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Martinelli J, Habes D, Majed L, Guettier C, Gonzalès E, Linglart A, Larue C, Furlan V, Pariente D, Baujard C, Branchereau S, Gauthier F, Jacquemin E, Bernard O. Long-term outcome of liver transplantation in childhood: A study of 20-year survivors. Am J Transplant 2018; 18:1680-1689. [PMID: 29247469 DOI: 10.1111/ajt.14626] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 04/04/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 01/25/2023]
Abstract
We report the results of a study of survival, liver and kidney functions, and growth with a median follow-up of 24 years following liver transplantation in childhood. From 1988 to 1993, 128 children underwent deceased donor liver transplantation (median age: 2.5 years). Twenty-year patient and graft survival rates were 79% and 64%, respectively. Raised serum aminotransferase and/or γ-glutamyl transferase activities were present in 42% of survivors after a single transplantation. Graft histology (35 patients) showed signs of chronic rejection in 11 and biliary obstruction in 5. Mean total fibrosis scores were 4.5/9 and 3/9 in patients with abnormal and normal serum liver tests, respectively. Glomerular filtration rate was <90 mL·min-1 in 35 survivors, including 4 in end-stage renal disease who were undergoing dialysis or had undergone renal transplantation. Median final heights were 159 cm for women and 172 cm for men; final height was below the target height in 37 patients. Twenty-year survival after childhood liver transplantation may be close to 80%, and final height is within the normal range for most patients. However, chronic kidney disease or altered liver biochemistries are present in over one third of patients, which is a matter of concern for the future.
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Affiliation(s)
- J Martinelli
- Hépatologie pédiatrique and centre de référence national de l'atrésie des voies biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - D Habes
- Hépatologie pédiatrique and centre de référence national de l'atrésie des voies biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - L Majed
- Biostatistique et épidémiologie, Gustave Roussy, Villejuif, France
| | - C Guettier
- Anatomie pathologique, Hopital Paul Brousse-Bicetre, AP-HP, Inserm U 1193, Hopital Paul Brousse, Villejuif, France
| | - E Gonzalès
- Hépatologie pédiatrique and centre de référence national de l'atrésie des voies biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France.,Inserm U 1174, Hepatinov, Université Paris-Sud, Orsay, France
| | - A Linglart
- Department of pediatric endocrinology, APHP, Reference center for rare disorders of the mineral metabolism, and Plateforme d'Expertise Maladies Rares Paris-Sud, Le Kremlin Bicêtre, France.,INSERM U1169, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris-Saclay, Orsay, France
| | - C Larue
- Biostatistique et épidémiologie, Gustave Roussy, Villejuif, France
| | - V Furlan
- Toxicologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - D Pariente
- Radiologie pédiatrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - C Baujard
- Anesthésie réanimation chirurgicale, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - S Branchereau
- Chirurgie pédiatrique, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - F Gauthier
- Chirurgie pédiatrique, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - E Jacquemin
- Hépatologie pédiatrique and centre de référence national de l'atrésie des voies biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France.,Inserm U 1174, Hepatinov, Université Paris-Sud, Orsay, France
| | - O Bernard
- Hépatologie pédiatrique and centre de référence national de l'atrésie des voies biliaires, Hôpital Bicêtre, AP-HP and Université Paris-Sud, Le Kremlin-Bicêtre, France
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Borel M, Rousseau R, Le Saché F, Pariente D, Castro S, Delay M, Hausfater P, Raux M, Menegaux F. Organization in response to massive afflux of war victims in civilian practice - experimental feedback from the November 2015 Paris terrorist attacks. J Visc Surg 2017; 154 Suppl 1:S3-S7. [PMID: 29055662 DOI: 10.1016/j.jviscsurg.2017.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The arrival of a large number of war-weapon casualties at a civilian trauma center requires anticipation. A plan defining the management principles and the respective roles of the involved physicians and nurses and their interaction with each other is essential. Uni-directional patient flow associated with adequate numbers of staff physicians and nurses under the leadership of a medical director is essential to prevent the overwhelming of the trauma center. Routine and regular interaction between the pre-hospital medical flow control system and the medical director, on one hand, and between surgical teams and the medical director, on the other, are necessary to know when to apply "damage control" surgical techniques. Based on the feedback of a level 1 trauma center that received 53 victims of the November 13, 2015 terrorist attack in Paris, we present the factors of success, and the stumbling blocks.
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Affiliation(s)
- M Borel
- Département d'anesthésie réanimation, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
| | - R Rousseau
- Service d'orthopédie et traumatologie, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | - F Le Saché
- Département d'anesthésie réanimation, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
| | - D Pariente
- Service d'accueil des urgences, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
| | - S Castro
- Service d'accueil des urgences, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
| | - M Delay
- Service d'accueil des urgences, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
| | - P Hausfater
- Sorbonne universités, UPMC université Paris 06, 75013 Paris, France; Service d'accueil des urgences, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
| | - M Raux
- Département d'anesthésie réanimation, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France.
| | - F Menegaux
- Sorbonne universités, UPMC université Paris 06, 75013 Paris, France; Service de chirurgie viscérale et endocrinienne, groupe hospitalier Pitié-Salpêtrière Charles-Foix, AP-HP, 75013 Paris, France
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Le Stradic C, Aroulandom J, Kotobi H, Pariente D, Gaboran C, Lemale J, Dubern B, Tounian P. [Duodenal duplication revealed by acute pancreatitis]. Arch Pediatr 2016; 23:1063-1066. [PMID: 27618291 DOI: 10.1016/j.arcped.2016.06.015] [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] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/01/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Duodenal duplications are rare congenital malformations whose revealing signs are highly variable and nonspecific. OBSERVATION We report the case of a female infant who presented with neonatal acute pancreatitis complicated by recurrent ascites, profound hypoalbuminemia responsible for pleural and pericardial effusions, revealing a duodenal duplication cyst. The unusual and original clinical presentation as well as the difficulty detecting the duplication radiologically delayed the diagnosis. A prolonged medical treatment with octreotide, albumin infusions, and exclusive parenteral nutrition led to an almost total disappearance of the ascites before surgery. The outcome was favorable after surgical removal of the duplication with 1 year of follow-up. CONCLUSION The diagnosis of duodenal duplication can be difficult and it may be necessary to repeat the ultrasound examinations. Surgical resection is delicate, especially when there is an abundant pancreatic ascites. Therefore, an adequate prolonged medical treatment to reduce this ascites is recommended before the surgery.
