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J Raymond

Publications and source records attributed to J Raymond.

At least 91 records · Page 5Linked to original sources
PubMed1998

[Microbiological diagnosis of urinary tract infections in the child. Importance of rapid tests].

Urine collection study is one of the most common means of bacteriological diagnosis in the laboratory. However, numerous interpretation problems exist. The aim of this paper is to specify these problems and to indicate the place of rapid tests in the screening for urinary tract infection. Direct examination must be performed on rapidly collected and transported urine. In such conditions, absence or presence of both leukocytes or germs presents a good negative or positive predictive value. However, false positive leukocyturia is frequent. False positive bacteriuria is mostly due to bad collection or transport. In some cases the threshold of bacteriuria > or = 10(5) cfu/mL can be reduced. Rapid tests include leukocyte esterase and nitrite tests. In our study, recording 289 tests, we observed negative and positive predictive values of respectively, 92% and 100% when the two tests were used together. Dipsticks can be used to exclude a urinary tract infection when clinical symptoms are absent, but only if they are used correctly. When both tests are positive, a urinary tract infection is likely. Study on urine collection is difficult in children. Collaboration between clinician and bacteriologist is essential.

Bacteria↗
PubMed1998

[Nosocomial urinary tract infections: retrospective study in a pediatric hospital].

Urinary tract infections (UTI) are the most frequent nosocomial infection in the adult, yet very few data are available concerning these infections in children. In a retrospective 1-year study in a paediatric hospital, we analysed the incidence of nosocomial UTI and the characteristics of the affected children. The incidence was of 1.97/1,000 admissions which represented 6.8% of all UTI diagnosed by the microbiology laboratory. Most cases were in surgery and neurology wards. The frequency was inversely proportional to the age, with 50% of children being less than 2 years old. Pathogens most frequently isolated were E coli (39%), Pseudomonas sp (12.1%) and Enterococcus sp (12.1%). When compared with the organisms found in all the urine cultures during the same period, two organisms were more frequently found in nosocomial urinary tract infections: Pseudomonas sp and Candida sp. Most patients presented one or more risk factors, mainly:bladder catheterisation (41.4%), prior antibiotic therapy (62%), cerebral palsy (6.9%). No bacteriema was observed. The diagnosis of nosocomial UTI must be interpreted with caution and needs close collaboration between microbiologists and paediatricians. These infections increase the cost of hospitalisation, but only exceptionally do they present with complications. Some risk factors are inherent in hospital conditions, but others can be reduced by improving hand washing or by changing catheterisation practices.

Adolescent↗
PubMed1998

[Prevalence of Helicobacter pylori infection in children according to their age. A retrospective study].

UNLABELLED: The aim of this study was to evaluate the prevalence of H pylori infection in a Parisian children population. PATIENTS AND METHODS: During a 3-year period, H pylori infection was investigated in 623 children admitted to our hospital. Children were enrolled into two groups; either a symptomatic children group with clinical gastritis manifestations as infant colics or recurrent abdominal pain for more than 3 months in whom H pylori infection was suspected, or a control children group with growth retardation of more than -2 standard deviation (SD). Ethnic origin for all enrolled children was identified. A written parental consent was obtained for all children. H pylori infection was identified by enzyme-linked immunosorbent assay (ELISA) (Cobas Core Roche, IgG, 2nd generation, Roche, France). RESULTS: H pylori infection was identified in 99 children out of 623 (15.8%). There was no difference between the two groups of children for age, sex, ethnic origin and prevalence of H pylori infection. The prevalence of H pylori infection was widely dependent on age and rose regularly with an annual acquisition rate of 2.1%. The prevalence of this infection varied from 1.8% during the first year of life to 30% in 15-year-old children. CONCLUSION: The latter prevalence is quite similar to that found in adults, suggesting that infection might occur in early life.

Adolescent↗
PubMed1998

[Bacteriologic surveillance of nosocomial septicemia and bacteremia in a pediatric hospital].

