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Biomedical subjects

C Ricour

Publications and source records attributed to C Ricour.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Intestinal transplantation in children: preliminary experience in Paris.

From November 1994 to November 1998, 20 children (2.5 to 14 years) received a jejunoileal graft alone (SBTx; n = 10) or in combination with the liver (SBLTx; n = 10 and/or the right colon (5 SBTx). Indications were intractable diarrhea of infancy (n = 8), short bowel syndrome (n = 6), extensive Hirschsprung disease (n = 4), and chronic intestinal pseudoobstruction (n = 2). Immunosuppression included tacrolimus, methylprednisolone, and azathioprine. Current follow-up ranges from 6 to 54 months. Five patients died (3 SBTx) within the first 2 months. Acute liver rejection occurred in 5 patients during the first 2 months. Sixteen episodes of intestinal rejection during the first 3 months in 11 patients (8 in 4 SBTx) were successfully treated in all but 3 by increasing tacrolimus dose and/or a 3-day methyprednisolone bolus or required antilymphoglobulins in 3 cases. Surgical complications occurred 8 times after SBLTx and 3 after SBTx. Infectious complications were more frequent in SBLTx recipients. Reversible Epstein-Barr virus-related posttransplant lymphoproliferative disease occurred in 3 recipients. Five presented cytomegalovirus infection. The SB graft was removed in 5 recipients (3 chronic rejection). All patients were started with oral and/or enteral feeding from the 7th postoperative day by using either normal food or protein hydrolysate diet. Currently, 10 of 11 children (8 SBLTx) achieved digestive autonomy after 5 to 30 weeks. All recipients gained weight; however, growth velocity remained reduced during the first 6 months because of the steroid therapy. Overall graft and patient survival is higher after SBLTx. Intestinal transplantation is indicated for patients with permanent intestinal failure. However, because parenteral nutrition is generally well tolerated, even for long periods, each indication for transplantation must be weighed carefully in terms of risk and quality of life.

Adolescent↗
PubMedDate not supplied

[Arterial rigidity and endothelial dysfunction in obese children].

Obesity is a cardiovascular risk factor in adults. Poorly is known about effect of obesity on cardiovascular system in children. Mechanical properties of a great elastic trunk, the common carotid artery (CCA) and endothelium function of the brachial artery were studied in 130 obese children (age: 12 +/- 3 years, body mass index (BMI): 29 +/- 5.5 kg/m2, without hypertension (115 +/- 19/58 +/- 8 mmHg). These patients had a vascular high resolution echographical analysis. Cross sectional compliance (CSC), cross sectional distensibility (CSD) and incremental elastic modulus (Einc) were analysed at the CCA site. The brachial artery dilation was measured after hyperthemia (flow mediated dilation, FMD), an endothelium dependent function and after sublingually glyceryl trinitrate (GTNMD), an independent endothelium function. Fat mass composition and distribution were assessed by dual-energy X-ray absorptiometry in 70 patients. In 50 obese patients an oral glucose tolerance test was done to determine insulin resistance. The obese children had significantly lower CSC and CSD than the healthy controls (respectively 0.12 +/- 0.04 vs 0.14 +/- 0.05 mm2.mmHg-1; p < 0.05 and 0.5 +/- 0.2 vs 0.8 +/- 0.4 mmHg(-1).10(-2); p < 0.001). Obese children had higher value than the controls for Einc (2.4 +/- 0.4 vs 1 +/- 0.24 mmHg.10(3); p < 0.001) that correlated poorly with fasting insulin concentrations (r = 0.34; p < 0.06) and BMI (r = 0.34; p < 0.01). FMD was significantly lower in obese children than in controls (6 +/- 3 vs 8 +/- 4%, p < 0.01) without modification of GTNMD (17 +/- 6 vs 18 +/- 7%, NS). These two parameters were respectively correlated with the android fat distribution (r = 0.36; p < 0.01; r = 0.49; p < 0.001). The CCA stiffness of obese children is linked to the amount of the overweight and to insulin resistance. The android fat distribution is related to endothelium dysfunction.

Adolescent↗
PubMedDate not supplied

Medium-chain triglycerides and long-term parenteral nutrition in children.

There are no data concerning long-term utilization of medium-chain triglycerides (MCTs) in parenteral nutrition (PN) in children. Our study included 12 children, aged 1.5-17 yr, on total PN at home, supplying a daily intake of 214 +/- 92 mg/kg nitrogen and 47 +/- 17 kcal/kg nonprotein energy (NPE). NPE included 10-32% long-chain triglycerides (LCTs) (Intralipid 20%). After switching to emulsion containing 50% MCT and 50% LCT (Medialipide) at the same dosage regimen and infusion rate as before, the subjects were monitored at 1, 3, and 6 mo. No signs of clinical intolerance were observed. Among the laboratory parameters evaluated, the only significant (p < 0.05) changes were 1) an increase in apolipoproteins A-I and A-II at 1, 3, and 6 mo and 2) a decrease in gamma-glutamyltransferase (gamma-GT) at 6 mo. There were no changes in the status of essential fatty acids in plasma or in phospholipids (in erythrocyte membranes). Moderate urinary excretion of dicarboxylic acids (adipic, suberic, and sebacic) was evidence of peroxysomal omega-oxidation. The results support the proposal for use of MCT-rich emulsion in long-term PN, given its metabolic advantages relative to LCT.

