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Biomedical subjects

T Blanc

Publications and source records attributed to T Blanc.

At least 19 recordsLinked to original sources
PubMed2005

[Early spontaneous ileal perforations in preterm infants: report of 4 cases].

An ileal perforation occurred shortly after birth in 4 very premature newborns. Diagnosis was made on an abdominal distension with a pneumoperitoneum on X-ray. There were no biological, radiological nor histological signs of necrotizing enterocolitis. There were no digestive short- or long-term complications. According to the few authors who described this syndrome, there are some risk factors, but they were not clearly involved in our cases. Ileal perforation in the absence of signs of necrotizing enterocolitis is rarely reported but should be well known because of its good prognosis.

Diagnosis, Differential↗
PubMed2001

Prospective randomized multicenter comparison of high-frequency oscillatory ventilation and conventional ventilation in preterm infants of less than 30 weeks with respiratory distress syndrome.

BACKGROUND: Early use of high-frequency ventilation and exogenous surfactant is proposed as the optimal mode of ventilatory support in infants with respiratory distress syndrome. In very premature infants, we tested the hypothesis that high-frequency versus conventional ventilation could decrease exogenous surfactant requirements and improve pulmonary outcome, without altering the complication rate, including that of severe intraventricular hemorrhage. METHODS: Preterm infants with a postmenstrual age of 24 to 29 weeks, presenting with respiratory distress syndrome were randomly assigned to high-frequency oscillatory ventilation (lung volume recruitment strategy) or conventional ventilation. RESULTS: Two hundred seventy-three infants were enrolled. One hundred fifty-three had a postmenstrual age of 24 to 27 weeks, and 143 had a birth weight </=1000 g. One hundred thirty-four infants were randomized at 142 minutes of life (median) to receive conventional ventilation (mean postmenstrual age at birth: 27. 6 +/- 1.5 weeks; mean birth weight: 997 +/- 245 g); and 139 infants were randomized at 145 minutes of life to receive high-frequency ventilation (mean postmenstrual age at birth: 27.5 +/- 1.4 weeks; mean birth weight: 976 +/- 219 g). High-frequency ventilation, compared with conventional ventilation, was associated with a twofold reduction in the requirement for >/=2 instillations of exogenous surfactant (30% vs 62%; odds ratio:.27; 95% confidence interval:.16-.44) and no difference in pulmonary outcome. The incidence of severe intraventricular hemorrhage was 24% in the high-frequency group and 14% in the conventional ventilation group (adjusted odds ratio: 1.50; 95% confidence interval:.68-3.30). CONCLUSION: Early use of high-frequency oscillatory ventilation in very premature infants decreases exogenous surfactant requirements, does not improve the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage.

Bronchopulmonary Dysplasia↗
PubMed2001

[Os subfibulare in children secondary to an osteochondral fracture].

PURPOSE: The understanding of the os subfibulare in childhood. MATERIAL AND METHODS: A retrospective study of radiographs following for indirect ankle injury in childhood over a period of two years. RESULTS: The daily use of an oblique view during the exploration of ankle sprains in emergency has allowed us to image 12 small and linear chiplike fractures of the fibula by avulsion of the antero-medial part of the malleolar's tip where the talo-fibular collateral ligament is attached. Two children were reviewed one year after for a recurrent sprain: a larger and rounder fragment of bone has taken the place of the first piece of bone. CONCLUSION: Symptomatic ossicles of the lateral malleolus in children is frequently if not always the consequence of an avulsion of the tip of the fibula. The outcome of these children may be a localised tenderness and recurrent episodes of sprains for minimal injury due to the weakness of the lateral ligament.

Ankle Injuries↗
PubMed2000

Selectivity differences for C18 and C8 reversed-phase columns as a function of temperature and gradient steepness. I. Optimizing selectivity and resolution.

