcome and Measures The main outcome was the reporting odds ratio (ROR) for maternofetal complications in the group exposed to anti-ERBB2 agents compared with other anticancer agents, as determined using a disproportionality analysis. Results A total of 3558 reports (anti-ERBB2 agents, 328; other anticancer agents, 3230) were included in the analysis. In the group exposed to anti-ERBB2 agents, most reports were from the US (159 [48.5%]), the mean (SD) age of participants was 30.8 (10.4) years, and 209 patients (97.7%) were treated for breast cancers. The molecules most frequently involved in cases with anti-ERBB2 agents were trastuzumab (n = 302), pertuzumab (n = 55), trastuzumab-emtansine (n = 20), and lapatinib (n = 18). The outcomes overreported in these cases included oligohydramnios (ROR, 17.68 [95% CI, 12.26-25.52]; P < .001), congenital respiratory tract disorders (ROR, 9.98 [95% CI, 2.88-34.67]; P < .001), and neonatal kidney failure (ROR, 9.15 [95% CI, 4.62-18.12]; P < .001). Sensitivity and multivariable analyses found similar results. Toxic effects were also significantly overreported for trastuzumab-emtansine (cardiovascular malformation: ROR, 4.46 [95% CI, 1.02-19.52]) and lapatinib (intrauterine growth restriction: ROR, 7.68 [95% CI, 3.01-19.59]). Conclusions and Relevance In this case-control study of 328 individuals exposed to anti-ERBB2 agents during pregnancy, exposure was associated with a severe specific adverse pregnancy and fetal or newborn outcomes compared with exposure to other anticancer treatments.
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Affiliation(s)
- Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris, France, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Assistance Publique–Hôpitaux de Paris, Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Kevin Bihan
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Assistance Publique–Hôpitaux de Paris, Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Florence Coussy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Solenn Barraud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
| | - Bernard Asselain
- Department of Statistics, Association de Recherche sur les Cancers dont Gynécologiques–Groupe d’Investigateurs National des Etudes des Cancers Ovariens et du sein (ARCAGY-GINECO), Paris, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
| | - Clara Sebbag
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Assistance Publique–Hôpitaux de Paris, Necker Enfants-Malades Hospital, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Raphaëlle Savarino
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Enora Laas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris, France, Assistance Publique–Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale, UMRS 1136, Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Surgical Oncology, Institut Godinot, Reims, France
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
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Stirnemann J, Besson R, Debavelaere V, Loge F, Amabile C, Migeon P, Curran MA, Fries N, Smith E, Ostermayer E, Bradley KE, Armstrong L, Trychon K, Sheehan K, Flinn M, Rodriguez DA, Spiliopoulos M, Romero V, Jones DA, Allbert JR, Ghulmiyyah L, Spaggiari E, Ville Y. Abstracts of the 33rd World Congress on Ultrasound in Obstetrics and Gynecology, 16-19 October 2023, Seoul, South Korea. Ultrasound Obstet Gynecol 2023; 62 Suppl 1:1-316. [PMID: 37779444 DOI: 10.1002/uog.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Affiliation(s)
- J Stirnemann
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | | | | | | | | | | | - M A Curran
- Division of Maternal-Fetal Medicine, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - N Fries
- Collège Français d'Echographie Fetale, Paris, France
| | - E Smith
- BovenMaas, Rotterdam, Netherlands
| | - E Ostermayer
- Pränatalmedizin 5-Seen-Land, Seefeld-Hechendorf, Germany
| | - K E Bradley
- Private Practice, Westlake, Village, CA, USA
| | - L Armstrong
- UNC Southeastern Maternal-Fetal Medicine, Lumberton, NC, USA
| | - K Trychon
- Center for Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Sheehan
- Obstetrics and Gynecology, Private Practice, Ridgewood, NJ, USA
| | - M Flinn
- Diagnostic Center of Arizona, Chandler, AZ, USA
| | | | - M Spiliopoulos
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - V Romero
- Maternal-Fetal Medicine, Corewell Health-West, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - D A Jones
- Perinatal Specialists of the Palm Beaches, West Palm Beach, FL, USA
| | - J R Allbert
- Maternal-Fetal Medicine Associates, Charlotte, NC, USA
| | - L Ghulmiyyah
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - E Spaggiari
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
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4
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Stirnemann JJ, Besson R, Spaggiari E, Rojo S, Loge F, Peyro-Saint-Paul H, Allassonniere S, Le Pennec E, Hutchinson C, Sebire N, Ville Y. Development and clinical validation of real-time artificial intelligence diagnostic companion for fetal ultrasound examination. Ultrasound Obstet Gynecol 2023; 62:353-360. [PMID: 37161503 DOI: 10.1002/uog.26242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Prenatal diagnosis of a rare disease on ultrasound relies on a physician's ability to remember an intractable amount of knowledge. We developed a real-time decision support system (DSS) that suggests, at each step of the examination, the next phenotypic feature to assess, optimizing the diagnostic pathway to the smallest number of possible diagnoses. The objective of this study was to evaluate the performance of this real-time DSS using clinical data. METHODS This validation study was conducted on a database of 549 perinatal phenotypes collected from two referral centers (one in France and one in the UK). Inclusion criteria were: at least one anomaly was visible on fetal ultrasound after 11 weeks' gestation; the anomaly was confirmed postnatally; an associated rare disease was confirmed or ruled out based on postnatal/postmortem investigation, including physical examination, genetic testing and imaging; and, when confirmed, the syndrome was known by the DSS software. The cases were assessed retrospectively by the software, using either the full phenotype as a single input, or a stepwise input of phenotypic features, as prompted by the software, mimicking its use in a real-life clinical setting. Adjudication of discordant cases, in which there was disagreement between the DSS output and the postnatally confirmed ('ascertained') diagnosis, was performed by a panel of external experts. The proportion of ascertained diagnoses within the software's top-10 differential diagnoses output was evaluated, as well as the sensitivity and specificity of the software to select correctly as its best guess a syndromic or isolated condition. RESULTS The dataset covered 110/408 (27%) diagnoses within the software's database, yielding a cumulative prevalence of 83%. For syndromic cases, the ascertained diagnosis was within the top-10 list in 93% and 83% of cases using the full-phenotype and stepwise input, respectively, after adjudication. The full-phenotype and stepwise approaches were associated, respectively, with a specificity of 94% and 96% and a sensitivity of 99% and 84%. The stepwise approach required an average of 13 queries to reach the final set of diagnoses. CONCLUSIONS The DSS showed high performance when applied to real-world data. This validation study suggests that such software can improve perinatal care, efficiently providing complex and otherwise overlooked knowledge to care-providers involved in ultrasound-based prenatal diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
| | | | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
- Department of Histology-Embryology and Cytogenetics, Unit of Embryo and Fetal Pathology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | | | | | | | - S Allassonniere
- School of Medicine, Université de Paris, INRIA EPI HEKA, INSERM UMR 1138, Sorbonne Université, Paris, France
- Center for Applied Mathematics, Ecole Polytechnique, Institut Polytechnique de Paris, Paris, France
| | - E Le Pennec
- Center for Applied Mathematics, Ecole Polytechnique, Institut Polytechnique de Paris, Paris, France
- Xpop, INRIA Saclay Center, Paris, France
| | - C Hutchinson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - N Sebire
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
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Lajmi Y, Loeuillet L, Petrilli G, Egloff C, Nectoux J, Molac C, Roux N, Pannier E, Achaiaa A, Arkoub ZA, Chuon S, Coussement A, Dupont JM, Malan V, Spaggiari E, Razavi F, Amiel J, Bessières B, Grotto S, Attié-Bitach T. Two novel variations p.(Ser1275Thr) and p.(Ser1275Arg) in FLT4 causing prenatal hereditary lymphedema type 1. Birth Defects Res 2023; 115:563-571. [PMID: 36538874 DOI: 10.1002/bdr2.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hereditary lymphedema 1 is a rare congenital condition, characterized by the development of chronic swelling in body parts. It is highly variable in expression and age of onset with different presentations: from feet edema to hydrops fetalis. This affection is genetically heterogeneous with autosomal dominant inheritance and incomplete penetrance due to a mutation in the FLT4 gene in most cases. CASES In our study, we report on two fetuses harboring congenital lymphedema with FLT4 variation and review the prenatal confirmed ones of the literatures. Our cases were selected within fetuses explored by exome sequencing in a diagnosis setting. Prenatal ultrasonography showed hydrops fetalis in one case and an increased nuchal translucency with hydrothorax in the other. Comparative genomic hybridization array on amniocentesis was normal in both cases. Exome sequencing identified a variation p.(Ser1275Thr) and p.(Ser1275Arg) in fetus 1 and fetus 2 in the FLT4 gene, respectively. A de novo mutation at the same codon was reported in prenatal literature suggesting possible genotype phenotype correlation. CONCLUSION Cystic hygroma/hydrops fetalis are possible manifestations of several disorders. This study illustrates how the integration of exome sequencing in prenatal clinical practice can facilitate the diagnosis and genetic counseling of heterogeneous developmental affections.
