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Biomedical subjects

B Quinet

Publications and source records attributed to B Quinet.

At least 37 records · Page 2Linked to original sources
PubMed1998

Pharyngo-laryngeal histoplasmosis: one case in an immunocompetent child.

We report a very rare case of disseminated pharyngo-laryngeal histoplasmosis with systemic spread in a 10-year-old, immunocompetent child from Guyana. The main signs were a marked deterioration in his general condition, hepato-splenomegaly, multiple lymphadenopathy and ulcerated pharyngo-laryngeal lesions. The diagnosis was made from brushings of the ulcerative lesions, a lymph node biopsy and serological tests performed in the national reference center for histoplasmosis. The initial treatment was with amphotericin B, which was then replaced by oral itraconazole. We report here the main epidemiological, clinical and therapeutic characteristics.

Amphotericin B↗
PubMed1998

[Current definition of urinary tract infection in the child].

Urinary tract infections (UTI) encompass a spectrum of clinical and pathological conditions involving various parts of the urinary tract. Differentiating the syndromes associated with UTI has important implications for treatment and prognosis. To effectively communicate information on the subject, terminology should be standardized and precise--a challenge as it is difficult to strictly adapt the terms into French and subsequently apply them to practice.

Adolescent↗
PubMed1998

[The sickle cell anemia lung from childhood to adulthood].

The pulmonary complications remain the prime cause of morbidity and mortality in sickle cell disease. The pathogenetic mechanisms consists both of an alteration of the rheological properties of the blood, the existence of a hypercoagulability state and above all specific interactions between the abnormal sickle cells and the vascular endothelium and a dysregulation of the vascular reactivity in which nitrous oxide intervenes. The acute chest syndrome (ACS) is characterised by chest pain with dyspnoea and recent radiological abnormalities and it is an acute lung complication whose problem is one of aetiology. The infectious pneumonias are rarely documented. On the other hand, alveolar hypoventilation linked to infarcts of the thoracic ribs, thoracoabdominal trauma, subdiaphragmatic pain, the administration of analgesics causing respiratory depression, obesity or sleep disturbance are frequent causes of ACS. Bronchoalveolar lavage has revealed a frequency of fat emboli following infarcts in the long bones. Pulmonary emboli is rarely a cause. Pulmonary thrombosis is a serious complication, the diagnosis is difficult and is seen in a predisposed clinical setting. The treatment of ACS rests on controlled hydration and antibiotic therapy, oxygen therapy and controlled analgesic therapy. The indications for blood transfusion and for exchange transfusion merits a better evaluation. In the long term patients with sickle cell disease present with a failure of normal thoracopulmonary growth with a restrictive ventilatory defect and progressive diminution in the transfer factor of carbon monoxide with age. A history of ACS favours chronic lung disease. Pulmonary arterial hypertension is less frequent.

Acute Disease↗
PubMed1996

[Infectious diarrhea in young children and infants].

Acute diarrhoea is one of the major causes of outpatient paediatric consultation, especially during infancy. An infectious cause should be suspected on the acute onset of diarrhoea associated with fever. The specific pathogen is seldom investigated and individualized. Rotavirus has been recognized as the most important enteric pathogen, particularly in infants during winter months. It may be responsible for nosocomial infections in hospital and outbreaks in day-care centers. Bacteria may cause a diarrhoea by elaboration of enterotoxins, by invasiveness, or both. Use of antibiotic is usually not necessary even in bacterial infections because they are self-limited. Choice of the antibiotic is complicated by the rapid emergence of resistant pathogenic strains. The first step is rapid assessment of the hydratation status of the patient. Fluid and electrolytes replacement is the mainstay in the treatment of infectious diarrhoea of any cause.

Bacterial Infections↗
PubMed1993

[Dengue. Apropos of 2 cases].