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Affiliation(s)
- C Le Stradic
- Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - J Aroulandom
- Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - H Kotobi
- Service de chirurgie pédiatrique viscérale et néonatale, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - D Pariente
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - C Gaboran
- Service de pédiatrie, centre hospitalier François-Quesnay, boulevard Sully, 78200 Mantes-la-Jolie, France
| | - J Lemale
- Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - B Dubern
- Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P Tounian
- Service de nutrition et gastroentérologie pédiatriques, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
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Van Beers B, Cauquil P, Jamart J, Pariente D, Ajavon Y. Transcatheter Arterial Chemotherapy Using Doxorubicin, Iodized Oil and Gelfoam Embolization in Hepatocellular Carcinoma. Acta Radiol 2016. [DOI: 10.1177/028418518903000417] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Computed tomography (CT) was performed in 54 patients with hepatocellular carcinoma three weeks after transcatheter arterial chemotherapy using iodized oil and doxorubicin with or without gelfoam embolization. Patients with iodized oil retention in the tumor greater than 50 per cent of tumor size survived longer than patients with retention of less than 50 per cent. Differences were also found within Okuda stages I and II, but they were significant only in Okuda stage I (p<0.0001). These results suggest a possible relationship between iodized oil retention and survival. In addition to Okuda stage, several factors affected iodized oil retention: tumor vascularity, tumor size, portal thrombosis and Gelfoam embolization. These factors may thus influence the prognosis after transcatheter arterial chemotherapy.
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Koob M, Fayard C, Pariente D, Adamsbaum C, Franchi-Abella S. Prenatal diagnosis of orbital melanotic neuroectodermal tumor in infancy. Ultrasound Obstet Gynecol 2015; 46:249-250. [PMID: 25594399 DOI: 10.1002/uog.14787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/06/2015] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Affiliation(s)
- M Koob
- Service de Radiopédiatrie et Imagerie 2, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Laboratoire ICube, Université de Strasbourg et CNRS, Strasbourg, France
| | - C Fayard
- Service de Radiopédiatrie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - D Pariente
- Service de Radiopédiatrie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - C Adamsbaum
- Service de Radiopédiatrie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - S Franchi-Abella
- Service de Radiopédiatrie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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Hubert G, Giniès JL, Dabadie A, Tourtelier Y, Willot S, Pariente D, Lefrançois T, Caldari D. Shunts porto-systémiques congénitaux : expérience du Grand-Ouest sur cinq ans. Arch Pediatr 2014; 21:1187-94. [DOI: 10.1016/j.arcped.2014.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/30/2014] [Accepted: 08/22/2014] [Indexed: 11/29/2022]
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Péroux E, Franchi-Abella S, Sainte-Croix D, Canale S, Gauthier F, Martelli H, Pariente D, Adamsbaum C. Ovarian tumors in children and adolescents: a series of 41 cases. Diagn Interv Imaging 2014; 96:273-82. [PMID: 25220572 DOI: 10.1016/j.diii.2014.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pictorial review with a detailed semiological analysis of ovarian tumors in children and adolescents to provide a relevant diagnostic approach. PATIENTS AND METHODS Retrospective study (2001-2011) of 41 patients under the age of 15 who underwent surgery for an ovarian mass with a definite pathological diagnosis. RESULTS Sixty-two percent of the lesions were benign, 33% were malignant and 5% were borderline. Germ cell tumors were most frequent (77.5%), followed by sex cord stromal tumors (12.5%) and epithelial tumors (7.5%). Malignant tumors were more frequent in children between 0 and 2 years old. On imaging, calcifications and fat were specific for germ cell tumors; the presence of a mural nodule was predictive of a mature teratoma (P<0.001). Predictive factors for malignancy were clinical, including abdominal distension (P<0.01) or a palpable mass (P=0.05), biological, including increased hCG and/or AFP levels (P<0.001) and radiological, including tumors larger than 12 cm (P<0.05), tumoral hypervascularity (P<0.01) and voluminous ascites (P<0.01). CONCLUSION This semiological analysis confirms the role of imaging in diagnosing the etiology of ovarian lesions in children and adolescents and emphasizes the importance identifying tumoral hypervascularity, which, in addition to classic criteria, is highly predictive of malignancy.
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Affiliation(s)
- E Péroux
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - S Franchi-Abella
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - D Sainte-Croix
- Inserm, Santé publique et épidémiologie, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - S Canale
- Service d'imagerie médicale, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France
| | - F Gauthier
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris Sud, Paris, France
| | - H Martelli
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris Sud, Paris, France
| | - D Pariente
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - C Adamsbaum
- Service de radiologie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris Sud, Paris, France.
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Gervais Andre L, Linglart A, Gonzales E, Pariente D, Adamsbaum C, Franchi-Abella S. SFIPP CO-12 - Apports et limites de la densitométrie par scanner (QCT) chez l’enfant en pratique quotidienne. Réflexions à partir d’une série de 104 cas. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71849-4] [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: 11/25/2022]
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Guerin F, Merli L, Gabor F, Branchereau S, Pariente D, Martelli H. SFCP P-063 - Pièges du diagnostic et traitement des sarcomes indifférenciés du foie. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71778-6] [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: 10/25/2022]
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Bernard O, Franchi-Abella S, Branchereau S, Pariente D, Gauthier F, Jacquemin E. Congenital portosystemic shunts in children: recognition, evaluation, and management. Semin Liver Dis 2012; 32:273-87. [PMID: 23397528 DOI: 10.1055/s-0032-1329896] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [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: 02/01/2023]
Abstract
Congenital portosystemic shunts are present in one in 30,000 children. Among the associated risks of severe complications are neonatal cholestasis, benign and malignant liver tumors, hepatopulmonary syndrome, portopulmonary hypertension, and encephalopathy. They can be detected on prenatal ultrasonograms, during the investigation of a positive galactosemia screening test in neonates or of a complication, or be found fortuitously on an abdominal ultrasound. Small intrahepatic shunts may resolve spontaneously within one year of age, but other shunts such as extrahepatic, persistent ductus venosus or persisting intrahepatic shunts, must be closed in one or two steps, by interventional radiology techniques or surgically. The plasticity of the intrahepatic portal system allows revascularization of the liver after shunt closure, even when no intrahepatic portal structures can be detected on imaging studies. This leaves little or no place for liver transplantation in the management of these children.
