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Biomedical subjects

L Michaud

Publications and source records attributed to L Michaud.

At least 55 records · Page 3Linked to original sources
PubMed2001

Contamination of gastrostomy feeding systems in children in a home-based enteral nutrition program.

BACKGROUND: There are few data concerning the risk of contamination of enteral feeding systems via gastrostomy in children, and none for conditions that pertain to home-based care. METHODS: To investigate the risk of contamination of enteral feeding systems during the home-based care of 20 children receiving gastrostomy tube feeding, five samples were taken for analysis: two samples before the enteral feeding period (gastrostomy, enteral feeding system) and three after this period (gastrostomy, distal giving set, liquid remained in container). Microorganisms were identified and counted. Different factors were studied to elucidate their role in bacterial colonization: acid suppressive therapy, gastrostomy tube or button, hanging feeding time, rate of enteral feeding, gastric pullulation and retrograde contamination, manipulation error, and use of open or closed enteral feeding systems. RESULTS: Overgrowth was defined as a microorganismal load exceeding 10(4) colony-forming units (cfu)/mL. Overgrowth was present in 85% of gastrostomy samples before enteral nutrition started. Most microorganisms belonged to gastric flora. Some bacteria had an environmental origin or derived from cutaneous flora. Forty-five percent of the lines showed overgrowth at the end of enteral nutrition period, mainly with the same microorganism found in the gastrostomy. Closed enteral bags remained sterile, even if manipulation error occurred. Duration, rate of enteral feeding, and acid suppression treatment were not risk factors for overgrowth. CONCLUSIONS: Retrograde contamination of gastrostomy feeding systems occurs frequently. The preferential use of closed enteral feeding systems is recommended for home-based enteral nutrition programs.

Adolescent↗
PubMed2001

Late-onset complications of percutaneous endoscopic gastrostomy in children.

PURPOSE: The aim of this study was to report the late morbidity of percutaneous endoscopic gastrostomy (PEG) in a pediatric population and to identify possible risk factors for complications developing after PEG insertion. METHODS: A PEG was placed in 110 children between 1 May 1990 and 1 January 1997 using the pull technique. A retrospective study of late-onset complications was performed, with a follow-up period ranging from 1 to 8 years. All the complications occurring more than 6 days after PEG insertion were recorded, except for gastrostomy tube obstruction and accidental tube dislodgement. RESULTS: The prevalence of late-onset complications related to PEG in our patients varied from 3.8 to 4.4 per 10 5 days. The overall rate of late-onset complications was 44% (48 complications observed in 29 patients [26%]). Seventy-five percent of the complications appeared during the first 2 years after PEG insertion. Nine different types of complication have been identified: intragastric buried or extruded gastrostomy (n = 24), gastric metaplasia granulation tissue around the site of gastrostomy (n = 8), intragastric pseudotumoral proliferative gastric mucosa (n = 4), intragastric mucosal ulceration (n = 3), cutaneous necrosis (n = 3), cologastric fistula (n = 2), gastrostomy closure delay after tube removal (n = 2), subcostal neuralgia (n = 1), and peritonitis (n = 1). Wilcoxon and chi-square tests were used to compare the clinical characteristics of the patients and the type of material used in the two populations, with and without complications. No clinical risk factor for the development of complications could be identified. Intragastric buried or extruded gastrostomy appeared more frequently with the use of one type of button than with the use of tubes. CONCLUSIONS: The authors' experience suggests that PEG is associated with significant late morbidity, which is mainly observed within the first 2 years after PEG insertion. However, no risk factor for the development of such complications could be identified.

Adolescent↗
PubMed2001

Neonatal severe intractable diarrhoea as the presenting manifestation of an unclassified congenital disorder of glycosylation (CDG-x).

A case of severe and protracted diarrhoea is reported, which started in the neonatal period and progressively associated with neurological impairment, dysmorphy, hepatosplenomegaly, and hepatic insufficiency, from which the patient died at 2 years of age. Isoelectric focusing of serum transferrin showed a congenital disorder of glycosylation type I pattern but the basic defect could not be identified. This observation shows that congenital disorder of glycosylation is a cause of intractable diarrhoea in neonates.

