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Biomedical subjects

D Floret

Publications and source records attributed to D Floret.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1989

[Broncho-alveolar lavage by fibroscopy in immunodepressed children].

Thirty broncho-alveolar lavage (BAL) were performed in order to investigate 30 infectious episodes in immunocompromised children. Twenty patients were previously treated by high-dose chemotherapy and autologous bone marrow transplantation and 6 other patients by conventional methods. A specific etiologic diagnosis was obtained in 16 of 30 episodes (56%), 22 microorganisms were identified by BAL. The most frequently involved microorganism was Candida albicans and the other agents were as follows: 3 cytomegalovirus, 2 Pneumococcus, 2 Pneumocystis carinii, 1 Aspergillosis, 1 syncytial respiratory virus, 1 myxovirus, 1 Pseudomonas aeruginosa, 1 Mycoplasma pneumoniae, 1 Haemophilus influenzae and 1 Escherichia coli. In 5 cases, more than 2 agents were involved. This study emphasizes the diagnostic interest of BAL for infectious diseases of the immunocompromised child. BAL appears to be a non invasive, rapid and reproducible method, and a useful therapeutic approach in the treatment of infectious episodes occurring in grafted children where several microorganisms could be involved at the same time.

Bacterial Infections↗
PubMed1989

[Acute Borrelia burgdorferi encephalitis (Lyme disease) in an Algerian child].

A case of acute hemorrhagic leukoencephalitis is described in an Algerian child with renal insufficiency that had been diagnosed at the terminal stage. Convulsions, hemiplegia and consciousness disorders pointed to a necrotizing viral or bacterial form of encephalitis, but the definitive diagnosis was based on the detection of IgM and IgG specific serum antibodies raised against Borrelia burgdorferi.

Acute Disease↗
PubMed1988

Intracranial pressure in childhood central nervous system infections.

To determinate the importance of intracranial hypertension in central nervous system (CNS) acute infections, we studied intracranial pressure (ICP) in 27 patients, age 45 days to 13 years. Fourteen had meningitis and 13 had encephalitis; all were in deep coma with Glasgow Coma Scale 7 or less. Intracranial hypertension defined by a mean ICP above 15 mmHg, was observed in 12 patients with meningitis (86%) and in 9 with encephalitis (69%). Patients with meningitis exhibited a sudden and severe intracranial hypertension. A striking difference was noted between survivors and non survivors who had a very high maximal ICP with a severe reduction of cerebral perfusion pressure (CPP). Intracranial hypertension occurred in all patients with acute primary encephalitis but in only 3/7 patients with post-infectious encephalitis. ICP monitoring seems to be important in the comatose forms of: (1) bacterial meningitis in the early period (2) herpes encephalitis (3) post-infectious encephalitis with severe status epilepticus.

Adolescent↗
PubMed1988

[Recurrent infections caused by Salmonella typhimurium].

We report the case of a 27 month-old girl with recurrent Salmonella typhi murium infections. The study of the neutrophil cells showed a transitory selective deficiency of the chemiluminescent response. After 5 months of pefloxacine therapy, recovery was obtained.

Anti-Bacterial Agents↗
PubMed1988

[Neurologic manifestations of arterial hypertension in children].

Neurological complications of arterial hypertension are analyzed in 31 children (mean age = 9 years). All patients presented a renal or renovascular disease (acute nephritis + hypoplastic dysplasia , transplantation = 58%) for which malignant hypertension was the first symptom in 16%. The mean +/- SD initial blood pressure was 189 +/- 33/113 +/- 25 mm Hg and was preceded by previous symptoms in 1 patient out of 6. Neurological abnormalities consisted in seizures (48%), acute intracranial hypertension (39%), cranial palsy (23%), coma (19%), hemiplegia/paresia (16%), retinal changes (6%) or aphasia (6%). The EEG was abnormal in 50% of the patients, sometimes showing permanent paroxysmal activity. Neuroradiologic investigations revealed hemorrhagic and/or ischemic lesions in 1/5 patients. On follow-up, hypertension disappeared in 41% of the children; a decrease in renal function was noted in 56% of the patients at the last examination; neurological sequellae were present in 40% (EEG anomalies +/- epilepsy, motor deficit, retinal changes, psychomotor delay, cranial palsy) and 1 patient died. The morbidity of malignant hypertension stresses the importance of early diagnosis and treatment (calcium channel blockers) when its prevention is not possible.