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Affiliation(s)
- O Bernard
- Hépatologie pédiatrique, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
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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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Tran TA, Pariente D, Lecron JC, Delwail A, Taoufik Y, Meinzer U. Treatment of pediatric Erdheim-Chester disease with interleukin-1-targeting drugs. ACTA ACUST UNITED AC 2012; 63:4031-2. [PMID: 21898344 DOI: 10.1002/art.30638] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- T A Tran
- Hôpital Bicêtre, INSERM U1012, France
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Tran TA, Lecron JC, Pariente D, Jéru I, Delwail A, Kone-Paut I, Meinzer U. Rationale and efficacy of interleukin-1 targeting in pediatric Erdheim- Chester disease. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194727 DOI: 10.1186/1546-0096-9-s1-p67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Bourayou R, Zenkhri F, Pariente D, Koné-Paut I. [What is the value of the chest radiography in making the diagnosis of children pneumonia in 2011?]. Arch Pediatr 2011; 18:1251-4. [PMID: 21802265 DOI: 10.1016/j.arcped.2011.06.002] [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: 04/15/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 11/28/2022]
Abstract
UNLABELLED According to the French national health authority guidelines, the diagnosis of childhood pneumonia is based on clinical suspicion and radiological confirmation. The chest radiography is an expensive procedure, and potentially deleterious by its radiating character. We have attempted to clarify its diagnostic value in community acquired pneumonia in children through a literature review using the Pubmed search engine with the following keywords: "pneumonia, child, radiograph". CONCLUSION The indication of chest radiography in severe pneumonia achieved unanimity among the various scientific societies. In contrast, in mild forms, tendency of the available data is to not recommend the routine use of chest radiography; further randomised and prospective studies are necessary to confirm this trend. Finally, because of the frequency of atypical presentations in children, chest radiography retains all its usefulness in the etiologic diagnosis of fever of unknown origin.
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Affiliation(s)
- R Bourayou
- Service des urgences pédiatriques et de pédiatrie générale, CHU de Bicêtre, groupement hospitalier universitaire Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Josseaume J, Duchateau FX, Burnod A, Pariente D, Beaune S, Leroy C, Judde de la Rivière E, Huot-Maire V, Ricard-Hibon A, Juvin P, Mantz J. Observatoire du sujet âgé de plus de 80 ans pris en charge en urgence par le service mobile d’urgence et de réanimation. ACTA ACUST UNITED AC 2011; 30:553-8. [DOI: 10.1016/j.annfar.2011.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
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Branchereau S, Fouquet V, Hermeziu B, Habes D, Baujard C, Pariente D, Martelli H, Bernard O, Jacquemin E, Gauthier F. CL064 - Résultat de l’intervention de Kasai : cohorte unicentrique 2003-2007. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70280-3] [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: 10/19/2022]
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Potet J, Franchi-Abella S, Al Issa M, Fayard C, Pariente D. [Transrectal drainage of pediatric pouch of Douglas abscesses under suprapubic US guidance: technique and results]. J Radiol 2010; 91:221-225. [PMID: 20389269 DOI: 10.1016/s0221-0363(10)70027-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pelvic abscesses are not always amenable to percutaneous drainage. Transrectal drainage of pouch of Douglas abscesses, performed blindly by surgeons for many years, is not familiar to radiologists. The purpose of this article is to describe our technique for the drainage of pouch of Douglas abscesses under suprapubic US guidance and report our results in a series of 7 pediatric patients with deep pelvic abscess not amenable to percutaneous drainage after failure of antibiotics. The procedure was performed under general anesthesia. All procedures were successful and without complication. The drainage catheter was well tolerated in all cases with short post-drainage hospital stay. After failure of medical management, this technique can be used irrespective of patient age or sex using US transducers and drainage catheters routiney available in any radiology department.
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Affiliation(s)
- J Potet
- Service de Radiopédiatrie, CHU de Bicêtre, 94275 Le Kremlin- Bicêtre.
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Belpomme V, Devaud ML, Pariente D, Ricard-Hibon A, Mantz J. [Results of a national survey about the use of sedation scales in emergency prehospital medicine]. Ann Fr Anesth Reanim 2009; 28:307-310. [PMID: 19299105 DOI: 10.1016/j.annfar.2009.01.016] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 01/28/2009] [Indexed: 05/27/2023]
Abstract
The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. This prospective and clinical practice survey was begun in January 2005. An anonymous questionnaire was sent to the physicians working in the 377 Mobile Intensive Care Unit of the 105 French Emergency Medical Service System. The total response rate from physicians was 28% (n=497). Only 29% of the physicians (n=145) declared to use a sedation scale for a mechanically ventilated patient. The Ramsay score was used in 97% of the cases (n=141).The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.
