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Biomedical subjects

D Moulin

Publications and source records attributed to D Moulin.

At least 55 records · Page 3Linked to original sources
PubMed1987

Long-term follow-up of the Senning operation for transposition of the great arteries in children under 3 months of age.

Twenty-six patients aged 6 days to 3 months (mean 57 days) underwent a Senning procedure for transposition of the great arteries. Twenty-two had intact ventricular septum and four had a small ventricular septal defect. They were followed up for 1 month to 8 years (mean 4 years). There were no late deaths. At late examination, 25 patients were asymptomatic and there was no clinical or echographic evidence of caval or pulmonary venous obstruction. Growth was normal in all but two patients. Neurologic assessment was abnormal in eight patients. The electrocardiogram showed sinus rhythm in 22 patients and asymptomatic arrhythmias in four. Twenty-three patients underwent cardiac catheterization and angiographic studies 2 to 72 months postoperatively (mean 15 months), which demonstrated effective left and right atrial contraction. An atrial shunt was noted in one patient and a ventricular shunt in one. Two infants (8%) had a residual left ventricular outflow tract obstruction (gradients of 26 and 37 mm Hg). Two had mild superior vena caval obstruction (gradients of 4 and 5 mm Hg). We conclude that the Senning procedure can be performed in early infancy with good results and a low incidence of late complications.

Cardiac Catheterization↗
PubMed1986

The challenge of upper airway obstruction in pediatric intensive care.

Over a 5-year period, 75 patients were admitted to a pediatric intensive care unit because of acute upper airway obstruction (AUAO). Congenital abnormalities were demonstrated in 25 children; 9 of them died secondary to severe combined malformations or major central nervous system dysfunction. Acquired AUAOs were seen in 50 patients; 1 died in brain death secondary to anoxia. Obstructions were observed at all levels of the airways from the nose to the carina. In 28% of the patients, AUAO had remained undiagnosed until admission for complications such as acute respiratory failure, cardiac arrest, coma, seizures. With early diagnosis and prompt release of the obstruction the prognosis is good unless severe congenital abnormalities or major central nervous system damage are associated.

Airway Obstruction↗
PubMed1986

Prevalence and treatment of silent gastro-oesophageal reflux in children with recurrent respiratory disorders.

Thirty-six infants and children presenting with recurrent respiratory disorders (RRD) as the sole clinical symptom including bronchial asthma (6), recurrent obstructive bronchitis with or without wheezing (18), chronic nocturnal cough (3), recurrent episodes of pneumonia (3), recurrent pharyngitis (3) and recurrent laryngitis (3) were investigated for associated gastro-oesophageal reflux (GER) by oesophagram, endoscopy and continuous 24 h pH monitoring of the distal oesophagus. The pH monitoring criteria were selected on the basis of a preliminary study comparing statistically measurements of 32 variables recorded in 15 patients who all had clinical, radiological and endoscopic evidence of GER and in 8 asymptomatic controls. Although patients with symptomatic GER differed significantly from the asymptomatic ones for 27 variables examined, 6 variables emerged as having the highest value for discrimination (overlap score 0-1). Among these, the Euler-Byrne index (number of reflux pH less than 4 + 4 times the number of reflux episodes of more than 5 min), the percentage of total reflux time and the number of reflux episodes 1 h post-cibal scored 0 (no overlap). GER was considered to be present when at least five of these six parameters were abnormal. The overall incidence of GER in children with RRD was 41% (15) when detected by oesophagram and 61% (22) when diagnosed by pH monitoring criteria. In the children with bronchial asthma or with recurrent laryngitis, the percentage of reflux time during sleep was about 40 times higher than in asymptomatic controls and 2 times higher than in those with symptomatic GER.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1986

Yellow mercuric oxide ointment and mercury intoxication.

Repeated cutaneous application of yellow mercuric oxide ointment for infected eczema resulted in mercury poisoning in a 4-month-old infant. Toxic levels of mercury were measured in blood, urine, cerebrospinal fluid and tissues.

Administration, Topical↗
PubMed1986

Clinical events following neuroangiography. A prospective study.

The authors prospectively evaluated the clinical event rate over a 72 hour period following femorocerebral angiography in 1002 procedures. The neurologic event rate was 1.3 per cent in the first 24 hours (0.1% permanent) and 1.8 per cent between 24 and 72 hours (0.3% permanent). The non-neurologic event rate (mostly hematomas) was 7.2 per cent. There were no deaths. One hundred and nine pieces of data per procedure were analysed statistically. Delayed cerebral ischemia does occur and could be secondary to the procedure. The low risk of judiciously performed cerebral angiography was confirmed. Carefully cataloguing all events for up to 72 hours neither verifies nor excludes angiography as the cause of deterioration.

Adult↗
PubMed1985

AIDS in two African children--one with fibrosarcoma of the liver.

We report here on two black African girls who developed an acquired immune deficiency syndrome (AIDS). The first patient was a premature girl born to healthy parents. She suffered from interstitial pneumonitis during the first week of life and died of it at the age of 6 months. Her mother, although asymptomatic, had polyclonal hypergammaglobulinaemia, a reversed T-helper/T-suppressor ratio and a decreased lymphocyte response to mitogens. The second patient had the first symptoms at the age of 6 years, developed a primitive malignant fibrosarcoma of the liver at 8 years old and died 1 year later. AIDS can affect black African children who have not been transfused and whose family members are not considered as at a high risk for this disease. In children, AIDS and cancer can be associated. In the second patient, cytotoxic suppressor lymphocytes (OKT8 positive cells) were shown to behave in vitro as precursors of T-killer cells.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Fatal meningitis due to multi-resistant Haemophilus influenzae type b.

