PubMed Health⌕ Search

Biomedical subjects

D Pariente

Publications and source records attributed to D Pariente.

At least 19 recordsLinked to original sources
PubMed2002

[Noninfectious febrile inflammatory syndromes in children: diagnosis and usefulness of diagnostic procedures].

OBJECTIVE: To determine the causes and to quantify the benefits obtained from further diagnostic investigations in children presenting with a non infectious inflammatory fever. METHODS: The records of 62 children aged from two-months to 15 years (median: four years) admitted to a paediatric department between 1990 and 2000 for the evaluation of a fever associated to an inflammatory syndrome, defined as temperature over 38 degrees C with an increase of the erythrocyte sedimentation rate (ESR) more than 20 mm/h and/or a serum C-reactive protein level (CRP) > 20 mg/L, and excluding overt infectious diseases, were retrospectively reviewed. RESULTS: Of these patients, 79% children (49 cases) had inflammatory systemic disease, 3.2% (two cases) had malignancy, and 17.8% (11 cases) had undiagnosed disorders. The most frequent disease was Kawasaki disease (22 children), especially in young children. Increase of ESR above 100 mm/h and of CRP above 100 mg/L was present in 59% of Kawasaki disease, 71% of idiopathic juvenile arthritis, 100% of malignancies and 7% of unknown diagnoses. Increase of ESR below 50 mm/h and of CRP below 50 mg/L was present in 75% of hemophagocytic syndromes and 46% of unknown diagnosis. The polymorphonuclear count, hepatic function evaluation, triglycerides levels, abdominal ultrasound, abdominal computed tomography, echocardiography, biopsies were useful diagnosis tools. Technetium scintigraphy was helpful only when abnormalities were found on physical examination. CONCLUSION: The diagnosis of Kawasaki disease must be quickly suspected in febrile young children with inflammatory syndrome without infection. ESR and CRP values, abdominal ultrasound and echocardiography are helpful tools for the diagnostic procedure.

Adolescent↗
PubMed2001

[Sonography of the pediatric abdomen: liver and biliary tract].

Ultrasound is a routine imaging modality that is quite valuable to assess the pediatric abdomen. The objective of this article is to describe the sonographic appearance of the liver and bile ducts in children. Our goal is to emphasize normal variants and specific pediatric diseases, even if some of them may be encountered in adults.

Abdomen↗
PubMed2000

Postshunt encephalopathy in liver transplanted children with portal vein thrombosis.

BACKGROUND: Surgical portosystemic shunting has been reported to alleviate successfully portal hypertension in liver transplanted recipients with portal vein thrombosis. METHODS: We report two liver transplanted children with portal vein thrombosis who developed post-shunt acute encephalopathy. In one child, a mesocaval H-type shunt was created surgically because of bleeding related to Roux-en-Y loop varices at 3 months posttransplantation; in the other, a large spontaneous splenorenal shunt was discovered at the time of diagnosis of portal vein thrombosis on day 34 posttransplantation and was preserved. RESULTS: Post-shunt encephalopathy developed 6 months and 2.7 years after transplantation, causing death in one child. CONCLUSIONS: This report illustrates the risk and the possible dismal outcome of post-shunt encephalopathy in liver transplanted children. Therapeutic procedures other than portosystemic shunting that will restore an hepatopetal portal flow to the liver graft should be considered in liver-transplanted children with portal vein thrombosis.

Brain Diseases↗
PubMed2000

Common bile duct stenosis with hypereosinophilia and pancreatitis in childhood: report of 2 cases.

Common bile duct stenosis associated with pancreatitis and hypereosinophilia is described in two children. Ultrasonography and CT showed slight increase in the size of the pancreas and bile duct dilatation. Percutaneous cholangiography (PTC) demonstrated extrinsic stenosis of the bile duct at the level of the pancreas. Spontaneous resolution of the clinical and radiological findings was observed. Knowledge of this rare pathological association with favourable evolution can avoid an unnecessary surgical procedure.

Child, Preschool↗
PubMed2000

[Diagnosis of a persistent left superior vena cava in the operating room during a central venous catheterization].

A 2-year-old boy was admitted for surgical excision of a hepatoblastome. A central venous catheter was inserted by a subclavian approach, without difficulty. The chest radiograph showed the catheter positioned along the left heart border. The diagnosis of persistent left superior vena cava was suspected after analysis of the central venous pressure curve. An postoperative chest X-ray confirmed the diagnosis. The catheter was maintained for five days without any complication.

