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1.
Pulmonology ; 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38402125

RESUMO

BACKGROUND AND OBJECTIVE: Traditionally, the diagnosis of acute rejection (AR) relies on invasive transbronchial biopsies (TBBs) to obtain histopathological samples. We aimed to evaluate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) as a complementary and non-invasive tool for ACR screening, comparing its results with those obtained from TBBs. METHODS: Between January 2015 and April 2022, we conducted a retrospective study of all lung transplant recipients aged over 18 years at Toulouse University Hospital (France). All patients who underwent bronchoscopies with both TBBs and pCLE imaging were included. Two experienced interpreters (TV and MS) reviewed the pCLE images independently, blinded to all clinical information and pathology results. RESULTS: From 120 procedures in 85 patients, 34 abnormal histological samples were identified. Probe-based confocal laser endomicroscopy revealed significant associations between both alveolar (ALC) and perivascular (PVC) cellularities and abnormal histological samples (p<0.0001 and 0.003 respectively). Alveolar cellularity demonstrated a sensitivity (Se) of 85.3 %, specificity (Spe) of 43 %, positive predictive value (PPV) of 37.2 % and negative predictive value (NPV) of 88.1 %. For PVC, Se was 70.6 %, Spe 80.2 %, PPV 58.5 % and NPV 87.3 %. Intra-interpreter correlation (TV) was 88.3 % for the number of vessels (+/-1), 98.3 % for ALC and 90 % for PVC. Inter-interpreter correlation (TV and MS) was 80 % for vessels (+/-1), 97.5 % for ALC and 83.3 % for PVC. CONCLUSION: Our study demonstrates the feasibility of incorporating pCLE into clinical practice, demonstrating good diagnostic yield and reproducible outcomes in the screening of AR in lung transplant recipients.

2.
Rev Mal Respir ; 40(1): 94-100, 2023 Jan.
Artigo em Francês | MEDLINE | ID: mdl-36577607

RESUMO

Up to 30% of lung cancer patients suffer from central airway obstruction, resulting in major deterioration in prognosis and quality of life. Interventional bronchoscopy combines a number of invasive techniques used during rigid bronchoscopy. It is designed to rapidly improve symptoms, primarily dyspnea. Applied according to very precise indications, this technique requires careful patient selection and needs to be incorporated into the multimodal oncological management in combination with systemic treatments, radiation therapy and surgery.


Assuntos
Obstrução das Vias Respiratórias , Neoplasias Pulmonares , Humanos , Qualidade de Vida , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Neoplasias Pulmonares/complicações , Broncoscopia/métodos , Prognóstico , Stents
3.
Rev Mal Respir ; 39(5): 477-485, 2022 May.
Artigo em Francês | MEDLINE | ID: mdl-35305856

RESUMO

In the overwhelming majority of cases, Airway stents offer relief of malignant or benign central airway obstruction. In some non-tumoral situations, they can be curative, providing a bridge to local or systemic treatments in the context of malignant obstruction. The efficacy and tolerance of these medical devices have dramatically improved over the past three decades with the development of silicone airway stents and, more recently, of third-generation, covered, self-expandable metallic stents with an increasingly widened panel of shapes. We review herein the main categories of airway stents with their specific indications, pitfalls, and advantages, not only in neoplastic situations, but also in the treatment of benign stenoses of the respiratory tract. The recent advances and perspectives in the field are also taken into consideration, particularly the development of biodegradable, drug-eluting, and patient-specific customized AS.


