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Tardieu M, Cudejko C, Cano A, Hoebeke C, Bernoux D, Goetz V, Pichard S, Brassier A, Schiff M, Feillet F, Rollier P, Mention K, Dobbelaere D, Fouilhoux A, Espil-Taris C, Eyer D, Huet F, Walther-Louvier U, Barth M, Chevret L, Kuster A, Lefranc J, Neveu J, Pitelet G, Ropars J, Rivier F, Roubertie A, Touati G, Vanhulle C, Tardieu E, Caillaud C, Froissart R, Champeaux M, Labarthe F, Chabrol B. Long-term follow-up of 64 children with classical infantile-onset Pompe disease since 2004: A French real-life observational study. Eur J Neurol 2023; 30:2828-2837. [PMID: 37235686 DOI: 10.1111/ene.15894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Classical infantile-onset Pompe disease (IOPD) is the most severe form of Pompe disease. Enzyme replacement therapy (ERT) has significantly increased survival but only a few studies have reported long-term outcomes. METHODS We retrospectively analyzed the outcomes of classical IOPD patients diagnosed in France between 2004 and 2020. RESULTS Sixty-four patients were identified. At diagnosis (median age 4 months) all patients had cardiomyopathy and most had severe hypotonia (57 of 62 patients, 92%). ERT was initiated in 50 (78%) patients and stopped later due to being ineffective in 10 (21%). Thirty-seven (58%) patients died during follow-up, including all untreated and discontinued ERT patients, and 13 additional patients. Mortality was higher during the first 3 years of life and after the age of 12 years. Persistence of cardiomyopathy during follow-up and/or the presence of heart failure were highly associated with an increased risk of death. In contrast, cross-reactive immunologic material (CRIM)-negative status (n = 16, 26%) was unrelated to increased mortality, presumably because immunomodulation protocols prevent the emergence of high antibody titers to ERT. Besides survival, decreased ERT efficacy appeared after the age of 6 years, with a progressive decline in motor and pulmonary functions for most survivors. CONCLUSIONS This study reports the long-term follow-up of one of the largest cohorts of classical IOPD patients and demonstrates high long-term mortality and morbidity rates with a secondary decline in muscular and respiratory functions. This decreased efficacy seems to be multifactorial, highlighting the importance of developing new therapeutic approaches targeting various aspects of pathogenesis.
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Affiliation(s)
- Marine Tardieu
- Centre de Référence des Maladies Héréditaires du Métabolisme ToTeM, Service de Médecine Pédiatrique, Hôpital Clocheville, Tours, France
| | - Céline Cudejko
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurométabolisme Pédiatrique, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - Aline Cano
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurométabolisme Pédiatrique, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - Célia Hoebeke
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurométabolisme Pédiatrique, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - Delphine Bernoux
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurométabolisme Pédiatrique, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - Violette Goetz
- Centre de Référence des Maladies Héréditaires du Métabolisme ToTeM, Service de Médecine Pédiatrique, Hôpital Clocheville, Tours, France
| | - Samia Pichard
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Métabolisme Pédiatrique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Anaïs Brassier
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Métabolisme Pédiatrique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Manuel Schiff
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Métabolisme Pédiatrique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - François Feillet
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Médecine Infantile, Hôpital Brabois Enfants; Unité INSERM NGERE U 1256, Campus Babrois-Santé, Vandœuvre-lès-Nancy, France
| | - Paul Rollier
- Service de Génétique Clinique, Site Hôpital Sud, Rennes, France
| | - Karine Mention
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service Néphrologie, Endocrinologie, Maladies Métaboliques et Hématologie Pédiatrique, Hôpital Jeanne de Flandre, Lille, France
| | - Dries Dobbelaere
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service Néphrologie, Endocrinologie, Maladies Métaboliques et Hématologie Pédiatrique, Hôpital Jeanne de Flandre, Lille, France
| | - Alain Fouilhoux
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service d'Endocrinologie et de Diabétologie Pédiatriques et Maladies Héréditaires du Métabolisme, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Caroline Espil-Taris
- Centre de Référence des Maladies Neuromusculaires AOC, Service de Neuropédiatrie, Hôpital des Enfants Pellegrin, Bordeaux, France
| | - Didier Eyer
- Service des Maladies Métaboliques, Hôpital de Hautepierre, Strasbourg, France
| | - Frédéric Huet
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Service de Pédiatrie Multidisciplinaire, Hôpital d'Enfants, Dijon, France
| | - Ulrike Walther-Louvier
- Centre de Référence des Maladies Neuromusculaires AOC, Service de Neuropédiatrie, Hôpital Gui de Chauliac, Montpellier, France
| | - Magalie Barth
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Service de Génétique, CHU Angers, Angers, France
| | - Laurent Chevret
- Service Pédiatrie et Urgences Pédiatriques, CH Saint-Brieuc, Saint-Brieuc, France
| | - Alice Kuster
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Service de Réanimation Pédiatrique, CHU Nantes, Nantes, France
| | | | - Julien Neveu
- Service de Neuropédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Gaele Pitelet
- Service de Neuropédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Juliette Ropars
- Centre de Référence Maladies Neuromusculaires AOC, Service de Neuropédiatrie, Hôpital Morvan, Brest, France
| | - François Rivier
- Centre de Référence des Maladies Neuromusculaires AOC, Service de Neuropédiatrie, Hôpital Gui de Chauliac, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Agathe Roubertie
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Service de Neurologie Pédiatrique, Hôpital Gui de Chauliac; INM, INSERM U 1298, Université de Montpellier, Montpellier, France
| | - Guy Touati
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Gastro-entérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Catherine Vanhulle
- Service de Néonatalogie et Réanimation Pédiatrique, Hôpital Charles Nicolle, Rouen, France
| | - Emilie Tardieu
- Service de Santé Universitaire, Université Lumière Lyon 2, Lyon, France
| | - Catherine Caillaud
- Service de Biochimie Métabolique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Roseline Froissart
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - Murielle Champeaux
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurométabolisme Pédiatrique, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - François Labarthe
- Centre de Référence des Maladies Héréditaires du Métabolisme ToTeM, Service de Médecine Pédiatrique, Hôpital Clocheville, Tours, France
- Inserm U1069, N2C, Université de Tours, Tours, France
| | - Brigitte Chabrol
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurométabolisme Pédiatrique, Hôpital Timone Enfants, AP-HM, Marseille, France
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Ditters IAM, Huidekoper HH, Kruijshaar ME, Rizopoulos D, Hahn A, Mongini TE, Labarthe F, Tardieu M, Chabrol B, Brassier A, Parini R, Parenti G, van der Beek NAME, van der Ploeg AT, van den Hout JMP, Mengel E, Hennermann J, Smitka M, Muschol N, Marquardt T, Marquardt M, Thiels C, Spada M, Pagliardini V, Menni F, della Casa R, Deodato F, Gasperini S, Burlina A, Donati A, Pichard S, Feillet F, Huet F, Mention K, Eyer D, Kuster A, Espil Taris C, Lefranc J, Barth M, Bruel H, Chevret L, Pitelet G, Pitelet C, Rivier F, Dobbelaere D. Effect of alglucosidase alfa dosage on survival and walking ability in patients with classic infantile Pompe disease: a multicentre observational cohort study from the European Pompe Consortium. The Lancet Child & Adolescent Health 2022; 6:28-37. [DOI: 10.1016/s2352-4642(21)00308-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022]
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Recher M, Bertrac C, Guillot C, Baudelet JB, Karaca‐Altintas Y, Hubert H, Leclerc F, Leteurtre S, Devictor D, Chevret L, Javouhey E, Vanel B, Valla F, Cambonie G, Milesi C, Liet J, Joram N, Hubert P, Dupic L, Ozanne B, Tirel O, Dauger S, Desprez P, Chantreuil J. Enhance quality care performance: Determination of the variables for establishing a common database in French paediatric critical care units. J Eval Clin Pract 2018; 24:767-771. [PMID: 29987866 PMCID: PMC6174952 DOI: 10.1111/jep.12984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
Selected variables for the French Paediatric Intensive Care registry. RATIONALE, AIMS, AND OBJECTIVES Providing quality care requires follow-up in regard to clinical and economic activities. Over the past decade, medical databases and patient registries have expanded considerably, particularly in paediatric critical care medicine (eg, the Paediatric Intensive Care Audit Network (PICANet) in the UK, the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry in Australia and New Zealand, and the Virtual Paediatric Intensive Care Unit Performance System (VPS) in the USA). Such a registry is not yet available in France. The aim of this study was to determine variables that ought to be included in a French paediatric critical care registry. METHODS Variables, items, and subitems from 3 foreign registries and 2 French local databases were used. Items described each variable, and subitems described items. The Delphi method was used to evaluate and rate 65 variables, 90 items, and 17 subitems taking into account importance or relevance based on input from 28 French physicians affiliated with the French Paediatric Critical Care Group. Two ratings were used between January and May 2013. RESULTS Fifteen files from 10 paediatric intensive care units were included. Out of 65 potential variables, 48 (74%) were considered to be indispensable, 16 (25%) were considered to be optional, and 1 (2%) was considered to be irrelevant. Out of 90 potential items, 62 (69%) were considered to be relevant, 23 (26%) were considered to be of little relevance, and 5 (6%) were considered to be irrelevant. Out of 17 potential subitems, 9 (53%) were considered to be relevant, 6 (35%) were considered to be of little relevance, and 2 (12%) were considered to be irrelevant. CONCLUSIONS The necessary variables that ought to be included in a French paediatric critical care registry were identified. The challenge now is to develop the French registry for paediatric intensive care units.