Adolescent↗
PubMed1988

[Acid gastroesophageal reflux in the child with intubation, artificial respiration and continuous nutrition. Apropos of 28 cases].

Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.

Enteral Nutrition↗
PubMed1988

[Resuscitation of severe meningitis in infants and children].

Meningeal penetration of bacteria induces an inflammatory response which affects mainly the endothelium of cerebral vessels. This inflammatory reaction is directly responsible for thrombosis and indirectly creates cerebral oedema and reduced cerebral blood flow. Cerebral ischemia is the result of all these phenomenons. Nowadays, control of cerebral oedema is the main goal of intensive care treatment of meningitis that needs invasive monitoring of intracranial pressure. We may hope that in a next future new therapeutic agents will be able to control inflammatory reaction and vascular process.

Brain Diseases↗
PubMed1988

[Intracranial pressure in comatose meningitis and encephalitis in children].

To determine the importance of intracranial hypertension in central nervous system acute infections, we studied intracranial pressure (ICP) in 27 patients, aged 45 days to 13 years. Fourteen had meningitis and 13 had encephalitis; all were in deep coma with a Glasgow Coma Scale 7 or less. Intracranial hypertension defined by a mean ICP above 15 mm Hg was observed in 12 patients with meningitis (86%) and in 9 with encephalitis (69%). Patients with meningitis exhibited a very early and severe intracranial hypertension. A striking difference is noted between survivors and non-survivors who had a very high maximal ICP with a severe reduction in cerebral perfusion pressure. Intracranial hypertension occurred in all patients with acute primitive encephalitis but only in 3/7 patients with post-infectious encephalitis. ICP monitoring seems to be important in the comatose forms of bacterial meningitis in the early period, herpes encephalitis and postinfectious encephalitis with severe status epilepticus.

Adolescent↗
PubMed1988

[Cardiac arrest in children. Causes and future after cardiopulmonary resuscitation].

A 24 months retrospective study was carried out to investigate 133 patients with an unexpected cardiorespiratory arrest (CRA). Cardiopulmonary resuscitation (CPR) was undertaken in all cases. 96 patients suffered CRA outside of hospital, 11 patients in the wards of the hospital, and 26 in the pediatric intensive care unit (PICU). Sixty children (44%) responded to initial resuscitation and 20 patients (15%) survived after discharge, 12 (9%) of them with a good neurologic outcome. The best results were obtained in patients with an CRA in the PICU. The results of this study suggest that survival among resuscitated children is not better than that among adults, but can be improved with early recognition and monitoring of children at risk.

Adolescent↗
PubMed1988

[Plasma exchange in children].

Plasma exchanges are indicated in several diseases in children, mainly immunologic, hematologic and nephrologic disorders. The techniques used for adult patients can be applied to children, but complications, especially infections, are more frequent. The vascular access is the main limiting factor, particularly in infants. Therefore, pediatric plasma exchanges should be performed under adequate supervision in an intensive care unit.

Catheterization, Central Venous↗
PubMed1988

[Suppurated pneumococcal meningitis in infants and children: complications and prognostic factors].

This paper investigates 21 patients (16 infants and 5 children) with Pneumococcal meningitis, 15 of which presented with a severe form. Intracranial pressure (IP) monitoring was performed in 7 patients who all had severe (4) or mild (3) intracranial hypertension (IH). Twelve children had a favourable outcome, 7 had sequelae (3 severe) and 2 died from coning, one before monitoring, the second after exhibiting the highest IP and the lowest cerebral perfusion pressure of the series. The 3 children with severe sequelae had a severe form (2) or a mild but prolonged form (1) of IH. The 4 patients who recovered with moderate sequelae presented severe (1), mild IH (1) or were not monitored (2). There were 14 cases with neurological complications. In 8 patients, this seemed to be related to cerebral oedema and IH; coning caused the death of 2 of them; the 6 others exhibited lesions of cerebral oedema on CT-scan, isolated or associated with cerebral infarction or subdural effusion. In the 6 others patients, IP monitoring was not performed; there was no evidence of cerebral oedema on CT-scan; 2 exhibited cerebral infarction and 3 a moderate ventricular dilatation; 2 had hemodynamic problems from acute pneumococcemia in one case and neurovegetative disturbances associated with cerebral infarction in the second. Pneumococcus meningitis remains a severe disease. The prognosis of severe forms can be improved by IP monitoring since IH seems to be the most frequent mechanism of complication.

Brain Edema↗