Assuntos
Obstrução das Vias Respiratórias , Broncoscopia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Humanos , Sistema Respiratório , Silicones , Stents/efeitos adversos , Resultado do Tratamento
4.
Rev Mal Respir ; 38(8): 853-858, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34325956

RESUMO

INTRODUCTION: Complications following COVID-19 are starting to emerge; neurological disorders are already described in the literature. CASE REPORT: This case is about a 20-year old male with a severe COVID-19, hospitalized in a Reanimation and Intensive Care Unit with an Acute Respiratory Distress Syndrome, thromboembolic complication and secondary bacterial infection. This patient had a non-specific neurological disorder with a pseudobulbar palsy, (MRI, ENMG and lumbar puncture were normal), associated 4 months later with persistent left shoulder motor deficit and respiratory failure. Respiratory and neurological check-up led to a diagnosis of the Parsonage-Turner syndrome or neuralgic amyotrophy affecting C5-C6 nerve roots, the lateral pectoral and phrenic nerves at the origin of the scapular belt, amyotrophy and left diaphragm paralysis. CONCLUSIONS: This case shows that persistant dyspnoea after COVID 19 infection should lead to a search for a diaphragmatic cause which is not always the result of Reanimation Neuropathy but may also indicate a neuralgic amyotrophy. It is the fourth case of neuralgic amyotrophy following COVID-19. This brings the medical community to consider the risk of diaphragm paralysis apart from critical illness polyneuropathy. Respiratory muscle evaluation and diaphragmatic ultrasound should be considered in case of persistent dyspnoea.


Assuntos
Neurite do Plexo Braquial , COVID-19 , Paralisia Respiratória , Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/etiologia , Humanos , Masculino , Nervo Frênico , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , SARS-CoV-2 , Adulto Jovem
5.
Arch Pediatr ; 28(5): 411-416, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34034929

RESUMO

AIM: To evaluate the prognostic significance of initial central nervous system (CNS) involvement of children with acute lymphoblastic leukemia (ALL) enrolled in the EORTC 58951 trial. PATIENTS AND METHODS: From 1998 to 2008, 1930 ALL patients were included in the randomized EORTC 58951 trial. Overall treatment intensity was adjusted according to known prognostic factors including the level of minimal residual disease after induction treatment. CNS-directed therapy comprised four to 11 courses of i.v. methotrexate (5g/m2), and 10 to 19 intrathecal chemotherapy injections, depending on risk group and CNS status. Cranial irradiation was omitted for all patients. RESULTS: The overall 8-year event-free survival (EFS) and overall survival (OS) rates were 81.3% and 88.1%, respectively. In the CNS-1, TPL+, CNS-2, and CNS-3 groups, the 8-year EFS rates were 82.1%, 77.1%, 78.3%, and 57.4%, respectively. Multivariable analysis indicated that initial CNS-3 status, but not CNS-2 or TLP+, was an independent adverse predictor of outcome. The 8-year incidence of isolated CNS relapse was 1.7% and of isolated or combined CNS relapse it was 3.7%. NCI high-risk group, male sex, CNS-2 and CNS-3 status were independent predictors for a higher incidence of any CNS relapse. CONCLUSIONS: CNS-3 status remains associated with poor prognosis and requires intensification of both systemic and CNS-directed therapy. This trial was registered at https://clinicaltrials.gov/under/NCT00003728.


Assuntos
Sistema Nervoso Central/anormalidades , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Valor Preditivo dos Testes , Adolescente , Biomarcadores Tumorais/análise , Sistema Nervoso Central/fisiopatologia , Criança , Pré-Escolar , Irradiação Craniana/tendências , Feminino , Humanos , Lactente , Masculino , Pediatria/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Prognóstico , Resultado do Tratamento
6.
Rev Mal Respir ; 38(3): 289-296, 2021 Mar.
Artigo em Francês | MEDLINE | ID: mdl-33531186

RESUMO

Bronchial thermoplasty has been developed over the past fifteen years and is the first endoscopic technique approved in the management of severe asthma. This procedure uses radiofrequency applied to the airway wall to target bronchial smooth muscle. Patients treated in randomized controlled trials have experienced significant decreases in the use of rescue medications, urgent care visits, and exacerbations rate. The lack of reliable predictive markers of response to this expensive, minimally-invasive technique currently makes it a last-line treatment option. We review the principles and supposed mechanisms of action of this treatment, the results from the main trials and clinical registry data and discuss the place of bronchial thermoplasty in the current management of severe asthma. We also discuss perspectives to better characterize the mechanisms of action and identify the responder phenotype, the main challenge of current studies.