BACKGROUND: Nosocomial bloodstream infections in pediatrics are an important cause of morbidity and mortality. To identify pathogens causing nosocomial bloodstream infections, evaluate associated risk factors and take preventive measures, we conducted a prospective study from January 1995 to December 1995 at Saint-Vincent-de-Paul Hospital (Paris). PATIENTS AND RESULTS: All patients hospitalized more than 48 hours were included in the study. During this period, we recorded 21 bloodstream infections in 20 children. The incidence rate of nosocomial bloodstream infection was 1/1,000 admissions. Sixteen children were hospitalized in surgery, three in medical intensive care unit; the median day onset of infection was approximately 20 days. Recorded risk factors were: surgery, invasive procedures, central catheterization, bladder catheters, parenteral nutrition, device, endotracheal tube, antibiotic therapy before infection. The number of risk factors ranged from zero to six per patient. The most common isolated pathogens were in ten cases Gram positive cocci: five methicillin-sensible Staphylococcus aureus, four methicillin-resistant coagulase-negative staphylococci and one Streptococcus milleri. Other bacteria were seven enterobacteria, three Pseudomonas sp and three Candida sp. In 11 cases, the same bacteria as in bloodstream infection could be found: in three urine samples, in two tracheal samples, in two gastro-intestinal samples, two puncture sites, one device, and one umbilical catheter. CONCLUSION: In our study, 6.2% of positive blood culture were due to a nosocomial infection. We confirm the importance of Gram positive cocci, and particularly of methicillin-resistant coagulase negative staphylococci.

Adolescent↗
PubMed1998

[The 13C-urea breath test in Helicobacter pylori gastric infection in children].

Helicobacter pylori gastric infection in children is a public health problem. Classical diagnostic tools such as endoscopy are excessively invasive in the usual clinical context. Serology at this age has multiple drawbacks. The urea-13C breath test seems today the most appropriate alternative method. The principle of the test relies upon the indirect detection of H pylori through its high urease activity. The test uses a stable (ie, non radioactive) isotope, which allows its repeated use. The main indications are the detection and the follow-up of H pylori infection.

Adult↗
PubMed1998

A randomized trial of maintenance interferon following high-dose chemotherapy in multiple myeloma: long-term follow-up results.

High-dose chemotherapy (melphalan) with autologous marrow stem cell support (AMSCS) results in high response rates in multiple myeloma (MM), with up to 50% of patients achieving complete remission. However, these remissions are generally not durable. As the cytokine interferon alpha has been shown to prolong partial response following conventional chemotherapy, this trial was conducted to evaluate its role following high-dose chemotherapy. 85 patients were randomly assigned to maintenance treatment with interferon alpha, 3 x 10(6) units/m2 subcutaneously three times weekly until relapse or no further treatment following recovery from high-dose chemotherapy (melphalan 140-200 mg/m2 or busulphan 16 mg/kg) combined with AMSCS. At 5.8 years following the accrual of the last patient in this trial, 38 patients had died, 17 in the interferon arm and 21 in the control arm. The median progression-free survival (PFS) in the 42 patients randomized to interferon alpha was 46 months versus 27 months in the controls. Both overall survival and PFS, which were highly significant at median follow-up of 52 months, have now ceased to be significant, because most patients have ultimately succumbed to their disease. Interferon was tolerated by the majority of patients with very good compliance. Toxicity consisted mainly of flu-like symptoms and malaise which were usually self-limiting. The results of such a pilot study should be carefully interpreted and the benefits of interferon should be confirmed in larger multicentre studies in the setting of minimal residual disease following autologous transplantation.

Adult↗
PubMed1998

The 13carbon urea breath test for the noninvasive detection of Helicobacter pylori in children: comparison with culture and determination of minimum analysis requirements.