Four experimental runs where temperature T and gradient time tG are varied allow the computer-prediction of reversed-phase liquid chromatographic (RPLC) separation for different combinations of temperature and gradient time. This in turn can provide significant changes in selectivity and a resulting optimization of separation. If this procedure is repeated for different columns, additional control over selectivity and resolution becomes possible. The simultaneous variation of T and tG for columns from different sources was studied for two samples, as a means of evaluating the general advantage of this approach for RPLC method development. Changes in relative retention with T were found to be approximately constant for different values of tG and for different RPLC columns; similarly, changes in relative retention with tG were roughly independent of changes in temperature or the column. The latter relationships can be useful in matching ("tracking") peaks between runs during method development based on the present approach, as well as for other applications discussed in here and in Part II.

Chromatography, Liquid↗
PubMed2000

Selectivity differences for C18 and C8 reversed-phase columns as a function of temperature and gradient steepness. II. Minimizing column reproducibility problems.

The choice of T and tG as variables for controlling selectivity and resolution during reversed-phase liquid chromatography (RPLC) method development can be used to minimize problems caused by column batch-to-batch irreproducibility. When a new column fails to provide adequate separation of the sample, altered values of T and tG can be predicted that will restore the separation obtained with the previous column. Alternatively, columns from different manufacturers can be tested during method development, in order to find a common set of conditions (T and tG) that provide acceptable separation with two or more of these columns. In this way, any of several columns from different sources become usable for the method. Examples are shown of these different computer-assisted procedures for minimizing problems due to column variability.

Chromatography, Liquid↗
PubMed1999

[Recurrence of herpes simplex encephalitis].

UNLABELLED: Herpes simplex encephalitis (HSE) rarely occurs in children, is not easily diagnosed, and has a poor prognosis. CASE REPORT: We report a pediatric case with a relapse on the 29th day despite conventional acyclovir therapy. As the relapse mechanism is not clearly understood, antiviral and immunosuppressive therapy was administered. CONCLUSION: This case underlines the importance of clinical examination and the necessity of accurate testing prior stopping antiviral treatment. A better understanding of the relapse mechanism is required in order to propose more efficient treatment.

Acyclovir↗
PubMed1999

[Anaphylaxis in children and adolescents: apropos of 44 patients aged 2 months to 15 years].

The increase in frequency of anaphylaxis, an acute allergic reaction which may be fatal, might be explained by the rise in food allergy. We report a cohort of 44 children, aged 2 months to 15.5 years, who were admitted in a pediatric emergency unit for serious allergic events. Thirty-two percent, 86% and 66% presented hypotension, severe edema and respiratory distress, respectively. Three patients were admitted to the ICU. One-fourth of all children had an angioneurotic edema history, 1/3 were asthmatics and 41% had known allergy. Etiologies were: food allergy (42.5%), drugs (14.8%), respiratory allergy (9%), miscellaneous (14.8%), idiopathic (6.4%) and unknown because of incomplete investigations (12.4%). Three-fourths of food allergies were comprised of the expected protein categories (milk, nuts, eggs and fish). Nine children had an allergic relapse during the following months. We otherwise assessed that adrenaline was underused by the medical staff.

Adolescent↗
PubMed1997

Prognostic value of neonatal electroencephalography in premature newborns less than 33 weeks of gestational age.

In a prospective study of 417 premature neonates born before 33 weeks' gestational age, neonatal tracings were reviewed to evaluate the use of EEG in prognosis of neurological injuries. The population was divided into two groups: Group 1, infants who died before the age of 1, and Group 2, survivors in which two categories of motor development were considered. Category A, were abnormal, and Category B, were always normal. Positive rolandic sharp waves (PRSW), which reflect white matter injury, occurred equally in both groups, indicating a similar incidence of white matter damage in Groups 1 and 2. In Group 2, there was a significant correlation of PRSW with developmental motor sequelae (Category A). A frequency of PRSW above 2/min (suggesting more severe periventricular white matter injury) and seizures were significantly more prevalent in Group 1 than in Group 2 and in Category A of Group 2 than in Category B. Background abnormalities occurred equally in both subgroups of extremely premature infants (< or = 28 weeks' gestation) they were significantly more numerous in the subgroup of very premature infants (between 28 and 33 weeks' gestation) who died, than in the subgroup of very premature infants who survived. This study shows the potential utility of using neonatal EEG in association with transfontanellar ultrasonography in anticipating the neurological development of very (> 28 weeks' gestation) and extremely (< or = 28 weeks' gestation) premature newborns.

