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Ogunjimi B, Zhang SY, Sørensen KB, Skipper KA, Carter-Timofte M, Kerner G, Luecke S, Prabakaran T, Cai Y, Meester J, Bartholomeus E, Bolar NA, Vandeweyer G, Claes C, Sillis Y, Lorenzo L, Fiorenza RA, Boucherit S, Dielman C, Heynderickx S, Elias G, Kurotova A, Auwera AV, Verstraete L, Lagae L, Verhelst H, Jansen A, Ramet J, Suls A, Smits E, Ceulemans B, Van Laer L, Plat Wilson G, Kreth J, Picard C, Von Bernuth H, Fluss J, Chabrier S, Abel L, Mortier G, Fribourg S, Mikkelsen JG, Casanova JL, Paludan SR, Mogensen TH. Inborn errors in RNA polymerase III underlie severe varicella zoster virus infections. J Clin Invest 2017; 127:3543-3556. [PMID: 28783042 DOI: 10.1172/jci92280] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/26/2017] [Indexed: 01/13/2023] Open
Abstract
Varicella zoster virus (VZV) typically causes chickenpox upon primary infection. In rare cases, VZV can give rise to life-threatening disease in otherwise healthy people, but the immunological basis for this remains unexplained. We report 4 cases of acute severe VZV infection affecting the central nervous system or the lungs in unrelated, otherwise healthy children who are heterozygous for rare missense mutations in POLR3A (one patient), POLR3C (one patient), or both (two patients). POLR3A and POLR3C encode subunits of RNA polymerase III. Leukocytes from all 4 patients tested exhibited poor IFN induction in response to synthetic or VZV-derived DNA. Moreover, leukocytes from 3 of the patients displayed defective IFN production upon VZV infection and reduced control of VZV replication. These phenotypes were rescued by transduction with relevant WT alleles. This work demonstrates that monogenic or digenic POLR3A and POLR3C deficiencies confer increased susceptibility to severe VZV disease in otherwise healthy children, providing evidence for an essential role of a DNA sensor in human immunity.
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Affiliation(s)
- Benson Ogunjimi
- Centre for Health Economics Research & Modeling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium.,Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.,Antwerp Unit for Data Analysis and Computation in Immunology & Sequencing, Antwerp, Belgium
| | - Shen-Ying Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Katrine B Sørensen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark.,Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Kristian A Skipper
- Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Madalina Carter-Timofte
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Gaspard Kerner
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Stefanie Luecke
- Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Thaneas Prabakaran
- Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Yujia Cai
- Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Josephina Meester
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Esther Bartholomeus
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Nikhita Ajit Bolar
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Geert Vandeweyer
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Charlotte Claes
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Yasmine Sillis
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Lazaro Lorenzo
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Raffaele A Fiorenza
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Soraya Boucherit
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Charlotte Dielman
- Department of Child Neurology, Queen Paola Child Hospital, Antwerp, Belgium
| | - Steven Heynderickx
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - George Elias
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Andrea Kurotova
- Department of Pediatrics, Sint-Vincentius Hospital, Antwerp, Belgium
| | - Ann Vander Auwera
- Department of Pediatrics, Sint-Augustinus Hospital, Antwerp, Belgium
| | | | - Lieven Lagae
- Department of Development and Regeneration - Section Paediatric Neurology, University Hospitals KULeuven, Leuven, Belgium
| | - Helene Verhelst
- Department of Paediatric Neurology, Ghent University Hospital, Ghent, Belgium
| | - Anna Jansen
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Brussels, Belgium.,Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Ramet
- Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Arvid Suls
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Evelien Smits
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Berten Ceulemans
- Department of Neurology, Pediatric Neurology, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium
| | - Lut Van Laer
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | | | - Jonas Kreth
- Neuropediatric Department, Hospital for Children and Adolescents, gGmbH Klinikum Leverkusen, Leverkusen, Germany
| | - Capucine Picard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Horst Von Bernuth
- Department of Pediatric Pulmonology and Immunology, Charité Berlin - Campus Rudolf Virchow, Berlin, Germany
| | - Joël Fluss
- FMH Pediatric Neurology, Children's Hospital, Geneva, Switzerland
| | - Stephane Chabrier
- CHU Saint-Étienne, French Centre for Paediatric Stroke, Saint-Étienne, France
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France
| | - Geert Mortier
- Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | | | - Jacob Giehm Mikkelsen
- Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Paris Descartes University, Imagine Institute, Paris, France.,Howard Hughes Medical Institute, New York, New York, USA.,Pediatric Immunology-Hematology Unit, Necker Hospital for Sick Children, Paris, France
| | - Søren R Paludan
- Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
| | - Trine H Mogensen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark.,Department of Biomedicine and.,Aarhus Research Center for Innate Immunology, Aarhus University, Aarhus, Denmark
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Abstract
Abdominal Compartment Syndrome (ACS) occurs relatively infrequent in a paediatric population when compared with adults. Overall mortality is still high. Also, the pathophysiologic mechanism that leads to ACS is different in children. In this review, we will present an overview on ACS in children admitted to a paediatric intensive care unit.
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Taruscio D, Morciano C, Laricchiuta P, Mincarone P, Palazzo F, Leo CG, Sabina S, Guarino R, Auld J, Sejersen T, Gavhed D, Ritchie K, Hilton-Boon M, Manson J, Kanavos PG, Tordrup D, Tzouma V, Le Cam Y, Senecat J, Filippini G, Minozzi S, Del Giovane C, Schünemann H, Meerpohl JJ, Prediger B, Schell L, Stefanov R, Iskrov G, Miteva-Katrandzhieva T, Serrano-Aguilar P, Perestelo-Perez L, Trujillo-Martín MM, Pérez-Ramos J, Rivero-Santana A, Brand A, van Kranen H, Bushby K, Atalaia A, Ramet J, Siderius L, Posada M, Abaitua-Borda I, Ferreira V, Hens-Pérez M, Manzanares FJ. RARE-Bestpractices: a platform for sharing best practices for the management of rare diseases. Orphanet J Rare Dis 2014. [PMCID: PMC4249596 DOI: 10.1186/1750-1172-9-s1-o14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Van Eyck A, Van Hoorenbeeck K, De Winter BY, Ramet J, Van Gaal L, De Backer W, Verhulst SL. Sleep-disordered breathing and C-reactive protein in obese children and adolescents. Sleep Breath 2013; 18:335-40. [PMID: 23999834 DOI: 10.1007/s11325-013-0890-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep-disordered breathing (SDB) is common among overweight and obese children. It is a risk factor for several health complications, including cardiovascular disease. Inflammatory processes leading to endothelial dysfunction are a possible mechanism linking SDB and cardiovascular disease. Elevated C-reactive protein (CRP) is a risk factor for cardiovascular disease and is independently correlated with obstructive sleep apnea syndrome (OSAS) in adults. Our goal is to evaluate the relationship between CRP and OSAS in overweight and obese children and adolescents. METHODS One hundred and twenty children were prospectively studied (85 without OSAS, 20 mild OSAS, 15 moderate-to-severe OSAS). All subjects underwent polysomnography, and a blood sample was taken to determine CRP levels. RESULTS No significant differences were found in CRP between subjects with or without OSAS, and no correlations were found between CRP and OSAS severity, despite the relationship between CRP and BMI (r = 0.21, p = 0.015) and between CRP and fat mass (r = 0.31, p < 0.001). CONCLUSION These results suggest that CRP levels are correlated with the level of obesity but are not influenced by SDB in obese children and adolescents; hence, this in contrast to that in adult population.
