Biomedical subjects
Publications and source records attributed to F Moulin.
Serum procalcitonin was determined in newborn infants at the time of admission to the pediatrics or obstetrics unit. Increased levels were found in all neonates with bacterial sepsis. Neonates with viral infection, bacterial colonization, or neonatal distress had normal or slightly increased levels. These data suggest that procalcitonin might be of value in diagnosing neonatal sepsis.
BACKGROUND: Serum alpha-interferon (IFN-alpha) concentrations are high in some children with viral meningitis and other viral infections. We have tried to assess the utility of determining serum IFN-alpha concentrations as a marker of acute viral respiratory infections. METHODS: Measurement of IFN-alpha via a biologic assay on Madin-Darby bovine kidney cells was performed in 138 patients with lower respiratory tract infection in whom a pathogen was identified. RESULTS: Serum IFN-alpha was detectable at the early stage of respiratory infections in the era of 59 of 75 (78.7%) of patients with a viral infection and in 4 of 63 (6.3%) of those with bacterial infection (P < 0.001). In the 4 patients with positive IFN-alpha and bacterial infection, a concomitant viral infection was found. The production of IFN-alpha is independent of age, and detectable levels are found in young infants, including the first 3 months of life, and in children with an acute viral disease. CONCLUSION: This test could be useful in distinguishing between bacterial and viral origins in lower respiratory tract infection (the specificity was 94% and the sensitivity was 79%) and could help guide the use of antibiotics, but more rapid techniques, available in a matter of hours, are required.
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BACKGROUND: Quinolone antibiotics are effective in the treatment of Salmonella infections in adults. Their use in children is limited by their side-effects. POPULATION AND METHODS: Forty-two patients (21 girls and 21 boys), aged 1 month to 12 years (mean 3.3 yrs) were admitted from September 1991 to June 1993 for severe Salmonella infections. Criteria of severity were persistent diarrhea and fever for more than 3 days. Thirty-one of these patients were less than 5 years of age. Blood culture was positive in 7 out of 35 patients: culture of the stools was positive in all patients. Five of the 42 patients had presented an acute episode of Salmonella infection a few weeks earlier and had remained asymptomatic carriers until the new acute and severe episode of diarrhea. All patients were given usual antibiotics, mainly ampicillin, amoxicillin, trimethoprime-sulfamethoxazole. Twenty-five of these patients were then given pefloxacin, 12 mg/kg/day, since the 5th day, for 7 days, because persistence of diarrhea and fever. RESULTS: Diarrhea and fever disappeared within less than 2 days in the group of patients given pefloxacin, even though in 6 patients the infecting Salmonella was in vitro resistant to beta-lactamins. Twenty % of patients remained asymptomatic carriers of Salmonella in the group treated by pefloxacin vs 47% in the group without it. There was no difference in species of Salmonella between both groups. None of the patients treated by pefloxacin developed side-effects during the six months following its administration. CONCLUSIONS: Short treatment by pefloxacin may be an alternative choice for treating severe Salmonella infections in children.
BACKGROUND: The carrier state of Salmonella may represent a source of contamination for other people. Its treatment is unsatisfactory so that a carrier may shed organisms for numerous months. POPULATION AND METHODS: From 1990 to 1993, 17 children aged 1.5 months to 8 years were seen because they were asymptomatic carriers of non-typhoid Salmonella, confirmed by three successive stool cultures. All had presented earlier acute severe infection having required treatment with amoxicillin (13 cases) and ceftriaxone or cefotaxime (four cases). They were given one dose of pefloxacin, 12 mg/kg, 4 to 8 weeks after the initial episode. This unique dose was administered again 4 days later. Stool cultures were performed before the first administration and 10, 30, 45 and 60 days after, with a last control 3 to 4 months later. RESULTS: Eradication of the Salmonella was obtained by the 10th day in 13 patients and within the 3 following weeks in 2 others. Those children who excreted a few number of organisms were early eradicated while the 2 patients who did not respond to pefloxacin shed larger number of bacteria. There was no side-effects of treatment. CONCLUSION: A short treatment with pefloxacin appears to be effective and safe in eradicating the carrier state when stool excretion of Salmonella is moderate.
We treated 54 eyes of 51 patients with refractory glaucoma by using contact transscleral Neodymium: YAG laser cyclophotocoagulation; 32 burns (7 watts during 0.7 second) were applied to each eye by positionning the anterior edge of the probe at 0.5 to 1 mm from the limbus. The mean preoperative intraocular pressure (IOP) was 33.7 mmHg and the mean postoperative IOP was 25.6 mmHg with a follow-up of five months. There was a decrease of IOP in 72.3% of the cases. The postoperative IOP was controlled (IOP < 21 mmHg) in 41.3% of the treated eyes. Pain decreased in 6.7% of the cases that had no control of IOP and they could stop their medical treatment. During the follow-up period we observed neither early post operative hypertonia nor phtisis bulbi. Three eyes had scleral perforations. Laser treatment can be repeated if necessary in no controlled IOP cases. We had less complications with the laser treatment than with cyclocryoapplication. We described the advantages of the contact probe used.