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Affiliation(s)
- Morgan Recher
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
| | | | | | - Jean Benoit Baudelet
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
| | | | - Hervé Hubert
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
- French National Out‐of‐Hospital Cardiac Arrest Registry (RéAC)LilleFrance
| | - Francis Leclerc
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
| | - Stéphane Leteurtre
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
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Essouri S, Baudin F, Chevret L, Vincent M, Emeriaud G, Jouvet P. Variability of Care in Infants with Severe Bronchiolitis: Less-Invasive Respiratory Management Leads to Similar Outcomes. J Pediatr 2017; 188:156-162.e1. [PMID: 28602381 DOI: 10.1016/j.jpeds.2017.05.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the management of children with severe bronchiolitis requiring intensive care (based on duration of ventilatory support and duration of pediatric intensive care unit [PICU] stay) in 2 countries with differing pediatric transport and PICU organizations. STUDY DESIGN This was a prospective observational care study in 2 PICUs of tertiary care university hospitals, 1 in France and 1 in Canada. All children with bronchiolitis who required admission to the PICU between November 1, 2013, and March 31, 2014, were included. RESULTS A total of 194 children were included. Baseline characteristics and illness severity were similar at the 2 sites. There was a significant difference between centers in the use of invasive ventilation (3% in France vs 26% in Canada; P < .0001). The number of investigations performed from admission to emergency department presentation and during the PICU stay was significantly higher in Canada for both chest radiographs and blood tests (P < .001). The use of antibiotics was significantly higher in Canada both before (60% vs 28%; P < .001) and during (72% vs 33%; P < .0001) the PICU stay. The duration of ventilatory support, median length of stay, and rate of PICU readmission were similar in the 2 centers. CONCLUSION Important differences in the management of children with severe bronchiolitis were observed during both prehospital transport and PICU treatment. Less invasive management resulted in similar outcomes with in fewer complications.
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Affiliation(s)
- Sandrine Essouri
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada; Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Kremlin Bicêtre, Paris South University, Le Kremlin Bicêtre, France.
| | - Florent Baudin
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Université Lyon, Bron, France
| | - Laurent Chevret
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Kremlin Bicêtre, Paris South University, Le Kremlin Bicêtre, France
| | - Mélanie Vincent
- Division of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Philippe Jouvet
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
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Moh-Klaren J, Bodivit G, Jugie M, Chadebech P, Chevret L, Mokhtari M, Chamillard X, Gallon P, Tissières P, Bierling P, Djoudi R, Pirenne F, Burin-des-Roziers N. Severe hemolysis after plasma transfusion in a neonate with necrotizing enterocolitis, Clostridium perfringens
infection, and red blood cell T-polyagglutination. Transfusion 2017. [DOI: 10.1111/trf.14196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Gwellaouen Bodivit
- Etablissement Français du Sang (EFS) Ile-de-France; Paris
- INSERM U955, Équipe 2 “Transfusion et Maladies du Globule Rouge”; Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil Val-de-Marne (UPEC), Créteil; Laboratoire d'Excellence GR-Ex; Paris
| | - Myriam Jugie
- Réanimation Chirurgicale Pédiatrique; Hôpital Necker-Enfants Malades; Paris
| | - Philippe Chadebech
- Etablissement Français du Sang (EFS) Ile-de-France; Paris
- INSERM U955, Équipe 2 “Transfusion et Maladies du Globule Rouge”; Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil Val-de-Marne (UPEC), Créteil; Laboratoire d'Excellence GR-Ex; Paris
| | - Laurent Chevret
- Réanimation Pédiatrique et Néonatale; Le Kremlin Bicêtre France
| | | | | | - Philippe Gallon
- Unité d'Hémovigilance; Hôpital Bicêtre; Le Kremlin Bicêtre France
| | | | - Philippe Bierling
- Etablissement Français du Sang (EFS) Ile-de-France; Paris
- INSERM U955, Équipe 2 “Transfusion et Maladies du Globule Rouge”; Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil Val-de-Marne (UPEC), Créteil; Laboratoire d'Excellence GR-Ex; Paris
| | - Rachid Djoudi
- Etablissement Français du Sang (EFS) Ile-de-France; Paris
| | - France Pirenne
- Etablissement Français du Sang (EFS) Ile-de-France; Paris
- INSERM U955, Équipe 2 “Transfusion et Maladies du Globule Rouge”; Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil Val-de-Marne (UPEC), Créteil; Laboratoire d'Excellence GR-Ex; Paris
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Burin des Roziers N, Chadebech P, Bodivit G, Guinchard E, Bruneel A, Dupré T, Chevret L, Jugie M, Gallon P, Bierling P, Noizat-Pirenne F. Red blood cell Thomsen-Friedenreich antigen expression and galectin-3 plasma concentrations in Streptococcus pneumoniae-associated hemolytic uremic syndrome and hemolytic anemia. Transfusion 2014; 55:1563-71. [PMID: 25556575 DOI: 10.1111/trf.12981] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pneumococcal hemolytic uremic syndrome (P-HUS) is a rare but severe complication of invasive pneumococcal disease (IPD) in young children. Consensual biologic diagnosis criteria are currently lacking. STUDY DESIGN AND METHODS A prospective study was conducted on 10 children with culture-confirmed IPD. Five presented with full-blown P-HUS, three had an incomplete form with hemolytic anemia and mild or no uremia (P-HA), and two had neither HUS nor HA. Thomsen-Friedenreich (T), Th, and Tk cryptantigens and sialic acid expression were determined on red blood cells (RBCs) with peanut (PNA), Glycine soja (SBA), Bandeiraea simplicifolia II, and Maackia amurensis lectins. Plasma concentrations of the major endogenous T-antigen-binding protein, galectin-3 (Gal-3), were analyzed. RESULTS We found that RBCs strongly reacted with PNA and SBA lectins in all P-HUS and P-HA patients. Three P-HUS and three P-HA patients showed also concomitant Tk activation. Direct antiglobulin test (DAT) was positive in three P-HUS (one with anti-C3d and two with anti-IgG) and two P-HA patients (one with anti-C3d and one with anti-IgG). RBCs derived from the two uncomplicated IPD patients reacted with PNA but not with SBA lectin. Gal-3 plasma concentrations were increased in all P-HUS patients. CONCLUSIONS The results indicate high levels of neuraminidase activity and desialylation in both P-HUS and P-HA patients. T-antigen activation is more sensitive than DAT for P-HUS diagnosis. Combining PNA and SBA lectins is needed to improve the specificity of T-antigen activation. High concentrations of Gal-3 in P-HUS patients suggest that Gal-3 may contribute to the pathogenesis of P-HUS.
