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Biomedical subjects

P Micheau

Publications and source records attributed to P Micheau.

At least 19 recordsLinked to original sources
PubMed2006

[Babywalker use (baby-trot, youpala): an unsafe practice].

AIM: Epidemiological analysis of accidents related to babywalker use admitted to a pediatric emergency department. METHODS: Retrospective, descriptive study of injuries related to babywalkers admitted to the pediatric emergency department between January 1st, 2003 and December 31st, 2005. RESULTS: One hundred and seventy-eight children were admitted due to an accident related to babywalker use. The sex ratio was 1.7 with a male prevalence. Mean age was 11+/-4 months. Seventy-eight percent of babywalker-related injuries were attributable to fall down a flight of stairs. The mean number of steps that a child fell down was 7 (range 1-20 steps). The repartition of accidents was bimodal: during the year, 1 peak in May and 1 in October; during the week: 54% of the cases occurred on Thursday or on the weekend; during the day (1 peak between 10 a.m. and 1 p.m. and 1 peak between 4 p.m. and 7 p.m.). Non-severe head traumas represented the most frequent injury (72%). Twenty-one children were hospitalised for concussion (N=15), cranial fractures (N=3), forearm fracture (N=1), dental subluxation (N=1) and extradural hematoma (N=1). A social problem (families with unsafe domestic practices) was identified in 26 children (15%), 16 of these situations were recognized due to the retrospective character of the study and the analysis of hospital admissions after the first accident. CONCLUSION: Stairway related falls associated with babywalker use and fall down in the stairs are very frequent in children less than 1 year-old. This resulted in babywalkers being prohibited in Canada since 2004. In several countries, advocates are working to ban babywalkers. Active or passive prevention methods have shown their limits. This unsafe and dangerous practice should be banned in France.

Accidental Falls↗
PubMed2006

[Necrotizing pneumonia and arthritis due to Staphylococcus aureus producing Panton and Valentine leukocidin in a 10-year-old boy].

Staphylococcal necrotizing pneumonia producing the Panton Valentine leukotoxin (PVL) has been described for many years. The french reference center for staphylococcal toxaemia defined it with precision in 1999. A 10-year-old child, died in 36 hours from respiratory distress and shock. Staphylococcal pneumonia was suspected then confirmed: S. Aureus producing PVL was isolated in lung, blood and articulations.

Arthritis, Infectious↗
PubMed2006

[B-natriuretic peptide and cardiological emergencies in childhood].

The increase in B-natiuretic peptide (BNP) is well correlated with cardiovascular symptoms in adults. Its use in children is recent and only partially evaluated. The authors undertook a prospective study of BNP concentrations and its kinetics in 54 children with an average age of 15 months (5 days to 11 years) admitted as paediatric emergencies. The symptoms were dyspnoea (60%), shock (15%), suspicion of Kawasaki disease (15%) and other (10%). Twenty children had BNP levels of more than 100 pg/ml related to decompensation of known congenital heart disease in 7 patients (average BNP 462 +/- 323 pg/ml), due to neonatal coarctation in 2 patients (BNP > 3000 pg/ml), due to cardiomyopathy in 6 patients (BNP= 2576 +/- 1215 pg/ml), due to an arrhythmia in 1 patient (BNP= 3754 pg/ml) and to Kawasaki disease in 4 patients (BNP= 521 +/- 448 pg/ml). Thirty-four children had BNP values of less than 100 pg/ml; 29 had no cardiac disease and 5 had known congenital heart disease with other symptoms. Measuring BNP is quick and economical and is a valuable aid in the diagnosis of cardiac dysfunction in symptomatic children in the emergency room. High BNP values seem to be correlated with the severity of the cardiac disease. Low BNP values seem to have a good negative predictive value in children without underlying cardiac disease. The interpretation of intermediary values, especially when there is previous cardiac disease, is more difficult in view of the absence of known threshold values for different haemodynamic situations. Further studies are required to determine the value of this test for the follow-up and setting up of prognostic values in children with congenital heart disease.

