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Biomedical subjects

D Floret

Publications and source records attributed to D Floret.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Acid gastroesophageal reflux in the child with intubation, artificial respiration and continuous nutrition. Apropos of 28 cases].

Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.

Enteral Nutrition↗
PubMed1988

[Resuscitation of severe meningitis in infants and children].

Meningeal penetration of bacteria induces an inflammatory response which affects mainly the endothelium of cerebral vessels. This inflammatory reaction is directly responsible for thrombosis and indirectly creates cerebral oedema and reduced cerebral blood flow. Cerebral ischemia is the result of all these phenomenons. Nowadays, control of cerebral oedema is the main goal of intensive care treatment of meningitis that needs invasive monitoring of intracranial pressure. We may hope that in a next future new therapeutic agents will be able to control inflammatory reaction and vascular process.

Brain Diseases↗
PubMed1988

[Intracranial pressure in comatose meningitis and encephalitis in children].

To determine the importance of intracranial hypertension in central nervous system acute infections, we studied intracranial pressure (ICP) in 27 patients, aged 45 days to 13 years. Fourteen had meningitis and 13 had encephalitis; all were in deep coma with a Glasgow Coma Scale 7 or less. Intracranial hypertension defined by a mean ICP above 15 mm Hg was observed in 12 patients with meningitis (86%) and in 9 with encephalitis (69%). Patients with meningitis exhibited a very early and severe intracranial hypertension. A striking difference is noted between survivors and non-survivors who had a very high maximal ICP with a severe reduction in cerebral perfusion pressure. Intracranial hypertension occurred in all patients with acute primitive encephalitis but only in 3/7 patients with post-infectious encephalitis. ICP monitoring seems to be important in the comatose forms of bacterial meningitis in the early period, herpes encephalitis and postinfectious encephalitis with severe status epilepticus.

Adolescent↗
PubMed1988

[Cardiac arrest in children. Causes and future after cardiopulmonary resuscitation].

A 24 months retrospective study was carried out to investigate 133 patients with an unexpected cardiorespiratory arrest (CRA). Cardiopulmonary resuscitation (CPR) was undertaken in all cases. 96 patients suffered CRA outside of hospital, 11 patients in the wards of the hospital, and 26 in the pediatric intensive care unit (PICU). Sixty children (44%) responded to initial resuscitation and 20 patients (15%) survived after discharge, 12 (9%) of them with a good neurologic outcome. The best results were obtained in patients with an CRA in the PICU. The results of this study suggest that survival among resuscitated children is not better than that among adults, but can be improved with early recognition and monitoring of children at risk.

Adolescent↗
PubMed1988

[Plasma exchange in children].

Plasma exchanges are indicated in several diseases in children, mainly immunologic, hematologic and nephrologic disorders. The techniques used for adult patients can be applied to children, but complications, especially infections, are more frequent. The vascular access is the main limiting factor, particularly in infants. Therefore, pediatric plasma exchanges should be performed under adequate supervision in an intensive care unit.

Catheterization, Central Venous↗
PubMed1988

[Suppurated pneumococcal meningitis in infants and children: complications and prognostic factors].

This paper investigates 21 patients (16 infants and 5 children) with Pneumococcal meningitis, 15 of which presented with a severe form. Intracranial pressure (IP) monitoring was performed in 7 patients who all had severe (4) or mild (3) intracranial hypertension (IH). Twelve children had a favourable outcome, 7 had sequelae (3 severe) and 2 died from coning, one before monitoring, the second after exhibiting the highest IP and the lowest cerebral perfusion pressure of the series. The 3 children with severe sequelae had a severe form (2) or a mild but prolonged form (1) of IH. The 4 patients who recovered with moderate sequelae presented severe (1), mild IH (1) or were not monitored (2). There were 14 cases with neurological complications. In 8 patients, this seemed to be related to cerebral oedema and IH; coning caused the death of 2 of them; the 6 others exhibited lesions of cerebral oedema on CT-scan, isolated or associated with cerebral infarction or subdural effusion. In the 6 others patients, IP monitoring was not performed; there was no evidence of cerebral oedema on CT-scan; 2 exhibited cerebral infarction and 3 a moderate ventricular dilatation; 2 had hemodynamic problems from acute pneumococcemia in one case and neurovegetative disturbances associated with cerebral infarction in the second. Pneumococcus meningitis remains a severe disease. The prognosis of severe forms can be improved by IP monitoring since IH seems to be the most frequent mechanism of complication.