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Affiliation(s)
| | - Philippe Chadebech
- Etablissement Français du Sang Ile de France, Villejuif, France.,Inserm UMR955, Créteil, France
| | - Gwellaouen Bodivit
- Etablissement Français du Sang Ile de France, Villejuif, France.,Inserm UMR955, Créteil, France
| | | | - Arnaud Bruneel
- Laboratoire de Biochimie Métabolique et Cellulaire, Hôpital Bichat, Paris, France
| | - Thierry Dupré
- Laboratoire de Biochimie Métabolique et Cellulaire, Hôpital Bichat, Paris, France
| | - Laurent Chevret
- Réanimation Pédiatrique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Myriam Jugie
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Philippe Gallon
- Etablissement Français du Sang Ile de France, Villejuif, France
| | - Philippe Bierling
- Etablissement Français du Sang Ile de France, Villejuif, France.,Inserm UMR955, Créteil, France
| | - France Noizat-Pirenne
- Etablissement Français du Sang Ile de France, Villejuif, France.,Inserm UMR955, Créteil, France
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Puccinelli F, Deiva K, Bellesme C, Durand P, Chevret L, Husson B, Sachet M, Ducreux D, Saliou G. Cerebral venous thrombosis after embolization of pediatric AVM with jugular bulb stenosis or occlusion: management and prevention. Eur J Paediatr Neurol 2014; 18:766-73. [PMID: 25130940 DOI: 10.1016/j.ejpn.2014.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/29/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Thrombosis of cerebral arteriovenous malformation after embolization is rare, but can involve the normal venous network with extensive venous thrombosis. We report angioarchitecture findings, our management and prevention strategy for this complication in pediatric AVMs. METHODS In this 5.5-year retrospective series, we reviewed records of 13 patients under 15 years who were anticoagulated after embolization. In our initial experience 4 children who didn't receive any prophylactic anticoagulation presented with extensive venous thrombosis after embolization (group 1). Following this, nine children with similar angioarchitecture and embolization modalities were treated with prophylactic anticoagulation immediately after embolization (group 2). We analyzed the type of AVM, angioarchitecture, dose of prophylactic anticoagulant, efficacy/complications of treatment and late outcome. RESULTS All patients in group 1 had severe jugular bulb stenosis/occlusion associated with cerebral venous dilatation. In group 2 with similar angioarchitecture, only three patients (33%) developed extensive thrombosis. In both groups, thrombosis occurred within two days of treatment in six children and two weeks in one child. The diagnosis was suspected on intracranial hypertension in five patients and occulomotor disorder in one. One was asymptomatic. All children were treated with therapeutic doses of LMWH (anti-Xa: 0.5-1). No hemorrhagic complications occurred. Good venous remodeling was observed in all but one patient. CONCLUSION Anticoagulation in extensive venous thrombosis after AVM embolization in children appears to be safe and effective. In cases with angioarchitectural features of dilatation of the cerebral venous network and occlusion/severe stenosis of the jugular bulbs, full dose anticoagulation may be required to prevent thrombosis.
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Affiliation(s)
- F Puccinelli
- Service de Neuroradiologie, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France; National Referral Center for Neurovascular Malformations in Children, France
| | - K Deiva
- Service de Neurologie pédiatrique, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - C Bellesme
- Service de Neurologie pédiatrique, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - P Durand
- Service de Réanimation pédiatrique, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - L Chevret
- Service de Réanimation pédiatrique, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - B Husson
- Service de Radiologie pédiatrique, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - M Sachet
- Service de Neuroradiologie, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France; National Referral Center for Neurovascular Malformations in Children, France
| | - D Ducreux
- Service de Neuroradiologie, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France; National Referral Center for Neurovascular Malformations in Children, France
| | - G Saliou
- Service de Neuroradiologie, CHU Bicêtre, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre Cedex, France; National Referral Center for Neurovascular Malformations in Children, France.
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Denier C, Balu L, Husson B, Nasser G, Burglen L, Rodriguez D, Labauge P, Chevret L. Familial acute necrotizing encephalopathy due to mutation in the RANBP2 gene. J Neurol Sci 2014; 345:236-8. [PMID: 25128471 DOI: 10.1016/j.jns.2014.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute necrotizing encephalopathy (ANE) is a rare and severe parainfectious central nervous system disease in which previously healthy children develop rapidly progressive coma following viral illness. While most ANE are sporadic, familial autosomal dominant ANE due to mutations in the RANBP2 gene has been recently reported (ANE1 or infection-induced acute encephalopathy-3 (IIAE3)). To date, only few IIAE3 families with ADANE episodes have been described. OBJECTIVE To report a new family with ADANE, describe clinical and radiological features and discuss differential diagnosis including Leigh syndrome or multiple sclerosis. OBSERVATION The family included 3 symptomatic individuals and one 59 year-old asymptomatic obligate carrier. Patients presented acute episodes of encephalopathy few days after common viral infection. Ages of onset ranged from 6 months to 5 years. Episodes not only occurred in childhood but also recurred in adulthood. Initial neurological signs included coma, focal neurological deficits and seizures. MRI showed typical necrotizing lesions primarily in the thalamus and brainstem, and in the temporal lobes and insula. CSF cell count and cultures were normal during episodes. RANBP2 gene screening identified pathogenic heterozygous c.1754C>T mutation (p.Thr585Met). Episodes led to cognitive or physical handicap in 2 patients and were fatal in one child. CONCLUSION IIAE3 or ADANE due to RANBP2 mutations has a large clinical heterogeneity. Our family illustrates the associated phenotypes from asymptomatic carrier to severe episodes of encephalopathy. Based on MRI features, the genetic IIAE3 diagnosis is important since prophylaxis and symptomatic management of infections may be beneficial, possibly in association with steroid or gammaglobulins.