Aortic Coarctation↗
PubMed2004

[Caustic burns. Clinical study of 24 patients with sulfuric acid burns in Cambodia].

Over a period of 12 years, 24 burns have been treated by a Cambodgian and French team (Doctors of the World). This experience has revealed some characteristics of this population: (1) a majority of young women (2/3), (2) victims of assault (20 cases). These notions are found in the medical literature particularly South East Asia. All cases are of a third degree. Every surgeon, every anesthetist should apply emergency measures which are recalled here. The aims is to close all the burns surface through a skin graft within a month. However the patients are treated 6 months to 2 years after the burn and have, at this stage, terrible sequella (22 patients). Treating them requires the coordinated efforts of a multidisciplinary specialized team. The challenge is to save the eyes, the mouth, the nose and give back a "human" face to these young burns who are often rejected because of their handicap. Enabling them to smile again is a strong commitment from the surgeon and from the patient who has to undergo multiple operations and a long treatment over the years.

Adolescent↗
PubMed2004

[Humanitarian surgical mission. Coming home].

Every mission questions our motivation, our skills, and our efficiency through the discovery of a disconcerting world. Three points should be considered to keep a lucid commitment: to evaluate what we have done, which requires modesty; to testify to the courage, the beauty, the violence we have seen; to seek a meaning to the mission beyond the surgical frame: questioning our selves; isn't there a mission going farther the mission?

Altruism↗
PubMed2004

[Neonatal accidental burn by isopropyl alcohol].

Antiseptic solutions are commonly used for skin care but are not always safe. In preterm infants, application of antiseptic solutions can lead to serious burns. We report the case of a premature newborn who developed severe burns at 35 weeks post-conceptional age, after his mother used disposable antiseptic towels containing isopropyl alcohol for his skin care. Burns outcome led to diffuse skin burn and death of the baby. Several cases of isopropyl alcohol poisoning through skin absorption have been reported in neonate and infants. Because of its neonatal toxicity, isopropyl alcohol has been excluded from composition of antiseptic solutions commonly used in neonatology. However, isopropyl alcohol is still available in many housecleaning and cosmetic products, while its toxic effects in children are not clearly mentioned. A specific mention "toxic for infants and children" should appear on mass consumption products containing isopropyl alcohol. Moreover, health workers may individually inform parents about possible hazards of poisoning through skin absorption.

2-Propanol↗
PubMed2003

[Food allergy and asthma in children].

The links between food allergy and asthma are becoming more clear. The association of food allergy and asthma in the same child is unusual (less than 10% in atopic subjects). This association is however a sign of gravity leading to more severe manifestations of food allergy in asthmatic children. Compared with the non-asthmatic child, the asthmatic child has a 14-fold higher risk of developing a severe allergic reaction to the ingestion of food. The most commonly cited foods are fruits with a rind, cow's milk and, of course, nuts. Epidemiological data established from methodologically sound studies should enable a definition of the current allergic environment. Formal diagnosis is established with standardized tests. Treatment is oriented towards prevention associating a restricted diet, asthma control, patient education, and prescription of an emergency first aid kit with epinephrine. Supplementary inquiries are needed to determine the outcome in children with food allergy and respiratory symptoms.

Allergens↗
PubMed2002

[Lung abscess due to Mycoplasma pneumoniae in an adolescent].

UNLABELLED: Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.

Adolescent↗
PubMed2002

A stability analysis of a decentralized adaptive feedback active control system of sinusoidal sound in free space.

