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Vinit N, Heidet L, Taghavi K, Salomon LJ, Ville Y, Blanc T. Long-term urological and nephrological outcome after in-utero incision of obstructive duplex-system ureterocele. Ultrasound Obstet Gynecol 2024. [PMID: 38700062 DOI: 10.1002/uog.27673] [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] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants malades Hospital, APHP, Paris, France
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- EA FETUS 7328- PACT, Imagine Institute, Université Paris Cité, 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, Université Paris Cité, Paris, France
| | - K Taghavi
- Department of Pediatrics, Monasch University, Melbourne, Victoria, Australia
- Department of Pediatric Urology, Monash Children's Hospital, Monash University, Melbourne, Victoria, Australia
| | - L J Salomon
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- EA FETUS 7328- PACT, Imagine Institute, Université Paris Cité, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants malades Hospital, APHP, Paris, France
| | - Y Ville
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- EA FETUS 7328- PACT, Imagine Institute, Université Paris Cité, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants malades Hospital, APHP, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants malades Hospital, APHP, Paris, France
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- INSERM U1151-CNRS UMR 8253, Université Paris Cité, Paris, France
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Franzini S, Querciagrossa S, Brebion M, Lapenta C, Blanc T, Orliaguet G. Expanding safety boundaries in pediatric robotic-assisted laparoscopic surgery: are we protecting our children? J Robot Surg 2024; 18:185. [PMID: 38683478 DOI: 10.1007/s11701-024-01959-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024]
Abstract
Little is known about the effects of CO2 insufflation (CDI) on cerebral oxygen saturation (CrSO2) during laparoscopy in the pediatric population. In children undergoing robotic-assisted laparoscopic pyeloplasty (RALP), we prospectively assessed the effects of CDI using standard monitoring and cerebral near-infrared spectroscopy (NIRS). We also explored whether a correlation existed between CrSO2 and parameters known to affect cerebral blood flow. Between January 2021 and September 2023, a cohort of consecutive children older than 2 years underwent RALP at Necker-Enfants Malades Hospital in Paris. A ventilation protocol aimed to prevent hypercarbia was implemented. Data collected included standard monitoring parameters and CrSO2 by NIRS. Thirty patients (16 females), mean age 5.5 ± 3.9 (2.0-9.5) years, were included. Twenty-three patients underwent a retroperitoneal approach. The mean baseline CrSO2 value was 83.0 ± 9.8. Mean CrSO2 decreased during progressive CDI, never below baseline values, while standard-monitoring parameters did not significantly change. No significant correlation was detected between CrSO2 and end tidal CO2, or between CrSO2 and mean arterial pressure, at any operative time. During RALP, a gradual CDI doesn't cause pathological derangements of CrSO2. The lack of correlation between CrSO2 and standard parameters affecting cerebral blood flow suggests the likely presence of cerebral autoregulation in our population.
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Affiliation(s)
- Stefania Franzini
- Department of Pediatric and Obstetrical Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, 149, Rue de Sèvres, 75015, Paris, France.
| | - Stefania Querciagrossa
- Department of Pediatric and Obstetrical Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, 149, Rue de Sèvres, 75015, Paris, France
| | - Myriam Brebion
- Department of Pediatric and Obstetrical Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, 149, Rue de Sèvres, 75015, Paris, France
| | - Cristina Lapenta
- Department of Pediatric and Obstetrical Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, 149, Rue de Sèvres, 75015, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université Paris Cité, Paris, France
| | - Gilles Orliaguet
- Department of Pediatric and Obstetrical Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, 149, Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
- Pharmacologie et Évaluation des Thérapeutiques chez l'enfant et la Femme Enceinte, Unité de Recherche EA 7323, Hôpitaux Universitaires Paris Centre-Site Tarnier Université Paris Cité, 75006, Paris, France
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Pio L, Abib S, Guerin F, Chardot C, Blanc T, Sarrai N, Martelli H, de Souza FKM, Fanelli MCA, Tamisier D, Guilhen JCS, Le Bret E, Belli E, Fadel E, Cypriano MDS, Minard V, Pasqualini C, Schleiermacher G, Lemelle L, Rod J, Irtan S, Pistorio A, Gauthier F, Branchereau S, Sarnacki S. ASO Author Reflections: Surgical Management of Wilms Tumors with Intravenous Extension: A Multicenter Analysis of Clinical Management with Technical Insights. Ann Surg Oncol 2024:10.1245/s10434-024-15325-6. [PMID: 38679687 DOI: 10.1245/s10434-024-15325-6] [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: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Luca Pio
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France.
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Paris Kids Cancer, Paris, France.
| | - Simone Abib
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute - GRAACC - Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Florent Guerin
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- Paris Kids Cancer, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Nadia Sarrai
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Helene Martelli
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | | | - Mayara C A Fanelli
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel Tamisier
- Department of Cardiovascular Surgery, Hôpital Universitaire Necker Enfants Malades-Université de Paris Cité, Paris, France
| | - José Cícero S Guilhen
- Department of Cardiovascular Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Emmanuel Le Bret
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Emré Belli
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Monica D S Cypriano
- Pediatric Oncology, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Véronique Minard
- Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France
- Paris Kids Cancer, Paris, France
| | - Claudia Pasqualini
- Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France
- Paris Kids Cancer, Paris, France
| | - Gudrun Schleiermacher
- Pediatric Oncology Unit, Institut Curie, Paris, France
- Paris Kids Cancer, Paris, France
| | - Lauriane Lemelle
- Pediatric Oncology Unit, Institut Curie, Paris, France
- Paris Kids Cancer, Paris, France
| | - Julien Rod
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Angela Pistorio
- Epidemiology, and Biostatistics Unit, Instituto Giannina Gaslini, Genoa, Italy
| | - Frederic Gauthier
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Sophie Branchereau
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- Paris Kids Cancer, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
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Pio L, Abib S, Guerin F, Chardot C, Blanc T, Sarrai N, Martelli H, De Souza FKM, Fanelli MCA, Tamisier D, Guilhen JCS, Le Bret E, Belli E, Fadel E, Cypriano MDS, Minard V, Pasqualini C, Schleiermacher G, Lemelle L, Rod J, Irtan S, Pistorio A, Gauthier F, Branchereau S, Sarnacki S. Surgical Management of Wilms Tumors with Intravenous Extension: A Multicenter Analysis of Clinical Management with Technical Insights. Ann Surg Oncol 2024:10.1245/s10434-024-15232-w. [PMID: 38578552 DOI: 10.1245/s10434-024-15232-w] [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: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND About 5% of Wilms tumors present with vascular extension, which sometimes extends to the right atrium. Vascular extension does not affect the prognosis, but impacts the surgical strategy, which is complex and not fully standardized. Our goal is to identify elements of successful surgical management of Wilms tumors with vascular extensions. PATIENTS AND METHODS A retrospective study of pediatric Wilms tumors treated at three sites (January 1999-June 2019) was conducted. The inclusion criterion was the presence of a renal vein and vena cava thrombus at diagnosis. Tumor stage, pre and postoperative treatment, preoperative imaging, operative report, pathology, operative complications, and follow-up data were reviewed. RESULTS Of the 696 pediatric patients with Wilms tumors, 69 (9.9%) met the inclusion criterion. In total, 24 patients (37.5%) had a right atrial extension and two presented with Budd-Chiari syndrome at diagnosis. Two died at diagnosis owing to pulmonary embolism. All patients received neoadjuvant chemotherapy and thrombus regressed in 35.6% of cases. Overall, 14 patients had persistent intra-atrial thrombus extension (58%) and underwent cardiopulmonary bypass. Most thrombi (72%) were removed intact with nephrectomy. Massive intraoperative bleeding occurred during three procedures. Postoperative renal insufficiency was identified as a risk factor for patient survival (p = 0.01). With a median follow-up of 9 years (range: 0.5-20 years), overall survival was 89% and event-free survival was 78%. CONCLUSIONS Neoadjuvant chemotherapy with proper surgical strategy resulted in a survival rate comparable to that of children with Wilms tumors without intravascular extension. Clinicians should be aware that postoperative renal insufficiency is associated with worse survival outcomes.
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Affiliation(s)
- Luca Pio
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Paris Kids Cancer, Paris, France.
| | - Simone Abib
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Florent Guerin
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
- Paris Kids Cancer, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Nadia Sarrai
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Helene Martelli
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Fernanda K M De Souza
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mayara C A Fanelli
- Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel Tamisier
- Department of Cardiovascular Surgery, Hôpital Universitaire Necker Enfants Malades-Université de Paris Cité, Paris, France
| | - José Cícero S Guilhen
- Department of Cardiovascular Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Emmanuel Le Bret
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Emré Belli
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue-Groupe Hospitalier Paris-Saclay, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Monica D S Cypriano
- Pediatric Oncology, Pediatric Oncology Institute-GRAACC-Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Véronique Minard
- Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France
- Paris Kids Cancer, Paris, France
| | - Claudia Pasqualini
- Pediatric Oncology Unit, Institut Gustave Roussy, Paris, France
- Paris Kids Cancer, Paris, France
| | - Gudrun Schleiermacher
- Pediatric Oncology Unit, Institut Curie, Paris, France
- Paris Kids Cancer, Paris, France
| | - Lauriane Lemelle
- Pediatric Oncology Unit, Institut Curie, Paris, France
- Paris Kids Cancer, Paris, France
| | - Julien Rod
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
| | - Angela Pistorio
- Epidemiology, and Biostatistics Unit, Instituto Giannina Gaslini, Genoa, Italy
| | - Frederic Gauthier
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Bicêtre Hospital, Paris-Saclay University, GHU Paris Saclay Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
- Paris Kids Cancer, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Necker Enfants Malades-Université de Paris Cité, Paris, France
- Paris Kids Cancer, Paris, France
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Faure A, Paye Jaouen A, Demede D, Juricic M, Arnaud A, Garcia C, Charbonnier M, Abbo O, Botto N, Blanc T, Leclair MD, Loubersac T. Safety and feasability of ureteroscopy for pediatric stone, in children under 5 Years (SFUPA 5): A French multicentric study. J Pediatr Urol 2024; 20:225.e1-225.e8. [PMID: 38030430 DOI: 10.1016/j.jpurol.2023.11.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20 mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. OBJECTIVE To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. STUDY DESIGN After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. RESULTS Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14 Kg (6.3-23). Median stone size was 13 mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91 % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2 % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2 % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. DISCUSSION Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. CONCLUSION URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.
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Affiliation(s)
- A Faure
- APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France.
| | - A Paye Jaouen
- APHP, Robert-Debré University Hospital, National Reference Center for Rare Urinary Tract Diseases "MARVU", Pediatric Urology, Paris, France
| | - D Demede
- University Hospital of Lyon, Pediatric Urology, Lyon, France
| | - M Juricic
- University Hospital of Rennes, Pediatric Urology, Rennes, France
| | - A Arnaud
- University Hospital of Rennes, Pediatric Urology, Rennes, France
| | - C Garcia
- University Hospital of Toulouse, Pediatric Urology, Toulouse, France
| | - M Charbonnier
- APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France
| | - O Abbo
- University Hospital of Toulouse, Pediatric Urology, Toulouse, France
| | - N Botto
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France
| | - M D Leclair
- Nantes Université, Pediatric Urology, Nantes, France
| | - T Loubersac
- Nantes Université, Pediatric Urology, Nantes, France
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Taghavi K, Sarnacki S, Blanc T, Boyer O, Heloury Y. The rationale for nephron-sparing surgery in unilateral non-syndromic Wilms tumour. Pediatr Nephrol 2024; 39:1023-1032. [PMID: 37603086 PMCID: PMC10899288 DOI: 10.1007/s00467-023-06099-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
The central question of nephron-sparing surgery in unilateral non-syndromic Wilms tumour sits at a crossroads between surgery, oncology, and nephrology. There has been a significant paradigm shift in paediatric oncology towards reducing toxicity and addressing long-term treatment-related sequalae amongst childhood cancer survivors. After paediatric nephrectomy and 30-50 years of follow-up, 40% of patients will have chronic kidney disease, including 22% with hypertension and 23% with albuminuria. It is difficult to predict which patients will progress to develop hypertension, reduced glomerular filtration rate, albuminuria, and a higher cardiovascular risk. For these reasons, nephron-sparing surgery when it is technically feasible must be considered. To decrease the incidence of positive surgical margins (viable tumour present at a resection margin), incomplete lymph node sampling, and complications, these procedures should be performed at specialist and experienced reference centres. Based on the impacts of individual treatment pathways, survivors of childhood WT need to be followed through adulthood for early detection of chronic kidney disease, hypertension, and prevention of cardiovascular events.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Victoria, Melbourne, Australia.
- Department of Paediatrics, Monash University, Victoria, Melbourne, Australia.
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France.
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Yves Heloury
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
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Bidault-Jourdainne V, Botto N, Peycelon M, Carricaburu E, Lopez P, Bonnard A, Blanc T, El-Ghoneimi A, Paye-Jaouen A. Response to commentary on: Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division Vs traction? a multicentric comparative study. J Pediatr Urol 2024:S1477-5131(24)00146-3. [PMID: 38493043 DOI: 10.1016/j.jpurol.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Valeska Bidault-Jourdainne
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France.
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France; Sorbonne Université, INSERM, Maladies génétiques d'expression pédiatrique, APHP, Hôpital d'Enfants Armand Trousseau, Paris, France; UMR INSERM 1141 NEURODEV, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Thomas Blanc
- Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRESCENDO), France
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Sartorius V, Giuseppi A, Iacobelli S, Leroy-Terquem E, Vinit N, Heidet L, Blanc T, Stirnemann J, Kermorvant-Duchemin E, Lapillonne A. Post-obstructive diuresis after posterior urethral valve treatment in neonates: a retrospective cohort study. Pediatr Nephrol 2024; 39:505-511. [PMID: 37656311 DOI: 10.1007/s00467-023-06100-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The management of posterior urethral valve (PUV) in neonates requires close monitoring in the intensive care unit because of the risk of post-obstructive diuresis (POD). Our aim was to describe the incidence and factors associated with POD in newborns treated for PUV. METHODS Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021. RESULTS Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg-1.h-1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137-246] vs. 95 [77-125] µmol.l-1; p < 0.001) and urea (8.5 [5.2-12.2] vs. 4.1 [3.5-4.7] mmol.l-1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively). CONCLUSIONS In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Victor Sartorius
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, Paris, France.
| | - Agnès Giuseppi
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Silvia Iacobelli
- Department of Neonatal and Pediatric Intensive Care, CHU La Réunion, Saint-Pierre, France
| | - Elise Leroy-Terquem
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Nicolas Vinit
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Laurence Heidet
- Université Paris Cité, Paris, France
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Diseases (MARHEA), AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Julien Stirnemann
- Université Paris Cité, Paris, France
- Department of Obstetrics and Fetal Medicine, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Lapillonne
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
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9
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Bidault-Jourdainne V, Botto N, Peycelon M, Carricaburu E, Lopez P, Bonnard A, Blanc T, El-Ghoneimi A, Paye-Jaouen A. Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study. J Pediatr Urol 2024:S1477-5131(24)00046-9. [PMID: 38310033 DOI: 10.1016/j.jpurol.2024.01.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques. OBJECTIVE To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS). STUDY DESIGN Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared. RESULTS A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques. DISCUSSION Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view. CONCLUSIONS This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.
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Affiliation(s)
- Valeska Bidault-Jourdainne
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France.