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Affiliation(s)
- Yosra Lajmi
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Laurence Loeuillet
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Giulia Petrilli
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Charles Egloff
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Juliette Nectoux
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Clémence Molac
- Clinical Genetics, Maternity Port-Royal, APHP Center, University Paris Cité, Paris, France
| | - Nathalie Roux
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Emmanuelle Pannier
- Gynecology-Obstetrics Department, Port-Royal Hospital, APHP Center, University Paris Cité, Paris, France
| | - Amale Achaiaa
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Zaina Ait Arkoub
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Sophie Chuon
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Aurélie Coussement
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Jean Michel Dupont
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Valérie Malan
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Emmanuel Spaggiari
- Gynecology-Obstetrics Department, Necker Hospital for Children Diseases, APHP Center, University Paris Cité, Paris, France
| | - Ferechte Razavi
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Jeanne Amiel
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Bettina Bessières
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Sarah Grotto
- Clinical Genetics, Maternity Port-Royal, APHP Center, University Paris Cité, Paris, France
| | - Tania Attié-Bitach
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
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Vinit N, Bessières B, Spaggiari E, Heidet L, Gubler MC, Dreux S, Attie-Bitach T, Blanc T, Ville Y. Pathological and sonographic review of early isolated severe lower urinary tract obstruction and implications for prenatal treatment. Ultrasound Obstet Gynecol 2022; 59:513-521. [PMID: 34182598 DOI: 10.1002/uog.23718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify favorable renal histology in fetuses with early severe lower urinary tract obstruction (LUTO) and determine the best timing and selection criteria for prenatal surgery. METHODS This multicenter, retrospective study included male fetuses with severe LUTO which died before 24 weeks of gestation during the period January 2000 to December 2018. Age-matched controls were used as reference standard for renal histology. Prenatal ultrasound features and fetal serum and/or urine β2microglobulin level were retrieved and kidney histology slides (hematein-eosin-safran and α-smooth-muscle-actin (αSMA) immunostaining) were prepared and reviewed. αSMA-positive staining of the blastema is due to its aberrant differentiation into myofibroblastic cells. Cases were sorted into histopathologic groups (favorable or unfavorable) according to the blastema's morphology and αSMA labeling and the data of these groups were compared. RESULTS Included in the study were 74 fetuses with a median gestational age at outcome of 17 + 6 (range, 13 + 0 to 23 + 5) weeks. Parenchymal organization was preserved in 48% of the kidneys. A blastema was present in 90% of the kidneys, but it was morphologically normal in only 9% and αSMA-negative in only 1% of them. Most (82%) fetuses had an unfavorable prognosis, and 36% of fetuses died ≤ 18 weeks and had severe renal lesions detected on histology (early unfavorable prognosis). A favorable renal prognosis was associated with an earlier gestational age (P = 0.001). Fetuses with LUTO had a significantly lower number of mature glomeruli (P < 0.001) compared with controls. However, there was no significant difference in the number of glomeruli generations between the early-unfavorable-prognosis group (≤ 18 weeks) and the group with a favorable prognosis (P = 0.19). A comparison of prenatal ultrasound features and biochemical markers between groups could not identify any prenatal selection criteria. CONCLUSIONS Before 18 weeks, around 30% of fetuses with severe LUTO still have potential for kidney development. Identification of these cases would enable them to be targeted for prenatal therapy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
| | - B Bessières
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - E Spaggiari
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, University of Paris, Paris, France
| | - M-C Gubler
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, University of Paris, Paris, France
| | - S Dreux
- Department of Biochemistry-Hormonology, Robert Debré Hospital, APHP, Paris, France
| | - T Attie-Bitach
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1151-CNRS UMR 8253, Paris University, Paris, France
| | - Y Ville
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
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7
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Leruez-Ville M, Guilleminot T, Stirnemann J, Salomon LJ, Spaggiari E, Faure-Bardon V, Magny JF, Ville Y. Quantifying the Burden of Congenital Cytomegalovirus Infection With Long-term Sequelae in Subsequent Pregnancies of Women Seronegative at Their First Pregnancy. Clin Infect Dis 2021; 71:1598-1603. [PMID: 31665306 DOI: 10.1093/cid/ciz1067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In women seronegative before pregnancy, congenital cytomegalovirus (cCMV)-related sequelae are exclusively seen in those infected in the first trimester of pregnancy. Following a maternal primary infection in the first trimester, up to 30% of infected neonates suffer long-term sequelae. Maternal parity is an established risk factor of cCMV in previously seronegative women. Our objective was to quantify, in a population of women seronegative at their first pregnancy, the risk of cCMV and related sequelae following primary infections in the first trimester in subsequent pregnancies. METHODS There were 739 women seronegative at their first pregnancy who had at least 1 of 971 subsequent pregnancies and deliveries managed at our institution. All women had CMV immunoglobin (Ig) G and IgM testing at 11-14 weeks of each pregnancy. RESULTS Between 2 consecutive pregnancies, 15.6% (115/739) of women seroconverted. Of these seroconversions, 29% (33/115) occurred in the periconceptional period or in the first trimester. The risks for cCMV and related sequelae (neurologic and/or hearing loss) following a maternal infection in the first trimester were, respectively, 24- and 6-fold higher (risk ratios, 24 [95% confidence interval {CI}, 10.8-62.3] and 6 [95% CI 1.5-24], respectively) than in the general pregnant population. Of all primary maternal infections and fetal infections in the first trimester, 88% (29/33) and 92% (11/12), respectively, occurred when the inter-pregnancy interval was ≤2 years. CONCLUSIONS Women seronegative at their first pregnancy with a subsequent pregnancy within 2 years have the highest risk of delivering a child with cCMV-related sequelae. These women should be made aware of the risk and given the opportunity of serology screening in the first trimester.
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Affiliation(s)
- Marianne Leruez-Ville
- Paris Descartes University, Paris, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Tiffany Guilleminot
- Paris Descartes University, Paris, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Julien Stirnemann
- Paris Descartes University, Paris, France.,Maternity, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Laurent J Salomon
- Paris Descartes University, Paris, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Emmanuel Spaggiari
- Paris Descartes University, Paris, France.,Maternity, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Valentine Faure-Bardon
- Paris Descartes University, Paris, France.,Maternity, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Jean-Francois Magny
- Paris Descartes University, Paris, France.,Neonatal Intensive Care Unit, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
| | - Yves Ville
- Paris Descartes University, Paris, France.,Maternity, Assistance Publique-Hopitaux de Paris, Hospital Necker, Paris, France
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8
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Macraigne L, Allaf B, Buffat C, Spaggiari E, Dimitrov G, Fabre A, Rosenblatt J, Dreux S. Prenatal biochemical diagnosis of two forms of congenital diarrheal disorders (congenital chloride diarrhea and congenital sodium diarrhea): A series of 12 cases. Prenat Diagn 2021; 41:434-439. [PMID: 33350492 DOI: 10.1002/pd.5878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/02/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Congenital diarrheal disorders (CDDs) are a group of rare diseases among which some present as inherited disorders of intestinal electrolyte transportation: congenital chloride diarrhea (CCD) and congenital sodium diarrhea (CSD) with prenatal manifestations, mainly polyhydramnios, leading to premature delivery. Affected neonates present with watery stools, sometimes mistaken as urine, leading to a misdiagnosis of Bartter syndrome. The aim of this study was to study the value of a prenatal biochemical pattern in the case of suspected CDD. METHODS We retrospectively studied 12 amniotic fluids of CDD-affected fetuses prenatally suspected and confirmed after birth. Digestive enzymes, proteins, and electrolytes were assayed and showed abnormal biochemical patterns. RESULTS The 12 infants (eight CCD- and four CSD-affected) were born prematurely with a normal birth weight. Electrolytes and the Bartter index were normal for all cases. Amniotic fluid enzyme patterns were abnormal: anal leakage for nine, as expected, but vomiting of bile was observed for three infants, for whom an occlusive syndrome required surgery, and thereafter severe complications appeared with a poor prognosis. CONCLUSION Amniotic fluid biochemical patterns differentiate CDD from Bartter syndrome. If a vomiting bile pattern is observed, postnatal management should take into account the hypothesis of a most severe complication.
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Affiliation(s)
- Laure Macraigne
- Unité de Biochimie Prénatale, Laboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France
| | - Bichr Allaf
- Unité de Biochimie Prénatale, Laboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France
| | - Christophe Buffat
- Département de Génétique Médicale, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, AP-HP, Necker Enfants-Malades Hospital, Paris, France
| | | | - Alexandre Fabre
- Pediatric Gastroenterology and Nutrition, Hospital La Timone, AP-HM, Marseille, France
| | - Jonathan Rosenblatt
- Department of Gynecology and Obstetrics, AP-HP, Robert Debré Hospital, University Paris Diderot and Paris Sorbonne-Cité, Paris, France
| | - Sophie Dreux
- Unité de Biochimie Prénatale, Laboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France
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9
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Taconet S, Dreux S, Guimiot F, Pettazzoni M, Allaf B, Spaggiari E, Rosenblatt J, Khung-Savatovsky S. Finding vacuolated lymphocytes in fetal effusions improves the prenatal diagnosis of lysosomal storage diseases. Prenat Diagn 2020; 40:605-611. [PMID: 32003481 DOI: 10.1002/pd.5657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES There are many causes of fetal effusions, including the rare lysosomal storage diseases (LSDs). Vacuolated lymphocytes (VLs) are found in the blood of infants with LSDs, and their presence in fetal effusion could increase the risk of underlying LSD. METHODS Between 2006 and 2018, all fetal effusions samples from 43 fetal multidisciplinary centers were referred to a single laboratory. Cells were counted, and, if observed, VLs were categorized and counted. Screening for LSDs was performed by metabolite analyses on amniotic fluid supernatant. The diagnosis of an LSD was confirmed by measuring the activity of the corresponding enzyme and/or mutation analysis. RESULTS Our laboratory received 614 ascitic fluids and 280 pleural fluids sampled between 22 and 33 weeks of gestation. The final diagnosis was LSD in 16 cases (1.8%). VLs were reported in all these 16 cases, in a mix of lymphocytes with and without vacuoles. Vacuoles in VLs varied in size and number. In most cases, VLs were easy to recognize, with numerous, large, round, well-defined vacuoles, but in three cases of LSDs, VLs were atypical. CONCLUSION The finding of VLs in fetal effusions is an inexpensive first-line test that may help to prioritize biochemical and genetic tests for LSDs.