BACKGROUND: The purpose of the study was to determine the accuracy of the labelled 13carbon urea breath test for the diagnosis of Helicobacter pylori in children and to simplify the 13carbon urea breath test in identifying the most discriminating sampling time. METHODS: H. pylori was searched for in 100 children aged 10.5+/-4.5 years by histology, bacteriological counts, and culture on antral biopsies together with serology and 13carbon urea breath test. Breath samples were obtained before ingestion (T0) of 75 mg urea-13C and every 10 minutes after until T60. 13CO2 excess ratio was measured by isotope ratio mass spectrometry, and values expressed as delta per mil over baseline enrichment (delta 13CO2). The arithmetic mean (Mdelta 13CO2) of T20 to T60 values was calculated and the test considered positive with Mdelta 3CO2 higher than Mdelta 13CO2 + 3 SD as determined in noninfected children. RESULTS: Mdelta 13CO2 of noninfected children as assessed by culture was 1.4+/-0.6 per mil, determining a positive cut-off value of 3.44 per mil. Mdelta 13CO2 was correlated in 11 children with biopsy bacteriological counts. Both culture and 13carbon urea breath test were positive in 38 of 100 children, without any discordance. Plotting 13carbon urea breath test results at each sampling time versus Mdelta 13CO2 showed weaker correlations at T20, T30, T50, and T60, than at T40. The two-sample method at T0 and T30, T40, T50, had high sensitivity and specificity. Single-sample analysis obtained at T40 gave a comparable sensitivity and a slightly reduced specificity. CONCLUSION: 13carbon urea breath test is sensitive and specific in children. Two samples collected at T0 and T40 provide the most discriminating procedure.

Adolescent↗
PubMed1998

Effect of metronidazole resistance on bacterial eradication of Helicobacter pylori in infected children.

A prospective study was performed with 23 Helicobacter pylori-infected children (mean age, 9.5 +/- 4.4 years) with clinical symptoms of gastritis and positive results of culture and histologic examination of gastric biopsy specimens to evaluate the influence of antibiotic resistance on eradication. Positive children were treated for 4 weeks with lansoprazole and for 2 weeks with either amoxicillin-metronidazole or spiramycin (a macrolide)-metronidazole. At endoscopy 1 month after the discontinuation of therapy, the eradication rate and improvement of histologically related gastritis were significantly dependent on the susceptibility or the resistance of the infecting organism to metronidazole (83 versus 17% and 88 versus 16.6%, respectively). Pretreatment determination of the susceptibility is appropriate in any anti-H, pylori regimen, including one with metronidazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Craniocervical dural fistula associated with cervical myelopathy: angiographic demonstration of normal venous drainage of the thoracolumbar cord does not rule out diagnosis.

We report a case of craniocervical dural arteriovenous fistula with perimedullary venous drainage associated with cervical myelopathy in which spinal angiography showed a normal venous phase after injection of the artery of Adamkiewicz. We conclude that because of the complex venous drainage of the spinal cord, a dural arteriovenous fistula with spinal drainage cannot be ruled out solely because a normal venous phase is seen in the lower part of the cord, as has previously been suggested.

Aged↗
PubMed1998

[Procalcitonin, a marker of bacterial meningitis in children].

Procalcitonin (PCT) is a new marker connected to systemic bacterial infection. Blood values are parallel to the severity of the disease. In the present Knowledge on PCT, the usefulness is focused on acute pediatric pathology, ICU, and the follow up of grafts and surgery. This paper dwells on the interest in the differential diagnosis for meningitis (viral versus bacterial). At the opposite of CRP and IL6, a very clear cut off for all the cases has been found. The cut off in this study is about 2-3 micrograms/l. PCT, at the difference of cytokines is a very stable molecule in the blood sample. Also a very small quantity of serum (or plasma) 20 microliters is sufficient for one assay. In the future, a point of care assay will be available and should be very interesting in the emergency wards (pediatric or adult ICU). The origin of PCT seems to be--but perhaps not exclusively--mononuclear cells. The absence of an animal model (except monkeys) is actually a difficulty to progress.

Adolescent↗
PubMed1997

Cytosolic Ca2+ and protein kinase Calpha couple cellular metabolism to membrane K+ permeability in a human biliary cell line.

