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Biomedical subjects

J Laugier

Publications and source records attributed to J Laugier.

At least 91 records · Page 5Linked to original sources
PubMed1989

[The effect of roxithromycin on the aerobic fecal flora in children].

To evaluate the effect of roxithromycin on aerobic flora in 14 children treated orally (5 mg/kg/day during 5 to 7 days) quantitative stool cultures were performed using selective media. Enterobacteriaceae (EB), streptococci D (STR D), Staphylococcus aureus, Candida were counted at days 0, 2 and 5 days, and 2 days after treatment. The MIC of each strain was determined for roxithromycin, erythromycin and spiramycin. Ten infants in a nursery had already received antibiotics. A moderate albeit significant (p less than 0.01) decrease was observed for EB, falling from 7.2 log 10 (range 5-9) to 4.9 (range 2-8) per gram of stools, rising to 5.8 after treatment. There was no significant effect for STR D. The MIC of roxithromycin for EB increased from 244 mg/l (range 0.03-512) to 340 (range 0.03-512). For STR. D, it increased from 138 (range 1-1024) to 427 (range 1-1024). The bacteria with low MIC (less than or equal to 64 mg/l for EB and less than or equal to 4 mg/l for STR. D) are Escherichia coli and Streptococcus faecium. The MIC increased for the three macrolides tested.

Adolescent↗
PubMed1989

[A psychiatric consultation service at a pediatric hospital. Definitions, nomenclature, perspectives].

A psychiatric consultation service has been implanted for the last 15 years at the Children's Hospital of Tours. It co-ordinates pediatric psychiatric activities on the various wards of this large pediatric center (200 beds). All pediatric psychiatry personnel belong to this autonomous unit which plans their work: clinical care and liaisons, teaching and research activities. This unit manages 1,000 cases a year: 20% of children are aged 0 to 2 years, 40% are under 5 years of age. This type of structure in a university pediatric hospital fosters considerably an early diagnosis and the prompt triaging of children to the services available in their home districts for appropriate care. Furthermore, it facilitates a comprehensive approach with appropriate integration of the somatic and of the psychodynamic dimensions of the child. This type of implantation constitutes a significant step forward in the field. However, its professional activities are handicapped because of the discrepancy between resources made available to psychiatry and pediatrics due to the failure to take into account the type of interventions required of the pediatric psychiatrist. In the hope of remedying these problems of evaluating the services distributed by psychiatry to young children hospitalized in clinical units, we present a specific nomenclature, elaborated after several years of experience. It classifies services in four large categories: Consultation and liaison in in-patient care units; chronic care carried out on a part time basis; admissions to the Pediatric Psychiatry Unit in beds belonging to various pediatric services; complete workups in day care beds.

Adolescent↗
PubMed1989

[Value of the esophageal approach in the diagnosis, treatment and therapeutic surveillance of arrhythmia in children].

For the past few years, a new method for the investigation and treatment of arrhythmias has been used: transoesophageal atrial pacing and recording (TAPR). In the light of 6 cases observed recently, we review the technical aspects and the indications for TAPR. A bipolar stimulation catheter is inserted in the oesophagus and positioned in the area where the atrial wave of greater amplitude is recorded. Atrial stimulation is done with impulses of long duration obtained with a special stimulator. Two cases validated this technique which was effective to correct atrial flutter in a neonate with heart failure resistant to medical treatment as well as in a 5 year-old child. The value of TAPR as a diagnostic tool in cases of tachycardia is discussed in the context of 2 cases: a 5 week-old with wide QRS and a 14 month-old with narrow QRS. Finally, the value of TAPR for monitoring the efficacy of anti-arrhythmia medications is illustrated by 4 cases of supraventricular tachycardia, in whom the optimal dosage of the anti-arrhythmic drug used was determined with the help of TAPR-induced tachycardia. The current literature concerning the technique, indications and results of TAPR are reviewed. This method is likely to take a great importance for the study and treatment of supraventricular arrhythmias in children.

Arrhythmias, Cardiac↗
PubMed1989

[The effect of previous antibiotherapy on the colonization of an Escherichia coli strain sensitive to antibiotics in the digestive tract of hospitalized children].