BACKGROUND. Dengue is an acute febrile illness caused by several arthropod-born viruses and characterized by biphasic fever, myalgia or arthralgia, rash, leukopenia and lymphadenopathy. Its diagnosis is based on knowledge of the geographic distribution of dengue viruses. CASE REPORTS Case no 1: A 11 year-old boy suffered from sudden onset of fever accompanied by retro-orbital headache, arthralgia and diffuse myalgia. There was no rash. Hemogram showed: hemoglobin: 11.6 g%; leukocytes: 3,400/mm3 (PMN: 76%); platelets: 190,000/mm3. A diagnosis of viral infection was considered, but, as the boy had recently been to the French West-Indies, a serologic study was performed. This was negative 2 days after the onset of disease and positive (specific IgM for the 4 dengue types), 13 days later. Case no 2: A 7 year-old boy suffered from sudden onset of fever. Severe calf muscle pain 4 days later led to his admission. Creatine phosphokinase activity was very high: 83,100 units (N: 30-120). Hemogram showed: hemoglobin: 11.4 g%; leukocytes: 2,500/mm3 (PMN: 60%); platelets: 124,000/mm3. A diagnosis of acute myositis was considered, but as the patient had recently visited Venezuela, a serologic study was performed. This was negative 8 days after the onset of disease and positive (specific IgM for the 4 dengue types) 16 days later. CONCLUSION. The first case is characteristic of the classical form of dengue fever. The second patient presented with very localized myalgia. The diagnosis in both cases was facilitated by the knowledge that the patient had recently stayed in an endemic area.

Acute Disease↗
PubMed1993

[Pharmacokinetic study of antibiotics in otitis].

Antibiotic concentrations in middle ear fluid can be determined in the purulent effusions of acute otitis media or in chronic effusions at the time of myringotomy with tympanostomy tube insertion. Measurements are usually made using microbiological methods. The concentration of betalactamines in middle ear fluid is 20 to 40% serum concentrations. Therefore, in the treatment of otitis media, it is necessary to use high doses of antibiotics, so that the concentration in the middle ear fluid is higher than the minimum inhibitory concentration (MIC) for the most frequent infecting organisms. Sulfamides penetrate well into the middle ear. On the other hand, the concentration of macrolides is not significant until two or three doses have been delivered and a steady state is reached. While direct measurements of the antibiotic concentrations in middle ear fluid can provide information concerning the effectiveness of the antibiotic relative to the MIC, they do not replace clinical trials in confirming the indications of new antibiotic molecules in the treatment of otitis media. In addition, direct measurements are delicate and show great interindividual variations.

Anti-Bacterial Agents↗
PubMed1993

[Duration of the treatment of meningitis except in the neonatal period].

Optimal treatment of bacterial meningitis raises three questions: which antibiotic? which dosage? which duration? The overall duration of antibiotherapy has been shortened since the last decade. If a short-course treatment shows similar efficacy and rate of relapse, unnecessary prolonged course of treatment exposes to increased cost, duration of hospitalization and secondary effects. From 1979, Gold et al in Toronto treated all uncomplicated cases of meningitis for seven days and obtained satisfactory results. The first randomized trials evaluating optimal duration of treatment in meningitis were performed in 1985 by Lin et al: they showed no difference in terms of efficacy and complications between conventional and short-term treatment. Current rules in meningococcal meningitis consist of seven days or less on therapy, and 7-10 days for pneumococcal or Haemophilus meningitis. The sequential follow-up of C-reactive protein (CRP) levels seems a useful tool for the management of bacterial meningitis.

Anti-Bacterial Agents↗
PubMed1991

[Malaria of importation in the child: epidemiological, clinical and therapeutic analysis. Apropos of 70 cases observed in a pediatric hospital in Paris].

Seventy children from 7 months to 15 years old have been treated for malaria at Hospital Trousseau (Paris) during years 1987 and 1988. Thirty nine of them were living in France usually. The infection was one chiefly in Africa (68 cases), and by P. falciparum in 78% of children. The digestive symptoms were frequent (40/70); splenomegaly was observed in 40 children and hepatomegaly in 31. Anemia was present in 59 cases and mild thrombopenia for 31 cases. The C. reactive protein raised in 92% of cases. The diagnosis was late in 31 patients. Only one cerebral malaria case was observed. The chemoprophylaxis was unfitted or absent in 74% of children living in Paris. The chloroquino-resistance was clinically present in 17 cases and the mefloquine was more often used during 1988 year.

