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  • 1
    Electronic Resource
    Electronic Resource
    Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome (1999)
    Springer
    Intensive care medicine 25 (1999), S. 293-299 
    Details
    ISSN: 1432-1238
    Keywords: Key words Encephalopathy ; Coma ; Shock ; Fever ; Hyperthermia ; Heat-shock protein
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The haemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease. The aetiology of this syndrome is unknown, and, despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. Objective: To assess the neurological features and potential prognostic markers of the disease. Design: Retrospective study. Setting: Division of Neuropaediatrics in a children's university hospital. Patients and methods: Fourteen patients fullfilling the HSES criteria out of 42 children admitted with fever and shock to the Paediatric Intensive Care Unit between 1986 and 1994, were analysed for clinical, biological, neuroradiological, EEG and neuropathological findings. Results: The patients (age range from 2 to 33 months) were found at night or in the morning either comatous (n = 3) or convulsing (n = 11). All but one were healthy before admission, although eight had had a brief prodromal infectious disease. All were febrile (mean body temperature 39.9 °C ± 0.9 °). Seasonal clustering during the winter months was observed. Coma and seizures with frequent status epilepticus were the main neurological manifestations. All children recovered from their multiple organ failure within a few days. Seven died (50 %); four survivors had neurological sequelae (29 %) with a developmental quotient (DQ) of 50 % or less in three and a DQ of 75 % in one and three infants (21 %) had normal outcomes. Computed tomography (CT) displayed a diffuse area of low density mainly in the cerebral cortex and intraventricular and parenchymal haemorrhages. Magnetic resonance imaging (MRI) showed haemorrhagic cortical lesions. Post-mortem examination of the brain conducted in three patients showed necrotic and haemorrhagic lesions, mainly in cortical areas. Comparison of the children with adverse outcome (death or neurological sequelae) with those with normal outcome revealed that predictors of poor outcome were status epilepticus (p = 0.003) and coma for more than 24 h (p = 0.01). Infants without disseminated intravascular coagulation, without a biphasic course and without brain hypodensities or haemorrhages on CT scans performed at least 4 days after onset had a normal neurodevelopmental outcome. Conclusion: The central nervous system appeared to be the main target of the HSES lesions. The most common outcome was brain death or severe brain damage. Further studies with a larger sample are necessary to determine whether the prognostic indicators we identified are reliable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050838
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  • 2
    Electronic Resource
    Electronic Resource
    Flumazenil in the treatment of hepatic encephalopathy in children with fulminant liver failure (1995)
    Springer
    Intensive care medicine 21 (1995), S. 253-256 
    Details
    ISSN: 1432-1238
    Keywords: Coma ; Benzodiazepines ; Flumazenil ; Liver failure ; Hepatic encephalopathy ; Pediatric
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the effect of flumazenil on hepatic encephalopathy complicating fulminant liver failure in children. Design Uncontrolled prospective study. Setting Pediatric Intensive Care Unit, tertiary care center. Patients 9 children with fulminant liver failure and hepatic encephalopathy awaiting emergency liver transplantation Interventions Changes in hepatic encephalopathy grade and in electroencephalogram were recorded during the injection of a bolus of flumazenil (0.01 mg/kg/IV bolus) followed by a continuous infusion of flumazenil (0.01mg/kg/h). Measurements and main results Before flumazenil, 7 children had grade 2 and 2 had grade 3 hepatic encephalopathy. Flumazenil injection mediated an arousal effect in 1 child in whom encephalopathy improved from grade 3 to grade 2. This effect lasted 30 min. No clinical response was observed in other children. An improvement of EEG anomalies was observed lasting 3 min in one child. Despite continuous infusion of flumazenil, encephalopathy worsened in all children. Conclusion The effect of intravenous administration of flumazenil on hepatic encephalopathy in children with fulminant liver failure is inconsistent. Its efficacy is transient. The therapeutic value of flumazenil in children with fulminant liver failure awaiting a liver graft is minimal at this dosage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01701483
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  • 3
    Electronic Resource
    Electronic Resource
    Medical errors during cardiopulmonary resuscitation of neonates (1993)
    Springer
    European journal of pediatrics 152 (1993), S. 781-781 
    Details
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01954003
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  • 4
    Electronic Resource
    Electronic Resource
    Vein of Galen aneurysmal malformations (1989)
    Springer
    Acta neurochirurgica 99 (1989), S. 26-37 
    Details
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors report a series of 36 vein of Galen aneurysmal malformations (VGM) diagnosed in the paediatric (78%) and adult (22%) populations that were referred to them for therapeutic management between 1982 and 1988. The clinical signs leading to the diagnosis were variable: 36% of systemic manifestations, 22% of neurological symptoms, 17% of hydrocephaly and 11% of intracranial haemorrhage. 