Biomedical subjects
P Le Roux
Publications and source records attributed to P Le Roux.
[Medicoeconomic results of the pediatric unit at Le Havre hospital].
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[Macroamylasemia: one pediatric case].
We report a case of macroamylasemia in an 11-year-old boy. We compare our clinical and paraclinical data with those described in pediatric literature. Macroamylase resulted in a complex of amylase and immuglobulin. Its fortuitous detection did not reveal, up to now, any associated pathology, in particular any autoimmune disorders or celiac disease. Identification of this biochemical abnormality is essential in order to avoid invasive investigations and/or unnecessary therapies.
[Smoking and the adolescent. An inquiry into motivation and knowledge of the effects of tobacco].
INTRODUCTION: The nicotinism at the teenagers is a concern of public health. The objective of our prospective and descriptive investigation was to better include/understand the nicotinic practices of the teenagers. METHODS: A questionnaire was distributed to the children from 12 to 16 years presenting at the Paediatric emergency department of Le Havre from September 2003 on May 2004. The items collected related to the practices and knowledge on the nicotinism. RESULTS: Hundred answers were collected at teenagers with an average age 14 years. We found 35% of smokers. Among smokers, the average age of the beginning of the nicotinism is at 12,2 years. The girls smoke significantly more than the boys (42% versus 22%, p<0.01). Sex ratio is 2,8 (26 girls and 9 boys). The degree of dependence was evaluated by the score of Fagerström. Half of the questioned teenagers are fairly with strongly dependent (score > 5), in spite of a daily consumption of 5 cigarettes on average. The consumption of other "drugs" was announced at 51.5% of the smokers. On the 100 teenagers, 7 stopped smoking, but 3 think of smoking a day again. The teenagers of single-parent family or separate smoke significantly more than if the parents are in couple (58.3% versus 41.6, p<0.01). The class of third represented the peak of making of contact with the tobacco. CONCLUSION: The tobacco at the teenagers is a control at the risk justifying the continuation of the actions of prevention by the whole of the doctors.
[Semi-invasive necrotic aspergillosis in a child with cystic fibrosis].
INTRODUCTION: Aspergillosis colonisation in cystic fibrosis (CF), usually due to Aspergillus fumigatus (AF), classically presents as allergic bronchopulmonary aspergillosis. However, aspergillus infection can produce a range of manifestations: from minor colonization to an invasive infection. CASE REPORT: A 14-year-old CF patient, chronically colonized with Staphylococcus aureus and Pseudomonas aeruginosa, presented with acute right-sided chest pain, a moderate fever and no modification of the sputum. The chest X-ray showed a 5 cm round opacity. Laboratory parameters were WBC 24,500 G/l, CRP 27 mg/l, Total IgE 1527 UI/l, Specific Aspergillus fumigatus IgE 31 UI/l. Bronchoscopy revealed external compression of the middle lobe bronchus with mucopurulent secretions coming from apical segment of the lower lobe. Bronchoalveolar lavage revealed the presence of pseudomonas aeruginosa 103 CFA/ml, staph aureus 107 CFA/ml and one colony of AF. Chest CT scan showed a large necrotic mass with an air-fluid level located in the apical segment of the right lower lobe. Initial therapy with itraconazole and corticosteroid was replaced by voriconazole, caspofungin, metronidazole and linezolide. Treatment was well tolerated and after 8 weeks the chest X-ray appearances had returned to normal. CONCLUSIONS: The possible diagnoses and therapeutic options are discussed. Conventional antifungal treatment with amphotericin B is limited by nephrotoxicity. These newer antifungal agents appear to be effective and well-tolerated.
Endoluminal angioplasty of the popliteal artery. Review of 54 consecutive patients.