Cholangiocytes represent an important target of injury during the ischemia and metabolic stress that accompanies liver preservation. Since K+ efflux serves to minimize injury during ATP depletion in certain other cell types, the purpose of these studies was to evaluate the effects of ATP depletion on plasma membrane K+ permeability of Mz-ChA-1 cells, a model human biliary cell line. Cells were exposed to dinitrophenol (50 microM) and 2-deoxyglucose (10 mM) as the standard model of metabolic injury. Whole-cell and single K+ channel currents were measured using patch clamp techniques; and intracellular [Ca2+] ([Ca2+]i) was estimated by calcium green-1 fluorescence. Metabolic stress increased [Ca2+]i, and stimulated translocation of the alpha isoform of protein kinase C (PKCalpha) from cytosolic to particulate cell fractions. The same maneuver increased membrane K+ permeability 40-70-fold as detected by (a) activation of K+selective whole cell currents of 2,176+/-218 pA (n = 34), and (b) opening of apamin-sensitive K+ channels with a unitary conductance of 17.0+/-0.2 pS. PKCalpha translocation and channel opening appear to be related since stress-induced K+ efflux is inhibited by chelation of cytosolic Ca2+, exposure to the PKC inhibitor chelerythrine (25 microM) and downregulation of PKC by phorbol esters. Moreover, K+ currents were activated by intracellular perfusion with recombinant PKCalpha in the absence of metabolic inhibitors. These findings indicate that in biliary cells apamin-sensitive K+ channels are functionally coupled to cell metabolism and suggest that cytosolic Ca2+ and PKCalpha are selectively involved in the response.

2,4-Dinitrophenol↗
PubMed1997

Progression of borderline increases in albuminuria in adolescents with insulin-dependent diabetes mellitus.

We aimed to determine the natural history of borderline increases in albuminuria in adolescents with insulin-dependent (Type 1) diabetes mellitus (IDDM) and factors which are associated with progression to persistent microalbuminura. Fifty-five normotensive adolescents with IDDM and intermittent microalbuminura (overnight albumin excretion ratte of 20-200 micrograms min-1 on one of three consecutive timed collections, n = 29) or borderline albuminura (mean overnight albumin excretion rate of 7.2-20 micrograms min-1 on one of three consecutive timed collections, n = 30) were followed prospectively at 3 monthly intervals. The endpoint was persistent microalbuminuria defined as a minimum of three of four consecutive overnight albumin excretion rates of greater than 20 micrograms min-1. One hundred and forty-two adolescents with IDDM and normoalbuminura were also followed prospectively. Fifteen of the 59 patients (25.4%) with intermittent (9/29) or borderline (6/30) albuminura progressed to persistent microalbuminura (progressors) over 28 (15-50) months [median (range)] in comparison with two of the 142 patients with normoalbuminuria at entry (relative risk = 12.6; p = 0.001). Progressors to persistent microalbuminura were pubertal and had higher systolic (p = 0.02) and diastolic (p = 0.02) blood pressure, and HbA1c (p = 0.004) than non-progressors. All patients remained normotensive. Glomerular filtration rate, apolipoproteins, dietary phosphorus, protein and sodium intakes, and prevalence of smoking did not differ between progressors and non-progressors. Total renin was higher in the diabetic patients without a difference between progressors and non-progressors. In conclusion there is a relatively high rate of progression to persistent microalbuminuria in pubertal adolescents with borderline increases in albuminura and duration greater than 3 years. These patients require attention to minimize associated factors of poor metabolic control and higher blood pressure in the development of incipient nephropathy.

Adolescent↗
PubMed1997

Etiology and response to antibiotic therapy of community-acquired pneumonia in French children.

The aim of this study was to determine the etiologic agents associated with community-acquired pneumonia in 104 French children ages 18 months to 13 years. Potential respiratory pathogens were identified in 87 (85%) cases; these included respiratory syncytial virus in ten, other viruses in 20, Streptococcus pneumoniae in 14 and Mycoplasma pneumoniae (diagnosed by serologic procedures) in 43. Of 32 patients with Mycoplasma pneumoniae infection who were initially treated with beta-lactam antibiotics, 30 failed treatment. Recovery from mycoplasma infection occurred rapidly in patients treated with macrolide antibiotics (which included spiramycin in 31 patients, josamycin in 7, and erythromycin in 3); however, cough persisted in 12 patients for one month. The high frequency of Mycoplasma pneumoniae in children over 18 months of age must be considered when selecting an antibiotic for initial therapy.

Adolescent↗
PubMed1997

Staphylococcal scalded skin syndrome in a neonate.

A case of staphylococcal scalded skin syndrome in a neonate caused by mother-to-child transmission through breast-feeding is reported. Staphylococcus aureus isolates from mother and child were identified using random-amplified polymorphic DNA analysis, which is a simple and rapid method for comparing strains. This study confirms the need to avoid breast-feeding in cases of breast abscess.

DNA, Bacterial↗