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Biomedical subjects

D Devictor

Publications and source records attributed to D Devictor.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Serious acute hepatocellular insufficiency in children: EEG prognostic features].

Fulminant Hepatic Failure (FHF) in children leads to 60 to 90% of mortality without age influence, depending on the studies. Twenty-two children with this disease had daily EEG, 15 died, seven survived. The neurological electroclinical study evidenced a stereotyped evolution of the EEG anomalies which were not age-related, but correlated to clinical stages of coma and to severe coagulation disorders; 5/22 children with clinical and/or EEG convulsive disorders died. One child exhibited triphasic slow waves and died from paracetamol intoxication. A prospective study of a larger population could help to recognize factors of decision for hepatic transplantation.

Adolescent↗
PubMed1990

[Severe poisoning with intravenous phenytoin in the newborn. Value of peritoneal dialysis].

A severe poisoning with intravenous phenytoin in a newborn was treated with peritoneal dialysis in spite of its reported poor effectiveness, the drug being 90% protein-bound. During 10 hours, 1.41 mg/hr were eliminated by biotransformation and 1.80 mg/hr were removed with peritoneal dialysis allowing to suppress quickly life threatening cardiac side effects. This efficacy may be explained by an increase in the unbound protein fraction and a diffusion speed through the peritoneum higher than in older patients.

Biotransformation↗
PubMed1990

[Prognostic evaluation of severe head injuries in children].

In 34 children overcoming a severe head injury (coma greater than 1 d, mean: 10 d), the follow-up (mean: 25 m) has been correlated with several data. 1) The quality of life, according to a 3 grade-score, is mostly dependent upon the degree of neuropsychological sequelae. By decreasing frequency were noted disturbances of: memory, intelligence (the most significantly correlated with the quality of life), attention, rapidity of performances, behaviour, visuoconstructive activities. Most often several disturbances were associated, but without systematization. 2) Correlations between general outcome and early findings: a coma greater than 10 d, a subdural collection on the CT scan at 2-6 weeks have a pejorative meaning. Age does not appear to be relevant. 3) In a sequential study of neuropsychological functions, an early evaluation is poorly predictive, except in case of rapid normalization. Evaluation at 6 months gives a good picture of the outcome. Sectorial improvements can occur beyond the 1st year but do not appear to modify dramatically the general outcome.

Adolescent↗
PubMed1990

[Severe thrombocytopenia induced by heparin in an infant with acute myocarditis].

A severe heparin-induced thrombocytopenia is reported in a child suffering from acute myocarditis. Thrombocytopenia (80.10(9)/l) occurred on day 5 (D5) of heparin therapy which was thus discontinued during 8 hours but reintroduced on the view of a negative platelet aggregation test using standard heparin. On D10, while thrombocytopenia persisted the presence of two intra-cardiac thrombi led to replace standard heparin by low molecular weight heparin (Fraxiparin), associated with vitamin K antagonist (phenindione). On D12, a 3rd intra-cardiac thrombus required immediate discontinuation of Fraxiparin therapy. Platelet aggregation tests performed on D14 were positive in the presence of standard heparin and of low molecular weight heparin, thus demonstrating the existence of thrombocytopenia induced by standard heparin and secondly by low molecular weight heparin. This observation led the authors to discuss the diagnosis and the therapeutic management of heparin-induced thrombocytopenia.

Acute Disease↗
PubMed1989

[Non-invasive methods of respiratory monitoring during resuscitation in neonatal and pediatric care].

The authors review the non-invasive methods currently used in paediatric intensive care units to monitor the oxygenation and ventilation of neonates and infants. They deal successively with the qualities and defects technique (transcutaneous measurement of PO2, SaPO2 and PCO2) and with the usefulness of capnography. These various methods of investigation and monitoring must complete each other to ensure the safety of children in situations of distress.

Blood Gas Monitoring, Transcutaneous↗
PubMed1989

Vein of Galen aneurysmal malformations. Report of 36 cases managed between 1982 and 1988.

The authors report a series of 36 vein of Galen aneurysmal malformations (VGM) diagnosed in the paediatric (78%) and adult (22%) populations that were referred to them for therapeutic management between 1982 and 1988. The clinical signs leading to the diagnosis were variable: 36% of systemic manifestations, 22% of neurological symptoms, 17% of hydrocephaly and 11% of intracranial haemorrhage. 30 angioarchitectural analyses could be obtained and allowed to classify these VGMs into 5 different types: 44% parenchymatous AVMs, 20% mural AVFs, 30% choroidal arteriovenous fistulas, 3% dural AVFs, 7% vein of Galen varices. This series demonstrates that the paediatric population is most sensitive to shunt effect whatever its type. Systemic manifestations and hydrocephaly are the most common signs encountered in the newborn and infants; whereas neurological signs and symptoms and haemorrhage belong mostly to the adult symptomatology. Because of the poor outcome of VGMs, all authors believe that these malformations have to be treated aggressively. However, we found contra-indications to be represented by pretherapeutic demonstration of cerebral tissue damage, or uncontrollable systemic failure, thus treatment is indicated to compensate for cardiac failure previously responding (even partially) to medical treatment. Secondly, appearance of sub-cortical calcifications, resistance to medication or clinical deterioration will also lead to urgent treatment. The endovascular method represents at present the best treatment with an overall low mortality (13%) and a 0% technical morbidity in children compared to the surgical one of (91% mortality in newborns and 38% in infants). The results achieved by embolization in this series were as follows: 27% satisfactory results with complete or almost complete occlusion of AV Shunt, 53% significant clinical improvement, 7% of patients were unchanged. The authors believe fundamentally that these patients (specially those belonging to the paediatric population) have to be treated in a centre where a paediatric intensive care unit, neurological, neurosurgical and surgical neuro-angiographic departments coexist, in order to assure the best possible management of these children.

