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Biomedical subjects

P Helardot

Publications and source records attributed to P Helardot.

13 recordsLinked to original sources
PubMed2006

Conservative use of chest-tube insertion in children with pleural effusion.

The aim of this work was to evaluate the effect of a more conservative use of chest-tube insertion on the short-term and long-term outcome of pleural infection. Sixty-five patients with pleural infection, aged 1 month to 16 years were each treated according to one of the two protocols: classical management with chest-tube insertion (classical group, n = 33), or conservative use of chest-tube insertion (conservative group, n = 32), with drainage indicated only in the case of voluminous pleural effusion defined by a mediastinal shift and respiratory distress and/or an uncontrolled septic situation. The two groups were comparable with regard to age, baseline C-reactive protein (CRP) value and white blood cell counts, pleural thickness, identified bacteria, and antibiotic treatment. Chest-tube insertion was performed in 17 patients (52%) of the classical group compared to eight patients (25%) of the conservative group (P = 0.03). Duration of temperature above 39 degrees C was shorter in the conservative group (10 +/- 1 vs. 14 +/- 1 days, P = 0.01), as was the normalization of CRP (13 +/- 1 vs. 17 +/- 1 days, P = 0.03). Duration of hospitalization and intravenous (IV) antibiotherapy as well as the delay of chest-radiograph normalization was not significantly different between the two groups. A more conservative use of chest-tube insertion did not change short- and long-term outcome of the pleural infection in children. Drainage could be restricted to the most severely affected patients with pleural empyema causing a mediastinal shift and respiratory distress and/or presenting with an uncontrolled septic situation.

Adolescent↗
PubMed2003

Localized cervical neuroblastoma: prevention of surgical complications.

OBJECTIVES: The purpose of this study focused on cervical neuroblastoma (NB) was to assess the prognosis, define the most suitable methods of investigation, and evaluate risk factors for complications following primary surgery. METHODS: Between 1990 and 1999, we conducted two consecutive prospective multicentric studies (NBL90 and NBL94) on localized NB. Because the first study (1990-1994) found surgery-related morbidity and mortality, several surgical risk factors (i.e. adhesion to major vessels, size, friability, and dumb bell tumor) were defined and used prospectively as criteria of resectability in the second study (1994-1999). RESULTS: Of 617 cases included in the two studies, 43 involved cervical NB including 17 cervicothoracic tumors. With a median follow-up of 4 years, overall survival and event-free survival rates were 91 and 81%, respectively with no significant difference between cervical or cervicothoracic NB. Seventeen patients were included in the second study; surgery was used as the first line treatment in 11. Full pre-operative work-up was performed in eight patients, demonstrating one or more risk factors in three. The remaining three patients underwent emergency surgery with no pre-operative work-up or only ultrasound: two developed serious complications. All three patients presenting documented risk factors developed post-operative complications versus only two of the eight patients who presented no risk factor (n = 5) or were inadequately evaluated (n = 3) (P = 0.06). None of the five patients in whom full work-up demonstrated no risk factor had post-operative complications (P = 0.02). CONCLUSIONS: Cervical neuroblastoma has a favorable prognosis. Surgery is the treatment of choice but there is a risk of complications. Appropriate pre-operative work-up is mandatory to evaluate resectability. The surgical risk factors defined for our second study seem to be significant predictors of post-operative complications.

Female↗
PubMed2003

[Postnatal management of urinary tract anomalies after antenatal diagnosis].

PURPOSE: Antenatal diagnosis of urinary tract anomalies raises the question of appropriate therapeutic management. Two risks should be avoided: excessive treatment, belated treatment. Postnatal management of these infants should be determined before birth. The aim of this study is to define indications more precisely. MATERIALS AND METHODS: A comprehensive review of the literature on postnatal treatment of antenatally diagnosed urinary tract anomalies was performed in order to propose a model of immediate management. RESULTS: Neonates with hydronephrosis should be placed on antibiotic prophylaxis. Postnatal sonographic exploration should be done immediately after birth in case of bilateral pathology, and if renal function is compromised: posterior urethral valves, bilateral dilatation with parenchymal thinning; exploration is done at day 10 in other cases, when diuresis is normalized. Voiding cystourethrogram is performed soon after birth if posterior urethral valves are suspected, later in other cases. In cases of intermittent renal pelvic dilatation, often an indirect sign of reflux, the need for a voiding cystogram is controversial. Diuretic renogram with mercaptoacetyl triglycine (MAG 3) is used to access renal function and efficiency of kidney drainage, both are needed for later monitoring. Surgical treatment is indicated in the event of deteriorated renal function with permanent obstruction. The most common uropathies are ureteropelvic junction obstruction, vesicoureteral reflux, posterior urethral valves, and primary obstructive megaureter. CONCLUSION: Antenatal diagnosis of urinary tract anomalies allowed immediate prophylactic treatment of urinary infections, and decrease the risk of severe complications previously observed. Long-term beneficial effects on preserving the renal parenchyma are yet to be determined.

