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.
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
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.
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.
INTRODUCTION:Antigen delisting has emerged as a strategy to expand kidney transplant opportunities for highly sensitized candidates, but its clinical safety limits remain uncertain. Since October 2019, eight elite French kidney transplant centers have applied automated delisting, allowing systematic and adjustment of unacceptable HLA antigens. METHODS:We retrospectively reviewed all delisting decisions applied to 2418 candidates enrolled until March 2025. Two approaches were used: time-dependent delisting, restricting unacceptable antigens to those detected within a defined look-back period, and mean fluorescent intensity-dependent delisting, reintroducing weak antigens by raising the mean fluorescence intensity threshold for unacceptable ones. Post-transplant outcomes were assessed in 804 recipients with available follow-up. RESULTS:Delisting significantly improved transplant probability only for candidates with a baseline calculated panel-reactive antibody (cPRA) 96.6% or more. A two-fold increase in donor offers was sufficient at 99% or more, while a three-fold increase was required at 98% or more. Among the transplanted recipients, the risk of graft loss or death was significantly higher when donor-specific antibodies persisted at above 2000 mean fluorescence intensity at transplant (24.4% vs 10.7%). Patients with historical antibodies that had fallen below 2000 mean fluorescence intensity before transplant showed an early post-transplant donor-specific antibody rebound but had outcomes comparable to antibody-negative recipients. CONCLUSIONS:Automated delisting primarily benefited extremely sensitized patients. Time-dependent strategies that required antibody clearance before transplant appeared safer than approaches accepting persistent donor-specific antibodies. A conservative three-year time threshold with a 2000 mean fluorescence intensity offered a balanced approach for candidates with baseline cPRA 98% or more.
Background Epstein-Barr virus (EBV)-associated primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma closely linked to immunodeficiency. Imaging characteristics of EBV-associated are reported to differ from those of typical EBV-negative PCNSL. This study aims to describe the radiological and nuclear medicine imaging features in a large cohort of patients with EBV-associated PCNSL.Methods We conducted a multicenter retrospective descriptive study between 2008 and 2025 on patients with a diagnosis of EBV-associated PCNSL. MRI variables and FDG-PET/CT uptake were assessed.Results Fifty-eight cases of EBV-associated PCNSL were included. All but 1 patient were immunosuppressed. Multiple lesions were present in 71% of cases (41/58). Supratentorial involvement was observed in 90% of cases (52/58). Heterogeneous contrast enhancement was noted in 90% (52/58), with ring-like enhancement in 41% (24/58). Leptomeningeal enhancement occurred in 31% of cases (18/58), and within this group, 50% showed perivascular space enhancement. Lesions showed hypercellularity in 83% (48/58) and intralesional hemorrhage in 81% (47/58). An "eccentric target" sign was present in 26% of cases (15/58), while a "concentric target" sign in 14% (5/35). On FDG-PET, 25/30 patients had hypermetabolic lesions (25/30, 83%).Conclusion Diagnosing EBV-associated PCNSL is challenging due to its rarity and the broad differential diagnosis. Multiple necrotic and hemorrhagic lesions are the most suggestive MRI feature of EBV-associated PCNSL. "Eccentric" and "concentric" target signs, typically associated with CNS toxoplasmosis, can be observed. FDG-PET often reveals hypermetabolic lesions that support a neoplastic diagnosis. Histological confirmation remains essential for confidently treating this tumor entity.