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Affiliation(s)
- Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium,
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5
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Van Hoorenbeeck K, Franckx H, Debode P, Aerts P, Ramet J, Van Gaal LF, Desager KN, De Backer WA, Verhulst SL. Metabolic disregulation in obese adolescents with sleep-disordered breathing before and after weight loss. Obesity (Silver Spring) 2013; 21:1446-50. [PMID: 23408643 DOI: 10.1002/oby.20337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 08/26/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is prevalent in obesity. Weight loss is one of the most effective treatment options. The aim was to assess the association of SDB and metabolic disruption before and after weight loss. DESIGN AND METHODS Obese adolescents were included when entering an in-patient weight loss program. Fasting blood analysis was performed at baseline and after 4-6 months. Sleep screening was done at baseline and at follow-up in case of baseline SDB. RESULTS 224 obese adolescents were included. Median age was 15.5 years (10.1-18.0) and mean BMI z-score was 2.74 ± 0.42. About 30% had SDB at baseline (N = 68). High-density lipoprotein (HDL)-cholesterol was associated with mean nocturnal oxygen saturation (<SaO2>) (partial r = 0.21; P = 0.002). Aspartate aminotransferase (ASAT) and alanine aminotransferase were related with oxygen desaturation index (partial r = -0.15; P = 0.03 and partial r = -0.15; P = 0.02), but this became insignificant after correction for sex. After weight loss, 24% had residual SDB. Linear regression showed an association between ASAT and <SaO2> (partial r = -0.34; P = 0.002). There were no significant correlations between improvements in laboratory measurements and sleep parameters. HDL-cholesterol improved in relation with the decrease in BMI z-score. CONCLUSION SDB at baseline was associated with higher levels of liver enzymes and lower HDL-cholesterol concentration. Improvements in sleep parameters were not associated with improvements in laboratory measurements.
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Affiliation(s)
- K Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
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6
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Van Holsbeke C, Vos W, Van Hoorenbeeck K, Boudewyns A, Salgado R, Verdonck PR, Ramet J, De Backer J, De Backer W, Verhulst SL. Functional respiratory imaging as a tool to assess upper airway patency in children with obstructive sleep apnea. Sleep Med 2013; 14:433-9. [PMID: 23474060 DOI: 10.1016/j.sleep.2012.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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] [Received: 09/02/2012] [Revised: 11/28/2012] [Accepted: 12/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aim to investigate if anatomical and functional properties of the upper airway using computerized 3D models derived from computed tomography (CT) scans better predict obstructive sleep apnea (OSA) severity than standard clinical markers. METHODS Consecutive children with suspected OSA underwent polysomnography, clinical assessment of upper airway patency, and a CT scan while awake. A three-dimensional (3D) reconstruction of the pharyngeal airway was built from these images, and computational fluid dynamics modeling of low inspiratory flow was performed using open-source software. RESULTS Thirty-three children were included (23 boys; mean age, was 6.0±3.2y). OSA was diagnosed in 23 patients. Children with OSA had a significantly lower volume of the overlap region between tonsils and the adenoids (median volume, 1408 mm compared to 2173 mm; p=0.04), a lower mean cross-sectional area at this location (median volume, 69.3mm(2) compared to 114.3mm2; p=0.04), and a lower minimal cross-sectional area (median volume, 17.9 mm2 compared to 25.9 mm2; p=0.05). Various significant correlations were found between several imaging parameters and the severity of OSA, most pronounced for upper airway conductance (r=-0.46) (p<0.01) for correlation between upper airway conductance and the apnea-hypopnea index. No differences or significant correlations were observed with clinical parameters of upper airway patency. Preliminary data after treatment showed that none of the patients with residual OSA had their smallest cross-sectional area located in segment 3, and this frequency was significantly lower than in their peers whose sleep study normalized (64%; p=0.05). CONCLUSION Functional imaging parameters are highly correlated with OSA severity and are a more powerful correlate than clinical scores of upper airway patency. Preliminary data also showed that we could identify differences in the upper airway of those subjects who did not benefit from a local upper airway treatment.
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7
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Nicholson AJ, Ramet J. Improving immunisation uptake across Europe. Ir Med J 2012; 105:280-282. [PMID: 23155919] [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: 06/01/2023]
Affiliation(s)
- A J Nicholson
- The Children's University Hospital, Temple St, Dublin 1.
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8
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Verhulst SL, De Dooy J, Ramet J, Bockaert N, Van Coster R, Ceulemans B, De Backer W. Acetazolamide for severe apnea in Pitt-Hopkins syndrome. Am J Med Genet A 2012; 158A:932-4. [PMID: 22407847 DOI: 10.1002/ajmg.a.35247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 12/21/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Stijn L Verhulst
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
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9
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Van Hoorenbeeck K, Franckx H, Debode P, Aerts P, Wouters K, Ramet J, Van Gaal LF, Desager KN, De Backer WA, Verhulst SL. Weight loss and sleep-disordered breathing in childhood obesity: effects on inflammation and uric acid. Obesity (Silver Spring) 2012; 20:172-7. [PMID: 21938074 DOI: 10.1038/oby.2011.282] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [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: 11/08/2022]
Abstract
Sleep-disordered breathing (SDB) is prevalent in childhood obesity. It may be an independent risk factor for the metabolic syndrome. Possible mechanisms are inflammation and oxidative stress. Adenotonsillectomy in childhood obesity is associated with a high recurrence rate and risk of postoperative weight gain. Therefore, this study assessed the effects of SDB on inflammation and oxidative stress in childhood obesity before and after weight loss. We included 132 obese subjects between 10 and 18 years consecutively. Median age was 15.4 years (10.1-18.0). Mean BMI z-score was 2.72 ± 0.42. Leukocytes and differentiation, high sensitivity C-reactive protein (hs-CRP), and uric acid (UA) were determined at baseline and subjects underwent a sleep assessment. SDB was diagnosed in 39%. Linear regression analysis showed an association between UA(log) and oxygen desaturation index(log) (ODI(log)) (r = 0.20; P = 0.03), between leukocytes(log) and respiratory disturbance index(log) (RDI(log)) (r = 0.23; P = 0.01), and between lymphocytes(log) and RDI(log) (r = 0.19; P = 0.04). Follow-up was organized after 4-6 months of treatment. Median decrease in BMI z-score was 32%. Laboratory measurements were repeated. Subjects with SDB at baseline underwent a second sleep study. Of these 49 subjects, 12 showed residual SDB. This corresponds with a treatment success rate of 71%. Unlike changes in inflammatory markers, improvements in UA were associated with improvements in RDI and ODI (respectively: r = 0.44; P = 0.007, r = 0.41; P = 0.01). In conclusion, weight loss is effective in treating obese children with SDB. At baseline, a link exists between inflammation and SDB. Oxidative stress is reflected by UA at baseline and the concentration decreases after treatment according to improvements in SDB.