Assuntos
Asma , Termoplastia Brônquica , Assistência Ambulatorial , Asma/cirurgia , Humanos , Músculo Liso , Fenótipo
8.
Rev Mal Respir ; 34(7): 770-773, 2017 Sep.
Artigo em Francês | MEDLINE | ID: mdl-28867308

RESUMO

Currently about 50% of cases of haemoptysis are thought to be cryptogenic. Haemorrhage from the pulmonary arterial system is rare and usually due to aneurysms or pseudoaneurysms, the radiological diagnosis of which is often difficult. We report here the case of a patient admitted with a heavy haemoptysis in whom the thoracic CT scan did not reveal the diagnosis. Bronchoscopy with endobronchial ultrasound showed a vascular malformation of a branch of the pulmonary artery allowing a radiological embolisation. This case underlines the importance of bronchoscopy and the role of ultrasound in the diagnosis of haemoptysis, considered ideopathic, complicating vascular malformations.


Assuntos
Broncoscopia/métodos , Endossonografia/métodos , Hemoptise/diagnóstico , Adulto , Embolização Terapêutica , Hemoptise/terapia , Humanos , Masculino , Artéria Pulmonar/anormalidades , Artéria Pulmonar/patologia , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico , Malformações Vasculares/terapia
9.
Bone Marrow Transplant ; 52(4): 516-521, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27941778

RESUMO

We analyzed the impact of cytogenetics on 193 children enrolled in two successive French trials (LAME89/91 and ELAM02), who received hematopoietic stem cell transplantation during CR1. Detailed karyotype was available for 66/74 (89%) in LAME89/91 and 118/119 (99%) in ELAM02. Several karyotype and transplant characteristics differed according to therapeutic protocol: unfavorable karyotypes were more frequent in ELAM02 (36% vs 18%), pretransplant chemotherapy included high-dose cytarabine in ELAM02 and not in LAME89/91, IV replaced oral busulfan in the conditioning regimen, methotrexate was removed from post-transplant immunosuppression, and matched unrelated donor and cord blood transplantation were introduced. Five-year overall survival (OS) was 78.2% in LAME89 and 81.4% in ELAM02. OS was significantly lower for the unfavorable cytogenetic risk group in LAME89/91 when compared with intermediate and favorable groups (50% vs 90.6 and 86.4%, P=0.001). This difference was no longer apparent in ELAM02 (80.9% vs 71.3% and 5/5, respectively). Survival improvement for children with unfavorable karyotype was statistically significant (P=0.026) and was due to decrease in relapse risk. Five-year transplantation-related mortality was 6.75% in LAME89/91. In ELAM02, it was 3.2% for patients with a sibling donor and 10.9% with an unrelated donor or cord blood. We conclude that the outcome of children with unfavorable karyotype transplanted in CR1 has improved.


Assuntos
Citogenética , Transplante de Células-Tronco Hematopoéticas/métodos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/terapia , Criança , Feminino , França , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Cariotipagem , Leucemia Mieloide Aguda/mortalidade , Masculino , Indução de Remissão , Análise de Sobrevida , Transplante Homólogo , Resultado do Tratamento
10.
Ann Hematol ; 95(8): 1295-305, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27270301