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Sorbonne Université, INSERM, Maladies génétiques d'expression pédiatrique, APHP, Hôpital d'Enfants Armand Trousseau, Paris, France; UMR INSERM 1141 NEURODEV, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
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10
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Esposito C, Blanc T, Di Mento C, Ballouhey Q, Fourcade L, Mendoza-Sagaon M, Chiodi A, Cardone R, Escolino M. Robotic-assisted surgery for gynecological indications in children and adolescents: European multicenter report. J Robot Surg 2024; 18:20. [PMID: 38217834 PMCID: PMC10787885 DOI: 10.1007/s11701-023-01767-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
Robotic-assisted surgery (RAS) is increasingly adopted in the pediatric population. This retrospective multicenter study aimed to report application of RAS for gynecological indications in pediatric patients. The medical records of all girls with gynecological pathology, operated in 4 different institutions over a 3-year period, were retrospectively collected. Robot docking time, total operative time, length of stay (LOS), requirement time of pain medication, complication rate, conversion rate, and pathology were analyzed. Twenty-three girls, with median age of 12.3 years (range 0.6-17.8) and median weight of 47.2 kg (range 9-73), received the following RAS procedures: ovarian cystectomy for ovarian cyst/mass (n = 10), salpingo-oophorectomy for ovarian complex mass (n = 6), bilateral gonadectomy for Turner syndrome SRY + (n = 1), salpingectomy for fallopian tube lesion (n = 1), paratubal cyst excision (n = 1), Gartner cyst excision (n = 1), paravaginal ganglioneuroma resection (n = 1), fistula closure in urogenital sinus (n = 1), and vaginoplasty using ileal flap in cloaca malformation (n = 1). Median operative time was 144.9 min (range 64-360), and median docking time was 17.3 min (range 7-50). Conversion to open or laparoscopy was not necessary in any case. Median LOS was 2.1 days (range 1-7), and median analgesic requirement was 2.2 days (range 1-6). One patient (4.3%) needed redo-surgery for recurrent Gartner cyst (Clavien 3b). This preliminary experience showed that RAS is safe and feasible for surgical treatment of gynecological pathology in pediatric patients, although no conclusive data are available to confirm its superiority over traditional laparoscopy. Randomized, prospective, comparative studies are needed to identify the gold standard approach for such indication.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Division, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Thomas Blanc
- Pediatric Surgery Division, Hôpital Necker-Enfants Malades, Paris, France
| | - Claudia Di Mento
- Pediatric Surgery Division, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Quentin Ballouhey
- Pediatric Surgery Division, University Hospital, CHU de Limoges, Limoges, France
| | - Laurent Fourcade
- Pediatric Surgery Division, University Hospital, CHU de Limoges, Limoges, France
| | - Mario Mendoza-Sagaon
- Pediatric Surgery Division, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Annalisa Chiodi
- Pediatric Surgery Division, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Roberto Cardone
- Pediatric Surgery Division, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Maria Escolino
- Pediatric Surgery Division, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
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11
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Taghavi K, Blanc T. Reply to Panagiotis Nikolinakos, Ivo Donkov, Joseph M. Norris, and Nikolaos Zavras's Letter to the Editor re: Aline Broch, Annabel Paye-Jaouen, Beatrice Bruneau, et al. Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible? Eur Urol Open Sci 2023;51:55-61. EUR UROL SUPPL 2024; 59:3-4. [PMID: 38298770 PMCID: PMC10829597 DOI: 10.1016/j.euros.2023.11.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Kiarash Taghavi
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Department of Paediatric Urology, Monash Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
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12
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Vinit N, Sarnacki S, Blanc T. Robotic-assisted laparoscopy in pediatric surgical oncology: a narrative review. Transl Pediatr 2023; 12:2256-2266. [PMID: 38197107 PMCID: PMC10772838 DOI: 10.21037/tp-23-251] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Objective Robotic surgical oncology in children calls for experienced surgeons in minimally invasive surgery (MIS) and a solid oncological background. The aim of this review was to analyze the current state of robotic-assisted laparoscopy in pediatric tumor resection, assess the necessary framework of minimally invasive surgical oncology and describe future developments of the robotic technology. Methods A literature search of the MEDLINE/PubMed database was conducted, using the terms "robotic surgery", "pediatric" or "children" and "oncology" or "tumor". All relevant English-language studies published between 2008 and 2022 were reviewed. Key Content and Findings Although concerns have been raised regarding the use of MIS in surgical oncology, current literature reports similar oncological outcome if surgeons comply with the oncologic principles. The benefits of MIS have been established for robotic surgery in adult studies, including a shorter time to adjuvant chemotherapy. Surgical feasibility should be assessed based on tumor characteristics, preoperative imaging focusing on vascular involvement and surgeon's experience until clear guidelines are issued. The difficulties in establishing eligibility criteria for robotic resection of pediatric tumors lie in the great variability of indications, heterogeneity in tumor histology with their own surgical specificities, and wide range of age and weight, as shown by the literature review we performed. Between 2008 and 2022, 31 studies reported 171 cases with three studies including at least ten patients. The most reported procedure was adrenalectomy (41 cases). Current research in pediatric surgical oncology focuses on intraoperative locoregional treatment, improved vision with fluorescence and dyed-loaded specific probes and the many possibilities of enhancement software using the robotic console. Conclusions The robotic technology allows the surgeon to push the boundaries of conventional laparoscopy. Specific surgical guidelines are necessary.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- UFR de Médecine, Université Paris Cité, Paris, France
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13
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Vinit N, Vatta F, Broch A, Hidalgo M, Kohaut J, Querciagrossa S, Couloigner V, Khen-Dunlop N, Botto N, Capito C, Sarnacki S, Blanc T. Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study. Ann Surg 2023; 278:e932-e938. [PMID: 36692109 DOI: 10.1097/sla.0000000000005808] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To report one-year morbidity of robotic-assisted laparoscopic surgery (RALS) in a dedicated, multidisciplinary, pediatric robotic surgery program. Summary Background Data. RALS in pediatric surgery is expanding, but data on morbidity in children is limited. METHODS All children who underwent RALS (Da Vinci Xi, Intuitive Surgical, USA) were prospectively included (October 2016 to May 2020; follow-up ≥1 year). Analyzed data: patient characteristics, surgical indication/procedure, intraoperative adverse events (ClassIntra classification), blood transfusion, hospital stay, postoperative complications (Clavien-Dindo). RESULTS Three hundred consecutive surgeries were included: urology/gynecology (n=105), digestive surgery (n=83), oncology (n=66), ENT surgery (n=28), thoracic surgery (n=18). Median age and weight at surgery were 9.5 [interquartile range (IQR)=8.8] years and 31 [IQR=29.3] kg, respectively. Over one year, 65 (22%) children presented with ≥1 complication, with Clavien-Dindo ≥III in 14/300 (5%) children at ≤30 days, 7/300 (2%) at 30-90 days, and 12/300 (4%) at >90 days. Perioperative transfusion was necessary in 15 (5%) children, mostly oncological (n=8). Eight (3%) robotic malfunctions were noted, one leading to conversion (laparotomy). Overall conversion rate was 4%. ASA ≥3, weight ≤15 kg, and surgical oncology did not significantly increase the conversion rate, complications, or intraoperative adverse events (ClassIntra ≥2). ASA score was significantly higher in children with complications (Clavien-Dindo ≥III) than without (p=0.01). Median hospital stay was 2 [IQR=3] days. Three children died after a median follow-up of 20 [IQR=16] months. CONCLUSIONS RALS is safe, even in the most vulnerable children with a wide scope of indications, age, and weight. Robot-specific complications or malfunctions are scarce.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Mary Hidalgo
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Stefania Querciagrossa
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
- Department of Pediatric ENT, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
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Franzini S, Querciagrossa S, Brebion M, Consonni D, Blanc T, Orliaguet G. Effect of retropneumoperitoneum on cerebral and renal oxygen saturation during retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) in a pediatric population: Preliminary results of a prospective observational study using a dedicated anesthetic protocol and Near-InfraRed Spectroscopy. Anaesth Crit Care Pain Med 2023; 42:101234. [PMID: 37121359 DOI: 10.1016/j.accpm.2023.101234] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) for ureteropelvic junction obstruction (UPJO) has gained growing acceptance among pediatric urologists, and is increasingly performed as day-case surgery, involving smaller children and infants. However, retroperitoneal CO2 insufflation may cause hemodynamic derangements, respiratory changes, and hypercapnia, whose consequences are poorly investigated. We, therefore, decided to prospectively study its effect on regional tissue perfusion and oxygenation in a cohort of pediatric patients undergoing R-RALP, using a dedicated anesthetic protocol and cerebral and renal Near InfraRed Spectroscopy (NIRS). MATERIAL AND METHODS Between January 2021 and September 2022, a cohort of 21 consecutive children [12 males (9 females), mean age of 7.1 ± 3.8 years and mean body weight of 25.7 ± 12.3 kg] underwent their first elective pyeloplasty for UPJO by R-RALP. The surgical procedure followed a previously described standardized technique and a dedicated anesthetic protocol. In conjunction with the minimal expected standard monitoring, cerebral and renal NIRS were added. Standard monitoring parameters and NIRS values were recorded at preset points throughout the procedures. RESULTS Standard monitoring and NIRS measurements during R-RALP were not adversely affected by CO2 insufflation, pending a significant increase in respiratory rate, aimed to avoid hypercapnia, while keeping the ventilation pressure within the safety range, preventing lung injury. CONCLUSIONS R-RALP, using a constant retroperitoneal CO2 insufflation pressure of 12 mmHg with a 5 L.min-1 flow, does not adversely affect respiratory and hemodynamics parameters, pending the implementation of a specifically designed anesthetic protocol aimed to prevent hypercapnia, the most threatening effect of retroperitoneal CO2 insufflation. CLINICAL TRIAL REGISTRATION NUMBER NCT03274050.
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Affiliation(s)
- Stefania Franzini
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre-Université Paris Cité, Paris, France.
| | - Stefania Querciagrossa
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre-Université Paris Cité, Paris, France
| | - Myriam Brebion
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre-Université Paris Cité, Paris, France
| | - Dario Consonni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Thomas Blanc
- Department of Pediatric Surgery, Necker-Enfants Malades University Hospital, AP-HP Centre-Université Paris Cité, Paris, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre-Université Paris Cité, Paris, France; Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Unité de recherche EA 7323, Hôpitaux Universitaires Paris Centre - Site Tarnier, Université Paris Cité, Paris 75006, France
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15
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Semeraro M, Fouquet C, Vial Y, Amiel J, Galmiche L, Cretolle C, Blanc T, Jolaine V, Garcelon N, Entz-Werle N, Pellier I, Vérité C, Sophie Taque, Coulomb A, Petit A, Corradini N, Bouazza N, Lacour B, Clavel J, Brugières L, Bourdeaut F, Sarnacki S. Pediatric Tumors and Developmental Anomalies: A French Nationwide Cohort Study. J Pediatr 2023; 259:113451. [PMID: 37169337 DOI: 10.1016/j.jpeds.2023.113451] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/17/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To assess the associations between congenital abnormalities and pediatric malignancies and evaluate the potential underlying molecular basis by collecting information on pediatric patients with cancer and congenital abnormalities. STUDY DESIGN Tumeur Et Développement is a national, prospective, and retrospective multicenter study recording data of children with cancer and congenital abnormalities. When feasible, blood and tumoral samples are collected for virtual biobanking. RESULTS From June 2013 to December 2019, 679 associations between pediatric cancers and congenital abnormalities were recorded. The most represented cancers were central nervous system tumors (n = 139; 20%), leukemia and myelodysplastic syndromes (n = 123; 18.1%), and renal tumors (n = 101; 15%). Congenital abnormalities were not related to any known genetic disorder in 66.5% of cases. In this group, the most common anomaly was intellectual disability (22.3%), followed by musculoskeletal (14.2%) and genitourinary anomalies (12.4%). Intellectual disability was mostly associated with hematologic malignancies. Embryonic tumors (neuroblastoma, Wilms tumor, and rhabdomyosarcoma) were associated with consistent abnormalities, sometimes with a close anatomical neighborhood between the abnormality and the neoplasm. CONCLUSIONS In the first Tumeur Et Développement analysis, 3 major themes have been identified: (1) germline mutations with or without known cancer predisposition, (2) postzygotic events responsible for genomic mosaicism, (3) coincidental associations. New pathways involved in cancer development need to be investigated to improve our understanding of childhood cancers.
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Affiliation(s)
- Michaela Semeraro
- Centre d'Investigation Clinique-Unité de Recherche Clinique, Hôpital Universitaire Necker Enfants-Malades, AP-HP Centre - Université Paris Cité, Paris, France; Université de Paris Cité, Paris, France; Equipe d'Accueil 7323, Université de Paris, Paris, France.
| | - Cyrielle Fouquet
- Départment de Pédiatrie, Unité d'onco-hématologie pédiatrique, Hôpital Pellegrin, Bordeaux, France
| | - Yoann Vial
- Université de Paris Cité, Paris, France; Département de génétique, CHU Paris-Hôpital Robert Debré, Paris, France
| | - Jeanne Amiel
- Université de Paris Cité, Paris, France; Laboratoire 408 Embryologie et génétique des malformations, INSERM UMR-1163, Institut Imagine, Paris, France
| | - Louise Galmiche
- Départment de Pédiatrie, Service Anatomie Pathologique, Hôpital Necker Enfants Malades, Paris, France
| | - Célia Cretolle
- Départment de Pédiatrie, Service de Chirurgie viscérale pédiatrique, Hôpital Universitaire Necker Enfants-Malades, GH Paris Centre, Paris, France
| | - Thomas Blanc
- Université de Paris Cité, Paris, France; Départment de Pédiatrie, Service de Chirurgie viscérale pédiatrique, Hôpital Universitaire Necker Enfants-Malades, GH Paris Centre, Paris, France
| | - Valérie Jolaine
- Centre d'Investigation Clinique-Unité de Recherche Clinique, Hôpital Universitaire Necker Enfants-Malades, AP-HP Centre - Université Paris Cité, Paris, France
| | - Nicolas Garcelon
- Départment de Pédiatrie, UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Natacha Entz-Werle
- Départment de Pédiatrie, CHRU Hautepierre Strasbourg, Service de Pédiatrie Onco-Hématologie, Strasbourg, France
| | - Isabelle Pellier
- Hematology-Oncology-Immunology Department, CHU Angers, Angers, France
| | - Cécile Vérité
- Départment de Pédiatrie, Unité d'onco-hématologie pédiatrique, Hôpital Pellegrin, Bordeaux, France
| | - Sophie Taque
- Départment de Pédiatrie, Hôpital Universitaire de Rennes, Rennes, France
| | - Aurore Coulomb
- Department of Pathology, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Arnaud Petit
- Department of Onco-Haematology, AP-HP, Armand Trousseau Hospital, Paris, France
| | - Nadège Corradini
- Department of Pediatric Oncology, Institut d'hématologie et d'oncologie pédiatrique, Lyon, France
| | - Naim Bouazza
- Université de Paris Cité, Paris, France; Clinical Research Unit, Tarnier Hospital, Paris, France
| | - Brigitte Lacour
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - Jacqueline Clavel
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - Laurence Brugières
- Child and Adolescent Cancer Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Franck Bourdeaut
- Université de Paris Cité, Paris, France; Laboratoire de Recherche Translationnelle en Oncologie Pédiatrique, INSERM U830, Institut Curie, Paris, France
| | - Sabine Sarnacki
- Université de Paris Cité, Paris, France; Départment de Pédiatrie, Service de Chirurgie viscérale pédiatrique, Hôpital Universitaire Necker Enfants-Malades, GH Paris Centre, Paris, France
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Vinit N, Glénisson M, Chalouhi G, Salomon LJ, Millischer-Bellaiche AE, Beaudoin S, Blanc T. Prenatal diagnosis of unusual variant of exstrophy-epispadias complex. Ultrasound Obstet Gynecol 2023; 62:155-156. [PMID: 36704969 DOI: 10.1002/uog.26166] [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] [Received: 11/01/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 06/06/2023]
Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - M Glénisson
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - G Chalouhi
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - L J Salomon
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - A-E Millischer-Bellaiche
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - S Beaudoin
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Cité, Paris, France
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17
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Broch A, Paye-Jaouen A, Bruneau B, Glenisson M, Taghavi K, Botto N, Goulin J, Lopez P, Querciagrossa S, El Ghoneimi A, Dahmani S, Hidalgo M, Blanc T. Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible? EUR UROL SUPPL 2023; 51:55-61. [PMID: 37187722 PMCID: PMC10175732 DOI: 10.1016/j.euros.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Background Robot-assisted pyeloplasty is the most frequently performed robotic procedure in children. A retroperitoneal approach limits surgical trauma and avoids peritoneal irritation. This led to the establishment of the criteria for day surgery (DS) and a related clinical care pathway. Objective To assess the feasibility and safety of DS in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty (R-RALP). Design setting and participants We performed a bicentric prospective study (NCT03274050) over 2 yr involving the two major paediatric urology teaching hospitals in Paris. A clinical pathway and a prospective research protocol were specifically established. Intervention DS in selected children undergoing R-RALP. Outcome measurements and statistical analysis The primary outcomes were DS failure, 30-d complications, and readmission rates. The secondary outcomes included preoperative characteristics, perioperative parameters, and surgical outcomes. Quantitative variables were expressed as medians with interquartile ranges. Results and limitations Thirty-two children fulfilled specific inclusion criteria and were consecutively selected for DS following R-RALP. The median patient age was 7.6 yr (4.1-11.8) and weight 25 kg (14-45). The median console time was 137 min (108-167). There were no intraoperative complications or conversions. Six children were kept under observation overnight and discharged the following day due to persistent pain (n = 3), parental anxiety (n = 2), or a prolonged procedure (n = 1). The median duration of hospital stay of the 26 children in the DS setting was 12.7 h (12.2-13.2). During the 30-d period, there were four emergency room visits (15%) resulting in two patients requiring readmission (8%): one for febrile urinary tract infection (Clavien-Dindo II) and one child with no JJ stent for urinoma (Clavien-Dindo IIIb). Radiological studies confirmed improvement in dilatation for all cases with no recurrence (median follow-up: 15 mo). Conclusions This prospective case series is the first to demonstrate the feasibility and safety of DS in children undergoing R-RALP, obviating the need for routine inpatient care. Excellent results can be achieved by careful patient selection, a clear clinical pathway, and a dedicated team. Further evaluation is warranted to assess the cost effectiveness. Patient summary This study shows that day surgery after robotic pyeloplasty is both safe and effective in selected children.