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Affiliation(s)
- V Belpomme
- Service d'anesthésie-réanimation-Smur, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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20
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Pajot C, Pariente D, Muller S, Gabolde M, Croisille L, Archambaud F, Dommergues JP, Bader-Meunier B. [Noninfectious febrile inflammatory syndromes in children: diagnosis and usefulness of diagnostic procedures]. Arch Pediatr 2002; 9:671-8. [PMID: 12162154 DOI: 10.1016/s0929-693x(01)00964-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
OBJECTIVE To determine the causes and to quantify the benefits obtained from further diagnostic investigations in children presenting with a non infectious inflammatory fever. METHODS The records of 62 children aged from two-months to 15 years (median: four years) admitted to a paediatric department between 1990 and 2000 for the evaluation of a fever associated to an inflammatory syndrome, defined as temperature over 38 degrees C with an increase of the erythrocyte sedimentation rate (ESR) more than 20 mm/h and/or a serum C-reactive protein level (CRP) > 20 mg/L, and excluding overt infectious diseases, were retrospectively reviewed. RESULTS Of these patients, 79% children (49 cases) had inflammatory systemic disease, 3.2% (two cases) had malignancy, and 17.8% (11 cases) had undiagnosed disorders. The most frequent disease was Kawasaki disease (22 children), especially in young children. Increase of ESR above 100 mm/h and of CRP above 100 mg/L was present in 59% of Kawasaki disease, 71% of idiopathic juvenile arthritis, 100% of malignancies and 7% of unknown diagnoses. Increase of ESR below 50 mm/h and of CRP below 50 mg/L was present in 75% of hemophagocytic syndromes and 46% of unknown diagnosis. The polymorphonuclear count, hepatic function evaluation, triglycerides levels, abdominal ultrasound, abdominal computed tomography, echocardiography, biopsies were useful diagnosis tools. Technetium scintigraphy was helpful only when abnormalities were found on physical examination. CONCLUSION The diagnosis of Kawasaki disease must be quickly suspected in febrile young children with inflammatory syndrome without infection. ESR and CRP values, abdominal ultrasound and echocardiography are helpful tools for the diagnostic procedure.
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Affiliation(s)
- C Pajot
- Fédération de pédiatrie, hôpital de Bicêtre, Assistance publique, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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21
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Pariente D. [Sonography of the pediatric abdomen: liver and biliary tract]. J Radiol 2001; 82:741-51; discussion 753-4. [PMID: 11443293] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Ultrasound is a routine imaging modality that is quite valuable to assess the pediatric abdomen. The objective of this article is to describe the sonographic appearance of the liver and bile ducts in children. Our goal is to emphasize normal variants and specific pediatric diseases, even if some of them may be encountered in adults.
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Affiliation(s)
- D Pariente
- Service de Radiologie Pédiatrique, Hôpital Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex
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Tissières P, Pariente D, Chardot C, Gauthier F, Devictor D, Debray D. Postshunt encephalopathy in liver transplanted children with portal vein thrombosis. Transplantation 2000; 70:1536-9. [PMID: 11118103 DOI: 10.1097/00007890-200011270-00024] [Citation(s) in RCA: 9] [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: 11/25/2022]
Abstract
BACKGROUND Surgical portosystemic shunting has been reported to alleviate successfully portal hypertension in liver transplanted recipients with portal vein thrombosis. METHODS We report two liver transplanted children with portal vein thrombosis who developed post-shunt acute encephalopathy. In one child, a mesocaval H-type shunt was created surgically because of bleeding related to Roux-en-Y loop varices at 3 months posttransplantation; in the other, a large spontaneous splenorenal shunt was discovered at the time of diagnosis of portal vein thrombosis on day 34 posttransplantation and was preserved. RESULTS Post-shunt encephalopathy developed 6 months and 2.7 years after transplantation, causing death in one child. CONCLUSIONS This report illustrates the risk and the possible dismal outcome of post-shunt encephalopathy in liver transplanted children. Therapeutic procedures other than portosystemic shunting that will restore an hepatopetal portal flow to the liver graft should be considered in liver-transplanted children with portal vein thrombosis.
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Affiliation(s)
- P Tissières
- Groupe de Transplantation Hépatique Pédiatrique, Assistance Publique, H pitaux de Paris, France
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24
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Danon O, Mofredj A, Morsli F, Duval-Arnould M, Pariente D, Waguet J, Fabre M, Chardot C, Nocton F. [Papillary solid tumor of the pancreas in a child: a case report]. Ann Med Interne (Paris) 2000; 151:606-608. [PMID: 11139664] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
We present a case of a papillary solid neoplasm of the head of the pancreas incidentally diagnosed after an abdominal trauma in a thirteen year old boy. Imaging features (US, CT) of the lesion were not specific enough to permit a precise diagnosis with certainty. Preoperative percutaneous needle biopsy can give presumptive evidence which may guide the treatment. Prognosis is fairly better than other pancreatic neoplasms in children (particularly pancreatoblastoma). Treatment relies only on surgery.
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Affiliation(s)
- O Danon
- Service de Radiologie, Hôpital Laennec, Creil
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25
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Franchi-Abella S, Waguet J, Aboun M, Sariego F, Pariente D. [Cyclic filling cystourethrography in the study of febrile urinary tract infection in children]. J Radiol 2000; 81:1615-8. [PMID: 11104976] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE To assess the value of cyclic voiding cystourethrography (VCUG) for the detection of reflux in a large population of children with urinary tract infection. MATERIALS AND METHODS 234 patients (67% less than 3 years of age) underwent VCUG with two fillings in 214 cases and three fillings in 139 cases. Appearance or increase in the grade of reflux compared with previous filling was expressed as "modification of the radiology report" (MRR). The amount of contrast material, the duration of fluoroscopy and the number of films were recorded. RESULTS The rate of reflux was 18.4% at the first filling, 16% at the second filling with 9.8% MRR and 14.7% at the third filling with 10% MRR. These results were the same for children younger and older than 3 years. For children under three years, if one considered reflux grade higher than 1, the MRR was 9.6% at the second filling and 7.5% at the third while it was 5.8% and 3% for older children. On average, the use of contrast material increased 50% with a third filling, number of films was not modified and the time of fluoroscopy increased by 6 sec per filling. CONCLUSION VCUG is recommended in all children. The detection of reflux higher than grade 1 is more frequent with multiple fillings in children under 3 years. The increase in radiation exposure and cost seems negligible.