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Affiliation(s)
- Sarah Taconet
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Simone Veil, Eaubonne, France
| | - Sophie Dreux
- Laboratoire de Biochimie Hormonologie, Hôpital Robert-Debré, APHP, Paris, France
| | - Fabien Guimiot
- Fœtopathologie, Hôpital Robert-Debré Paris, APHP, Paris, France
| | - Magali Pettazzoni
- Service de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Métaboliques, Érythrocytaires et Dépistage Périnatal, Hospices Civils de Lyon, Paris, France
| | - Bichr Allaf
- Laboratoire de Biochimie Hormonologie, Hôpital Robert-Debré, APHP, Paris, France
| | - Emmanuel Spaggiari
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker, APHP, Paris, France
| | - Jonathan Rosenblatt
- Centre Pluridisciplinaire de Diagnostic Prénatal Robert-Debré, APHP, Paris, France
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10
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Gueneuc A, Spaggiari E, Millischer AE, Michot C, O'Gorman N, Ville Y. Contribution of three-dimensional ultrasound and three-dimensional helical computed tomography to prenatal diagnosis of Stickler syndrome. Ultrasound Obstet Gynecol 2019; 54:279-280. [PMID: 30251283 DOI: 10.1002/uog.20127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- A Gueneuc
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - A E Millischer
- Department of Pediatrics Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - C Michot
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Department of Medical Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - N O'Gorman
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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11
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Millischer AE, Sonigo P, Attie T, Spaggiari E, O'Gorman N, Bessieres B, Kermorvant E, Boddaert N, Salomon LJ, Grevent D. Fetal MRI findings in a retrospective cohort of 26 cases of prenatally diagnosed CHARGE syndrome individuals. Prenat Diagn 2019; 39:781-791. [PMID: 30715739 DOI: 10.1002/pd.5429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Abstract
"CHARGE syndrome" (CS) is a multifaceted syndrome associated with a poor prognosis. The prenatal diagnosis remains challenging especially as the fetal anomalies that may evoke suspicion of CS are not comprehensively described. OBJECTIVE This study aims to identify the anomalies in MRI with suspected CHARGE syndrome and to propose a possible standardization in the image-based prenatal diagnosis of CS. METHODS This was a retrospective study of 26 fetuses who underwent MRI and had a confirmed diagnosis of CS, as proven by histopathological and/or neonatal examinations and/or the presence of the CHD7 gene mutation. RESULTS The three most frequent MRI anomalies confirmed at histopathological and/or neonatal examinations were arhinencephaly in 100% (26 of 26), dysplasia of the semicircular canals agenesis (SCA) in 100% (24 of 24), and posterior fossa anomalies in 100% (22 of 22). Our study also revealed short petrous bones with a particular triangular shape in 24 of 24 cases of SCA. Other relevant findings included external ear anomalies in 36% (9 of 25), cleft lip and palate (9 of 9), ventriculomegaly (VMG) (6 of 6), short corpus callosum (3 of 3), and ocular asymmetry in 36.6% (4 of 11). CONCLUSION Our study emphasizes the interest of fetal MRI in the diagnosis of CS with an adapted knowledge of semiology.
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Affiliation(s)
- Anne-Elodie Millischer
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,EA fetus, Necker Hospital, Paris, France
| | - Pascale Sonigo
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Tania Attie
- Service de Génétique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Emmanuel Spaggiari
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Neil O'Gorman
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Bettina Bessieres
- Service d'anatomopathologie, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Elsa Kermorvant
- Service de néonatologie, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Nathalie Boddaert
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Laurent-Julien Salomon
- EA fetus, Necker Hospital, Paris, France.,Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - David Grevent
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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12
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Hureaux M, Molin A, Jay N, Saliou AH, Spaggiari E, Salomon R, Benachi A, Vargas-Poussou R, Heidet L. Prenatal hyperechogenic kidneys in three cases of infantile hypercalcemia associated with SLC34A1 mutations. Pediatr Nephrol 2018; 33:1723-1729. [PMID: 29959532 DOI: 10.1007/s00467-018-3998-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prenatal diagnosis of hyperechogenic kidneys is associated with a wide range of etiologies and prognoses. The recent advances in fetal ultrasound associated with the development of next-generation sequencing for molecular analysis have enlarged the spectrum of etiologies, making antenatal diagnosis a very challenging discipline. Of the various known causes of hyperechogenic fetal kidneys, calcium and phosphate metabolism disorders represent a rare cause. An accurate diagnosis is crucial for providing appropriate genetic counseling and medical follow-up after birth. METHODS We report on three cases of fetal hyperechogenic kidneys corresponding to postnatal diagnosis of nephrocalcinosis. In all cases, antenatal ultrasound showed hyperechogenic kidneys of normal to large size from 22 gestational weeks, with a normal amount of amniotic fluid. Postnatal ultrasound follow-up showed nephrocalcinosis associated with hypercalcemia, hypercalciuria, elevated 1,25(OH)2-vitamin D, and suppressed parathyroid hormone levels. RESULTS Molecular genetic analysis by next-generation sequencing performed after birth in the three newborns revealed biallelic pathogenic variants in the SLC34A1 gene, encoding the sodium/phosphate cotransporter type 2 (Npt2a), confirming the diagnosis of infantile hypercalcemia. CONCLUSIONS Nephrocalcinosis due to infantile hypercalcemia can be a cause of fetal hyperechogenic kidneys, which suggests early antenatal anomaly of calcium and phosphate metabolism. This entity should be considered in differential diagnosis. Postnatal follow-up of infants with hyperechogenic kidneys should include evaluation of calcium and phosphate metabolism.
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Affiliation(s)
- Marguerite Hureaux
- Département de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France
| | - Arnaud Molin
- Service de Génétique, Centre Hospitalier Universitaire de Caen, Caen, France.,Centre de Référence des Maladies rares du Métabolisme du calcium et du phosphate (filière OSCAR), FilièreOSCAR, Paris, France.,Université Caen Normandie, UFR de médecine (Medical School), EA7450 BioTarGen, Caen, France
| | - Nadine Jay
- Centre Hospitalier Universitaire de Brest, Service de Pédiatrie et Génétique Médicale, Brest, France
| | | | - Emmanuel Spaggiari
- Département de Gynécologie-Obstétrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Paris, France
| | - Rémi Salomon
- Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France.,Département de Néphrologie Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Paris, France
| | - Alexandra Benachi
- Département de Gynécologie-Obstétrique, Assistance Publique Hôpitaux de Paris, Hôpital Antoine-Béclère, Université Paris-Sud, Clamart, France
| | - Rosa Vargas-Poussou
- Département de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20-40 rue Leblanc, 75015, Paris, France. .,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France.
| | - Laurence Heidet
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Filière ORKiD, Paris, France.,Département de Néphrologie Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital Necker - Enfants Malades, Paris, France
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13
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Letard P, Schepers D, Albuisson J, Bruneval P, Spaggiari E, Van de Beek G, Khung-Savatovsky S, Belarbi N, Capri Y, Delezoide AL, Loeys B, Guimiot F. Severe Phenotype of Cutis Laxa Type 1B with Antenatal Signs due to a Novel Homozygous Nonsense Mutation in EFEMP2. Mol Syndromol 2018; 9:190-196. [PMID: 30140196 DOI: 10.1159/000489838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 01/18/2023] Open
Abstract
EFEMP2 mutations are known to be responsible for autosomal recessive cutis laxa type 1B (ARCL1B), a rare multisystem disease affecting skin, skeleton, and vascular structures. We report 2 additional related cases of ARCL1B of particular severity leading to termination of pregnancy. Cardinal signs of this connective tissue disease were already seen during the second trimester of pregnancy, then confirmed and clarified at autopsy. Anomalies included cutis laxa, arachnodactyly, clubfoot, wormian bones, moderate bowing of long bones with slender bone trabeculae, rib fractures, undermuscularized diaphragm, hiatal hernia, and arterial tortuosity with thick vascular walls and disorganized elastic fibers. Sequencing of the EFEMP2 gene revealed a novel homozygous nonsense mutation: c.639C>A (p.Cys213*). We performed a thorough histological analysis and discuss differential diagnoses, genotype-phenotype correlations, and the challenge of prenatal diagnosis of this disease.
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Affiliation(s)
| | - Dorien Schepers
- Unités Fonctionnelles de Center for Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | | | - Patrick Bruneval
- Unités Fonctionnelles de Service d'Anatomie et de Cytologie Pathologiques, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Gerarda Van de Beek
- Unités Fonctionnelles de Center for Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | | | - Nadia Belarbi
- Unités Fonctionnelles de Service de Radiologie Pédiatrique, Hôpital Robert Debré
| | - Yline Capri
- Unités Fonctionnelles de Génétique Clinique, Département de Génétique
| | | | - Bart Loeys
- Unités Fonctionnelles de Center for Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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14
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Rosenblatt J, Dreux S, Spaggiari E, Morin C, Allaf B, Valat AS, Halim D, Oury JF, Muller F. Prenatal diagnosis of megacystis microcolon intestinal hypoperistalsis syndrome by biochemical analysis of fetal urine. Prenat Diagn 2018; 38:585-590. [PMID: 29752823 DOI: 10.1002/pd.5283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the study is to determine a model of fetal urine biochemical markers to differentiate megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) from other megacystis. METHOD This is a retrospective study of biochemical analysis of fetal urine in patients who presented prenatally with megacystis. We studied β2-microglobulin, sodium, calcium, and phosphorus. Twenty-six patients subsequently diagnosed with MMIHS were compared with 2 control groups: one of end-stage renal failure (64 fetuses) and the second of "good" postnatal renal function (control group, 64 fetuses). RESULTS Mean fetal urine β2-microglobulin was significantly higher (P < .001) in end-stage renal failure (15.7 mg/L) than in MMIHS (2.2 mg/L) and the control group (3.2 mg/L). Fetal urine profiles differed significantly (P < .001) between MMIHS and the control group: median sodium 46.5 and 51 mmol/L, median calcium 1.12 and 0.73 mmol/L, and median phosphorus 0.03 and 0.15 mmol/L respectively. Fetal urinary ionic index [ratio: calcium / (phosphorus × sodium)] gave an area under the ROC curve of 0.86, at 54% sensitivity and 97% specificity, with correct classification in 84% of cases. We defined a nomogram to obtain a probability for MMIHS. CONCLUSION Fetal urinalysis can be helpful in prenatal differentiation of MMIHS from posterior urethral valves with good postnatal renal function.