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Affiliation(s)
- Christian Denier
- Department of Neurology, Bicêtre Hospital, Assistance-Publique-Hôpitaux de Paris (AP-HP), France.
| | - Laurent Balu
- Department of Pediatry, Bicêtre Hospital, Assistance-Publique-Hôpitaux de Paris (AP-HP), France
| | - Béatrice Husson
- Department of Radiology, Bicêtre Hospital, Assistance-Publique-Hôpitaux de Paris (AP-HP), France
| | - Ghaidaa Nasser
- Department of Radiology, Bicêtre Hospital, Assistance-Publique-Hôpitaux de Paris (AP-HP), France
| | - Lydie Burglen
- Department of Genetics, Trousseau Hospital, AP-HP, France
| | - Diana Rodriguez
- Department of Pediatry, Robert Debré Hospital, AP-HP, France
| | | | - Laurent Chevret
- Department of Neurology, Bicêtre Hospital, Assistance-Publique-Hôpitaux de Paris (AP-HP), France
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Duché M, Ducot B, Ackermann O, Baujard C, Chevret L, Frank-Soltysiak M, Jacquemin E, Bernard O. Experience with endoscopic management of high-risk gastroesophageal varices, with and without bleeding, in children with biliary atresia. Gastroenterology 2013; 145:801-7. [PMID: 23792202 DOI: 10.1053/j.gastro.2013.06.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/05/2013] [Accepted: 06/15/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Biliary atresia, the most common cause of childhood cirrhosis, increases the risks for portal hypertension and gastrointestinal bleeding. We report the results from a single-center study of primary and secondary prophylaxis of bleeding in children with portal hypertension and high-risk varices. METHODS We collected data from 66 children with major endoscopic signs of portal hypertension, including grade 3 esophageal varices or grade 2 varices with red wale markings and/or gastric varices, treated consecutively from February 2001 through May 2011. Thirty-six children (mean age, 22 mo) underwent primary prophylaxis (sclerotherapy and/or banding, depending on age and weight). Thirty children (mean age, 24 mo) who presented with gastrointestinal bleeding received endoscopic treatment to prevent a relapse of bleeding (secondary prophylaxis). RESULTS In the primary prophylaxis group, a mean number of 4.2 sessions were needed to eradicate varices; no bleeding from gastroesophageal varices was observed after eradication. Varices reappeared in 37% of children, and 97% survived for 3 years. In the secondary prophylaxis group, a mean number of 4.6 sessions was needed to eradicate varices. Varices reappeared in 45%, and 10% had breakthrough bleeding; 84% survived for 3 years. There were no or only minor complications of either form of prophylaxis. CONCLUSIONS Endoscopic therapy as primary or secondary prophylaxis of bleeding appears to be well tolerated and greatly reduces the risk of variceal bleeding in children with biliary atresia and high-risk gastroesophageal varices. However, there is a risk that varices will recur, therefore continued endoscopic surveillance is needed.
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Affiliation(s)
- Mathieu Duché
- Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; Université Paris-Sud 11, Le Kremlin-Bicêtre, France; Radiologie Pédiatrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
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10
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Le Saché N, Afanetti M, Deiva K, Chevret L, Tissières P. Fulminant toxic shock syndrome following rituximab therapy in an 11-year-old boy. J Neurol 2013; 260:2892-3. [PMID: 24052118 DOI: 10.1007/s00415-013-7107-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Nolwenn Le Saché
- Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals AP-HP, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
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11
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Deiva K, Chevret L, Tissieres P. Les encéphalites non infectieuses en réanimation pédiatrique. Réanimation 2013. [DOI: 10.1007/s13546-012-0625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Ackermann O, Branchereau S, Franchi-Abella S, Pariente D, Chevret L, Debray D, Jacquemin E, Gauthier F, Hill C, Bernard O. The long-term outcome of hepatic artery thrombosis after liver transplantation in children: role of urgent revascularization. Am J Transplant 2012; 12:1496-503. [PMID: 22390346 DOI: 10.1111/j.1600-6143.2011.03984.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hepatic artery thrombosis (HAT), one of the most severe complications of pediatric orthotopic liver transplantation (OLT), often compromises graft and/or child survival. Of 590 OLT performed in 516 children over a 20-year period, 45 were complicated by early HAT, during the first 2 weeks after transplantation. Systematic Doppler ultrasonographic detection of HAT allowed successful surgical revascularization in 19 instances, resulting in a 20-year graft survival rate of 77% versus 24% of cases when revascularization was not attempted or failed. A combination of surgical emergency revascularization, biliary interventional radiology, biliary surgery and/or retransplantation resulted in an 80% 20-year patient survival rate, identical to that of transplanted children who did not experience early HAT. The majority of long-term survivors with their initial graft had normal liver tests, no biliary dilation on ultrasonography and minimal or moderate fibrosis on liver histology. A failed attempt at revascularization did not significantly alter patient survival. Despite these encouraging results, for the children and their parents to overcome the entire process in terms of reoperations, repeated radiological interventions, number of hospitalizations and emotional stress, remains an ordeal of such magnitude that it justifies renewed efforts to progress in the prevention of this complication.
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Affiliation(s)
- O Ackermann
- Hépatologie Pédiatrique, Hôpital Bicêtre, APHP, Assistance Publique - Hôpitaux de Paris, France and Université Paris Sud 11, Paris, France.
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13
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Abstract
Acute liver failure (ALF) is a rare but devastating syndrome. ALF in children differs from that observed in adults in both the etiologic spectrum and the clinical picture. Specific therapy to promote liver recovery is often not available and the underlying cause of the liver failure is often not determined. Management requires a multidisciplinary approach and should focus on preventing or treating complications and arranging for early referral to a transplant center. Although liver transplantation has increased the chance of survival, children who have ALF still face an increased risk of death, both while on the waiting list and after emergency liver transplantation. This article will review the current knowledge of the epidemiology, pathobiology and treatment of ALF in neonates, infants and children, and discuss some recent controversies.
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Affiliation(s)
- Denis Devictor
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, APHP-Bicêtre Hospital, Paris 11-Sud University, 94275 Le Kremlin-Bicêtre, France.
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Essouri S, Durand P, Chevret L, Balu L, Devictor D, Fauroux B, Tissières P. Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med 2011; 37:2002-7. [DOI: 10.1007/s00134-011-2372-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 05/06/2011] [Indexed: 11/28/2022]
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15
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Orostegui L, Balu L, Chevret L, Habes D, Pussard E. Community management of anti-malarials in Africa and iatrogenic risk. J Trop Pediatr 2011; 57:225-6. [PMID: 20807830 DOI: 10.1093/tropej/fmq074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distribution of anti-malarials at the community level is one of the interventions recommended to reduce mortality from febrile illnesses. Inappropriate treatment of fever with anti-malarials may result in missed diagnosis and delays in appropriate treatments including consideration of other illnesses than malaria. We report the case of an 8-year-old black girl receiving prophylaxis with sulfadoxine-pyrimethamine from the caretaker of the community during her holidays in Ivory Coast. A persistent fever suspected to be due to malaria was treated inappropriately with atovaquone-proguanil and then with sulfadoxine-pyrimethamine again. Cumulative toxicity of anti-malarials leads to irreversible hepatic damages requiring hepatic transplantation. Community caretakers must be aware of the potential side effects and the contraindications of anti-malarials. Early identification of drug-induced toxicity and immediate discontinuation of the drug are the more effective tools to limit the progression of tissue damage.
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Affiliation(s)
- Lupé Orostegui
- Service de Pharmacologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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16
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El Choueiry E, Cuzon G, Dugelay F, Chevret L, Durand P, Bergounioux J. [Necrotizing community-acquired Staphylococcus aureus pneumonia]. Arch Pediatr 2011; 18:767-71. [PMID: 21565474 DOI: 10.1016/j.arcped.2011.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/27/2010] [Accepted: 04/03/2011] [Indexed: 11/28/2022]
Abstract
Acute necrotizing pneumonia due to Panton-Valentine secreting Staphylococcus aureus was identified as a clinical entity by Gilet et al., in 2002. This severe acute necrotizing pneumonia occurring in previously healthy children and adolescents can lead to a rapid fatal outcome even if quickly diagnosed and treated. We report the case of a healthy 10-year-old girl presenting with hemorrhagic necrotizing pneumonia and septic shock. Bacteriological cultures yielded methicillin-susceptible Staphylococcus aureus. The course of the disease was characterized by recurrent uncontrolled hemoptysia leading to refractory hypoxemia. The details of the hospital stay are presented. We discuss the clinical features of the disease and describe recent epidemiologic data and Panton-Valentine toxin research results as well as primary hospital care and treatment.
