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International audience; Background and purpose: Previous studies have demonstrated the usefulness of non-EPI DWI for detection of residual cholesteatoma. However, limited data are available to determine the suitable duration of imaging follow-up after a first MR imaging with normal findings has been obtained. The present study aimed to determine the optimal duration of non-EPI DWI follow-up for residual cholesteatoma.Materials and methods: A retrospective, monocentric study was performed between 2013 and 2019 and included all participants followed up after canal wall up tympanoplasty with at least 2 non-EPI DWI examinations performed on the same 1.5T MR imaging scanner. MR images were reviewed independently by 2 radiologists. Sensitivity and specificity values were calculated as a function of time after the operation. Receiver operating characteristic curves were analyzed to determine the optimal follow-up duration.Results: We analyzed 47 MRIs from 17 participants. At the end of the individual follow-up period, a residual cholesteatoma had been found in 41.1% of cases. The follow-up duration ranged from 20 to 198 months (mean, 65.9 [SD, 43.9] months). Participants underwent between 2 and 5 non-EPI DWI examinations. Analyses of the receiver operating characteristic curves revealed that the optimal diagnostic value of non-EPI DWI occurred 56 months after the operation when the first MR imaging performed a mean of 17.3 (SD, 6.8) months after the operation had normal findings (sensitivity = 0.71; specificity = 0.7, Youden index = 0.43).Conclusions: Repeat non-EPI DWI is required to detect slow-growing middle ear residual cholesteatomas. We, therefore, recommend performing non-EPI DWI for at least the first 5 years after the initial operation.

Forensic dentistry is the branch of forensic science concerned with the study of teeth and jaws. To facilitate the work of experts, new comparative identification tools are emerging, with digital techniques such as the intra-oral camera, which are revolutionising current techniques in forensic dentistry. Objective The aim of this study is to evaluate the diagnostic quality of the post-mortem odontogram carried out remotely via a video of the oral cavity using an intra-oral camera. The gold standard is the post-mortem odontogram obtained via the standard identification technique during the clinical examination. Materials and methods 25 deceased patients were included in the study and the data were collected in the Forensic Medicine and Thanatology Department at the University Hospital of Montpellier. The protocol was divided into three stages: the gold standard consultation, the recording of videos with the Soprocare® camera, and the remote analysis of the images obtained. The gold standard consultation and the remote analysis were carried out by two separate dental surgeons responsible for completing a clinical file, used to establish the odontogram of the deceased patient. Results The study was carried out on 25 deceased subjects, between 13 May and 12 June 2019. Our sample was composed of 68% men and 32% women. A sensitivity threshold of 0.97 was observed for the performance of the odontogram, i.e., for all the teeth actually present in the mouth for all subjects in the study, 97% of them were identified with the videos taken using the intraoral camera. The examination with the intra-oral camera demonstrated a good diagnostic performance in the detection of missing teeth with a PPV of 97.9% and a NPV of 98.2%. Practitioner became more skilled at recording the videos with the intra-oral camera. One can therefore note an ease in the handling of this digital tool, which gradually improved with the number of subjects included in the study Conclusions The Soprocare® intraoral camera has an acceptable diagnostic validity in establishing the odontogram of the deceased. It enables fundamental elements to be detected with optimal efficiency. However, several points still need to be improved, in order to make the use of the camera during data collection as easy and efficient as possible.

Aims Intra-aortic balloon pump (IABP) utilization was expected to be quickly abandoned following the IABP-shock trial and its class III, level B of recommendation in the 2016 ESC guidelines. The aim of this study was to evaluate the use of IABP compared to other mechanical support devices in a nationwide approach. Methods We conducted a retrospective study based on the French national hospital discharge database. All patients implanted by an assist device either by IABP, extracorporeal membrane oxygenation (ECMO) or IMPELLA® from 2014 to 2018 (2 years before/2 years after the 2016 guidelines) were included. The primary endpoint was the incidence of IABP implantation over the years. Secondary endpoints were incidence of total assist devices implantations, ECMO and IMPELLA® implantation. Results From 2014 to 2018, a total of 18,872 patients benefited from mechanical support by IABP (n=6,637, 35.2%), ECMO (n=11,833, 62.7%) or IMPELLA® (n=402, 2.1%) in France. The incidence of total mechanical support implantations (ECMO and IABP) was constant over the years. IABP implantation decreased progressively from 1,725 implantations in 2014 to 976 in 2018 (−44%). By contrast, ECMO implantation increased progressively from 1,919 implantations in 2014 to 2,715 implantations in 2018 (+42%). IMPELLA® implantations remained stable over the years from 63 (1.7%) implantations in 2014 to 83 (2.1%) in 2018. Conclusion In this nationwide real-life study, despite a significant decline in IABP implantations over the years since the ESC guidelines, this device remained used in clinical practice with around 1,000 implantations in 2018. The size of the centers is not strictly correlated with this use, suggesting differential uses depending of the local background. Funding Acknowledgement Type of funding source: None