Antineoplastic Agents↗
PubMed2000

[Cyclic filling cystourethrography in the study of febrile urinary tract infection in children].

PURPOSE: To assess the value of cyclic voiding cystourethrography (VCUG) for the detection of reflux in a large population of children with urinary tract infection. MATERIALS AND METHODS: 234 patients (67% less than 3 years of age) underwent VCUG with two fillings in 214 cases and three fillings in 139 cases. Appearance or increase in the grade of reflux compared with previous filling was expressed as "modification of the radiology report" (MRR). The amount of contrast material, the duration of fluoroscopy and the number of films were recorded. RESULTS: The rate of reflux was 18.4% at the first filling, 16% at the second filling with 9.8% MRR and 14.7% at the third filling with 10% MRR. These results were the same for children younger and older than 3 years. For children under three years, if one considered reflux grade higher than 1, the MRR was 9.6% at the second filling and 7.5% at the third while it was 5.8% and 3% for older children. On average, the use of contrast material increased 50% with a third filling, number of films was not modified and the time of fluoroscopy increased by 6 sec per filling. CONCLUSION: VCUG is recommended in all children. The detection of reflux higher than grade 1 is more frequent with multiple fillings in children under 3 years. The increase in radiation exposure and cost seems negligible.

Adolescent↗
PubMed2000

[Papillary solid tumor of the pancreas in a child: a case report].

We present a case of a papillary solid neoplasm of the head of the pancreas incidentally diagnosed after an abdominal trauma in a thirteen year old boy. Imaging features (US, CT) of the lesion were not specific enough to permit a precise diagnosis with certainty. Preoperative percutaneous needle biopsy can give presumptive evidence which may guide the treatment. Prognosis is fairly better than other pancreatic neoplasms in children (particularly pancreatoblastoma). Treatment relies only on surgery.

Adolescent↗
PubMed1999

Peliosis hepatis with initial presentation as acute hepatic failure and intraperitoneal hemorrhage in children.

Peliosis hepatis, a condition characterized by the presence of blood-filled lacunar spaces in the liver, usually has a chronic presentation pattern and is mainly reported in adult patients in association with chronic wasting disorders and after administration of various drugs. The present report concerns two previously healthy young children in whom peliosis hepatis initially presented as acute hepatic failure and who had Escherichia coli pyelonephritis. Both patients had active intraperitoneal hemorrhage from the peliotic liver lesions, and liver ultrasonography showed multiple hypoechoic areas of different sizes, which in this context should suggest the diagnosis. One child died from hypovolemic shock and the other recovered. This study indicates that acute peliosis hepatis can be a serious life-threatening disease in children.

Acute Disease↗
PubMed1998

MRI-neuropathological correlations in type 1 lissencephaly.

Although imperfect, MRI is the best way of distinguishing type 1 lissencephaly from other, less classical lissencephalic malformations. We reported a case in which correlation of MRI and neuropathology was possible. Besides the classical radiological features of lissencephaly, i.e., agyria and excessive thickness of the cortex, an additional sign was observed: a thin cortical band, which gave high signal on T2-weighted images, represented a paucicellular and partially myelinated band, 1500 microns thick, lying under the true superficial cortex. This MRI feature could be characteristic of the particular cortical lamination observed in true type 1 lissencephaly.

Cerebral Cortex↗
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

Fatal acute fulminant liver failure due to clozapine: a case report and review of clozapine-induced hepatotoxicity.

Clozapine-induced hepatotoxicity is not well known and is usually of no clinical significance. This report describes fatal acute fulminant liver failure caused by clozapine in a 39-year-old man with chronic paranoid schizophrenia. The hepatotoxicity of clozapine is reviewed. Asymptomatic elevation of transaminase levels is observed most commonly, affecting between 30% and 50% of patients. Icteric hepatitis is uncommon, noted in 84 of 136,000 patients (0.06%). Fatal acute fulminant hepatitis has been documented in 2 patients (0.001%). The mechanism of clozapine hepatotoxicity is unknown. Although serious toxicity is rare, prescribers of clozapine should be aware of the hepatotoxic potential.

Acute Disease↗
PubMed1996

The value of MRI in the early diagnosis of growing skull fracture.