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Affiliation(s)
- Jonathan Rosenblatt
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | | | - Cécile Morin
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Bichr Allaf
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Anne Sylvie Valat
- Gynécologie-Obstétrique, Centre Hospitalier Lens, CPDPN, Lille, France
| | - Danny Halim
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jean-François Oury
- Gynecologie-Obstétrique, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Universitaire Robert Debré, APHP, Paris, France
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15
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Spaggiari E, Stirnemann JJ, Benedetti S, Dreux S, Salomon LJ, Blanc T, Rosenblatt J, Favre R, Ville Y, Muller F. Comparison of biochemical analysis of fetal serum and fetal urine in the prediction of postnatal renal outcome in lower urinary tract obstruction. Prenat Diagn 2018; 38:555-560. [PMID: 29644715 DOI: 10.1002/pd.5263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/18/2018] [Accepted: 04/02/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the prognostic value of fetal serum biochemistry and fetal urine biochemistry in predicting renal outcome in lower urinary tract obstruction (LUTO). METHODS We retrospectively studied renal outcome following a prenatal diagnosis of LUTO in cases for which both fetal blood and fetal urine were sampled. We classified the renal outcome as either "favorable," when postnatal renal function was normal, or "adverse," in the case of postnatal chronic renal failure or when renal histological lesions were present at autopsy in the case of termination of pregnancy. A prognostic model was constructed for urine and serum separately. β2-Microglobulin was the only remaining independent predictor in fetal urine. β2-Microglobulin in serum and urine were compared by using receiver operating characteristic curves. RESULTS In the 50 cases included, the rate of adverse outcome was 34 of 50(68%): autopsy confirmed severity of renal disease in all 27 cases who underwent termination of pregnancy, and among the 23 live born children, 7 developed renal failure. Fetal serum and urine markers were all significantly associated with renal outcome (P < .01). The receiver operating characteristic curves for fetal serum and fetal urinary β2-microglobulin were similar (area under the curve = 0.908 versus 0.909, P = .96). CONCLUSION Fetal serum biochemistry and fetal urine biochemistry are of similar prognostic value in predicting postnatal renal outcome in fetuses with LUTO.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julien J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Sara Benedetti
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Sophie Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Jonathan Rosenblatt
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Romain Favre
- Obstetrics and Gynecology Department, Hautepierre and CMCO Hospital, Strasbourg, France
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Françoise Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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Stirnemann J, Djaafri F, Kim A, Mediouni I, Bussieres L, Spaggiari E, Veluppillai C, Lapillonne A, Kermorvant E, Magny JF, Colmant C, Ville Y. Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases. BJOG 2018; 125:1154-1162. [DOI: 10.1111/1471-0528.15147] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J Stirnemann
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
| | - F Djaafri
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - A Kim
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - I Mediouni
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - L Bussieres
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
| | - E Spaggiari
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
| | - C Veluppillai
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - A Lapillonne
- EA7328 and PACT; Université Paris Descartes; Paris France
- Neonatology and Intensive Care Unit; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - E Kermorvant
- EA7328 and PACT; Université Paris Descartes; Paris France
- Neonatology and Intensive Care Unit; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - J-F Magny
- EA7328 and PACT; Université Paris Descartes; Paris France
- Neonatology and Intensive Care Unit; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - C Colmant
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
| | - Y Ville
- Obstetrics and Fetal Medicine; Hôpital Necker Enfants Malades; AP-HP; Paris France
- EA7328 and PACT; Université Paris Descartes; Paris France
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17
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Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Stirnemann JJ, Guimiot F, Heidet L, Favre R, Salomon LJ, Oury JF, Ville Y, Muller F. Sequential fetal serum β2-microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction. Ultrasound Obstet Gynecol 2017; 49:617-622. [PMID: 27197901 DOI: 10.1002/uog.15968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Fetal serum β2-microglobulin has been shown to predict postnatal renal outcome in cases of fetal obstructive uropathy. We assessed the value of serial measurements of fetal serum β2-microglobulin in the prediction of postnatal renal outcome. METHODS We retrospectively studied renal outcome in 42 fetuses with bilateral or low urinary tract obstruction that had fetal blood sampling on at least two occasions to assay serum levels of β2-microglobulin. Amniotic fluid volume at the time of each sampling was recorded. We classified renal outcome as either favorable (when postnatal renal function was normal) or adverse (when postnatal chronic renal failure occurred or when renal dysplasia at autopsy was noted). A β2-microglobulin cut-off of 5 mg/L and amniotic fluid index of 5 cm were used to predict postnatal renal outcome. RESULTS Renal outcome was adverse in 28 cases and favorable in 14. In 12 (28.6%) cases, fetal serum β2-microglobulin concentration differed between the first and last measurement. Prediction of postnatal renal outcome was correct in 11 of these cases based on the last β2-microglobulin measurement. The sensitivity of β2-microglobulin in predicting renal outcome was significantly higher (P = 0.005) when using the last rather than the first measurement (96.4% vs 64.3%), with similar specificity for both measurements (85.7% vs 78.6%, non-significant). The sensitivity of amniotic fluid volume was also significantly higher (P = 0.005) when using the last rather than the first measurement (75.0% vs 35.7%), with similar specificity for both measurements (64.3% vs 71.4%, non-significant). CONCLUSION Sequential measurement of serum β2-microglobulin, performed for adverse ultrasound findings, such as renal parenchymal abnormality or decreasing amniotic fluid volume, predicts postnatal renal outcome more accurately than does a single assay. This may be due to possible worsening of renal injury with increasing duration of urinary tract obstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - G Faure
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - S Dreux
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - I Czerkiewicz
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - J J Stirnemann
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Guimiot
- Department of Developmental Biology, Robert Debré Hospital, AP-HP, Paris, France
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynecology, Hautepierre and CMCO Hospital, Strasbourg, France
| | - L J Salomon
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - J F Oury
- University Paris Diderot and Sorbonne Paris-Cité, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - F Muller
- Department of Biochemistry and Hormonology, Robert Debré Hospital, AP-HP, Paris, France
- University Versailles Saint-Quentin, Versailles, France
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18
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Spaggiari E, Dreux S, Stirnemann JJ, Czerkiewicz I, Houfflin-Debarge V, Segonne A, Jouannic JM, Ville Y, Muller F. Impact on spina bifida screening of shifting prenatal Down syndrome maternal serum screening from the second trimester to the first. Prenat Diagn 2017; 37:673-679. [PMID: 28453864 DOI: 10.1002/pd.5064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Shifting screening for trisomy 21 to the first trimester has resulted in the loss of maternal serum alpha-fetoprotein screening for spina bifida. The aim of this study was to study the impact on open spina bifida prenatal screening. STUDY DESIGN We reviewed prenatally diagnosed cases of spina bifida over three years: 2009 (only second-trimester screening, MSM2T), 2010 (transient period) and 2011 (majority first-trimester screening, MSM1T). Cases were assigned to three groups based on maternal serum markers (MSM2T, MSM1T and 'not performed'). Gestational age at diagnosis of spina bifida was compared between these three groups and between the years 2009 and 2011. RESULTS Median gestational ages at diagnosis of the 742 spina bifida cases between the three groups were 22 weeks [18+6 -23], 22+1 weeks [21+3 -23] and 21+4 weeks [14+1 -23], respectively (P < 0.005). The diagnosis was made at 14-20 weeks in 34.7% for MSM2T group versus 8.5% for MSM1T (P < 0.001). Spina bifida diagnosis at 14-20 weeks declined from 38.8% in 2009 to 13.3% in 2011 (P < 0.001). CONCLUSION Loss of maternal serum alpha-fetoprotein had a tangible effect on the gestational age at diagnosis of spina bifida and resulted in a decrease of 25% of cases of spina bifida detected before 20 weeks. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Sophie Dreux
- Department of Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Julien J Stirnemann
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Isabelle Czerkiewicz
- Department of Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | | | - Alexandra Segonne
- Department of Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
| | - Jean-Marie Jouannic
- Department of Obstetrics and Gynecology, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes and Sorbonne Paris-Cité, Paris, France
| | - Francoise Muller
- Department of Biochemistry-Hormonology, Robert Debré Hospital, AP-HP, Paris, France
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19
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Gueneuc A, Spaggiari E, Bonniere M, Hajal NJ, Ville Y, Salomon LJ. Pitfall in first-trimester diagnosis of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 2017; 49:277-278. [PMID: 27000969 DOI: 10.1002/uog.15922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Affiliation(s)
- A Gueneuc
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
- Service de Gynécologie-Obstétrique et de Médecine de la Reproduction, CHU de Caen-FEH, Université Basse-Normandie, Caen, France
| | - E Spaggiari
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
| | - M Bonniere
- Département d'Histo-Embryologie et de Cytogénétique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - N J Hajal
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
| | - Y Ville
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
| | - L J Salomon
- Service d'Obstétrique et de Médecine Fœtale, Hôpital Necker-Enfants-Malades, APHP, Université Paris Descartes, 149 rue de Sèvres, Sorbonne Paris Cité, Paris, France
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20
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Spaggiari E, Czerkiewicz I, Sault C, Dreux S, Galland A, Salomon LJ, Ville Y, Muller F. Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening. Fetal Diagn Ther 2015; 40:214-218. [PMID: 26656919 DOI: 10.1159/000442198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION First-trimester Down syndrome (DS) screening combining maternal age, serum markers (pregnancy-associated plasma protein-A and beta-human chorionic gonadotropin) and nuchal translucency (NT) gives an 85% detection rate for a 5% false-positive rate. These results largely depend on quality assessment of biochemical markers and of NT. In routine practice, despite an ultrasound quality control organization, NT images can be considered inadequate. The aim of the study was to evaluate the consequences for risk calculation when NT measurement is not taken into account. MATERIAL AND METHOD Comparison of detection and false-positive rates of first-trimester DS screening (PerkinElmer, Turku, Finland), with and without NT, based on a retrospective study of 117,126 patients including 274 trisomy 21-affected fetuses. NT was measured by more than 3,000 certified sonographers. RESULTS There was no significant difference in detection rates between the two strategies including or excluding NT measurement (86.7 vs. 81.8%). However, there was a significant difference in the false-positive rates (2.23 vs. 9.97%, p < 0.001). DISCUSSION Sonographers should be aware that removing NT from combined first-trimester screening would result in a 5-fold increase in false-positive rate to maintain the expected detection rates. This should be an incentive for maintaining quality in NT measurement.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
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21
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Spaggiari E, De Foucher T, Stirnemann JJ, Guennas F, Bounan S, Hatem G. Untreated maternal hyperthyroidism responsible of early neonatal demise. J OBSTET GYNAECOL 2015; 36:66-7. [PMID: 26439901 DOI: 10.3109/01443615.2015.1036408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- E Spaggiari
- a Department of Obstetrics and Maternal-Fetal Medicine , Necker-Enfants Malades Hospital, AP-HP , Paris , France.,b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France.,c University Paris Descartes , Sorbonne Paris-Cité, Paris , France
| | - T De Foucher
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
| | - J J Stirnemann
- a Department of Obstetrics and Maternal-Fetal Medicine , Necker-Enfants Malades Hospital, AP-HP , Paris , France.,c University Paris Descartes , Sorbonne Paris-Cité, Paris , France
| | - F Guennas
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
| | - S Bounan
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
| | - G Hatem
- b Department of Obstetrics and Gynecology , Delafontaine Hospital , Saint-Denis , France
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22
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Wells C, Spaggiari E, Malan V, Stirnemann JJ, Attie-Bitach T, Ville Y, Vekemans M, Bessieres B, Romana S. First fetal case of the 8q24.3 contiguous genes syndrome. Am J Med Genet A 2015; 170A:239-42. [PMID: 26437074 DOI: 10.1002/ajmg.a.37411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 11/08/2022]
Abstract
Molecular cytogenetics, particularly array-CGH, opened the way to the « genotype first approach » and for the discovery of new micro rearrangement syndromes. This was the case for the 8q24.3 microdeletion syndrome. Here, we describe the phenotype of a fetus with a 8q24.3 deletion. This rare condition has to be considered as a contiguous genes syndrome because its phenotype is generated by the SCRIB and PUF60 adjacent gene endophenotypes. The fetus presented atrioventricular septal defect and hypoplastic aortic arch, facial dysmorphism, microretrognathia, dysmorphic ears, clinodactyly of the 5th digit on both hands, mild rocker bottom feet and abnormal third sacral vertebra. This fetus is the first case where the endophenotype produced by SCRIB gene is absent. This case is compared with the previous published cases.