In some cases, the implementation of active control of sound in free space requires a large number of secondary sources and error sensors. In terms of control hardware, this may translate into considerable processing power requirement. A practical method to decrease processing power is to decentralize the control; that is, implement many single-input, single-output independent controllers operating simultaneously instead of a large multiple-input, multiple-output system. The main drawback of decentralized control is the risk of global instability. The purpose of this paper is to derive conditions under which globally stable control system behavior can be obtained in the case of adaptive feedback decentralized control for a sinusoidal disturbance. The main objective is to give practical conditions derived from the small gain theorem and the Nyquist criterion for the stability of the control system. These conditions only take into account the geometrical arrangement of the secondary sources and error sensors. This analysis involves a new parameter beta called "performance index," which is associated with both the convergence of the individual controllers and the global stability of the system. Simulation and experimental results are shown to illustrate the effectiveness of the developed analytical tools.

Feedback↗
PubMed2001

[The consequences of parental smoking in children: pediatricians must act].

Prenatal and childhood passive tobacco smoke exposure resulting from parental smoking may have severe side effects, such as low birth weight, prematurity, sudden infant death syndrome, upper and lower respiratory tract infections and asthma. By giving information to parents, and particularly by emphasizing the dangers of passive smoke exposure for their children, pediatricians have a critical role to play in their prevention. This may also be helpful for adolescents who are starting to smoke actively by trying to understand the needs that they express by this behavior, and encouraging them to go to a stop smoking counseling center.

Adolescent↗
PubMed2001

[Chronic cough in children: etiology and decision trees].

Recurrent or chronic cough can be the symptom of a worrying condition which must be diagnosed without delay (cystic fibrosis, asthma, bronchial foreign body, bronchiectasis). Investigation of recurrent or chronic cough is based on simple principles: careful history-taking concerning the characteristics of the cough, full clinical examination to look for any associated symptoms, and auxological assessment to detect any interruption in weight increase. Only when this initial evaluation has been carried out can complementary investigations be sought. Ordinary respiratory infections that are part of the building up of immunity are predominant in coughs of children aged under 6 years and are aggravated by deleterious factors such as passive exposure to tobacco, early introduction to communal life, and urban pollution. We describe the most frequent causes of cough and their frequency according to the age of the child.

Age Factors↗
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↗
PubMed2000

[Relationship between respiratory syncytial virus bronchiolitis and asthma].

Data of the literature over the last 20 years indicate that infantile asthma, although heterogeneous, often appears following RSV bronchiotitis, especially when sufficiently severe to justify hospitalisation. The risk of developing episodes of wheezing (bronchial obstruction syndrome) over the following 2 to 3 years is higher than 50%, but estimations vary according to the authors. Functional disturbances (pulmonary distension, nonspecific bronchial hypperreactivity, hypoxia), with or without associated clinical symptoms, may be observed several months to several years after hospitalisation for bronchiolitis. On the other hand, mild bronchiolitis, and most of the recurrent expiratory obstructive syndromes with asymptomatic free intervals between episodes do not appear to carry a risk of functional sequelae. Children suffering from severe bronchiolitis usually develop a severe bronchial obstruction syndrome. In asthma, the percentage of IgE-dependent sensitization is less than 20% before the age of 4 years. The presence of positive skin tests and/or specific serum IgE directed against the usual allergens are associated with the persistence of asthma during the childhood. Similarly, the appearance of wheezing after the age of 3 years (or recurrence after this age) is associated with the persistence of asthma. Prospective studies of cohorts followed since birth show that pre-existing functional abnormalities can promote the appearance of bronchiolitis and bronchial obstruction syndrome. Asthma in infants comprises several phenotypes with very different prognoses.

Asthma↗
PubMed1999

[What are the objectives of a humanitarian reconstructive plastic surgery mission?].

What is the place of plastic and reconstructive surgery within the field of general surgery in developing countries? A limited personal experience (15 missions, 220 operated patients), and a more extensive experience of colleagues working in the field for several years, constitute the starting point for discussion. General surgery represented 80% of all surgical activity in the 1970s, but has progressively become more specialized. Analysis of the type of operations shows that the most frequent techniques are simple procedures (skin grafts, local autoplasties). "Basic" plastic surgery corresponds to local possibilities and the population's real needs. The authors describe the demands usually encountered during their missions (Africa, South East Asia). They emphasize the long-term involvement of the same team, at the same site, with the same program to pass on knowledge and, for the surgeon, to experience the richness of another world.