Growing skull fracture (GSF) is a progressive enlargement of a fracture due to an underlying tear of the dura mater. It is a rare complication of severe head injury mainly reported in young children. Classically, the diagnosis is made during follow-up, late after the original injury, when a palpable skull defect or a bulging mass is discovered clinically. Initial skull radiographs show a diastatic fracture developing later into a large bony defect. CT will show the brain damage which is usually present beneath the fracture. We present the MRI findings of GSF in a series of eight children. All patients initially had a large linear fracture and underlying brain damage on CT. In all cases MRI showed a zone of the same intensity as the brain contusion or cerebrospinal fluid advancing through the bone margins of the fracture to the subcutaneous plane. This finding was interpreted as an indirect sign of the dural tear. Seven patients were operated on with surgical confirmation of GSF. MRI can make an early diagnosis of GSF possible so that surgical repair with closure of the dura can be carried out before the dural tear enlarges.

Brain↗
PubMed1996

Absorbable Adams-DeWeese caval clip: an experimental study.

Adams-DeWeese caval clips have been shown to be effective in preventing pulmonary embolism. However, the use of Teflon clips constitutes a permanent solution for this transient risk. We tested an absorbable caval clip made of currently available synthetic biodegradable polymers in five female beagle dogs. The polymer used was PLA 96 containing 96% L lactic acid and 4% D lactic acid. After placement through a laparotomy, clips were routinely inspected and samples of the material were collected at regular intervals between 3 and 19 months postoperatively. The characteristics of absorption of PLA 96 in the retroperitoneal space were the same as those previously described in the literature. The clip retained its shape, rigidity, and effectiveness for 7 months. Complete degradation of the clip took between 18 and 19 months. Absorption did not cause a major inflammatory reaction and had no thrombogenic effect. Given the small number of animals studied, these results must be considered preliminary.

Animals↗
PubMed1996

Spontaneous perforation of the biliary tract in infancy: a series of 11 cases.

Eleven patients presenting with spontaneous perforation of the biliary tract were treated at Bicêtre Hospital between 1971 and 1993. Three groups were individualised, each with a different pattern of local presentation: generalised biliary peritonitis (n = 2), localised biliary peritonitis (n = 4), secondary biliary stenosis (n = 5). In each case, cholestatic jaundice developed after a postnatal symptom-free interval. Ten patients were operated on. Perforation was located in the cystic duct (n = 2), at the junction of the cystic and hepatic ducts (n = 4), in the common hepatic duct (n = 1) or common bile duct (n = 1). The site of perforation was no longer identifiable in two cases with stenosis. A cholecystectomy was performed in the 2 cases with cystic duct perforation; in the cases of lesions of the main duct, either simple external biliary drainage (n = 3) or biliary reconstruction (n = 5) was carried out. Postoperative complications included bile leak (n = 2), ascending cholangitis (n = 1), portal vein thrombosis (n = 2). Five patients were submitted to further surgery including biliary revision (n = 3), porto-systemic shunt (n = 1), and other procedures (n = 2). One infant died from postoperative sepsis; 2 were lost to follow-up, one of which probably did not survive; 4 are alive and well. Late sequelae are present in 4 children: portal hypertension (n = 1), mild residual bile duct dilatation without cholestasis (n = 1), and mild to moderate liver fibrosis (n = 2). Prompt diagnosis and appropriate treatment should improve the prognosis of this rare condition.

Bile Duct Diseases↗
PubMed1995

[Acute gastric dilatation with superior mesenteric artery syndrome in a young girl with anorexia nervosa].

BACKGROUND: Acute gastric dilatation is a rare complication of anorexia nervosa which may be fatal in case of gastric perforation. Superior mesenteric artery syndrome may be associated with gastric dilatation. CASE REPORT: A 14 year-old girl was admitted suffering from severe anorexia nervosa. Shortly after admission, she complained of abdominal pain related to a bulimic episode a few days before, followed by nausea and vomiting. Distended abdomen and tachycardia suggested acute small-bowel obstruction. A diagnosis of acute gastric dilatation with superior mesenteric artery syndrome was suspected on X-ray examination and confirmed by esophagogastrography after gastric evacuation. The patient improved rapidly under total parenteral nutrition. Upper gastrointestinal study repeated 10 days later showed normal stomach. CONCLUSIONS: Small-bowel obstruction in anorexia nervosa first evokes acute gastric dilatation, and a perforation has to be ruled out by esophagogastrography. Association with superior mesenteric artery syndrome is possible; it does not necessarily lead to surgery.

Acute Disease↗