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18
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Vinit N, Ville Y, Blanc T. [In utero surgery for lower urinary tract obstruction]. Med Sci (Paris) 2023; 39:227-233. [PMID: 36943119 DOI: 10.1051/medsci/2023030] [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] [Indexed: 03/23/2023] Open
Abstract
Prenatal therapy for LUTO (Lower Urinary Tract Obstruction) is debated due to mixed results regarding postnatal renal function following fetal cystoscopy or vesicoamniotic shunting. Current literature is, however, limited by the inability to determine the cause of the obstruction using plain sonography and the lack of selection criteria for fetuses who may benefit from prenatal therapy. Fetal cystoscopy may serve as a diagnostic tool and would offer a more "physiologic" treatment for bladder outlet obstruction. However, it carries additional technical issues due to inappropriate instrumentation.
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Affiliation(s)
- Nicolas Vinit
- Service de chirurgie viscérale et urologie pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France - UFR de médecine Paris Centre, université Paris Cité, Paris, France
| | - Yves Ville
- Service d'obstétrique, médecine et chirurgie fœtale, Hôpital Necker-Enfants Malades, AP-HP, 149 rue des Sèvres, 75015 Paris, France - UFR de médecine Paris Centre, université Paris Cité, Paris, France
| | - Thomas Blanc
- Service de chirurgie viscérale et urologie pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France - UFR de médecine Paris Centre, université Paris Cité, Paris, France
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Vibert R, Lahlou-Laforêt K, Samadi M, Krivosic V, Blanc T, Amar L, Burnichon N, Abadie C, Richard S, Gimenez-Roqueplo AP. Minors at risk of von Hippel-Lindau disease: 10 years' experience of predictive genetic testing and follow-up adherence. Eur J Hum Genet 2022; 30:1171-1177. [PMID: 35918537 PMCID: PMC9553881 DOI: 10.1038/s41431-022-01157-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/08/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022] Open
Abstract
Von Hippel-Lindau (VHL) disease is one of the most common cancer predisposition syndromes. Penetrance is high with around 20% of children presenting detectable and curable manifestations of the disease at 15 years old. VHL predictive genetic testing (PGT) is recommended during childhood from age 5 years in France. Insufficient compliance to surveillance of VHL pathogenic variant (PV) carriers is associated with severe outcome. PGT experienced by children and their parents is probably critical in influencing future acceptance of the result and adherence to surveillance. We conducted a retrospective study on minors tested (aged 5 to 16 years old) from 2010 to 2020, in a multidisciplinary oncogenetics consultation which follows a 3-step protocol based on psychological familial support. The objectives were to assess the adherence to follow-up within the National Expert Center for inherited predispositions to renal tumors (PREDIR) network of VHL PV carriers and its benefit through tumor detection and medical interventions. A VHL PGT was carried out in 34 children. Among the 16 children diagnosed as VHL PV carriers addressed to the PREDIR network, none had discontinued surveillance after a median of 41 months. Follow-up examinations detected 11 tumors in 6 children, 4 have been surgically treated. All had a favorable outcome. Our data suggest that a specific and adapted procedure for PGT in at-risk VHL children as well as a follow-up, organized within a specialized expert network, fosters a complete adherence to the surveillance protocol and thus lead to a favorable clinical outcome.
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Affiliation(s)
- Roseline Vibert
- Département de Médecine Génomique des Tumeurs et Cancers/UF Oncogénétique Tumeurs et Cancers Rares, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France
| | - Khadija Lahlou-Laforêt
- Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, F-75015, Paris, France
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Maryam Samadi
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Valérie Krivosic
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Service d'Ophtalmologie, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Thomas Blanc
- Service de Chirurgie Viscérale et Urologie Pédiatrique, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - Laurence Amar
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Service d'Hypertension Artérielle, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Nelly Burnichon
- Département de Médecine Génomique des Tumeurs et Cancers/UF Oncogénétique Tumeurs et Cancers Rares, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Caroline Abadie
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Unité d'Oncogénétique, Institut de Cancérologie de l'Ouest, F-44800, Saint-Herblain, France
| | - Stéphane Richard
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- EPHE, PSL Université, 75015 Paris, and CNRS UMR 9019, Gustave Roussy, Université Paris-Saclay, 94800, Villejuif, France
| | - Anne-Paule Gimenez-Roqueplo
- Département de Médecine Génomique des Tumeurs et Cancers/UF Oncogénétique Tumeurs et Cancers Rares, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France.
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France.
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
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Valades-Cruz CA, Leconte L, Fouche G, Blanc T, Van Hille N, Fournier K, Laurent T, Gallean B, Deslandes F, Hajj B, Faure E, Argelaguet F, Trubuil A, Isenberg T, Masson JB, Salamero J, Kervrann C. Challenges of intracellular visualization using virtual and augmented reality. Front Bioinform 2022; 2:997082. [PMID: 36304296 PMCID: PMC9580941 DOI: 10.3389/fbinf.2022.997082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Microscopy image observation is commonly performed on 2D screens, which limits human capacities to grasp volumetric, complex, and discrete biological dynamics. With the massive production of multidimensional images (3D + time, multi-channels) and derived images (e.g., restored images, segmentation maps, and object tracks), scientists need appropriate visualization and navigation methods to better apprehend the amount of information in their content. New modes of visualization have emerged, including virtual reality (VR)/augmented reality (AR) approaches which should allow more accurate analysis and exploration of large time series of volumetric images, such as those produced by the latest 3D + time fluorescence microscopy. They include integrated algorithms that allow researchers to interactively explore complex spatiotemporal objects at the scale of single cells or multicellular systems, almost in a real time manner. In practice, however, immersion of the user within 3D + time microscopy data represents both a paradigm shift in human-image interaction and an acculturation challenge, for the concerned community. To promote a broader adoption of these approaches by biologists, further dialogue is needed between the bioimaging community and the VR&AR developers.
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Affiliation(s)
- Cesar Augusto Valades-Cruz
- SERPICO Project Team, Inria Centre Rennes-Bretagne Atlantique, Rennes, France
- SERPICO/STED Team, UMR144 CNRS Institut Curie, PSL Research University, Sorbonne Universites, Paris, France
| | - Ludovic Leconte
- SERPICO Project Team, Inria Centre Rennes-Bretagne Atlantique, Rennes, France
- SERPICO/STED Team, UMR144 CNRS Institut Curie, PSL Research University, Sorbonne Universites, Paris, France
| | - Gwendal Fouche
- SERPICO Project Team, Inria Centre Rennes-Bretagne Atlantique, Rennes, France
- SERPICO/STED Team, UMR144 CNRS Institut Curie, PSL Research University, Sorbonne Universites, Paris, France
- Inria, CNRS, IRISA, University Rennes, Rennes, France
| | - Thomas Blanc
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, Sorbonne Universites, CNRS UMR168, Paris, France
| | | | - Kevin Fournier
- SERPICO Project Team, Inria Centre Rennes-Bretagne Atlantique, Rennes, France
- SERPICO/STED Team, UMR144 CNRS Institut Curie, PSL Research University, Sorbonne Universites, Paris, France
- Inria, CNRS, IRISA, University Rennes, Rennes, France
| | - Tao Laurent
- LIRMM, Université Montpellier, CNRS, Montpellier, France
| | | | | | - Bassam Hajj
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, Sorbonne Universites, CNRS UMR168, Paris, France
| | - Emmanuel Faure
- LIRMM, Université Montpellier, CNRS, Montpellier, France
| | | | - Alain Trubuil
- MaIAGE, INRAE, Université Paris-Saclay, Jouy-en-Josas, France
| | | | - Jean-Baptiste Masson
- Decision and Bayesian Computation, Neuroscience and Computational Biology Departments, CNRS UMR 3571, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jean Salamero
- SERPICO Project Team, Inria Centre Rennes-Bretagne Atlantique, Rennes, France
- SERPICO/STED Team, UMR144 CNRS Institut Curie, PSL Research University, Sorbonne Universites, Paris, France
| | - Charles Kervrann
- SERPICO Project Team, Inria Centre Rennes-Bretagne Atlantique, Rennes, France
- SERPICO/STED Team, UMR144 CNRS Institut Curie, PSL Research University, Sorbonne Universites, Paris, France
- *Correspondence: Charles Kervrann,
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21
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Esposito C, Blanc T, Lardy H, Masieri L, Fourcade L, Mendoza-Sagaon M, Nappo S, Lopez M, Pelizzo G, Steyaert H, Gamba P, Scuderi MG, Escolino M, Castagnetti M, Chiarenza F, Ghoneimi AE. Robotic Surgery in Pediatric Urology: A Critical Appraisal of the GECI and SIVI Consensus of European Experts. J Laparoendosc Adv Surg Tech A 2022; 32:1108-1113. [PMID: 35796702 DOI: 10.1089/lap.2021.0837] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: This study aimed to create a consensus statement on the indications, applications, and limitations of robotics in pediatric urology. Methods: After a panel and interactive discussion focused on pediatric robotics, a televoting with 10 questions was administered to 100 pediatric surgeons/urologists attending the joint meeting of the French Group of Pediatric Laparoscopy (GECI)/Italian Society of Videosurgery in Infancy (SIVI) in 2021. The results of televoting were analyzed electronically using Mentometer software. Results: Ninety-four percent of participants stated that the cutoff weight for robotics should be >10-15 kg. A minimum of 20-30 procedures should be performed to become confident in robotics (74%). Pediatric urology is the main field of application (73%) and pyeloplasty is the best indication for robotics (63%). Technical problems may happen intraoperatively in 1/10-15 cases (64%). The mean duration of robotic procedures ranges from 150 to 200 minutes (72%). The main drawbacks of robotics are high costs and limited development of miniaturized instruments (74%). Ninety-five percent believed that the costs of robotics may significantly drop with the availability of more robotic brands. The main advantages of robotics over laparoscopy include improved dexterity, easier suturing, and better ergonomics (100%), whereas the main disadvantage of sharing the robot with other specialties is the wearing out of instruments (100%). Conclusions: This is the first consensus statement, endorsed by the GECI and SIVI societies, on the use of robotics in pediatric urology. The need to introduce more robotic brands on the market to lower the costs and to develop miniaturized instruments to be adopted in infants less than 10 kg emerged. Pediatric urology is the main field of application of pediatric robotics, and robotic pyeloplasty is the most common procedure performed. Proctorship is needed for the first 20-30 procedures and technical problems may occur intraoperatively in 1/10-15 cases. The main advantages of robotics over laparoscopy are improved dexterity, easier suturing, and better surgeon ergonomics.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Thomas Blanc
- Division of Pediatric Surgery, Hôpital Necker Enfants Malades, Paris, France
| | - Hubert Lardy
- Division of Pediatric Surgery, CHU-Centre de Pédiatrie de Clocheville, Tours, France
| | - Lorenzo Masieri
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - Laurent Fourcade
- Division of Pediatric Surgery, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Mario Mendoza-Sagaon
- Division of Pediatric Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Simona Nappo
- Division of Pediatric Urology, Regina Margherita Hospital, Turin, Italy
| | - Manuel Lopez
- Division of Pediatric Surgery, Val d'Hebron Maternity and Children's Hospital, Barcelona, Spain
| | - Gloria Pelizzo
- Division of Pediatric Surgery, Buzzi Children Hospital, Milan, Italy
| | - Henri Steyaert
- Division of Pediatric Surgery, Huderf Children's Hospital, Brussels, Belgium
| | - Piergiorgio Gamba
- Division of Pediatric Surgery, Medical University of Padua, Padua, Italy
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Bambin Gesù Children Hospital, Rome, Italy
| | - Fabio Chiarenza
- Division of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
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Blanc T, Abbo O, Vatta F, Grosman J, Marquant F, Elie C, Juricic M, Laraqui S, Broch A, Arnaud A. Transperitoneal Versus Retroperitoneal Robotic-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children. A Multicentre, Prospective Study. EUR UROL SUPPL 2022; 41:134-140. [PMID: 35813254 PMCID: PMC9257661 DOI: 10.1016/j.euros.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/27/2022] Open
Abstract
Background Robotic-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among paediatric urologists. Objective To compare surgical variables and clinical outcomes, including complications and success rate, with RALP using the transperitoneal (T-RALP) and retroperitoneal (R-RALP) approaches. Design, setting, and participants We performed a multicentre, prospective, cohort study (NCT03274050) between November 2016 and October 2021 in three paediatric urology teaching centres (transperitoneal approach, n = 2; retroperitoneal approach, n = 1). The diagnosis of ureteropelvic junction obstruction (UPJO) was confirmed by renal ultrasound and mercaptoacetyltriglycine-3 renal scan or uro–magnetic resonance imaging with functional evaluation. The exclusion criteria were children <2 yr old, persistent UPJO after failed pyeloplasty, and horseshoe and ectopic kidney. Intervention We performed dismembered pyeloplasty using running monofilament 6-0 absorbable suture. Outcome measurements and statistical analysis We assessed intra- and postoperative morbidity (primary outcome) and success (secondary outcome). Data were expressed as medians and interquartile range (25th and 75th percentiles) for quantitative variables, and analysed comparatively. Results and limitations We operated on 106 children (T-RALP, n = 53; R-RALP, n = 53). Preoperative data were comparable between groups (median age 9.1 [6.2–11.2] yr; median weight 26.8 [21–40] kg). Set-up time (10 vs 31 min), anastomotic time (49 vs 73 min), and console time (97 vs 153 min) were significantly shorter with T-RALP than with R-RALP (p < 0.001). No intraoperative complications occurred. No conversion to open surgery was necessary. The median hospital stay was longer after T-RALP (2 d) than after R-RALP (1 d; p < 0.001). Overall, postoperative complication rates were similar. No failure had occurred at the mean follow-up of 25.4 (15.1–34.7) mo. Conclusions In selected children, RALP is safe and effective using either the transperitoneal or the retroperitoneal approach, with a shorter hospital stay after R-RALP. Patient summary In our multicentre, prospective study, we compared the results and complications of robotic-assisted laparoscopic pyeloplasty (RALP) using the transperitoneal and retroperitoneal approaches. We found that RALP is safe and effective using either approach, with a shorter hospital stay after R-RALP.
