[Iconographic rubric. Mesenteric compression syndrome].
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Child, Preschool↗
Biomedical subjects
F Gottrand
Publications and source records attributed to F Gottrand.
Local antibiotic lock for the treatment of infections related to central catheters in parenteral nutrition in children.
BACKGROUND: Central venous catheter-related (CVC) infections represent the most common complication of parenteral nutrition. These infections are usually treated by means of long-term systemic antibiotic treatment. The objective of this study was to determine the efficacy of combining a local antibiotic lock with a short systemic double antibiotic to treat CVC-related staphylococci infections. METHODS: Any child with coagulase-negative staphylococci or Staphylococcus aureus septicemia, confirmed by a positive blood culture, was included in the study. A double antibiotic systemic treatment composed of amikacin and teicoplanin was started and continued for 5 days. The antibiotic treatment was combined from the first day (D0) with a local teicoplanin lock, which was left for 12 hours a day in the catheter for 15 days. Parenteral nutrition was continued on a nocturnal cyclic mode during antibiotic treatment. The efficacy of the treatment was evaluated by clinical (body temperature), biologic [C-reactive protein levels (CRP)], and bacteriologic (blood culture) measures. RESULTS: Twenty CVC-related infection episodes in 13 patients were analyzed for the study. In the initial biologic test, CRP varied from 2 to 130 mg/L (mean 43 mg/L). After 3 days of treatment, CRP varied from 2 to 61 mg/L (mean 12 mg/L). The median time until normalization of temperature and CRP levels after the beginning of antibiotic treatment was 3.2 days (range 1 to 14 days) and 6.2 days (range 2 to 19 days), respectively. All blood cultures were negative for infection 48 hours after stopping the treatment. Only 1 therapeutic failure was observed during the treatment. The patient had persistent signs of clinical septicemia that required removal of the CVC. Two catheter-related infection recurrences were observed in the month after termination of the local antibiotic lock, which also required removal of the CVC. The central venous catheter was maintained in the other cases. CONCLUSIONS: Teicoplanin antibiotic locks, combined with a short conventional systemic antibiotic treatment and continuation of cyclic parenteral nutrition, seem effective and well-tolerated treatments for CVC infections.
Adolescent↗
[Abnormalities of intestinal permeability of 51Cr-EDTA in mucoviscidosis].
Intestinal permeability to 51Cr-EDTA was studied in 20 children with cystic fibrosis (CF) and a mean age of 10.7 years, in 7 control adults and in 11 control children. 51Cr-EDTA urinary excretion (mean +/- SD) expressed as a percentage of the orally administered activity was: control children: 1.59 +/- 0.55%, control adults: 1.47 +/- 0.62%, CF patients: 10.7 +/- 8.6%. The difference between CF patients and control children on one hand, between CF patients and control adults on the other hand, was statistically significant (p less than 0.001). Only 3 CF patients had values within the limits of those observed in controls. A statistically significant correlation (p less than 0.01) was observed between the 51Cr-EDTA urinary excretion and steatorrhea. No correlation was found between 51Cr-EDTA urinary excretion and the following parameters: age, sex, weight, height, Shwachman score, liver cirrhosis, oral administration of a mucolytic agent. The eventual, especially nutritional, consequences of this increase of the intestinal permeability in the course of CF remain to be clarified.
Adolescent↗
[A rare cause of hydrocephalus in an infant: chronic vitamin A poisoning].
A case of chronic vitamin A intoxication is reported in an infant under 6 months of age. The features included hydrocephalus, usually described in acute hypervitaminosis A and the other cutaneous, hepatic and skeletal signs observed in chronic intoxication.
Alkaline Phosphatase↗
The role of "occult" gastroesophageal reflux in chronic pulmonary disease in children.
It has repeatedly been demonstrated that a correlation exists between gastroesophageal reflux and the presence of various "atypical" complaints, such as recurrent chest pain, apneic attacks in infants, and recurrent or chronic respiratory symptoms. Very recently it has been shown that gastroesophageal reflux is frequently associated with non-controlled asthma in children and that medical treatment for reflux can improve the further course of respiratory disease. The aim of the present study was to investigate a possible cause-relationship between recurrent respiratory symptoms in children and the presence of gastroesophageal reflux disease, and to investigate the value of continuous 24-hour esophageal pH-monitoring in the diagnosis and management of these complaints in 62 children with chronic respiratory disease. Continuous 24-hour pH-monitoring was abnormal in 39/62 patients (62.9%). However, no statistically significant correlation could be detected between the presence of gastroesophageal reflux and various anamnestic parameters (parental smoking, pet in household, sibling with gastroesophageal reflux disease), or concomitant atopy. All children that were found positive for gastroesophageal reflux (n = 39) were started on an antireflux therapy (cisapride 0.2 mg/kg q.i.d.). This treatment resulted in an improvement of the symptoms in 84.6%. We conclude that gastroesophageal reflux is an important (causative) factor in chronic recurrent respiratory disease. This entity is often resistant to "classical" respiratory treatment, but can be treated with an anti-reflux therapy. We, therefore, suggest to perform continuous 24-hour esophageal pH-monitorings as a standard procedure in all patients with recurrent respiratory complaints, independent of the severity of their symptoms.
Adolescent↗