Asphyxia↗
PubMed1997

Comparing results of concurrent and retrospective designs in a hospital utilization review.

Hospital utilization reviews are performed on the basis of lists of explicit criteria, such as the Appropriateness Evaluation Protocol, both concurrently and retrospectively, in an increasing number of settings as part of efforts to improve the performance of hospitals and to reduce health care costs. Retrospective data collection has advantages in terms of expenses and ease of sampling, but relies on the quality of medical records. We report on a comparison between concurrent and retrospective data collection performed simultaneously and independently by two reviewers on the same hospital stays in the regional St-Loup Hospital. Results suggest that retrospective data collection produces higher rates of inappropriate hospital utilization, due to a limited number of criteria that are recorded concurrently, but are not found in the retrospective reading of medical records. These results should encourage a further investigation of the comparability between concurrent and retrospective designs in other settings.

Concurrent Review↗
PubMed1995

Medical appropriateness of hospital utilization: an overview of the Swiss experience.

We present here the principal results of four concurrent hospital utilization reviews conducted in Switzerland in 1990 and 1991, based on an adapted Appropriateness Evaluation Protocol. The studies were performed on all the hospital days from a sample of patients admitted over a 6 month period. The level of inappropriate use ranged between 8 and 15% in terms of days and was consistently higher in medicine than in surgery. In comparison with other published studies, the low proportion of observed inappropriate days is probably due, at least partly, to differences in study design.

Bias↗
PubMed1995

Infarct size-limiting properties of Ro 40-5967, a novel nondihydropyridine calcium channel, in anesthetized rats: comparison with verapamil.

We assessed the hemodynamic and infarct size (IS)-limiting effects of the new calcium antagonist Ro 40-5967 in a rat model of ischemia/reperfusion and compared the effects of Ro 40-5967 with those of verapamil. Open-chest rats underwent 20-min coronary occlusion followed by 2-h reperfusion. We determined area at risk (AAR) and IS at the end of reperfusion by India ink injection and triphenyltetrazolium chloride (TTC) staining, using computerized analysis of enlarged sections after color video acquisition. Ro 40-5967 [0.3 mg/kg intravenous (i.v.) bolus 15 min before ischemia + 0.3 mg/kg/h i.v. infusion] and verapamil (0.3 mg/kg followed by 0.3 mg/kg/h) induced significant and similar limitations of IS (percentage of AAR: controls, 61.2 +/- 3.5%; Ro 40-5967, 41.0 +/- 4.0%; verapamil, 43 +/- 4.8%; both p < 0.01 versus controls). The IS-limiting effect of Ro 40-5967 was not accompanied by any changes in heart rate (HR) or rate-pressure product (RPP), whereas verapamil decreased both HR and RPP throughout ischemia/reperfusion. In contrast, verapamil administered at a lower dose (0.03 mg/kg followed by 0.03 mg/kg/h), which induced hemodynamic effects similar to those of Ro 40-5967, had no effect on IS (57.1 +/- 5.2, p = NS). Furthermore, additional hemodynamic studies performed in noninfarcted rats showed that Ro 40-5967 exerted negative inotropic effects that were less marked than those induced by verapamil. Therefore, Ro 40-5967 exerts myocardial protective effects that appear to be independent of changes in systemic hemodynamics or myocardial contractility.

Anesthesia↗
PubMed1995

Myocardial and coronary endothelial protective effects of acetylcholine after myocardial ischaemia and reperfusion in rats: role of nitric oxide.