Africa↗
PubMed1990

[Tropical parasitic diseases in children].

All children returning from countries where parasitic diseases are endemic should be investigated for one or several of these diseases according to the region visited and the duration of the visit. Investigations should include at least a parasitological examination of the stools, sometimes completed by a search for urinary schistosomiasis and, at the slightest suspicion, an examination of the eye. The gastrointestinal and percutaneous modes of transmission of parasitoses are such that children are particularly at risk. The most frequently encountered diseases are ankylostomiasis, anguilluliasis, amoebiasis, urinary schistomiasis and filariasis. Side by side with these strictly tropical parasitoses, one may find massive infestation with ascarides and lamblias. Effective and well tolerated treatments are available for most of these diseases, but advice on prophylactic measures is essential to reduce the risk of contamination.

Child↗
PubMed1990

[Management of children with sickle-cell disease].

The management of children with sickle-cell disease in specialized centres may take place either during the intercritical phase of the disease or in the period of vaso-occlusive phenomena and acute complications. Without any doubt, a regular follow-up of these children, starting immediately after the diagnosis is made, improves the prognosis. Repeated visits enable the physician to inform the family and thereafter the child on the disease, its consequences and its transmission and to implement such prophylactic measures as preventive antibiotic therapy, specific immunizations and advice on hydration. As years go by, this monitoring is modified according to the patient's age, the course of the disease and the age-related complications. Acute accidents are frequent and often difficult to diagnose. In the immediate and well-adjusted management they require rehydration, rest, analgesics and antibiotics play a major role. The purpose of management is to avoid most complications and raise the child to adulthood in the best possible conditions.

Acute Disease↗
PubMed1990

[Acute otitis media in children: a randomized and open clinical trial of the efficacy of 2 major antibiotics (erythromycin ethylsuccinate/acetyl sulfafurazole vs amoxicillin/clavulanic acid)].

In a prospective randomized open study, 111 young children with otitis media were orally treated during 10 days with Pediazole (50 mg/kg/day in 3 divided doses) or amoxicillin + clavulanic acid (40 mg/kg/day in 3 or 4 divided doses) for efficacy and safety evaluation. 51 children wer assigned to amoxicillin + clavulanic acid (group I) and 60 to erythromycin-sulfisoxazole (group II). Mean age was respectively 24.7 months in group I and 23.4 months in group II. Results of efficacy evaluation were as follows: (table; see text) there was no statistically significant difference between the two treatment groups for efficacy. Overall safety was good. The treatment was discontinued only in four cases (3 in the amoxicillin + clavulanic acid group and 1 in the EES-sulfisoxazole group). In conclusion, Erythromycin sulfisoxazole combination (Pediazole) fits in with current epidemiological profile of Acute Otitis Media and represents a therapy of choice in this indication.

Acute Disease↗
PubMed1989

[Tonsillar diffusion of cefixime in children].

Cefixime was assayed by a microbiological method in the tonsils of 21 children (mean age 59 months). Tonsillectomy was performed 5 hours after a third dose of 4 mg/kg administered 12-hourly. Plasma cefixime levels were evaluated 10 hours after the second dose with a mean value of 0.84 mg/l (range: 0 to 1.35) and again after a third dose during amygdalectomy with a mean value of 1.24 mg/l (range: 0.1 to 3.9). Cefixime concentrations were 0.74 micrograms/g in the right tonsils and 0.53 micrograms/g in the left tonsils. The antibiotics could not be detected in both tonsils in 6 children and in one of the two tonsils in 11 children. The tissue penetration of cefixime in tonsils therefore was about 1 micrograms/g in those cases where cefixime was detectable. As with other beta-lactam antibiotics, this penetration is not regular, being dependent on the degree of tonsillar fibrosis inhibitin their diffusion.

Biological Transport↗
PubMed1989

[Clinical and pharmacokinetic study of ceftizoxime in newborn infants and children].