Congenital Disorders of Glycosylation↗
PubMed2000

Simplification of the method of assessing daily and nightly energy expenditure in children, using heart rate monitoring calibrated against open circuit indirect calorimetry.

Total daily energy expenditure (TDEE) can be assessed in children using several methods: the double-labelled water technique (DLW); indirect whole-body calorimetry; activity diary; accelerometry and heart rate (HR) monitoring. This last, low-cost and convenient technique has been validated against the DLW technique that is normally considered the reference method. The main advantages of HR monitoring are its social acceptability, and the examination of the time spent in specific activities or intensive exercise sessions. The aim of this study was to assess a new method for computing energy expenditure (EE) with the HR monitoring technique in children, using an open-circuit ventilated hood indirect calorimetry system. Eleven healthy children participated in this study, with a mean age of age 8.9+/-3 years. Seven of them were studied again 6 months later, so that 17 measurements were available for analysis. The calibration period was used to collect simultaneous data from HR and EE measured by indirect calorimetry (IC). Measurements were made when the children were resting (REE=Resting Energy Expenditure), during 30 min of a post-prandial period, and during two different activity levels on a cyclergometer (two periods of 15 min at 20 and 60 W output). Results of EE during a longer calibration period (2.5 h) were compared with those of a shorter period (1.5 h), for a group of six subjects. Results of nightly EE measurements of five subjects were recorded using IC and compared with the HR predicted method. Results of EE measurements estimated with different regression equations were compared to EE measured by IC. The short calibration period (1.5 h) gave similar results to a longer period (2.5 h), with a mean difference of less than 3%. The polynomial third-order relationship between HR and EE gave the highest correlation coefficient, the smallest mean square error and the best agreement (Bland-Altman method). EE predicted with this model gave the best results during the total calibration period, the post-prandial period and the medium and high activity periods. Comparison between measured and predicted nightly EE showed that REE - REE/10 was the best formula to assess nightly EE, and the mean difference was less than 4%. This study demonstrates the validity of a shortening of the calibration period and the reliability of the REE - REE/10 formula to compute nightly EE. The best model for computing daily EE is a polynomial third-order regression equation.

Adolescent↗
PubMed1999

Favorable nutritional outcome after isolated liver transplantation for liver failure in a child with short bowel syndrome.

A patient with short gut syndrome presented with end-stage liver disease. She underwent an isolated liver transplantation at the age of 3.5 years. Parenteral nutrition was discontinued 1.5 years after surgery. At 7 years of age, the patient has maintained normal nutritional indices and growth while on a normal oral diet. This observation suggests that liver transplantation alone can be a valuable alternative to the combined small bowel/liver transplantation in short bowel syndrome when intestinal adaptation is expected and if the ileocecal valve is present and that improvement of gut function can occur after successful liver transplantation.

Child, Preschool↗
PubMed1999

Effect of glucose to fat ratio on energy substrate disposal in children with cystic fibrosis fed enterally.

High fat containing diets lower VCO(2)in patients with impaired pulmonary function fed at a high level of energy intake. We tested the effect of a high fat enteral nutrition on VCO(2)and substrate oxidation in cystic fibrosis patients fed enterally 130% RDA. VCO(2)and substrate oxidation were studied in a group of eight 6-19 year old patients while receiving for 1 month and in a random order isocaloric (1000 kcal/m(2)), isonitrogenous enteral diet with a normal fat and a high fat content (40% and 67% of non-protein energy intake). Substrate oxidation and net balance were estimated using indirect calorimetry at the end of each study period. Overnight high fat enteral infusion resulted in no significant change in VCO(2)and VO(2)but lowered RQ (0.84 +/- 0.01 vs 0.88 +/- 0.01, P= 0.02) and non-protein RQ (0.83 +/- 0.01 vs 0.88 +/- 0.01). In spite of a higher glucose oxidation rate (8.1 +/- 0.5 vs 6.3 +/- 0.5 g. h(-1), P= 0.04), glucose net balance was significantly higher during normal fat formula administration (+2.5 +/- 0.8 v -0.3 7plusmn; 0.7 g/h, P< 0.05). The present study failed to show any benefit of a high fat diet on VCO(2)in non oxygenodependant cystic fibrosis children and adolescents fed slightly above RAD. Normal fat enteral formula led to higher glycogen repletion.