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Affiliation(s)
- Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
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10
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Peeters E, Verhulst S, Wojciechowski M, Vlieghe E, Jorens P, Van Marck V, Ramet J, De Dooy J. Visceral leishmaniasis in a child infected with the human immunodeficiency virus in a non-endemic region. J Trop Pediatr 2011; 57:493-5. [PMID: 21367850 DOI: 10.1093/tropej/fmr024] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We reported the case of a boy who fled from Chechnya to Belgium. He was diagnosed with a human immune deficiency virus (HIV)/Visceral leishmaniasis (VL) coinfection. In both countries, the prevalence of HIV-infected children is low and VL is not endemic. Migration of people results in confrontation with diseases that are not frequent in the countries of destination and becomes a challenge for pediatricians.
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Affiliation(s)
- Ellen Peeters
- Department of Pediatric Intensive Care, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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11
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Dierckx E, van Hoorenbeeck K, Valdivia Tamayo J, Verbeeck P, Ceulemans B, De Backer W, Desager K, Ramet J, Verhulst S. Witnessed apnoeas in a 6-yr-old boy: a brain teaser. Breathe (Sheff) 2011. [DOI: 10.1183/20734735.003511] [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: 11/05/2022] Open
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12
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Docx MKF, Gewillig M, Simons A, Vandenberghe P, Weyler J, Ramet J, Mertens L. Pericardial effusions in adolescent girls with anorexia nervosa: clinical course and risk factors. Eat Disord 2010; 18:218-25. [PMID: 20419526 DOI: 10.1080/10640261003719484] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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: 10/19/2022]
Abstract
The aim of this study was to evaluate cardiac, biochemical and endocrine differences between female adolescents with anorexia nervosa (AN) with and without pericardial effusions. We studied 128 female adolescents (9.8-17.7 years) with anorexia nervosa (AN) diagnosed according to DSM-IV (American Psychiatric Association, 1994) criteria. They all underwent an echocardiographic evaluation. In 29 patients (22.2 %) a pericardial effusion (ranging between >or= 0.35-2.5 cm) was noted. None of the patients were clinically symptomatic. After 3 months of refeeding, the effusions disappeared in 18/29 patients while in 7/29 patients a pericardial effusion > 0.3 cm persisted. Risk factors for development of effusions were a BMI <or= 13,5 kg/m(2), weight loss >or= 25% and IGF-1-level <or=100 ng/ml. Pericardial effusions are common in adolescent AN patients. They are mostly asymptomatic not requiring any intervention and spontaneously regress with refeeding. They are more common in the patients with the most significant weight loss.
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Affiliation(s)
- Martine K F Docx
- Department of Paediatrics, Chronic Diseases, and Hypertension, Queen Paola Children's Hospital, Antwerp, Belgium
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13
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Vergauwen W, Op de Beeck B, Hagendorens M, Wojciechowski M, Vaneerdeweg W, Ramet J. A solid pseudopapillary tumour of the pancreas presenting after an abdominal trauma. Acta Chir Belg 2010; 110:390-3. [PMID: 20690532 DOI: 10.1080/00015458.2010.11680642] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of 12-year-old girl who was referred with persistent abdominal pain and a palpable mass after blunt trauma and whose final diagnosis was a solid pseudopapillary tumour of the pancreas. This is the second case in our hospital of a solid pseudopapillary tumour of the pancreas presenting after a blunt abdominal trauma. Solid pseudopapillary tumour of the pancreas is a rare neoplasm. It comprises 2 to 3% of primary pancreatic tumours occurring at all ages. It was first described in 1959 by Frantz. The presenting symptoms are usually a slow growing abdominal mass with vague abdominal discomfort. Sometimes they are discovered after a trauma. Solid pseudopapillary tumours of the pancreas have a fairly characteristic appearance on imaging but the final diagnosis depends on histological confirmation. After resection the prognosis is excellent.
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Affiliation(s)
- W. Vergauwen
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
| | - B. Op de Beeck
- Department of Radiology, Antwerp University Hospital, University of Antwerp
| | - M. Hagendorens
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
| | - M. Wojciechowski
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
| | - W. Vaneerdeweg
- Department of Paediatric Surgery, Antwerp University Hospital, University of Antwerp
| | - J. Ramet
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
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Abstract
In order to adapt African programs for antiretroviral treatment (ART) to children's needs, a good understanding of the unique features of pediatric HIV in Africa and realistic expectations of the results of such programs are crucial. We compared pediatric HIV in African settings to pediatric HIV in Western settings and to adult HIV in African settings. As an illustration, we also compared baseline characteristics and ART-outcomes from 15 African pediatric studies, 11 Western pediatric studies and 15 studies of African adults. Several differences in diagnostic, clinical, immunological and virological characteristics were identified, as well as variations in the most influential factors for disease progression and response to ART. Environmental factors may influence disease progression, mortality, loss to follow-up, adherence and the need to adapt the regimen. Many of the responses to ART are two-phased, the first phase taking longer in children than in adults. The selected African pediatric programs recorded a higher increase in median CD4-percent than the selected Western pediatric programs and a higher increase in CD4-count than the selected African adult programs. Compared to the adult programs, the African pediatric programs had lower drop-out rates, higher reported adherence levels and comparable mortality rates. The Western pediatric programs, however, had the lowest mortality rates. While several challenges complicate comparisons between ART-programs, increased knowledge of the unique features of pediatric HIV in Africa may greatly assist in improving pediatric HIV care on a global level.