The administration of the Escherichia coli (az) strain has already been used successfully to protect premature infants against intestinal colonization by nosocomial strains of antibiotic resistant enteric organisms. The purpose of the present study was to assess the protective value of this strain in older full term babies after cessation of an antibiotics treatment. Two groups of children treated with antibiotics of respectively 8-90 days and 3-12 months of age were studied and compared to two control groups of untreated children. In both groups of children, the implantation of E. coli az was higher in treated than in untreated subjects. The group of younger children was significantly less colonized by antibiotic resistant hospital acquired enteric organisms, whereas in 3-12 months old children non protective effect of E. coli az was recorded. Therefore, the antagonistic effect of the strain studied appeared as age dependent.

Anti-Bacterial Agents↗
PubMed1988

[Comparison of plasma levels of amoxicillin administered by oral and intravenous routes in neonatal bacterial colonization].

Twenty-one full-term neonates who had a diagnosis of bacterial colonization were randomly assigned to receive amoxicillin 40 mg.kg-1 every 12 hours by either IV or oral route. Plasma levels of amoxicillin were assayed by HPLC at 0.5 (H0.5), 2 (H2), 6 (H6), 9 (H9) hours after the amoxicillin dose for both administration routes and also at the end of the infusion for the IV route. Average levels of plasma amoxicillin with IV and oral routes were not different except at H0.5 where they were higher with the IV route. With oral route Cmax was measured at H2 (6 times) or H6 (4 times). At the end of the infusion, plasma levels were between 55 and 154 mg.l-1 (81 +/- 32 mg.l-1). They decreased quickly so half life of amoxicillin by IV route was between 1.79 and 8.9 hs (4.28 +/- 2.4 hs). They were always above MIC for germs encountered in neonates except at H9 twice with IV and once with oral route. Pharmacokinetic data of this study allow to use oral route for amoxicillin for bacterial colonization in neonates: this administration route could also be proposed in infections following IV route as soon as hemodynamic and gastrointestinal conditions permit. The efficacy of such an attitude could be evaluated by a clinical trial.

Administration, Oral↗
PubMed1988

[The procurement of organs of children. General aspects].

Improved results of organs transplantation have resulted in an increased request for organs. All brain-dead children do not undergo organ harvesting for 3 main reasons. First, the definition of brain death, which should remain strict, is not accepted by everyone, in spite of the laws on this topics. Then, organizing organs harvesting requires specific hospital structures, a co-ordinator and motivated medical staff. Finally, parent's authorization is mandatory before organs harvesting in children. Parents still often refuse. An improvement might be reached by informing the general public, a maintained trust in the medical profession and the quality of the talk with the parents when the child dies. All energies should tend to develop the collective consciousness in order to improve this new aspect of medicine.

Attitude of Health Personnel↗
PubMed1988

[Large patent ductus arteriosus and interventricular communication associated with congenital absence of the pulmonary valve].

A case of pulmonary valve agenesis with ventricular septal defect and large patent ductus arteriosus is reported in a neonate. Heart failure occurred at 10 days of life; clinical examination showed continuous murmur. Echocardiography and angiocardiography visualized a major dilatation of the pulmonary artery. At cardiac catheterization there was an important left to right shunt through a large ductus, and pulmonary hypertension. There was also marked pulmonic regurgitation. Because of respiratory distress, ligation of ductus arteriosus was performed at 5 weeks of life. Five years later the patient is still in good condition. Patent ductus arterious is rarely associated with pulmonary valvular agenesis and ventricular septal defect. Our case is not explained by the fetal circulation theory described in this heart malformation.

Abnormalities, Multiple↗
PubMed1988

[Neonatal intracranial hematoma in hemophilia A].

A case of subdural and intracerebral hematoma which appeared spontaneously in a neonate with severe hemophilia A is reported. This rare complication justifies some preventive measures in families at risk : antenatal ultrasonographic diagnosis of sex, vitamin K administration to the mother at the end of pregnancy and plasma assay for factors VIII and IX in the male neonate. Clinical and ultrasonographic examination of the intracranial content must be repeated during the first week of life and specific replacement therapy must be instituted if the clinical condition requires it.

Cerebral Hemorrhage↗
PubMed1988

[Limitations of two-dimensional echocardiography in infants under one month of age].

