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C Fourier

Publications and source records attributed to C Fourier.

32 records · Page 2Linked to original sources
PubMed1997

[Acute respiratory insufficiency revealing myasthenia gravis: apropos of 3 cases].

BACKGROUND: Myasthenia gravis is usually revealed by a ptosis or a diplopia. A respiratory muscle weakness often occurs during the course but an acute respiratory failure as initial feature is unusual. CASE REPORTS: Three girls, aged 8, 10 and 14 years, were hospitalised in an intensive care unit, along a 15 year-period, for an acute respiratory distress. The first two children suffered from skeletal and bulbar muscle weakness. The third, admitted with the diagnosis of unexplained pneumonia, was complaining of skeletal and bulbar muscle weakness for the last 18 months. Myasthenia gravis was confirmed with electromyography, and detection of the acetylcholine-receptors antibodies in all three cases. CONCLUSION: Any unexplained acute respiratory distress must lead to search for skeletal and bulbar muscle weakness, specially after muscular exercise or at the end of day, manifestations which characterize myasthenia gravis.

Acute Disease↗
PubMed1996

Spondylodiscitis and mediastinitis after esophageal perforation owing to a swallowed radiolucent foreign body.

A 6-year-old boy with aphagia presented with a radiolucent foreign body, esophageal perforation, mediastinitis, and a C6-C7 spondylodiscitis. A rigid plastic gear wheel was removed via thoracotomy, and the mediastinal abscess was drained through the esophagomediastinal fistula. Treatment included antibiotics as well as nonsurgical orthopedic management of the spondylodiscitis. The recovery period was uneventful, and the patient has remained asymptomatic for 2 years. Physicians must be aware of radiolucent foreign bodies. Computed tomography is very helpful in establishing the diagnosis of radiolucent foreign body, mediastinal abscess, and spondylodiscitis.

Abscess↗
PubMed1996

Simultaneous tracheal and oesophageal pH monitoring during mechanical ventilation.

OBJECTIVE: To simultaneously record tracheal and oesophageal pH in mechanically ventilated children to determine: (1) the feasibility and safety of the method; (2) the incidence of gastro-oesophageal reflux (GOR) and pulmonary contamination; and (3) their associated risk factors. DESIGN: Prospective study. SETTING: Paediatric intensive care unit in a university hospital. PATIENTS: Twenty mechanically ventilated children (mean age 6.7 years) who met the following inclusion criteria: endotracheal tube with an internal diameter of 4 mm or more (cuffed or uncuffed), mechanical ventilation for an acute disease, no treatment with antiacids, prokinetics, or H2-receptor blockers, and no nasogastric or orogastric tube. METHODS: The tracheal antimony pH probe was positioned 1 cm below the distal end of the endotracheal tube. The oesophageal antimony pH probe was positioned at the lower third of the oesophagus. pH was recorded on a double channel recorder and analysed with EsopHogram 5.01 software and by examination of the trace. The following definitions were used: GOR index, percentage of time pH < 4; pathological GOR, GOR index > 4.8%; tracheal reflux, fall in tracheal pH < 4, 4.5, or 5, or a decrease of one unit from baseline, in both cases preceded by an episode of GOR. The results were analysed statistically by Fisher's exact and the Kruskal-Wallis test. RESULTS: The procedure was well tolerated and the median duration of analysable recording was 6 hours (range 5-22.6). Pathological GOR was observed in eight (40%) children. GOR was more frequent with an uncuffed endotracheal tube than with a cuffed one (p = 0.01). Tracheal reflux (pH < 4) was observed in four children (20%) without clinical evidence of pulmonary aspiration. Episodes of tracheal reflux were associated with a GOR index > 10% (p < 0.01) and were more frequent with a maximal inspiratory pressure of < 25 cm H2O (p = 0.03), but were not related to the indication for mechanical ventilation, whether the endotracheal tube was cuffed or not, age, or drug treatment. CONCLUSIONS: Simultaneous tracheal and oesophageal pH monitoring was feasible in the setting of this study. Tracheal reflux can occur without pathological GOR, and GOR may occur without tracheal reflux. Further prospective studies in larger groups of patients are now justified.

Adolescent↗
PubMed1995

[Vascular tracheal compression presenting as bronchiolitis in infants].