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15
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De Baets AJ, Lepage P, Ramet J, Mujuru H, Savadogo LGB, Van der Linden D, Bulterys M. Using a sociological model to analyze access to pediatric HIV/AIDS care in rural sub-Saharan Africa. Curr HIV Res 2008; 6:563-71. [PMID: 18991623 DOI: 10.2174/157016208786501553] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The decentralization of pediatric HIV/AIDS-treatment programs to primary health care centers in rural Africa has lagged behind. In order to guide an analysis of current access to care, a sociological conceptual framework was developed. This framework focused on conditions of seeking pediatric HIV care among community members and initiating pediatric HIV care by primary health care workers (PHCWs). The use of the sociological conceptual framework helped in determining basic research questions and current gaps in knowledge (e.g. the effectiveness and long-term impact of Western counseling models in rural African settings), exploring the need for healthcare level specific research and policy (e.g. in infant HIV-testing), identifying potential pitfalls in decentralizing pediatric HIV treatment programs to rural African communities (e.g. lack of self-confidence in HIV counseling among PHCWs). Consequently, the use of the sociological model is helpful in maximizing efforts and resources allocated to such roll-out. A renewed appreciation for primary health care in general, however, remains crucial for a successful decentralization of pediatric HIV/AIDS-treatment programs to rural Africa.
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De Dooy J, Ramet J. ACS in paediatrics. Acta Clin Belg 2007; 62 Suppl 1:149-51. [PMID: 17469713] [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: 05/15/2023]
Abstract
Abdominal Compartment Syndrome (ACS) occurs relatively infrequent in a paediatric population when compared with adults. Overall mortality is still high. Also, the pathophysiologic mechanism that leads to ACS is different in children. In this review, we will present an overview on ACS in children admitted to a paediatric intensive care unit.
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Affiliation(s)
- J De Dooy
- Universitair Ziekenhuis Antwerpen, UA, België
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17
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Abstract
Influenza in young children represents a significant problem to families and to society, as this population is most susceptible to developing complications and is also a major route of disease spread within communities. However, there is a paucity of European data for the burden of disease in children and the health benefits and cost-effectiveness of vaccination, leading to a lack of awareness by governments, authorities, healthcare professionals and parents. The experience in elderly individuals and the paediatric experience in the US may provide some guidance in developing studies that will provide evidence for the creation of guidelines and educational strategies within Europe.
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Affiliation(s)
- Jose Ramet
- Universitair Ziekenhuis Antwerpen, Department of Paediatrics, UZA & ZNA Koningin Paola Kinderziekenhuis, Antwerp, Belgium.
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Provoost V, Cools F, Mortier F, Bilsen J, Ramet J, Vandenplas Y, Deliens L. [Medical end-of-life decisions in neonates and infants in Flanders, Belgium; 1999/2000]. Ned Tijdschr Geneeskd 2006; 150:377-82. [PMID: 16523802] [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: 05/07/2023]
Abstract
OBJECTIVE To determine the number of medical end-of-life decisions in critically ill neonates and infants in Flanders, Belgium. DESIGN Retrospective. METHOD A death certificate study on all deaths of neonates and infants in the whole of Flanders was carried out over a i2-month period (August 1999-July 2000). An anonymous questionnaire was sent by mail to the attending physician of each of the 292 children who died under the age of 1 year. All physicians who had attended at least one death during the study period were included in an attitude study. RESULTS A total of 253 (87%) of the 292 questionnaires were returned and 121 (69%) of the 175 physicians involved completed the questions on attitude. An end-of-life decision had been possible in 194 (77%; 95% CI: 70.4-82.4) of the 253 deaths for which questionnaires were returned, and such a decision was actually made in 143 cases (57%; 95% CI: 48.9-64.0). Lethal drugs were administered in 15 of 117 early neonatal deaths and in 2 of 77 later deaths (13% versus 3%; p = 0.018). The attitude study showed that 69 (58%; 95% CI: 48.1-66.5) of the 120 physicians supported a change in the law making life-termination possible in some well-defined cases. CONCLUSION The death of neonates and infants was commonly preceded by an end-of-life decision in Flanders. The type of decision varied substantially according to the age of the child. The majority of physicians involved, favoured legalization of the use of lethal drugs in some well-defined cases.
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Affiliation(s)
- V Provoost
- Vrije Universiteit BrussellAcademisch Ziekenhuis, Laarbeeklaan 103, B-109 Brussel, België
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Abstract
For the first time, a live attenuated varicella vaccine with an indication for universal vaccination is licensed in all EU countries. It is now time to consider whether in Europe there should be widespread vaccination against varicella to prevent this common and highly infectious disease. Increasing numbers of countries are adopting vaccination programmes against the disease. In those countries where a routine vaccination policy has been adopted, the success of the vaccine has been significant. The USA, which prior to the launch of a universal vaccination programme in 1995 had 4 million cases of varicella per year, has seen a dramatic reduction in varicella morbidity and mortality rates. A universal varicella vaccination policy is an option that needs to be considered for Europe not only in medical terms but also because it would be socially and economically appropriate.
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Affiliation(s)
- J Ramet
- Universiteit Antwerpen, UZA and Paola Kinderziekenhuis ZNA, Antwerp, Belgium.
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Provoost V, Deliens L, Cools F, Deconinck PG, Ramet J, Mortier F, Vandenplas Y. A classification of end-of-life decisions in neonates and infants. Acta Paediatr 2004; 93:301-5. [PMID: 15124828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM Valid and reliable data are needed to gain insight into the decisions of paediatricians concerning the end of life of newborns and infants. Such data could throw light on the poorly documented aspects of medical practice regarding these end-of-life decisions (ELDs). In this article a classification of ELDs is developed. METHODS The classification is developed from knowledge generated from large-scale epidemiological studies on ELDs. RESULTS This classification sets out from considerations of the various possible medical end-of-life procedures for newborns and infants and from important ethical aspects of the decision-making process. From both ethical and legal viewpoints the life-shortening intention of the physician is a significant factor for the qualification of ELDs. Furthermore, the consultation of the parents is an important factor in absence of the possibility of the patient's self-determination. CONCLUSION This classification has been devised with the aim of making reliable and valid descriptions of both the incidence and nature of ELDs in this specific population of newborns and infants.
