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Biomedical subjects

D Unal

Publications and source records attributed to D Unal.

At least 19 recordsLinked to original sources
PubMed1996

[Resistance of Leishmania infantum to Glucantime: risk factors and therapeutic management].

BACKGROUND: Resistance to antimonial drugs is rarely observed in immunocompetent patients. CASE REPORT: A 1-year-old girl was admitted suffering from persistent fever. A diagnosis of visceral leishmaniasis was made. The patient was given two courses of meglumine antimoniate (Glucantime) (60 mg/kg/d for 15 days) and one course of 12 injections of pentamidine (4 mg/kg). She relapsed 8 months later and failed to respond to Glucantime. Immunological tests performed during the relapse showed a suppression of the T cell response to Leishmania antigen and no production of interferon gamma. The patient was then successfully given liposomal amphotericin B (3 mg/kg/d for 10 days). She was asymptomatic 9 months later and had acquired specific cellular immunity against Leishmania. CONCLUSION: Deficient cell-mediated immunity and interferon gamma production are some factors responsible for decreased sensitivity to antimonial drugs. The WHO recommendations treating visceral leishmaniasis with prolonged administration of Glucantime may prevent relapses. Liposomal amphotericin B could be an alternative treatment.

Animals↗
PubMed1996

[Value of toxicological research in newborn infants of addicted mothers by the study of several samples (urine, meconium, hair)].

BACKGROUND: Urinary detection of prenatal drug exposure in the neonate may give false-negative results. We report our experience on meconium and hair testing, in addition to urine testing in order to improve diagnosis of fetal drug exposure. POPULATION AND METHODS: Thirty-one infants (aged 1-45 days) whose mothers were confirmed (n = 12) or suspected (n = 19) to be drug-addicted were included in the study. One or more specimens of urine, meconium or hair were collected in the 31 infants, two of the specimens in 17 and three in six. Drugs and their metabolites were detected by immunoenzymologic techniques and positive results were confirmed by gas-exchange chromatography. All the mothers and families were interviewed during admission and the information was compared to those provided by medical and social services; the results of laboratory analysis were not known by the investigators at this time of the study. RESULTS: The maternal drug addiction was confirmed after clinical investigation in 18 cases including the 12 cases detected by prenatal interview (group 1), and recused in 13 other cases (group 2). In group 1, nine infants of 12 had a positive urine test (seven opiate, one cocaine, one cannabis), 11 of 11 a positive meconium test (nine opiate, one cocaine, one cannabis), ten of 19 a positive hair test (eight opiate, one cocaine, one cannabis); all infants in this group had at least one positive result. In group 2, all tests were negative except one urine test positive for opiate after cesarean delivery performed under anesthesia including opiate analgesia. CONCLUSIONS: Urine, meconium and hair testing versus urine testing alone increase the sensitivity of laboratory analysis for detection of prenatal drug exposure.

Cannabis↗
PubMed1995

Influence of photoisomers in bilirubin determinations on Kodak Ektachem and Hitachi analysers in neonatal specimens study of the contribution of structural and configurational isomers.

We compared data obtained with the Kodak Ektachem and Hitachi 717 Analysers and HPLC from 83 neonates under phototherapy. Total bilirubin values determined with the Kodak and Hitachi are in good agreement, but we observed a large discrepancy in the results for conjugated (Kodak) and direct (Hitachi) bilirubin. HPLC revealed that all the samples contained configurational isomers, while only 7.7% and 30.8% contained conjugated bilirubin and structural isomers, respectively. We developed a device for the specific and quantitative production of configurational or structural isomers, by irradiation with blue or green light. In vitro, total bilirubin values are coherent for the routine analysers in the presence of configurational or structural isomers. With configurational isomers, unconjugated bilirubin (Kodak) is lower than total bilirubin (Kodak), and conjugated bilirubin (Kodak) is always equal to zero, so the apparatus gives a false positive response for delta bilirubin. In contrast, the direct bilirubin (Hitachi) is constant. Furthermore, in the presence of structural isomers, unconjugated bilirubin (Kodak) is unexpectedly higher than total bilirubin (Kodak), conjugated bilirubin (Kodak) is proportional to the quantity of these isomers, and direct bilirubin (Hitachi) is constant. The contribution of photoisomers in bilirubin measurements is discussed.

Bilirubin↗
PubMed1995

[Validation trial of a neonatal prophylactic antibiotic protocol in the delivery room].