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Grapin M, Berteloot L, Berthaud R, Temmam S, Blanc T, Charbit M, Pastural M, Eloit M, Sermet-Gaudelus I, Dehoux L, Boyer O. MO1039: 1-Year Follow-Up Data of Arterial Abnormalities Identified in Kidneys Transplanted into Children During the First Covid-19 Pandemic Wave. Nephrol Dial Transplant 2022. [PMCID: PMC9383796 DOI: 10.1093/ndt/gfac089.016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND AIMS Graft artery stenosis can have a significant short- and long-term negative impact on kidney graft function. We previously reported an unusual number of graft-arterial anomalies following kidney transplantation (KTx) in children during the first coronavirus disease (COVID-19) pandemic wave (Berteloot et al.) [1]. We report herein the 1-year follow-up of these patients. METHOD In this retrospective study, we included all children who received a KTx at our centre from February to July 2020. We compared their outcome to that of paediatric recipients who were transplanted at our centre from 2015 to 2019 and presented an allograft vascular complication (‘Historic’ group) by querying our local data warehouse. RESULTS Among the 9 children who received a KTx at our centre between February and July 2020 [8 boys, median age 10 years (3–17)], 8 presented Doppler features suggesting arterial stenosis, with an unusual extensive pattern (Figure 1) after a median delay of 13 days (8–113). For comparison, persistent spectral Doppler arterial anomalies were observed in only 5% of children following KTx at our centre over the previous 5-year period and were all focal anastomotic stenoses. In addition, five children had lymphoceles, which required surgical management as compared to only one patient in the 5 previous years (1%). We retrospectively diagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20 infection in 6/8 children with arterial stenosis on serologies performed at D0, including one boy with a history of positive real time reverse transcription-polymerase chain reaction (RT-PCR) 120 days before KTx. None of the patients had reported any symptom suggestive of COVID-19. The remaining two patients had received a graft from an asymptomatic deceased adolescent donor with a positive serology at D0. These data led us to suspect immune post-viral graft vasculitis, triggered by SARS-CoV-2. At 1-year post-transplantation, the outcome was favourable in the 8 isolated KTx recipients. A total of 4/8 children had normal blood pressure and 4 had controlled high blood pressure on mono or bi-therapy. Doppler anomalies had resolved in 5/8 and persisted in 3/8 with a trend for improvement of peak systolic velocities and no severe consequences on kidney function and histology. Indeed, the median glomerular filtration rate (GFR) was 91 mL/min/1.73 m² (65–129), with unspecific and mild lesions on 4/8 protocol kidney biopsies (IFTA 1 or Cpt 1). One liver-kidney graft recipient had persistent hypertension and diffuse irregular inflammatory parietal thickening of the whole vascular graft associated with a parietal thrombus upstream of the birth of the two hepatic arteries (Figure 2); treated with anti-aggregation and prednisone 10 mg/d. CONCLUSION Our case series suggests a risk of post-viral kidney graft vasculitis in children with recent SARS-CoV-2 infection in the recipient or donor. Pre-transplant vaccination against COVID-19 is mandatory in children > 5 years and their kidney donor candidates at our centre. We also strongly recommend vaccination of all people aged > 5 years in the household.
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Affiliation(s)
- Mathilde Grapin
- Necker Hospital, Imagine Institute, Paris University, Paediatric nephrology, Paris, France
| | - Laureline Berteloot
- Necker Hospital, Imagine Institute, Paris University, Paediatric Radiology, Paris, France
| | - Romain Berthaud
- Necker Hospital, Imagine Institute, Paris University, Paediatric nephrology, Paris, France
| | - Sarah Temmam
- Pasteur Institute, Pathogen Discovery Lab, Paris, France
| | - Thomas Blanc
- Necker Hospital, Imagine Institute, Paris University, Paediatric Urology, Paris, France
| | - Marina Charbit
- Necker Hospital, Imagine Institute, Paris University, Paediatric nephrology, Paris, France
| | | | - Marc Eloit
- Pasteur Institute, Pathogen Discovery Lab, Paris, France
| | | | - Laurène Dehoux
- Necker Hospital, Imagine Institute, Paris University, Paediatric nephrology, Paris, France
| | - Olivia Boyer
- Necker Hospital, Imagine Institute, Paris University, Paediatric nephrology, Paris, France
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Marret JB, Blanc T, Balaton A, La Vignera S, Zanghì G, Lottmann HB, Bagnara V. Symptomatic Parapelvic Cysts in Children: Anatomical and Histological Features, Diagnostic Pitfalls and Urological Management. J Clin Med 2022; 11:jcm11072035. [PMID: 35407642 PMCID: PMC9000015 DOI: 10.3390/jcm11072035] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Symptomatic parapelvic cysts (PPC) are rare entities. Our objective is to highlight specific features of PPC to avoid a misdiagnosis of UPJ obstruction. Methods: We retrospectively reviewed the records of children managed between 2012–2017. Results: All four patients (18 months–8 years) presented with acute renal colic with a large intra-sinusal liquid mass (42–85 mm) on ultrasound, evoking a diagnosis of UPJ obstruction. On preoperative renal scintigraphy (n = 3) there was no dilatation of the renal pelvis and ipsilateral differential function was impaired in 2. Diagnosis of PPC was suspected preoperatively in three children (CT scan (n = 1); MRI (n = 2)) and made peri-operatively (n = 1). Preoperative retrograde pyelography (n = 3) and a further intraoperative retrograde pyelography with methylene blue (n = 1) did not identify communication with the cyst. No renal pelvis was identified in two patients. De-roofing of the cyst was curative in all cases at 5 years mean follow-up (no leakage, cyst recurrence or loss of function) and all 4 patients became asymptomatic after surgery. Histology demonstrated a single flat epithelial cell layer. Renal function normalized in one patient but remained impaired in the other. Conclusion: In case of symptoms of UPJ obstruction with a medial renal liquid mass on ultrasound, PPC should be considered when no dilatated pelvis on renal scan is identified. In such cases, a complementary imaging work-up is mandatory prior to surgery.
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Affiliation(s)
- Jean-Baptiste Marret
- Department of Paediatric Surgery and Urology, Hôpital Necker Enfants Malades, APHP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France; (J.-B.M.); (T.B.); (H.B.L.)
| | - Thomas Blanc
- Department of Paediatric Surgery and Urology, Hôpital Necker Enfants Malades, APHP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France; (J.-B.M.); (T.B.); (H.B.L.)
- Mechanisms and Therapeutic Strategies of Chronic Kidney Disease, INSERM U1151-CNRS UMR 8253, Institut Necker Enfants Malades, Département “Croissance et Signalisation”, Hôpital Necker Enfants Malades, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France
| | - Andre Balaton
- Department of Pathology, Praxea Diagnostics, 1 Rue Galvani, 91300 Massy, France;
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Guido Zanghì
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Henri Bernard Lottmann
- Department of Paediatric Surgery and Urology, Hôpital Necker Enfants Malades, APHP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France; (J.-B.M.); (T.B.); (H.B.L.)
| | - Vincenzo Bagnara
- Department of Paediatric Surgery, Policlinico “G.B. Morgagni”, Via Del Bosco 105, 95125 Catania, Italy;
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Brönnimann E, Alova I, Vatta F, Blanc T, Lottmann H. What makes the bladder neck sling procedure a success in a selected population of children and adolescents? A STROBE-compliant investigation. J Pediatr Urol 2022; 18:187-195. [PMID: 35135726 DOI: 10.1016/j.jpurol.2022.01.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Achievement of continence in children suffering from neurogenic bladder dysfunction or severe urogenital malformation is of fundamental importance to the wellbeing of affected children and their families. A valid approach to treating incontinence with hypoactive sphincter is the placement of a bladder neck sling thus increasing outlet resistance of the bladder. OBJECTIVES In this retrospective study in children and adolescents, we aimed to assess the outcome of bladder neck sling procedures conducted at our institution. In addition, we aimed to identify predictors of the successful correction of incontinence. PATIENTS AND METHODS We treated 36 patients (25 girls, 11 boys, aged 5.0-19.7 years). In total, 32 (88.9%) patients suffered from neurogenic incontinence. Overall, 16 patients had previously received unsuccessful injection of bulking agent into the bladder neck. For the bladder neck sling, we used a fascial strip of rectus abdominis muscle (n = 29), detrusor muscle (n = 6), or combined fascial and detrusor strip (n = 1). In 8 (22.2%) patients, the surgical procedure involved wrapping the strip around the bladder neck, while in 6 (16.7%) patients, the bladder neck was suspended with the sling. In 22 (61.1%) patients, the two techniques were combined. Overall, 22 (61.1%) and 9 (25.0%) patients additionally underwent enterocystoplasty or detrusorotomy, respectively. We assessed urinary continence of our patients after 3-6 months (first evaluation) and ≥12 months (final evaluation). We classified the state of continence as 'dry' (dry for >3 h between catheterizations and dry at night), 'significantly improved' (minimal incontinence, no more than one protective pad per day, interval of at least 3 h between catheterizations, dry at night, and no demand for additional treatment), or 'wet'. Bladder neck sling treatment was considered successful if the patient was rated as 'dry' or 'significantly improved'. RESULTS At the first evaluation, the bladder neck sling procedure proved successful in 19 (52.8%) patients. Enterocystoplasty significantly increased the success rate compared to detrusorotomy or no bladder augmentation (68.1% vs. 28.6%; p = 0.04). The remaining 17 patients who were still classified as wet after bladder neck sling placement subsequently underwent one or more additional interventions, i.e. implant injection (n = 11), bladder augmentation (n = 10), and/or sling replacement (n = 5). At the final evaluation after a median follow-up of 64.5 months (range, 12-181 months), continence without sling replacement was achieved in 29 (80.6%) of the 36 patients. CONCLUSION In our study population, bladder neck sling placement achieved good results in the treatment of severe organic urinary incontinence with hypoactive sphincter. To optimize treatment outcome, bladder neck sling placement should be combined with enterocystoplasty.
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Affiliation(s)
- Enrico Brönnimann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France; University Center of Pediatric Surgery of Western Switzerland, Division of Child and Adolescent Surgery, Department of Women, Child and Adolescent, Geneva University Hospitals, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
| | - Ilona Alova
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Henri Lottmann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
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Bronnimann E, Alova I, Vatta F, Blanc T, Lottmann H. Response to commentary 2 'what makes the bladder neck sling procedure a success in a selected population of children and adolescents? A STROBE-compliant investigation'. J Pediatr Urol 2022; 18:201. [PMID: 35307336 DOI: 10.1016/j.jpurol.2022.02.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Enrico Bronnimann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France; University Center of Pediatric Surgery of Western Switzerland, Division of Child and Adolescent Surgery, Department of Women, Child and Adolescent, Geneva University Hospitals, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
| | - Ilona Alova
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Paris, France.
| | - Henri Lottmann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, 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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28
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Brönnimann E, Alova I, Vatta F, Blanc T, Lottmann H. Response to commentary re 'What makes the bladder neck sling procedure a success in a selected population of children and adolescents? A STROBE-compliant investigation'. J Pediatr Urol 2022; 18:198. [PMID: 35260359 DOI: 10.1016/j.jpurol.2022.02.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Enrico Brönnimann
- Division of Child and Adolescent Surgery, Department of Women, Child and Adolescent, Geneva University Hospitals, Rue Willy-Donzé 6, 1205, Genève, Switzerland.
| | - Ilona Alova
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, 149 Rue de Sèvre, 75015, Paris, France.
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, 149 Rue de Sèvre, 75015, Paris, France.
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, 149 Rue de Sèvre, 75015, Paris, France.
| | - Henri Lottmann
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, 149 Rue de Sèvre, 75015, Paris, France.
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Ferrero PA, Blanc T, Binet A, Arnaud A, Abbo O, Vatta F, Bonnard A, Spampinato G, Lardy H, Fourcade L, Ballouhey Q. The Potential and the Limitations of Esophageal Robotic Surgery in Children. Eur J Pediatr Surg 2022; 32:170-176. [PMID: 33378777 DOI: 10.1055/s-0040-1721770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There have been numerous reports of robotic pediatric surgery in the literature, particularly regarding urological procedures for school-aged children. Thoracic procedures appear to be less common, despite the fact that encouraging results were reported more than 10 years. Our aim was to report a national experience of esophageal robotic-assisted thoracoscopic surgery (ERATS) and to discuss the most appropriate indications. MATERIALS AND METHODS A retrospective multicenter study was conducted to compile the ERATS performed at five French surgical centers that have been involved in spearheading robotic pediatric surgery over the past 15 years. The data were supplemented by a review of the literature. RESULTS Over the study period, 68 cases of robotic thoracic surgery were performed at the five pediatric centers in question. ERATS was performed for 18 patients (mean age 7.1 years [ ± 5.6]) in four of the centers. These comprised seven esophageal duplications, four esophageal atresias, five Heller's myotomies, and two cases of esophagoplasty. A conversion was needed for two neonates (11%) due to exposure difficulties. Four other procedures for patients who weighed less than 15 kg were successfully completed without causing postoperative complications. In the past 12 years, 22 other cases of ERATS were published worldwide. The indications were the same, except for esophagoplasty, which was not found. CONCLUSION Aside from accessibility issues with the robotic platform, the main limitation is still very much that the low body weight of children results in incompatibility between the size of the trocars and the size of the intercostal space. ERATS is clearly a feasible procedure with technical advantages for most pediatric cases with body weights more than 15 kg. A transdiaphragmatic abdominal approach should be considered for lower esophagus surgery.
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Affiliation(s)
| | - Thomas Blanc
- Department of Pediatric Surgery, Hôpital Universitaire Necker-Enfants malades, Paris, Île-de-France, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre Region, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Olivier Abbo
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery, Necker-Enfants Malades Hospitals, Paris, Île-de-France, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Grazia Spampinato
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre Region, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
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30
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Morin G, Degrugillier-Chopinet C, Vincent M, Fraissenon A, Aubert H, Chapelle C, Hoguin C, Dubos F, Catteau B, Petit F, Mezel A, Domanski O, Herbreteau G, Alesandrini M, Boddaert N, Boutry N, Broissand C, Han TK, Branle F, Sarnacki S, Blanc T, Guibaud L, Canaud G. Treatment of two infants with PIK3CA-related overgrowth spectrum by alpelisib. J Exp Med 2022; 219:212982. [PMID: 35080595 PMCID: PMC8932545 DOI: 10.1084/jem.20212148] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/25/2021] [Accepted: 01/03/2022] [Indexed: 12/04/2022] Open
Abstract
PIK3CA-related overgrowth spectrum (PROS) includes rare genetic conditions due to gain-of-function mutations in the PIK3CA gene. There is no approved medical therapy for patients with PROS, and alpelisib, an approved PIK3CA inhibitor in oncology, showed promising results in preclinical models and in patients. Here, we report for the first time the outcome of two infants with PROS having life-threatening conditions treated with alpelisib (25 mg) and monitored with pharmacokinetics. Patient 1 was an 8-mo-old girl with voluminous vascular malformation. Patient 2 was a 9-mo-old boy presenting with asymmetrical body overgrowth and right hemimegalencephaly with West syndrome. After 12 mo of follow-up, alpelisib treatment was associated with improvement in signs and symptoms, morphological lesions and vascular anomalies in the two patients. No adverse events were reported during the study. In this case series, pharmacological inhibition of PIK3CA with low-dose alpelisib was feasible and associated with clinical improvements, including a smaller size of associated complex tissue malformations and good tolerability.