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Affiliation(s)
- V Provoost
- Department of Medical Sociology, Free University of Brussels (VUB), Brussels, Belgium
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21
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Ramet J, Najafi N, Benatar A. An Update of Childhood Meningococcal Sepsis. Intensive Care Med 2003. [DOI: 10.1007/978-1-4757-5548-0_8] [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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Benatar A, Ramet J, Decraene T, Vandenplas Y. QT interval in normal infants during sleep with concurrent evaluation of QT correction formulae. Med Sci Monit 2002; 8:CR351-6. [PMID: 12011777] [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: 02/25/2023] Open
Abstract
BACKGROUND Physiological changes in the QT interval caused by sleep are important in the evaluation of the normal QT interval. Traditionally, Bazett's formula is used for correcting the QT interval for heart rate in childhood. We set out to establish the QT-RR relationship in infants during sleep and concurrently test the performance of four QT correction formulae to determine their comparability and clinical utility. MATERIAL/METHODS 130 healthy term born infants undergoing routine 8-hour polysomnography were enrolled. Continuous EKG limb lead II recording, saturation monitoring, and electroencephalography were conducted. QT intervals and heart rate were measured manually digitally on-screen at hourly intervals. The QT-RR relationship was plotted and QTc calculated using the Bazett, Hodges, Fridericia and Framingham formulae. QTc values for each formula were plotted against age and RR interval. Analysis of variance and regression analysis were used to compare the four formulae and the QT-RR relationship. RESULTS Mean age was 17.7 weeks (range 4-72) and mean weight 6.3 kg (range 2.68-12.7). The QT-RR relationship during sleep is curvilinear and appears to be slightly shifted. With increasing heart rate and younger age the Bazett and Hodges formulae overcorrect the QTc whereas the Fridericia and Framingham formulae undercorrect. The Hodges formula correlated best with the RR interval. CONCLUSIONS These formulae are strongly dependent on heart rate. In the setting of a borderline QTc Bazett prolongation, Hodges formula may be a useful adjunct. Normal infants may have a slightly longer QTc Bazett during sleep.
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Affiliation(s)
- Avram Benatar
- Department of Pediatric Cardiology, Academic Hospital, Free University of Brussels, Brussels, Belgium.
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23
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De Raeve L, Ramet J, Desprechins B, Otten J. Chronic, infantile, neurological, cutaneous, and articular syndrome in a neonate: a case report. Arch Dermatol 2000; 136:431-3. [PMID: 10724222 DOI: 10.1001/archderm.136.3.431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Orphenadrine is an anticholinergic drug used mainly in the treatment of Parkinson's disease. It has a peripheral and central effect and a known cardiotoxic effect when taken in large doses. We report the successful outcome of the treatment of a 2 1/2-year-old girl who accidentally ingested 400 mg of orphenadrine hydrochloride (Disipal). One hour after ingestion she presented neurological symptoms: confusion, ataxic walking, and periods of severe agitation. Generalized tonic-clonic seizures appeared resistant to the administration of multiple antiepileptics. They ceased after a supplementary dose of intravenous diazepam, endotracheal intubation, and mechanical ventilation. An episode of ventricular tachycardia responded well to i. v. lidocaine. Physostigmine was administered in three successive doses. The initial orphenadrine plasma level (3,55 microg/ml) was in the toxic range, associated with high mortality. The calculated elimination half-life was 10.2 h and the molecule and/or its metabolites were found up to 90 h after ingestion.
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MESH Headings
- Akathisia, Drug-Induced/blood
- Akathisia, Drug-Induced/etiology
- Akathisia, Drug-Induced/therapy
- Anti-Arrhythmia Agents/therapeutic use
- Anticonvulsants/therapeutic use
- Antiparkinson Agents/poisoning
- Ataxia/blood
- Ataxia/chemically induced
- Ataxia/therapy
- Child, Preschool
- Cholinesterase Inhibitors/blood
- Cholinesterase Inhibitors/pharmacokinetics
- Cholinesterase Inhibitors/therapeutic use
- Critical Care/methods
- Diazepam/therapeutic use
- Drug Monitoring
- Epilepsy, Tonic-Clonic/blood
- Epilepsy, Tonic-Clonic/chemically induced
- Epilepsy, Tonic-Clonic/therapy
- Female
- Humans
- Lidocaine/therapeutic use
- Muscarinic Antagonists/poisoning
- Orphenadrine/poisoning
- Physostigmine/blood
- Physostigmine/pharmacokinetics
- Physostigmine/therapeutic use
- Respiration, Artificial
- Tachycardia, Ventricular/blood
- Tachycardia, Ventricular/chemically induced
- Tachycardia, Ventricular/therapy
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Affiliation(s)
- I Van Herreweghe
- Pediatric Intensive Care Unit, Academic Hospital of the Free University of Brussels, Laarbeeklaan 101, B-1090 Brussels Belgium
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de Raeve L, Ramet J, Danschutter D, Roseeuw D. [Management of congenital epidermolysis bullosa]. Ann Dermatol Venereol 1998; 125:743-7. [PMID: 9835972] [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: 02/09/2023]
Affiliation(s)
- L de Raeve
- Service de Dermatologie, Academisch Ziekenhuis Vrije Universiteit Brussel, Belgique
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Ramet J, Clybouw C, Benatar A, Hachimi-Idrissi S, Corne L. Successful use of an intraosseous infusion in an 800 grams preterm infant. Eur J Emerg Med 1998; 5:327-8. [PMID: 9827836] [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: 02/09/2023]
Abstract
An intravascular access line for the administration of life support drugs and volume expanders may be particularly difficult, especially in very small premature babies. We report on the successful use of an intraosseous accessline in an 800 grams preterm infant for the administration of drugs and fluid. The use and technique of an intraosseous access is an important emergency alternative which may be lifesaving, even in very preterm babies, when other methods fail.
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Affiliation(s)
- J Ramet
- A.Z.-Vrije Universiteit Brussel, Paediatric Intensive Care Unit, Brussels, Belgium
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27
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Hachimi-Idrissi S, Corne L, Ramet J. Evaluation of scoring systems in acute meningococcaemia. Eur J Emerg Med 1998; 5:225-30. [PMID: 9846250] [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: 02/09/2023]
Abstract
Patients expected to develop life-threatening complications in acute meningococcal infections require early recognition and appropriate monitoring. Different prognostic scoring systems have been developed. Three of them, chosen according to their bedside availability, were compared with our clinical observations. Twenty consecutive cases of proven meningococcal infection were admitted to the paediatric intensive care unit (PICU) of the Free University of Brussels (AZ-VUB). Biological and clinical features required for prognostic scoring were evaluated as soon as possible after admission. Glasgow meningococcal sepsis prognostic score (GMSPS), Neisseria sepsis index (NESI) and Algren criteria were retrospectively calculated and evaluated for their prognostic significance. Neisseria meningitidis was cultured from blood and cerebrospinal fluid in 11 patients and from blood in only nine patients. The age of the patients was between 1 and 15 years (mean 4.1 years). All patients received the same therapy on admission. Four patients died with a multiorgan failure within 18 hours. The three scoring systems in these four patients predicted death. Overall, the GMSPS score, the NESI score and the Algren criteria predicted death in respectively 10, nine and five patients. Death was falsely predicted in six patients by the GMSPS score, in five patients by the NESI score and in one patient by the Algren criteria. The Algren criteria predicted the severity of the clinical process more accurately than did the GMSPS and NESI scores. However, such predictability should be cautiously used even when 100% mortality is predicted. It might be used in decision-making in regard to the following issues: patient transfer to tertiary centres and mode of transportation, monitoring of patients in intensive care units, early insertion of invasive cardiovascular monitoring catheters and consideration of new or even experimental therapy. However, one should be extremely cautious of taking any therapeutically or ethical decision on the basis of one or more of the described scoring system, since we showed the lack of precision concerning the outcome of paediatric patients with meningococcaemia.
