Biomedical subjects
Publications and source records attributed to B Boudailliez.
Neonatal renal venous thrombosis may result in severe morbidity. Predisposing conditions are well known. We report the case of an unusual and early neonatal renal venous thrombosis. The mother received an electrical shock at 34 weeks gestation. This case demonstrates that maternal electrical shock effect on the fetus should be early investigated.
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The increasing prevalence of adolescent obesity justifies widespread effort and attention of the paediatrician. In order to manage, following points are to be documented: (I) weight status assessed on the basis of body mass index (BMI)split in two levels: obesity grade I: >or=97 ème centile, obesity grade 2: level IOTFC 30; (2) complete anamnesis including age at adiposity rebound and existence of overweight in family; (3) research of associated morbidity and medical risks;(4) assessment of food intake and feeding practice; (5) assessment of physical activity; (6) talk with the adolescent to assess the psychological status, looking after depressive symptoms, anxiety, loss of self esteem. Once the items are documented, it allowed making a plan to manage the obesity in alliance with the adolescent and his family.
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The aim of this study was to determine the prevalence of celiac disease (CD) markers in a French cohort of 84 children type 1 diabetics. Detection of antitransglutaminase (AtTG), antiendomysium (AEA) and antigliadin (AGA) antibodies was performed. Group 1 included 81 (96.4%) diabetic patients with negative antibodies. Group 2 included 3 patients (3.6%) with positive serological markers: 1 AGA-AEA-AtTG and 1 AEA-AtTG with proved histological diagnosis and 1 AGA positive with negative histology. No statistically significant difference was observed between the groups with regard to age, duration of diabetes, familial target stature, and ratios Height/Age and Weight/Height. Presence of CD serological markers was related to a lower level of HbA1c. Prevalence of CD serological markers is important in this French cohort but lower than other countries.
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PURPOSE: The aim of this study was to evaluate the change in ureteropelvic junction management, from surgical correction to observation of the hydronephrosis. We checked wether or not it was deleterious for kidney. MATERIALS AND METHODS: We retrospectively reviewed 96 charts between 1988 and 1998. Initial ultrasonography, and voiding cystourethrogram were available for all cases. Intravenous urography and diuretic renography were studied when available. Minimal follow-up of patients was one year. Patients were divided into three groups: surgery right away, surgery after observation, and observation only. RESULTS: Later was the diagnosis, more significant were the hydronephrosis and impairment of renal function (p < 0.01). In group operated on right away (69 cases), drainage improved, hydronephrosis decreased, but renal function did not improve significantly (p = 0.37). Sixteen patients were operated on after observation without deleterious effect for kidney. Eleven patients were only observed: hydronephrosis progressively decreased. Initial radiological results were not different between the last two groups (p > 0.05), and were not predictive of their course. CONCLUSION: Initial non operative management of hydronephrosis was not dangerous for renal function. It is advisable to detect at the earliest all signs of obstruction, because surgery improves renal drainage but not renal function.
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Central venous catheter (CVC) are being increasingly used as hemodialysis vascular access. In order to evaluate the indications, practice and uses in the pediatric population, we conducted a study in children with renal failure (RF). A questionnaire was sent to the 21 french paediatric hemodialysis centers to inquire population deserved, number, type, site and indications of CVC, procedure of management and attitude towards infection and thrombosis. A prospective survey was added to compile information about CVC during the period 7/2000-31/12/2000. Results (exhaustivity response 80%) showed 1. large diversity in choice of material with predominance of pediatric permcath QUINTON; 2. exclusive surgical insertion for 8 out of 19 centers; 3. rare use of femoral route (never and exceptionally reported, respectively by 4 and 6 centers and predominantly in acute RF; 4. heterogene attitude towards fixing, dressing, heparine locking and procedure of urokinase administration in case of thrombosis, whilst procedure towards infection was homogeneous; 5. indications of insertion of the 31 prospective study CVC were distributed in 4 subgroups a) breakdown of vascular permanent access (6 cases) or of peritoneal dialysis (2 cases), b) unexpected terminal renal failure (6 cases), c) deliberate choice to wait transplantation (4 cases) or to face breakdown of transplantation (4 cases), d) dysfunction of a previous CVC (7 cases); 6. a rate of 20% of dysfunction (flow problem); 7. a rate of replacement of 11%. AVC are effective forms of vascular access. However CVC indications should be carefully analysed and balanced if possible with alternative route such as anticipated creation of arterioveinous fistula, peritoneal dialysis and preemptive transplantation.