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Affiliation(s)
- Gabriel Morin
- Université de Paris, Paris, France.,Institut national de la santé et de la recherche médicale U1151, Institut Necker-Enfants Malades, Paris, France.,Unité d'Hypercroissance Dysharmonieuse et Anomalies Vasculaires, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Caroline Degrugillier-Chopinet
- Service de Physiologie & Explorations Fonctionnelles Cardiovasculaires, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marie Vincent
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Antoine Fraissenon
- Institut national de la santé et de la recherche médicale U1151, Institut Necker-Enfants Malades, Paris, France.,Service d'Imagerie Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.,Service de Radiologie Mère-Enfant, Hôpital Nord, Saint Etienne, France.,CREATIS Unité mixte de recherche 5220, Villeurbanne, France
| | - Hélène Aubert
- Service de Dermatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Célia Chapelle
- Institut national de la santé et de la recherche médicale U1151, Institut Necker-Enfants Malades, Paris, France.,Unité d'Hypercroissance Dysharmonieuse et Anomalies Vasculaires, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Clément Hoguin
- Université de Paris, Paris, France.,Institut national de la santé et de la recherche médicale U1151, Institut Necker-Enfants Malades, Paris, France
| | - François Dubos
- Urgences Pédiatriques et Maladies Infectieuses, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Benoit Catteau
- Clinique de Dermatologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Florence Petit
- Clinique de Génétique, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Aurélie Mezel
- Service d'Orthopédie Pédiatrique, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Olivia Domanski
- Service de Cardiologie Pédiatrique et Congénitale, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Guillaume Herbreteau
- Laboratoire de Biochimie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marie Alesandrini
- Service de Pédiatrie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Nathalie Boddaert
- Université de Paris, Paris, France.,Service d'Imagerie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Nathalie Boutry
- Service de Radiologie et Imagerie de l'Enfant, Centre Hospitalier Universitaire Jeanne de Flandre, Lille, France
| | - Christine Broissand
- Pharmacie, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | | | - Sabine Sarnacki
- Université de Paris, Paris, France.,Service de Chirurgie Viscérale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Thomas Blanc
- Université de Paris, Paris, France.,Service de Chirurgie Viscérale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Laurent Guibaud
- Service d'Imagerie Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Guillaume Canaud
- Université de Paris, Paris, France.,Institut national de la santé et de la recherche médicale U1151, Institut Necker-Enfants Malades, Paris, France.,Unité d'Hypercroissance Dysharmonieuse et Anomalies Vasculaires, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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Guérinot C, Marcon V, Godard C, Blanc T, Verdier H, Planchon G, Raimondi F, Boddaert N, Alonso M, Sailor K, Lledo PM, Hajj B, El Beheiry M, Masson JB. New Approach to Accelerated Image Annotation by Leveraging Virtual Reality and Cloud Computing. Front Bioinform 2022; 1:777101. [PMID: 36303792 PMCID: PMC9580868 DOI: 10.3389/fbinf.2021.777101] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
Three-dimensional imaging is at the core of medical imaging and is becoming a standard in biological research. As a result, there is an increasing need to visualize, analyze and interact with data in a natural three-dimensional context. By combining stereoscopy and motion tracking, commercial virtual reality (VR) headsets provide a solution to this critical visualization challenge by allowing users to view volumetric image stacks in a highly intuitive fashion. While optimizing the visualization and interaction process in VR remains an active topic, one of the most pressing issue is how to utilize VR for annotation and analysis of data. Annotating data is often a required step for training machine learning algorithms. For example, enhancing the ability to annotate complex three-dimensional data in biological research as newly acquired data may come in limited quantities. Similarly, medical data annotation is often time-consuming and requires expert knowledge to identify structures of interest correctly. Moreover, simultaneous data analysis and visualization in VR is computationally demanding. Here, we introduce a new procedure to visualize, interact, annotate and analyze data by combining VR with cloud computing. VR is leveraged to provide natural interactions with volumetric representations of experimental imaging data. In parallel, cloud computing performs costly computations to accelerate the data annotation with minimal input required from the user. We demonstrate multiple proof-of-concept applications of our approach on volumetric fluorescent microscopy images of mouse neurons and tumor or organ annotations in medical images.
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Affiliation(s)
- Corentin Guérinot
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
- Sorbonne Université, Collège Doctoral, Paris, France
| | - Valentin Marcon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Charlotte Godard
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Thomas Blanc
- Sorbonne Université, Collège Doctoral, Paris, France
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
| | - Hippolyte Verdier
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Histopathology and Bio-Imaging Group, Sanofi R&D, Vitry-Sur-Seine, France
- Université de Paris, UFR de Physique, Paris, France
| | - Guillaume Planchon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Francesca Raimondi
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Kurt Sailor
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Bassam Hajj
- Sorbonne Université, Collège Doctoral, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
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32
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Blanc T, Verdier H, Regnier L, Planchon G, Guérinot C, El Beheiry M, Masson JB, Hajj B. Towards Human in the Loop Analysis of Complex Point Clouds: Advanced Visualizations, Quantifications, and Communication Features in Virtual Reality. Front Bioinform 2022; 1:775379. [PMID: 36303735 PMCID: PMC9580855 DOI: 10.3389/fbinf.2021.775379] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Multiple fields in biological and medical research produce large amounts of point cloud data with high dimensionality and complexity. In addition, a large set of experiments generate point clouds, including segmented medical data or single-molecule localization microscopy. In the latter, individual molecules are observed within their natural cellular environment. Analyzing this type of experimental data is a complex task and presents unique challenges, where providing extra physical dimensions for visualization and analysis could be beneficial. Furthermore, whether highly noisy data comes from single-molecule recordings or segmented medical data, the necessity to guide analysis with user intervention creates both an ergonomic challenge to facilitate this interaction and a computational challenge to provide fluid interactions as information is being processed. Several applications, including our software DIVA for image stack and our platform Genuage for point clouds, have leveraged Virtual Reality (VR) to visualize and interact with data in 3D. While the visualization aspects can be made compatible with different types of data, quantifications, on the other hand, are far from being standard. In addition, complex analysis can require significant computational resources, making the real-time VR experience uncomfortable. Moreover, visualization software is mainly designed to represent a set of data points but lacks flexibility in manipulating and analyzing the data. This paper introduces new libraries to enhance the interaction and human-in-the-loop analysis of point cloud data in virtual reality and integrate them into the open-source platform Genuage. We first detail a new toolbox of communication tools that enhance user experience and improve flexibility. Then, we introduce a mapping toolbox allowing the representation of physical properties in space overlaid on a 3D mesh while maintaining a point cloud dedicated shader. We introduce later a new and programmable video capture tool in VR and desktop modes for intuitive data dissemination. Finally, we highlight the protocols that allow simultaneous analysis and fluid manipulation of data with a high refresh rate. We illustrate this principle by performing real-time inference of random walk properties of recorded trajectories with a pre-trained Graph Neural Network running in Python.
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Affiliation(s)
- Thomas Blanc
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Hippolyte Verdier
- Decision and Bayesian Computation, CNRS USR 3756, Department of Computational Biology and Neuroscience, CNRS UMR 3571, Université de Paris, Institut Pasteur, Université de Paris, Paris, France
| | - Louise Regnier
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Guillaume Planchon
- Decision and Bayesian Computation, CNRS USR 3756, Department of Computational Biology and Neuroscience, CNRS UMR 3571, Université de Paris, Institut Pasteur, Université de Paris, Paris, France
| | - Corentin Guérinot
- Decision and Bayesian Computation, CNRS USR 3756, Department of Computational Biology and Neuroscience, CNRS UMR 3571, Université de Paris, Institut Pasteur, Université de Paris, Paris, France
- Sorbonne Universités, Collège Doctoral, Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, CNRS USR 3756, Department of Computational Biology and Neuroscience, CNRS UMR 3571, Université de Paris, Institut Pasteur, Université de Paris, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, CNRS USR 3756, Department of Computational Biology and Neuroscience, CNRS UMR 3571, Université de Paris, Institut Pasteur, Université de Paris, Paris, France
- *Correspondence: Jean-Baptiste Masson, ; Bassam Hajj,
| | - Bassam Hajj
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, Paris, France
- *Correspondence: Jean-Baptiste Masson, ; Bassam Hajj,
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. Correction to: Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience. Ann Surg Oncol 2021; 28:901. [PMID: 34601667 DOI: 10.1245/s10434-021-10861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Grapin M, Gaillard F, Biebuyck N, Ould-Rabah M, Hennequin C, Berthaud R, Dorval G, Blanc T, Hourmant M, Kamar N, Rostaing L, Couzi L, Garcelon N, Prié D, Boyer O, Bienaimé F. The spectrum of kidney function alterations in adolescents with a solitary functioning kidney. Pediatr Nephrol 2021; 36:3159-3168. [PMID: 33895898 DOI: 10.1007/s00467-021-05074-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A precise assessment of glomerular filtration rate is key to delineate the care of children with a solitary functioning kidney (SFK). Data regarding measured GFR (mGFR) in this population is restricted to a single study of 77 individuals, which suggested that a GFR estimation (eGFR) method based on creatinine and cystatin C (eGFR-CKiD2) performed better than Schwartz's equation (eGFR-Schwartz). METHODS We measured GFR in 210 consecutive adolescents (7 to 22 years old) with an SFK referred to our institution between 2014 and 2019 and in 43 young candidates for kidney donation (18 to 25 years old). We compared the distribution of mGFR in both groups and determined the factors associated with reduced mGFR in adolescents with an SFK. We further compared different eGFR formulas with mGFR and assessed the association of mGFR and eGFRs with PTH and FGF23, two early indicators of GFR reduction. RESULTS While adolescents with an SFK had a similar median mGFR to healthy controls (103 ± 24ml/min/1.73m2 vs. 107 ± 12 ml/min/1.73m2), the fraction of individuals with an mGFR below 90 ml/min/1.73m2 was higher in patients with SFK (23% vs. 5% in controls; P = 0.005). Multiple linear regression identified older age, ipsilateral abnormalities of the urinary tract, lack of compensatory hypertrophy, and treated hypertension as independent factors associated with reduced mGFR. A smaller bias using eGFR-Schwartz (95% confidence interval (95%CI): 3 to 7) was revealed when compared to other eGFR. Compared to eGFR-Schwartz, mGFR showed a stronger correlation with PTH (r = 0.04 vs. r = 0.1) and FGF23 (r = 0.03 vs. r = 0.05). CONCLUSION SFK is not a benign condition, since 20% of the patients display altered kidney function. Our results raise caution regarding the use of the cystatin-based equation. mGFR shows a better ability than eGFR-Schwartz to differentiate patients showing early homeostatic adaptation to GFR reduction.
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Affiliation(s)
- Mathilde Grapin
- Service de Néphrologie Pédiatrique, Centre de référence Marhea, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Institut Necker-Enfants Malades Inserm U1151, Paris, France
- Sorbonne Université, Paris, France
| | - François Gaillard
- Service de Néphrologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Biebuyck
- Service de Néphrologie Pédiatrique, Centre de référence Marhea, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Melissa Ould-Rabah
- Service de Physiologie, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carole Hennequin
- Service de Biochimie, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Berthaud
- Service de Néphrologie Pédiatrique, Centre de référence Marhea, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Guillaume Dorval
- Service de Néphrologie Pédiatrique, Centre de référence Marhea, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Thomas Blanc
- Université de Paris, Institut Necker-Enfants Malades Inserm U1151, Paris, France
- Service de Chirurgie Pédiatrie, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Nassim Kamar
- Service de Néphrologie et de Transplantation, CHU Rangueil, Toulouse, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Lionel Couzi
- Service de Néphrologie, Transplantation, Dialyse et Aphérèse, CHU de Bordeaux, Bordeaux, France
| | - Nicolas Garcelon
- Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Dominique Prié
- Université de Paris, Institut Necker-Enfants Malades Inserm U1151, Paris, France
- Service de Physiologie, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Centre de référence Marhea, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Inserm U1163, Université de Paris, Paris, France
| | - Frank Bienaimé
- Université de Paris, Institut Necker-Enfants Malades Inserm U1151, Paris, France.
- Service de Physiologie, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Simon F, Luscan R, Blanc T, Sarnacki S, Denoyelle F, Couloigner V, Aidan P. Technique, Pearls, and Pitfalls of the Transaxillary Approach for Robotic Thyroidectomy (With Video). Laryngoscope 2021; 132:488-492. [PMID: 34581446 DOI: 10.1002/lary.29753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/07/2021] [Accepted: 06/30/2021] [Indexed: 11/12/2022]
Affiliation(s)
- François Simon
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Romain Luscan
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Thomas Blanc
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Surgery and Urology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sabine Sarnacki
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Surgery and Urology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Patrick Aidan
- Department of Otorhinolaryngology, American Hospital of Paris, Neuilly-sur-Seine, France
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36
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Harper L, Blanc T, Peycelon M, Michel JL, Leclair MD, Garnier S, Flaum V, Arnaud AP, Merrot T, Dobremez E, Faure A, Fourcade L, Poli-Merol ML, Chaussy Y, Dunand O, Collin F, Huiart L, Ferdynus C, Sauvat F. Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial. Eur Urol 2021; 81:64-72. [PMID: 34563412 DOI: 10.1016/j.eururo.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 03/26/2021] [Accepted: 08/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Boys with posterior urethral valves (PUVs) have an increased risk of febrile urinary tract infections (fUTIs). Circumcision is believed to reduce the risk of fUTIs in boys, although there are no randomized trials demonstrating this. OBJECTIVE To determine the effect of circumcision on the risk of fUTIs in boys with PUVs. DESIGN, SETTING, AND PARTICIPANTS A clinical randomized trial that ran between August 2012 and July 2017 was conducted. The trial was multicentric, including 13 referral centers for pediatric urology. Male boys, aged 1-28 d, diagnosed with posterior urethral valves, confirmed by voiding cystogram, were included. The exclusion criteria included presence of a genital malformation contraindicating performing a circumcision. INTERVENTION Participants were randomized to neonatal circumcision + antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5 °C) with evidence of pyuria and culture-proven infection on urinalysis, obtained by urethral catheterization or suprapubic aspiration. A bivariate analysis of the primary outcome was performed using the Kaplan-Meier method. RESULTS AND LIMITATIONS In total, 91 patients were included: 49 in group CATB and 42 in group ATB. The probability of presenting an fUTI was 20% in group ATB versus 3% in group CATB. The hazard ratio of presenting an fUTI within 2 yr in the ATB group compared with that in the CATB group was 10.3 (95% confidence interval: 1.3-82.5). Sixty-four children (70.3%) had a complete follow-up at 2 yr of age. CONCLUSIONS Circumcision significantly decreases the risk of presenting an fUTI in boys with PUVs. PATIENT SUMMARY In this report, we compared, in a multicentric trial, the number of febrile urinary tract infections (UTIs) in boys with posterior urethral valves who had either antibiotic prophylaxis alone or antibiotic prophylaxis and circumcision. We found that those who had a circumcision had a significantly lower risk of febrile UTIs.
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Affiliation(s)
- Luke Harper
- Department of Pediatric Surgery, CHU de La Réunion, Saint Denis de La Réunion, France; Department of Pediatric Surgery and Urology, University Hospital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France.
| | - T Blanc
- Department of Pediatric Surgery and Urology, APHP, Hôpital Necker, Paris, France
| | - M Peycelon
- Department of Pediatric Urology, University Hospital Robert Debre, APHP, University of Paris, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), Paris, France
| | - J L Michel
- Department of Pediatric Surgery, CHU de La Réunion, Saint Denis de La Réunion, France
| | - M D Leclair
- Department of Pediatric Surgery and Urology, Children's University Hospital, CHU de Nantes, Nantes, France
| | - S Garnier
- Department of Pediatric Surgery and Urology, Lapeyronie University Hospital, CHU de Montpellier, Montpellier, France
| | - V Flaum
- Department of Pediatric Surgery, Armand Trousseau Children's University Hospital, Paris, France
| | - A P Arnaud
- Department of Pediatric Surgery, Rennes University Hospital, CHU de Rennes, Rennes, France
| | - T Merrot
- Department of Pediatric Surgery, North and Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - E Dobremez
- Department of Pediatric Surgery and Urology, University Hospital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
| | - A Faure
- Department of Pediatric Surgery, North and Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - L Fourcade
- Department of Pediatric Surgery, University Hospital, CHU de Limoges, Limoges, France
| | - M L Poli-Merol
- Department of Pediatric Surgery, Reims University Hospital, Reims, France
| | - Y Chaussy
- Department of Pediatric Surgery, Besançon University Hospital, CHU de Besançon, Besançon, France
| | - O Dunand
- Department of Pediatric Nephrology, CHU de La Réunion, Saint-Denis de La Réunion, France
| | - F Collin
- Clinical Research Department, INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France
| | - L Huiart
- Clinical Research Department, INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France
| | - C Ferdynus
- Clinical Research Department, INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France; Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis de La Réunion, France
| | - F Sauvat
- Department of Pediatric Surgery, CHU de La Réunion, Saint Denis de La Réunion, France
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. ASO Visual Abstract: Robotic Surgery in Pediatric Oncology-Lessons Learned from the First 100 Tumors: A Nationwide Experience. Ann Surg Oncol 2021. [PMID: 34549364 DOI: 10.1245/s10434-021-10850-0] [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: 11/18/2022]
Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Center National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience. Ann Surg Oncol 2021; 29:1315-1326. [PMID: 34523002 DOI: 10.1245/s10434-021-10777-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND While robotics has become commonplace in adult oncology, it remains rare in pediatric oncology due to the rarity of childhood cancers. We present the results of a large nationwide experience with robotic oncology, with the aim of providing practical and feasible guidelines for child selection. METHODS This was a prospective analysis performed over a period of 4 years. Treatment was delivered according to the Société Internationale d'Oncologie Pédiatrique/International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOP/SIOPEN) protocols. Indications were approved by a certified tumor board. RESULTS Overall, 100 tumors were resected during 93 procedures (abdomen, 67%; thorax, 17%; pelvis, 10%; retroperitoneum, 6%) in 89 children (56 girls). The median age at surgery was 8.2 years (range 3.6-13); 19 children (21%) harbored germinal genetic alterations predisposing to cancer. No intraoperative tumor ruptures occurred. Seven conversions (8%) to an open approach were performed. Neuroblastic tumors (n = 31) comprised the main group (18 neuroblastomas, 4 ganglioneuroblastomas, 9 ganglioneuromas) and renal tumors comprised the second largest group (n = 24, including 20 Wilms' tumors). The remaining 45 tumors included neuroendocrine (n = 12), adrenal (n = 9), germ-cell (n = 7), pancreatic (n = 4), thymic (n = 4), inflammatory myofibroblastic (n = 4), and different rare tumors (n = 5). Overall, 51 tumors were malignant, 2 were borderline, and 47 were benign. The median hospital stay was 3 days (2-4), and five postoperative complications occurred within the first 30 days. During a median follow-up of 2.4 years, one child (Wilms' tumor) presented with pleural recurrence. One girl with Wilms' tumor died of central nervous system metastasis. CONCLUSIONS Robotic surgery for pediatric tumors is a safe option in highly selected cases. Indications should be discussed by tumor boards to avoid widespread and uncontrolled application.
