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C Le Coultre

Publications and source records attributed to C Le Coultre.

At least 19 recordsLinked to original sources
PubMed2003

Fulminant liver failure in a child with invasive group A streptococcal infection.

UNLABELLED: Liver involvement is mentioned in streptococcal toxic shock syndrome, but never as fulminant liver failure (FLF). We report the case of a 2-year-old child who developed isolated FLF secondary to invasive group A streptococcal infection without shock due to a M1T1-type strain expressing speA, speB and speC toxin genes. On antibiotics, he recovered rapidly without liver transplantation. CONCLUSION: A streptococcal pyrogenic exotoxin likely constituted the initial insult leading to FLF. This etiology can be included in the differential diagnosis of FLF and would support early introduction of antibiotics.

Anti-Bacterial Agents↗
PubMed2003

Severe bronchial synechia after removal of a long-standing bronchial foreign body: a case report to support control bronchoscopy.

The authors report the case of a child who had severe bronchial synechia of the left main bronchus after removal of a pistachio shell embedded in granulation tissue. Histology finding of the removed granulation tissue at initial bronchoscopy showed an Actinomyces bacterial invasion. It was decided not to treat this local contamination and to perform a control bronchoscopy to verify the disappearance of local bacterial invasion. The control bonchoscopy performed 4 weeks after the foreign body (FB) removal disclosed a large central left main bronchus synechia producing a 70% reduction of the lumen, although the child had become asymptomatic except for a slight residual cough. The resection of the synechia restored a normal bronchial lumen. The performance of a systematic control bronchoscopy after removal of long standing FB is discussed and recommended.

Actinomycosis↗
PubMed2003

Selective hepatic artery ligation for hepatic haemangioendothelioma: case report and review of the literature.

Although benign, hepatic haemangioendotheliomas (HHE) are rare vascular tumours of the infant which have a high mortality rate secondary to high output congestive heart failure. The management of these tumours is still controversial and none of the different medical or surgical options has been unanimously accepted. We report the case of a neonate with congestive heart failure (CHF) due to a localized HHE, treated successfully by selective ligation of the left hepatic artery branch irrigating the tumour, under perioperative ultrasound Doppler control. A review of the literature showed 35 cases of HHE treated by hepatic artery ligation (HAL) with a survival rate of 80 %.

Female↗
PubMed2002

Thoracoscopic sympathectomy using ultrasonic coagulating shears: a technical improvement in the treatment of palmar hyperhidrosis.

Thoracoscopic sympathectomy has emerged in recent years as the treatment of choice for primary palmar hyperhidrosis when medical treatment fails. Postoperative complications have been reported in large series, however, including neurologic problems such as temporary or definitive Horner syndrome and peripheral nerve injuries. The authors report the use of ultrasonic coagulating scissors instead of electrocautery for the dissection and removal of a segment of sympathetic chain in an 11-year-old girl. A bilateral procedure was performed sequentially through three 5-mm axillary trocars on each side. The use of ultrasonic shears eliminates the risk of distal nerve injury induced by the spread of electric current and could possibly reduce the incidence of the above-mentioned complications.

Child↗
PubMed2001

[Scooter injuries or a chronicle of a new epidemic. Apropos of a prospective study of Geneva cases].

AIM: Confronted with an increasing number of an unpowered scooter-related injury and an absence of available data in the literature, we undertook a prospective and exploratory study, in order to assess the circumstances and trauma consequences of this kind of injury. METHOD: Between the 15th of August 2000 and the 15th of November 2000, each child consulting our emergency room for a scooter-related injury was questioned about the circumstances of the accident and his general scooter experience. Data about all injuries and there treatment were collected. RESULTS: 32 children (16 B/16 G) with a the mean age of 10.1 +/- 2.3 years have consulted. Eight children (25%) required hospitalization. In almost half of the cases, the injury was caused by direct or indirect material facts. No child was wearing protection at the time of the accident. Fracture was the most frequent injury (55%) and the upper limb was concerned by almost half of the lesions. Four fractures required osteosynthesis (12.5%) and six treatments a general anesthesia (19%). The severity of injury and the treatment were more substantial when the unpowered scooters were used for transport rather than for playing. CONCLUSION: Our short study gives a first estimation of the potential danger of the unpowered scooter and its confrontation with the traffic, without prevention given by the law or the producer. However this product can lead to important injuries.

Adolescent↗
PubMed2001

Biliary atresia and orthotopic liver transplantation. 11 years of experience in Geneva.

Biliary atresia (BA) is a congenital malformation or an evolutive inflammatory process which, without treatment, leads to cirrhosis, hepatic failure and death within two years of birth. The literature gives a survival rate of 60% at five years and 25% to adulthood after an initial operation performed for BA. 30% of children do not survive beyond two years of age. BA has become the most frequent indication for liver transplantation (LT) in children. With LT, survival expectancy is 90%. Results of the operation designed for BA remain unsatisfactory, and seem to depend on the age of the infants, as well as on other factors such as liver histology, and centre experience. Since 1989, onset of the paediatric hepatic transplantation program in Geneva, to July 2000, 20 children have been referred for initial treatment of BA, and 26 for possible hepatic transplantation after initial treatment done in another centre. The aim of the current study is to analyse our own results of the initial operation and to present the results of liver transplantation in this particular group of patients. All the patients with a BA are included in this study. The initial operation for BA yielded 43% favourable outcome at five years and the survival in this group following LT reached 91.3% survival. The importance of the age of the patient at time of initial operation is underlined.