Adolescent↗
PubMed1999

No evidence for systolic or diastolic left ventricular dysfunction at rest in selected patients with long-term type I diabetes mellitus.

We assessed left ventricular systolic and diastolic function using pulsed-waved Doppler echocardiography in a selected group of 20 patients with insulin-dependent diabetes mellitus (IDDM) (mean age, 35 +/- 8 years; mean diabetes duration, 17 + 7 years). Our patients were free of autonomic neuropathy and major micro- or macrovascular complications and had no evidence of ischemic heart disease or hypertension. The results were compared with those of 20 age- and sex-matched control subjects. We found that left ventricular geometry and mass, systolic function by M-mode and 2D-echocardiography, isovolumetric relaxation time, deceleration time and the PEP/LVET ratio were not significantly different between patients and control subjects. Hemodynamic parameters were also not significantly different except for a slightly higher heart rate in the patient group (75 +/- 11 vs. 68 + 6 bpm, P = 0.019). After correction of A-peak velocities for differences in heart rate, there was no significant difference of Doppler indices of diastolic left ventricular function between patients and control subjects. The absence of significant left ventricular systolic and diastolic dysfunction by Doppler echocardiography in our study patients may be explained by our patient selection. Left ventricular dysfunction in diabetic patients without concomitant hypertensive or ischemic heart disease may only occur in conjunction with microvascular disease in other organ systems, with autonomic neuropathy or with poor metabolic control.

Adult↗
PubMed1999

Experience of parenteral nutrition for nutritional rescue in children with severe liver disease following failure of enteral nutrition.

Nutritional support is often necessary in chronic liver disease in childhood, and when enteral nutrition is insufficient, parenteral nutrition (PN) can be envisaged as a last resort. Pediatric experience is still limited in this indication. Seven children with severe liver disease received PN for a mean duration of 105 d, with additional enteral nutrition. Clinical tolerance was assessed and anthropometric and biological data were compared at the beginning and at the end of the study by the paired non-parametric test of Wilcoxon. Weight change, expressed as weight-for-age or weight-for-height Z-scores, increased. Conjugated bilirubin increased significantly. This retrospective study suggests that PN is a well-tolerated method for maintaining nutritional status in pediatric chronic liver disease when enteral nutrition has failed.

Child↗
PubMed1999

13C-urea breath test and gastric mucosal colonization by Helicobacter pylori in children: quantitative relation and usefulness for diagnosis of infection.

OBJECTIVE: Because in children Helicobacter pylori colonization could differ as compared to that in adults, gastric metabolism of urea and the reliability of the breath test must be evaluated. The aim of this study was to quantify the relationship between breath test and colonization. METHODOLOGY: We studied data from 50 endoscopies performed in 39 children and adolescents (20 girls, 19 boys, aged 3-18 years); 28 were infected with H. pylori. Biopsies were analyzed for histological and microbiological diagnosis of infection and for quantitative antral culture of H. pylori. A 13C urea breath test was performed on the same day as that of endoscopy (n = 33) or delayed between 2 and 90 days (n = 17). RESULTS: Using a cut-off value of 3 delta/1000, sensitivity was 96.5%, and specificity was 91.5%. The three children showing discrepancies between breath test and biopsy results had a delta/1000 value close to the cut-off. For the 26 cases with a positive culture, we noted a significant correlation (r = 0.63; p < .001) that was not affected by the delay between breath test and gastroscopy. CONCLUSION: This quantitative relation between bacterial density and delta/1000 permits increasing the reliability of the test by interpreting carefully those results that approach the cut-off value.

Adolescent↗
PubMed1999

Nitrous oxide sedation in pediatric patients undergoing gastrointestinal endoscopy.

