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Biomedical subjects

D Devictor

Publications and source records attributed to D Devictor.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Chronic cor pulmonale and refractory hypoxemia following pulmonary embolism in a six-month-old infant: surgical management by thromboendarterectomy].

UNLABELLED: A diagnosis of pulmonary embolism is uncommon in the infant and the child, and chronic cor pulmonale secondary to pulmonary embolism is an even rarer occurrence. CASE REPORT: In this study, a case of pulmonary embolism in a 6-month-old male infant has been reported. His past history included preterm birth, and severe bronchopulmonary dysplasia, with prolonged oxygen dependency. The positive diagnosis was based on cardiac ultrasound examination, with the direct imaging of a right pulmonary arterial thrombus. Surgical thromboendarterectomy was performed, with a long-term favorable outcome. CONCLUSION: After excluding from the diagnosis those hemostatic disorders known to be thrombogenic, the most likely hypothesis was retained, i.e., that it was catheter-related. A central venous catheter had been inserted during the neonatal period, and was probably responsible for the embolism. The clinical characteristics and the diagnostic and therapeutic aspects of chronic postembolic cor pulmonale have been discussed in the light of the present findings.

Chronic Disease↗
PubMed1999

[Attitude of general practitioners facing patients at the end of life in home care].

OBJECTIVES: General practitioners (GPs) are directly confronted with patients experiencing end-of-life situations in their homes. We conducted a survey to ascertain the GPs' approach as there has been little work in France concerning this type of situation. METHODS: A questionnaire was sent to 478 general practitioners in the Essonne department who are corresponding physicians at the Louis-Michel hospital in Evry. There were 233 responses (49.8%). RESULTS: The main findings demonstrated that important decisions concerning dying patients are made on a consensus basis in 58.8% of the cases. Problems related to end-of-life situations are discussed with persons close to patients with incurable conditions (for 85% of the responding GPs) and with the patient (74%). Patients participating in the discussion express the desire to continue living in 65.7% of the cases. The familial situation appears to be the essential element for managing these patients in their home and is the number one reason for hospitalization. This contrasts with the opinion of general practitioners who favor home management (82% of the responding physicians). CONCLUSION: Our study demonstrates an important gap in medical education since 66.5% of the practitioners felt they had not received appropriate training in this area. It also emphasizes the lack of sufficient communication between general practitioners and hospital physicians and the need to organize a network which would better respond to patient, family, and physician demands.

Aged↗
PubMed1999

[Organ procurement from cardiac arrest donors: outcome of kidney grafts and recommendations].

OBJECTIVES: To compare literature data with results obtained with organs procured from donors who died from cardiac arrest and to make proposals for this mode of organ procurement in France. METHODS: Over the last 10 years, 10 organ donors (2%) among a series of 486 donors in a state of brain death, had died of cardiac arrest. The arrest were perfused with double-balloon catheters. The outcome of the subsequent kidney grafts was compared with data in the literature. RESULTS: Fifteen of the 18 kidneys from cardiac arrest donors were functioning 1 month after implantation compared with 17 of the 20 kidneys from braindeath donors with beating hearts. The rate of acute tubular necrosis was 55% in the cardiac arrest kidneys and 40% in the beating-heart kidneys. Serum creatinine at 1 yeart was 145 +/- 69 mumol/l 17 +/- 29 mumol/l respectively. DISCUSSION: These results and those reported in the literature demonstrate that kidney procurement from cardiac arrest donors is feasible. If intensive care and surgery units are well organized, this type of organ procurement could provide a larger number of organs for transplantation. Emergency teams must be available for preparing and transferring the organs.

Cadaver↗
PubMed1999

Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome.