RESUMO

Peripheral T cell lymphomas (PTCL) are rare in children and adolescents, and data about outcome and treatment results are scarce. The present study is a joint, international, retrospective analysis of 143 reported cases of non-anaplastic PTCL in patients <19 years of age, with a focus on treatment and outcome features. One hundred forty-three patients, between 0.3 and 18.7 years old, diagnosed between 2000 and 2015 were included in the study. PTCL not otherwise specified was the largest subgroup, followed by extranodal NK/T cell lymphoma, hepatosplenic T cell lymphoma (HS TCL), and subcutaneous panniculitis-like T cell lymphoma (SP TCL). Probability of overall survival (pOS) at 5 years for the whole group was 0.56 ± 0.05, and probability of event-free survival was (pEFS) 0.45 ± 0.05. Patients with SP TCL had a good outcome with 5-year pOS of 0.78 ± 0.1 while patients with HS TCL were reported with 5-year pOS of only 0.13 ± 0.12. Twenty-five percent of the patients were reported to have a pre-existing condition, and this group had a dismal outcome with 5-year pOS of 0.29 ± 0.09. The distribution of non-anaplastic PTCL subtypes in pediatric and adolescent patients differs from what is reported in adult patients. Overall outcome depends on the subtype with some doing better than others. Pre-existing conditions are frequent and associated with poor outcomes. There is a clear need for subtype-based treatment recommendations for children and adolescents with PTCL.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/métodos , Linfoma de Células T Periférico/terapia , Avaliação de Resultados em Cuidados de Saúde/métodos , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Intervalo Livre de Doença , Feminino , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Humanos , Lactente , Cooperação Internacional , Masculino , Indução de Remissão , Estudos Retrospectivos , Adulto Jovem
11.
Leukemia ; 29(11): 2154-61, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26050650

RESUMO

The added value of IKZF1 gene deletion (IKZF1(del)) as a stratifying criterion in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is still debated. We performed a comprehensive analysis of the impact of IKZF1(del) in a large cohort of children (n=1223) with BCR-ABL1-negative BCP-ALL treated in the EORTC-CLG trial 58951. Patients with IKZF1(del) had a lower 8-year event-free survival (EFS, 67.7% versus 86.5%; hazard ratio (HR)=2.41; 95% confidence interval (CI)=1.75-3.32; P<0.001). Importantly, despite association with high-risk features such as high minimal residual disease, IKZF1(del) remained significantly predictive in multivariate analyses. Analysis by genetic subtype showed that IKZF1(del) increased risk only in the high hyperdiploid ALLs (HR=2.57; 95% CI=1.19-5.55; P=0.013) and in 'B-other' ALLs, that is, lacking classifying genetic lesions (HR=2.22; 95% CI=1.45-3.39; P<0.001), the latter having then a dramatically low 8-year EFS (56.4; 95% CI=44.6-66.7). Among IKZF1(del)-positive patients randomized for vincristine-steroid pulses during maintenance, those receiving pulses had a significantly higher 8-year EFS (93.3; 95% CI=61.3-99.0 versus 42.1; 95% CI=20.4-62.5). Thus, IKZF1(del) retains independent prognostic significance in the context of current risk-adapted protocols, and is associated with a dismal outcome in 'B-other' ALL. Addition of vincristine-steroid pulses during maintenance may specifically benefit to IKZF1(del) patients in preventing relapses.


Assuntos
Deleção de Genes , Fator de Transcrição Ikaros/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/mortalidade , Prognóstico , Recidiva
12.
Rev Mal Respir ; 31(3): 208-13, 2014 Mar.
Artigo em Francês | MEDLINE | ID: mdl-24680111

RESUMO

INTRODUCTION: Lung cancer is the main cause of cancer death in France. The diagnosis is often late and the delay between the onset of symptoms and management is considered an aggravating factor. MATERIAL AND METHODS: Our prospective study collected the dates of the start of management of 139 consecutive patients receiving first line treatment for thoracic cancer in our hospital between November 2008 and May 2009. The aim of this study was to evaluate the delays in medical or surgical treatments in patients with thoracic cancer and to determine the cause of these delays. RESULTS: The median delay between the first abnormal chest X-ray and treatment was 9.6 weeks. The delays were significantly shorter in the late stages and in small cell cancer (P=0.001). There was a tendency for shorter delays in women and for longer delays in older patients. CONCLUSION: Evaluation of the delays in treatment, particularly in the early stages, is part of the quality control of management of these diseases.