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Affiliation(s)
- Constance Wells
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Emmanuel Spaggiari
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Valérie Malan
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Julien J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Tania Attie-Bitach
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Michel Vekemans
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Bettina Bessieres
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Serge Romana
- Department of Histology-Embryology and Cytogenetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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23
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Spaggiari E, Faure G, Rousseau V, Sonigo P, Millischer-Bellaiche AE, Kermorvant-Duchemin E, Muller F, Czerkiewicz I, Ville Y, Salomon LJ. Performance of prenatal diagnosis in esophageal atresia. Prenat Diagn 2015; 35:888-93. [DOI: 10.1002/pd.4630] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/27/2015] [Accepted: 06/03/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
| | - Giuliana Faure
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
| | - Veronique Rousseau
- Department of Pediatric Surgery; Necker-Enfants Malades Hospital, AP-HP; Paris France
| | - Pascale Sonigo
- Department of Radiology; Necker-Enfants Malades Hospital, AP-HP; Paris France
| | | | - Elsa Kermorvant-Duchemin
- Department of Neonatalogy; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
| | - Francoise Muller
- Department of Biochemistry and Hormonology; AP-HP, Robert Debré Hospital; Paris France
- University Paris Ile de France Ouest; Versailles Saint-Quentin France
| | - Isabelle Czerkiewicz
- Department of Biochemistry and Hormonology; AP-HP, Robert Debré Hospital; Paris France
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
| | - Laurent J. Salomon
- Department of Obstetrics and Maternal-Fetal Medicine; Necker-Enfants Malades Hospital, AP-HP; Paris France
- Paris Descartes University - Sorbonne Paris-Cité; Paris France
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24
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Spaggiari E, Stirnemann JJ, Sonigo P, Khen-Dunlop N, De Saint Blanquat L, Ville Y. Prenatal prediction of pulmonary arterial hypertension in congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2015; 45:572-577. [PMID: 24976012 DOI: 10.1002/uog.13450] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/12/2014] [Accepted: 06/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the role of prenatal prognostic markers obtained routinely by ultrasound examination and magnetic resonance imaging (MRI) in the prediction of development of postnatal pulmonary arterial hypertension (PAH) in isolated congenital diaphragmatic hernia (CDH). METHODS One hundred and ten cases of isolated CDH were referred to our fetal medicine unit between January 2004 and April 2013. Mortality and morbidity rates were reviewed for those presenting with postnatal PAH. The following prenatal markers were evaluated as potential predictive factors of PAH: liver position, side of the CDH defect, lung area to head circumference ratio (LHR) and observed/expected LHR (o/e-LHR), which were measured by ultrasound, and observed/expected total fetal lung volume (o/e-TFLV), which was measured by MRI. Univariable logistic regression was used to assess associations. RESULTS PAH was significantly associated with perinatal mortality and morbidity (P < 0.001). The occurrence of PAH decreased significantly with an increasing LHR, o/e-LHR and o/e-TFLV and was significantly increased for cases with an intrathoracic liver, but not for those with right-sided defects. Univariable regression revealed that o/e-TFLV (odds ratio (OR), 0.9 (95% CI, 0.86-0.95); P < 0.05 for percentage unit change in o/e), LHR (OR, 0.19 (95% CI, 0.09-0.40); P < 0.05 for unit change), o/e-LHR (OR, 0.95 (95% CI, 0.93-0.98); P < 0.05 for percentage unit change in o/e) and liver position (OR, 2.82 (95% CI, 1.13-7.00); P < 0.05 for intrathoracic liver) were significant predictors of subsequent PAH. No differences were found after adjusting for gestational age at delivery. The areas under the receiver-operating characteristics curve were 0.80 and 0.75 for o/e-TFLV and o/e-LHR, respectively. CONCLUSION In cases of CDH, PAH is associated with high rates of mortality and morbidity. Routinely obtained prenatal markers, usually used for the assessment of pulmonary hypoplasia, are also relevant for the postnatal prediction of PAH.
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MESH Headings
- Female
- Gestational Age
- Head
- Hernias, Diaphragmatic, Congenital/diagnosis
- Hernias, Diaphragmatic, Congenital/embryology
- Hernias, Diaphragmatic, Congenital/pathology
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/embryology
- Hypertension, Pulmonary/pathology
- Infant, Newborn
- Liver/embryology
- Liver/pathology
- Lung/embryology
- Lung/pathology
- Lung Volume Measurements/methods
- Predictive Value of Tests
- Pregnancy
- Prognosis
- Survival Rate
- Ultrasonography, Prenatal
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France; University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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25
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Dupont C, Bucourt M, Guimiot F, Kraoua L, Smiljkovski D, Le Tessier D, Lebugle C, Gerard B, Spaggiari E, Bourdoncle P, Tabet AC, Benzacken B, Dupont JM. 3D-FISH analysis reveals chromatid cohesion defect during interphase in Roberts syndrome. Mol Cytogenet 2014; 7:59. [PMID: 25320640 PMCID: PMC4197286 DOI: 10.1186/s13039-014-0059-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/21/2014] [Indexed: 01/12/2023] Open
Abstract
Background Roberts syndrome (RBS) is a rare autosomal recessive disorder mainly characterized by growth retardation, limb defects and craniofacial anomalies. Characteristic cytogenetic findings are “railroad track” appearance of chromatids and premature centromere separation in metaphase spreads. Mutations in the ESCO2 (establishment of cohesion 1 homolog 2) gene located in 8p21.1 have been found in several families. ESCO2, a member of the cohesion establishing complex, has a role in the effective cohesion between sister chromatids. In order to analyze sister chromatids topography during interphase, we performed 3D-FISH using pericentromeric heterochromatin probes of chromosomes 1, 4, 9 and 16, on preserved nuclei from a fetus with RBS carrying compound heterozygous null mutations in the ESCO2 gene. Results Along with the first observation of an abnormal separation between sister chromatids in heterochromatic regions, we observed a statistically significant change in the intranuclear localization of pericentromeric heterochromatin of chromosome 1 in cells of the fetus compared to normal cells, demonstrating for the first time a modification in the spatial arrangement of chromosome domains during interphase. Conclusion We hypothesize that the disorganization of nuclear architecture may result in multiple gene deregulations, either through disruption of DNA cis interaction –such as modification of chromatin loop formation and gene insulation - mediated by cohesin complex, or by relocation of chromosome territories. These changes may modify interactions between the chromatin and the proteins associated with the inner nuclear membrane or the pore complexes. This model offers a link between the molecular defect in cohesion and the complex phenotypic anomalies observed in RBS. Electronic supplementary material The online version of this article (doi:10.1186/s13039-014-0059-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Celine Dupont
- Unité fonctionnelle de Cytogénétique-Département de Génétique- APHP, Hôpital Robert Debré, 48 Bd Sérurier, 75935 Paris, France
| | - Martine Bucourt
- Laboratoire de Fœtopathologie- APHP, Hôpital Jean Verdier, Bondy, France
| | - Fabien Guimiot
- Service de Biologie du Développement- APHP, Hôpital Robert Debré, Paris, France ; Université Paris Diderot Sorbonne Paris Cité, UMR 1141, F-75019 Paris, France
| | - Lilia Kraoua
- Unité fonctionnelle de Génétique moléculaire - Département de Génétique- APHP, Hôpital Robert Debré, Paris, France
| | - Daniel Smiljkovski
- Génomique, Epigénétique et Physiopathologie de la Reproduction, U1016 INSERM-UMR 8104 CNRS (Institut Cochin), Université Paris Descartes, Faculté de Médecine, Paris, France ; Laboratoire de Cytogénétique- APHP, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Dominique Le Tessier
- Laboratoire de Cytogénétique- APHP, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Camille Lebugle
- Institut Cochin, Plateforme d'imagerie cellulaire, Paris, France
| | - Benedicte Gerard
- Unité fonctionnelle de Génétique moléculaire - Département de Génétique- APHP, Hôpital Robert Debré, Paris, France
| | - Emmanuel Spaggiari
- Service de Biologie du Développement- APHP, Hôpital Robert Debré, Paris, France
| | | | - Anne-Claude Tabet
- Unité fonctionnelle de Cytogénétique-Département de Génétique- APHP, Hôpital Robert Debré, 48 Bd Sérurier, 75935 Paris, France
| | - Brigitte Benzacken
- Unité fonctionnelle de Cytogénétique-Département de Génétique- APHP, Hôpital Robert Debré, 48 Bd Sérurier, 75935 Paris, France ; Service d'Histologie, Embryologie et Cytogénétique, Biologie de la Reproduction- APHP, Hôpital Jean Verdier, Bondy, France; UFR-SMBH, Paris, XIII France
| | - Jean-Michel Dupont
- Génomique, Epigénétique et Physiopathologie de la Reproduction, U1016 INSERM-UMR 8104 CNRS (Institut Cochin), Université Paris Descartes, Faculté de Médecine, Paris, France ; Laboratoire de Cytogénétique- APHP, Hôpitaux Universitaires Paris Centre, Paris, France
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Quelin C, Spaggiari E, Khung-Savatovsky S, Dupont C, Pasquier L, Loeuillet L, Jaillard S, Lucas J, Marcorelles P, Journel H, Pluquailec-Bilavarn K, Bazin A, Verloes A, Delezoide AL, Aboura A, Guimiot F. Inversion duplication deletions involving the long arm of chromosome 13: phenotypic description of additional three fetuses and genotype-phenotype correlation. Am J Med Genet A 2014; 164A:2504-9. [PMID: 24975584 DOI: 10.1002/ajmg.a.36658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 05/28/2014] [Indexed: 11/09/2022]
Abstract
Inversion duplication and terminal deletion of the long arm of chromosome 13 (inv dup del 13q) is a rare chromosomal rearrangement: only five patients have been reported, mostly involving a ring chromosome 13. We report on additional three fetuses with pure inv dup del 13q: Patient 1 had macrosomia, enlarged kidneys, hypersegmented lungs, unilateral moderate ventriculomegaly, and a mild form of hand and feet preaxial polydactyly; Patient 2 had intrauterine growth retardation, widely spaced eyes, left microphthalmia, right anophthalmia, short nose, bilateral absent thumbs, cutaneous syndactyly of toes 4 and 5, bifid third metacarpal, a small left kidney, hyposegmented lungs, and partial agenesis of the corpus callosum; Patient 3 had widely spaced eyes, long and smooth philtrum, low-set ears, median notch in the upper alveolar ridge, bifid tongue, cutaneous syndactyly of toes 2 and 3, enlarged kidneys and pancreas, arhinencephaly, and partial agenesis of the corpus callosum. We compared the phenotypes of these patients to those previously reported for ring chromosome 13, pure 13q deletions and duplications. We narrowed some critical regions previously reported for lung, kidney and fetal growth, and for thumb, cerebral, and eye anomalies.