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Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Durand M, Musleh L, Vatta F, Orofino G, Querciagrossa S, Jugie M, Bustarret O, Delacourt C, Sarnacki S, Blanc T, Khen-Dunlop N. Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology. J Pediatr Surg 2021; 56:1606-1610. [PMID: 33250217 DOI: 10.1016/j.jpedsurg.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/31/2020] [Accepted: 11/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND/PURPOSE Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis. METHODS Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014-2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California). RESULTS Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication. CONCLUSIONS Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection - useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes.
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Affiliation(s)
- Marion Durand
- Ramsay Générale de Santé, Hôpital Privé d'Antony, Antony, France
| | - Layla Musleh
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France
| | - Fabrizio Vatta
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Giorgia Orofino
- Département d'Anesthésie Hôpital Necker-Enfants Malades, Paris, France
| | | | - Myriam Jugie
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Bustarret
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France
| | - Thomas Blanc
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France
| | - Naziha Khen-Dunlop
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France.
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Lahlou M, Hukkinen M, Alova I, Botto N, Cheikhelard A, Blanc T, Lottmann HB. Comparison of antegrade and retrograde endoscopic injection techniques for neurogenic sphincteric incontinence in children with neurogenic bladder. J Pediatr Urol 2021; 17:526.e1-526.e6. [PMID: 34119422 DOI: 10.1016/j.jpurol.2021.05.019] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/11/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/BACKGROUND Urinary incontinence is common in children with neuropathic bladder. Results of endoscopic injections of bulking agents in the bladder neck are promising but it remains unclear whether they should be performed an antegrade or retrograde fashion. OBJECTIVE Our aim was to compare the antegrade and retrograde endoscopic injection techniques for the treatment of urinary incontinence. STUDY DESIGN A prospective study evaluating bladder neck dextranomer-hyaluronic acid polymer injections for urinary incontinence in children with neurogenic bladder was initiated in 1997. Children with normal bladder capacity and compliance and without uncontrolled detrusor overactivity or previous bladder neck surgery were included. Patients were classified as success (dry or significantly improved, the latter defined as no need for more than one pad per day, continent during night, and patient seeking no further treatment) or failure at regular follow-up visits. RESULTS During 1997-2016, 34 children underwent endoscopic treatment in a retrograde while 17 children in antegrade fashion (mean age 11 years, range 5-20). Most patients (n = 47/51) had neuropathic bladder due to congenital malformations, 13 (25%) had had previous bladder augmentation, and 19 (37%) were in wheelchair. Sex, age, etiology of neurogenic bladder, degree of physical impairment, or era of treatment (1997-2012 vs. 2012-2016) had no influence on success rates (Summary Table). After mean follow-ups of 69 (range 12-156) months, success rates were 71% for the antegrade and 53% for the retrograde technique (p = 0.366). Mean number of injections to obtain success was similar between the techniques (1.4 vs. 1.2). While the proportion of dry patients was similar between the two techniques (35%), the proportion of significantly improved patients tended to be higher after antegrade than retrograde injections (35% vs. 18%, p = 0.181). DISCUSSION Better visualization of the bladder neck may explain the tendency for improved results of antegrade compared to retrograde technique. Further studies in larger patient samples are needed to define the optimal endoscopic injection technique. CONCLUSION Long-term results of the antegrade endoscopic bladder neck injections of dextranomer-hyaluronic acid polymer for urinary incontinence in children with neurogenic bladder are promising.
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Affiliation(s)
- Mohamed Lahlou
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France
| | - Maria Hukkinen
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France.
| | - Ilona Alova
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France
| | - Natalie Botto
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France
| | - Alaa Cheikhelard
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France
| | - Thomas Blanc
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France
| | - Henri B Lottmann
- Division of Pediatric Surgery, Necker Hospital for Sick Children, Paris, France
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Wright NJ, Leather AJ, Ade-Ajayi N, Sevdalis N, Davies J, Poenaru D, Ameh E, Ademuyiwa A, Lakhoo K, Smith ER, Douiri A, Elstad M, Sim M, Riboni C, Martinez-Leo B, Akhbari M, Tabiri S, Mitul A, Aziz DAA, Fachin C, Niyukuri A, Arshad M, Ibrahim F, Moitt N, Doheim MF, Thompson H, Ubhi H, Williams I, Hashim S, Philipo GS, Herrera L, Yunus A, Vervoort D, Parker S, Benaskeur YI, Alser OH, Adofo-Ansong N, Alhamid A, Salem HK, Saleh M, Elrais SA, Abukhalaf S, Shinondo P, Nour I, Aydin E, Vaitkiene A, Naranjo K, Dube AM, Ngwenya S, Yacoub MA, Kwasau H, Hyman G, Elghazaly SM, Al-Slaibi I, Hisham I, Franco H, Arbab H, Samad L, Soomro A, Chaudhry MA, Karim S, Khattak MAK, Nah SA, Dimatatac DM, Choo CSC, Maistry N, Mitul AR, Hasan S, Karim S, Yousuf H, Qureshi T, Nour IR, Al-Taher RN, Sarhan OAK, Garcia-Aparicio L, Prat J, Blazquez-Gomez E, Tarrado X, Iriondo M, Bragagnini P, Rite S, Hagander L, Svensson E, Owusu S, Abdul-Mumin A, Bagbio D, Ismavel VA, Miriam A, T S, Anaya Dominguez M, Ivanov M, Serban AM, Derbew M, Elfiky M, Olivos Perez M, Abrunhosa Matias M, Arnaud AP, Negida A, King S, Fazli MR, Hamidi N, Touabti S, Chipalavela RF, Lobos P, Jones B, Ljuhar D, Singer G, Hasan S, Cordonnier A, Jáuregui L, Zvizdic Z, Wong J, St-Louis E, Shu Q, Lui Y, Correa C, Pos L, Alcántara E, Féliz E, Zea-Salazar LE, Ali L, Peycelon M, Anatole NK, Jallow CS, Lindert J, Ghosh D, Adhiwidjaja CF, Tabari AK, Lotfollahzadeh S, Mussein HM, Vatta F, Pasqua N, Kihiko D, Gohil H, Nour IR, Elhadi M, Almada SA, Verkauskas G, Risteski T, Peñarrieta Daher A, Outani O, Hamill J, Lawal T, Mulu J, Yapo B, Saldaña L, Espineda B, Toczewski K, Tuyishime E, Ndayishimiye I, Raboe E, Hammond P, Walker G, Djordjevic I, Chitnis M, Son J, Lee S, Hussien M, Malik S, Ismail EM, Boonthai A, Dahman NBH, Hall N, Castedo Camacho FR, Sobrero H, Butler M, Makhmud A, Novotny N, Hammouri AG, Al-Rayyes M, Bvulani B, Muraveji Q, Murzaie MY, Sherzad A, Haidari SA, Monawar AB, Samadi DAZ, Thiessen J, Venant N, Hospital SI, Jérémie N, Mbonicura JC, Vianney BJM, Tadesse A, Negash S, Roberts CA, Jabang JN, Bah A, Camamra K, Correa A, Sowe B, Gai A, Jaiteh M, Raymond KJ, Mvukiyehe JP, Itangishaka I, Kayibanda E, Manirambona E, Lule J, Costas-Chavarri A, Shyaka Gashugi I, Ndata A, Gasana G, Nezerwa YC, Simeon T, Muragijimana JDD, Rashid S, Msuya D, Elisante J, Solanki M, Manjira E, Lodhia J, Jusabani M, Tarmohamed M, Koipapi S, Souhem T, Sara N, Sihem B, Dania B, Toufik IA, Mounira BNEI, Habiba A, Aragão L, Gonçalves V, Lino Urquizo MM, Varela MF, Mercado P, Horacio B, Damiani A, Mac C, Putruele D, Liljesthrom K, Bernaus M, Jauri C, Cripovich A, Bianchin E, Puig MG, Andreussi L, Iracelay S, Marcos D, Herrera C, Palacios N, Avile R, Serezo B, Montoya D, Cepeda R, Vaquila J, Veronica S, Pardo L, Valeria P, Julio L, Martin AD, Lucio P, Gabriel C, Marianella D, Calderón Arancibia JA, Huespe E, Losa GN, Arancibia Gutiérrez E, Scherl H, Gonzalez DE, Baistrocchi V, Silva Y, Galdeano M, Medard P, Sueiras I, Romero Manteola E, Defago VH, Mieres C, Alberto C, Cornelli F, Molina M, Ravetta P, Patiño Gonzalez CC, Dallegre MB, Szklarz MT, Leyba MF, Rivarola NI, Charras MD, Morales A, Caseb P, Toselli L, Millán C, Junes MDC, Di Siervi O, Gilardi J, Simon S, Contreras CS, Rojas N, Arnoletto LB, Blain OE, Bravo MN, Sanchez N, Herrera Pesara LM, Moreno ME, Sferco CA, Huq U, Ferdousi T, Al-Mamun A, Sultana S, Mahmud R, Mahmud K, Sayeed F, Svirsky A, Sempertegui D, Negrete A, Teran A, Sadagurschi M, Popovic N, Karavdic K, Milisic E, Jonuzi A, Mesic A, Terzic S, Dendusic N, Biber E, Sehic A, Zvizdic N, Letic E, Saracevic A, Hamidovic A, Selak N, Horozic D, Hukic L, Muhic A, Vanis N, Sokolovic E, Sabic A, Becker K, Novochadlo Klüppel E, dos Santos Dias AIB, Agulham MA, Bischoff C, Sabbatini S, Fernandes de Souza R, Souza Machado AB, Werneck Raposo J, da Silva Augusto ML, Martins BM, de Souza Santos Ferreira M, Fernandes de Oliveira D, Silva dos Santos C, Ribeiro de Fernández y Alcázar F, Alves Dutra da Silva É, Furtado M, Tamada H, Silva Ferreira dos Santos M, Lopes de Almeida T, Oliveira de Andrade S, Gurgel do Amaral AC, Sartori Giovanoni L, de Deus Passos Leles K, Corrêa Costa E, Feldens L, Ferraz Schopf L, Soares de Fraga JC, Colombo de Holanda F, Brolin Santis Isolan PM, Loyola Ferreira J, Bruxel CL, Lopes Teixeira Ferdinando D, Zottis Barcelos F, Baseggio N, Knorr Brenner N, Trindade Deyl R, Dure C, Nunes Kist I, Bueno Mazzuca R, Bueno Motter S, Ramos Y, Suzana Trein C, Rezende Rosa B, de Assis Silva M, Menin FA, Semensato Carloni IC, Norberto da Silva JA, Gomes AL, Girão Tauffer M, Bassan Gonçalves PC, Nogueira Marques GM, Moriya E, Labonia C, Carrasco AL, Furtado Meyer K, Farion-Aguiar L, Amado F, Antunes A, Silva E, Telles L, Almeida G, Belmino Gadelha AA, de Azevedo Belesa F, Gonçalves da Cunha, Jr A, Souza Barros B, Zanellato JB, Guimarães P, Silva KID, Ribas B, Reuter C, Casado FT, Correa Leite MT, Testoni D, Guinsburg R, de Campos Vieira Abib S, Khodor Cury E, Dornellas do Nascimento S, Almeida Aguiar A, Melo Gallindo R, Gonçalves Borges C, Liu Y, Duote C, Wang J, Gao Z, Liang L, Luo W, Zhao X, Chen R, Wang P, Han Y, Huang T, Donglai H, Xiaodong G, Junjie C, Zhu L, Wu G, Bao X, Li H, Lv J, Li Z, Yong F, Gao ZC, Bai Q, Tang W, Xie H, Motee J, Zhu J, Wen G, Ruan W, Li S, Chen L, Huang S, Lv Z, Lu J, Huang L, Yu M, Dajia W, Bai YZ, Rincon LC, Mancera J, Alzate Gallego E, Torres-Canchala L, Silva Beltrán N, Osorio Fory G, Castaño Avila D, Forero Ladino AM, Gomez J, Jaramillo M, Morales O, Sanchez B, Tinoco Guzmán NJ, Castañeda Espinosa S, Prieto Vargas O, Pardo LM, Toral E, Cáceres Aucatoma F, Hinostroza D, Valencia S, Salinas V, Landivar Cino E, Ponce Fajardo GY, Astudillo M, Garcia V, Muñoz G, Verduga L, Verduga I, Murillo E, Bucaram E, Guayelema M, Marmol M, Sanchez J, Vergara C, Mena A, Velaña J, Salazar K, Lara S, Chiriboga E, Silva J, Gad D, Samy D, Elsadek MA, Mohammed HM, Abouheba M, Ali KO, Rashwan H, Fawzy OM, Kamel TM, Nemer R, Hassan MA, Falah EH, Abdelhady DS, Zain M, Ibrahim EAA, Elsiraffy OO, Aboelela A, Farag EM, Oshiba AM, Emam OS, Attia AM, Laymouna MA, Ghorab IA, Mohammed MM, Soliman NA, Ghaly KAE, Sadek K, Elsherbiny M, Saleh A, Sheir H, Wafa T, Elmenam MA, Abdelmaksoud S, Reda A, Mansour I, Elzohiri M, Waseem B, Elewaily M, El-Ghazaly M, Elhattab A, Shalaby A, Elsaied A, Adawy A, Sadek M, Ahmed MA, Herdan MO, Elassall GMH, Mohammed AA, Takrouney MH, Essa TM, Mahmoud AM, Saad AM, Fouly MAN, Ibrahim MA, Nageh M, Saad MM, Badr H, Fouda MF, Nofal AH, Almohamady H, Arafa MA, Amad M, Mansour MA, O'Connor