The efficacy of therapeutic ultrasound was retrospectively assessed in 456 patients who presented with uncontrolled glaucoma refractory to maximal medical therapy and filtration surgery from April 1987 to January 1992. Treatment was performed under local anaesthesia in ambulatory outpatients. Therapeutic ultrasound induced local destruction of the ciliary epithelium and a thickening of the sclera. A 47% decrease in intraocular pressure (IOP) was obtained from the mean preoperative (33.8 mmHg) and the mean postoperative (18.2 mm Hg) values. After a 33-month mean follow-up, 65% of treated eyes had an IOP less than or egal to 20 mmHg. Therapeutic ultrasound was effective in most of the glaucomas, especially in open angle, closed angle, aphakic, pseudophakic and post-silicone oil glaucoma. The main complications were immediate ocular hypertension and corneoscleral alterations. Phtysis bulbi occurred in 5.7% of the eyes. The therapeutic interest of ultrasound were compared with those of the other cyclodestruction techniques.
Fifteen children (age range 1.5 months to 7.2 years), who were excluded from schools or nurseries due to asymptomatic convalescent-phase non-typhoidal Salmonella carriage, received two oral doses of pefloxacin (12 mg/kg on days 1 and 4) and were examined on days 10, 30, 45 and 60. Definitive eradication was observed in 13 patients, all of whom had initial low Salmonella counts in stools and were culture-negative by day 10. In the two patients who failed to respond, the same treatment was effective when repeated 4 and 6 months later respectively. No side-effects were observed. In six other children, considered as controls, eradication by day 10 was observed in only one case after administration of amoxicillin for eight days. Two oral doses of pefloxacin could be a useful and safe means for eliminating Salmonella carriage in young children.
To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. 159 eyes had a 5 year-follow-up, 147 eyes had a 8 year-follow-up and 127 eyes had a minimal 10 year-follow-up. These eyes corresponded to an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (< or = 3 mmHg), progression of visual field loss and need of filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to those criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. In the 147 eyes with a 8 year-follow-up 25 eyes (17%), and in the 127 eyes with a 10 year-follow-up 14 eyes (11%) were still controlled. At the 10 year-follow-up, the surgical failure rate was 35% (40 eyes in 113), quite similar to the rate at 5 years: 33% (27 in 82). Thirty eyes excluded in the study belonged to patients who died during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
To determine the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), 211 photocoagulated phakic eyes were analyzed. 159 eyes had a 5-year follow-up, 147 eyes had an 8-year follow-up and 127 eyes had a minimal 10-year follow-up. These eyes came from an initial group of 151 patients, 76 women and 75 men, with a mean age of 67 years. We decided, to judge trabeculoplasty results according to three combined criteria of failure--insufficient or transient intraocular pressure drop (< or = 3 mm Hg), progression in visual field loss and need for filtrating surgery--and according to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a nontolerated medical treatment, and try to cease all medical treatment in noncompliant patients. According to these criteria, during the first 5 years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the 1st year to 52% (82 eyes) in the 5th year. In the 147 eyes with an 8-year follow-up, 25 eyes (17%) were successful and in the 127 eyes with a 10-year follow-up 14 eyes (11%) were still controlled. At the 10-year follow-up the surgical failure rate (35%; 40 eyes in 113) was similar to the rate at 5 years (33%; 27 in 82). 30 eyes, which were excluded from the study, despite being still controlled, belonged to patients who had died during the follow-up. Their mean age at the time of ALT was 76 years. The low success rate at 10 years was predictable from the 10% new failure cases per year encountered in the 5-year data.(ABSTRACT TRUNCATED AT 250 WORDS)
Early predictive factors of HIV infection in infants born to HIV infected mothers were carried out to evaluate the roles of immunological parameters for the diagnosis and prognosis of HIV infection. T-lymphocyte subsets and serum immunoglobulins were studied on cord blood in three groups of neonates: 14 infected infants, 29 sero-reverted infants and 31 control neonates. No differences were observed between the three groups. At 3 months, IgG were significantly higher in the infected infants than in sero-reverted infants. After 6 months, CD4 + cell counts, CD4/CD8 ratio were significantly lower in the infected infants and serum IgG, IgA and IgM were significantly higher in the infected group. Antigenemia p24 was detected in 78% of the infected group before 6 months. Total HIV-specific antibody persisted and progressed after 6 months. These data and viral detection appear to be complementary and useful for therapeutic strategies.
We present a case of a bilateral chronic open-angle glaucoma in a 74 year old woman, operated on the right eye by conventional trabeculectomy and the left eye by holmium laser ab externo sclerostomy. Both filtering blebs remained elevated and functional for 18 months. After this follow-up period, both blebs simultaneously collapsed and intra-ocular pressure rose again. This case shows that a late conjunctival scarring process, depending on a non surgical factor, may still be encountered after Holmium: YAG laser sclerostomy just as after standard trabeculectomy despite reduced conjunctival tissue trauma.