1. Recent experiments suggest that acetylcholine (ACh) may exert myocardial protective effects during ischaemia (I) and reperfusion (R). The present study was designed (i) to assess whether ACh limits infarct size and protects coronary endothelial cells in a rat model of I and R, (ii) to evaluate the role of ATP-sensitive potassium (KATP) channels and nitric oxide (NO) in the beneficial effect of ACh (iii) to evaluate whether the protective effect of ACh also extends to coronary endothelial cells and (iv) to assess whether ACh contributes to the beneficial effect of preconditioning. 2. Anaesthetized rats were subjected to 20 min I (left coronary artery occlusion) and 2 h of R. Infarct size was assessed by triphenyltetrazolium (TTC) staining and expressed as a % of the area at risk (India ink injection). Vascular studies were performed on 1.5-2 mm coronary segments (internal diameter 250-300 micros) removed distal to the site of occlusion and mounted in wire myographs. 3. ACh limited infarct size (from 59 +/- 3 to 26 +/- 5%, P < 0.01), and this was prevented by atropine (46 +/- 7%; P < 0.05 vs ACh), but not by the inhibitor of KATP channels, glibenclamide (29 +/- 8%). The inhibitor of NO synthesis NG-nitro L-arginine did not affect infarct size (54 +/- 5%) but abolished the beneficial effect of ACh (59 +/- 8%; P < 0.05 vs ACh), whereas the NO donor 3-morpholinosydnonimine-N-ethylcarbamide (SIN-1 limited infarct size to the same extent as ACh (28 +/- 6%). Preconditioning also limited infarct size (5 +/- 2%, P< 0.01 vs control), and this was not affected by atropine (6 +/- 2%). I and R induced a significant decrease in the endothelium-dependent relaxations of isolated coronary arteries toACh (maximal response: sham: 58+/-4; I/R: 25+/-5%; P<0.01) and this dysfunction was prevented by prior in vivo treatment with ACh (55+/-7%; P<0.01 vs I/R) or (SIN-1 50+/-5%; P<0.05 vs I/R).4 Thus, in the rat model, ACh is able to stimulate potent endogenous protective mechanisms during I and R, which are evident both at the level of myocardial and coronary endothelial cells, and appear entirely mediated through the production of NO. Pharmacological stimulation of this endogenous protective mechanism may constitute a new approach in the treatment of acute myocaridal ischaemia.

Acetylcholine↗
PubMed1994

SETH: an expert system for the management on acute drug poisoning in adults.

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of adult drug poisoning. SETH is developed with an off the shelf expert system shell (KBMS) and runs on a microcomputer. Technical choices were done according to this analysis, financial considerations and portability. Currently, the database contains 1000 French drugs from 75 different toxicological classes. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. Two phases of evaluation were performed. The experimental implementation of Seth began in April 1992 in our Poison Control Centre. Since then, 1100 cases inputted by residents were analysed by SETH. The extension of the knowledge base to child poisoning began in March 1993.

Acute Disease↗
PubMed1994

Role of endogenous endothelin in myocardial and coronary endothelial injury after ischaemia and reperfusion in rats: studies with bosentan, a mixed ETA-ETB antagonist.

1. Previous studies suggested that endothelin-1 (ET-1) may play a role in myocardial ischaemia and reperfusion. This study was designed to test the effect of a new nonpeptide antagonist of endothelin ETA and ETB receptors, bosentan, on myocardial infarct size, ventricular arrhythmias, and coronary endothelial dysfunction after ischaemia and reperfusion. 2. Anaesthetized male Wistar rats were subjected to 20 min ischaemia (left coronary artery occlusion) followed by 1 h (for the evaluation of coronary endothelial dysfunction) or 2 h (for the evaluation of infarct size) reperfusion, or 5 min ischaemia followed by 15 min reperfusion (for the evaluation of reperfusion arrhythmias). Vascular studies were performed on 1.5-2 mm coronary segments (internal diameter 250-300 microns) removed distal to the site of occlusion and mounted in wire myographs for isometric tension recording. Area at risk and infarct size were determined by Indian ink injection and triphenyl tetrazolium staining, using computerized analysis of enlarged sections after colour video acquisition. 3. Bosentan, administered at a dose which virtually abolished the pressor response to big ET-1 (3 mg kg-1, i.v. before ischaemia) did not affect heart rate, arterial pressure or the rate pressure product before ischaemia, during ischaemia and during reperfusion. Bosentan did not affect the incidence of reperfusion-induced ventricular fibrillation (controls: 86%, n = 14; bosentan: 93%, n = 15), and did not modify infarct size (% of area at risk: controls: 63 +/- 4, n = 10; bosentan: 60 +/- 6, n = 8). Ischaemia followed by reperfusion markedly reduced the endothelium-dependent relaxations to acetylcholine(maximal response: sham: 59 +/- 4%, n = 9; ischaemia-reperfusion: 26+/- 6%, n = 8; P<0.01), characteristic of reperfusion-induced endothelial dysfunction, and this dysfunction was not prevented by bosentan (maximal response to acetylcholine: 25 +/-5%, n = 9; P<0.01 vs sham; P = NS vs ischaemia/reperfusion).4. These experiments suggest that endogenous endothelin does not contribute to myocyte or coronary endothelial injury in this rat model of ischaemia and reperfusion.

