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Biomedical subjects

D Floret

Publications and source records attributed to D Floret.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Role of macrolides in the treatment of respiratory tract infections in children].

Macrolides are antibiotics with high intracellular concentrations. They have a bacteriostatic activity but are also bactericides for concentrations five times greater than the minimal inhibitory concentration, concentrations in which they reach in the respiratory tract. They are usually active on Streptococcus, Neisseria, Moraxella catarrhalis, Listeria monocytogenes, Bordetella pertussis, Pasteurella multocida, Chlamydia, Mycoplasma pneumoniae, Legionella pneumophila and Helicobacter pylori. They have few secondary effects, some in relation with drug interactions. Their main indications are bronchopulmonary infections due to Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Legionella pneumophila. They are also useful in whooping cough allowing the eradication of Bordetella pertussis in the rhinopharynx, thus limiting the dissemination of the infection in children. In amygdalitis and pharyngitis, macrolides are a good substitute in the case of allergy to penicillin. New generation of macrolides (roxithromycine, clarithromycine, dirithromycine, azithromycine) might open other interesting therapeutic perspectives.

Anti-Bacterial Agents↗
PubMed1995

Management of subglottic haemangioma.

Between 1980 and 1993, 10 infants underwent endoscopic treatment and/or open surgical excision of a subglottic haemangioma. Of the eight children treated with the laser, four showed simple evolution following a single laser treatment, one required repeated laser treatments and two needed tracheotomy despite repeated laser treatments. The last three children developed moderate subglottic stenosis. Laser treatment was followed by open surgical excision in one child. Two children underwent primary surgical excision, allowing extubation between 8 and 10 days post-operatively. After a period in which we systematically treated subglottic haemangiomas with the laser, these findings have led us to employ open surgery in children with large subglottic haemangiomas or when airway obstruction requires a tracheostomy.

Airway Obstruction↗
PubMed1995

[Acute infectious myocarditis in children. Apropos of 2 series from Lyon].

Acute infectious myocarditis in childhood has a very poor initial outcome, but the long-term outlook is relatively good for the survivors. This retrospective study was based on cases of acute myocarditis admitted to two hospital departments with different modes of recruitment. Firstly, a polyvalent paediatric intensive care unit where 12 children (mean age 12 months) were admitted during the acute phase of myocarditis. The initial symptoms were non-specific and misleading, the diagnosis being established at autopsy in 9 cases. Only 4 children presented with typical cardiac failure. The clinical signs were hepatomegaly, sinus tachycardia, cardiomegaly, ECG ST-T wave changes and biological signs of multiple organ failure. Left ventricular function was very poor with a fractional shortening of only 17%. The causal agent was usually viral. The clinical course was marked by a high early mortality (11/26, 42%) within 23 hours of hospital admission. Secondly, a paediatric cardiology unit where 81 children (mean age 15 months) were followed up after acute infectious myocarditis. Thirteen cases were taken from our first series and were included for long-term follow-up; 76.5% had premonitory signs of infection and 71% were in cardiac failure, Classes III or IV, during the hospital admission. The causal agent was identified in 30 cases (37%) and was usually a virus (22 cases). Treatment was classical (association of digitalis, diuretics, angiotensin converting enzyme inhibitors, anticoagulants and beta-sympathomimetics when necessary).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

[Surveillance of children with liver transplantation].

The benefit of liver transplantation in children with end-stage liver disease is now well established. About 80% of the children are alive 5 years after liver transplantation. These good results are obtained not only because of the improvements of the surgical techniques, but also secondary to the reffinements of the follow-up of the patients. In the intensive care unit, clinical, biological and radiological cares must be permanent, allowing graft function assessment, correction of the haemodynamic disturbances, initiation of specific therapies and the research of any complication which must be promptly treated. The main surgical complications are intraperitoneal haemorrhage, biliary and vascular failures. Bacterial and viral infections, rejection represent frequent medical complications. Following the discharge from the intensive care unit, the children are checked daily until patient and graft conditions reach normal status. As time goes, the risk of complications is decreasing, but does not disappear, underlying the need for regular and long follow-up. In almost children, liver transplantation offers normal growth and scooling.

Age Factors↗
PubMed1994

Outcome of cadaver kidney transplantation in small children.