Brain Edema↗
PubMed1988

[Metastatic neuroblastoma with secondary hypersecretion of vasoactive intestinal peptide].

A 18-month-old boy with stage 4 neuroblastoma needed intensive care because of prerenal acute renal failure related to an intractable watery diarrhoea syndrome occurring 10 months after the diagnosis of the primary tumor. This diarrhoea was in relation with a late hyperproduction of vasoactive intestinal peptide by the relapsing neuroblastoma itself and stopped with intravenous somatostatin administration.

Diarrhea, Infantile↗
PubMed1988

[Treatment of hypertensive attacks in children with nicardipine].

A prospective study of the hypotensive effects of nicardipine has been performed during 65 administrations of the drug in 6 children with malignant hypertension. We conclude that this calcium channel blocker is useful to treat hypertensive emergency in children owing to its tolerance and its efficacy (mean arterial blood pressure was lowered by 28 to 38% after 90 min). In addition, it ensures the maintenance of cerebral, renal and myocardial blood flow. A posology of 1 mg/kg/dose, 3 or 4 times/day (oral route) seems to be sufficient, as its effects last 6 to 10 h. Nevertheless the control of acute arterial hypertension must always be associated with the introduction or adjustment of long-term antihypertensive therapy.

Acute Disease↗
PubMed1988

[Epidemiological study and cost evaluation of measles in Lyons hospitals over a 5-year period].

The study of 414 measles cases, admitted in several childrens' hospitals in the Lyons area, underlines the important cost of this disease. Moreover, the occurrence of complications (in 56% of children hospitalized with measles), some of which as severe as encephalitis (n = 9) and/or death (n = 4), shows that an improvement of preventive measures is indispensable. Vaccination appears to be the most effective way, but the actual immunization level remains insufficient in France. This situation could be optimized either by intensifying the sensibilization fields or by rendering vaccination compulsory before entrance to school and collectivities.

Adolescent↗
PubMed1988

[Resuscitation of children in the brain death state from the view of organ procurement for therapeutic purposes].

Thirty-six brain-dead children were managed to allow organ harvesting, which was possible in 21 (7 multi-organ). Optimal ventilation allowed for normal PaO2 and PaCO2 (mean +/- SEM FiO2 = 0.50 +/- 0.05). The management of hemodynamics was quite difficult and cardiac arrest may be due to patient transport, electrolyte disorders and dehydration. Vascular filling was of main importance and required standard solutes (5 or 2.5% glucose, normal saline, Ringer lactate) at a rate of 3.0 +/- 0.5 ml/kg/h, adapted for electrolytes (mainly KCl); sometimes, other solutes may be used: blood (17 patients), human 20% serum albumin (17 patients), plasma (9 patients). This filling was sufficient for 15 patients; the others required inotropic agents: dopamine (17 +/- 8 micrograms/kg/min), dobutamine (42 +/- 18 micrograms/kg/min). Diuresis was more than 3 ml/kg/h in 38% of the patients and desmopressin was used in 3 cases. Hypothermia (minimum 31.2 degrees) had no major consequence. No infection was found. Quality of management of brain-dead patients is of main importance; the possibility of organ harvesting must be evoked in such situations and is the first step in organ transplantations.

Adolescent↗
PubMed1987

Evaluation of pediatric intensive care in Europe. A collaborative study by the European Club of Pediatric Intensive Care.

There are no reports analyzing the results of pediatric intensive care in Europe. We evaluated quantitatively the severity of illness and the amount of care required for 714 consecutively admitted patients. We used simultaneously the Clinical Classification System (CCS) the Acute Physiology Score (APS) and the Therapeutic Intervention Scoring System (TISS). Overall mortality at 1 month was 15%. The mortality rate was higher for CCS Class IV patients (32.3%) than for CCS III (4.5%) and CCS II (3.2%). The difference was significant between CCS IV and CCS III and II respectively (p less than 0.001) but no difference was observed between CCS III and CCS II. The patients were also classified among 7 major organ system failures: cardio vascular, respiratory, neurologic, gastro intestinal, renal, metabolic, hematologic. Three of them were primarily involved: respiratory (44.9%) cardio-vascular (20.7%), neurologic (18.8%). Among these 3 groups the highest mortality was observed in cardio-vascular patients (p less than 0.01 v.s. respiratory, p less than 0.05 v.s. neurologic). The death rate was 22% among the 264 neonates, 9.7% among the 247 infants (p less than 0.01) and 12.6% among the 198 children. APS and TISS scores increased significantly with the CCS classes.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1987

[Isolated rupture of the choledochus in closed injury of the abdomen in children].