UNLABELLED: The haemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease. The aetiology of this syndrome is unknown, and, despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. OBJECTIVE: To assess the neurological features and potential prognostic markers of the disease. DESIGN: Retrospective study. SETTING: Division of Neuropaediatrics in a children's university hospital. PATIENTS AND METHODS: Fourteen patients fulfilling the HSES criteria out of 42 children admitted with fever and shock to the Paediatric Intensive Care Unit between 1986 and 1994, were analysed for clinical, biological, neuroradiological, EEG and neuropathological findings. RESULTS: The patients (age range from 2 to 33 months) were found at night or in the morning either comatous (n = 3) or convulsing (n = 11). All but one were healthy before admission, although eight had had a brief prodromal infectious disease. All were febrile (mean body temperature 39.9 degrees C +/-0.9 degrees). Seasonal clustering during the winter months was observed. Coma and seizures with frequent status epilepticus were the main neurological manifestations. All children recovered from their multiple organ failure within a few days. Seven died (50%); four survivors had neurological sequelae (29%) with a developmental quotient (DQ) of 50% or less in three and a DQ of 75% in one and three infants (21%) had normal outcomes. Computed tomography (CT) displayed a diffuse area of low density mainly in the cerebral cortex and intraventricular and parenchymal haemorrhages. Magnetic resonance imaging (MRI) showed haemorrhagic cortical lesions. Postmortem examination of the brain conducted in three patients showed necrotic and haemorrhagic lesions, mainly in cortical areas. Comparison of the children with adverse outcome (death or neurological sequelae) with those with normal outcome revealed that predictors of poor outcome were status epilepticus (p = 0.003) and coma for more than 24 h (p = 0.01). Infants without disseminated intravascular coagulation, without a biphasic course and without brain hypodensities or haemorrhages on CT scans performed at least 4 days after onset had a normal neurodevelopmental outcome. CONCLUSION: The central nervous system appeared to be the main target of the HSES lesions. The most common outcome was brain death or severe brain damage. Further studies with a larger sample are necessary to determine whether the prognostic indicators we identified are reliable.

Brain↗
PubMed1998

Reversal of hypoxemia by inhaled nitric oxide in children with severe hepatopulmonary syndrome, type 1, during and after liver transplantation.

BACKGROUND: The hepatopulmonary syndrome with profound hypoxemia is a rare but severe complication for children with liver cirrhosis. It can be reversed by liver transplantation (LT), which is now regarded as a good indication. However, previous reports have described cases of transient or fatal deteriorations of intrapulmonary shunting after pediatric liver transplantation with dramatically worsening hypoxemia. METHODS AND RESULTS: A similar case during and after LT in a 4-year-old girl with severe hepatopulmonary syndrome is described with prompt reversal of hypoxemia by inhaled nitric oxide, which was discontinued definitely until day 14 after LT. CONCLUSIONS: During or after LT, worsening hypoxemia may be improved by using inhaled nitric oxide in pediatric patients undergoing liver transplantation for liver cirrhosis and hepatopulmonary syndrome. The mechanisms are unclear, but may involve mismatching lung ventilation-perfusion. However, additional clinical reports are necessary before accepting these results.

Administration, Inhalation↗
PubMed1998

Early liver transplantation is crucial in children with liver disease and pulmonary artery hypertension.

BACKGROUND/AIMS: Early liver transplantation is crucial in children with liver disease and pulmonary artery hypertension. Some severe pulmonary vascular anomalies associated with portal hypertension disappear after isolated liver transplantation. Evolution of pulmonary artery hypertension due to plexogenic arteriopathy is controversial, as this association is still considered a contraindication to isolated liver transplantation. Outcome of pulmonary hypertension after isolated liver transplantation is reported in three patients with portal hypertension. METHODS: After echocardiographic diagnosis, the patients had a complete hemodynamic exploration, and two had a lung biopsy. After liver transplantation, the survivors had echocardiographic follow up and a second hemodynamic exploration. RESULTS: In two children, pulmonary pressures and resistances returned to near-normal values 1 and 6 years after successful isolated liver transplantation. The third patient, with the most severe arteriopathy, had to wait 1 year for a donor, and the attempted transplantation was complicated by ventricular tachycardia; death occurred 2 days after surgery. CONCLUSIONS: Liver transplantation can reverse pulmonary artery hypertension due to high pulmonary resistances complicating liver disease with portal hypertension, provided it is carried out at an early stage. Early detection of pulmonary hypertension by systematic echocardiography may thus be crucial in these children with portal hypertension.

Adolescent↗
PubMed1998

[[Emergency pediatric EEG in mental confusion, behavioral disorders and vigilance disorders: a retrospective study].