Adolescent↗
PubMedDate not supplied

[Extensive small intestinal resection in newborn infants].

This retrospective study analyzes the management of 83 infants who had undergone extensive small bowel resection as newborns between 1970 and 1987. Resection was performed for atresia (n = 34), volvulus (n = 21), laparoschisis (n = 10), vascular enteropathy (n = 10) and other disorders in 8 cases. The patients were divided into two groups: Group I (33 children) has less than 40 cm and Group II (50 children) 40-80 cm of residual small bowel respectively. Survival depended on the length of residual small bowel (Group I: 63.6%, Group II: 92%) and on their date of birth (born before 1980: 65%, after 1980: 95%). The time required for acquisition of intestinal autonomy depended on the intestinal length (average time, 29.5 months for Group I and 14 months for Group II) and especially on the presence of the ileocecal valve. The residual ileal and/or colon length also influenced adaptation. Artificial parenteral and/or enteral nutrition ensured normal height/weight increases. Home parenteral nutrition allowed children to be returned to their families during intestinal adaptation.

Body Weight↗
PubMedDate not supplied

Home TPN.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

[Nycthemeral gastric secretion in children under parenteral feeding].

The nycthemeral basal gastric secretion was studied in 11 children under continuous or cyclic total parenteral feeding (TPF). The suppression of the prandial stimulation shows nycthemeral changes in the secretory flow with a nocturnal minimum and a diurnal morning maximum, independent of the TPF infusion-conditions. The role of the infused aminoacids and lipid emulsion, as well as the duration of TPF is suggested to explain the increase or decrease in the basal acid flow. The authors suggest that an H2 antihistaminic should be used if the morning secretory peak induces a significant functional impairment.

Adolescent↗
PubMedDate not supplied

[Cyclic parenteral nutrition in children and glucose metabolism].

The effect of cyclic perfusion on glucose metabolism and insulin secretion was determined in 10 children under prolonged parenteral nutrition according to glycosylated hemoglobin (HbA1c) levels and C-peptide urinary excretion. Lack of glycosuria and increase in HbA1c levels (m: 4.4 +/- 0.7%) indicates a good regulation of glycemia. A ten times increase in urinary C-peptide (m: 47.2 +/- 33.3 nmol/m2-1) as compared with controls shows an hypersecretion of insulin induced by the high infusion delivery of glucose. This hypersecretion of insulin, which probably involves long-term risks, may be reduced if parenteral nutrition does not contain more than the energetic requirements for growth and if about 30% of the energetic intake is given as a lipid perfusion.

Adolescent↗
PubMedDate not supplied

[Use of parenteral and elementary enteral nutrition in the treatment of Crohn's disease and ulcerative colitis in children].

Nine children, aged 2 to 16 years, presented with severe Crohn's disease (5 cases) and ulcerative colitis (4 cases). They were given exclusive parenteral feeding 6 times and elementary enteral feeding at constant flow 9 times. In 6 cases, an anti-inflammatory treatment and/or surgical excision were associated. In all cases, immediate results were excellent and permitted to overcome an acute phase. Considering these results, the authors discuss the relative indications of these techniques of nutrition, in the treatment of severe cases of Crohn's disease and ulcerative colitis in children.

Adolescent↗
PubMedDate not supplied

[Estimates of trace elements requirements of children receiving total parenteral nutrition].

Ten children on total parenteral nutrition were studied. Plasma copper, zinc, manganese and selenium levels were determined by neutron activation and gamma spectrometry, every 10 days. With a copper intake of 20 microgram/kg/24 h, the average level 120 microgram% (94-144) was normal (N: 118 microgram +/- 11%). With a manganese intake of 40 microgram/kg/24 h, the level increased to 2.6 microgram% (1.3-4.5) (N: 1.1 microgram +/- 0.2%). With a zinc intake of 30 microgram/kg/24 h, the level decreased to 45.9 microgram % (20-63) (N: 83 microgram +/- 28%); with an intake of 50 microgram/kg/24 h the level remained under normal. With a selenium intake of 1 microgram/kg/24 h, the level decreased to 10.6 ng/ml (3.6-21.6) (N: 38.2 ng/ml +/- 11.9), but was normalized with an intake of 3 microgram/kg/24 h. From these results, with all reserves that estimation implies, the authors suggest that the disorders due to deficit or excess of trace elements could be avoided by daily intakes per kg of body weight: copper 20 microgram, zinc 100 microgram, manganese 10 microgram and selenium 3 microgram, with supplementation of iron, iodine and fluoride.

Child↗