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Affiliation(s)
- Chloe Quelin
- Department of Developmental Biology, AP-HP, Robert Debré University Hospital, Paris and Diderot University, Paris, France; Clinical Genetics Unit, Rennes Sud University Hospital, Rennes, France
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27
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Bornes M, Spaggiari E, Schmitz T, Dreux S, Czerkiewicz I, Delezoide AL, El-Ghoneimi A, Oury JF, Muller F. Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis. Prenat Diagn 2013; 33:1162-6. [PMID: 23939878 DOI: 10.1002/pd.4215] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/28/2013] [Accepted: 08/09/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the gestational age-specific outcomes and the different etiologies of megacystis diagnosed at screening ultrasound. METHODS A retrospective single-center study was conducted between 1989 and 2009. We identified all consecutive cases of megacystis prenatally diagnosed during routine ultrasound screening. Outcome, final diagnosis, and renal function were recorded. RESULTS Eighty-four patients were included. An isolated lower urinary tract obstruction was observed in 38/84 (45.2%), ureterovesical reflux in 9/84 (10.7%), an associated congenital abnormality in 32/84 (38.1%) and a normal bladder in 5/84 (6%). Increased gestational age at diagnosis was correlated with an increased rate of live born children (P < 0.01). No cases of megacystis diagnosed in the first trimester were born alive. When diagnosis of posterior urethral valves (PUV) was made in the third trimester, the ultimate survival rate was 11/13 (84.6%) compared with 3/12 (25%) for a diagnosis made in the second trimester (P = 0.02). CONCLUSION Lower urinary tract obstruction is the main etiology of megacystis. Megacystis can also be part of more complex malformations. Outcome of megacystis detected in the first trimester is poor. PUV detected in the third trimester had a better overall survival rate than PUV detected in the second trimester.
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Affiliation(s)
- Marie Bornes
- Gynecology and Obstetrics, AP-HP, Robert Debré Hospital, Paris, France; Gynecology and Obstetrics, AP-HP, Tenon Hospital, Paris, France
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28
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Spaggiari E, Stirnemann JJ, Heidet L, Dreux S, Ville Y, Oury JF, Delezoide AL, Muller F. Outcome following prenatal diagnosis of severe bilateral renal hypoplasia. Prenat Diagn 2013; 33:1167-72. [PMID: 23943585 DOI: 10.1002/pd.4217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 07/28/2013] [Accepted: 08/09/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this research was to evaluate the outcome and prognostic value of fetal serum β2-microglobulin in case of prenatal diagnosis of severe bilateral renal hypoplasia. METHODS Cases of hypoplastic kidneys were detected on ultrasound and referred to our laboratory for determination of fetal blood β2-microglobulin, over a 12-year period. Prenatal prognostic assessment was based upon amniotic fluid volume and fetal serum β2-microglobulin (cut-off: 5 mg/L). Outcome measures were postnatal renal function or renal pathological features when termination of pregnancy (TOP) and genetic studies were performed. RESULTS A total of 34 cases were identified; 13 (38%) were liveborn and 21 (62%) underwent TOP. Renal hypoplasia was confirmed postnatally in all cases. Oligohydramnios/anhydramnios was observed in 30/34 (88%) cases. Associated genetic or anatomical anomalies were found in 8/34 (24%) cases. Renal function of liveborn infants was normal in 4/13 cases. Renal lesions were observed in all TOPs (21/21 cases). Overall, 30/34 (88.2%) cases had a poor outcome. β2-microglobulin accurately predicts poor renal outcome in 27/31 (87.1%) cases. β2-microglobulin was not interpretable in three cases due to amniotic fluid contamination. The prognostic value of β2-microglobulin was similar to that of amniotic fluid volume assessment. CONCLUSION Hypoplastic kidneys complicated by oligohydramnios/anhydramnios are associated with poor outcome. Fetal serum β2-microglobulin and oligohydramnios both predicted poor outcome.
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29
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Dupont C, Baumann C, Le Du N, Schaefer E, Guimiot F, Boutaud L, Capri Y, Spaggiari E, Aboura A, Benzacken B, Tabet AC. COL2A1 gene disruption by a balanced translocation t(12;15)(q13;q22.2) in familial Stickler syndrome. Am J Med Genet A 2013; 161A:2663-5. [PMID: 23918474 DOI: 10.1002/ajmg.a.36081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 05/05/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Céline Dupont
- AP-HP, Department of Genetic-Cytogenetic Unit, Robert Debre Hospital, Paris, France
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30
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Spaggiari E, Ruas M, Dreux S, Valat AS, Czerkiewicz I, Guimiot F, Schmitz T, Delezoide AL, Muller F. Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay. Am J Obstet Gynecol 2013; 208:303.e1-7. [PMID: 23313312 DOI: 10.1016/j.ajog.2013.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/08/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein. STUDY DESIGN A retrospective cohort study in 658 patients with maternal serum alpha-fetoprotein ≥2.5 multiple of median, performed at routine Down syndrome screening. Maternal serum alpha-fetoprotein was assayed a second time in 341 of them. Outcomes were recorded in all cases. RESULTS The group with unexplained maternal serum alpha-fetoprotein persistently ≥2.5 multiple of median was associated with more pregnancy complications 37 of 92 (40.2%) as fetal death, preeclampsia, intrauterine growth restriction, and congenital nephrotic syndrome, compared with the group with maternal serum alpha-fetoprotein that returned to a normal level 37 of 226 (16.4%) (P < .001). CONCLUSION When maternal serum alpha-fetoprotein returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat maternal serum alpha-fetoprotein assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. Alpha-fetoprotein should be monitored in pregnancies associated with unexplained high maternal serum alpha-fetoprotein. A management strategy based on ultrasound examination, second maternal serum alpha-fetoprotein assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, University Paris Diderot and Paris Sorbonne-Cité, Paris, France
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31
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Spaggiari E, Baumann C, Alison M, Oury JF, Belarbi N, Dupont C, Guimiot F, Delezoide AL. Mowat-Wilson syndrome in a fetus with antenatal diagnosis of short corpus callosum: advocacy for standard autopsy. Eur J Med Genet 2013; 56:297-300. [PMID: 23523603 DOI: 10.1016/j.ejmg.2013.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/05/2013] [Indexed: 02/05/2023]
Abstract
Mowat-Wilson syndrome (MWS) is a genetic disease caused by heterozygous mutations or deletions of the ZEB2 gene rarely diagnosed prenatally and with little fetal description reported. It is mainly characterized by moderate-to-severe intellectual disability, epilepsy, facial dysmorphism and various malformations including Hirschsprung disease and corpus callosum anomalies. Here we report a fetal case of MWS well described, suspected at standard autopsy. The association of a corpus callosum hypoplasia with a histological Hirschsprung disease and a typical facial gestalt allowed the guiding of genetic testing. Classical fetopathological examination still keeps indications in cases of syndromic association in the era of virtual autopsy.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Developmental Biology, Robert Debré Hospital, AP-HP, 48 Boulevard Sérurier, Paris, France.