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Affiliation(s)
- E El Choueiry
- Service de réanimation pédiatrique polyvalente, hôpital de Bicêtre, 63, avenue Gabriel-Péri, 94270 Le-Kremlin-Bicêtre, France
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17
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Deiva K, Sothratanak S, Husson B, Chevret L, Landrieu P. Febrile brain stroke and tuberculous meningitis: persisting threat in non-endemic countries. Neuropediatrics 2010; 41:273-5. [PMID: 21445820 DOI: 10.1055/s-0031-1273706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tuberculous meningitis is uncommon in western countries and its outcome is poor when it is not diagnosed and treated in good time. Here, we present a case of febrile brain stroke revealing a tuberculous arachnoiditis in a 13-month-old infant living in a non-endemic country. Thanks to prompt specific antibiotherapy, the clinical outcome was globally favourable in spite of the occurrence of an asymptomatic brain tuberculoma, which disappeared spontaneously. Although tuberculous meningitis is rare in non-endemic countries, it must be evoked in strokes occurring in a febrile context.
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Affiliation(s)
- K Deiva
- Pediatric Neurology Department, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France.
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18
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Aghakhani N, Durand P, Chevret L, Parker F, Devictor D, Tardieu M, Tadié M. Decompressive craniectomy in children with nontraumatic refractory high intracranial pressure. Clinical article. J Neurosurg Pediatr 2009; 3:66-9. [PMID: 19119908 DOI: 10.3171/2008.10.peds08116] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this study, the authors investigated the clinical efficacy of decompressive craniectomy treatments for nontraumatic intracranial hypertension in children. METHODS Seven patients with nontraumatic refractory high intracranial pressure (ICP) were enrolled in the study between 1995 and 2005; there were 2 boys and 5 girls with a mean age of 9 years (range 4-14). Decompressive craniectomy was performed in all patients after standard medical therapy had proven insufficient and ICP remained > 50 mm Hg. All patients had a Glasgow Coma Scale score < 8 at admission and a mean Pediatric Risk of Mortality Scale score of 20 (range 10-27). RESULTS One patient died of persistent high ICP and circulatory failure 48 hours after surgery. Six months later, according to their Glasgow Outcome Scale scores, 3 patients had adequate recoveries, 2 patients recovered with moderate disabilities, and 1 patient had severe disabilities. According to the Pediatric Overall Performance Category Scale, 4 patients received a score of 2 (mild disability), 1 a score of 3 (moderate disability), and 1 a score of 4 (severe disability). Five patients returned to school and normal life. CONCLUSIONS The authors found decompressive craniectomy to be an effective and lifesaving technique in children. This procedure should be included in the arsenal of treatments for nontraumatic intracranial hypertension.
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Affiliation(s)
- Nozar Aghakhani
- Department of Neurosurgery, Bicêtre University Hospital, Bicêtre, France. nozar.
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Fouquet V, Franchi S, Chevret L, Branchereau S, Martelli H, Jacquemin E, Bernard O, Gauthier F. SFCP-033 – Chirurgie viscérale – Transplantation hépatique pour atrésie des voies biliaires avec et sans syndrome de polysplénie. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)71985-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Lefort A, Mainardi J, Bretagne S, Podglajen I, Chevret L, Gay-Andrieu F, Treilhaud M. E-06 Endocardites aspergillaires à l’ère des nouveaux traitements antifongiques. Med Mal Infect 2008. [DOI: 10.1016/s0399-077x(08)73108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Lefort A, Mainardi JL, Bretagne S, Podglajen I, Chevret L, Gay-Andrieu F, Treilhaud M, Sidi D, Bougnoux ME, Dannaoui E, Dromer F, Lortholary O. Endocardites aspergillaires à l’ère des nouveaux traitements antifongiques. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Boichard A, Venet L, Naas T, Boutron A, Chevret L, de Baulny HO, De Lonlay P, Legrand A, Nordman P, Brivet M. Two silent substitutions in the PDHA1 gene cause exon 5 skipping by disruption of a putative exonic splicing enhancer. Mol Genet Metab 2008; 93:323-30. [PMID: 18023225 DOI: 10.1016/j.ymgme.2007.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 09/28/2007] [Accepted: 09/28/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND Synonymous mutations within exons may cause aberrant splicing by disrupting exonic splicing enhancer (ESE) motifs in the vicinity of non consensus splice sites. Mutational analysis of PDHA1 revealed only one silent single nucleotide substitution in exon 5 in two unrelated boys and a girl (c.483C>T and c.498C>T variants, respectively). For both patients, pyruvate dehydrogenase complex activity was low and the immunoreactive E1alpha protein was defective in cultured fibroblasts. METHODS AND RESULTS One of the boys was a somatic mosaic for the c.483C>T variant, as shown by the variable ratio of mutant to normal alleles in fibroblast, lymphocyte and single hair root DNA. Transcript analysis in fibroblasts from the three patients revealed the presence of both normal and truncated cDNAs, with the splicing out of exon 5 predicted to result in a frame shift and premature termination (p.Arg141AlafsX11). The treatment of fibroblasts with emetine before harvesting to prevent nonsense mRNA-mediated decay increased the amount of mutant mRNA. In silico analysis revealed that each variant disrupted a putative SRp55 binding site and that the intron 5 donor splice site (5'ss) contained a weak splicing signal. Transient transfection of COS-7 or Hela cells with hybrid minigene constructs containing wild-type or mutant PDHA1 exon 5, followed by RT-PCR demonstrated that each variant resulted in the incomplete inclusion of PDHA1 exon 5, and that this defect was corrected following the restoration of a perfect consensus sequence for the 5' splice site by site-directed mutagenesis. CONCLUSION These two synonymous mutations expand the spectrum of rare PDHA1 splicing mutations, all of which are located in non canonical splice sites.
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Affiliation(s)
- A Boichard
- Biochemistry laboratory, AP-HP hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Durand P, Chevret L, Essouri S, Haas V, Devictor D. Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children. Intensive Care Med 2008; 34:888-94. [PMID: 18259726 DOI: 10.1007/s00134-008-1021-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 01/16/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether respiratory variations in aortic blood flow velocity (DeltaVpeak ao), systolic arterial pressure (DeltaPS) and pulse pressure (DeltaPP) could accurately predict fluid responsiveness in ventilated children. DESIGN AND SETTING Prospective study in a 18-bed pediatric intensive care unit. PATIENTS Twenty-six children [median age 28.5 (16-44) months] with preserved left ventricular (LV) function. INTERVENTION Standardized volume expansion (VE). MEASUREMENTS AND MAIN RESULTS Analysis of aortic blood flow by transthoracic pulsed-Doppler allowed LV stroke volume measurement and on-line DeltaVpeak ao calculation. The VE-induced increase in LV stroke volume was >15% in 18 patients (responders) and <15% in 8 (non-responders). Before VE, the DeltaVpeak ao in responders was higher than that in non-responders [19% (12.1-26.3) vs. 9% (7.3-11.8), p=0.001], whereas DeltaPP and DeltaPS did not significantly differ between groups. The prediction of fluid responsiveness was higher with DeltaVpeak ao [ROC curve area 0.85 (95% IC 0.99-1.8), p=0.001] than with DeltaPS (0.64) or DeltaPP (0.59). The best cut-off for DeltaVpeak ao was 12%, with sensitivity, specificity, and positive and negative predictive values of 81.2%, 85.7%, 93% and 66.6%, respectively. A positive linear correlation was found between baseline DeltaVpeak ao and VE-induced gain in stroke volume (rho=0.68, p=0.001). CONCLUSIONS While respiratory variations in aortic blood flow velocity measured by pulsed Doppler before VE accurately predict the effects of VE, DeltaPS and DeltaPP are of little value in ventilated children.