Recording of electroencephalogram (EEG) is of value to estimate vigilance states in children as in adults. In order to determine the diagnostic and prognostic value of emergency EEG in case of mental confusion, behavioral disorders and vigilance disorders in childhood, we conducted a retrospective study in 397 children (aged 2 months to 16 years). EEG was recorded less than 24 hours after an emergency consultation for acute confusion or acute behavioral disorder (n = 106) or after admission to the intensive care unit for comatose stage (n = 291). EEG gave diagnostic indications mainly in case of convulsive pathology or hepatic encephalopathy. In comatose children, we established a 4-stage EEG scale of increasing severity. This classification was compared to EEG scales already published in the literature and appeared very similar to that from Pampiglione and Harden, established in 150 children after cardiac arrest. A highly poor prognostic value was associated with burst-suppression post-anoxic patterns and with isoelectric records signaling brain death. Our classification of emergency EEG patterns is mainly helpful in these two situations, but does not exclude strict and repeated clinical and EEG follow-up in other cases, as a relatively preserved initial EEG may later deteriorate.

Adolescent↗
PubMed1998

Haemophilia A: two cases showing unusual features at birth.

We report two patients with severe haemophilia A, factor VIII < 2 u dL-1, diagnosed at birth, through isolated bleeding in the adrenal gland (case 1) and through a haematoma in the liver (case 2). In these two clinical cases, the vital emergency, with haemorrhagic shock, required early diagnosis of the hereditary coagulation defect. Generally at birth, any unexplained bleeding should prompt screening for haemophilia. In the newborn period, the PTT is inadequate for many reasons and the laboratory evaluation must include factor VIII and IX levels.

Adrenal Gland Diseases↗
PubMed1998

Acute pancreatitis after orthotopic liver transplantation in children: incidence, contributing factors, and outcome.

BACKGROUND: Acute pancreatitis after orthotopic liver transplantation is a well-known complication in adults that has never been described in children. In adults, end-stage liver disease related to hepatitis B, intraoperative pancreatic injury caused by extensive peripancreatic dissection, the type of biliary anastomosis performed, and numerous drugs, have all been described as predisposing factors in acute pancreatitis after liver transplantation. The current retrospective review was undertaken to identify the incidence, the contributing factors, and the outcome of acute pancreatitis after liver transplantation in children. METHODS: During a 10-year period, 375 children underwent 434 liver transplantations in the authors' institution. In seven patients (1.9%), clinical acute pancreatitis developed after orthotopic liver transplantation. Indication for initial liver transplantation was biliary atresia (n = 3), acute liver failure (n = 3), and type 1 Crigler-Najjar syndrome. In all seven patients, liver graft function was initially adequate. The diagnosis of acute pancreatitis was based on clinical, biochemical, ultrasonographic, and surgical signs. RESULTS: In six patients, acute pancreatitis appeared within the first week after transplantation. The diagnosis was confirmed by abdominal laparotomy in five children. In the current series, emergency liver transplantation (p < 0.001), retransplantations (p < 0.001), and infectious peritonitis (p < 0.001) were contributing factors. Despite supportive measures, three patients died (43%) because of multiple organ dysfunction syndrome. CONCLUSIONS: Acute pancreatitis is an uncommon but life-threatening complication after liver transplantation in children. Early diagnosis and aggressive treatment of infectious complications are major elements in the management of acute pancreatitis after liver transplantation.

Acute Disease↗
PubMed1997

Portal vein complications after liver transplantation for biliary atresia.

The objective of this report is to review portal complications (PC) after pediatric liver transplantation (LT) for biliary atresia (BA) in the Bicêtre surgical series. From January 1, 1988, to February 28, 1995, 96 children with BA underwent 115 LTs Portal anastomosis was done on either the recipient portal vein (n = 85) or superior mesenteric vein (n = 11). No antiaggregative agents were administered postoperatively. Median follow-up was 50 months (range, 12 to 97). Nineteen PC (16.5%) occurred in 17 recipients: 16 portal thrombosis (PT) and 3 portal stenosis (PS). Fifteen instances of early PT occurred between days 0 and 17 (median, day 2). Emergency thrombectomy was performed in 9 cases (successful in 5). Three children underwent a secondary portosystemic shunt (successful in 2). Three PS were cured by either surgery or balloon dilatation. Four children died, 3 are alive with portal hypertension (PHT), and 10 are alive without PHT. Three-year patient actuarial survival is 82.4% in PC cases and 82% in others (NS). Significant risk factors of PC are young age and weight at the time of LT, small portal vein, and emergency LT. Analysis of our own results and review of the literature suggest that prevention of PC depends primarily on appropriate surgical technique. Reduction of postoperative hypercoagulability may also play an important role: a meta-analysis of 1,257 published pediatric LT show an overall risk of PT of 2.2% in teams using aspirin with or without dipyridamole compared with 7.8% when no antiaggregative agents are given (P = .0001).