Background:Joint replacement is a therapeutic option increasingly widespread among osteoarthritis (OA) patients. Besides improving operating techniques and postoperative management, it is important to pursue the best preoperative conditions in order to achieve the desired result. As physical activity (PA) potentially acts on the preoperative predictors, knowing the effect of leisure and occupational PA should be of great interest to obtain a positive outcome.Objectives:To investigate the influence of preoperative PA on the clinical outcomes of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in OA patients.Methods:Data from the Knee and Hip OsteoArthritis Long-term Assessment (KHOALA) cohort (1), a multi-regional French cohort of 878 patients with symptomatic hip and/or knee OA, were analysed. We included in our study patients undergoing THA or TKA during a 7-year-follow-up period. The level of total and leisure-time preoperative PA was measured with the Modifiable Activity Questionnaire (MAQ). Outcomes were measured one year after surgery. For the primary endpoint, quality of life (QoL) was measured with the OsteoArthritis Knee and Hip Quality Of Life questionnaire (OAKHQOL). For secondary endpoints, QoL was measured with Short Form 36 (SF-36), pain with the Visual Analogue Scale (VAS), function with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and with walking distance. The population characteristics were described using frequency or mean and standard deviation (SD), depending on the distribution of the variable. Association between exposures and outcomes was calculated with a multivariate linear analysis with backward selection, adjusting for confounders (age, sex, body mass index, site of joint replacement, polyarticular OA, OA duration, comorbidities, radiological grade of OA, inclusion centre, rehabilitation after surgery, previous joint issues, instruction level). A p-value Results:150 patients were included. 58.7% underwent TKA and 41.3% THA. The mean age at the time of surgery was 66.6 years (±7.7 SD). The majority of patients were female (75%), overweight (mean BMI 29.63 kg/m2, ±5.5 SD) and had polyarticular OA (60%). 53% of patients met the World Health Organization recommendations on PA before surgery. For the primary endpoint, a high preoperative total PA was associated with a better relationship with the partner (β = 0.55, p = 0.02) one year after surgery. As for secondary endpoints, a high two-year preoperative total PA was associated with an impaired SF-36 Mental Component Summary score (β = -0.87, p = 0.02), but a longer walking distance (β = 442.81, p < 0.01). Leisure-time PA also showed a positive impact on walking distance (β = 76.25, p = 0.02), but a negative one on social functioning in SF-36 (β = -0.47, p = 0.01). No statistically significant association between preoperative PA and pain nor WOMAC was found.Conclusion:In this cohort study, the preoperative level of PA demonstrated a heterogeneous effect on the various aspects of QoL one year after THA and TKA in OA patients. Preoperative PA was directly associated with gain of function, measured as walking distance, after surgery. Considering the increasing prevalence of OA and the crucial role of PA on health, further studies on this relevant topic are needed.References:[1]Guillemin F, Rat A-C, Roux CH, Fautrel B, Mazieres B, Chevalier X, et al. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012 Dec 1;79(6):597–603.Disclosure of Interests:Enrica Vandelli: None declared, Claire Duflos: None declared, Sandrine Akouete: None declared, Francis Guillemin Grant/research support from: Francis Guillemin received a grant from Expanscience paid to his institution., Anne-Christine Rat: None declared, Yves-Marie Pers: None declared

International audience; Le risque de cancers cutanés induits par des médicaments photosensibilisants est connu. Le rôle de l’hydrochlorothiazide a été soulevé par plusieurs études épidémiologiques récentes. Une revue systématique des études cas-témoins ou de cohortes prospectives montre qu’il existe un surrisque de carcinomes épidermoïdes dans la majorité des études même si certains facteurs de confusion comme le tabac n’ont pas été pris en compte. Les données sont plus contradictoires pour les carcinomes basocellulaires et les mélanomes. Ces résultats ne remettent pas en cause le rapport bénéfice/risque de cette molécule, mais peuvent inciter à des mesures de prévention renforcées chez les malades pour lesquels une prescription d’hydrochlorothiazide est proposée : identifier les patients à risque de carcinomes cutanés, éviter si possible de prescrire cette molécule chez les patients immunodéprimés ou ayant un carcinome, effectuer un examen cutané régulier chez les malades recevant ce traitement au long cours.