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Affiliation(s)
- S Hachimi-Idrissi
- Paediatric Emergency Department, University Hospital of the Free University Brussels (AZ-VUB), Belgium
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Hamels K, Gordts F, Ramet J. Invasive sino-nasal aspergillosis: a case report. Acta Otorhinolaryngol Belg 1998; 52:63-7. [PMID: 9581200] [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: 02/07/2023]
Abstract
A case of invasive sino-nasal aspergillosis in an immunocompromised child is reported. Prognosis of this fulminant disease is usually poor. This paper reviews the early symptoms, clinical manifestations, risk factors, diagnosis and treatment. Awareness of the disease and early diagnosis by histological examination is essential. Treatment should consist of early administration of i.v. Amphotericin B and extensive surgical debridement.
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Affiliation(s)
- K Hamels
- Department of Otorhinolaryngology, Free University Brussels, Belgium
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Ramet J, Van Herreweghe I. La ventilation assistée. Avantages à la prescription d'une analgésie. Arch Pediatr 1997. [DOI: 10.1016/s0929-693x(97)89006-9] [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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Levtchenko E, Ramet J. Exogenous surfactant therapy for status asthmaticus. Eur J Pediatr 1997; 156:508. [PMID: 9208256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
Gitaloxin is a digitalis glycoside used for the same indications as digoxin and digitoxin. The successful outcome for a 2 1/2-year-old boy who accidentally ingested 3 mg of gitaloxin (100 times the normal therapeutic dose) is reported. At admission the child presented with irregular heart rhythm. He subsequently started vomiting, even after continuous gastric feeding. Only 48 h after ingestion of gitaloxin he became somnolent and developed bradyarrhythmia. The symptoms disappeared 96 h later; the bradyarrhythmia, however, (second-degree atrioventricular block) decreased progressively only after 120 h. The initial clinical presentation of gitaloxin poisoning may be misleading and careful observation in a pediatric intensive care unit is mandatory. A cross-reaction between the fluorescence polarization immunoassay for digitoxin and the radioimmunoassay for gitaloxin was found and was used as a helpful, but rough, estimate of the severity of gitaloxin poisoning, in the absence of a specific measurement of gitaloxin.
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Affiliation(s)
- S Hachimi-Idrissi
- Toxicology Department, University Hospital, Free University Brussels, Belgium
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Nielsen J, Hansen EG, Antonsen K, Frederiksen HJ, Lippert FK, Bonde J, Danschutter D, Goris J, Ramet J, Koutsoukou A, Papadhimitriou SI, Kithreotis P, Stratouli S, Vlahogiorgos G, Veldekis D, Eliopoulos E, Dexter TJ, Challant G, Waldmann CS, Bernau F, Waldmann CS, Meanock C, Thomas J, Defouilloy C, Defouilloy I, Tinturier F, Magnier S, Slama M, Ossart M, Hofhuis J, Rommes JH, Bakker J, Roupie E, Durand-Zaleski I, Picard JY, Lemaire F, Pateman I, Conyers AB, Ramet J, Van Herreweghe I, Danschutter D, Spapen H, Diltoer M, Huyghens L, Bouchet MF, Wysocki M, Dejeux D, Mirarda DR, Iapichino G, Moreao R, Lamb FJ, Mitchell IA, Grounds RM, Bennett ED, Bihari DJ, Jacques T, Angus DC, Clermont G, Lee KH, Craig MT, Abramson NS. Posters. Intensive Care Med 1996. [DOI: 10.1007/bf03216416] [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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Diltoer MW, Rosseneu S, Ramet J, De Wolf D, Spapen HD, De Turck BJ, Huyghens LP. Anticholinergic treatment for choreoathetosis in a child after induction with propofol. Anesth Analg 1996; 82:670. [PMID: 8623983 DOI: 10.1097/00000539-199603000-00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Diltoer MW, Rosseneu S, Ramet J, De Wolf D, Spapen HDM, De Turck BJG, Huyghens LP. Anticholinergic Treatment for Choreoathetosis in a Child After Induction with Propofol. Anesth Analg 1996. [DOI: 10.1213/00000539-199603000-00047] [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: 11/05/2022]
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Ramet J, Van Herreweghe I. [Analgesia and sedation in children under mechanical ventilation]. Arch Pediatr 1996; 3 Suppl 1:338s-339s. [PMID: 8796068 DOI: 10.1016/0929-693x(96)86093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Diltoer MW, Colle IO, Hubloue I, Ramet J, Spapen HD, Nguyen N, Huyghens LP. Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide. Eur J Emerg Med 1995; 2:231-5. [PMID: 9422213 DOI: 10.1097/00063110-199512000-00011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe the case of an adolescent who developed a severe but fully reversible cardiac dysfunction with low blood levels of carboxy haemoglobin (COHb = 10%) after a prolonged exposure to carbon monoxide. A 15-year-old male was admitted with a Glasgow Coma Scale of 8/15 with suspected postictal state and postanoxic encephalopathy. The cardiorespiratory failure which he developed soon after admission mandated mechanical ventilation, inotropic support and ultimately left ventricular support by intra-aortic balloon counterpulsation. The cardiac dysfunction was documented by radionuclide imaging and echocardiography. The patient fully recovered without neurological deficit. A low blood COHb concentration is a poor safety indicator since high tissue levels of accumulated carbon monoxide can be associated with coma and fulminant cardiorespiratory failure requiring advanced life support facilities.
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Affiliation(s)
- M W Diltoer
- Intensive Care Department, University Hospital, Vrije Universiteit Brussel, Belgium
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Abstract
UNLABELLED Babies born after in vitro fertilisation (IVF) are increasing in number, and, although these babies are considered as very precious, no data are available regarding their risk for sudden infant death or apnoea. To evaluate the respiratory maturity of IVF babies, we evaluated the incidence of apnoea during an 8-h polysomnography in 50 consecutively presented IVF babies and in a group of 50 unselected naturally conceived babies. All infants were in good health and matched for term (born > 38 weeks of gestation), birth weight, sex and age at the time of investigation (6-11 weeks post term, median 8.0). There were 24 twins in the IVF and 6 twins in the control group. The incidence of obstructive and isolated central apnoea was comparable in the IVF and control group. However, IVF babies had significantly more periodic breathing episodes than control babies (median 2.30 (range 0-15.30) in IVF, and 1.02 (range 0-11.2) in control babies; P < 0.01). This difference was not related to the higher number of twins in the IVF group. Single IVF babies had significantly more short central apnoeas (5-10 s) than IVF twins (5-10 s) (mean 38.80 +/- 18.63 and 22.33 +/- 13.35; P < 0.001). This difference between single and twin babies was not found in the control group. CONCLUSION IVF babies have more periodic breathing episodes indicating an immature respiratory pattern than normally conceived babies.