A 3 1/2 year old child presented with an isolated rupture of common bile duct from a closed abdominal injury. Findings in this case, and a literature review involving 15 cases, demonstrate the rare nature of this lesion in children, the frequent delay in diagnosis after the initial period of shock, diagnostic features being the mucocutaneous jaundice, discolored stools and poor general condition, and the use of either direct suture of intestinal by pass operation to repair lesion. Prolonged surveillance is necessary because of the risk of delayed stenosis of the anastomoses.

Abdominal Injuries↗
PubMed1987

[Psychological aspects of accidental poisoning in children].

The following points stand out from a semi-open questionnaire which was sent to the parents of 28 children hospitalized for accidental intoxication. Intoxications often occur in children who are hyperactive, curious, rebellious and have strong affective needs. Parents find it very difficult to set bans and limitations to their children, whose behaviour seems to be actively calling out for such restrictions. These children frequently put themselves in a situation of self-aggression, which shows the parents' inability to teach them to develop a vital self protective attitude from life's daily experience. Most often, the child is aware of transgressing a ban and in a few cases, intoxication seems to be a deliberate act on his part. It generally occurs when stress has been building up in the family, thus threatening the balance of the family. If it happens in a family where relationships are already deeply disturbed, it must be considered as a signal of alarm. It is then necessary to suggest that the family should undergo a psychotherapeutic course to help them to put an end to the deadly process in which they are involved.

Child↗
PubMed1987

[Urinary sediment in acute renal failure].

Over a one-year period, 31 episodes of acute renal failure in children have been studied for urine sediment by contrast phase microscopy (maintained diuresis: 15, oligoanuria: 16, dialysed patients: 9). The etiologies of acute renal failure were: sepsis = 8; nephrotoxicity = 7; hemolytic uremic syndrome = 5; acute nephritic syndrome = 3; hemodynamical changes = 4; obstructive renal failure = 2; others = 3; acute rejections after renal allograft were excluded. The first urine sediment examination was performed 5 days after the onset of renal failure, and has been controlled in 11 children. In 28 cases (90%), there was a good correlation between clinical, biological, ultrasonographic and pathological (4 cases) data. The mechanism of renal failure has been determined by urine sediment examination in most cases, sometimes allowing to rectify a previous diagnosis. The value of this examination seems to be more of anatomoclinical than of prognostic interest, mainly for definite (hemolytic uremic syndrome) or polyfactorial (oncohematological diseases) renal dysfunctions.

Acute Kidney Injury↗
PubMed1987

[Ecchymotic cellulitis in infants: consider Haemophilus influenzae].

Three cases of ecchymotic cellulitis in 7 to 11 month old infants are reported. Haemophilus influenzae was isolated from blood in two cases. Ecchymotic cellulitis in infants should, in the first place, evoke an Haemophilus influenzae infection. Bacteremia being frequent in this condition, blood cultures should be performed.

Amoxicillin↗
PubMed1987

[Evoked potentials in comatose children].

Auditory and somatosensory EPS obtained after median nerve stimulation are an interesting approach for the central nervous system investigation. However, there are some problems of interpretation during the first year of life, related to the maturation of the nervous system. We studied 20 severely comatose children aged 8 months to 15 years, admitted in an intensive care unit. Most of them were intubated, mechanically ventilated and received high doses of barbiturates. Coma was related to severe head injury, meningitis, encephalitis, Reye syndrome, malignant hyperthermia, cerebral lymphoma. Normal EP are correlated with a good recovery. Patients with abnormal EP may die or exhibit neurological sequelae. The absence of somatosensory EP is correlated with a bad outcome and is generally related to cerebral oedema. Appreciation of the prognosis in comatose children may be improved by repeated determination of auditory and somatosensory EP.

Adolescent↗