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UNLABELLED: Recent studies have shown a high prevalence of calcium and vitamin D deficiencies in adolescents. The aim of this present study was to follow the changes in calcium status and 25 hydroxyvitamin D (25[OH]D) and parathyroid hormone (iPTH) levels during winter in preadolescents and adolescents from four university hospitals in northern France. SUBJECTS AND METHODS: Two groups of teenagers and adolescents (range: 10-15 years) were followed from October 1996 to June 1997. They were given either 100,000 IU of vitamin D (treated group n = 33) or a placebo (control group n = 35) in October, January and April. Serum calcium, phosphate, 25(OH)D and iPTH levels were measured at inclusion and every three months thereafter. RESULTS: At inclusion, plasma or serum 25(OH)D levels were < or = 10 ng/mL in 16 subjects and < 6 ng/mL in six. In control children, no significant change in 25(OH)D occurred during the study, while plasma or serum iPTH levels increased to 34 +/- 11 pg/mL. In the treated groups, 25(OH)D levels remained > 20 ng/mL in every subject; no hypercalcemia was observed; and the mean plasma or serum iPTH level was 25 +/- 14 pg/mL at the end of the study. CONCLUSION: Teenagers presented with a high prevalence of biological vitamin D deficiency at the end of summer. The increase of iPTH during winter in the unsupplemented group suggests that this has secondary consequences on their calcium homeostasis unless they are supplemented with vitamin D. We advocate a sufficient calcium supply and a 100,000 IU vitamin D supplement given two or three times during winter to preadolescents and adolescents living in northern France.
PURPOSE: Comparing Power Doppler imaging versus technetium-dimercapto-succinic-acid (Tc-DMSA) scintigraphy in acute pyelonephritis of childhood. PATIENTS AND METHODS INCLUSION CRITERIA: First episode of urinary tract infection, clinical and biological findings suggesting an upper lesion, absence of urological malformation or obstruction, absence of reflux (or vesico-ureteral reflux inferior to grade 3). Number of patients: 49, length of the study: 26 months (from November 95 to January 98). METHODS: Tc99m-DMSA scintigraphy (after five days), B mode and Power Doppler imaging (on the day of admission or the following day). Systematic cystography (day 5 to day 30). RESULTS: In terms of positive diagnosis, scintigraphy was superior to Power Doppler, and the latter was superior to B mode ultrasonography. Sensitivity (scintigraphy being the gold standard) was equal for both B mode and Power DopplerUS imaging, but combined Power Doppler and B mode US provided improved results. CONCLUSION: Currently, the results with Power Doppler imaging are insufficient to replace DMSA scintigraphy. However, Power Doppler is a good complement to B mode US.
BACKGROUND: Cardiac involvement rarely occurs in classic hemolytic uremic syndrome (HUS); it is often fatal. CASE REPORTS: The first patient, a 21-month-old boy, developed classic HUS with acute renal failure. Peritoneal dialysis was performed for 20 days. On the 10th day of dialysis, myocardial infarction occurred, probably related to coronary thrombus. The patient was given heparin and antibiotics because of an unexplained fever. The outcome was favorable despite antero-apical cardiac necrosis, and moderated chronic renal failure. The second patient, a 24-month-old girl, also showed a classic HUS, which required peritoneal dialysis for 10 days. Dilated cardiomyopathy with cardiac failure appeared on the 4th day of dialysis, not related to the volume overload and metabolic consequences of the acute renal failure, such as systemic hypertension or ineffective dialysis. On the 5th day of dialysis neurological involvement appeared. Neurological, cardiac and renal outcome was favorable. The third patient, a 25-month-old girl, developed a classical HUS, requiring peritoneal dialysis for 25 days. No cardiac insult appeared during the acute phase of the disease. After dialysis, the child had chronic renal failure (creatinine clearance: 15 mL/min/1.73 m2). Dilated cardiomyopathy appeared 3 months later, without definite etiology. The outcome was favorable with digoxin treatment. CONCLUSION: A cardiac involvement should also be searched for in the acute phase of HUS and several months later.