Maternofetal infection occurs in 1 to 10 of every 1,000 newborns. Prognosis is poor and an extremely rapid the clinical course is sometimes observed. The situation suggests that widespread use of antibiotics and more than 90% of the newborns receiving antibiotics are not infected. A prospective study based on simple, recognized criteria predictive of maternal-fetal infection was conducted in 3,392 deliveries to evaluate the effect of an antibiotic prophylaxy protocol. Specificity, sensitivity, positive and negative predictive value were evaluated for each of the eleven criteria retained with the goal of increasing sensitivity and decrease the use of unnecessary antibiotics. Among the 3,392 infants delivered from January 1989 to December 1990, 286 (8.4%) newborns entered the study and were given mezlocillin (150 mg/kg/12 h). This treatment was stopped at 48 hours of life if the infant was not infected. RESULTS. Infection was confirmed in 48 of 3,392 infants (1.4%). All were in the risk group: 48/286 (16.7%). The germs the most often found were group B Streptococcus (n = 16), Escherichia coli (n = 8) and Listeria monocytogenes (n = 3). Nine criteria were well correlated with maternal-fetal infection. The two most important criteria were maternal pyrexia above 39 degrees C and Apgar score below 7 to 5 min (poor neonatal adaptation), with a 99% and 90% and a positive predictive value of 80% and 37% respectively. Inversely, Two criteria were poorly correlated with maternal-fetal infection: labour duration above 12 hours and instrumental extraction (positive predictive value from 10% to 17%).(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1994

[Pulmonary tuberculosis in infants. Apropos of 6 cases].

BACKGROUND: The present increased incidence of tuberculosis in children can be explained by contacts with infected adults and/or late BCG vaccination. PATIENTS: Six infants, 3 to 18 months-old (mean: 8 months), were admitted from November 1990 to May 1992 for various reasons; only two were admitted with a diagnosis of tuberculosis based on tuberculin test and only one was given a BCG vaccine. The disease produced a broad range of symptoms. Diagnosis was based on tuberculin test and radiographic examination showing lymph node enlargement of mediastinum and segmental consolidation lesions. Mycobacterium tuberculosis was found in two cases. The patients were given isoniazid, rifampin, ethambutol and/or pyrazinamide; corticosteroids were added in five patients. Each patient received four or three drugs for 2-4 months and two drugs (isoniazid plus rifampin) beyond, for a mean total duration of 13 months (range: 9-17 months). Repeated CT scan of thorax was performed to evaluate the efficacy of treatment. Tuberculosis was diagnosed in 11 subjects in contact with these children. CONCLUSION: Tuberculosis in children is not rare, and BCG vaccination of neonates should be seriously considered.

BCG Vaccine↗
PubMed1993

[Unusual intrathoracic tumor in children: lipoma].

BACKGROUND: Intrathoracic lipomas are rare, often asymptomatic and, in this case, discovered by chance on X-ray. CASE REPORT: A 3 year-old girl was admitted because chest X-rays prescribed for a persistent cough showed a mass in the right axillary area. The CT scan showed a mass with density of -80 Hounsfield units, characteristic of adipose tissue. There was a slight rib change in contact with the mass, but radionuclide bone scan showed no area of increased uptake. A chest X-ray performed 3 years earlier had shown such a mass, but it was not recognized at that time. Surgery demonstrated that the mass was extrapleural in location and adhering to the rib which was partly excised. Histologic examination showed the presence of mature adipocytes, but no malignant cells. CONCLUSION: The fatty component of an intrathoracic tumor is easily recognized with CT scan. Erosion of bone in contact with it has been reported.

Age Factors↗
PubMed1992

[Pseudo-tumoral form of urinary bilharziasis in a child].

A tumor-like form of urinary schistosomiasis is reported. Diagnosis was established intraoperatively. The finding of hematuria and of a stay in an area where schistosomiasis is endemic suggested the diagnosis but specific investigations were negative. Cystoscopy revealed a budding, hemorrhagic tumor lying against the posterior aspect of the bladder with no other lesions suggestive of schistosomiasis. The true prevalence of these tumor-like forms of urinary schistosomiasis is analyzed. Emphasis is put on the need for using several investigations to reach the correct diagnosis.

Child↗
PubMed1992

[Imipramine withdrawal syndrome during a treatment for enuresis].

The authors report on an observation of imipramine withdrawal syndrome which appeared when tapering the treatment of a case of bed-wetting. Symptoms included vomiting, digestive intolerance and dehydration. Such a presentation can mislead diagnosis towards abdominal or neurosurgical pathology. All symptoms disappeared after a symptomatic treatment or in combination with the return of imipramine. It is therefore important to be aware of this complication before prescribing imipramine treatment for enuresis. The discontinuation of this drug must be very progressive.

Adolescent↗
PubMed1992

[Endoscopic bronchial exploration under local anesthesia in children].