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Affiliation(s)
- Philippe Durand
- Pediatric Intensive Care Unit, Bicêtre Hospital, 78 rue du Gal Leclerc, 94275 Le Kremlin Bicêtre, France.
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Chevret L, Husson B, Nguefack S, Nehlig A, Bouilleret V. Prolonged refractory status epilepticus with early and persistent restricted hippocampal signal MRI abnormality. J Neurol 2008; 255:112-6. [PMID: 18204804 DOI: 10.1007/s00415-008-0713-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 07/06/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
Abstract
We report a series of four children with a prolonged refractory status epilepticus with an early persistent and restricted hippocampal signal MRI abnormality but otherwise no proven etiology. The mean duration of status epilepticus was 53 days (range, 20-91 days) with a mean length of stay in Pediatric Intensive Care Unit (PICU) of 2 months (range, 26-115 days). Neurological outcome showed epilepsy disease in all, and mild to severe disability. In long-term follow-up, the initial MRI signal abnormality developed into a cortical atrophy in all cases. The establishment of the diagnosis, etiology, and options for treatment are discussed.
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Affiliation(s)
- Laurent Chevret
- Pediatric Intensive Care Unit, CHU Bicêtre, 78, rue du Gal Leclerc, 94275 Le Kremlin Bicêtre, France.
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Chevret L, Boutolleau D, Halimi-Idri N, Branchereau S, Baujard C, Fabre M, Gautheret-Dejean A, Debray D. Human herpesvirus-6 infection: A prospective study evaluating HHV-6 DNA levels in liver from children with acute liver failure. J Med Virol 2008; 80:1051-7. [DOI: 10.1002/jmv.21143] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Larrar S, Essouri S, Durand P, Chevret L, Haas V, Chabernaud JL, Leyronnas D, Devictor D. Place de la ventilation non invasive nasale dans la prise en charge des broncho-alvéolites sévères. Arch Pediatr 2006; 13:1397-403. [PMID: 16959476 DOI: 10.1016/j.arcped.2006.07.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 07/04/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Usefulness of nasal continuous positive airway pressure (NCPAP) in severe acute bronchiolitis has been checked. The objective of this descriptive study was to evaluate the feasibility, safety and risk factors of NCPAP failure. POPULATION AND METHODS One hundred and forty-five infants were hospitalised in our intensive care unit during the 2 last epidemics (2003-2004, 2004-2005). Among them, 121 needed a respiratory support, either invasive ventilation (N=68) or NCPAP (N=53). RESULTS General characteristics were similar during the 2 periods. Percentage of NCPAP failure, defined by tracheal intubation requirement during the stay in paediatric intensive care unit, was quite similar during the 2 periods (25%), but number of NCPAP increased twofold. Whatever the evolution was in the NCPAP group, we observed a significant decrease in respiratory rate (60+/-16 vs 47.5+/-13.7 cycle/min., P<0.001) and PaCO2 (64.3+/-13.8 vs 52.6+/-11.7 mmHg, P=0.001) during NCPAP. Only PRISM calculated at day 1 and initial reduction of PaCO2 were predictive of NCPAP failure. Percentage of ventilator associated pneumonia was similar (22%) between the invasive ventilation group and infants who where intubated because of failure of NCPAP. Duration of respiratory support and stay were reduced in the NCPAP group (P<0.002). CONCLUSION NCPAP appears to be a safe alternative to immediate intubation in infants with severe bronchiolitis.
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Affiliation(s)
- S Larrar
- Assistance publique-Hôpitaux de Paris, service de réanimation pédiatrique, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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Abstract
Acyclovir-induced neurotoxicity is a rare adverse effect, found especially in adults with pre-existing renal failure. We report a case of neurotoxicity of acyclovir in a six-month-old liver transplant recipient. Case report and review of literature are discussed.
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Affiliation(s)
- L Chevret
- Pediatric Intensive Care Unit, CHU Bicetre, Le Kremlin, Bicetre, France.
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Abstract
OBJECTIVES To evaluate the feasibility and outcome of noninvasive positive pressure ventilation (NPPV) in daily clinical practice. DESIGN Observational retrospective cohort study. SETTING Pediatric intensive care unit in a university hospital. PATIENTS : Patients treated by NPPV, regardless of the indication, during five consecutive years (2000-2004). MEASUREMENTS AND RESULTS A total of 114 patients were included, and 83 of the 114 patients (77%) were successfully treated by NPPV without intubation (NPPV success group). The success rate of NPPV was significantly lower (22%) in the patients with acute respiratory distress syndrome (p < .05) than in the other patients. The Pediatric Risk of Mortality II (p = .003) and Pediatric Logistic Organ Dysfunction scores (p = .002) at admission were significantly higher in patients who were unsuccessfully treated with NPPV (NPPV failure group). Baseline values of Pco2, pulse oximetry, and respiratory rate did not differ between the two groups. A significant decrease in Pco2 and respiratory rate within the first 2 hrs of NPPV was observed in the NPPV success group. Multivariate analysis showed that a diagnosis of acute respiratory distress syndrome (odds ratio, 76.8; 95% confidence interval, 4.4-1342; p = .003) and a high Pediatric Logistic Organ Dysfunction score (odds ratio, 1.09; 95% confidence interval, 1.01-1.17; p = .01) were independent predictive factors for NPPV failure. A total of 11 patients (9.6%), all belonging to the NPPV failure group, died during the study. CONCLUSIONS This study demonstrates the feasibility and efficacy of NPPV in the daily practice of a pediatric intensive care unit. This ventilatory support could be proposed as a first-line treatment in children with acute respiratory distress, except in those with a diagnosis of acute respiratory distress syndrome.
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Affiliation(s)
- Sandrine Essouri
- Pediatric Intensive Care Unit, Kremlin-Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicetre, France
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Tiras S, Haas V, Chevret L, Decobert M, Buisine A, Devictor D, Durand P, Tissières P. Nonketotic hyperglycemic coma in toddlers after unintentional methadone ingestion. Ann Emerg Med 2006; 48:448-51. [PMID: 16997682 DOI: 10.1016/j.annemergmed.2006.02.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 02/21/2006] [Accepted: 02/22/2006] [Indexed: 11/19/2022]
Abstract
Methadone overdoses are increasing in parallel with the increased frequency of opiate substitution therapy in adults. Although unintentional methadone intoxication in children is rare, it is becoming more frequently recognized. We report 3 cases of unintentional methadone overdose in toddlers who initially displayed central nervous system depression associated with severe nonketotic hyperglycemia and discuss the possible pathophysiologic mechanisms of an underrecognized symptom of opiate intoxication in young children.
