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Biomedical subjects

M Fayon

Publications and source records attributed to M Fayon.

At least 19 recordsLinked to original sources
PubMed2006

CF-Emerging therapies: Modulation inflammation.

Persistent and dysregulated inflammation, combined with an exaggerated host response is a major contributor to CF lung disease. As lung disease progresses, neutrophil accumulation in the airways ensues. Modulation of CF airway inflammation may result in either beneficial or deleterious side effects, resulting in more harm than good. Antibiotics, in particular, macrolides which act as a long-term anti-inflammatory agent with an excellent safety profile, and dornase alpha, are very interesting agents; steroids are not indicated in CF except in very special situations, and other promising agents such as leukotriene modifiers, high-dose N-acetylcysteine, anti-elastase and anti-cytokines require further research. Research should focus on early treatment, before lung damage has occurred.

Acetylcysteine↗
PubMed2005

Right pulmonary agenesis associated with remaining bronchus stenosis, an equivalent of postpneumonectomy syndrome. Treatment by insertion of tissue expander in the thoracic cavity.

We report a case of right pulmonary agenesis with worsening of mediastinal shift during a viral bronchiolitis at the age of 5 months. The respiratory failure was due to stretching and narrowing of the remaining bronchus, as in postpneumonectomy syndrome. Weaning of respiratory assistance was possible after inserting a tissue expander in the empty side of the thoracic cavity. The correction of the shift brought a liberation of the left main stem bronchus. The main risk is heart compression. The child is now 3 years old and is at home. Filling of the prosthesis is done according to the clinical evolution.

Bronchial Diseases↗
PubMed2004

[Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology].

INTRODUCTION: Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS: In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS: Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS: This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.

Bronchoscopes↗
PubMed2003

Intra-rachidian disorders: two unusual cases of recurrent abdominal pain in children.

UNLABELLED: Recurrent abdominal pain (RAP) is generally thought to be of psychological origin but organic aetiologies are increasingly being identified. The cases of two children with vertebral disorders revealed by recurrent abdominal pain are reported. A 14-y-old girl presented with RAP associated with scoliosis, due to a T8-T9 intra-dural extra-medullary tumour. A 7-y-old girl who suffered from nocturnal RAP located in the right iliac fossa for 1 y had decreased muscular strength, pyramidal signs, and a 10 degree Lassègue sign in the right lower limb, revealing a vascular malformation extending from T12 to L2. CONCLUSION: Atypical pain and associated neurological signs or scoliosis must raise the possibility of intra-rachidian disorders. Magnetic resonance examination will then precisely state the location and nature of the pathological process, avoiding excessive delay in therapeutic management.

Abdominal Pain↗
PubMed2003

Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine).

Chylothorax is defined as an accumulation of chyle in the pleural space. This condition usually occurs after an operation, the congenital idiopathic form being rare (1/15 000 births). Recovery is observed within four to six weeks of diagnosis in most cases. Treatment is either conservative or surgical. Four cases are reported of congenital chylothorax (three idiopathic, one accompanied by diffuse lymphangectasia) managed by chemical pleurodesis (intrapleural injection of povidone-iodine). Tolerance was satisfactory: unaltered thyroid function in the three cases explored; one case of transient generalised oedema. Treatment was deemed successful in three of the four cases. One child died from renal failure (unrelated to the chemical pleurodesis). Pleurodesis by povidone-iodine appears to be well tolerated and may represent a good alternative to mechanical abrasion or surgery for congenital idiopathic chylothorax. Its use for refractory chylothorax may also decrease the morbidity related to prolonged hospital stay.

Chylothorax↗
PubMed2003

Early respiratory system mechanics and the prediction of chronic lung disease in ventilated preterm neonates requiring surfactant treatment.

