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Biomedical subjects

D Unal

Publications and source records attributed to D Unal.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Neonatal Haemophilus influenzae infection. Apropos of 4 cases].

Four cases of neonatal haemophilus influenzae have been reported in Intensive Care Unite of Timone's Hospital (Marseille) during a 2 year period. Three of the cases were due to non typable organism, one was a type III. Hemoculture was positive twice. None of the patients had meningitis. Clinically it was a neonatal septicemia without particularity. Prognosis is bad (50% mortality). Several hypothesis have been proposed to explain the increase of the frequency of this neonatal infection. One of the major problem is the choice and the moment of prescription of antibiotherapy.

Anti-Bacterial Agents↗
PubMed1981

[Kinetics of multiple-dose amikacin in the newborn infant].

A pharmacokinetic study of amikacin was carried out in 12 neonates hospitalized in the intensive care unit. Serum amikacin levels were measured using a bacteriological method after one of several intramuscular injections of 7.5 micrograms/kg. Serum levels were greater than 10 micrograms/ml during the first three hours in 11 cases with values greater than or equal to 30 micrograms/ml. during the first two hours in five cases. The half life was measured in five patients and varied between three and eight hours. The plasma clearance was between 8.9 and 14 mil per minute per 1.73 m2. There is an unpredictable accumulation of this antibiotic especially in premature babies aged less than five days with a birth weight less than two kg. This accumulation is transitory when the clinical evolution of the case is favorable but it can be prolonged in unfavorable cases. The elimination of amikacin depends mainly on a patient's renal function. So, because of the risk of ototoxicity, the dosage should be reduced to 10 mg per kg-1 per 24 h-1, with measurements of the serum peak level and the level just before the following injection.

Amikacin↗
PubMed1980

[Diagnosis and preoperative intensive therapy of congenital diaphragmatic hernias].

For newborn infants hospitalised after the 24 th hour, preparation is simple and poses no more problems than a standard thoracic surgical procedure. Children hospitalised during the first 24 hours may be divided into two groups: those without marked signs of respiratory distress and those with severe respiratory insufficiency. It is essential to reequilibrate these children before surgery, since the latter will not be associated with any immediate spectacular improvement. The first gesture should be the insertion of a gastric tube, if possible before any ventilation by mask. Intubation and artificial ventilation are often essential but it must be born in mind that the risk of contralateral pneumothorax is high, because of the commonly present pulmonary hypoplasia, which usually leads to the use of high respiratory rates, low tidal volumes and requires perfect adaptation of the child ventilation. Acidosis is as a rule corrected by artificial ventilation only and the excessive use of buffer substances should be avoided. An adequate and effective venous line is essential and the insertion of a central catheter via the external or internal jugular is usually possible. It is essential in severe forms to have access to open measurement of blood pressure from the right radial, either by puncture or cutdown. We do not feel that the insertion of an aortic catheter via the umbilical artery is absolutely essential. By contrast, permanent record of pulmonary artery pressure would be of value but comes up against technical problems which are difficult to resolve. It is essential that the child taken to the operating room should be normothermic, normocapnic, have a satisfactory blood pressure and a good peripheral circulation. These conditions are essential but do not suffice to guarantee success in a child with pulmonary hypoplasia incompatible with survival.

Hernia, Diaphragmatic↗
PubMed1980

[Anesthesia for congenital diaphragmatic hernia].