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Affiliation(s)
- S Franchi-Abella
- Service de radiopédiatrie, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre - France
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Abstract
Common bile duct stenosis associated with pancreatitis and hypereosinophilia is described in two children. Ultrasonography and CT showed slight increase in the size of the pancreas and bile duct dilatation. Percutaneous cholangiography (PTC) demonstrated extrinsic stenosis of the bile duct at the level of the pancreas. Spontaneous resolution of the clinical and radiological findings was observed. Knowledge of this rare pathological association with favourable evolution can avoid an unnecessary surgical procedure.
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Affiliation(s)
- J Waguet
- Department of Paediatric Radiology, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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27
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Marret E, Meunier JF, Dubousset AM, Pariente D, Samii K. [Diagnosis of a persistent left superior vena cava in the operating room during a central venous catheterization]. Ann Fr Anesth Reanim 2000; 19:191-4. [PMID: 10782243 DOI: 10.1016/s0750-7658(00)00205-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 2-year-old boy was admitted for surgical excision of a hepatoblastome. A central venous catheter was inserted by a subclavian approach, without difficulty. The chest radiograph showed the catheter positioned along the left heart border. The diagnosis of persistent left superior vena cava was suspected after analysis of the central venous pressure curve. An postoperative chest X-ray confirmed the diagnosis. The catheter was maintained for five days without any complication.
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Affiliation(s)
- E Marret
- Département d'anesthésie-réanimation, centre hospitalo-universitaire de Bicêtre, Le Kremlin-Bicêtre, France
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28
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El Amrani R, Abirached F, Guibert J, Pariente D, Zorn J. P-106. Non-invasive assessment of uterine receptivity before embryo thawing by the association of progesterone plasma concentration and colour Doppler ultrasonographic aspect of endometrium. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.194] [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: 11/12/2022] Open
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Jacquemin E, Pariente D, Fabre M, Huault G, Valayer J, Bernard O. Peliosis hepatis with initial presentation as acute hepatic failure and intraperitoneal hemorrhage in children. J Hepatol 1999; 30:1146-50. [PMID: 10406195 DOI: 10.1016/s0168-8278(99)80271-2] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Peliosis hepatis, a condition characterized by the presence of blood-filled lacunar spaces in the liver, usually has a chronic presentation pattern and is mainly reported in adult patients in association with chronic wasting disorders and after administration of various drugs. The present report concerns two previously healthy young children in whom peliosis hepatis initially presented as acute hepatic failure and who had Escherichia coli pyelonephritis. Both patients had active intraperitoneal hemorrhage from the peliotic liver lesions, and liver ultrasonography showed multiple hypoechoic areas of different sizes, which in this context should suggest the diagnosis. One child died from hypovolemic shock and the other recovered. This study indicates that acute peliosis hepatis can be a serious life-threatening disease in children.
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Affiliation(s)
- E Jacquemin
- Department of Pediatrics, Unit of Hepatology, Bicêtre Hospital, Le Kremlin Bicêtre, France
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30
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Abstract
Although imperfect, MRI is the best way of distinguishing type 1 lissencephaly from other, less classical lissencephalic malformations. We reported a case in which correlation of MRI and neuropathology was possible. Besides the classical radiological features of lissencephaly, i.e., agyria and excessive thickness of the cortex, an additional sign was observed: a thin cortical band, which gave high signal on T2-weighted images, represented a paucicellular and partially myelinated band, 1500 microns thick, lying under the true superficial cortex. This MRI feature could be characteristic of the particular cortical lamination observed in true type 1 lissencephaly.
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Affiliation(s)
- P Landrieu
- Department of Paediatric Neurology, CHU Bicêtre, France
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31
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Chardot C, Herrera JM, Debray D, Branchereau S, De Dreuzy O, Devictor D, Dartayet B, Norwood P, Lambert T, Pariente D, Gauthier F, Valayer J. Portal vein complications after liver transplantation for biliary atresia. Liver Transpl Surg 1997; 3:351-8. [PMID: 9346763 DOI: 10.1002/lt.500030401] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective of this report is to review portal complications (PC) after pediatric liver transplantation (LT) for biliary atresia (BA) in the Bicêtre surgical series. From January 1, 1988, to February 28, 1995, 96 children with BA underwent 115 LTs Portal anastomosis was done on either the recipient portal vein (n = 85) or superior mesenteric vein (n = 11). No antiaggregative agents were administered postoperatively. Median follow-up was 50 months (range, 12 to 97). Nineteen PC (16.5%) occurred in 17 recipients: 16 portal thrombosis (PT) and 3 portal stenosis (PS). Fifteen instances of early PT occurred between days 0 and 17 (median, day 2). Emergency thrombectomy was performed in 9 cases (successful in 5). Three children underwent a secondary portosystemic shunt (successful in 2). Three PS were cured by either surgery or balloon dilatation. Four children died, 3 are alive with portal hypertension (PHT), and 10 are alive without PHT. Three-year patient actuarial survival is 82.4% in PC cases and 82% in others (NS). Significant risk factors of PC are young age and weight at the time of LT, small portal vein, and emergency LT. Analysis of our own results and review of the literature suggest that prevention of PC depends primarily on appropriate surgical technique. Reduction of postoperative hypercoagulability may also play an important role: a meta-analysis of 1,257 published pediatric LT show an overall risk of PT of 2.2% in teams using aspirin with or without dipyridamole compared with 7.8% when no antiaggregative agents are given (P = .0001).
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Affiliation(s)
- C Chardot
- Paediatric Surgery Unit, Bicêtre Hospital, France
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32
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Macfarlane B, Davies S, Mannan K, Sarsam R, Pariente D, Dooley J. Fatal acute fulminant liver failure due to clozapine: a case report and review of clozapine-induced hepatotoxicity. Gastroenterology 1997; 112:1707-9. [PMID: 9136851 DOI: 10.1016/s0016-5085(97)70054-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [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: 02/07/2023]
Abstract
Clozapine-induced hepatotoxicity is not well known and is usually of no clinical significance. This report describes fatal acute fulminant liver failure caused by clozapine in a 39-year-old man with chronic paranoid schizophrenia. The hepatotoxicity of clozapine is reviewed. Asymptomatic elevation of transaminase levels is observed most commonly, affecting between 30% and 50% of patients. Icteric hepatitis is uncommon, noted in 84 of 136,000 patients (0.06%). Fatal acute fulminant hepatitis has been documented in 2 patients (0.001%). The mechanism of clozapine hepatotoxicity is unknown. Although serious toxicity is rare, prescribers of clozapine should be aware of the hepatotoxic potential.