BACKGROUND: Anomalies of the aortic arch and pulmonary arteries may produce compression of the trachea with chronic stridor or wheezing aggravated by crying, feeding and flexion of the neck. CASE REPORTS: Three infants, 3, 5 and 2 months-old, respectively, were admitted suffering from acute bronchiolitis. The first patient had intermittent wheezing for one month; lateral chest X-rays showed an opaque area inserted between the trachea and oesophagus and computed tomography showed pulmonary artery sling with tracheal stenosis which was successfully operated. The second patient displayed pulmonary atelectasia which required bronchoscopy; this technique showed tracheal stenosis which was due to pulmonary artery sling. The third patient had a history of congenital stridor: he required endotracheal intubation; a bronchoscopy performed because persistent pulmonary atelectasia showed tracheal stenosis which was secondary to a double aortic arch. The condition was improved after surgical correction. CONCLUSIONS: A history of stridor and/or wheezing in patients admitted for bronchiolitis must lead to consider the possibility of vascular compression of the trachea and to perform specific investigations.

Aorta, Thoracic↗
PubMed1995

[Modality and causes of 259 deaths in a pediatric intensive care unit].

BACKGROUND: There are few data available from European pediatric intensive care units (PICU) regarding the modes of death and their causes. POPULATION AND METHODS: Two hundred and fifty nine children, not including neonates, died in the PICU over a 7-year period (1987-1993). Data were obtained from a computerized data base and the retrospective review of medical records by two intensivists. Deaths were classified into three groups according to the terminal event: brain death (BD), unsuccessful resuscitation (UR), do-not-resuscitate order and limitation and/or withdrawal of therapy (LWT). RESULTS: BD was the most common mode of death (38%); UR accounted for 34% and LWT for 28% of deaths. There was no significant annual variation in the proportion of BD, UR and LWT. Age and sex were similar in the three groups. The predominant organ system failure involved upon admission was the central nervous system (52%) in the LWT group, and the cardiovascular system (54%) in the UR group. Severe chronic disease (37%) and immunosuppression (19%) were more prevalent in the LWT group than in the BD group. Time from admission to death was longer in the LWT group (median = 119 hours) as compared to the UR group (10 hours) and the BD group (54 hours). Ten percent of the BD patients became organ transplant donors. Sixty-seven per cent of BD patients had medical contraindication for organ donation: parents did not accept organ donation in 61% of potential cases. Thirty deaths (12%) seemed to be avoidable; dehydration from acute infectious gastroenteritis (n = 7) was the most common cause of avoidable death. CONCLUSIONS: The modes of death in our PICU were statistically not different from those seen in two of four North-American PICUs; LWT was less prevalent than in the two other PICUs, but the patient populations were very different (presence of neonates and many cardiovascular surgery patients). Assessment of the severity of illness at admission and of functional outcome in the survivors are mandatory in future studies.

Adolescent↗
PubMed1995

[Effects of hypocaloric diet on respiratory manifestations in Willi-Prader syndrome].

BACKGROUND: Prader-Willi syndrome (PWS) is a multisystem disorder with hyperphagia and obesity. Breathing disorders such as snoring, sleep apnea syndrome, and sleep hypoventilation have also been reported. CASE REPORT: Jonathan was born with the typical features of PWS. He developed exercise dyspnea, cyanosis and nocturnal sweating at the age of 3 years. A few months later, a respiratory failure required his admission to the intensive care unit. His weight was then 48 kg (300% ideal body weight (IBW); physical examination showed polypnea (60 breaths/min), cyanosis, fat deposition on the chest wall. Transcutaneous oxygen saturation was 65%, carbon dioxide tension 81 mmHg (capillary sample). Pulmonary hypertension was found (mean arterial pulmonary pressure = 55 mmHg). Polysomnography detected hypoventilation with persistent hypoxemia increasing during the night and transient dips of oxygen saturation with bradycardia. He was treated with oxygen, mechanical ventilation (facial mask) and a low caloric diet (600 cal/day). Four months later, he weighed 33 kg (200% IBW); the respiratory features had resolved and gazometric values and pulmonary pressure returned to the normal ranges. Polysomnography showed only obstruction apnea and hypopnea without oxygen desaturation. CONCLUSIONS: Patients with PWS may develop respiratory symptoms sufficient by severity to be life threatening. They are related to morbid obesity and are influenced by a hypocaloric diet. Follow-up of patients with this syndrome must include repeated respiratory evaluation.

Child, Preschool↗
PubMed1994

[Treatment with intermittent high dosage corticotherapy in chronic interstitial pneumonia in an infant. A case report].

Chronic interstitial pneumonia (PIC) are rare in infants. We report a case of an infant who presented with a chronic interstitial pneumonia following an infection with a respiratory syncytial virus. The diagnosis was confirmed histologically (open lung biopsy). The failure of oral steroid therapy (Prednisolone 2 mg/kg/day) led to the use of boluses of methylprednisone (30 mg/kg/day, daily for three days in three series one month apart). The treatment led to a progressive improvement and thirty months after the last bolus the respiratory examination was normal as was the radiology. The efficacy of bolus steroid therapy observed by other authors should be confirmed in multicentre trials using surgical biopsy to precise the pulmonary lesions.

Administration, Oral↗