We report the case of a 3-month-old boy suffering from an acute bacterial meningitis due to a multi-resistant strain of Haemophilus influenzae type b. Also presented is our current strategy of treatment and chemoprophylaxis of Haemophilus influenzae meningitis in children.

Ampicillin↗
PubMed1985

Upper airway lesions in children after accidental ingestion of caustic substances.

Of 33 children admitted within 24 hours after accidental ingestion of a caustic substance, 14 (42.5%) had evidence of upper airway lesions on direct laryngoscopy. Three patients, 10 to 12 months old, needed endotracheal intubation for acute respiratory obstruction; four patients younger than 2 years had severe dyspnea without obstruction; seven patients had mild or no respiratory symptoms. All were discharged without respiratory sequelae, although esophageal stenosis developed in six patients. Nine of 13 patients younger than 2 years, compared to five of 20 patients older than 2 years, had upper airway lesions (P less than 0.01). The frequency of respiratory tract lesions was higher in patients with severe esophagitis. Eleven of 17 patients with severe esophagitis, compared to three of 16 with mild inflammation, had respiratory tract lesions (P less than 0.025). No specific caustic substance predisposed to upper airway lesions.

Ampicillin↗
PubMed1985

Obstructive sleep apnea induced by a parapharyngeal cystic hygroma in an infant.

A 7-week-old infant with severe sleep apnea underwent polysomnography that revealed as many as 455 obstructive apneas per night; the apneic episodes had a mean duration of 34 s. A growing tumor in the neck, a parapharyngeal cystic hygroma, was discovered and surgically removed. The infant's condition improved dramatically, and a follow-up polygraphic recording was normal. During the following 10 months the child's condition remained stable. The case reported illustrates a rare cause of severe sleep obstructive apnea. It also reinforces the need for a complete medical approach to the diagnosis and treatment of obstructive sleep apnea in infants.

Head and Neck Neoplasms↗
PubMed1985

Localized absence of colonic musculature: an unusual cause of perforation in a colonic esophageal transplant.

A 4 1/2-year-old boy underwent subtotal esophageal substitution by left colon for caustic soda stricture. The transposed colon had to be removed for perforation 9 days later, and pathological examination showed several tiny perforations in an area 1.8 cm in diameter where the colonic wall was thin and devoid of muscularis. Arguments are presented to show that this absence of muscle coat is congenital. The perforations are thought to be the result of minimal ischemia in a colonic wall weakened by the defect.

Child, Preschool↗
PubMed1985

Intensive care course after orthotopic liver transplantation in children.

Eight children 1 to 13 years old, were submitted to OLT. Six patients had normal liver function and complete rehabilitation 4 to 17 months after OLT. Two patients died during their ICU course respectively on day 15 and 34 after operation. The ICU management of the surviving patients is compared to the two fatal cases. At the time of admission in the ICU, there was no difference between the two groups, except for age. All patients were physiologically stable and needed essentially continuous monitoring and nursing care. All were rapidly weaned off artificial ventilation. During the first week after operation, surviving patients demonstrate improvement of liver function test, absence of infection, normal renal function and short ICU stay. They all suffered from systemic hypertension easily controlled by drugs. The two fatal cases were less than 15 months old and did not show improvement of their liver function. They suffered from severe infection, renal failure and protracted systemic hypertension and needed prolonged invasive monitoring and therapy.

Adolescent↗
PubMed1985

[Liver transplantation in children].

Liver transplantation has become a clinical therapeutic modality for end stage liver diseases. The results achieved in children are better than in adults: in T.E. Starzl unique experience in Pittsburgh, USA, the survival rate at one and four years are 75 and 70% respectively. Complete rehabilitation of these children can nowadays be expected. Between March 1984 and June 1985, 8 children received an orthotopic liver transplantation at the University of Louvain Medical School in Brussels, Belgium; one child received two transplantations after acute and irreversible rejection of a first ABO incompatible graft. The indications were biliary atresia in five (polysplenia in one), biliary hypoplasia in one, alpha-1-antitrypsine deficiency in one and Crigler-Najjar syndrome type I in one. The age of the patients at the time of liver replacement was 12 to 18 months in four, 8 to 13 years in four. Six patients are alive after 17, 14, 12, 10, 3 and 3 months; the two youngest children deceased during the first postoperative month. The Kaplan-Meyer one year survival rate is 75%; all surviving children are in excellent clinical condition with a normal liver function. The 9 transplanted livers were harvested from multiorgan cerebral death donors with the exception of one neonate whose liver alone was removed; 4 were retrieved locally, the five others were offered by foreign hospitals through the organ procurement agencies (Eurotransplant, France-Transplant, U.K. Transplant). Due to appropriate logistics with air flight transportation of the harvesting team when indicated, the total ischaemia time was kept below 6 hours in every case. Two small children underwent a left lobe orthotopic transplantation after ex vivo right trisegmentectomy of the liver retrieved from an older donor with one long term survival. The indications for liver transplantation in children are end-stage liver diseases consisting of a) cholestatic diseases among which the most frequent is biliary atresia after unsuccessful Kasai procedure followed by familial cholestasis (Byler syndrome) and the paucity of the intrahepatic bile ducts of the syndromatic (Alagille syndrome) or non syndromatic type. b) the metabolic diseases resulting either in cirrhosis with liver failure (alpha-1-antitrypsin deficiency, Wilson disease, glycogen storage disease type I and IV, protoporphyria) or in extrahepatic complications of enzymatic deficiency of an otherwise normally functioning liver (Crigler-Najjar syndrome type I, familial hypercholesterolemia and perhaps oxalosis). c) the hepatocellular diseases either chronic with cirrhosis of various origin or acute, eg. toxic hepatitis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