AIM: To determine the results of endoluminal angioplasty for occlusive or stenotic lesions of the popliteal artery. METHODS: Retrospective study of symptomatic patients having popliteal occlusive lesions treated by endoluminal balloon angioplasty. All patients underwent systematic preoperative and postoperative color duplex scan and preoperative angiography. The principal endpoints were primary and primary assisted patency. RESULTS: Fifty-four percutaneous endoluminal angioplasties of the popliteal artery, including six procedures with stents, were performed in 50 patients. In all cases, the superficial femoral artery was patent and without significant stenosis. Primary patency for the entire cohort was 57.4+/-6.7% at 1 and 2 years. Primary assisted patency was 86.3+/-4.8% at 1 year, and 79.1+/-5.9% at 2 years. The results of angioplasty appeared to be better in patients with intermittent claudication when compared to patients with critical limb ischaemia, (p=0.0006). Angioplasty of single occlusive lesions had a better prognosis than that of multiple occlusive lesions (p=0.01). Results of angioplasty were better at the below-knee and median popliteal artery than at the femoro-popliteal junction or in the above-knee popliteal artery (p=0.03). Tibial run-off and isolated popliteal stenosis versus isolated popliteal thrombosis did not seem to affect primary patency rate. CONCLUSION: Results of angioplasty of the popliteal artery are acceptable for claudicants, especially those with TASC-A lesions and those with lesions in the distal two thirds of the popliteal artery.
[Optimizing history taking for evaluating the risk of venous thromboembolism: the OPTIMEV study].
UNLABELLED: Venous thromboembolism (VTE) is a frequent disease and remains a major cause of mortality and morbidity among our patients. During the 20 past years, clinical description, diagnostic tools, and treatment have changed dramatically. Most published data describing risk factors for VTE no longer apply to the patients seen in daily practice. We present here the rationale, aims, and methodology of the OPTIMEV Study (OPTimisation de l'Interrogatoire pour la Maladie thromboEmbolique Veineuse). RATIONALE: Risk factors for VTE are numerous, complex and interactions between them and their clinical importance is difficult to measure (table I). For example, odds ratios for VTE recurrence vary greatly across longitudinal studies. We searched the National Library of Medecine (PubMed) and the Amedeo website using the following keywords: "venous thromboembolism", "pulmonary embolism", "deep vein thrombosis", "risk factors". We selected 84 relevant articles published between 1972 and 2005. Based on this literature analysis, we identified the following major risk factors: VTE recurrence, surgery, cancer, immobilization, age, biological factors. For these factors, data are lacking and some questions are proposed. OBJECTIVES: The broad objective of the study is to better evaluate clinical risk factors that fit today's practice against VTE. Specific aims are: 1) to determine whether risk factors are different between proximal and distal deep vein thrombosis (DVT); 2) to develop and prospectively validate a new prediction rule for outpatients. The primary hypothesis is that careful assessment of VTE recurrence, adequate surgical thromboprophylaxis, cancer staging, and varicose vein stratification according to the CEAP classification, is mandatory for accurate evaluation of thromboembolic disease risk. METHODS: We conducted a multicenter, prospective, cohort study of 10000 patients. Enrollees are inpatients and outpatients presenting with a clinical suspicion of VTE in Emergency Departments and outpatient clinics in France. 4173 patients have been enrolled at this time (Figure 2). All eligible patients are enrolled during a selected period of time through different seasons. Data are collected by physicians in charge of the patients using an electronic case recording form. Collected data include baseline characteristics, risk factors, results of diagnostic investigations. Outcome measures obtained through telephone interview at 3 and 12 months include cancer diagnosis, VTE recurrence, haemorrhagic events, treatments, death. Univariate and multivariate analysis will be performed using multilevel logistic regression. The study organization is performed by the Centre d'Investigation Clinique de Grenoble and is sponsored by the French Society of Vascular Medicine. First results, to be published in 2006, will allow development of new prediction rules for VTE diagnosis.
[Extra-pulmonary tuberculosis in childhood].
Extra-pulmonary tuberculosis (EPT) accounts for around 25% of cases of the disease, and around 20% in children. In Pott's disease and other forms of bone and joint involvement (globally 10-15% of EPT cases), modern imaging techniques like MRI scan have improved diagnosis and follow-up of treatment outcomes. Tuberculous meningitis has not disappeared even in BCG vaccinated children and remains a severe form of the disease. Techniques like the polymerase chain reaction and MRI contribute to an early diagnosis and controversy persists regarding the role of corticosteroid therapy in the treatment strategy. Other localisations are rare in children, including tuberculosis of the urogenital tract, infection of the digestive tract or pericarditis.