Animals↗
PubMed1993

[Neonatal septicemia due to Pneumococcus resistant to beta-lactam antibiotics].

BACKGROUND: Neonatal sepsis due to Streptococcus pneumoniae is relatively rare. The increasing risk that this bacterium is resistant to betalactam antibiotics worsens its prognosis. CASE REPORT: A newborn was delivered by cesarean section because of an abnormal fetal heart rate pattern. Despite intubation, respiratory support and correction of acidosis, the baby remained cyanotic and displayed signs of shock. Neutropenia, increased percentage of immature neutrophils, high C-reactive protein levels and an X-ray pattern of pneumonia also indicated an infection. The child was given symptomatic therapy, and amoxicillin, cefotaxime and amikacin. Pneumococci type 9 were isolated from peripheral secretions and from the blood. Deterioration of the respiratory condition required higher doses of amoxicillin and cefotaxime on day 2 pending the results of antibiotic sensitivity testing. This test showed that the strains were resistant to beta-lactam antibiotics. On day 3, the treatment was replaced by a combination of vancomycin, rifampicin, amikacin and cefotaxime. This treatment was pursued for 2 weeks, except for rifampicin which was stopped after 2 days. The follow-up was uneventful. A search for pneumococci in the mother was negative. CONCLUSIONS: Streptococcus pneumoniae should always be considered as a cause of neonatal sepsis. Poor therapeutic control indicates resistance to beta-lactam antibiotics. This patient may be the first reported case of maternal-fetal infection with this resistant strain.

Anti-Bacterial Agents↗
PubMed1992

[Systemic gas embolism in the greater circulation in a ventilated premature infant].

BACKGROUND: Pneumothorax is common complication in newborns; its incidence is increased by intubation, particularly when high pressure ventilation is necessary. Systemic air embolism is a rare and usually fatal form of "displaced air". CASE REPORT: A preterm newborn, 27 weeks of gestational age, weighing 940 g, with respiratory distress syndrome was treated by intubation at 1 min of life and high pressure ventilation (Peak 36 cmH2O, PEP 6 cmH2O, FiO2 = 1). Bilateral pulmonary interstitial emphysema was seen on X-rays at 4 hr of life. Acute cyanosis and bradycardia occurred at 7 hr of life; large amounts of air mixed with blood were withdrawn from the umbilical vein catheter. There was no pneumothorax, pneumomediastinum or subcutaneous emphysema. The newborn died at 9 hr of life. Post mortem injection of contrast fluid into umbilical vein catheter indicated no cardiac perforation: this finding was confirmed by autopsy. CONCLUSION: This is a new case of systemic air embolism that may be due to high pressure ventilation in an extremely underweight newborn. Preventive measures consist of monitoring ventilation, possibly using new techniques, but their efficacy remain to be demonstrated.

Embolism, Air↗
PubMed1990

Free solution capillary electrophoresis and micellar electrokinetic resolution of amino acid enantiomers and peptide isomers with L- and D-Marfey's reagents.

Separation of amino acid enantiomers and peptide isomers has been made possible through the use of Marfey's reagent and high-performance capillary electrophoresis (HPCE). Samples of amino acids and peptides were first derivatized with Marfey's reagent and subsequently analyzed by HPCE. Different modes of separation were investigated including free solution and micellar electrokinetic chromatography. The use of micellar electrokinetic chromatography in combination with L- and D-Marfey's reagent offered unequivocal means to confirm the presence of D-amino acid in an unknown sample. This method is also particularly useful for the analysis of peptide isomers.

Alanine↗