Adult↗
PubMed1999

[Incisional hernia. Patient management. Approach to the future operated patients].

Incisional hernia, an abnormal orifice of the midline abdominal wall secondary to an operation, presents in a wide range of forms to the plastic surgeon: small orifice (< 6 cm) in a young, muscular subject, or vast defect (> 10 cm) in an obese subject who has undergone multiple operations, or who presents one or more diseases. Regardless of this presentation, the approach to the patient must always be just as rigorous, based on a precise assessment of the clinical signs. This clinical examination is irreplaceable, but is often insufficient, incomplete, and misleading. Only CT imaging of the abdominal wall provides a good analysis of the damage. Beyond the simple orifice, a large incisional hernia is responsible for a whole range of disease. This "incisional hernia disease", with its visceral and respiratory components, requires a multidisciplinary assessment. The anaesthetist and respiratory physician must assess the repercussions of this lesion and detect any risk factors. Based on this assessment, major incisional hernias (2/3 of the 350 operated patients of our series) require specific preparation involving the following elements: eradication of any site of wound infection, weight loss, muscle building, abdominal and chest physiotherapy, and pneumoperitoneum. Pneumoperitoneum according to the Goni Moreno protocol is an essential element of the preparation of the most difficult forms (irreducible, double, or complicated incisional hernias). Only this gaseous expansion of the abdomen can facilitate reintegration of the viscera and reconstruction of the abdominal wall. In our practice, the operation itself consists of 2 types of procedures: simple local abdominoplasty (e.g. Judd's technique) for small incisional hernias (about 20% of cases), or a combination of reconstitution of the deep fascia by extensive cleavage of the posterior sheath of the rectus abdominis and prosthesis. This prosthesis, which lines the fascial plane, is placed extraperitoneally. This technique, with several variants described here, is based on a similar concept to that promoted by Rives et al. and Stoppa et al. It is the preferred procedure in all large incisional hernias (80% in our experience). Patient selection, intensive preparation, meticulous technique, and intensive postoperative nursing give stable, solid results (90% of patients) and ensure optimal security, bearing in mind that repair of a large incisional hernia is always difficult and sometimes dangerous (1% mortality, 6 to 10% morbidity in all large series).

Abdominal Muscles↗
PubMed1999

[Incisional hernia repair techniques for the abdominal wall].

Incisional hernia repair has been the subject many publications over the last century. Suture techniques in one plane (Judd, 1912) or in several planes (Quenu, 1896) were described first. They remain suitable for the closure of small incisional hernias. Rectus abdominis sheath dissection techniques, also known as fascioplasties, then reinforced hernia repair by prolonging the anterior (Welti-Eudel, 1941) or posterior leaflet (Gibson, 1920) of the sheath. These plasties are still widely used, either alone, to repair medium-sized hernial orifices, or in combination with a prosthesis to repair large hernial orifices. Autologous tissues, such as fascia graft (Mac Arthur, 1901) or skin graft (Gossec, 1949) are now used because of the marked capacity of prostheses for secondary distension and their sensitivity to infection. Flaps, especially the tensor fasciae latae flap (Nahai, 1974), are indicated in infraumbilical incisional hernias in a septic context. Currently, only reinforcement prostheses can achieve lasting repair of large incisional hernias. Some teams still use intraperitoneal mesh implantation, but most teams prefer extraperitoneal implantation, generally associated with fascioplasty. Extraperitoneal mesh may be placed in a pre-musculo-aponeurotic or retromuscular position. Based on their experience, the authors opted for a pre-fascio-aponeurotic retromuscular prosthesis. They describe in detail the technique used and the results obtained based on the analysis of a series of 252 patients.

Abdominal Muscles↗