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Biomedical subjects

D Floret

Publications and source records attributed to D Floret.

At least 91 records · Page 5Linked to original sources
PubMed1991

[Resuscitation during renal transplantation in children].

Over a 4 yr-period, 60 children (aged 10 months to 17 yr) received 66 kidney transplants with the same surgical intensive care program, the fist 48 hr-period of which has been analysed in this study. Thirty percent of recipients were transplanted without previous dialysis and in 8%, body weight was below 10 kg at the time of surgery. The duration of anesthesia was 4.4 +/- 1.0 h and 32% received locoregional anesthesia. The mean duration for cold ischemia was 14.7 +/- 11.7 h and 26 +/- 7 min for warm ischemia; diuresis began during the operation in 79% of the patients. Routine vascular filling consisted of standard isotonic solute (11 +/- 4 ml/kg/h) associated with mannitol infusion; 59% of recipients required 20% human serum albumin and 42% blood transfusion. Post-operative diuresis was 7.4 +/- 6.0 ml/kg/h during the first 24 h, and sometimes resulted in hypovolemic episodes; 9% of the patients had primary non-functioning kidneys (4 transient acute tubular necrosis; 2 vascular thrombosis) and 4% required dialysis; the 1-yr survival rate was 82% for the grafts and 98% of the patients.

Adolescent↗
PubMed1991

[Aberrant left pulmonary artery and tracheal abnormality].

A case of left pulmonary artery sling and tracheobronchial tree malformation is reported in a 3 month-old infant. Acute respiratory presenting symptoms required mechanical ventilatory support. The malformation was suspected because of ventilatory support difficulties. Barium oesophagogram showed an anterior indentation, fiberoptic bronchoscopy and tracheobronchography showed a severe tracheal stenosis from a right bronchus lobaris superior to the carina. This was worsened by the right side compression of trachea end part, due to the abnormal left pulmonary artery as demonstrated by pulmonary angiography. A surgical left artery transposition relieved lateral compression and allowed weaning of ventilatory support. After a 27 month-follow-up, the girl's respiratory status is satisfactory.

Female↗
PubMed1990

[Kawasaki disease].

First described in Japan in 1967, Kawasaki disease is now observed in all countries. Despite extensive research, the aetiology of this infectious disease which affects mainly infants and young children remains mysterious. The six main clinical presentations of Kawasaki disease are: prolonged fever, conjunctivitis, lesions of the oral and pharyngeal mucosa, inflammatory reddening and swelling of the hands and feet, skin rash and cervical lymph node enlargement. Laboratory data show an inflammatory syndrome and thrombocytosis. The disease usually resolves within a few weeks. The major risk is cardiovascular involvement with pericarditis, myocarditis and, chiefly, coronary artery aneurysms which usually regress but are the main cause of mortality (1 to 2 p. 100 of the cases). Treatment consists of gammaglobulins and aspirin in high doses; when administered at an early stage, it prevents the formation of coronary aneurysms.

Aspirin↗
PubMed1990

[Transplantation in children: selection of donors and organization of organ procurement].

The rise of organ transplantation in children has resulted in an acute donor shortage. In 1987, a study was undertaken by the French-speaking Group of Paediatric Intensive Care with a triple goal: to evaluate the number of potential organ donors, to list and count the organs that have effectively been removed and to sensitize the teams of intensive care units (ICU) to the transplantation problem. This study showed that brain death occurs in one-third of the infants and children who die (i.e. about 200 each year). As a result of this study, over a two-years period the number of children whose organs had been removed (42 in 1988) as well as the number of organ procurement centres and multiple organ procurements have increased. One-half of the non-procurements are due to the parents' refusal, so that further advances are possible by sensitizing not only ICU teams but also the general public. It seems that the best solution would be to set up local organizations that would enable procurements to be performed within Paediatric ICU's. France-Transplant is of invaluable help to identify organ receivers and co-ordinate the activities of procurement teams.

Child↗
PubMed1990

[Early somatosensory and auditory evoked potentials in anoxic coma. Role in evaluating and prognostic value].

Early somatosensory (ESEP) and auditory (EAEP) evoked potentials were recorded in 27 patients with severe coma (Glasgow score less than 5) following cardiorespiratory arrest, within the first 7 days of its course. Somatosensory responses were elicited by stimulation of the median nerve. ESEP were abolished in 17 patients due to a parietal thalamo-cortical lesion. Among these, 6 patients died within one month and 11 presented with a persistent vegetative state. In all patients EAEP were obtained, showing functional brainstem activity. Low-voltage EAEP, especially for peak V (inferior colliculus or upper part of the brainstem), was sometimes observed. One patient, in whom ESEP and EAEP were initially abolished, died rapidly. In 9 other patients scalp-recorded ESEP and EAEP were normal; all emerged from coma including 5 with good neurological recovery and 4 with neurological sequelae. Clinical, electroencephalographic and computerized tomographic data appeared to be devoid of predictive value at the same initial period. In view of their sensitivity to anoxia and to cerebral oedema, even with neurosedative drugs, ESEP seemed to be reliable in predicting outcomes and in evaluating central nervous system lesions at cortical and subcortical levels (basal ganglia and brainstem) after cardiorespiratory arrest.