One hundred and thirty-three children less than one month of age and presenting with congenital heart disease were investigated using two-dimensional echocardiography (TD echo). In these children, 234 cardiovascular abnormalities had been proven by hemodynamic and angiographic investigations (n = 103), post-mortem examinations (n = 15) or operative findings (n = 12). TD echo identified 201 cardiovascular abnormalities with 33 false negatives (sensitivity 86%) and 12 false positives (specificity 94%). Diagnosis after TD echo was correct in 100 children (75%), incomplete in 18 (13.5%), imprecise in 11 (8.3%) and false in 4 (3%). The most frequently unrecognized lesions were: anomalous systemic venous drainage (5/8), persistent ductus arteriosus (5/12), pulmonary stenosis (3/8), ventricular septal defect (5/27), coarctation (2/18). The lesions difficult to characterize concerned mostly the pulmonary valve and the aspect of the aortic arch. On the other hand, TD echo allowed to correctly identify major intracardiac abnormalities, malpositions of the great vessels and to well appreciate the dimensions of the trunk and branches of the pulmonary artery. These results allow to refrain from diagnostic endocavitary investigations in most of the heart defects revealed in the neonatal period and to perform curative or palliative closed heart surgery without preoperative catheterization. However, clinical, angiographic and hemodynamic investigations keep an important place in the preoperative evaluation of defects that may benefit from open heart surgery.

Cardiac Catheterization↗
PubMed1987

[Maternal-fetal Haemophilus influenzae infections].

In a systematic screening programme for neonatal infections involving 16,008 births, Haemophilus influenzae was isolated in 14 mother-infant couples (0.8 to 1,000 births). Comparisons with other series published in the U.S.A. showed similar circumstances of occurrence and initial clinical manifestations. However, the course of the infection was different, since there was no septicaemia or meningitis in our series. This raises the question of whether the strains responsible for the disease in the U.S.A. have a particular aggressiveness that is unidentifiable by serotype or biotype. In view of the post-partum occurrence of pelvic infections after isolation of H. influenzae during high risk deliveries, asymptomatic parturient women should be treated prophylactically. The 14 strains of H. influenzae isolated, most of them non capsulated and 2/3 of them of biotype IV, probably were of genital origin, although there was no evidence of cervico-vaginal infection. These results are consistent with the concept of genitotropic H. influenzae.

Female↗
PubMed1987

[Cardiac and cerebral involvement in aneurysms of the ampulla of Galen. Contribution of echography and cerebral Doppler flowmeter in the neonatal period].

An arteriovenous malformation of the vein of Galen was diagnosed using two-dimensional ultrasound and pulsed Doppler method, in a neonate with congestive heart failure. Contrast echocardiography showed right to left atrial and ductal shunting. Sector scans of the brain revealed an echo free intracranial mass with venous flow at the Doppler. Doppler assessment of the main cerebral arteries was also performed. In neonates presenting with severe congestive heart failure of unknown etiology, two-dimensional ultrasonography provides an accurate and rapid diagnosis of a cerebral arteriovenous malformation with aneurysm of the vein of Galen. Ultrasound method may also contribute to improve the comprehension of the physiopathology underlying the clinical findings.

Cerebral Veins↗
PubMed1987

[Effect of aztreonam on the fecal aerobic flora in children].

Aztreonam, a new monobactam, has a spectrum limited to Gram negative aerobic bacilli. To evaluate its effect after parenteral administration on aerobic stool flora (Gram negative bacilli, Streptococci D, Staphylococci, Candida), quantitative cultures used serial dilution of stools twice a week on selective media. For Gram negative bacilli, agar dishes containing aztreonam or not were used. Colonies of different morphologies were counted. Representatives of each morphological type were then picked for identification and susceptibility tests. Among the 16 patients treated, 12 were decontaminated for aerobic gram negative bacilli by the 3rd day. Sensitive bacteria persisted in 4 cases, although at a low level. Resistant bacteria (Enterobacter cloacae and Acinetobacter) appeared at a "normal" level in 2 patients initially decontaminated. No dramatic change could be detected for Streptococci D, Staphylococci and Candida. In twelve additional infants neither hospitalized nor treated, no aztreonam resistant Gram negative bacilli could be found.

Adolescent↗