Biomedical subjects
Publications and source records attributed to Isabelle Simon.
INTRODUCTION: Fetal CT is helpful in the diagnosis of bony anomalies, particularly with 3D reconstructions. DISCUSSION: Because of the potential risks of irradiation, CT should not be performed before 32 weeks' gestation and should be restricted to a carefully selected group of patients.
INTRODUCTION: Diastematomyelia, also termed split cord malformation, is a form of occult spinal dysraphism characterized by a cleft in the spinal cord. Prenatal diagnosis of this anomaly is possible by ultrasonography (US), and fetal MRI can be used to diagnose the type of diastematomyelia precisely. Diastematomyelia can be isolated or associated with other dysraphisms, segmental anomalies of the vertebral bodies, or visceral malformations (horseshoe or ectopic kidney, utero-ovarian malformation, and anorectal malformation). We present three cases of fetal diastematomyelia investigated using a multimodal prenatal work-up (US, MRI, 3D-CT). CASES: The first case, detected at 20 weeks' gestation, had a lumbar meningocele. At 30 weeks' gestation, direct US visualization revealed the division of the spinal cord into two hemicords. This patient illustrates an isolated type II diastematomyelia with a favorable prognosis. The second case, detected at 22 weeks' gestation, presented with disorganization of bony process of the vertebral column with a midline echogenic bony spur, asymmetrical hemicords, and a foot malposition. Fetal MRI at 26 weeks' gestation and CT/3D reconstructed at 32 weeks' gestation confirmed a type I diastematomyelia with orthopedic malposition. The third case, detected at 22 weeks' gestation, presented with widening of the lumbar canal and scoliosis. Prenatal work-up (US, MRI) disclosed other visceral malformations (pelvic kidney), which led to the assumption of a complex polymalformative syndrome. The pregnancy was terminated. Fetopathologic examination disclosed even more visceral malformations (anal atresia and unicorn uterus).
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STUDY OBJECTIVES: To validate a new method of evaluation of respiratory efforts during polysomnographic recordings. SETTING: NA PARTICIPANTS: 26 patients with sleep apnea syndrome, either during diagnostic assessment (n=16) or under nasal continuous positive airway pressure (n=10). METHODS: This method consists of measuring suprastemal pressure by a pressure transducer placed over the trachea above the sternal notch (Pst). It was compared to the reference method (ie, esophageal pressure) during the same polysomnogram. RESULTS: The analysis was based on 3,261 episodes of apnea, classified as obstructive in 2,556 cases, mixed in 347 cases, and central in 358 cases according to the esophageal pressure monitor. The concordance between the two methods was very good, with a sensitivity of Pst of 99.4% for the detection of apneas with respiratory efforts and a specificity of 93.6%. Twenty-three (6.4%) of the 358 central apneas were classified by Pst as apneas with respiratory efforts and 18 of the 353 central apneas classified by Pst were actually apneas with respiratory efforts on the esophageal pressure monitor. CONCLUSION: The suprasternal pressure transducer, which presents a good sensitivity and a good specificity for identification of respiratory efforts, can be used to classify apneas during polysomnographic recordings in clinical practice.