Adolescent↗
PubMed1989

Short- and long-term prognostic value of the electroencephalogram in children with severe head injury.

To determine the prognostic value of the EEG in severely head-injured children, 24 patients were studied for 8-36 months. During coma, 4 EEG patterns were found: borderline, sleep-like, changeable and slow monotonous (SM). For the short-term prognosis, we conclude that the SM pattern (12/24 patients) indicates a bad prognosis because it was associated with a longer coma and awakening period than that of other EEG patterns and because it was observed in the 3 patients who died from brain injury. In contrast, we describe a 'prewake' pattern (11/22 survivors) which, when it occurs, always announces the onset of a complete awakening. For the long-term prognosis, only 50% of the survivors who had an SM pattern during coma have as good an intellectual and motor outcome as the survivors who displayed other EEG patterns. No other EEG features recorded during coma have short- or long-term prognostic significance.

Child↗
PubMed1989

[Streptococcus group B tardive meningitis revealing chronic septic granulomatosis].

A first-born boy operated on D20 for an abscess of the anal margin (E. Coli, Klebsiella) developed purulent meningitis due to a group B serotype III streptococcus on D35. The outcome was rapidly fatal. Results of immunologic investigations done on the day before death were suggestive of chronic granulomatous disease (CGD) as complete absence of reduction of nitroblue tetrazolium (NBT) was evidenced. Studies of polymorphonuclear cells from the mother showed normal production of oxygen, chemiluminescence and NBT reduction. During the subsequent pregnancy, fetal blood was sampled 19 weeks after the last menstrual period; results showed the fetus was male and the polymorphonuclear cells were incapable of reducing NBT and exhibited decreased chemiluminescence and oxygen production. The pregnancy was terminated. This case shows that delayed group B streptococcus infection can occur as the first manifestation of CGD, although this condition is usually responsible for infections due to staphylococci, enterobacteriaceae and yeasts.

Granulomatous Disease, Chronic↗
PubMed1987

[Prognostic factors in cerebral hypoxic-ischemias in infants less than a year old].

In order to establish criteria for early cerebral prognosis after acute cerebral hypoxic ischemic insult, we studied 31 cases of patients presenting, during their first year of life, cardio-respiratory arrests due to SIDS (21 cases), anesthesia (4 cases), other causes (6 cases). A favourable evolution was observed in 5 cases where coma lasted less than 8 hours. Conversely unfavorable evolution was seen in the 26 patients (21 deaths, 5 sequellae) where coma lasted more than 8 hours. Among 12 patients of this group surviving after the 4th day, 9 expressed seizures or status epilepticus. The poor evolution was correlated with hyperproteinorachia during the first 24 hours and with cortico-subcortical hypodensity on CT scan. Early EEG and transfontanellar echography seemed less useful to establish a prognosis, specifically to discriminate children surviving with and without sequelae.

Brain Ischemia↗
PubMed1987

[Submaxillary streptococcal B cellulitis in young infants].

The authors report 3 cases of young infants with B streptococcal cellulitis revealed by submandibular inflammatory induration. The clinical findings, similar to the cases reported in literature, were characteristic, due to the infants' ages, the aspect and localization of the cellulitis. Bacteriologic diagnosis relies on blood cultures and aspiration of the lesion.

Ampicillin↗
PubMed1986

[Medical treatment of staphylococcal epiduritis].

The authors report a case of extensive spinal epidural staphylococcal abscess responsible for spinal compression. All symptoms regressed after conservative management consisting of parenteral antibiotic therapy with Gentamycin and Vancomycin.

Abscess↗
PubMed1985

Prognostic factors of severe infectious purpura in children.

The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p less than 0.001), coma (p less than 0.05), ecchymotic or necrotic purpura (p less than 0.01), temperature less than 36 degrees C (p less than 0.05), no clinical meningism (p less than 0.001), white cell count less than 10,000/mm3 (p less than 0.05), thrombocytopenia less than 100,000 (p less than 0.01), fibrinogen less than 1.5 g/l (p less than 0.001), kalemia greater than 5 mEq/l (p less than 0.01), spinal fluid cell count less than 20/mm3 (p less than 0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.

Child↗