[Nosocomial viral infections in a pediatric service: example of rotaviral gastroenteritis and respiratory syncytial viral bronchiolitis].
UNLABELLED: Nosocomial infections are a preoccupation in a pediatric hospital mainly during the winter with bronchiolitis and gastroenteritis epidemics. We have examined the risk factors of nosocomial infections. MATERIAL AND METHODS: A prospective study was conducted between November, 1999 and March, 2000 in the infants units of the Le Havre hospital. We systematically listed the admissions and contacted the family after their discharge by phone. A geographic information system was implemented to display the epidemiological data; this software is able to illustrate the sectors at risk. RESULTS: During the study, 687 infants were hospitalized of whom 458 for bronchiolitis and community-acquired gastroenteritis. Mean age was 5.4 months old. No nosocomial bronchiolitis occurred. Prevalence of nosocomial gastroenteritis was 10% (68 cases including nine after discharge). Infants with nosocomial infection were younger than those with community-acquired infection (6.6 months vs. 11.2 months, P < 0.01). The mean length of stay was longer in nosocomial infection (7.7 vs. 4.1 days, P < 0.05). Among the infants with bronchiolitis, 16% have developed nosocomial intestinal infections (RR = 2.65, IC: 1.59-4.4; P < 0.01). The geographic analysis pointed the area with nosocomial risk (bedroom without water, nearness of nurse office and games room). CONCLUSION: Geographic information system is a part of the quality control system and may have some interaction effect on final decision making. Incidence of nosocomial infections showed the need for a prevention strategy in a pediatric hospital.
[Pediatric telephone advice in the emergency department].
OBJECTIVES: To describe the activity of telephone advice in a pediatric emergency department and assess the influencing factors to improve quality of care. METHODS: Descriptive study about all the anonymous telephone calls received on the direct line of the pediatric emergency room of Le Havre hospital, from 25 January to 25 July 2002, and all the advices given by a doctor or a nurse. RESULTS: The mean daily call frequency was 2.15 (0-12) with 586 calls during the 6 months period and the mean call duration was 3 min (1-20). Parents took telephone advices for: fever (27%), digestive troubles (22%), and trauma (14%). We found no difference concerning symptoms according to season. The rush hours were, on a bimodal graph, 0-1 am and 8-9 pm, paralleling the rush activity of consultation in pediatric emergency room. The heavy days for phone advices during the week were Tuesday and Wednesday. We found no correlation between heavy days of week and phone call duration. Thirty percent of cases did not need any advice because the asks were only an orientation advice. Advice to go to our emergency department was done in 11% of orientation advice. The call duration was significantly longer for: (1) calls including several symptoms or griefs, (2) calls given by a nurse; (3) calls taking place during hours of lowest activity in the emergency room (between 6 and 12 am), (4) calls including advice about medication or diet; (5) calls for counselling an orientation other than medical establishment. CONCLUSION: Our assessment of telephone call advices represented the first step to improve the quality of answer to families. Next step will be written protocols to answer more adequately to main griefs and symptoms that lead families to search for phone counselling.
[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.
[Celiac disease and myocarditis: a fortuitous association?].
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[Inhaled bronchodilators and mucolytic agents in cystic fibrosis].
Poor clearance of airway secretions contributes to the pulmonary disease in cystic fibrosis (CF). Bronchodilator therapy might benefit in CF, but the efficacy is controversial. Effects of mucolytic agents have not been demonstrated conclusively. Only, efficacy of recombinant human deoxyribonuclease (rhDNase) is established with a rapid onset of benefit.
[Is influenza vaccination necessary in children with asthma?].
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[Acute alcohol intoxication in adolescent emergencies: prospective multicenter study].
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[Telephone consultation in pediatric emergencies. Epidemiologic study of the Havre Hospital Group].
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Pigmented purpuric dermatitis preceding the diagnosis of mycosis fungoides by 24 years.
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[Practice guidelines for the prevention of venous thromboembolism in elderly patients hospitalized in subacute care and rehabilitation facilities (short text). Association for the Promotion of Hospital Angiology].
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