Small children have often been reported to have poor outcome after kidney transplantation (KT). Recent reports from North America have shown that the use of living-related donors improves patient and graft survival. We report the experience in one centre of primary cadaveric KT using sequential immunosuppression in nine children aged 8-30 months and weighing 5.4-9.8 kg; donors were 0.7-12.3 years old. Four patients had pre-emptive KT and the other five were on peritoneal dialysis; the mean +/- SD waiting time was 2.0 +/- 2.4 months. Perioperative care has been published previously. The surgical approach was intraperitoneal if the aorta and vena cava were used (n = 7) and extraperitoneal for common iliac vessels anastomosis (n = 2); the duration of surgery was 3.5 +/- 0.9 h and the time for vascular anastomosis was 32 +/- 6 min. The recipients received ATG, azathioprine, prednisone and delayed administration of cyclosporin A. The patients were followed for 12-98 (median 41) months and showed good graft function (inulin clearance 63-100 ml/min/1.73 m2); only one child with recurrent haemolytic uraemic syndrome lost his graft three months post-transplantation and died after he had received a second graft. None of the recipients required post-transplant dialysis; arterial hypertension involved four children and was related to graft artery stenosis in two. Growth improved by 0.24 +/- 0.48 SD score of height per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗
PubMed1994

Epidemiology of viral infections and evaluation of the potential benefit of OM-85 BV on the virologic status of children attending day-care centers.

Viral investigations were performed during 4 winter seasons (88/89, 89/90, 92/93, 93/94) in children attending day-care centers (DCCs) in the Rhône Département in eastern France. Over the total observation period of 4 winter seasons, 780 children were screened with a nasal swab for the presence of viruses. Of those, 230 (29.5%) had a positive viral culture. The viruses identified were respiratory syncytial virus (RSV), influenza A and B virus, parainfluenza virus, coronavirus, rhinovirus, adenovirus and enterovirus. During that time, 83 epidemic events in 47 DCC were recorded. A particular virus was judged to be causally related to an epidemic if the identical virus was isolated in > or = 3 children during the same outbreak of respiratory diseases. Thus, in 51 cases (61.4%) of all epidemics, the following viruses were responsible for an epidemic: RSV (n = 23), coronavirus (n = 10) (only during the season of 1993-1994), influenza A virus (n = 6), rhinovirus (n = 4), enterovirus (n = 4), adenovirus (n = 3) and parainfluenza virus (n = 1). Except for the somewhat surprising accumulation of coronavirus epidemics during the winter of 1993-1994, there were only minor seasonal variations from one year to another. As expected, RSV accounted for about one third of all respiratory tract infections in children attending DCCs and was therefore the most important single causative agent. These results are compared with data from children who did not attend a DCC and were cared for in a private practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvants, Immunologic↗
PubMed1993

Comparative study of human expertise and an expert system: application to the diagnosis of child's meningitis.

We present a general method of statistical evaluation for expert systems, applied to a system for the diagnosis of child's meningitis. Fifty difficult clinical cases of child's meningitis were submitted to the system, to seven senior specialists and to seven young physicians. Multidimensional analysis of the diagnosis of the infection category reveals that the two groups of physicians separate naturally and that the system is located among the group of experts. The study of the agreement of the microbiological diagnosis and therapeutic advice shows that the advice of the two groups of physicians is significantly different and that the advice of the system is significantly closer to that of the experts. This result is confirmed by the study of therapeutic errors. This type of study allows one to classify the performance of the system among physicians having different levels of expertise without referring to an objective solution.

Child↗
PubMed1993

Carnitine palmitoyl transferase I deficiency presenting as a Reye-like syndrome without hypoglycaemia.

An apparently healthy girl aged 2 years 9 months developed a coma with hepatomegaly within 24 h after an influenza-like infection. Plasma glucose and urinary organic acid profile were normal but plasma and urinary carnitine concentrations were increased. Despite symptomatic therapy, she died 11 days later. Oxidation of [1-14C] palmitic acid in the patient's fibroblasts was severely decreased (13% of controls). Further investigations revealed a deficiency of carnitine palmitoyl transferase I (CPT I) in the patient's fibroblasts (15% of controls) whereas CPT II activity was normal. Only four patients with CPT I deficiency have been reported so far. The subtle clinical and biochemical presentation of this disorder, which may account for the small number of cases diagnosed, is discussed.

Carnitine↗
PubMed1993

Cleft larynx: management and one-stage surgical repair by anterior translaryngotracheal approach in two children.