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Affiliation(s)
- B Macfarlane
- Department of Medicine, Royal Free Hospital School of Medicine, London, England
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Affiliation(s)
- P Lykavieris
- Départment de Pédiatrie, CHU Bicêtre, Kremlin Bicêtre, France
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Chardot C, Iskandarani F, De Dreuzy O, Duquesne B, Pariente D, Bernard O, Gauthier F, Valayer J. Spontaneous perforation of the biliary tract in infancy: a series of 11 cases. Eur J Pediatr Surg 1996; 6:341-6. [PMID: 9007467 DOI: 10.1055/s-2008-1071011] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [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: 02/03/2023]
Abstract
Eleven patients presenting with spontaneous perforation of the biliary tract were treated at Bicêtre Hospital between 1971 and 1993. Three groups were individualised, each with a different pattern of local presentation: generalised biliary peritonitis (n = 2), localised biliary peritonitis (n = 4), secondary biliary stenosis (n = 5). In each case, cholestatic jaundice developed after a postnatal symptom-free interval. Ten patients were operated on. Perforation was located in the cystic duct (n = 2), at the junction of the cystic and hepatic ducts (n = 4), in the common hepatic duct (n = 1) or common bile duct (n = 1). The site of perforation was no longer identifiable in two cases with stenosis. A cholecystectomy was performed in the 2 cases with cystic duct perforation; in the cases of lesions of the main duct, either simple external biliary drainage (n = 3) or biliary reconstruction (n = 5) was carried out. Postoperative complications included bile leak (n = 2), ascending cholangitis (n = 1), portal vein thrombosis (n = 2). Five patients were submitted to further surgery including biliary revision (n = 3), porto-systemic shunt (n = 1), and other procedures (n = 2). One infant died from postoperative sepsis; 2 were lost to follow-up, one of which probably did not survive; 4 are alive and well. Late sequelae are present in 4 children: portal hypertension (n = 1), mild residual bile duct dilatation without cholestasis (n = 1), and mild to moderate liver fibrosis (n = 2). Prompt diagnosis and appropriate treatment should improve the prognosis of this rare condition.
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Affiliation(s)
- C Chardot
- Surgical Unit, Department of Paediatrics of Bicêtre Hôpital, Le Kremlin-Bicêtre, France
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35
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Bonnichon P, Sarfati PO, Santoni P, Jeanty I, Meatchi T, Crougneau S, Pariente D, Ming LS. Absorbable Adams-DeWeese caval clip: an experimental study. Ann Vasc Surg 1996; 10:517-23. [PMID: 8989967 DOI: 10.1007/bf02000439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/03/2023]
Abstract
Adams-DeWeese caval clips have been shown to be effective in preventing pulmonary embolism. However, the use of Teflon clips constitutes a permanent solution for this transient risk. We tested an absorbable caval clip made of currently available synthetic biodegradable polymers in five female beagle dogs. The polymer used was PLA 96 containing 96% L lactic acid and 4% D lactic acid. After placement through a laparotomy, clips were routinely inspected and samples of the material were collected at regular intervals between 3 and 19 months postoperatively. The characteristics of absorption of PLA 96 in the retroperitoneal space were the same as those previously described in the literature. The clip retained its shape, rigidity, and effectiveness for 7 months. Complete degradation of the clip took between 18 and 19 months. Absorption did not cause a major inflammatory reaction and had no thrombogenic effect. Given the small number of animals studied, these results must be considered preliminary.
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Affiliation(s)
- P Bonnichon
- Clinique Chirurgicale, Hôpital Cochin, Paris, France
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Abstract
Growing skull fracture (GSF) is a progressive enlargement of a fracture due to an underlying tear of the dura mater. It is a rare complication of severe head injury mainly reported in young children. Classically, the diagnosis is made during follow-up, late after the original injury, when a palpable skull defect or a bulging mass is discovered clinically. Initial skull radiographs show a diastatic fracture developing later into a large bony defect. CT will show the brain damage which is usually present beneath the fracture. We present the MRI findings of GSF in a series of eight children. All patients initially had a large linear fracture and underlying brain damage on CT. In all cases MRI showed a zone of the same intensity as the brain contusion or cerebrospinal fluid advancing through the bone margins of the fracture to the subcutaneous plane. This finding was interpreted as an indirect sign of the dural tear. Seven patients were operated on with surgical confirmation of GSF. MRI can make an early diagnosis of GSF possible so that surgical repair with closure of the dura can be carried out before the dural tear enlarges.
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Affiliation(s)
- B Husson
- Department of Pediatric Radiology, Hospital of Kremlin Bicêtre, France
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37
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Bregere A, Pavillon MC, Macé B, Pariente D. [Reduction of acute intestinal invagination in children by insufflation]. Rev Infirm 1996:50-3. [PMID: 8900662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
BACKGROUND Acute gastric dilatation is a rare complication of anorexia nervosa which may be fatal in case of gastric perforation. Superior mesenteric artery syndrome may be associated with gastric dilatation. CASE REPORT A 14 year-old girl was admitted suffering from severe anorexia nervosa. Shortly after admission, she complained of abdominal pain related to a bulimic episode a few days before, followed by nausea and vomiting. Distended abdomen and tachycardia suggested acute small-bowel obstruction. A diagnosis of acute gastric dilatation with superior mesenteric artery syndrome was suspected on X-ray examination and confirmed by esophagogastrography after gastric evacuation. The patient improved rapidly under total parenteral nutrition. Upper gastrointestinal study repeated 10 days later showed normal stomach. CONCLUSIONS Small-bowel obstruction in anorexia nervosa first evokes acute gastric dilatation, and a perforation has to be ruled out by esophagogastrography. Association with superior mesenteric artery syndrome is possible; it does not necessarily lead to surgery.