Adolescent↗
PubMed1990

Interleukin 2 immunotherapy in children with neuroblastoma after high-dose chemotherapy and autologous bone marrow transplantation.

Four children with persistent neuroblastoma after marrow ablative chemoradiotherapy and autologous bone marrow transplantation received continuous infusion of recombinant interleukin 2, 75 to 120 days after the graft. Recombinant interleukin 2 therapy did not induce any major or nonreversible toxicity, hematological toxicity in particular. One patient entered complete remission for 9 months and a second patient had a long-lasting normalization of urinary catecholamine metabolites with more than 50% regression of bone marrow metastases (8 months). In three children, recombinant interleukin 2 and a second patient entered complete remission for 9 months therapy was followed by major increase and activation of circulating natural killer cells which amounted to 80% of the circulating mononuclear cells.

Bone Marrow Transplantation↗
PubMed1990

[Use of nucleic probes in bacteriology (1)].

After having been widely used in biological research, nucleic probes are now becoming available for the purposes of diagnosis in the clinical microbiology laboratories. Due to various technical improvements, an increasing number of kits will be provided and will allow a rapid and specific diagnosis to be carried out for bacterial agents (ie diarrhea, respiratory infections, sexually transmitted diseases...).

Bacterial Infections↗
PubMed1990

[The autopsy].

In France, Caillavet's law sets the conditions required for autopsy and organ removal. Despite the liberal conditions of this law, the autopsy rate is becoming rare. Other obstacles exist, in particular, religious beliefs in the case of islamic and jewish people. The final decision rests with the family although this decision may be influenced by the physician, if the family can be convinced of the importance of such an examination.

Autopsy↗
PubMed1989

A phase-II study of adoptive immunotherapy with continuous infusion of interleukin-2 in children with advanced neuroblastoma. A report on 11 cases.

Nine children with poor prognosis neuroblastoma have been treated by continuous infusion of IL-2 and autologous LAK cells, as described previously by West et al. in adult patients. Six patients were in relapse after high-dose chemotherapy and autologous BMT and three presented with primary refractory disease after conventional therapy. Although patients were very young (median age 6 years; average weight 17 kg), infusion of IL-2, cytapheresis and reinjection of LAK cells appeared feasible with the usual and transient complications observed with IL-2. Haematological toxicity, although reversible, was more important than usually described and due to the presence of bone-marrow metastases in 8 of the 9 patients. Life-threatening toxicity was observed in only one of the admission centres and was probably due to the rapid reinjection of a very large number of activated cells. Two patients presenting with very active disease after high-dose chemotherapy and autologous or allogeneic BMT received IL-2 alone, at 120 days and at 90 days after the graft. The reactivation of grade-II GVHD was the major complication in the patient treated after an allograft, whereas no BMT-related toxicity was observed in the patient treated after the autologous BMT. Immunological modifications induced by IL-2 were very different between these patients. As expected, a preferential outgrowth of NK cells with both NK and LAK activity was observed in the patient treated just after the autograft. In contrast, in the patient treated after an allograft and in the 9 patients in relapse, T lymphocytes remained the major mononuclear cell population with a very large excess of CD8+ T cells. All patients progressed after the first induction cycle with the exception of the only patient treated after autologous BMT who reached a very good partial remission with disappearance of the local tumor and bone metastases. Although very preliminary, these data clearly show that the efficacy of IL-2 largely depends on the patient's immunological status with the optimal effect being observed when IL-2 is given in the first few months following an autograft.

Bone Marrow Transplantation↗
PubMed1989

Systemic interleukin-2 therapy in children with progressive neuroblastoma after high dose chemotherapy and bone marrow transplantation.

Two children with active metastatic neuroblastoma after high dose chemotherapy and bone marrow transplantation (BMT) received a high dose continuous infusion of interleukin-2 (IL2) 120 days after an autologous BMT for patient 1 and 90 days after an allogeneic non T cell-depleted BMT for patient 2. Usual side effects of IL2 therapy were observed without life-threatening complications or any major hematological toxicity. The reactivation of graft-versus-host disease during IL2 infusion in patient 2 was the major BM-related complication but it improved with IL2 interruption and corticosteroids. IL2 induced a complete remission (9+ months) in patient 1 with the disappearance of bone metastases and local tumor but patient 2 progressed after cessation of therapy. Patient 1 presented with a large excess of circulating NK cells in the period after autologous BMT and IL2 induced a preferential outgrowth of this lymphocyte subset.

Adrenal Cortex Hormones↗