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32
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Spaggiari E, Vuillard E, Khung-Savatovsky S, Muller F, Oury JF, Delezoide AL, Guimiot F. Ultrasound detection of eyelashes: a clue for prenatal diagnosis of Cornelia de Lange syndrome. Ultrasound Obstet Gynecol 2013; 41:341-342. [PMID: 22903543 DOI: 10.1002/uog.12285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Spaggiari E, Stirnemann J, Bernard JP, De Saint Blanquat L, Beaudoin S, Ville Y. Prognostic value of a hernia sac in congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2013; 41:286-290. [PMID: 22605546 DOI: 10.1002/uog.11189] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia (CDH). METHODS Our database was searched to identify all consecutive cases of CDH referred to our fetal medicine unit between January 2004 and August 2011. Presence or absence of a hernia sac was assessed in liveborn cases using surgery or postnatal autopsy reports. We studied the correlation between the presence of a hernia sac and prenatal findings and perinatal morbidity and mortality. RESULTS Over the study period, there were 70 cases with isolated CDH born alive in which either a surgery or autopsy report was available. Neonatal death, either preoperative or postoperative, occurred in 1/18 (5.6%) infants with a hernia sac and in 17/52 (32.7%) cases without a hernia sac (P = 0.03). Patients with a hernia sac had a significantly higher observed to expected pulmonary volume on prenatal magnetic resonance imaging (51.9 vs 39.3%, P = 0.01). Neonatal morbidity in surviving infants was lower in the group with a hernia sac, although not significantly. CONCLUSION The presence of a hernia sac is associated with a higher pulmonary volume and a better overall prognosis for CDH.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker Enfants-Malades, AP-HP and Université Paris Descartes, Paris, France
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34
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Spaggiari E, Dreux S, Czerkiewicz I, Favre R, Schmitz T, Guimiot F, Laurichesse Delmas H, Verspyck E, Oury JF, Ville Y, Muller F. Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β-2-microglobulin. Ultrasound Obstet Gynecol 2013; 41:185-189. [PMID: 23090907 DOI: 10.1002/uog.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether the prognostic value of fetal serum β-2-microglobulin is altered and whether the occurrence of fetal urinary ascites prevents kidney damage in cases of fetal obstructive uropathy with urinary ascites. METHODS This was a retrospective study of cases of fetal bilateral obstructive uropathy that occurred between 2006 and 2010, for which both fetal serum and ascites samples were sent to our laboratory for analysis. β-2-microglobulin was assayed in both fetal serum and the corresponding ascites. Renal outcome was analyzed. Histological features of the kidney in cases of termination of pregnancy and renal function of liveborn infants were recorded. RESULTS Fourteen cases with analysis of fetal serum and fetal ascites in a context of urinary obstruction were included. Renal outcome was unfavorable in eight cases (57%) and favorable in six (43%). When fetal serum β-2-microglobulin was < 5 mg/L, renal outcome was favorable in all cases (4/4). When fetal serum β-2-microglobulin was ≥ 5 mg/L, 8/10 cases (80%) had an unfavorable renal outcome (sensitivity, 100%; specificity, 66%). CONCLUSION Fetal serum β-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.
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Affiliation(s)
- E Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, and University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
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Spaggiari E, Heidet L, Grange G, Guimiot F, Dreux S, Delezoide AL, Muller F. Prognosis and outcome of pregnancies exposed to renin-angiotensin system blockers. Prenat Diagn 2012; 32:1071-6. [PMID: 22903358 DOI: 10.1002/pd.3960] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/17/2012] [Accepted: 07/23/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To study pregnancy outcomes and fetal renal prognosis markers in cases of exposure to renin-angiotensin system blockers. METHODS We conducted a retrospective study of a series of 21 patients exposed to blockers of the renin-angiotensin system during pregnancy. Two markers were prenatally studied, fetal serum β2-microglobulin and amniotic fluid volume. Poor renal prognosis evaluation was based on postnatal glomerular filtration rate or on the presence of renal histologic lesions. RESULTS Of the 21 fetuses, only one had a normal postnatal renal function at birth (oligohydramnios regression and normal β2-microglobulin). All fetuses with persistent oligohydramnios or β2-microglobulin ≥ 5 mg/L presented an adverse renal outcome. CONCLUSION Exposure to renin-angiotensin system blockers complicated by oligohydramnios is associated with a very poor outcome. We propose a prenatal management based on amniotic fluid volume monitoring and fetal serum β2-microglobulin. However, our preliminary results have to be confirmed by a larger study.
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Spaggiari E, Stirnemann J, Ville Y. Outcome in fetuses with isolated congenital diaphragmatic hernia with increased nuchal translucency thickness in first trimester. Prenat Diagn 2012; 32:268-71. [PMID: 22430726 DOI: 10.1002/pd.3819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the possible association between increased nuchal translucency (NT) thickness in the first trimester and perinatal outcome in isolated congenital diaphragmatic hernia (CDH). METHODS We conducted a retrospective study between January 2004 and June 2010. The database was searched to identify all consecutive cases of CDH referred to the fetal medicine center of Necker Hospital in Paris. Enlarged NT was defined above the 95th centile. Only children born alive with an isolated CDH were selected for the analysis of prognostic factors. We also studied the correlation between NT thickness in the first trimester and lung-to-head ratio, observed to expected lung area-to-head ratio, lung volume estimated by magnetic resonance imaging, and other prenatal features of intrathoracic compression. RESULTS Seventy-one cases of isolated CDH were available. The fetal NT was above the 95th centile in 9 of the 71 cases. Neonatal death occurred in 7/9 (78%) cases with enlarged NT, compared with 24/62 (38%) with normal NT (P = 0.035). Enlarged NT was significantly associated with prenatal features of intrathoracic compression. CONCLUSION Enlarged NT thickness in CDH is associated with a poor outcome and is related to an early intrathoracic compression.
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Affiliation(s)
- E Spaggiari
- AP-HP, Department of Obstetrics and Gynecology, Necker Enfants-Malades Hospital, Paris, France
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37
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Spaggiari E, Bucau M, Capri Y, Belarbi N, Bekmezian A, Briffa JM, Delezoide AL, Guimiot F. Prenatal phenotype of congenital hyperparathyroidism. Prenat Diagn 2012; 32:906-8. [DOI: 10.1002/pd.3912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 05/05/2012] [Accepted: 05/06/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | - Margot Bucau
- Department of Developmental Biology; AP-HP, Robert Debré Hospital; Paris; France
| | | | - Nadia Belarbi
- Department of Radiology; AP-HP, Robert Debré Hospital; Paris; France
| | | | - Jean-Michel Briffa
- Department of Gynecology and Obstetrics; Lagny Hospital; Lagny-sur-Marne; France
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Spaggiari E, Aboura A, Sinico M, Mabboux P, Dupont C, Delezoide AL, Guimiot F. Prenatal diagnosis of a 7p15-p21 deletion encompassing the TWIST1 gene involved in Saethre-Chotzen syndrome. Eur J Med Genet 2012; 55:498-501. [PMID: 22569119 DOI: 10.1016/j.ejmg.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/20/2012] [Indexed: 11/28/2022]
Abstract
Saethre-Chotzen syndrome is a craniosynostosis syndrome that is rarely diagnosed prenatally. It is caused by cytogenetic deletions or mutations of the TWIST1 gene. We report here a de novo prenatal case with clinically and molecularly well defined Saethre-Chotzen syndrome due to a TWIST1 deletion. This is the first reported case of a deletion encompassing the TWIST1 gene to be diagnosed prenatally. We recommend screening for a deletion of the TWIST1 gene if signs of coronal craniosynostosis with no clear etiology are observed on ultrasound examination.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, 48, Boulevard Sérurier, 75019 Paris, France
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39
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Spaggiari E, Vuillard E, Baumann C, Dupont C, Belarbi N, Oury JF, Delezoide AL, Guimiot F. Ultrasound detection of hyaloid artery in the third trimester of pregnancy: a pathological finding. Ultrasound Obstet Gynecol 2012; 39:478-479. [PMID: 22012788 DOI: 10.1002/uog.10123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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40
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Venuta A, Spaggiari E, Bertolani P, Balli F. [The use of ondansetron in acute gastroenteritis. Its impact in a pediatric emergency department]. Pediatr Med Chir 2011; 33:193-195. [PMID: 22423479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Ondansentron is in consideration in literature for its use in vomiting secondary to acute gastroenteritis in children. OBJECTIVE To evaluate its usefulness in children with acute gastroenteritis referred to a paediatric emergency department. METHODS A retrospective study considered 967 children treated with ondansetron (0,06 mg/kg IM) plus oral rehydration, with a control group of 286 children who received only oral rehydration. RESULTS The time spent into the short-stay observation unit and the total emergency department stay were significantly reduced in children receiving ondansentron. No adverse reactions to the drug were recorded.
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Affiliation(s)
- A Venuta
- Dipartimento Materno Infantile, Largo del Pozzo 71--41100 Modena.
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41
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Venuta A, Spaggiari E, Bertolani P, Balli F. [The use of ondansetron in acute gastroenteritis. Its impact in a pediatric emergency department]. Pediatr Med Chir 2011; 33:143-145. [PMID: 22145300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Ondansentron is in consideration in literature for its use in vomiting secondary to acute gastroenteritis in children. OBJECTIVE To evaluate its usefulness in children with acute gastroenteritis referred to a paediatric emergency department. METHODS A retrospective study considered 967 children treated with ondansetron (0,06 mg/kg IM) plus oral rehydration, with a control group of 286 children who received only oral rehydration. RESULTS The time spent into the short-stay observation unit and the total emergency department stay were significantly reduced in children receiving ondansentron. No adverse reactions to the drug were recorded.
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Affiliation(s)
- A Venuta
- Dipartimento Materno Infantile, Università Di Modena e Reggio Emilia.
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42
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Stirnemann J, Spaggiari E, Benachi A, De Saint Blanquat L, Ville Y. 417: A score-based approach for prenatal staging of congenital diaphragmatic hernia. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bnà C, Zompatori M, Poletti V, Spaggiari E, Chetta A, Calabrò E, Ormitti F, Berti E, Cancellieri A, Chilosi M. Differential diagnosis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) assessed by high-resolution computed tomography (HRCT). Radiol Med 2005; 109:472-87. [PMID: 15973221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to assess the accuracy of high-resolution CT in the differential diagnosis between UIP and NSIP, and the correlations with histological and functional findings. MATERIALS AND METHODS Patients underwent thin-collimation spiral CT (1 mm), with 10-mm interval. Pulmonary function was assessed with a pneumotacograph and body plethysmograph connected with a computer for data analysis. Three pathologists, blinded to the clinical and functional data, provided a histological diagnosis based on established criteria reported in the literature. The study group only included patients with a histological diagnosis of either UIP or NSIP. RESULTS We achieved a correct diagnosis of NSIP in 86.6% of cases (76.4% sensitivity; 84.6% specificity), whereas UIP was correctly diagnosed in 73.3% of cases (84.6% sensitivity; 76.5% specificity). An 80% agreement was achieved between the HRCT and histological findings in the whole case series (73% sensitivity, 87% specificity, p<0.01). CONCLUSIONS The most important finding of our study was that a ground glass appearance equal to or greater than 15% is highly suggestive of NSIP. Therefore, our results could be useful to confirm a suggested diagnosis of NSIP.