Biliary Atresia↗
PubMed2001

Intestinal obstruction caused by an ectopic fallopian tube in a child: case report and literature review.

The authors present the case of a prepubertal 14-year-old girl who was admitted for an acute abdominal pain, fever, and vomiting. She was in a poor general state, having recently suffered a weight loss of 5 kg. A plain abdominal x-ray disclosed signs of mechanical ileus. An abdominal ultrasound scan showed a normal uterus, a normal right-sided ovary, but no left ovary. An emergency laparoscopy found a normal uterus with complete absence of the left ovary and salpinx, the upper left dome of the uterus being smooth with no visible horn. The right ovary and salpinx were normal. Intestinal obstruction was caused by a strangulating cordlike structure of unclear origin. After converting to a laparotomy, we found an abnormal fallopian tube inserted in the left parieto-colic groove. The tube extended next on the lateral sigmoïd mesentery and wrapped itself around the ileum, provoking a local strangulation and an ischemic covered bowel perforation. The bowel perforation was treated by a segmental bowel resection. Careful dissection of the cordlike structure disclosed a true rudimentary fallopian tube with hypotrophic fimbriae and a small distal round structure containing ovarian tissue. These structures were removed entirely. A review of the literature on this rare situation is presented and discussed.

Abdomen, Acute↗
PubMed2000

Etiology and management of pediatric chylothorax.

OBJECTIVES: To determine the incidence and etiology of chylothorax and to assess our therapeutic management approach. STUDY DESIGN: We reviewed 51 patients diagnosed with chylothorax over a 12-year period. Cause, interval between operation and diagnosis, duration of chylothorax, and total volume loss per weight were recorded. RESULTS: Chylothorax was diagnosed in 46 children after cardiothoracic surgery, giving an incidence of 2.5% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifestation of lymph angiomatosis. Three etiologic groups were identified: group 1, direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and/or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment in 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuroperitoneal shunts. Patients in groups 2 and 3 were at higher risk for failure of conservative treatment (P <. 005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P <.01). CONCLUSION: Conservative treatment was successful in 80% of the patients with our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruction, may further improve success of conservative treatment. Congenital chylothorax seems different and may require a specific approach.

Angiomatosis↗
PubMed2000

Doppler waveform of hepatic veins in healthy children.

OBJECTIVE: This study intends to document the presence or absence of triphasic waveforms in hepatic veins in healthy children. Does absence of triphasic hepatic vein flow indicate hepatic abnormality? SUBJECTS AND METHODS: One hundred children without a known hepatic or intrathoracic abnormality underwent Doppler sonography of their hepatic veins. Fifty girls and 50 boys were divided into five age groups. RESULTS: Forty-two children had triphasic flow in all three hepatic veins. Veins approaching an angle of 90 degrees with the inferior vena cava could not be assessed or had the least flow modulations despite angle correction. Neonates had the highest percentage of monophasic flow (seven of 21) in all three hepatic veins and none had triphasic flow in all three veins. CONCLUSION: Not all healthy children have a triphasic flow pattern in all hepatic veins. Before suspecting hepatic abnormality with abnormal parenchymal compliance (cirrhosis, graft rejection) by virtue of lack of triphasic hepatic vein flow, a normal variant of the flow should be considered. Only the change of a previously documented triphasic flow to monophasic flow in a given vein should be assessed as a sign of possible abnormality.

Adolescent↗
PubMed2000

[Epidemiology of in-line skate injuries: state of the art].

During the last decade, in-line skating has become an increasingly popular activity. Along with the number of reports, highlighting the number of injuries and their degree of severity, in-line skating injuries have to be considered a growing public health issue. The objective of this work is to report epidemiological knowledge about in-line skate injuries and ways of prevention. A thorough search of all reports and publications on the subject was performed through the Medline database and in references of selected publications. There are numerous case series studies and several observational ones, most of them undertaken in North America. In-line skates are used for recreation, sports, and transportation, in a variety of settings (parks, streets, bike path, etc.) and by most of age groups (5 to 71 years, median generally about 15). The most common site of injury is the wrist and forearm, although other parts of the body can be severely injured. Age, sex, physical training level, formal instruction level, lack of wearing of protective gear, skating location, may be risk factors for injury. Some preventive measures were proposed by a number of research workers (information campaigns, wearing of protective gear, instruction, laws, etc.). Several preventive attempts were undertaken but no one was appraised. In-line skates are used by all age groups and for a variety of activities. In-line skating is related to a great number of factors, such as cultural, social, geographic, urban and behavioural factors. Therefore, groups at risk for injury are very different. Emergence of an important type of injury should lead to the development of analytic epidemiological studies, based on particular groups of in-line skaters, in order to describe them, to identify and quantify risk factors and to design preventive measures, and then to appraise their efficiency.