J, O'Connor Z, Anatole N, Nkunzimana E, Machemedze S, Dieudonné L, Appeadu-Mensah W, Anyomih TTK, Alhassan P, Abantanga FA, Michael V, Mary Koshy R, Raj A, Kumar V, PT S, Prabhu PS, Vosoughi A, Al-Mayoof AF, Fadhle MJ, Joda AE, Algabri HNO, Al-Taher RN, Abdelhamid SS, Al-Momani HM, Amarin M, Zaghlol LY, Alsaadi NN, Qwaider YZ, Qutishat H, Aliwisat AH, Arabiat E, Bsisu I, Murshidi RM, Jabaiti MS, Bataineh ZA, Abuhayyeh HA, Quran TMA, Za'nouneh FJA, Alebbini MM, Qudah HA, Hussein OG, Murad AM, Amarin JZ, Suradi HH, Alzraikat SH, Omari RY, Matour BM, Al-Halbouni L, Zurikat RO, Yanis AH, Hussein SA, Shoubaki A, Ghanem WH, David K, Chitiavi SW, Mose M, Mugo R, Ndungu J, Mwai T, Shahbal S, Malik J, Chauhan N, Syovata F, Ochieng K, Omendo Liyenzero P, Hussain SR, Mugambi S, Ochieng R, Elkhazmi EOA, Khaled A, Albozidi A, Enbaya MB, Elgammudi M, Soula E, Khalel WIA, Elhajjaji YA, Alwaggaa NA, Ghayth S, Zreeg DA.S, Tantush SA, Bibas F, Layas T, Sharif RAM, Aljadidi WOFS, Tarek A, Ahmed H, Essamilghi KAM, Alfoghi M, Abuhlega MA, Arrmali S, Abduljawad FM, Alosta HM, Abuajaila A, Abdelmutalib F, Bashir F, Almengar I, Annajjar MH, Deyab A, Elzowawi F, Krayem Y, Drah W, Meftah A, Mohammed A, Arrmalli LA, Aljaboo H, Elayeb A, Altomi M, Altaweel A, Tumi M, Bazozi HM, Shaklawoon A, Alglaib MM, Elkaloush AA, Trainba S, Swessi H, Alnaeri A, Shnishah AE, Mustufa H, Gargum SA, Tarniba SA, Shalluf HA, Shokri HA, Sarkaz TL, Tababa O, Elhadi A, Naunova VC, Jovcheski L, Kamilovski M, Gavrilovska-Brzanov A, Latiff ZA, Pauzi SFM, Osman M, Lim F, Bakar AHA, Zaman ASK, Ishak S, Teo R, Qi DTTH, Othman MYB, Zahari DDZB, Hassan ZBM, Shan CH, Lechmiannandan A, Tamaddun HFB, Adanan MFSBM, Abdullah MYB, Junyi W, Nor MTM, Noor WR, Hassan MRB, Dalek NFRA, Hashim HHB, Zarwawi AZB, Vellusamy VMM, Yuen QS, Kannessan HA, Ramli NB, Bujarimin ASB, Anntinea J, Dass A, Khalid HM, Hanifah NABM, Jyun KWY, Razak RBA, Naim NABM, Hamzah SNABH, Vidal CRZ, Bracho Blanchet E, Dávila Perez R, Fernandez Portilla E, Villegas Silva R, Ibarra D, Calderon Moore A, Carrasco-Ortega C, Noguez Castillo M, Herappe Mellado D, Yanowsky Reyes G, Gonzalez Cortez LF, Santana Ortiz R, Orozco Perez J, Corona C.Rivera JR, Cardenas Ruiz Velasco JJ, Quiles Corona M, Peña Padilla C, Bobadilla Morales L, Corona Rivera A, Rios Flores IM, Aranda Sánchez CI, Ambriz-González G, Martínez Hernández Magro N, León Frutos FJ, Cárdenas Barón JDJ, González Ojeda A, Yarza Fernández J, Porras JD, Aguirre-Lopez P, Sánchez Paredes V, Montalvo Marin A, Diaz Gomez JM, Caamal LJ, Bulnes Mendizabal D, Sanchez Valladares P, Garcia Martinez H, Adesanya O, Olanrewaju M, Adegboyega R, Abdulraheem N, Aremo A, Dedeke F, Chukwuemeka ALJ, Mohammad MA, Lawalbarau A, Collins N, Ibukunolu O, Shonubi A, Ladipo-Ajayi O, Elebute OA, Seyi-Olajide J, Alakaloko F, Ihediwa G, Olayade K, Bode C, Ogundoyin O, Olulana DI, Egbuchulem IK, Kumolalo FO, Ulasi I, Ezomike UO, Ekenze SO, Nwankwo EP, Nwangwu EI, Chukwu I, Amah CC, Obianyo NE, Williams O, Osuoji RI, Faboya OM, Ajai OT, Abdulsalam MA, Agboola TH, Temilade BB, Osazuwa M, Salawu MM, Ejinkeonye EC, Yola MM, Mairami AB, Otuneye AT, Igoche M, Tanimola AG, Ajao EA, Agelebe E, Olori S, Mshelbwala PM, Osagie O, Oyinloye A, Abubakar AM, Oyebanji L, Shehu I, Cletus C, Bamanga A, Suleiman F, Adamu S, C.Nwosu D, S.Alkali Y, Jalo I, Rasaki A, T.Sambo Y, A.Mohammed K, M.Ballah A, Modekwe V, Ekwunife OH, Ezidiegwu US, Osuigwe AN, Ugwu JO, Ugwunne CA, Akhter N, Gondal MF, Raza R, Chaudary AR, Ali H, Nisar MU, Jamal MU, Pandit GS, Mumtaz U, Amjad MB, Talat N, Rehman WU, Saleem M, Mirza MB, Hashim I, Haider N, Hameed S, Saleem A, Dogar S, Sharif M, Bashir MK, Naumeri F, Rani Z, Baniowda MA, Ba'baa' B, Hassan MYM, Darwish A, Sehwiel AS, Shehada M, Balousha AG, Ajrami Y, Alzamari AAM, Yaghi B, Al-saleem HSHA, Farha MSA, Abdelhafez MOM, Anaya F, Qadomi AB, Odi AANB, Assi MAF, Sharabati F, Abueideh A, Beshtawi DMS, Arafat H, Khatatba LZA, Abatli SJ, Al-Tammam H, Jaber D, Kayed YIO, Abumunshar AA, Misk RA, Alzeer AMS, Sharabati M, Ghazzawi I, Darras OM, M.Qabaja M, Hajajreh MS, Samarah YA, Yaghi DH, Qunaibi MAF, Mayaleh AA, Joubeh S, Ebeido A, Adawi S, Adawi I, Alqor MOI, Arar AS, Awad H, Abu-Nejmah F, Shabana OS, Alqarajeh F, Alzughayyar TZ, Madieh J, Sbaih MF, Alkareem RMA, Lahlooh RA, Halabi YA, Baker W, Almusleh TFH, Tahyneh AAA, Atatri YYM, Jamie NA, Massry NAA, Lubbad W, A.Nemer A, Alser M, Salha AAS, Alnahhal K, Elmzyyen AM, Ghabayen ATS, Alamrain AAA, Al-Shwaikh SH, Elshaer OA, Shaheen N, Fares J, Dalloul H, Qawwash A, Jayyab MA, Ashour DA, Shaheen AA, Naim SRR, Shiha EA, Dammagh NMA, Almadhoun W, Al-Salhi AA, Hammato AY, Salim JM, Hasanain DK, Alwadia SMS, Nassar I, Al-Attar HM, Alshaikhkhalil HAA, Jamie YMKA, Ashour YS, Alijla SS, Tallaa MAE, Abuattaya AA, Wishah BD, ALDIRAWI MOHAMMEDA, Darwish AS, Alzerei ST, Wishah N, Alijla S, Garcia I, Diaz Echegaray M, Cañapataña Sahuanay VR, Trigoso Mori F, Alvarado Zelada J, Salinas Barreto JJ, Rivera Altamirano P, Torres Miranda C, Anicama Elias R, Rivera Alvarez J, Vasquez Matos JP, Ayque Rosas F, Ledesma Peraza J, Gutarra Palomino A, Vega Centen S, Casquero V, Ortiz Argomedo MR, Lapouble F, Llap Unchón G, Delgado Malaga FP, Ortega Sotelo L, Gamboa Kcomt S, Villalba Villalba A, Mendoza Leon NR, Cardenas Alva LR, Loo Neyra MS, Alanguia Chipana CL, Torres Picón CMDJ, Huaytalla Quiroz N, Dominguez D, Segura Calle C, Arauco J, Ormeño Calderón L, Ghilardi Silva X, Fernandez Wilson MD, Gutierrez Maldonado JE, Diaz Leon C, Berrocal Anaya W, Chavez Galvez P, Aguilar Gargurevich PP, Diaz Castañeda FDM, Guisse C, Ramos Paredes E, Apaza Leon JL, Aguilar Aguilar F, Ramirez De La Cruz R, Flores Carbajal L, Mendoza Chiroque C, Sulca Cruzado GJ, Tovar Gutierrez N, Sotelo Sanchez J, Paz Soldan C, Hernández Córdova K, Delgado Quinteros EF, Brito Quevedo LM, Mendoza Oviedo JJ, Samanez Obeso A, Paredes Espinoza P, de Guzman J, Yu R, Cosoreanu V, Ionescu S, Mironescu A, Vida L, Papa A, Verdeata R, Gavrila B, Muntean L, Lukac M, Stojanovic M, Toplicic D, Slavkovic M, Slavkovi A, Zivanovic D, Kostic A, Raicevic M, Nkuliza D, Sidler D, Vos CD, Merwe EV, Tasker D, Khamag O, Rengura C, Siyotula T, Jooma U, Delft DV, Arnold M, Mangray H, Harilal S, Madziba S, Wijekoon N, Gamage T, Bright BP, Abdulrahman A, Mohammed OAA, Salah M, Ajwa AEA, Morjan M, Batal MM, Faks V, Mouti MB, Assi A, Al-Mouakeh A, Tarabishi AS, Aljarad Z, Alhamid A, Khorana J, Poocharoen W, Liukitithara S, Sriniworn A, Nuntasunti W, Ngerncham M, Phannua R, Thaiwatcharamas K, Tanming P, Sahnoun L, Kchiche N, Abdelmoumen R, Eroğlu E, Ozen MA, Cömert HSY, İmamoğlu M, Sarıhan H, Kader Ş, Mutlu M, Aslan Y, Beşir A, Geze Ş, Çekiç B, Yalcinkaya A, Sönmez K, Karabulut R, Türkyılmaz Z, Şeref K, Altın M, Aykut M, Akan M, Erdem M, Ergenekon E, Türkyılmaz C, Keleş E, Canözer A, Yeniay AÖ, Eren E, Cesur İB, Özçelik Z, Kurt G, Mert MK, Kaya H, Çelik M, Karakus SC, Erturk N, Suzen A, Hakan N, Akova F, Pasaoglu M, Eshkabilov S, Yuldashev RZ, Abdunomonovich DA, Muslimovich AM, Patel A, Kapihya C, Ensar N, Nataraja RM, Sivasubramaniam M, Jones M, Teague W, Tanny ST, Thomas G, Roberts K, Venkatraman SS, Till H, Pigeolet M, Dassonville M, Shikha A, Win WSP, Ahmad ZAH, Meloche-Dumas L, Caouette-Laberge L, St-Vil D, Aspirot A, Piché N, Joharifard S, Safa N, Laberge JM, Emil S, Puligandla P, Shaw K, Wissanji H, Duggan E, Guadagno E, Puentes MC, Leal PO, Mendez Benavente C, Rygl M, Trojanová B, Berková K, Racková T, Planka L, Škvařil J, Štichhauer R, Sabti S, Macdonald A, Bouhadiba N, Kufeji D, Pardy C, Mccluney S, Keshtgar A, Roberts R, Rhodes H, Burns K, Garrett-Cox R, Ford K, Cornwall H, Ravi K, Arthur F, Losty P, Lander T, Jester I, Arul S, Gee O, Soccorso G, Singh M, Pachl M, Martin B, Alzubair A, Kelay A, Sutcliffe J, Middleton T, Thomas AH, Kurian M, Cameron F, Sivaraj J, Thomas MC, Rex D, Jones C, Bradshaw K, Bonnard A, Delforge X, Duchesne C, Gall CL, Defert C, Laraqui Hossini S, Guerin F, Hery G, Fouquet-Languillat V, Kohaut J, Broch A, Blanc T, Harper L, Delefortrie T, Ballouhey Q, Fourcade L, Grosos C, Parmentier B, Levard G, Grella MG, Renaux Petel M, Grynberg L, Abbo O, Mouttalib S, Juricic M, Scalabre A, Haraux E, Rissmann A, Krause H, Goebel P, Patzer L, Rolle U, Schmedding A, Antunez-Mora A, Tillig B, Bismarck SV, Barbosa PR, Knorr C, Stark D, Brunero M, Avolio L, Manni F, Molinelli M, Guazzotti M, Raffaele A, Romano PG, Cavaiuolo S, Parigi GB, Juhasz L, Rieth A, Strumila A, Dagilytė R, Liubsys A, Gurskas P, Malcius D, Mikneviciute A, Vinskaite A, Barauskas V, Vierboom L, Hall T, Beasley S, Goddard L, Stringer M, Weeratunga N, Adams S, Cama J, Wong M, Jayaratnam S, Kukkady A, Samarakkody U, Gerus S, Patkowski D, Wolny A, Koszutski T, Tobor S, Osowicka M, Czauderna P, Wyrzykowski D, Garnier H, Anzelewicz S, Marta O, Knurowska A, Weiszewsk A, Grabowski A, Korlacki W, Pasierbek M, Wolak P, Piotrowska A, Roszkiewicz A, Kalicińsk P, Trypens A, Kowalewsk G, Sigalet D, Alsaied A, Ali M, Alsaggaf A, Ghallab A, Owiwi Y, Zeinelabdeen A, Fayez M, Atta A, Zidan M, Radwan AS, Shalaby H, Abdelbaqi R, Alattas K, Kano Y, Sindi O, Alshehri A, Altokhais T, Alturki F, Almosaibli M, Krisanova D, Abbas W, Yang HB, Kim HY, Youn JK, Chung JH, Cho SH, Hwang IJ, Lee JY, Song ES, Arboleda J, Ruiz de Temiño Bravo M, Siles Hinojosa A, García M, Casal Beloy I, Oliu San Miguel D, Molina Vazquez ME, Alonso V, Sanchez A, Gomez O, Carrillo I, Wester T, Mesas Burgos C, Hagander L, Salö M, Omling E, Rudolfson N, Granéli C, Arnadóttir H, Grottling E, Abrahamsson K, Gatzinsky V, Dellenmark Blom M, Borbonet D, Puglia P, Jimenez Morejon V, Acuna G, Moraes M, Chan J, Brahmamdam P, Tom A, Sherer K, Gonzales B, Cunningham A, Krishnaswami S, Baertschiger R, Leech M, Williams R, Camp L, Gosain A, Mora M, Lyttle BD, Chang J, McColl Makepeace L, Fowler KL, Mansfield S, Hodgman E, Amaechi C, Beres A, Pernik MN, Dosselman LJ, Almasri M, Jain S, Modi V, Fernandez Ferrer M, Coon J, Gonzalez J, Honhar M, Ruzgar N, Coghill G, Ullrich S, Cheung M, Løfberg K, Greenberg J, Davenport K, Gadepalli S, Fox S, Johnson S, Pilkington M, Hamilton A, Lin N, Sola J, Yao Y, Davis JK, Langer M, Vacek J, Abdullah F, Khlevner J, Middlesworth W, Levitt M, Ahmad H, Siddiqui SM, Bowder A, Derks T, Amoabin AA, Pinar B, Owusu-Sekyere F, Saousen B, Naidoo R, Karamustafic A, Oliveira DPD, Motter SB, Andrade J, Šafus A, Langley J, Wilke A, Deya C, Murtadi HM, Berzanskis M, Calistus N, Ajiboye OS, Felix M, Olabisi OO, Erçin S, Muradi T, Burks SS, Lerma S, Jacobson J, Calancea C, Valerio-Vazquez R, Sikwete G, Sekyere O, Mbonisweni A, Syed S, Hyeon CS, Pajouhandeh F, Kunfah SMP. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet 2021; 398:325-339. [PMID: 34270932 PMCID: PMC8314066 DOI: 10.1016/s0140-6736(21)00767-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. METHODS We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FINDINGS We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2·8 kg (2·3-3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88-4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59-2·79], p<0·0001), sepsis at presentation (1·20 [1·04-1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1·82 [1·40-2·35], p<0·0001; ASA 3 vs ASA 1-2, 1·58, [1·30-1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02-1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41-2·71], p=0·0001; parenteral nutrition 1·35, [1·05-1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47-0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50-0·86], p=0·0024) or percutaneous central line (0·69 [0·48-1·00], p=0·049) were associated with lower mortality. INTERPRETATION Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. FUNDING Wellcome Trust.