One hundred and forty-two flexible fiberoptic bronchoscopies were carried out in 1 year, under local anaesthesia, in 123 children aged between 15 days and 17 years. Indications were tuberculosis (n = 26), persistent pneumonia (n = 20), suspected foreign body or control after extraction (n = 18), asthma (n = 17), atelectasis (n = 14), recurrent pneumonia (n = 13), opportunistic pneumonia (n = 11), permanent bronchial obstruction (n = 10), miscellaneous disease (n = 13). Fiberoptic bronchoscopy was abnormal in 101 patients (80%) and led to a change in the treatment in 84 cases (68%). True complications (n = 5) were all transient and were followed by complete recovery. Flexible fiberoptic bronchoscopy under local anaesthesia is a simple and safe procedure. It is an essential diagnostic and therapeutic tool in the management of pediatric respiratory disorders.

Adolescent↗
PubMed1992

[Neonatal resuscitation and preventive continuous positive pressure ventilation].

One of the aspects of prematurity in neonates is the respiratory distress syndrome. Although treatment with mechanical ventilation reduced the mortality rate, bronchopulmonary dysplasia still develops in many neonates. We have attempted to reduce intubation and mechanical ventilation by using, in the delivery room, humidified and warmed gas with fractional inspired oxygen as low as possible to obtain SaO2 between 85 and 95%. The gas was administered with a face mask using continuous positive air pressure 3-5 cm H2O. Seventeen out of 66 premature neonates born before the 35th week of gestation were ventilated immediately (n = 11) or subsequently (n = 6). Seven out of 26 infants (27%) born between 30 and 32 weeks required mechanical ventilation. In contrast, ventilation was necessary for eight out of 16 premature neonates born before the 29th week of gestation. Mortality rate was 6% (4/66) in the latter group (< 29 weeks), and only one neonate developed bronchopulmonary dysplasia.

Birth Weight↗
PubMed1992

[Neonatal hyperchloremia related to bromide poisoning].

Hyperchloremia may reveal bromism during the neonatal period. The authors report on two cases of neonatal bromism. The first case concerns triplets without clinical signs although the children and their mother displayed hyperchloremia. In the other case a 6 week old infant displayed neurological abnormalities associated with hyperchloremia and elevated plasma bromide levels.

Adult↗
PubMed1992

[Neonatal consequences of premature rupture of membranes (more than five days) before the 34th week of gestation].

Twenty-six cases of premature braking of the membranes which occurred before week 34 of amenorrhea and lasted for more than 5 days are assessed retrospectively. The mean age when the membranes broke was 26.6 weeks of amenorrhea. Delivery occurred on average at 31.5 +/- 2 WA, with an interval of between 6 and 91 days (mean 35 +/- 23 days). In 4 cases, chorioamniotitis complicated the premature breaking of the membranes. The perinatal mortality rate was 5 out of 27, including 2 still births. Nine of the neonates showed respiratory distress which required artificial ventilation. Four cases of pulmonary hypoplasia were confirmed by pathological examination. In all cases, this was associated with a reduction in the volume of the amniotic fluid, reduced fetal mobility and delayed intrauterine growth. In contrast, when these three factors were absent the prognosis was always good, regardless of the date at which the membranes broke. In the long term, the surviving children showed no neurological sequelae.

Birth Weight↗
PubMed1991

[Extrinsic allergic alveolitis. Apropos of a severe case].

A case of atypical extrinsic allergic alveolitis in a 13-year-old is reported. Onset was sudden with gradually increasing dyspnea on exertion over a four-day period. The chest film evidenced a reticulonodular syndrome with decreased respiratory movements. The patient's clinical status worsened over the next 48 hours with the development of respiratory distress. Under oxygen therapy (3 l/min), PO2 was 49 mmHg and SO2 was 82%. Dramatic improvement occurred after initiation of corticosteroid and antimicrobial therapy. Etiologic investigations were negative except for the immunofluorescence test with pigeon droppings which showed three precipitation arcs. A CT scan of the chest disclosed diffuse micronodular densities without thickening of connective tissue trabeculae, suggesting alveolar disease. Mediastinal lymph nodes were not enlarged. Vital capacity was 26% of the theoric value. Corticosteroids were given for one month. On follow-up chest films, the reticulomicronodular syndrome was seen to abate, globally at first, then from the apices to the bases of the lungs. However, a repeat CT scan at the 4th month showed that diffuse lesions were still present although the chest film was normal; 8 months after onset, there was only a bulla in the left lung base, with no evidence of fibrosis. Lung function tests slowly returned to normal, as did CT scan findings.

Adolescent↗
PubMed1988

[Septicemia, portal thrombosis and congenital protein C deficiency].

The authors report a case of Bacteroides fragilis septicemia with left portal vein thrombosis secondary to a liver abscess discovered by ultrasonography. This thrombosis was in relation with hereditary protein C deficiency. The authors emphasize the importance of assaying for C protein along with the other physiological coagulation inhibitors in the child presenting with venous thrombosis.

Bacteroides Infections↗