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Affiliation(s)
- C Bnà
- Sezione di Scienze Radiologiche, Dipartimento di Scienze Cliniche, Università degli studi di Parma, Parma, Italy
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Spaggiari E, Zompatori M, Verduri A, Chetta A, Bnà C, Ormitti F, Sverzellati N, Rabaiotti E. Early smoking-induced lung lesions in asymptomatic subjects. Correlations between high resolution dynamic CT and pulmonary function testing. Radiol Med 2005; 109:27-39. [PMID: 15729184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
PURPOSE To evaluate the prevalence and significance of the pathological effects of cigarette smoking on the lung and the sensitivity of high-resolution CT (HRCT) in the recognition of early smoking-induced lesions in asymptomatic former or current smokers. MATERIALS AND METHODS We performed a prospective and consecutive analysis of 36 volunteers (16 males, 20 females), 10 non-smokers (3 males; 7 females) and 26 smokers (13 males; 13 females / 17 current smokers; 9 former smokers), all asymptomatic and with normal respiratory flows. These subjects underwent lung function testing and HRCT, after providing written informed consent for the study. The HRCT scans were obtained at three pre-selected levels (aortic arch, tracheal carina and venous hilum). The same scans were obtained in post-expiration phase. At the level of the apical segmental bronchus of the right upper lobe, we measured on the monitor wall thickening, and the total and internal diameters using the techniques reported in literature. Each study was independently evaluated by two radiologists that were blinded to all clinical and functional data; they also evaluated the presence, prevalence and type of emphysema, areas of patchy hyperlucency and oligoemia in the inspiration phase and areas of expiratory air trapping. The extension was evaluated with the visual score method. The data obtained were analysed with the Windows SPSS package for statistical analysis. RESULTS The two groups (non smokers and smokers) showed significant differences in some functional tests such as FEV1 (p<0.005) and Tiffeneau index (p<0.005), which were lower in current-smokers or former-smokers, although still within the normal range. The HRCT study did not show areas of emphysema or air trapping in non smokers. In the smokers' group, air trapping was observed in 30.7% of cases: 33.3% former-smokers and 29.4% current smokers (mean extension was 21.36% in former smokers and 9.48% in current smokers). Mean extension in the smokers' group was 13.94%. Pulmonary emphysema was found in 34.6% of cases in the smokers' group: 33.3% former-smokers and 35.2% current-smokers. Emphysema was prevalent in the upper lobes (88.8%). Mean extension was 8.76% in the former smokers group and 18.81% in current-smokers, with a total mean extension of 15.47% in the smokers' group. Statistically, there was a significant difference between non-smokers and smokers as regards emphysema extension and expiratory air trapping (p=0.034 and p=0.050, respectively). The smokers' group had a significantly wider diameter of the apical segmental bronchus of the right upper lobe than the controls. There was no significant statistical correlation between this dilatation and the emphysema score (r=0.051; p=0.81). The entity of smoking history did not correlate with emphysema extension or air trapping or with the size of the apical segmental bronchus of the right upper lobe. CONCLUSIONS Our study demonstrates that HRCT is more sensitive and specific than commonly-used functional tests for the evaluation of initial emphysema in asymptomatic smokers. We observed expiratory air trapping only in the smokers' group, and only of the lobular type, without evidence of disease in inspiratory scans. Among the smokers and former-smokers, air trapping was found in 30.7% of subjects, with a mean extension lower than 10%. Our results therefore suggest that, even in asymptomatic subjects, expiratory air trapping is probably pathological and, once bronchial asthma has been excluded, it may be related to cigarette smoking and indicate early inflammatory bronchiolar damage. HRCT may therefore be regarded as a useful tool in the early diagnosis of smoking-related lung disease.
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Affiliation(s)
- E Spaggiari
- Sezione di Diagnostica per Immagini e UO di Scienze Radiologiche, Dipartimento di Scienze Cliniche, Università degli Studi, Parma, Italy
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Abstract
Castleman disease is an uncommon benign disorder mainly affecting mediastinal lymph nodes and rarely visceral organs. The most typical structural finding is hypervascularity which can be well demonstrated both by CT and MRI. We report MR findings of an unusual case of solitary parenchymal lung involvement.
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Affiliation(s)
- F Ferrozzi
- Department of Radiology, University of Parma, Via Gramsci 14, I-43100, Parma, Italy.
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Spaggiari E, Salati R, Nicolini P, Borgatti R, Pozzoli U, Polenghi F. Evolution of ocular clinical and electrophysiological findings in pediatric Bardet-Biedl syndrome. Int Ophthalmol 2001; 23:61-7. [PMID: 11196121 DOI: 10.1023/a:1026560721525] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bardet-Biedl syndrome (BBS) is a hereditary autosomal-recessive disorder, characterized by mental retardation, obesity, pigmentary retinopathy, polydactyly and, only in males, hypogenitalism. Even though genetic studies have revealed five different forms of BBS correlated to distinct loci on different chromosomes, a diagnosis of BBS is still primarily based on clinical data. The present study discusses the evolution of clinical ophthalmological and electrophysiological characteristics of BBS patients in developmental age. The main results obtained on a sample of 13 pediatric patients are the following: * progressive loss of visual acuity arised early in the first decade of life * ophthalmoscopic signs of pigmentary retinopathy were present only in 46% of the children studied * striking anomalies in the electroretinogram were also detected in the cases without pigmentary retinopathy * the electroretinographic results, when detectable, suggested a greater involvement of the photopic system as against the scotopic system.
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Affiliation(s)
- E Spaggiari
- Department of Pediatric Ophthalmology, Scientific Institute E. Medea Bosisio Parini (Lc), Italy
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Ferrozzi F, Tognini G, Marchesi G, Spaggiari E, Pavone P. [Gastric tumors with fatty components. CT findings and differential diagnosis]. Radiol Med 2000; 100:343-7. [PMID: 11213412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
PURPOSE To assess the role of CT in diagnosing and characterizing gastric fatty tumors. MATERIAL AND METHODS We reviewed the CT scans of 16 patients (8 men, 8 women, mean age 52 years) with gastric fatty tumors (11 lipomas, 3 liposarcomas, 1 angiolipoma, 1 teratoma) examined from 1990 to 1999. The differential diagnosis considered primary and secondary lipomatosis, carcinoma engulfing the perivisceral fat and thus mimicking a liposarcoma, mesenchymal gastric and primary peritoneal tumors. RESULTS Lipomas involved the fundus (7/11), the body (3/11), the antrum (1/11). Multifocality was found in one case. Lesions size ranged 25 to 65 mm (mean 35 mm). All the lipomas showed homogeneous structure with negative (-30 -100) HU values. A pseudocapsule was demonstrated in 7/11 cases. No infiltrative growth was demonstrated. The angiolipoma located in the fundus showed a vascular component with strong contrast enhancement. All the liposarcomas were bigger than 10 cm and there was a strong correlation between pathologic specimen and CT findings. The differentiated liposarcomas showed the classic heterogeneous fatty density; on the contrary the myxoid and the pleomorphic types showed an aspecific structure with necrotic/cystic changes, mostly demonstrated in the myxoid type. The teratoma was a solid mass with fatty, solid, necrotic and calcified components. CONCLUSION CT allows the diagnosis and characterization of gastric fatty tumors. The preoperative diagnosis of lipomas plays a major clinical role because it often makes surgery unnecessary.
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Affiliation(s)
- F Ferrozzi
- Istituto di Scienze Radiologiche, Università degli Studi, Parma.
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Salvi M, Spaggiari E, Neri F, Minelli R, Roti E. Expulsion of an artificial eye in a patient with thyroid-associated ophthalmopathy and surgical anophthalmos. Am J Med 1999; 107:191-2. [PMID: 10460062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Salvi M, Spaggiari E, Neri F, Macaluso C, Gardini E, Ferrozzi F, Minelli R, Wall JR, Roti E. The study of visual evoked potentials in patients with thyroid-associated ophthalmopathy identifies asymptomatic optic nerve involvement. J Clin Endocrinol Metab 1997; 82:1027-30. [PMID: 9100568 DOI: 10.1210/jcem.82.4.3877] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the present study we have recorded visual evoked cortical potentials (VECP) in 88 patients affected by autoimmune thyroid disease and thyroid-associated ophthalmopathy (TAO) without clinical signs of optic neuropathy. At the time of ophthalmological examination, 37 of these patients were hyperthyroid, 41 were euthyroid, and 8 were hypothyroid; 2 were not assessed. Twenty-nine normal subjects served as controls. We performed pattern reversal visual stimulation and recorded the amplitude and latency of the cortical electric response at 100 ms (P100 wave). There were no differences in the mean P100 amplitude of TAO patients and normal subjects. The mean P100 latency in patients was 105.6 +/- 0.5 ms, significantly higher than that in normal subjects (102.0 +/- 0.5 ms; P < 0.00003). Latency in euthyroid patients did not differ from that in either hypo- or hyperthyroid patients. The VECP test was positive (latency, > or = 110.0 ms) in 21 (23.8%) TAO patients. In patients with proptosis greater than 21 mm, latency was 106.7 +/- 0.7 ms, significantly higher than that in patients with normal Hertel measurements (104.3 +/- 0.6 ms; P < 0.01). Latency was not increased in patients with acute inflammatory signs compared to those with inactive eye disease and in patients with altered extrinsic motility. In patients with an abnormal visual field study, the mean latency was 110.3 +/- 1.5 ms, significantly higher than that in patients with a normal visual field (104.7 +/- 0.4; by t test, P < 0.000003). In conclusion, we observed a prolongation of the latency of the evoked cortical response in patients with TAO without subjective visual complaints and without optic nerve compression. We believe that the study of VECP in TAO is complementary to the study of the visual field in identifying early optic nerve dysfunction in the absence of decreased visual acuity.
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Affiliation(s)
- M Salvi
- Centro per lo Studio, Prevenzione, Diagnosi e Cura delle Tireopatie, Università di Parma, Italy
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