Although most often passing in silence, anaesthesia for diaphragmatic hernia is none the less the most perilous phase in this condition. Surgery, far from being a salvage procedure, often worsens the situation with regard to blood gases. This anaesthesia must fulfil the criteria of neonatal surgery and a thoracic surgery. In addition to standard measures of surveillance specific to this age group, emphasis must be placed on the need for continuous measurement of blood pressure via an open approach to the right radial artery. Anaesthesia as free of toxicity as possible, of the nitrous oxide-curare type, with low doses of analgesic, offers the maximum security. Ventilation is controlled manually during surgery using a Jackson Rees arrangement (modification of the Ayre type) with surveillance of blood gases. The risk of pneumothorax contralateral to the diaphragmatic hernia could lead to preventive drainage being envisaged in particularly severe forms. This is nevertheless a factor of poor prognosisà Infusion should be reduced to a minimum, between 5 and 7 ml/kg-1/h-1. The dangerous periods of this anaesthesia, in addition to transport and installation of the newborn infant are represented by abdominal closure because of the risk of compression. Patients are left intubated at the end of surgery since postoperative artificial ventilation is a necessity is such cases.

Anesthesia↗
PubMed1979

[Trials of propanidid in anesthesia for bronchial endoscopy in infants and children].

This study reports a series of 48 bronchial endoscopies performed in children aged between 3 months and 16 years using Propanidide as sole anaesthetic agent. Individual variations were large. Repeated examinations showed that this type of anaesthetic had only moderate effects upon haemodynamic parameters. Disturbances in pH and PCO2 in arterial blood measured five, fifteen, twenty five and thirty five minutes after induction were less than with anaesthesia by inhalation of halothane. The quality of recovery of such that examinations could be performed on an ambulatory basis. Intravenous administration has the advantage of separating the anaesthetic from the endobronchial examination.

Anesthesia, Intravenous↗
PubMed1979

[Neonatal consequences of cesarean section on the presumably healthy infant].

The authors studied the effects on the child of 196 caesarian sections performed in the absence of foetal distress. The following were noted for each child: the time before the first cry, the Apgar score, pH and the need or not for resuscitation techniques. Each feature was studied in terms of different factors: foetal, obstetric, anaesthetic and surgical. The conclusions were as follows: caesarian section, which remains the best means of preventing obstetric trauma, has its own direct complications which are linked to the conditions in which the operation takes place. These can be reduced to a minimum or even completely suppressed if the caesarian section is performed under ideal conditions: few or no depressant drugs before the operation (the use of diazepam for induction should be abandoned); inclined position of 15 degrees, even of the mother has never suffered from utero-caval syndrome and if possible on a heated mattress; extraction of the infant between the 5th and 15th minutes; finally, and above all, prior labour is desirable whenever obstetric conditions permit.

Amniotic Fluid↗
PubMed1979

[Reye's syndrome. Report of two cases (author's transl)].

Two cases of Reye's syndrome aged 11 and 13 are reported, confirmed by hepatic biopsy. The favorable outcome observed in the second case seems to be more related with supportive therapy than exsanguinotransfusion and peritoneal dialysis. The physiopathology of this syndrome is not quite clear, but probably in relation with a diffuse mitochondrial insult. Early diagnosis and supportive therapy are important for a favorable outcome.

Child↗
PubMed1978

Cardiac catheterization by percutaneous femoral venous approach in infants weighing less than 5 kg: observations in 97 cases.

The technique of cardiac catheterization after percutaneous introduction of a catheter can now be accomplished in neonates thanks to the refinement of the equipment and to the physicians' experience. In 100 catheterizations performed in infants of less than 5 kg, the new technique was utilized 97 times. Thanks to the utilization of introducers it permits Rashkind atrioseptostomy. Its main advantage is the preservation of venous integrity and this allows repeat investigations through the same route.

Body Weight↗
PubMed1978

Transposition of the great arteries. New technique for anatomical correction.

We describe a new technique for the correction of transposition of the great arteries by "detransposition". An aortopulmonary window is created and a patch placed over this and the coronary ostia so that the coronary arteries arisen from the new aorta. Thus, direct surgery on the coronary arteries is avoided with all the complications which may result from this in neonates and infants. A 4.2 kg infant, with transposition and ventricular septal defect, was successfully operated on using this technique. We discuss the indications for this type of operation and conclude that, until we have more experience, it should be used only in children with a left ventricular pressure at least half systemic.

Heart Septal Defects, Ventricular↗