Adolescent↗
PubMed1997

Rationale and technical constraints of a tertiary liver transplantation.

Because of the current shortage of donor organs, the routine performance of tertiary liver transplantation (LT) may be questioned. In this study, the indications of tertiary LT are discussed, paying particular attention to intraoperative technique. Of 501 LTs performed from 1986 to 1995, eight (1.6%) were tertiary LTs. Three patients underwent an emergent third LT because of associated hepatic artery and portal vein thromboses (n = 2) or hyperacute rejection (n = 1). Five patients had an elective third LT for ischemic cholangitis (n = 4) or chronic rejection (n = 1). The 3 patients who underwent retransplantation emergently died early from multiple-organ failure. Because of previous surgery and subsequent technical difficulties, the third LT in the remaining 5 patients required unroutine surgical procedures including the following: intrapericardial control of the suprahepatic vena cava (n = 1), "en bloc" clamping of both the infrahepatic vena cava and the hepatic pedicle (n = 1), arterial reconstruction onto the aorta via an aortoiliac conduit (n = 5), and aortic resection with aortoaortic prosthetic reconstruction (n = 1). Of these 5 patients, 4 required reoperation because of bowel perforation (n = 5) or intraperitoneal bleeding (n = 1). The 5 patients (62%) who were regrafted electively are alive and well after a median follow-up of 45 months. A third LT can be reasonably offered to selected young recipients if performed electively. Tertiary LT may require unroutine surgical procedures and may lead to severe morbidity.

Adult↗
PubMed1997

[Pediatric emergency admission: results of two national surveys on a "given day"].

BACKGROUND: Recently, several measures were implemented to restructure the frame-work of hospital emergency admissions. However, these measures concern primarily adults. Pediatricians made on their own several proposals to improve admission of children. They felt that these proposals should be supported by statistical numbers. Several investigations were then conducted. POPULATION AND METHODS: The authors report the results of two investigations conducted in January 1994 and January 1995 in all French hospitals admitting children in emergency. RESULTS: The results shows that 60% of the purposes for consultations are of a general medical nature which does not require emergency assistance. The emergency cases were estimated genuine in only 10% of all incoming patients while all other cases were benign or treated merely as simple outpatient consultations. Accidental pathology represented 30% of all cases. More than half of the children were less than five years old. In most cases, a pediatrician was readily available night and day in all University hospitals which was, unfortunately, not the case in most general hospitals where the number of pediatricians was insufficient to assure night duties. CONCLUSION: The result of these investigations does not provide an exhaustive picture of the overall pediatric emergencies. It demonstrates, however, the quantitative importance of pediatric emergencies while emphasizing on their differentiation in qualifications and specialization of the practicians and nurses in charge of incoming patients from one hospital to another. It demonstrates that serious efforts need to be made so that the child may be readily directed to an hospital emergency center with appropriate medical and paramedical personnel, a situation which, unfortunately, does not always prevail at present.

Child↗
PubMed1997

[Current aspects of acute respiratory distress syndrome in children].

Acute respiratory distress syndrome (ARDS) is a frequent condition in pediatric intensive care units. The mortality remains high despite advances in conventional mechanical ventilation and aetiological treatment. Several animal studies have documented lung injury during mechanical ventilation with high tidal volume, and clinical investigations have shown that in human ARDS, most ventilation is distributed to the small areas of remaining aerated lung resulting in overdistension of these areas and lung injury ("baby lung" theory). Nevertheless the usefulness of extrapulmonary gas exchange remains much debated. New ventilatory strategies have been developed in order to reduce ventilator-induced lung injury and to improve systemic oxygenation but multicentric randomized clinical trials are needed before these strategies can be validated.

Acute Disease↗