Assuntos
Carcinoma/terapia , Neoplasias Pulmonares/terapia , Tempo para o Tratamento , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma/epidemiologia , Carcinoma/patologia , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , Fatores Sexuais
13.
Leukemia ; 28(1): 70-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24064621

RESUMO

Oncogenic subtypes in childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) are used for risk stratification. However, a significant number of BCP-ALL patients are still genetically unassigned. Using array-comparative genomic hybridization in a selected BCP-ALL cohort, we characterized a recurrent V(D)J-mediated intragenic deletion of the ERG gene (ERG(del)). A breakpoint-specific PCR assay was designed and used to screen an independent non-selected cohort of 897 children aged 1-17 years treated for BCP-ALL in the EORTC-CLG 58951 trial. ERG(del) was found in 29/897 patients (3.2%) and was mutually exclusive of known classifying genetic lesions, suggesting that it characterized a distinct leukemia entity. ERG(del) was associated with higher age (median 7.0 vs. 4.0 years, P=0.004), aberrant CD2 expression (43.5% vs. 3.7%, P<0.001) and frequent IKZF1 Δ4-7 deletions (37.9% vs. 5.3%, P<0.001). However, ERG(del) patients had a very good outcome, with an 8-year event-free survival (8-y EFS) and an 8-year overall survival of 86.4% and 95.6%, respectively, suggesting that the IKZF1 deletion had no impact on prognosis in this genetic subtype. Accordingly, within patients with an IKZF1 Δ4-7 deletion, those with ERG(del) had a better outcome (8-y EFS: 85.7% vs. 51.3%; hazard ratio: 0.16; 95% confidence interval: 0.02-1.20; P=0.04). These findings have implications for further stratification including IKZF1 status.


Assuntos
Deleção de Genes , Fator de Transcrição Ikaros/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Transativadores/genética , Adolescente , Sequência de Bases , Criança , Pré-Escolar , Primers do DNA , Feminino , Humanos , Lactente , Masculino , Reação em Cadeia da Polimerase , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Regulador Transcricional ERG
14.
Clin Microbiol Infect ; 19(10): E458-65, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23714194

RESUMO

We have evaluated the multiplex molecular method xTAG(®) Gastrointestinal Panel (GPP) for detecting pathogens in stool samples of diarrhoeic patients. We collected 440 samples from 329 patients (male:female ratio of 1.2:1), including 102 immunosuppressed adults, 50 immunosuppressed children, 56 children attending the neonatal unit and 121 children attending the emergency unit. Of these, 176 samples from 162 patients were xTAG(®) GPP positive (102 viruses, 61 bacteria and 13 parasites) and the assay was more sensitive than the conventional test for detecting rotavirus (p <0.01), noroviruses (p <0.0001), Salmonella spp. (p <0.001), Campylobacter spp. (p <0.001) and toxigenic Clostridium difficile (p 0.005). The predominant pathogens were viruses (23.2%), with rotavirus (15.9%) being the most common. Bacterial agents were detected in 13.9%; the most common was Salmonella spp. (4.8%). Parasites were detected in 2.9%; Cryptosporidium spp. (2%) was the most common. There were 31 co-infections (7% of samples), involving two pathogens in 23 (5.2%) and three pathogens in eight (1.8%) samples. There were 113 (92.6%) positive samples from the children attending the emergency unit, 25 (17%) positive samples from immunosuppressed adults, 22 (25.3%) positive samples from immunosuppressed children and 16 (19%) positive samples from children attending the neonatal unit. The low turnaround time and technical hands-on time make this multiplex technique convenient for routine use. Nevertheless, conventional bacterial culture and parasitological stool examination are still required to detect other pathogens in specific cases and to determine susceptibility to antibiotics.