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MESH Headings
- Accidents, Home
- Animals
- Brain Damage, Chronic/etiology
- Child, Preschool
- Diabetes Mellitus, Type 1/diagnosis
- Diagnostic Errors
- Dobutamine/therapeutic use
- Drug Packaging
- Epinephrine/therapeutic use
- Female
- France
- Humans
- Hyperglycemic Hyperosmolar Nonketotic Coma/chemically induced
- Hyperglycemic Hyperosmolar Nonketotic Coma/complications
- Hyperglycemic Hyperosmolar Nonketotic Coma/diagnosis
- Hyperglycemic Hyperosmolar Nonketotic Coma/drug therapy
- Infant
- Insulin/therapeutic use
- Islets of Langerhans/drug effects
- Islets of Langerhans/physiopathology
- Male
- Methadone/pharmacology
- Methadone/poisoning
- Mice
- Multiple Organ Failure/etiology
- Myocardial Infarction/etiology
- Naloxone/therapeutic use
- Receptor, Insulin/drug effects
- Receptors, Opioid, mu/drug effects
- Receptors, Opioid, mu/physiology
- Shock, Cardiogenic/etiology
- Sweetening Agents
- Time Factors
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Affiliation(s)
- Sinan Tiras
- Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
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Chevret L, Mbieleu B, Essouri S, Durand P, Chevret S, Devictor D. [Bronchiolitis treated with mechanical ventilation: prognosis factors and outcome in a series of 135 children]. Arch Pediatr 2006; 12:385-90. [PMID: 15808426 DOI: 10.1016/j.arcped.2005.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Accepted: 01/12/2005] [Indexed: 12/17/2022]
Abstract
UNLABELLED Viral bronchiolitis is usually associated with favorable outcome as regard to mortality. Only few studies reported severe bronchiolitis requiring mechanical ventilation, and respiratory outcome is not well described. METHODS Therefore, we conducted a retrospective study in a series of 135 children admitted in a single Pediatric Intensive Care Unit (PICU) over a four year period (1994-1998). All of them were admitted for viral bronchiolitis requiring mechanical ventilation. RESULTS At admission, 83% of them were less than three months old. Prematurity at birth was present in 33,3%. Mortality was observed in four cases (2,9%), all premature babies with mechanical ventilation at birth. Univariate analysis showed as main factors associated to mortality: prematurity (P =0,056) and acute respiratory distress syndrome (P =0,017). Childhood asthma was observed in 40,4% of children without any associated factor wether at birth or in PICU related to such outcome. CONCLUSION Bronchiolitis associated with mechanical ventilation is particularly observed in very young babies and prematurity is the main factor associated to mortality. Mechanical ventilation seems not to be associated with unfavorable respiratory outcome. Considering physiology and population, non invasive ventilation could be an effective alternative of mechanical ventilation.
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Affiliation(s)
- L Chevret
- Service de réanimation pédiatrique, hôpital Bicêtre, assistance publique-hôpitaux de Paris, 78 rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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31
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Wasier AP, Chevret L, Essouri S, Durand P, Chevret S, Devictor D. Pneumococcal meningitis in a pediatric intensive care unit: prognostic factors in a series of 49 children. Pediatr Crit Care Med 2005; 6:568-72. [PMID: 16148819 DOI: 10.1097/01.pcc.0000170611.85012.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite advances in antibiotic therapy strategies and in pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. However, few prognostic studies have been published, especially in pediatric populations. METHODS We conducted a prognostic study to determine the factors associated with hospital mortality of 49 children admitted in a single pediatric intensive care unit during a 12-yr period (1990-2002). RESULTS Hospital mortality was 49% (24 of 49 patients), and neurologic sequels were observed in 47% of survivors. Among them, 90% had permanent sensory deafness. Based on univariable analyses, seven variables were associated with the outcome: Pediatric Risk of Mortality II score (p = .000005), Glasgow Coma Score of >8 (p = .001), use of mechanical ventilation (p = .001), platelet count (p = .007), white blood cells count (p = .002), cerebrospinal fluid glucose level (p = .02), and lack of corticosteroids use (p = .02). In multivariable analysis, only three factors were independently associated with in-hospital mortality: Pediatric Risk of Mortality II score (hazard ratio, 1.13; 95% confidence interval, 1.06-1.20; p = .0002), platelets count of >200 x 10/L (hazard ratio, 0.25; 95% confidence interval, 0.08-0.81; p = .021) and white blood cell count above 5 x 10/L (hazard ratio, 0.31; 95% confidence interval, 0.11-0.87; p = .026). CONCLUSIONS S. pneumoniae meningitis remains a devastating childhood disease in developed countries. Three variables were independently associated with the in-hospital death in our series-high Pediatric Risk of Mortality II score, low white blood cells count, and low platelet count-reflecting the main importance of severe sepsis and neurologic presentation in establishing the prognosis of these patients.
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Affiliation(s)
- Anne-Pascale Wasier
- Pediatric Intensive Care Unit, Kremlin-Bicêtre Hospital, Kremlin-Bicêtre, France
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Affiliation(s)
- C Kerdudo
- Département de pédiatrie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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Abstract
Hypercalcemia is a rare but potentially fatal complication during the management of childhood cancer. The treatment of severe hypercalcemia in children has not been clearly defined. The authors present a retrospective series of 16 children (11 boys and 5 girls) with severe hypercalcemia (>/=2.9 mmol/L) treated between 1997 and 2004 for malignancy. Median serum calcium level was 3.14 mmol/L. Hypercalcemia was present at the initial diagnosis of cancer (eight patients) or occurred during treatment (five patients) or during relapse (three patients). Three children had several episodes of hypercalcemia. All children were treated by hydration for a median of 7 days (range 2-12 days). Eight patients received intravenous pamidronate. The other treatments were adapted to the mechanism of hypercalcemia. Serum calcium levels were lowered to below 3 mmol/L after a median of 2 days and to below 2.7 mmol/L after a median of 4 days after starting treatment. Pamidronate was well tolerated apart from one case of multifactorial renal failure. Intravenous pamidronate is a safe and effective treatment for severe cancer-related hypercalcemia in children. Specific therapy must be initiated as soon as possible. Serum calcium levels must be monitored for a fortnight after administration of pamidronate due to the risk of hypocalcemia.
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Affiliation(s)
- L Chevret
- Service de réanimation pédiatrique, CHU de Bicêtre, 94275 Le Kremlin-Bicêtre, France.
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Thauvin-Robinet C, Faivre L, Barbier ML, Chevret L, Bourgeois J, Netter JC, Grimaldi M, Geneviève D, Ogier de Baulny H, Huet F, Saudubray JM, Gouyon JB. Severe lactic acidosis and acute thiamin deficiency: a report of 11 neonates with unsupplemented total parenteral nutrition. J Inherit Metab Dis 2004; 27:700-4. [PMID: 15669689 DOI: 10.1023/b:boli.0000043017.90837.93] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Devictor D, Chevret L. [Acute respiratory distress in the newborn, the child and the adult. Foreign bodies of the upper respiratory tract. 2nd part: in the infant and child]. Rev Prat 2003; 53:1723-31. [PMID: 14689923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Denis Devictor
- Service de réanimation pédiatrique, hôpital de Bicêtre, Le Kremlin-Bicêtre.
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Abstract
OBJECTIVES To characterize fulminant Wilson's disease in children, outline clinical and biochemical differences to fulminant hepatic failure of other etiologies, and compare sensitivity and specificity in diagnosing fulminant Wilson's disease of alkaline phosphatase to total bilirubin ratio and aspartate aminotransferase to alanine aminotransferase ratio. DESIGN Retrospective case study. SETTING Twenty-two-bed multidisciplinary pediatric intensive care unit in a tertiary university hospital, national referral center for pediatric liver transplantation. PATIENTS Between March 1986 and December 1999, seven children, aged between nine and 16 yrs, were admitted in our unit for fulminant Wilson's disease. During the same period of time, aged-matched analysis identified 12 other children with fulminant hepatic failure of other etiologies. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS On admission, pediatric risk of mortality score, coagulation variables, and hepatic encephalopathy grade were similar in both groups. Children with fulminant Wilson's disease (n = 7) were characterized by lowered hemoglobin and serum transaminases, elevated serum bilirubin, and the occurrence of Kayser-Fleischer rings. Although some admission variables were significantly different between both groups, the elevated variability did not allow us to define acceptable cutoff values. Receiver operating characteristics curve for alkaline phosphatase to total bilirubin ratio showed a good discriminative power (Az = 0.87) in differentiating fulminant Wilson's disease from fulminant hepatic failure of other causes, and a ratio <1 showed a 86% sensitivity and 50% specificity (odds ratio, 6; 95% confidence interval, 66-0.5; p =.173) for fulminant Wilson's disease diagnosis. CONCLUSIONS Although requiring prospective study to confirm, Kayser-Fleischer rings and serum alkaline phosphatase to total bilirubin ratio may assist in the early diagnosis of fulminant Wilson's disease.