A retrospective survey concerning all patients ages 12-19 who had registered themselves at the admitting service of the paediatric emergency unit in the university hospital centre of Amiens was carried out in 1995. 2812 adolescents were received (18% of total admissions). The male/female sex-ratio was 1 to 3. The average age was 13.2 years old. Hospitalisations were more frequent in the spring and were predominantly on Mondays (17%). More than 2/3 of the adolescents were accompanied by their parents and 20% were referred by their doctors or by the SAMU (mobile emergency medical service). Two percent arrive alone. Traumatic pathology is the main reason for admission (1960 patients). Organic pathologies represent 24% of admissions and are essentially digestive pathologies (40%). "Suffering" adolescents (defined as those requiring an intervention with a psychotherapist as a matter of priority) only represent 6% of visits to the emergency unit, of which 2/3 correspond to suicide attempts. 24% of adolescents are hospitalised at the university hospital centre of Amiens within the paediatric services or specialised services (ENT, stomatology, etc.).
This article reviews the clinical, biological, radiological, and pathological procedures and their respective indications for the practical diagnosis of the following various histological patterns of renal osteodystrophy: osteitis fibrosa due to parathyroid hormone (PTH) hypersecretion: osteomalacia or rickets due to native vitamin D deficiency and/or aluminum overload; and adynamic bone disease (ABD) due to aluminum overload and/or PTH secretion oversuppression. Our advice regarding bone biopsy is to restrict it to patients with symptoms and hypercalcemia, especially those who have been previously exposed to aluminum. In other cases, we propose relying merely on the determination of the plasma concentrations of calcium, protide, phosphate, bicarbonate, intact PTH, aluminum, 25(OH)D3, and alkaline phosphatase (total and bony if hepatic disease is associated) to choose the appropriate treatment. Because of the danger of the desferrioxamine treatment necessary to chelate and remove aluminum, the suspicion of aluminic bone disease (osteomalacia or ABD) will always be confirmed by a bone biopsy. In the case of nonaluminic osteomalacia, correction of the vitamin D deficiency by native vitamin D or 25(OH)D3, and of the calcium deficiency and acidosis by alkaline salts of calcium and if necessary sodium bicarbonate are sufficient to cure the disease. In the case of nonaluminic ABD, the stimulation of PTH secretion by the discontinuation of 1alpha hydroxylated vitamin D and the induction of a negative calcium balance during dialysis by decreasing the calcium concentration in the dialysate will allow an increase of the CaCO3 dose to correct for hyperphosphatemia without inducing hypercalcemia. For hyperparathyroidism, i.e., plasma intact PTH levels greater than two- or four-fold the upper limit of normal levels (according to the absence or presence of previous aluminum exposure), the treatment will consist in increasing the CaCO3 dose to correct for hyperphosphatemia together with a decrease of the calcium concentration in the dialysate if the dose of CaCO3 is so high that it induces hypercalcemia. When the hyperphosphatemia has been corrected and there is still a low or normal corrected plasma calcium level, 1alpha(OH)D3 in an oral bolus 2 or 3 times a week should be given at the minimal dose of 1 microg. When the PTH level stays above 400 pg while hypercalcemia occurs and hyperphosphatemia persists, surgical subtotal parathyroidectomy is recommended or the injection of calcitriol into the big nodular hyperplastic parathyroid glands under sonography control in high surgical risk patients. Special recommendations are given for children.
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