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Affiliation(s)
- H Audiens
- Academisch Ziekenhuis-Kinderen V.U.B., Brussels, Belgium
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Ramet J. Comparative Safety and Efficacy of Clarithromycin and Azithromycin Suspensions in the Short Course Treatment of Children with Acute Otitis Media. Clin Drug Investig 1995. [DOI: 10.2165/00044011-199509020-00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Spapen H, Deron P, Hamels K, Diltoer M, Ramet J, Huyghens L. Nosocomial pansinusitis in orotracheally intubated critically ill patients. Acta Otorhinolaryngol Belg 1995; 49:251-255. [PMID: 7484143] [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: 05/21/2023]
Abstract
Nosocomial pansinusitis (N P) is most often described in nasotracheally intubated patients with craniocerebral or facial trauma. We retrospectively reviewed its occurrence and complications in the course of prolonged mechanical ventilation in orotracheally intubated patients without maxillofacial or cranial injuries. N P was deemed to be present when (1) CT scan showed opacification and/or air-fluid levels in the maxillary, ethmoid and sphenoid sinuses and (2) aspiration of both maxillary sinuses yielded pus, cultures of which revealed a high concentration of micro organisms. Nosocomial pneumonia and bacteremia were considered related to the N P if the organisms found in the sinus were identical to those recovered from the blood and/or the bronchi. During an 18-month study period, 38 cases of sinusitis were diagnosed. N P was present in 13 patients: 18 organisms (12 Gram-negative, 5 Gram-positive and 1 Candida albicans) were isolated. Pneumonia occurred in 8 patients, 6 with multi-resistant Pseudominas aeruginosa and 2 with methicillin resistant Staphylococcus aureus. Pseudomonas aeruginosa was isolated from the blood, lung and sinus in two patients. This study demonstrates that N P is relatively frequent in patients requiring long-term mechanical ventilation, even in the absence of predisposing factors. N P in these patients is mostly monomicrobial with multi-resistant Pseudomonas aeruginosa and Staphylococcus aureus as the main causative agents.
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Affiliation(s)
- H Spapen
- Department of Intensive Care, University Hospital, Vrije Universiteit Brussel, Belgium
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Ramet J, Hauser B, Dehan M, Curzi-Dascalova L, Gaultier C. Effect of state of alertness on the heart rate response to ocular compression in human infants. Biol Neonate 1995; 68:270-5. [PMID: 8580219 DOI: 10.1159/000244246] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Because the state of alertness exerts a profound influence on autonomic cardiac control, we hypothesized, that the heart rate response to a vagal stimulus, i.e., ocular compression, may differ during different states of alertness. We studied 8 healthy infants with a postconceptional age of 35-41 weeks (mean +/- SD 37.9 +/- 2.1 weeks). They underwent a standardized ocular compression test during polygraphically controlled wakefulness, rapid eye movement (REM) sleep, and non-REM (NREM) sleep. The R-R intervals were measured (1) during the 60 s preceding the ocular compression test, to determine the mean control R-R interval, and (2) during compression. Percent R-R interval was defined as the longest R-R interval in milliseconds during the test divided by the mean control R-R interval and multiplied by 100. The longest R-R interval during the test was significantly greater in REM sleep than in wakefulness (p < 0.05) and in NREM sleep (p < 0.01):939 +/- 360, 623 +/- 355, and 538 +/- 60 ms, respectively. The percent R-R interval was significantly greater in REM sleep than in NREM sleep (p < 0.01):236 +/- 91 and 129 +/- 16, respectively. The time from the longest R-R interval to return to mean control R-R interval, i.e., vagal escape, was significantly shorter in REM sleep than in NREM sleep and in wakefulness (p < 0.01): 843 +/- 168, 2,131 +/- 712, and 2,078 +/- 913 ms, respectively. This study indicates that the state of alertness should be defined when performing tests on autonomic reflexes in infants.
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Affiliation(s)
- J Ramet
- Department of Pediatrics, AZ-Vrije Universiteit, Brussels, Belgium
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Blecker U, De Meirleir L, De Raeve L, Ramet J, Vandenplas Y. Acrodermatitis-like syndrome in organic aciduria. Pediatrics 1994; 93:537. [PMID: 8115227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Abstract
Cutaneous lesions resembling acrodermatitis enteropathica were present in two infants with methylmalonic acidemia and in one infant with propionic acidemia. All three infants were being fed a low-protein diet limited in branched-chain amino acids when the skin lesions developed. A deficiency in plasma levels of essential amino acids, particularly isoleucine, was confirmed. Supplementation of the diet with isoleucine in one of the patients led to a prompt improvement of the skin lesions. We conclude that dietary deficiencies associated with the treatment of organic aciduria should be added to the causes of acrodermatitis enteropathica-like cutaneous lesions.
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Affiliation(s)
- L De Raeve
- Department of Dermatology, Academisch Ziekenhuis, Vrije Universiteit Brussel, Belgium
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Abstract
Junctional epidermolysis bullosa letalis type Herlitz Pearson is a genetically determined, life-threatening disease. Effective therapy has been lacking to date. Therefore any therapy that improves wound healing would be beneficial for these patients. Cultured epidermal grafts are known to enhance wound epithelialization and have been used with success in some epidermolysis bullosa disorders. Encouraged by these reports, we grafted cultured allogeneic keratinocytes to an infant with a junctional epidermolysis bullosa letalis type.