Cleft larynx is a rare congenital anomaly which is now being reported with increasing frequency. It is characterized by a midline posterior defect. Two children underwent laryngeal cleft repair by an anterior translaryngeal approach. Tracheotomy was avoided and closure of the anterior laryngofissure was carried out over the nasotracheal tube. The patients were cared for in a pediatric intensive care unit until extubation. Extubation was performed on day 8. The older child had few functional problems and did well whereas the younger child did poorly. In this latter case, the initially successful surgical result was impaired by post-operative aspiration, due to numerous possible factors: gastroesophageal reflux secondarily controlled by Nissen fundoplication, disturbed swallowing as a result more of the cleft repair work than of the surgical approach, or else immaturity of the suction-swallowing reflex.

Child, Preschool↗
PubMed1993

Role of long-term stenting in treatment of pediatric subglottic stenosis.

Twelve cases of childhood subglottic stenosis diagnosed either acquired or congenital were treated using an endolaryngotracheal Montgomery T-tube. Stenting lasted on average 5.6 months. Tracheotomy closure was possible in 75% of cases on average 15.3 months after diagnosis. Tube-linked complications involved the child pulling out, forward migration of the tube out, lower tracheal migration of the tube, clogging and the formation of granulation tissue at its superior extremity. Comparison of outcomes with those for laryngeal surgery (cricoid split, laryngotracheal reconstruction) found in the literature, suggests that long-term T-tube stenting is the optimal treatment for subglottic stenosis where tracheomalacia precludes laryngeal surgery.

Airway Obstruction↗
PubMed1993

Treatment with lenograstim (glycosylated recombinant human granulocyte colony-stimulating factor) and orthotopic liver transplantation for glycogen storage disease type Ib.

A 7 1/2-year-old patient with glycogenosis type lb had chronic neutropenia, recurrent bacterial infections, and severe hypoglycemia in spite of continuous nasogastric feeding. She was treated with lenograstim (glycosylated recombinant human granulocyte colony-stimulating factor) and orthotopic liver transplantation. Absolute neutrophil counts and platelet counts rapidly reached normal values, and infectious episodes were reduced. She resumed oral feeding after transplantation and had no subsequent hypoglycemic episodes.

Adjuvants, Immunologic↗
PubMed1993

[Early somatosensory (SEP) and auditory (AEP) evoked potentials in anoxic coma: prognostic value].

Early somatosensory (SEP) and auditory (BAEP) evoked potentials, when recorded within the first seven days of the course of anoxic coma, appear to be reliable to evaluate anoxic ischemic cortical or under-cortical lesions. Prognosis depends especially on cortical SEP (N20-P25): the lack of SEP is a good outcome predictor of death (abnormal BAEP) or of vegetative status (normal BAEP); the presence of normal and bilateral cortical SEP (with normal BAEP) allows to predict awakening, without prejudging of neurologic sequelae, even if they are severe.

Acoustic Stimulation↗
PubMed1993

Stimulation of nonspecific immunity to reduce the risk of recurrent infections in children attending day-care centers. The Epicrèche Research Group.

A randomized, double blind, placebo-controlled clinical trial was performed in 423 children attending day-care centers to assess whether stimulating nonspecific immunity would reduce the incidence of recurrent infections. The drug used for the trial (Imocur) is an extract obtained from eight different species of bacteria. At the end of the total follow-up period (3 months with treatment and 4.5 months without), the risk for > or = 4 episodes of upper respiratory infections was not significantly lower in the treated group than in the placebo group (26.7% vs. 33.8%, relative risk, 0.79; 95% confidence interval, 0.59 to 1.06). In an exploratory analysis limited to the 3-month treatment period, however, we observed a 48% reduction in the risk of presenting > or = 3 episodes of upper respiratory infections: 9.5% vs. 18.3%, respectively, in the treatment group and the placebo group (relative risk, 0.52; 95% confidence interval, 0.31 to 0.86). Similar results were found for the risk of > or = 1 episode of gastroenteritis. We also observed a strong correlation between the drug efficacy and age; this observation is coherent with the underlying pathophysiologic model in which the immune system matures with age.

Adjuvants, Immunologic↗
PubMed1993

[3 pediatric cases of leptospirosis].

Three children presented with an association of pains, infectious syndrome, acute renal failure, hepatitis and meningitis, that lead to the diagnosis of leptospirosis. The clinical spectrum of this rare disease are recalled.

Adolescent↗