The objective of this study was to evaluate the predictive value of the respiratory system compliance (Crs) and resistance (Rrs) measured before surfactant therapy to identify infants at risk for chronic lung disease (CLD). Measurements of Crs and Rrs were obtained on 44 ventilated neonates with respiratory distress syndrome (RDS) before and after surfactant therapy using the passive expiratory flow-volume method. It was found that in addition to a lower gestational age (GA) and a lower birth weight (BW), infants with CLD (n = 10) exhibited a lower Pa/AO(2) [Pa/AO(2) = PaO(2)/(PiO(2) - PaCO(2))] and higher Rrs before surfactant compared to the infants without CLD (n = 28). Improvement in gas exchange 18 h after surfactant was reduced in the CLD group. Finally, we concluded that a low GA (< 28 weeks), a low BW (< 942 g), a low Pa/AO(2) before and 18 h after surfactant or a high Rrs before surfactant (>0.21 cm H(2)O/ml/s) were associated with an increased risk of CLD.

Biological Products↗
PubMed2002

Epidemiology of poisoning in children: a 7-year survey in a paediatric emergency care unit.

Acute poisoning in children is still a major public health problem, and represents a frequent cause of admission in emergency departments. We carried out an epidemiological study of poisonings leading to admission to a paediatric emergency care unit (PECU). We analysed data from 2988 children who were admitted to the PECU of Bordeaux, France with acute poisoning from 1989 through 1995. During the 7-year period, the poison exposure numbers decreased slightly from 490 to 382 (6% vs. 3% of total medical emergencies). This represented a mean annual incidence of 1.4 poison exposures per 1000 children younger than 18 years of age and living in Bordeaux and its surroundings. Characteristics of the study population, circumstances of poisoning and substances involved were similar to those previously described. Eighty per cent of children were younger than 5 years of age, presented with a benign course. Forty per cent were not treated and 75% were discharged home either immediately or within 24 hours of admission. Only 1.5% of cases, mainly adolescent girls who attempted suicide, were admitted to a paediatric intensive care unit. Overall mortality rate was 0.33/1000. In children, most cases of acute poisoning are accidental, benign, and mainly attributed to the ingestion of a non-toxic substance. This points to the need for better information of the population on availability of poison control centre calling facilities, in order to decrease the number of admissions to the PECU. Patients suspected of having ingested a potentially dangerous substance can be managed in short-stay observation units, thus avoiding unnecessarily prolonged hospitalization. Acute poisoning in children remains a frequent problem, highlighting the need to develop an education programme on primary prevention in our region.

Adolescent↗
PubMed2002

Minimal effective dose of indomethacin for the treatment of patent ductus arteriosus in preterm infants.

The aim of this study was to determine if it was possible to decrease the number of boluses of indomethacin for the treatment of patent ductus arteriosus. This retrospective study included 46 preterm neonates (<34 weeks' GA) who had had an ultrasound diagnosis predictive of subsequent symptomatic patent ductus arteriosus. All patients had received a daily intravenous doses of indomethacin, 0.1 mg/kg. Mean age at initiation of treatment was 4.5 +/- 3.1 days. Patency of the ductus arteriosus was controlled echocardiographically each day and treatment was discontinued as soon as the ductus arteriosus was closed. The initial success rate was 84.7%, of which 6.5% reopened. The mean cumulative dose of indomethacin was 0.35 mg/kg. There was no correlation between gestational age or birth weight and total cumulative dose. Overall tolerance was satisfactory with only one case of transient acute renal failure. A weak correlation between the cumulative dose of indomethacin and natremia (r = -0.43) or weight gain (r = 0.35) was noted, and none with serum creatinine or blood urea nitrogen levels. We confirm that lower indomethacin treatment of patent ductus arteriosus in premature neonates are as effective as standard protocols.

Cardiovascular Agents↗
PubMed2001

[Respiratory emergencies in infants].

Respiratory distress in childhood is a frequent cause of admission to the emergency department. The initial management requires a rapid clinical evaluation in order to initiate appropriate interventions, which will improve respiratory status, and avoid cardiac arrest and hypoxic encephalopathy. There are many possible etiologies but in the vast majority of cases the following conditions are observed: nasal obstruction before 3 months and laryngitis after 6 months. Moreover, during winter acute viral bronchiolitis is the most common disease of the respiratory tract during the first year of life, and occurs in annual epidemics. The diagnostic of an inhaled foreign body must always be suspected. Prevention is based upon information given to families, as well as the medical community, which often minimises the seriousness of inhalation hazards.