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Affiliation(s)
- C Stheneur
- Service de médecine pour adolescents, hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Debray D, Pariente D, Fabre M, Foucaud P, Valayer J, Bernard O. Fibrolamellar hepatocellular carcinoma: report of a case mimicking a liver abscess. J Pediatr Gastroenterol Nutr 1994; 19:468-72. [PMID: 7877006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D Debray
- Service d'Hépatologie Pédiatrique, Hôpital de Bicêtre, France
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40
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Rey C, Alvin P, Pariente D, Courtecuisse V. [Pneumomediastinum in a young girl with anorexia nervosa]. Arch Pediatr 1994; 1:652-4. [PMID: 7987463] [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: 01/28/2023]
Abstract
BACKGROUND Pneumomediastinum is a rare complication of anorexia nervosa. It may occur in patients with severe weight loss and a history of induced vomiting. CASE REPORT A 14 year-old girl was admitted suffering from severe anorexia nervosa. Shortly after admission, she complained of anterior thoracic pain. Examination showed subcutaneous emphysema of the supraclavicular fossae and the base of the neck. Thoracic X-ray showed pneumomediastinum without pneumothorax. At the time, the patient admitted to a history of surreptitious chronic induced vomiting. Gastrografin esophagography ruled out an oesophageal tear. The pneumomediastinum gradually disappeared over a period of several days with simple clinical and radiological monitoring. CONCLUSIONS This case, along with seven others reported in the literature, confirms that pneumomediastinum in anorexia nervosa is usually not accompanied by pneumothorax. An oesophageal perforation must always be ruled out. Spontaneous pneumomediastinum invariably has a favorable outcome.
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Affiliation(s)
- C Rey
- Service de médecine pour adolescents, hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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41
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Bader-Meunier B, Pinto G, Tardieu M, Pariente D, Bobin S, Dommergues JP. Mastoiditis, meningitis and venous sinus thrombosis caused by Fusobacterium necrophorum. Eur J Pediatr 1994; 153:339-41. [PMID: 8033922 DOI: 10.1007/bf01956414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/28/2023]
Abstract
The authors report a case of septic venous sinus thrombosis (VST) and meningitis occurring as an early complication of mastoiditis caused by Fusobacterium necrophorum. CT scan was normal, and cerebral angiography was required to diagnose the VST. The evolution was favourable with appropriate antimicrobial therapy and steroids.
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Affiliation(s)
- B Bader-Meunier
- Département de Pédiatrie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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42
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Yandza T, Hamada H, Gauthier F, Pariente D, Lababidi A, de Dreuzy O, Valayer J. Pediatric liver transplantation: effect of the site of arterial inflow on the incidence of hepatic artery thrombosis according to recipient weight. Transplant Proc 1994; 26:169-70. [PMID: 8108923] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Yandza
- Department of Pediatric Surgery, Hospital Bicetre, Kremlin-Bicetre, France
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Yandza T, Hamada H, Gauthier F, Pariente D, Lababidi A, de Dreuzy O, Valayer J. Choledochojejunostomy without stent in pediatric liver transplantation. Transplant Proc 1994; 26:171-2. [PMID: 8108925] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Yandza
- Department of Pediatric Surgery, Hopital Bicetre, Kremlin-Bicetre, France
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Abstract
A retrospective pediatric study of 30 angiograms in congenital hepatic fibrosis (CHF) was undertaken to analyze the different aspects of the portal venous system in this disease. Besides the classical angiographic signs (hepatofugal veins and intrahepatic duplications), a hepatopetal venous network was present in ten children, contrasting with the patency of the portal venous system. Analysis of the medical charts for these ten patients showed that the clinical signs and outcome were similar to classical CHF. Liver biopsies were available in six cases and, in addition to the diagnostic features of CHF, demonstrated paucity or absence of portal venules. This unusual association of hepatopetal and hepatofugal collateral veins in an intrahepatic block could be explained by hypoplasia or thrombosis of portal venules. Thus, the association between hepatomegaly and hepatopetal collateral veins without portal obstruction should be suggestive of CHF.
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Abstract
We report on 56 children with sclerosing cholangitis (SC) seen between 1972 and 1992. The first symptoms occurred at a mean age of 3.7 years; 15 infants had neonatal cholestatic jaundice. At diagnosis, cholestatic jaundice was present in 25 children, hepatomegaly in 54, splenomegaly in 41, and ascites in 12. Serum alkaline phosphatase activity was increased in 49 patients and gamma-glutamyltransferase activity in all patients tested. Most often the histopathologic findings were extensive portal fibrosis and neoductular proliferation. Cholangiography showed abnormal intrahepatic bile ducts in all children and abnormal extrahepatic bile ducts in 35 (63%). The children were separated into three groups: (1) those with SC of neonatal onset (27%); (2) those with SC of postneonatal onset associated with another disease (55%)--histiocytosis X in 14 children, immunodeficiency syndromes in 8, chronic inflammatory bowel disease or autoimmune hepatitis in 8, and congenital psoriasis in 1; and (3) those with SC of postneonatal onset without an associated disease (18%). Biliary cirrhosis was present in all but three children after 6 months to 19.3 years of follow-up. Eleven children died of portal hypertension or liver failure, and six died of a complication related to the associated disease. Fifteen children had liver transplantation; 11 of these are alive 6 months to 6 1/2 years later without recurrence of SC. The overall estimated median survival time of children with SC was 10 years from clinical onset. These results indicate that SC should be suspected in all children with a chronic cholestatic disease and increased serum gamma-glutamyl transferase activity, especially when diseases known to be associated with SC are present. The prognosis is poor, but liver transplantation should be considered except in those with severe immunodeficiency syndromes.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Cholangiography
- Cholangitis, Sclerosing/complications
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/mortality
- Cholangitis, Sclerosing/therapy
- Female
- Follow-Up Studies
- Hepatitis, Chronic/complications
- Hepatitis, Chronic/immunology
- Histiocytosis, Langerhans-Cell/complications
- Humans
- Immunologic Deficiency Syndromes/complications
- Infant
- Infant, Newborn
- Inflammatory Bowel Diseases/complications
- Jaundice, Neonatal/etiology
- Male
- Prognosis
- Survival Analysis
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Affiliation(s)
- D Debray
- Service d'Hépatologie Pédiatrique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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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.