30 angioarchitectural analyses could be obtained and allowed to classify these VGMs into 5 different types: 44% parenchymatous AVMs, 20% mural AVFs, 30% choroidal arteriovenous fistulas, 3% dural AVFs, 7% vein of Galen varices. This series demonstrates that the paediatric population is most sensitive to shunt effect whatever its type. Systemic manifestations and hydrocephaly are the most common signs encoutered in the newborn and infants; whereas neurological signs and symptoms and haemorrhage belong mostly to the adult symptomatology. Because of the poor outcome of VGMs, all authors believe that these malformations have to be treated aggressively. However, we found contra-indications to be represented by pretherapeutic demonstration of cerebral tissue damage, or uncontrolable systemic failure, thus treatment is indicated to compensate for cardiac failure previously responding (even partially) to medical treatment. Secondly, appearance of sub-cortical calcifications, resistance to medication or clinical deterioration will also lead to urgent treatment. The endovascular method represents at present the best treatment with an overall low mortality (13%) and a 0% technical morbidity in children compared to the surgical one of (91% mortality in newborns and 38% in infants). The results achieved by embolization in this series were as follows: 27% satisfactory results with complete or almost complete occlusion of AV Shunt, 53% significant clinical improvement, 7% of patients were unchanged. The authors believe fundamentally that these patients (specially those belonging to the paediatric population) have to be treated in a centre where a paediatric intensive care unit, neurological, neurosurgical and surgical neuro-angiographic departments coexist, in order to assure the best possible management of these children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01407773
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  • 5
    Electronic Resource
    Electronic Resource
    Prognostic factors of severe infectious purpura in children (1985)
    Springer
    Intensive care medicine 11 (1985), S. 140-143 
    Details
    ISSN: 1432-1238
    Keywords: Infectious purpura ; Fulminating meningococcemia ; Prognostic score
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p〈0.001), coma (p〈0.05), ecchymotic or necrotic purpura (p〈0.01), temperature 〈36°C (p〈0.05), no clinical meningism (p〈0.001), white cell count 〈10,000/mm3 (p〈0.05), thrombocytopenia 〈100,000 (p〈0.01), fibrinogen 〈1.5 g/l (p〈0.001), kalemia 〉5 mEq/l (p〈0.01), spinal fluid cell count 〈20/mm3 (p〈0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00258539
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  • 6
    Electronic Resource
    Electronic Resource
    Biliary complications after transplantation in children: Role of imaging modalites (1991)
    Springer
    Pediatric radiology 21 (1991), S. 175-178 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Among a series of 140 liver transplantations in children, 21 biliary complications (BC) (15%) are reported. BC were identified from 2 days to 3 months after LT. Positive US findings were present in 20 cases. Cholangiography was obtained by opacification of a surgical drain in 3 cases, per-operatively in 3 and by PTC in 15. Drainage was placed in 9 and ballon dilatation performed in 2. Causes of BC include hepatic artery (HA) thrombosis in 7, HA stenosis in 1, anastomosis stricture in 7, anastomosis kink in 3, mucocele of cystic duct remnant in 2 and sludge in 1. Treatment was surgical in all, but 2 cases were treated percutaneously. There is a great difference in severity of prognosis between complications secondary to HA thrombosis and isolated BC. Role of US in diagnosis and of PTC and interventional radiology in treatment are emphasized.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02011040
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  • 7
    Electronic Resource
    Electronic Resource
    Diaphragmatic paralysis in children: Diagnosis by TM-mode ultrasound (1994)
    Springer
    Pediatric radiology 24 (1994), S. 564-568 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diaphragmatic paralysis, a difficult diagnosis in the pediatric age group, has classically been made by fluoroscopy or B-mode ultrasound. We report our experience with TM-mode exploration. Twenty-seven patients suspected to have diaphragmatic paralysis were examined by means of inspiratory and expiratory chest radiography, fluoroscopy and B-mode ultrasound. The diaphragmatic echo was recorded on TM-tracing during spontaneous breathing using coronal oblique scans. Direction, excursion and the pattern of the transition between inspiration and expiration were analysed. In 7 patients examination was normal and TM mode demonstrated movement of normal direction and excursion with a sharp aspect of the transition zone. Diaphragmatic paralysis was present in 11 patients: unilateral in 9 and bilateral in 2 cases. TM mode demonstrated paradoxical movement, reduced excursion and a smooth transition zone. In 9 patients with diaphragmatic dysfunction TM mode demonstrated movement in the normal direction but with reduced excursion and a smooth transition zone. Compared to other imaging modalities, TM-mode records diaphragmatic movements more objectively. It can identify direction of the movement even if they are fast and of weak amplitude and in the case of bilateral paralysis. TM can differentiate paralysis from dysfunction. Moreover, this low-cost, non-irradiating made of imaging can be performed at the bedside and is available on all basic devices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02012733
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  • 8
    Electronic Resource
    Electronic Resource
    Variability of clinical presentation of hepatic artery thrombosis in pediatric liver transplantation: Role of imaging modalities (1990)
    Springer
    Pediatric radiology 20 (1990), S. 253-257 
    Details
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Among a series of 90 pediatric liver transplantations, 9 cases of hepatic artery thrombosis (HAT) in 8 patients are reported. All cases were diagnosed in the first two weeks and confirmed angiographically and surgically. Clinical presentation was often unreliable with only 2 cases showing the typical pattern of massive hepatic necrosis. Five cases presented with biliary complications and in 2 cases, HAT was discovered fortuitously on duplex sonography. The role of imaging modalities is emphasized. Duplex sonography is the best non-invasive screening method and we recommend a routine daily examination in the first 2 weeks. CT is the most useful method to assess the extension of liver infarction. PTC remains necessary to evaluate biliary complications and to plant the best therapeutic approach in this devastating event. Two patients died, 2 had to be retransplanted (one patient twice) and are doing well, 2 are on a waiting list for re-transplantation and one underwent an emergency surgical arterial desobstruction and is completely asymptomatic.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02019660
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