Ceftizoxime was evaluated in the treatment of 49 children and 15 neonates. The average dosage was 150 mg/kg/d for newborns and 115 mg/kg/d for children, administered IV, 3 or 4 times daily. Clinical and bacteriological cure was achieved in 93% children and 92% neonates. The clinical and biological tolerance was very good. Pharmacokinetic parameters were studied in 17 patients, including 2 neonates. In children the mean serum peak was 40 mug/ml and the mean half life was 2.2 +/- 0.6 H, after a dose of 30 mg/kg. In both neonates the half life was 3.1 H and 3.6 H. In urine, mean concentration of 4 g/l has been obtained in the first 2 hours after IV.

Adolescent↗
PubMed1989

[Clinical and pharmacokinetic study of imipenem/cilastatin in children and newborn infants].

Imipenem, a new carbapenem (thienamycin) beta lactam antibiotic which is clinically used in a 1:1 combination with cilastatin, an inhibitor or renal metabolism of imipenem, was evaluated in 25 patients; 11 children and 14 neonates. A mean daily dose of 60 mg/kg was given to children and the dose in neonates was 50 mg/kg. Clinically, 21 patients were cured, two failed to respond to treatment and two were not evaluable. Pharmacokinetic studies were performed in the 11 children and in 10 of the neonates. The mean elimination half-life of imipenem was 0.87 h in children and 2.1 h in neonates. The mean cilastatin elimination half-life was 0.73 h in children and 5.1 h in neonates. This difference in half-life between children and neonates is similar to the one noted between healthy adults and adults with renal insufficiency. No accumulation of imipenem was seen in neonates studied on the first and fifth days of treatment.

Adolescent↗
PubMed1989

[Tonsil diffusion of cefixime in children].

Cefixime is a new oral cephalosporin antibiotic, with broad-spectrum of activity, near than of third generation cephalosporin, especially against betelactamase producers bacteria. Cefixime has been assayed with microbiological method in tonsils of 21 children (mean age 59 months). Tonsillectomy was performed 5 hours after a third dose of 4 mg/kg cefixime. Plasma levels were evaluated 10 hours after the second dose, with mean level of 0.84 micrograms/ml (0 to 1.35). Blood level was evaluated after third dose, during amygdalectomy was 1.24 micrograms/ml (0.1 to 3.9). Tonsils levels were: for right tonsils 0.74 micrograms/g and for left tonsils 0.53 micrograms/g. Cefixime was not detected in both tonsils of 6 children, and in one of the two tonsils in 11 of them. The tonsils penetration of cefixime was about 1 microgram/g in the case where cefixime was detectable. This penetration is not regular as for other betalactam antibiotics in relation with fibrosis of tonsils tissue inhibiting a good diffusion of antibiotic.

Cefixime↗
PubMed1988

[Pharmacokinetics of ceftazidime in children and newborn infants. Study in 14 patients and review of the literature].

A pharmacokinetic study of ceftazidime was conducted in 1983, together with a clinical study, on 7 neonates (3 of them premature), 4 infants and 3 children. The antibiotic was administered by slow intravenous injection in mean doses of 30 mg/kg twice in 24 h in neonates and thrice in 24 h in older children. Blood samples were collected by micropuncture, and assays were performed by the microbiological method on agar plates. Curves of plasma concentrations over time showed two slopes compatible with a two-compartment model. The alpha half-life was the same in neonates and infants; the beta half-life varied from 1.9 to 5 h. The highest values were observed in the 3 youngest and most immature neonates. In infants and older children the mean beta half-life was the same as in adults: 1.4 +/- 0.19 h. The results of several studies performed on neonates differed as regards the influence of term, post-natal age and bodyweight on the pharmacokinetic constants of ceftazidime. A dose of 25 to 50 mg/kg twice a day administered to premature and full-term neonates during the 1st week of life gives therapeutically effective concentrations. Doses of 30 to 50 mg/kg 3 or 4 times a day are necessary in infants and older children. Dosage should be adjusted to renal maturity and renal functions as well as to the infection treated.

Adolescent↗