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To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. One hundred and fifty-nine eyes had a 5 year-follow-up and 147 eyes had a minimal 8 year-follow-up. These eyes came from an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (3 mmHg), progression in visual field loss and need for a filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to these criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. The initial mean intraocular pressure (27.22 mmHg) of 7 failures operated on during the first 2 months and that of all 27 operated on failures (24.41 mmHg) was higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mmHg). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
159 phakic eyes with chronic open-angle glaucoma were treated by argon laser trabeculoplasty and followed for 5 years. According to our criteria of failure, 31 eyes were failures at 1 year (19%), 47 eyes at 2 years (30%), 66 eyes at 3 years (41%), 77 eyes at 4 years (48%) and 82 eyes at 5 years (52%). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mm Hg and the initial medical treatment could be tapered or stopped in only 33 of the cases (43%). In the 82 failures, there was a greater percentage requiring surgery for pressure control during the first year after laser treatment: 16 trabeculectomies in 31 failures (52%). The initial mean intraocular pressures of 7 failures needing surgery during the first 2 months (27.22 mm Hg) and of the 27 failures needing surgery during the 5 year follow-up (24.41 mm Hg) were higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mm Hg). In the 159 eyes followed for 5 years, 19% (31 eyes) to 6% (5 eyes) new failure cases per year were encountered and the initial good results obtained by argon laser trabeculoplasty persisted for about 5 years in half of the cases.
In 1987, we presented a study of 141 eyes treated prophylactically following retinal detachment in the fellow eye. A hundred and nine of these patients are reviewed with a minimum follow-up of five years. Only the evolution was studied, whether a peripheral retinal lesion was present or not at the time of prophylactic treatment. The examiner noted if new lesions had occurred, or if lesions present at the time of the first examination had developed: lattice degeneration or snail track developing into a retinal tear, hole or tear causing a retinal detachment, contained or not by laser treatment. Our study contained sixty two myopes. Fifty eyes had visible, dangerous lesions, and fifty nine a normal retina. Forty five circular barrages with four anterior radial rows returning to the ora serrata were performed, and sixty four barrages with tight anterior grids and a localised barrage of visible lesions. The results were judged on one criterion only: retinal detachment requiring emergency surgery. Only one retinal detachment occurred behind the barrage, caused by proliferative vitreoretinopathy due to multiple tears, and surgical results were good. Eight tears appeared in front of the barrage, five of these in healthy retina. Two very posterior tears behind the barrage were blocked with no problem by laser treatment. Four localised detachments occurred in front of the barrage, three of these without anterior grid treatment. The advantage of this is undeniable since out of sixty three cases treated in this way, only three tears were seen to be blocked by the laser shots, and one anterior localised detachment where the anterior grid was insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)
Since 1982, and with informed patient consent, we have photocoagulated confluent drusen and limited serous pigment epithelium detachment (SPED) in the fellow eye of ten patients suffering from advanced, disciform type, age-related macula degeneration (ARMD). This treatment was only carried out on appearance of metamorphopsia. Photocoagulation was performed with either the green ray of the argon laser, or the yellow ray of a dye laser. Spots of about 200 microns were placed in a grid-like fashion among the drusen. No complications were observed due to the treatment. The follow-up period on these ten patients, eight women and two men, mean age 77 years, was two to eight years, and the three patients have died. The drusen disappeared completely in three patients and partially in one. The functional results seemed favorable in three cases. In one case of confluent drusen associated with SPED and serous retinal detachment, vision improved remarkably from 0.3 to 0.5 with a Parinaud 2, with a follow-up of five years. In another case, the improvement was from 0.4 to 0.7 but the patient died after only a few months. In another case, vision has been stable for five years. The vision of the seven remaining patients deteriorated; three cases showed central areolar sclerosis, and one case a localised new vessel with vision less than 0.1. In three cases vision dropped to 0.2 and Parinaud 6, but they have been stable for at least four years (eight years for one patient).(ABSTRACT TRUNCATED AT 250 WORDS)
There is currently a general consensus to perform argon laser trabeculoplasty (ALT) onto the 360 degrees of the trabecular ring to obtain the best long term results; but in two sessions a month apart with, during each session, 50 burns of a true 50 mu laser spot on 180 degrees, a 0.1 sec exposure time and a power high enough to create a tiny but visible trabecular reaction on the anterior edge of the posterior trabecular meshwork. During the first three hours after treatment, the main complication is raised intraocular pressure (IOP) which occurs in between 14% and 33% of the cases with a 10 mmHg rise above the initial IOP. In end stage glaucomas, a very close monitoring is mandatory during these first hours. Pretreatment with apraclonidine drops can dramatically reduce this complication. Our results and those of the literature with the same follow-up show that ALT seems effective in phakic chronic open-angle glaucomas (COAG) in half of the cases for about five years with a 10% new failure rate per year. The youngest patients, the aphakic patients and all the cases with trabecular severe disorganisation display the worst results. ALT must be considered to be a physical treatment - initially powerful but with decreasing efficacy in the long term. It should be used in presurgical glaucomas when IOP does not exceed 30 mmHg with intensive medical treatment and in intermediate stages of the disease where it is more effective.