Resume Objectif Evaluer les performances de l’IRM fonctionnelle (IRMF) effectuee par des radiologues generalistes (RG) dans la detection de l’extension extracapsulaire lobe specifique (EECLS) du cancer de la prostate (CaP). Methode Nous avons analyse retrospectivement 79 patients ayant eu une IRMF avec antenne pelvienne avant une prostatectomie radicale (PR) realisee au CHU de Nimes. Douze RG (dont trois au CHU) ont interprete les images durant leur pratique quotidienne. Les resultats de l’IRMF ont ete dichotomises en positif ou negatif et confrontes a l’anatomopathologie pour l’EECLS et l’envahissement des vesicules seminales lobe specifique (EVSLS), avec calcul des valeurs diagnostiques. L’influence du delai entre biopsie et IRMF, de la sequence de diffusion et de l’intensite de l’IRMF sur les performances diagnostiques ont ete evaluees par un test de Fisher. Resultats Une EECLS et un EVSLS ont ete observes a l’IRMF et a l’anatomopathologie respectivement sur 14 (8,8 %) et 38 (24,1 %) lobes prostatiques et sur six (3,8 %) et sept (4,4 %) lobes prostatiques. La sensibilite, specificite, les valeurs predictives positives et negatives de l’IRMF pour l’EECLS etaient respectivement de 24 %, 96 %, 64 % et 80 % ; et pour l’EVSLS de 14 %, 97 %, 17 % et 96 %. Le delai entre biopsie et IRMF, l’intensite de l’IRMF et la sequence de diffusion, n’influencaient pas la sensibilite et la specificite de l’IRMF au test de Fisher. Conclusion Cette etude a observe que l’IRMF prostatique preoperatoire realisee par des RG avait une bonne specificite, mais une sensibilite mediocre dans la prediction de l’EEC lobe specifique presente sur la piece de PR.

Localized breast lesions have been described in lupic or diabetic patients. However, the description of breast gigantomastia in women presenting with autoimmune diseases has not been reported.The study took place within the Department of Endocrinology and Reproductive Medicine, Necker Hospital, Paris, France.We describe eight patients with inflammatory gigantomastia, occurring in a context of immune-mediated diseases: myasthenia, chronic arthritis, or thyroiditis.Together with hormonal, immunological, and breast magnetic resonance imaging (MRI) evaluation, breast histology enabled us to perform immunocytochemical and indirect immunofluorescence studies. Control sera were obtained from patients with (n = 10) and without (n = 7) antinuclear antibodies.Six of the eight patients developed gigantomastia either at puberty or during pregnancy. Neither a hormonal oversecretion nor a specific immunological pattern was observed. All patients except one presented antinuclear antibodies. Histological study revealed a diffuse, stromal hyperplasia and a severe atrophy of the lobules. A rarefaction of adipocytes was also noted, as previously suggested on MRI. There was a perilobular lymphocytic infiltrate made of CD3+ lymphocytes. Study of sera from five of six cases of gigantomastia showed a nuclear immunofluorescence pattern in normal mammary ductal and lobular glandular epithelium, as well as in kidney and intestine epithelial cells. In control sera, a nuclear signal was observed only when antinuclear antibodies were present.We suggest that breast tissue may be a target tissue in autoimmune diseases, this process being favored by the hormonal milieu. However, the precise mechanism of such association is not individualized. The fact that stromal hyperplasia is the main histological feature justifies the search for the involvement of growth factors in such a process.

Resume Les thrombopenies secondaires aux chimiotherapies anticancereuses peuvent provoquer des hemorragies genitales severes au cours de l’adolescence. Un traitement œstroprogestatif entrainant une amenorrhee therapeutique est possible, mais peut augmenter les risques thromboemboliques et hepatiques de certaines chimiotherapies. Objectifs de l’etude. – Evaluer retrospectivement le risque d’hemorragie genitale pour des adolescentes presentant une thrombopenie severe apres chimiotherapie. Patientes et methodes. – Parmi les 140 jeunes filles âgees de 12 a 18 ans traitees entre 1991 et 1998 par chimiotherapie, 24 jeunes filles puberes ayant presente au moins un episode de thrombopenie severe (taux de plaquettes Resultats. – Six adolescentes sur 24 ont recu un traitement preventif œstroprogestatif. Un seul episode d’hemorragie genitale, sans risque vital associe, a ete observe, chez une adolescente ne recevant pas de traitement hormonal preventif. Trente-trois pour cent des patientes presentaient une amenorrhee spontanee avant la chimiotherapie et 17 % une insuffisance ovarienne secondaire definitive. Conclusion. – Le risque hemorragique est faible chez les adolescentes soumises a une chimiotherapie entrainant une thrombopenie. L’amenorrhee observee frequemment au debut du traitement, qu’elle soit fonctionnelle en rapport avec l’amaigrissement ou secondaire a la toxicite de la chimiotherapie, rend discutable la necessite d’un traitement hormonal preventif.