BACKGROUND: The ideal medication to administer to children before gastrointestinal endoscopy procedures has yet to be found. The efficacy of using inhaled nitrous oxide during endoscopy in children was assessed in a pilot study. METHODS: Patients aged 5 to 17 years, referred to our hospital for diagnostic upper gastrointestinal endoscopy or rectosigmoidoscopy procedures, were eligible for enrollment in this study. All received 50% nitrous oxide in oxygen (Entonox; AGA, Rueil-Malmaison, France) before endoscopy and some of them again during endoscopy. The pediatric endoscopist and the nurse performing the procedure were separately asked to rate cooperation, emotional state, drowsiness and overall efficacy of sedation. Oxygen saturation and adverse effects were recorded throughout the procedure. After endoscopy, children scored their degree of pain during the procedures on a visual analog scale (0, no pain; 100, agony) and on a body outline (projective method). Any adverse effects were noted. RESULTS: Thirty-seven patients were enrolled in the study. Thirty patients underwent diagnostic upper gastrointestinal endoscopy and seven diagnostic rectosigmoidoscopy. The median time from administration of nitrous oxide until insertion of the endoscope was 5 minutes (range, 3-8 minutes). Good or excellent efficacy of the sedation was noted in 92% of children by the endoscopist and in 89% by the nurses. Good or excellent cooperation was noted in 92% of the children by the endoscopist and in 78% by the nurses. The children's pain score on the visual analog scale ranged from 5 to 100 (median, 20) for upper gastrointestinal endoscopy and from 0 to 30 (median, 0) for rectosigmoidoscopy. The time of discharge after endoscopy, defined as the time elapsed between the end of the endoscopy and discharge from the endoscopy suite, varied from 1 to 7 minutes (median, 1.5 minutes). CONCLUSION: Entonox provides rapid and effective analgesia without heavy sedation, leads to adequate relaxation and cooperation, and facilitates quick and efficient endoscopy. The effect of Entonox was of short duration, allowing the children to leave the endoscopy unit without need for a long recovery period. The adverse effects of Entonox appeared to be minor, and their duration was always brief. Nitrous oxide-oxygen inhalation may provide a valuable alternative to conventional sedation regimens during gastrointestinal endoscopy in children, but randomized and prospective studies comparing nitrous oxide sedation and conventional sedation regimens are necessary.

Adolescent↗
PubMed1999

Characteristics and prevalence of Helicobacter heilmannii infection in children undergoing upper gastrointestinal endoscopy.

BACKGROUND: Helicobacter heilmannii, described in 1983 as a new cause of chronic gastritis, has been reported rarely in children. The purpose of this study was to determine the clinical characteristics and the prevalence of H. heilmannii infection, in comparison with Helicobacter pylori infection in children undergoing upper digestive endoscopy. METHODS: Diagnosis of H. heilmannii was based on its morphologic characteristics in gastric biopsy specimens (two from the antrum, one from the fundus), whereas H. pylori infection was defined by histology and/or culture (one specimen from the antrum, one from the fundus). Respective prevalences of H. heilmannii and H. pylori were calculated in 518 patients studied prospectively who underwent systematic biopsies. RESULTS: The prevalence of H. pylori was 8.9% (46/518) and increased with age (from 2% before 3 years of age to 18% after 10 years). On the contrary, the prevalence of H. heilmannii infection was low, 0.4% (2/518), and no different from that published in adults. After completion of the study period, a third H. heilmannii-infected child was diagnosed. Characteristics of H. heilmannii infection could be studied in these three children 5, 9, and 14 years old. Two of three had abdominal pain and one had dysphagia. Nodular gastritis was observed at endoscopy in two children. H. heilmannii chronic active gastritis (n = 3) was localized in the antrum, associated with an interstitial infiltrate, and could not be distinguished from H. pylori gastritis (n = 46). CONCLUSION: Clinical characteristics, endoscopic features and gastric histopathology did not allow H. heilmannii to be distinguished from H. pylori gastritis in our pediatric population. H. heilmannii infection should be considered and carefully looked for during histologic examination of gastric specimens in cases of H. pylori-negative gastritis.

Adolescent↗
PubMed1999

Natural outcome of Helicobacter pylori infection in asymptomatic children: a two-year follow-up study.