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Affiliation(s)
- D Roseeuw
- Department of Dermatology, Academic Hospital, Vrije Universiteit, Brussel, Belgium
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Abstract
Gastroesophageal reflux associated with apnea and/or bradycardia induces both dilatation of the esophagus and abrupt intrusion of acid content in it. To evaluate the relative importance of these two types of stimulation on cardiac and respiratory responses, a series of experimental protocols were designed, in which we evaluated the influence of esophageal dilatation alone, acid infusion alone and both stimulations simultaneously. The passage of a volume in the lower third of the esophagus (n = 14) during reflux was simulated by balloon dilation; the passage of acid gastric juice during reflux was simulated by an esophageal acid infusion test, within the physiological range (n = 8; duration = 5 min; pH = 2.2). Cardiac, respiratory and arousal responses were compared during a control period and during the distal balloon dilatation and esophageal saline and acid infusion periods. Distal esophageal balloon dilatation and acid infusion induced significant prolongation of the RR interval and of the duration of the respiratory cycle. The presence of the esophageal catheter did not lead to continuous vagal stimulation. Simultaneous stimulation by balloon dilatation and acid infusion provoked cardiac responses that were above the level reached by each stimulation separately. Behavioral and electroencephalographic observations demonstrate significantly more frequent and longer arousal responses during the acid infusion than during control and saline infusion periods. We conclude that distal esophageal balloon dilatation and acid infusion elicit significant cardiac and respiratory responses in newborns during active sleep.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Ramet
- Pediatric Unit, A.Z.-Vrije Universiteit, Brussels, Belgium
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Ramet J, Egreteau L, Curzi-Dascalova L, Escourrou P, Dehan M, Gaultier C. Cardiac, respiratory, and arousal responses to an esophageal acid infusion test in near-term infants during active sleep. J Pediatr Gastroenterol Nutr 1992; 15:135-40. [PMID: 1403460 DOI: 10.1097/00005176-199208000-00006] [Citation(s) in RCA: 7] [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: 12/26/2022]
Abstract
This study was designed to determine the cardiac, respiratory, and arousal responses to an esophageal acid infusion test in near-term infants free from neurological, gastroesophageal, and cardiopulmonary disease at time of testing during active sleep. Eight infants (gestational age 28-37.5 weeks, postconceptional age 36-40 weeks) were tested. Using standardized procedures and timing, we compared the cardiac, respiratory and arousal responses during a control period and during distal esophageal saline and acid infusion periods. The duration of each of these periods was 5 min. The pH of the acid infusion was 2.2. We found that this mild distal esophageal acid infusion test induced significant prolongation of the interval between successive electrocardiogram R waves compared with control and saline infusion periods (806.5 +/- 145.7 ms, 478.8 +/- 49.4 ms, and 468.8 +/- 37.2 ms, respectively; p less than 0.01) and of the duration of the respiratory cycle (2.9 +/- 0.7 s, 1.5 +/- 0.3 s, and 1.5 +/- 0.2 s, respectively; p less than 0.01). Esophageal acid infusion elicited significant electroencephalogram (EEG) arousal responses. The number of the EEG arousals was significantly increased during the acid period as compared with control and saline infusion periods (2.9 +/- 1.4, 0.5 +/- 0.5, and 0.4 +/- 0.5, respectively; p less than 0.01). Total arousal duration was significantly increased during acid as compared with control and saline infusion periods (42 +/- 17.5 s, 4.5 +/- 5.1 s, and 3.5 +/- 5.0 s, respectively; p less than 0.01). We conclude that distal esophageal acid stimulation elicits significant cardiac, respiratory, and EEG arousal responses in near-term infants during active sleep.
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Affiliation(s)
- J Ramet
- Laboratory of Physiology, INSERM CJF 8909, Clamart, France
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Abstract
To evaluate the existence of a circadian rhythm in cardiac responses to vagal stimulation tests, 10 children without neurologic or cardiopulmonary disease, were studied using a standardized procedure. A trigeminal airstream stimulation test (TAS) and an ocular compression test (OCT) were subsequently performed at 4 nonequidistant hours. These 2 vagal stimulation tests were performed according to well-established, previously published techniques. Prolongation of the RR-interval during TAS and OCT was calculated and compared to the mean control RR-interval preceding the stimulation period. Prolongation of the RR-interval during the stimulation period was obtained in all instances during TAS and OCT. Chronobiologic analysis was determined by the cosinor method and bootstrap analysis. A significant circadian rhythm was found in cardiac responses to vagal stimulation for both TAS and OCT. The maximal response hour for TAS was between 9:06 p.m. and 5:18 a.m. and for OCT between 10:18 p.m. and 4:24 a.m. The mean value and 95% intervals for the cardiac responses to both vagal stimulation tests revealed, when using the bootstrap analysis, an important overlap in the hour of appearance of the maximal responses to these procedures; the bootstrap analysis of the peak of the acrophase was at 2:50 a.m. for TAS and 1:15 a.m. for OCT. Our results indicate that there is a circadian rhythm in cardiac responses to vagal stimulation tests and demonstrate a preponderance of these responses during the early morning hours.
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Affiliation(s)
- J Ramet
- Department of Pediatrics, Academisch Ziekenhuis-Vrije Universiteit Brussel, Belgium
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Ramet J, Pierard D, Vandenberghe P, De Boeck K. Comparative study of cefetamet pivoxil and penicillin V in the treatment of group A beta-hemolytic streptococcal pharyngitis. Chemotherapy 1992; 38 Suppl 2:33-7. [PMID: 1516463 DOI: 10.1159/000239096] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The efficacy of cefetamet pivoxil (20 mg/kg and 10 mg/kg b.i.d.) was investigated in an open, prospective, randomized, comparative multicenter trial involving 148 children suffering from group A beta-hemolytic streptococcal (GABHS) pharyngo-tonsillitis. Phenoxymethylpenicillin given for 10 days was used as the reference drug and resulted in 15% treatment failures. After treatment with cefetamet pivoxil 20 mg/kg b.i.d., 2 failures (5.8%) were observed in 34 patients treated for 7 days and 2 (6%) in 33 patients after 10 days treatment. In 8 children treated with cefetamet pivoxil 10 mg/kg b.i.d. for 10 days, 7 were cured and 1 relapsed in the late follow-up. Recruitment for this dosage group is being continued. No serious adverse events occurred. Cefetamet pivoxil, given b.i.d., can be considered an alternative to phenoxymethylpenicillin in the treatment of GABHS pharyngo-tonsillitis.
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Affiliation(s)
- J Ramet
- Department of Pediatrics, Free University of Brussels, Belgium
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Lenoir P, Ramet J, Goossens A, Desprechins B, Stevens G, Otten J. Retropharyngeal synovial sarcoma in an infant: report of a case and of its response to chemotherapy; review of the literature. Pediatr Hematol Oncol 1991; 8:45-52. [PMID: 2029466 DOI: 10.3109/08880019109033426] [Citation(s) in RCA: 6] [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: 12/29/2022]
Abstract
Synovial sarcoma of the retropharynx is an extremely rare neoplasm. To date, only 10 cases have been reported in patients less than 15 years old. Our 15-month-old patient is, to our knowledge, the youngest ever reported with a retropharyngeal synovial sarcoma in the world literature. In the past, treatment usually consisted of surgery followed by radiotherapy or adjuvant chemotherapy, or both. In the case reported here, combination chemotherapy (ifosfamide, vincristine, and actinomycin D), used as the initial treatment modality, induced a dramatic decrease of the synovial sarcoma.
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Affiliation(s)
- P Lenoir
- Department of Pediatrics, AZ-Vrije Universiteit Brussels, Belgium
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Courtens W, De Boeck H, Naessens A, Ramet J. Septic arthritis associated with Haemophilus influenzae meningitis. Eur J Pediatr 1991; 150:217-8. [PMID: 2044597 DOI: 10.1007/bf01963572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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