Long cycles and excessive uterine bleeding are the most common menstrual disorders in adolescents. Long cycles usually result from a benign transitory functional disorder which spontaneously resolves within two to three years after menarche; however, this diagnosis can only be retained in the absence of hirsutism or galactorrhea as revealing symptoms of functional ovarian hyperandrogenism, polycystic ovary syndrome, late form of congenital adrenal hyperplasia or hyperprolactinemia; ovarian failure will be considered in case of isolated long cycles persisting more than two years after menarche. Excessive uterine bleeding usually occurs early after menarche. Although the main cause is functional, resulting from anovulation and the related absence of progesterone, coagulation disorders must always be excluded. Management of these disorders are described.

Summary Objective The efficacy and safety of height-limiting therapy with high-dose 17 β -oestradiol in girls with constitutionally tall stature (CTS) are controversial. We evaluated the effectiveness of high-dose 17 β -oestradiol in premenarchal girls with CTS treated until their bone age reached 14 years. Design We retrospectively reviewed the medical records of the girls managed between 1989 and 2000 with high-dose 17 β -estradiol for CTS with a predicted final height greater than +3SDs. Patients Tw enty-six girls met our inclusion criteria. At baseline, mean chronological age was 12·06 ± 1·51 years and mean height was 171·1 ± 6·5 cm with a height standard deviation score of 4·5 ± 0·24, and mean predicted final height was 183·0 ± 4·2 cm. Treatment was stopped when bone age reached 14 years; mean treatment duration was 1·62 ± 0·76 years. Measurements The following were obtained at 6-month intervals: height, body weight, Tanner stage, bone age, plasma cholesterol and triglycerides, plasma glucose and side effects. A mailed questionnaire on final height and satisfaction was sent 2 years after treatment discontinuation (response rate, 24/26). Results Final height was significantly ( P < 0·001) reduced, by 2·4 ± 3·2 cm, as compared to predictions. High-dose 17 β -estradiol therapy decreased growth velocity and significantly increased skeletal maturation ( P < 0·001). Linear growth after treatment discontinuation was 3·3 ± 1·9 cm. No serious side effects were recorded. Most of the patients were satisfied with the treatment. Conclusion High-dose 17 β -estradiol was moderately effective in reducing final height and should probably be reserved for selected patients, particularly as knowledge on potential long-term side effects is lacking.

Fibroadenomas and breast growth disorders are the most common breast diseases in adolescent women. Assessment of breast disorders in this age group generally involves clinical evaluation through history and physical examination and when is needed ultrasonography. Due to the absence of breast cancer in adolescent women, it is easy to reassure women at the first consultation. Breast growth disorders can lead great psychological and physical embarrassment. Treatment consists of surgical procedures when the cosmetic defect is severe. According to the ANDI classification, small fibroadenomas are normal, clinical fibroadenomas are a mild aberration of the normal processes, and giant or multiple fibroadenomas are placed to the disease end of the spectrum. Fibroadenomas can be treated conservatively provided diagnosis is confident. Giant fibroadenomas are treated by surgical enucleation. Breast abscess is mainly due to the duct ectasia. In adolescence, ectasia has been described as an exaggeration of sinus duct development and can be considered as a variant of normality. Diseases of the adolescent breast are usually benign and their management are simple using medical strategy and more rarely surgical therapy.

The clinical outcomes of seven girls presenting with pseudosexual precocity caused by isolated autonomous ovarian follicular cysts are presented. Six of the seven girls, aged 11 months to 6.9 years, had a unilateral ovarian cyst detected by ultrasound at the first acute episode. Plasma oestradiol was raised in only five of the cases, but all had a low response to luteinising hormone releasing hormone stimulation. Follow up lasted for up to eight years with recurrent episodes of variable frequency and severity in all seven patients. Evidence of McCune-Albright syndrome appeared later in only three patients. It could not be predicted from the initial symptoms or the clinical course. Mutations of the G(s)alpha protein leading to activation were investigated in the lymphocytes and ovarian and bone tissues of four patients. Only one patient showed a mutation in bone tissue. Close follow up with repeated searches for skeletal lesions remains necessary since the distribution of somatic mutations cannot be assessed by molecular studies. Most patients with recurrent ovarian cysts require a conservative approach.