Humans↗
PubMed1997

[Recurrent thyroid abscess in children and malformations of the pyriform sinus].

Recurrent "abscesses" occurring in the thyroid area in children are due to branchial anomalies. Their origin is located close to the oesophageal inlet at the apex of the lateral hypopharyngeal process: the pyriform sinus. The key for the diagnosis comes from laryngohypopharyngoscopy. The true original anomaly is a controversial topic: the persistence of a canal originating from the 3rd or 4th branchial pouch. Anyhow, these anomalies sometimes build tracts or cysts in the deeper parts of the neck, down to the supraclavicular or thoracic areas. Most often, they are limited to the soft tissues surrounding the left thyroid lobe. In these cases, no cyst wall can be found. The 3 cases reported here allow us to ascertain that a pharyngeal infection is the trigger for the neck abscess. Furthermore, a mucosal opening can be the only found anomaly. After recovery from the infectious process, these anomalies have to be treated by a mucosal suture of the pyriform sinus. The recurrent laryngeal nerve should be first discovered and the removal of a small piece of cartilage can be required. If these diagnostic and therapeutic procedures are used at the first infectious episode, they may prevent the occurrence of repeated thyroid "abscesses" in children.

Abscess↗
PubMed1986

[How I treat cryptorchidism].

The author describes the technic of septal orchidopexy, which he use for the treatment of cryptorchidism with palpable testis. The question of high level cryptorchidism is raised.

Cryptorchidism↗
PubMed1984

Intestinal lesions containing coronavirus-like particles in neonatal necrotizing enterocolitis: an ultrastructural analysis.

Since the outbreaks of neonatal necrotizing enterocolitis occurring in maternity hospitals of Paris and suburbs in 1979-1980, it has been possible to examine by light and electron microscopy gut specimens from ten newborns with this illness. Coronavirus-like particles, enclosed in intracytoplasmic vesicles of damaged epithelial cells of the intestinal mucosa, were observed in the small intestine, appendix, and colon. The ultrastructural study, supported by bacteriologic findings, suggests the role of coronavirus-like particles in the appearance of the lesions. Secondary proliferation of mainly anaerobic bacteria, probably responsible for pneumatosis, may aggravate the disease.

Appendix↗
PubMed1983

Necrotizing enterocolitis in full-term newborns.

During a 17-month period, 19 full-term newborn infants were hospitalized for necrotizing enterocolitis (NEC). 10 of these infants had no apparent risk factors. Only 7 suffered acute fetal distress. 16 of the 19 infants were born in the same hospital. Toxicological and bacteriological investigations of possible cause revealed no specific agent. Virological analysis of 8 stool samples revealed the presence of corona virus in 5 of the 8.

Bacteroides↗
PubMed1981

[Technic of muscle transplant for complete diaphragmatic aplasia (author's transl)].

The authors report a technic of muscular flap, to repair complete diaphragmatic aplasia. Based on a precise anatomical principle, they modified the Holcomb procedure (1961). The repair uses the Transversus abdominis muscle and the intercostal muscular layer. One case of survical with a satisfactory evolution can be attributed to the intervention. However, we must keep in mind that the prognosis is linked to the pulmonary hypoplasia associated with the malformation. As shown in the series we must emphasize that the degree of pulmonary involvement is not strictly related to the extend of the diaphragmatic effect.

Diaphragm↗
PubMed1980

[Complete congenital sternal cleft (author's transl)].

Complete Sternal Cleft is obviously a rare congenital malformation, except as a part of superior celosomy (Cantrell's Syndrome). Such a case is reported, who was operated on eight days after birth. The operation was done by taking off the skin over the pericardium and tightening both hemi-sternum, with non-absorbable material. Short-term and long-term post-operative course was uneventfull. We think positive pressure ventilation is needed only for some days. Results are better and surgery easier when performed shortly after birth.

Humans↗