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Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Answers. Pediatr Nephrol 2021; 36:2131-2135. [PMID: 33768327 DOI: 10.1007/s00467-021-05006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
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Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Questions. Pediatr Nephrol 2021; 36:2129-2130. [PMID: 33730286 DOI: 10.1007/s00467-021-04994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.
- Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France
- Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
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Berteloot L, Berthaud R, Temmam S, Lozach C, Zanelli E, Blanc T, Heloury Y, Capito C, Chardot C, Sarnacki S, Garcelon N, Lacaille F, Charbit M, Pastural M, Rabant M, Boddaert N, Leruez-Ville M, Eloit M, Sermet-Gaudelus I, Dehoux L, Boyer O. Arterial abnormalities identified in kidneys transplanted into children during the COVID-19 pandemic. Am J Transplant 2021; 21:1937-1943. [PMID: 33346946 PMCID: PMC9906447 DOI: 10.1111/ajt.16464] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/25/2023]
Abstract
Graft artery stenosis can have a significant short- and long-term negative impact on renal graft function. From the beginning of the COVID-19 pandemic, we noticed an unusual number of graft arterial anomalies following kidney transplant (KTx) in children. Nine children received a KTx at our center between February and July 2020, eight boys and one girl, of median age of 10 years. Seven presented Doppler features suggesting arterial stenosis, with an unusual extensive pattern. For comparison, over the previous 5-year period, persistent spectral Doppler arterial anomalies (focal anastomotic stenoses) following KTx were seen in 5% of children at our center. We retrospectively evidenced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in five of seven children with arterial stenosis. The remaining two patients had received a graft from a deceased adolescent donor with a positive serology at D0. These data led us to suspect immune postviral graft vasculitis, triggered by SARS-CoV-2. Because the diagnosis of COVID-19 is challenging in children, we recommend pretransplant monitoring of graft recipients and their parents by monthly RT-PCR and serology. We suggest balancing the risk of postviral graft vasculitis against the risk of prolonged dialysis when considering transplantation in a child during the pandemic.
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Affiliation(s)
- Laureline Berteloot
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,INSERM U1163, Institut Imagine, Paris, France,Correspondence Laureline Berteloot, Pediatric Radiology Department, Hôpital universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.
| | - Romain Berthaud
- Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
| | - Sarah Temmam
- Institut Pasteur, Laboratory of Pathogen Discovery, Paris, France
| | - Cécile Lozach
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
| | - Elisa Zanelli
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
| | - Thomas Blanc
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Yves Heloury
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Carmen Capito
- Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Christophe Chardot
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Sabine Sarnacki
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, Paris Descartes—Sorbonne Paris Cite University, Institut Imagine, France
| | - Florence Lacaille
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Marina Charbit
- Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | | | - Marion Rabant
- Université de Paris, Paris, France,Department of Pathology, APHP, Hôpital Universitaire Necker-Enfants malades, Paris, France,INSERM U1151, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,INSERM U1163, Institut Imagine, Paris, France,Université de Paris, Paris, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France,Virology Laboratory, APH-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Marc Eloit
- Institut Pasteur, Laboratory of Pathogen Discovery, Paris, France
| | - Isabelle Sermet-Gaudelus
- Université de Paris, Paris, France,EA 7328 University of Paris, Institut Imagine, Paris, France,INSERM U1151, Institut Necker Enfants malades, National Cystic Fibrosis Reference Center, Paris, France
| | - Laurène Dehoux
- Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Olivia Boyer
- INSERM U1163, Institut Imagine, Paris, France,Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
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45
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Harte C, Ren M, Querciagrossa S, Druot E, Vatta F, Sarnacki S, Dahmani S, Orliaguet G, Blanc T. Anaesthesia management during paediatric robotic surgery: preliminary results from a single centre multidisciplinary experience. Anaesth Crit Care Pain Med 2021; 40:100837. [PMID: 33757915 DOI: 10.1016/j.accpm.2021.100837] [Citation(s) in RCA: 2] [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] [Received: 11/07/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Paediatric robotic surgery is gaining popularity across multiple disciplines and offers technical advantages in complex procedures requiring delicate dissection. To date, limited publications describe its perioperative management in children. MATERIAL & METHODS We retrospectively analysed the prospectively collected anaesthetic data of the first 200 robotic-assisted surgery procedures in our paediatric university hospital as part of a multidisciplinary program from October of 2016 to February of 2019. Anaesthetic technique and monitoring were based on guidelines initially derived from adult data. We examined adverse events and particular outcomes including blood loss and analgesic requirements. RESULTS Fifty-one different surgical procedures were performed in patients aged 4 months to 18 years (weight 5-144 kg). Operative times averaged 4 h and conversion rate was 3%. Neither robotic arm nor positional injury occurred. Limited access to the patient did not lead to any complication. Hypothermia was frequent and mostly self-limiting. Negative physiological effects due to positioning, body cavity insufflation or surgery manifesting as significant respiratory and haemodynamic changes occurred in 14% and 11% of patients, respectively. Overt haemorrhage complicated one case. Eighty per cent of 170 patients did not require level 3 analgesics postoperatively, while thoracic and certain tumour cases had greater analgesic requirements. CONCLUSION These preliminary results show that paediatric robotic surgery is well tolerated with a low bleeding risk and that major intraoperative events are uncommon. A consistent anaesthetic approach is effective across a broad range of procedures. Analgesic requirements are low excluding thoracic and some complex abdominal cases. Future studies should focus on the rehabilitative aspects of robotic surgery technique.
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Affiliation(s)
- Caroline Harte
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France.
| | - Melissa Ren
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Stefania Querciagrossa
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Emilie Druot
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Fabrizio Vatta
- Department of Paediatric Surgery and Urology, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Sabine Sarnacki
- Department of Paediatric Surgery and Urology, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Souhayl Dahmani
- Department of Paediatric Anaesthesia and Intensive Care, Robert Debré University Hospital, AP-HP, Université de Paris, France
| | - Gilles Orliaguet
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France; Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Unité de recherche EA 7323, Hôpitaux Universitaires Paris centre - Site Tarnier, Université de Paris, 89 Rue d'Assas, Paris 75006, France
| | - Thomas Blanc
- Department of Paediatric Surgery and Urology, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France; Mechanisms and Therapeutic Strategies of Chronic Kidney Disease, INSERM U115-CNRS UMR 8253, Institut Necker Enfants Malades, Département "Croissance et Signalisation", Hôpital Necker Enfants Malades, Université de Paris, 149, Rue de Sèvres, Paris 75015, France
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46
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Blanc T, Pinar U, Anract J, Assouad J, Audenet F, Borghese B, De La Taille A, El Ghoneimi A, Mongiat-Artus P, Mordant P, Penna C, Roupret M. Impact of the COVID-19 pandemic on oncological and functional robotic-assisted surgical procedures. J Robot Surg 2021; 15:937-944. [PMID: 33511526 PMCID: PMC7843004 DOI: 10.1007/s11701-021-01201-y] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/17/2021] [Indexed: 12/20/2022]
Abstract
The COVID-19 pandemic led to a decrease in surgical activity to avoid nosocomial contamination. Robotic-assisted surgery safety is uncertain, since viral dissemination could be facilitated by gas environment. We assessed the impact and safety of the COVID-19 pandemic on robotic-assisted surgery. Data were collected prospectively during lockdown (March 16th–April 30th 2020) in 10 academic centres with robotic surgical activity and was compared to a reference period of similar length. After surgery, patients with suspected COVID-19 were tested by RT-PCR. During the COVID-19 lockdown we evidenced a 60% decrease in activity and a 49% decrease in oncological procedures. However, the overall proportion of oncological surgeries was significantly higher during the pandemic (p < 0.001). Thirteen (7.2%) patients had suspected COVID-19 contamination, but only three (1.6%) were confirmed by RT-PCR. The COVID-19 pandemic resulted in a significant decrease in robotic-assisted surgery. Robotic approach was safe with a low rate of postoperative COVID-19 contamination.
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Affiliation(s)
- Thomas Blanc
- Department of Paediatric Surgery and Urology, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Ugo Pinar
- Urology, Predictive Onco-Urology, GRC 5, APHP, Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France
| | - Julien Anract
- Urology, Predictive Onco-Urology, GRC 5, APHP, Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France
| | - Jalal Assouad
- Departement of Thoracic and Vascular Surgery, AP-HP, Hôpital Tenon, Sorbonne University, 75020, Paris, France
| | - François Audenet
- Department of Urology, AP-HP Centre, Hôpital Européen Georges Pompidou, Université de Paris, 75015, Paris, France
| | - Bruno Borghese
- Department of Gynaecologic Surgery, AP-HP. Centre, Hôpital Cochin, Université de Paris, 75014, Paris, France
| | - Alexandre De La Taille
- Department of Urology, APHP, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, 94010, Creteil, France
| | - Alaa El Ghoneimi
- Department of Paediatric Surgery and Urology, AP-HP. Nord, Hôpital Robert Debré, Université de Paris, 75019, Paris, France
| | - Pierre Mongiat-Artus
- Department of Urology, AP-HP. Nord, Hôpital Saint Louis, Université de Paris, 75010, Paris, France
| | - Pierre Mordant
- Department of Thoracic and Vascular Surgery, AP-HP. Nord, Hôpital Bichat, Université de Paris, 75010, Paris, France
| | - Christophe Penna
- Department of Digestive Surgery, APHP, Hôpital Bicêtre, Université Paris Saclay, 94270, Le Kremlin-Bicetre, France
| | - Morgan Roupret
- Urology, Predictive Onco-Urology, GRC 5, APHP, Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France.
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47
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Ruiz F, Neiva-Vaz C, Vazquez MP, Masson JB, El Beheiry M, Pannier S, De Tienda M, Berteloot L, Lopez P, Blanc T, Khonsari RH. Management of ischiopagus twin separation with a focus on W–S incision design. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2020.101747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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48
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Vinit N, Khoury A, Lopez P, Heidet L, Botto N, Traxer O, Boyer O, Blanc T, Lottmann HB. Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis. Front Pediatr 2021; 9:763317. [PMID: 34869121 PMCID: PMC8636798 DOI: 10.3389/fped.2021.763317] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder characterized by a defective reabsorption of cystine and dibasic amino acids leading to development of urinary tract calculi from childhood onward. Cystine lithiasis is known to be resistant to fragmentation. The aim was to evaluate our long-term experience with extracorporeal shockwave lithotripsy (ESWL) used as first-line urological treatment to treat cystine stones in children. Methods: We retrospectively reviewed the charts of all children who underwent ESWL for cystine stone. We assessed the 3-month stone-free rate, according to age, younger (group 1) or older (group 2) than 2 years old. Results: Between 2003 and 2016, 15 patients with a median (IQR) age at first treatment of 48 (15-108) months underwent ESWL in monotherapy. Median age was, respectively, 15 and 108 months in each group. The median (IQR) stone burden was 2,620 (1,202-8,265) mm3 in group I and 4,588 (2,039-5,427) mm3 in group II (p = 0.96). Eleven patients had bilateral calculi. ESWL was repeated on average 2.4 times, with a maximum of 4 for patients of group I, and 4.8 times, with a maximum of 9 for group II (p > 0.05). ESWL in monotherapy was significantly more efficient to reach stone-free status for children under 2 years of age: 83% vs. 6.2% (p = 0.040). The median (IQR) follow-up of the study was 69 (42-111) months. Conclusion: ESWL appears as a valid urological option for the treatment of cystine stones, in young children. Even if cystine stones are known to be resistant to fragmentation, we report 83% of stone-free status at 3 months with ESWL used in monotherapy in children under 2 years old with cystinuria. In older children, the success rate is too low to recommend ESWL as a first line approach.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Antoine Khoury
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurence 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, Université de Paris, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, APHP, Paris, France.,Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC no 20), Tenon Hospital, Sorbonne Université, Paris, France.,Sorbonne Université, Paris, France
| | - Olivia Boyer
- 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, Université de Paris, Paris, France.,Université de Paris, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Paris, France
| | - Henri B Lottmann
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
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49
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Hautier S, Kermorvant E, Khen-Dunlop N, de Wailly D, Beauquier B, Corroenne R, Milani G, Bonnet D, James S, Vinit N, Blanc T, Aigrain Y, Colmant C, Salomon L, Ville Y, Stirnemann J. [Prenatal path of care following the diagnosis of a malformation for which a novel prenatal therapy is available]. ACTA ACUST UNITED AC 2020; 49:172-179. [PMID: 33166705 DOI: 10.1016/j.gofs.2020.11.003] [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: 08/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fetal therapy is part of the available care offer for several severe malformations. The place of these emergent prenatal interventions in the prenatal path of care is poorly known. The objective of this study is to describe the decision-making process of patients facing the option of an emergent in utero intervention. METHODS We have conducted a retrospective monocentric descriptive study in the department of maternal-fetal medicine of Necker Hospital. We collected data regarding eligibility or not for fetal surgery and the pregnancy outcomes of patients referred for myelomeningocele, diaphragmatic hernia, aortic stenosis and low obstructive uropathies. RESULTS All indications combined, 70% of patients opted for fetal surgery. This rate was lower in the case of myelomeningocele with 21% consent, than in the other pathologies: 69% for diaphragmatic hernias, 90% for aortic stenoses and 76% for uropathy. When fetal intervention was declined, the vast majority of patients opted for termination of pregnancy: 86%. In 14% of the considering fetal surgery, the patient was referred too far. CONCLUSION The acceptance rate for fetal surgeries depends on condition. It offers an additional option and is an alternative for couples for which termination of pregnancy (TOP) is not an option. Timely referral to an expert center allows to discuss the place of a fetal intervention and not to deprive couples of this possibility.
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Affiliation(s)
- S Hautier
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - E Kermorvant
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - N Khen-Dunlop
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - D de Wailly
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - B Beauquier
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - R Corroenne
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - G Milani
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - D Bonnet
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - S James
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - N Vinit
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - T Blanc
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Aigrain
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - C Colmant
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - L Salomon
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Ville
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - J Stirnemann
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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50
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Blanc T, Goudin N, Zaidan M, Traore MG, Bienaime F, Turinsky L, Garbay S, Nguyen C, Burtin M, Friedlander G, Terzi F, Pontoglio M. Three-dimensional architecture of nephrons in the normal and cystic kidney. Kidney Int 2020; 99:632-645. [PMID: 33137337 DOI: 10.1016/j.kint.2020.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/05/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
Kidney function is crucially dependent on the complex three-dimensional structure of nephrons. Any distortion of their shape may lead to kidney dysfunction. Traditional histological methods present major limitations for three-dimensional tissue reconstruction. Here, we combined tissue clearing, multi-photon microscopy and digital tracing for the reconstruction of single nephrons under physiological and pathological conditions. Sets of nephrons differing in location, shape and size according to their function were identified. Interestingly, nephrons tend to lie in planes. When this technique was applied to a model of cystic kidney disease, cysts were found to develop only in specific nephron segments. Along the same segment, cysts are contiguous within normal non-dilated tubules. Moreover, the shapes of cysts varied according to the nephron segment. Thus, our findings provide a valuable strategy for visualizing the complex structure of kidneys at the single nephron level and, more importantly, provide a basis for understanding pathological processes such as cystogenesis.
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Affiliation(s)
- Thomas Blanc
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France; Service de Chirurgie Viscérale et Urologie Pédiatrique, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Nicolas Goudin
- Structure Fédérative de Recherche Necker, US24-UMS3633, Paris, France
| | - Mohamad Zaidan
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France; Service de Néphrologie-Transplantation, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Frank Bienaime
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France; Service d'Explorations Fonctionnelles, AP-HP, Hôpital Necker Enfants Malades, Paris, France
| | - Lisa Turinsky
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France
| | - Serge Garbay
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France
| | - Clément Nguyen
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France
| | - Martine Burtin
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France
| | - Gérard Friedlander
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France; Service d'Explorations Fonctionnelles, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Fabiola Terzi
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France.
| | - Marco Pontoglio
- Institut National de la Santé et de la Recherche Médicale U1151, Centre National de la Recherche Scientifique UMR8253, Université de Paris, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France.
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