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Affiliation(s)
- E Urvoas
- Department of Pediatric Radiology, CHU Bicêtre, Le Kremlin-Bicetre, France
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Abstract
Thymic hemorrhage related to coagulopathy by vitamin K deficiency is a rare condition. We report a case in a 4-week-old boy presenting with acute onset of respiratory distress and anemia. Ultrasound examination of a compressive anterior mediastinal mass established the diagnosis of thymic hemorrhage and allowed us to follow resolution under medical treatment.
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Affiliation(s)
- E Urvoas
- Department of Pediatric Radiology, CHU Bicêtre, Le Kremlin-Bicêtre, France
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Escourolle H, Abecassis JP, Bertagna X, Guilhaume B, Pariente D, Derome P, Bonnin A, Luton JP. Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease. Clin Endocrinol (Oxf) 1993; 39:307-13. [PMID: 8222293 DOI: 10.1111/j.1365-2265.1993.tb02370.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.7] [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: 01/29/2023]
Abstract
OBJECTIVE The vast majority of patients with Cushing's disease have a corticotroph adenoma, the selective removal of which, through the transsphenoidal route, has the potential to offer a definitive and complete cure. This study was designed to compare the diagnostic accuracy of computerized tomography (CT) and magnetic resonance imaging (MRI) to identify the presence, evaluate the size, and assess the topographic characteristics of pituitary corticotroph adenomas. METHODS Forty-two patients with Cushing's disease were included in this prospective study, of whom 16 were subsequently explored transsphenoidally. Computerized tomography used a CE 12,000 CGR apparatus with 1.5-mm coronal slices and a 2-mm interslice gap. Magnetic resonance imaging used an MR Max 0.5T GE apparatus; adjacent 3-mm slices were obtained with a T1-weighted gradient echo before and after gadolinium injection. RESULTS Lesions compatible with an adenoma were identified in 29 patients by MRI and in 21 patients by CT (69 vs 50%, P < 0.02). Seven macroadenomas were identified as well by the two methods. Eight of the 22 microadenomas detected by MRI were not identified by CT. Evidence for intracavernous tumour extension was found in nine patients: it was more frequently detected by MRI (8 patients) than by CT (4 patients). Fourteen patients with positive MRI had a pituitary examination: in one case the adenoma could not be reached because of purely suprasellar location; of the other 13 all were found by the surgeon and the surgical outcome was successful in 12 cases. CONCLUSION MRI is superior to CT for the examination of the pituitary gland in patients with Cushing's disease.
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Affiliation(s)
- H Escourolle
- Clinique des Maladies Endocriniennes et Métaboliques, CHU Cochin, Paris, France
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Goldszmidt D, Pariente D, Yandza T, Dubousset AM, Valayer J. [Kasabach-Merritt syndrome with pancreatic hemangioma in an infant]. Arch Fr Pediatr 1993; 50:593-7. [PMID: 8002725] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Kasabach-Merritt syndrome is characterized by one or more large hemangiomas associated with thrombocytopenia due to platelet trapping. The hemangiomas may be located in the abdominal viscera, in which case, treatment may be difficult. CASE REPORT A 2 1/2 month-old boy was admitted because of the discovery of an abdominal mass. He was anemic (hemoglobin: 6.8 g%; reticulocytosis: 288,000/mm3), thrombocytopenic (50,000/mm3), hypofibrinogenemic (0.95 g/l), with fibrin split products in the blood. Ultrasonography showed that this mass was retroperitoneal and heterogeneous. X-rays delineated the mass, which distorted the duodenal loop and pressed forward against the stomach. Surgery showed that the mass included the pancreas, the root of mesenterium and the extrahepatic bile duct. This mass was biopsied. Histological examination showed infantile type hemangioendothelioma. Abdominal angiography showed that the mass was not very hypervascularized, and there were no dilated supplying blood vessels. An aortogram showed two other small vascularized areas. The patient was given methylprednisolone, but the volume of the mass remained unchanged, while hepatosplenomegaly and jaundice developed and ultrasound showed dilated extra- and intrahepatic biliary ducts. The patient was then given interferon alpha 2b for 1 month. Embolization of the small supplying arteries was performed because of a lack of improvement after 1 week of treatment. This procedure was followed by rapid disappearance of the signs of consumption coagulopathy, a progressive improvement in cholestasis, and decrease in the mass. CONCLUSION Improvement in manifestations of this Kasabach-Merritt syndrome is difficult to assign to one of the several therapies. The rapid disappearance of consumption coagulopathy after arterial embolization suggests that this treatment was successful in our patient.
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Affiliation(s)
- D Goldszmidt
- Service de Chirurgie infantile, Hôpital de Bicêtre
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Malherbe V, Pariente D, Tardieu M, Lacroix C, Venencie PY, Hibon D, Vedrenne J, Landrieu P. Central nervous system lesions in hypomelanosis of Ito: an MRI and pathological study. J Neurol 1993; 240:302-4. [PMID: 8326336 DOI: 10.1007/bf00838167] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A severe form of hypomelanosis of Ito is reported, which presented as fetal macrocephaly and neonatal epileptic encephalopathy. Lymphocyte karyotypes were normal. MRI showed an absence of delineation between cortical grey matter and white matter. The prominent neuropathological finding was an abnormal cortical morphogenesis, with the co-existence of cells migrating normally and cells exhibiting arrêt en route or even the complete absence of migration. Intense astrocytic reaction with moderate dystrophic features was present. Juxtaposition of two migration behaviours in the neural cells paralleled the cutaneous findings and reinforced the hypothesis of a genetic chimerism.
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Affiliation(s)
- V Malherbe
- Service de Neuropédiatrie, CHU, Bicêtre, France
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