The Bicêtre Hospital is located in Le Kremlin-Bicêtre, a commune in the southern suburbs of Paris, France. It lies 4.5 km (2.8 miles) from the center of Paris. The Bicêtre Hospital was originally planned as a military hospital, with construction begun in 1634. With the help of Vincent de Paul, it was finally opened as an orphanage in 1642. It was incorporated into the Hôpital Général de Paris in 1656. In 1823, it was called the Hospice de la Vieillesse Hommes. In 1885, it was renamed the Hospice de Bicêtre.
Management of cerebral vasculopathy in sickle cell anemia (SCA) includes standard-care, that is, chronic transfusion (CT) or hydroxyurea, and hematopoietic cell transplantation (HCT). DREPAGREFFE-1 (December 2010/June 2013), a French multicenter trial, was the first prospective trial comparing standard-care to match sibling donor (MSD)-HCT in 67 (35F/32M) SCA children (5-15 year) on CT for abnormal time-averaged mean maximum velocities (TAMMV ≥ 200 cm/s). Seven had a stroke history. We reported that MSD-HCT reduced the highest TAMMVs at 1- and 3-year (p < 0.001) and improved quality of life (QoL) for physical and school functioning. In stroke-free patients, the 3-year stenosis score was lower (p = 0.010). Nevertheless, no significant difference was observed for silent cerebral infarcts (SCI) and cognitive performance. This prompted us to initiate DREPAGREFFE-2 to reevaluate the outcomes at 10 years (September 2022/August 2024) with the same 67 SCA children. No death or stroke occurred in either arm. No rejection or chronic-GvHD arose in the MSD-HCT group (n = 32). In the standard-care group (n = 35), 16 were on hydroxyurea, and 16 on CT at Year 10, and 3 received haploidentical-HCT. After MSD-HCT, the QoL was better, even for social functioning, and the number of hospitalizations, hospitalized days (p < 0.001), and crises (p = 0.001) was lower than on standard-care. In stroke-free patients, stenosis (p = 0.027) and SCI scores (p = 0.041) decreased significantly more after MSD-HCT than on standard-care; working memory (p = 0.016) and processing speed (p = 0.011) improved significantly after MSD-HCT, but worsened on standard-care. These effects were not previously detected with shorter follow-up. This supports earlier consideration of HCT for SCA children with MSD to preserve neurologic function and QoL for a more productive future.
Minimally invasive ileal pouch–anal anastomosis (IPAA) is the standard restorative procedure for ulcerative colitis (UC) requiring surgery. The clinical impact of the robotic approach remains uncertain. This study aimed to compare perioperative and long-term functional outcomes following robotic versus laparoscopic IPAA in two high-volume tertiary centers. This bicenter retrospective study included consecutive patients who underwent restorative proctocolectomy (RPC-IPAA) or restorative proctectomy (RP-IPAA) with IPAA for UC between 2012 and 2024. Patients were classified into robotic or laparoscopic groups. Perioperative outcomes included operative time, intraoperative complications, conversion to open, postoperative morbidity, and length of hospital stay. Functional results using the IPSS-20 score were evaluated at one year. One hundred and one patients were included, 58 (57.4
OBJECTIVE:The aim of the study was to investigate bone comorbidities and their management in patients included in the European Register on Cushing's syndrome (ERCUSYN). DESIGN:A retrospective multicentric cohort study and on-line survey. METHODS:We analyzed the prevalence of osteoporosis (OP) and fractures among 1682 patients with Cushing's syndrome (CS), at initial evaluation and during follow-up. All the ERCUSYN partners received a survey addressing bone disease management in CS. RESULTS:Seven hundred and sixty-six patients (45%) had DXA examination at baseline, of whom 157 (21%) presented OP at spine and 103 (13%) at hip. Risk factors for OP were older age (P=0.038) and lower BMI (P=0.022). An X-ray was performed in 492 (29%) patients and fracture was detected in 87 (18%). Risk factors for fractures at baseline were male sex (P<0.001), muscle weakness (P=0.026) and bone mineral density (BMD) at hip indicating OP (P=0.026). During follow-up, spine BMD deterioration was more common in older patients (P=0.005) and in those with diabetes mellitus (P=0.024), while worsening of hip BMD was more frequent in patients with hypopituitarism (P=0.021), diabetes mellitus (P=0.034), on levothyroxine substitution (P=0.008) and those less often treated with anti-osteoporotic agents (P=0.022). The survey evidenced significant heterogeneity in terms of timing of bone evaluation and treatment initiation. CONCLUSIONS:A significant number of patients with CS experienced OP and fractures. Clinical factors may help to select patients at the highest risk. There are currently no standards of care for the management of bone complications in CS across Europe.
Introduction: Many studies have investigated the contribution of transperineal ultrasound in determining the fetal head station during the management of the second stage of delivery. The head–perineum distance (HPD) remains 1 of the most studied measures.We hypothesized that a HPD measured “clinically” with a hysterometer might correlate with that measured by transperineal ultrasound and could be used to predict the risk of cesarean delivery. STUDY DESIGN: This was a unicentric prospective observational study that occurred between February 10, 2022, and June 30, 2024. Women with a singleton fetus in the cephalic presentation at term (≥37 weeks of gestation) who had an operative delivery (vaginal operative birth or cesarean delivery during the second stage) were eligible for this study. Women were included during the second stage if an operative delivery was expected. The HPD was measured using 2 devices: transperineal ultrasound (HPDus) and a hysterometer (HPDhys). Correlations and agreement were calculated, and receiver-operating characteristic curve analysis was conducted to evaluate the performance of each method in predicting cesarean delivery. RESULTS The final population comprised 671 women who underwent both HPDhys and HPDus. Pearson correlational analysis showed good agreement between both methods: r = .85 (95% confidence interval [CI] .84–.88). Correlations were independent of the level of the fetus head station and head position. The area-under-the-curve values were high for both methods: 0.87 (95% CI 82.8–92.1) for clinical HPDhys and 0.83 (95% CI 0.78–0.89) for HPDus ( P = .006). CONCLUSIONS HPD measured with a hysterometer is accessible to all practitioners and correlates well with HPD measured with transperineal ultrasound. HPD has potential as a tool to help clinicians select the appropriate indications for instrumental deliveries. It is hoped that this easily accessible technique will be used widely, especially in countries where ultrasound resources may be limited. Further studies are needed to confirm the results of this study.
Partial nephrectomy can lead to complications such as urinary fistulas, with an incidence ranging from 1 to 17