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Affiliation(s)
- Pierre Tissières
- Unité de Soins Intensifs, Département de Pédiatrie, Hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre, France
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Thauvin-Robinet C, Barbier M, Faivre L, Geneviève D, Chevret L, Bourgeois J, Netter J, Ogier de Baulny H, Saudubray J, Gouyon J. P1 Gastro-entérologie- Nutrition Acidose lactique severe deficit en thiamine secondaire a une alimentation parenterale exclusive non supplementee. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)90515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lazure T, Durand P, Chevret L, Cuilliere P, Pariente D, Bui M, Lhomme C, Fabre M. [Infantile and maternal choriocarcinoma]. Ann Pathol 2003; 23:153-6. [PMID: 12843970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Infantile or congenital choriocarcinoma is a very uncommon complication of gestational choriocarcinoma. We report such a case with fatal outcome in a 3-week-old newborn, admitted for a hemorrhagic syndrome. Lungs, liver and brain masses were discovered and suggested an angiomatous process. The diagnosis was made later on gingival biopsy with necropsic confirmation. The mother's B-HCG level was elevated. She had asymptomatic pulmonary nodules and a uterine mass. This case report highlights characteristic but non specific clinical findings leading to the diagnosis. Chemotherapy must be undertaken as soon as possible to be effective. It is also necessary to assay maternal serum B-HCG when infantile choriocarcinoma is disclosed.
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Affiliation(s)
- Thierry Lazure
- Service d'Anatomie et de Cytologie Pathologiques, CHU de Bicêtre, Le Kremlin-Bicêtre
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Abstract
The pediatric risk of mortality (PRISM) score as a severity scoring system has never been assessed in infants and children with fulminant liver failure (FLF). A retrospective case study of 109 infants and children admitted in a 22-bed pediatric and neonatal intensive care unit of a tertiary university hospital, National Referral Center for Pediatric Liver Transplantation, from March 1986 to August 1997 was carried out. PRISM score was not significantly different within etiologic FLF categories, or between infants and children. However, PRISM score (mean +/- SD) showed significant difference (p = 0.001) between the 27 patients who spontaneously recovered with supportive care (8.8 +/- 5.0) and 82 patients who underwent emergency liver transplantation (ELT) or those who died before (14.9 +/- 7.7). PRISM score-based probability of mortality was underestimated when compared with observed mortality. A death probability higher than 20% had a 24% sensitivity and 95% specificity for severe outcome. Reciever operating characteristic curve for PRISM score showed elevated discriminative power (Az = 0.91) for discerning children with severe outcome from those who spontaneously recovered with supportive care. A PRISM score more than 10 showed an odds ratio of 2.69 for predicting severe outcome (95% CI: 1.11-6.55; p = 0.038). In conclusion, the PRISM score is an accurate means of severity assessment in pediatric FLF. However, PRISM score-based mortality was of low predictive value.
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Affiliation(s)
- Pierre Tissières
- Unité de Soins Intensifs, Département de Pédiatrie, Hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre, France
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Chevret L, Durand P, Alvarez H, Lambert V, Caeymax L, Rodesch G, Devictor D, Lasjaunias P. Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates presenting with severe heart failure owing to vein of Galen arteriovenous malformation. Intensive Care Med 2002; 28:1126-30. [PMID: 12185436 DOI: 10.1007/s00134-002-1381-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2001] [Accepted: 05/22/2002] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Neonatal vein of Galen malformation complicated by severe cardiac failure is a rare disease. The purpose was to assess the outcome of this life-threatening malformation and identify hemodynamic prognostic factors. DESIGN Retrospective study. PATIENTS Twenty-four newborns with cardiac failure requiring mechanical ventilation were consecutively admitted from 1986 to 2000. INTERVENTIONS Cardiovascular evaluation including echocardiogram was performed in all cases. Eighteen transarterial shunt occlusions with glue were applied by the same team of three physicians. MEASUREMENTS AND RESULTS Twelve babies survived and underwent one endovascular session at least (median age 20 days) with a mean 63 months follow-up. Embolization was not performed in 6 of the 12 nonsurvivors because of severe brain damage or profound hypotension Cardiogenic shock occurred in all nonsurvivors, but also in one long-term survivor (p<0.0001). Echocardiogram showed signs of right ventricular failure, most often in the dead babies (p=0.005). The pulmonary systemic arterial pressure ratio was significantly higher in the nonsurvivor group (p=0.031), and it decreased significantly after the first embolization only in patients who survived (p=0.01). Patent ductus arteriosus and a diastolic aortic reversed-flow were present in all nonsurvivors in contrast to 30% of the long-term survivors (p=0.003 ). There was no difference in the left ventricular contractility and mean cardiac output between the two groups. CONCLUSIONS The outcome of vein of Galen malformation complicated by severe cardiac failure requiring mechanical ventilation remains poor. Neonatal embolization seems to be beneficial only in babies without suprasystemic pulmonary hypertension.
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Affiliation(s)
- L Chevret
- Service de Réanimation, Hopital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Thabet F, Durand P, Chevret L, Fabre M, Debray D, Brivet M, Devictor D. [Severe Reye syndrome: report of 14 cases managed in a pediatric intensive care unit over 11 years]. Arch Pediatr 2002; 9:581-6. [PMID: 12108311 DOI: 10.1016/s0929-693x(01)00924-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Idiopathic Reye syndrome is a rare disease revealed by unexplained encephalopathy and microvesicular liver steatosis. Some clinical and epidemiological studies mainly performed in English speaking countries questioned the reality of Reye syndrome because numerous know inherited metabolic diseases, and some of them unrecognized, could mimick this disorder. We focused in our study on severe forms of Reye syndrome admitted to a pediatric intensive care unit. METHODS Retrospective study over the last eleven years (1991-2001) included all the pediatric patients admitted to our tertiary referral center with the classical American Reye syndrome criteria (e.g. CDC). Extensive metabolic screening was performed in all cases, except for the ultimately dead patients. RESULT Fourteen patients (mean age 52 months) were included. Fever always occurred before their admission and aspirin (n = 12) or acetaminophen (n = 7) was prescribed. Median Glasgow scale was 7 on admission. Mean amoniac plasma level was 320 mumol/L and alanine-aminotransferase peak plasma level 1475 +/- 1387 IU/L. Mechanical ventilation was started in ten children and six of them underwent continuous venovenous hemofiltration. Three patients ultimately died and 11 survived with a mean five years follow-up without relapses or neurological impairment. Any of them demonstrated inherited metabolic disease except for one infant with hereditary fructose intolerance. CONCLUSION Unlike widespread opinion, severe Reye syndrome without identified metabolic disorders seems to not disappear in our country. Reye syndrome remains a potentially life threatening disease and raises for aggressive treatment of brain edema. If aspirin and Reye syndrome association are not formally documented in France, cautiousness must be kept in mind and all the aspirin adverse effects notifications should be addressed to the public drugs survey network.
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Affiliation(s)
- F Thabet
- Service de réanimation pédiatrique et néonatale, hôpital de Bicêtre, Assistance publique-hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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