BACKGROUND AND OBJECTIVES: It is known that Helicobacter pylori can be acquired in early childhood. There is not enough data to know whether or not infected children should be treated. A better knowledge of the natural outcome and implications of H pylori infection may provide evidence that eradication therapy is beneficial in childhood. This prospective study looks at clinical symptoms, endoscopic, microbial, and histologic changes during a 2-year period in infected asymptomatic children. It is hoped that some prognostic indicators will be found that select out the children that later need therapy. PATIENTS AND METHODS: During epidemiologic study of the prevalence of H pylori infection, 18 children aged 7 +/- 4 years (mean +/- 1 SD) were discovered to have H pylori infection and enrolled in the 2-year follow-up study. These patients had received no eradication therapy because they were asymptomatic. The follow-up for each patient consisted of an initial assessment, a clinical examination every 6 months, and an endoscopic reevaluation at the end of the first and second years. Gastric mucosal samples were analyzed for bacteriologic and histologic changes. Various factors were initially recorded: individual factors included sex, age, and housing conditions; microbial factors included bacterial load and the presence of the CagA gene. Inflammatory changes were also noted, such as the presence of active gastritis and nodular formation, and these were correlated with the histology which was described using the Sydney classification. Typing polymerase chain reaction-restriction fragment length polymorphism was performed to check the persistence of the same strain of H pylori in each patient. RESULTS: All of the children were still infected after 2 years with the same strain as in the initial assessment with the exception of 1 child whose infection cleared spontaneously. The density of antral and fundal mucosal colonization with H pylori also remained stable. There were progressive inflammatory changes in this cohort, particularly between the first and second year (histologic score, 3.5 +/- 1.3 vs 5 +/- 1). Active antral gastritis occurred in 3 out of 14 and 1 out of 8 children during the first and second year, respectively. Gastritis became active in the fundus in 2 out of 14 and 2 out of 8 children during the same period. Increases in the histologic score were found particularly in male children, and children colonized by cagA- strains of H pylori during the follow-up. The frequency of nodular gastritis significantly rose from 11% (2 out of 18 children) to 64% (9 out of 14 children) after 1 year, and to 80% (8 out of 10 children) after 2 years. CONCLUSION: These findings demonstrate a deterioration in the histologic features of the gastric mucosa of infected children despite stable H pylori colonization and the absence of symptoms.

Antigens, Bacterial↗
PubMed1999

Role of sphingolipids in the transport of prosaposin to the lysosomes.

Prosaposin is the precursor of four lysosomal saposins that promote the degradation of glycosphingolipids (GSLs) by acidic hydrolases. GSLs contain a hydrophobic ceramide moiety, which acts as a membrane anchor, and a hydrophilic oligosaccharide chain that faces the lumen of the Golgi apparatus and extracellular spaces. By using fumonisin B1, PDMP and D609, we tested the hypothesis that sphingolipids mediate the transport of prosaposin to the lysosomes. Fumonisin B1 interferes with the synthesis of ceramide, PDMP blocks the formation of glucosylceramide and D609 blocks the formation of sphingomyelin. Fumonisin B1 produced a 59;-85% decrease in the density of gold particles in the lysosomes of CHO and NRK cells immunolabeled with anti-prosaposin antibody, and a 55% reduction in the lysosomes of CHO cells stably transfected with an expression vector containing a human prosaposin cDNA. To examine whether the mannose 6-phosphate receptor pathway was affected by this treatment, NRK and CHO cells treated or not with fumonisin B1 were labeled with anti-cathepsin A antibody. The results showed no significant differences in labeling of the lysosomes, suggesting that the effect of fumonisin B1 was specific. When fumonisin B1 and D609 were added to the media of transfected CHO cells, a decrease in immunofluorescence with anti-prosaposin antibody was observed by confocal microscopy. PDMP did not cause any reduction in immunoreactivity, indicating that sphingolmyelin appears to be involved in this process. In conclusion, our data support the hypothesis that sphingolipids, possibly sphingomyelin, are involved in the transport of prosaposin to the lysosomes.

Animals↗
PubMed1999

American Academy of Pediatrics. Committee on Children With Disabilities. Care coordination: integrating health and related systems of care for children with special health care needs.

Care coordination is a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of the children and provide them with optimal health care. Care coordination often is complicated because there is no single entry point to multiple systems of care, and complex criteria determine the availability of funding and services among public and private payers. Economic and sociocultural barriers to coordination of care exist and affect families and health care professionals. In their important role of providing a medical home for all children, primary care pediatricians have a vital role in the process of care coordination, in concert with the family.

Case Management↗