Assuntos
Diarreia/diagnóstico , Técnicas Microbiológicas/métodos , Tipagem Molecular/métodos , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Diarreia/microbiologia , Diarreia/parasitologia , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Humanos , Lactente , Pessoa de Meia-Idade , Estudos Prospectivos
15.
Rev Mal Respir ; 29(4): 545-56, 2012 Apr.
Artigo em Francês | MEDLINE | ID: mdl-22542412

RESUMO

Lung cancer and chronic obstructive lung disease (COPD) are two common fatal diseases. Apart from their common link to tobacco, these two diseases are usually considered to be the result of separate distinct mechanisms. In the past 15 years, numerous studies have produced arguments in favour of a relationship between these two pathologies that goes beyond a simple addition of risk factors. At the epidemiological level, there are data that demonstrate an increased incidence of bronchial carcinoma in patients with COPD. The links between these two pathologies are still unexplained but there are numerous arguments supporting a common physiopathology. Common genetic and epigenetic abnormalities, mechanical factors and signalisation pathways have been quoted. COPD and lung cancer appear to be two diseases possessing a genetic basis that creates a predisposition to environmental or toxic assaults, resulting in a different clinical manifestation in each disease. Consequently, improvements in the management of these two diseases will involve a more intensive investigation of their physiopathology, and require a closer collaboration between research centres and clinical units.


Assuntos
Carcinoma Broncogênico/epidemiologia , Carcinoma Broncogênico/etiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Carcinoma Broncogênico/complicações , Carcinoma Broncogênico/genética , Predisposição Genética para Doença , Humanos , Inflamação/complicações , Inflamação/epidemiologia , Inflamação/genética , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/genética , Modelos Biológicos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/genética , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/genética , Estresse Mecânico
16.
Arch Mal Coeur Vaiss ; 100(5): 458-61, 2007 May.
Artigo em Francês | MEDLINE | ID: mdl-17646774

RESUMO

Alveolar capillary dysplasia is a rare cause of persistent pulmonary hypertension of the newborn. The diagnosis of this condition is made by histological study of a pulmonary biopsy. Familial forms and associated genitor-urinary and gastrointestinal malformations have been reported. Despite optimal management, the prognosis remains poor. The authors report the case of a neonate who developed cyanosis and cardiogenic shock on the 10th day of life. There was no associated neonatal pathology. Echocardiography showed supra-systemic pulmonary hypertension with normal cardiac structure. Pulmonary vasodilator therapies (inhaled NO, prostacyclin, sildenafil, bosentan) were ineffective and the child died on the 25th day of life. Autopsy revealed alveolar capillary dysplasia.


Assuntos
Síndrome da Persistência do Padrão de Circulação Fetal/etiologia , Alvéolos Pulmonares/anormalidades , Capilares/anormalidades , Cianose/etiologia , Ecocardiografia , Evolução Fatal , Humanos , Recém-Nascido , Masculino , Alvéolos Pulmonares/irrigação sanguínea , Choque Cardiogênico/etiologia
17.
Arch Pediatr ; 13(12): 1514-7, 2006 Dec.
Artigo em Francês | MEDLINE | ID: mdl-17029933

RESUMO

Acute myocarditis is a rare inflammatory cardiac disease in children with potentially fatal issue. Clinical findings are very variable from nausea and vomiting to acute cardiovascular collapse. The cardiac function can be reversible with circulatory support. We report the case of a 6-year-old girl with ECG changes like myocardial infarction and diagnosis of fulminant myocarditis. She developped rapidly a cardiogenic shock and died before treatment with mechanical circulatory support.