Accidents, Traffic↗
PubMed1999

[Results of a combined adult-child liver transplantation in Switzerland].

Between July 1987 and August 1998, 173 orthotopic liver transplantations (OLT) were performed in Geneva. We studied a homogeneous group of 114 OLT performed during the 6 years between 1992 and 1997 on 107 patients (89 adults and 18 children; 7 retransplantations). Although Geneva has the largest transplantation programme in Switzerland and is the only centre performing paediatric liver transplantation, the mean number of procedures per year was 19, corresponding to only a small transplantation programme in Europe. It could be reasonably questioned, therefore, whether Swiss patients are not at a disadvantage as compared with patients from European countries with larger liver transplantation centres. Although the perioperative morbidity was still considerable, the results of this series -90% of actuarial patient survival at 1 and 2 years and 84% at 5 years-compare favourably with the results of the European Liver Transplantation Registry: 76% of actuarial patient survival at 1 year and 65% at 5 years. In this series, 95 patients (89%) were alive on January 1, 1998. As no patient was refused on the severity of the liver disease and as more than 10% of OLT were performed as emergencies, a bias due to the selection of the best cases cannot explain the good results. This series demonstrates that a small liver transplantation centre may obtain results that compare favourably with the results of large European centres, and that Swiss patients are not at a disadvantage as compared with patients of other European countries.

Adult↗
PubMed1999

Improvement of the effect of hepatocyte isograft in the Gunn rat by cotransplantation of islets of Langerhans.

PURPOSE: Hepatocyte transplantation (HcTX) has been investigated for many years as an alternative therapy to orthotopic liver transplantation to treat hepatic congenital enzymatic deficiency disease. The animal model most used is the Gunn rat, which presents a hyperbilirubinemia caused by the lack of uridine-diphosphate-glucuronyl-transferase. Some investigators have clearly described a hepatotrophic effect mediated by islets of Langerhans (IL) when transplanted with hepatocytes (Hc). In this study, the functional effect of cotransplanted IL on hepatocytes (co-HcTX) in Gunn rats in an isograft model is assessed. METHODS: Two groups are compared: group 1 (n = 6), HcTX to group 2 (n = 6), co-HcTX. Cells isolated by enzymatic digestion are transplanted directly into the splenic parenchyma. Blood samples are taken regularly until day 100 to measure the unconjugated bilirubin (UB). Histological examination of the spleen is performed at the end of the experiment. RESULTS: Both groups show a significant decrease of the UB: group 1, 47%; group 2, 65%. The decrease is statistically more pronounced with co-HcTX. The histological analysis shows a trophic effect of the IL on the grafted hepatocytes in the co-HcTX group. CONCLUSIONS: The HcTX and the co-HcTX correct partially the hyperbilirubinemia of the Gunn rat. A functional assessment has been performed to evaluate the effect of cotransplanted IL on HcTX.

Analysis of Variance↗
PubMed1999

[Value of the Pediatric Trauma Score in routine hospital practice--apropos of a prospective one-year trial].

AIM: To test the usefulness of the Pediatric Trauma Score (PTS) in a university hospital setting. METHODS: All injured children who were admitted to our emergency room during a one year period were prospectively studies. The study was performed at the Pediatric University Hospital of Geneva. Patients were divided into two groups: group one included severely injured children with a PTS equal or lower 8 and group two included patients with a PTS greater than 8. RESULTS: A total of 6804 injured children were admitted to our emergency room and 927 (14%) were hospitalized. In group one (104 children, 1.5%), six patients died whereas in group two (823 children, 12%), all patients survived. In addition, children in group one demonstrated a significant higher number of general anesthesia, a longer stay in the ICU and a longer stay, and an increased number of sequelae 3 months after trauma. DISCUSSION: Our result confirm the usefulness of the PTS and the cutoff value of 8 in pediatric trauma. In addition, the study underlines the important morbidity and the residual sequelae after severe trauma in children. CONCLUSION: The PTS should be used in all injured children in order to identify patients at risk. This would allow to begin an appropriate treatment or, if necessary, initiate a transfer to a surgical pediatric center without delay.

Adolescent↗
PubMed1998

Reliability of color Doppler and power Doppler sonography in the evaluation of intussuscepted bowel viability.

In two similar cases of irreducible intussusception with wall necrosis and perforation, symptoms had begun 24 h before admission and the plain radiographs showed signs of small-bowel obstruction. The sonographic (US) appearances, however, were different: color Doppler (CD) US showed vascular flow in the intussuscepted bowel in one case and no flow in the other. After radio-clinical assessment, both children underwent surgery and an intestinal resection had to be performed, manual reduction being impossible. The reliability of the US findings and the prognostic value of CD and power Doppler US in determining the viability of the intussuscepted bowel are discussed with a review of the literature.

Anastomosis, Surgical↗