Bronchiolitis↗
PubMed2001

[Intrapleural fibrinolytic treatment and infectious pleuresies: three pediatric cases].

UNLABELLED: Intrapleural instillation of fibrinolytic agents has been proposed for the treatment of loculated pleural effusions, or whenever the biochemical characteristics of the pleural fluid (pH, glucose level, LDH) indicate the risk of a complicated outcome due to a pleural effusion with complications and the possible development of empyema. At present, there is no consensus regarding the use of intrapleural fibrinolytic agents in children. CASE REPORTS: In this study, the successful treatment by fibrinolytic agents and standard drainage are successfully performed in three children with a pleural effusion due to an infection. CONCLUSION: The clinical utility, in terms of the reduction of the duration of hospitalization and additional surgical treatment, should be assessed in prospective studies.

Anti-Bacterial Agents↗
PubMed2001

[Neonatal nonbacterial thrombotic endocarditis].

UNLABELLED: Nonbacterial thrombotic endocarditis is not widely known in neonates. CASE REPORTS: We report three new cases which illustrate some specific aspects of this pathology. Respiratory distress with severe pulmonary hypertension, systemic hypotension and disseminated intravascular coagulopathy in a full-term newborn were characteristic findings. CONCLUSION: An early echocardiography should lead to accurate diagnosis. Hypoxemia and genetic factors could be determining factors in its pathogenesis.

Diagnosis, Differential↗
PubMed2001

[Etiology of chronic cough in children: analysis of 100 cases].

In order to understand the epidemiological aspects of chronic cough, we analysed 100 patients' files referred for chronic cough in five pediatric-pulmonology consultations. The patients had a chronic cough for more than 3 weeks. The distribution of causes was: asthma, 56%; upper airway disorders, 16%; psychogenic, 4%; whooping cough, 4%; Mycoplasma pneumoniae pulmonary infection, 3%; Chlamydia pneumoniae pulmonary infection, 1%; bronchiectasis, 1%. In 15% of cases two or more causes were associated; In most cases, the clinical characteristics of the cough are evident enough to establish a diagnosis with few secondary explorations. The prognosis is on the whole favourable.

Adolescent↗
PubMed2001

Accidental caustic ingestion in children: is endoscopy always mandatory?

BACKGROUND: Patients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested-substance types as markers of severe esophagogastric lesions and to define indications for endoscopy. METHODS: Ingested-product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion. RESULTS: Forty-eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1). CONCLUSIONS: In conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.

Accidents, Home↗
PubMed2000

A short-stay observation unit improves care in the paediatric emergency care setting.

The aim of this study was to evaluate the influence of a short-stay observation unit (SSOU) on the hospitalization rate, the authors have analysed the activity of a SSOU opened in 1992 in a paediatric emergency department (PED) and the number of children hospitalized between 1987 and 1996. Among 2321 patients admitted to the SSOU in 1996, 644 medical patients have been analysed, showing a young population (55% under 3 years old), living in the town or surroundings (70%) and usually have not been referred by a general practitioner (64%). Twenty per cent were admitted for accurate diagnosis (group A), 49% for treatment and observation of a recognized acute pathology before decision of discharge (group B), and 31% waiting for a bed in a paediatric ward (group C). Sixty-eight per cent of children spent less than 6 hours in the SSOU, and 79% of those from groups A and B were thereafter discharged home. Between 1987 and 1991, the number of children hospitalized increased 5% per year on average. After the opening of the SSOU in 1992, this increase has been stopped although the number of medical referrals to PED was still going up. The SSOU in a PED can provide comprehensive care to young children requiring short-term treatment or observation, and is effective in limiting unappropriate hospitalizations.

Adolescent↗