Assuntos
Infarto do Miocárdio/diagnóstico , Miocardite/mortalidade , Doença Aguda , Fatores Etários , Criança , Diagnóstico Diferencial , Ecocardiografia Doppler , Eletrocardiografia , Emergências , Feminino , Humanos , Miocardite/diagnóstico , Prognóstico , Radiografia Torácica , Respiração Artificial , Choque Cardiogênico/diagnóstico
18.
Arch Pediatr ; 13(11): 1416-9, 2006 Nov.
Artigo em Francês | MEDLINE | ID: mdl-16928432

RESUMO

Cardiac tumors are rare in childhood and can be revealed by arrhythmias. We report the observation of an 18-month-old infant who had an episode of ventricular tachycardia (VT) which resulted in a large intramyocardic tumour diagnosis evocating a left ventricular fibroma. A treatment by amiodarone allowed a stable reduction of the VT. The presence of an intracardiac obstruction or uncontrollable arrhythmias would lead to a surgical resection.


Assuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Taquicardia Ventricular/etiologia , Neoplasias Cardíacas/diagnóstico , Humanos , Lactente , Masculino
19.
Arch Mal Coeur Vaiss ; 99(5): 477-81, 2006 May.
Artigo em Francês | MEDLINE | ID: mdl-16802738

RESUMO

The increase in B-natiuretic peptide (BNP) is well correlated with cardiovascular symptoms in adults. Its use in children is recent and only partially evaluated. The authors undertook a prospective study of BNP concentrations and its kinetics in 54 children with an average age of 15 months (5 days to 11 years) admitted as paediatric emergencies. The symptoms were dyspnoea (60%), shock (15%), suspicion of Kawasaki disease (15%) and other (10%). Twenty children had BNP levels of more than 100 pg/ml related to decompensation of known congenital heart disease in 7 patients (average BNP 462 +/- 323 pg/ml), due to neonatal coarctation in 2 patients (BNP > 3000 pg/ml), due to cardiomyopathy in 6 patients (BNP= 2576 +/- 1215 pg/ml), due to an arrhythmia in 1 patient (BNP= 3754 pg/ml) and to Kawasaki disease in 4 patients (BNP= 521 +/- 448 pg/ml). Thirty-four children had BNP values of less than 100 pg/ml; 29 had no cardiac disease and 5 had known congenital heart disease with other symptoms. Measuring BNP is quick and economical and is a valuable aid in the diagnosis of cardiac dysfunction in symptomatic children in the emergency room. High BNP values seem to be correlated with the severity of the cardiac disease. Low BNP values seem to have a good negative predictive value in children without underlying cardiac disease. The interpretation of intermediary values, especially when there is previous cardiac disease, is more difficult in view of the absence of known threshold values for different haemodynamic situations. Further studies are required to determine the value of this test for the follow-up and setting up of prognostic values in children with congenital heart disease.


Assuntos
Baixo Débito Cardíaco/sangue , Baixo Débito Cardíaco/etiologia , Peptídeo Natriurético Encefálico/sangue , Coartação Aórtica/sangue , Coartação Aórtica/complicações , Arritmias Cardíacas/sangue , Arritmias Cardíacas/complicações , Biomarcadores/sangue , Baixo Débito Cardíaco/complicações , Cardiomiopatias/sangue , Cardiomiopatias/complicações , Criança , Pré-Escolar , Dispneia/sangue , Dispneia/etiologia , Serviço Hospitalar de Emergência , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/complicações , Humanos , Lactente , Recém-Nascido , Síndrome de Linfonodos Mucocutâneos/sangue , Síndrome de Linfonodos Mucocutâneos/complicações , Valor Preditivo dos Testes , Estudos Prospectivos , Choque/sangue , Choque/etiologia
20.
Arch Pediatr ; 13(8): 1129-31, 2006 Aug.
Artigo em Francês | MEDLINE | ID: mdl-16766166

RESUMO

We report the case of a newborn presenting with neonatal respiratory distress due to acute pulmonary edema, the underlying diagnosis being cor triatriatum sinister. This rare anomaly can be lethal in the short term. However, it can be completely cured surgically provided that diagnosis is made on time.


Assuntos
Cardiopatias Congênitas/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Pré-Escolar , Eletrocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Radiografia Torácica , Resultado do Tratamento
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