Caudal block and light sevoflurane mask anesthesia in high-risk infants: An audit of 98 cases [Bloc caudal associé à une anesthésie au masque facial (sévoflurane) chez le nourrisson à haut risque d'apnée: Étude observationnelle]
Lacrosse D.,Cliniques Universitaires Mont Godinne |
Pirotte T.,Cliniques universitaires Saint Luc |
Veyckemans F.,Cliniques universitaires Saint Luc
Annales Francaises d'Anesthesie et de Reanimation | Year: 2012
Objective: In order to reduce the risk of postoperative apnoea, awake spinal anaesthesia orawake caudal anaesthesia are recommended for hernia surgery in newborn babies and former premature infants aged less than 60weeks of amenorrhoea. However, additional sedation is sometimes necessary. Our working hypothesis was that a general anaesthesia with a face mask (sevoflurane) with no opiates nor neuromuscular blocking agents, maintaining the infant's spontaneous breathing and combined with a caudal anaesthesia, could provide a safe and effective alternative. Study design: The epidemiological and technical data about the patient and the anaesthesia, as well as any per- and postoperative complications, were collected prospectively and analysed retrospectively. Patients and methods: Ninety-eight infants undergoing hernia surgery were included during the period from 2003 to 2008. Results: Caudal anaesthesia proved successful at first attempt in 69% of the infants (term or premature). Three attempts were needed in 8% of the infants born at term and 2% of the infants born prematurely. One failure was recorded. Seven patients presented one episode of peroperative apnoea; they were easily taken care of by means of brief face mask ventilation. The follow-up of these seven infants did not reveal any reappearance of postoperative apnoea/bradypnoea. Conclusion: The technique proposed is an effective alternative to the awake locoregional anaesthesia techniques: it provides excellent conditions for surgery and presents similar perioperative morbidity and risk of postoperative apnoea. © 2011 Société française d'anesthésie et de réanimation (Sfar).
Rahier J.,Cliniques Universitaires Mont Godinne |
Buche S.,Lille 2 University of Health and Law |
Peyrin-Biroulet L.,Nancy University Hospital Center |
Duclos B.,CHU |
And 7 more authors.
Clinical Gastroenterology and Hepatology | Year: 2010
Background & Aims: Psoriasiform and eczematiform lesions are associated with anti-tumor necrosis factor (TNF)-α therapies. We assessed clinical characteristics, risk factors, and outcomes of skin disease in patients with inflammatory bowel diseases that presented with psoriasiform and eczematiform lesions induced by anti-TNF-α agents. Methods: We studied 85 patients (69 with Crohn's disease, 15 with ulcerative colitis, and 1 with indeterminate colitis; 62 women) with inflammatory skin lesions (62 psoriasiform and 23 eczematiform lesions). Results: Twenty-four patients had a history of inflammatory skin lesions and 15 had a familial history of inflammatory skin disease. Locations of eczematiform lesions varied whereas scalp and flexural varieties were mostly psoriasiform. Skin lesions emerged but inflammatory bowel disease was quiescent in 69 patients following treatment with any type of anti-TNF-α agent (60 with infliximab, 20 with adalimumab, and 5 with certolizumab). Topical therapy resulted in partial or total remission in 41 patients. Patients with psoriasiform lesions that were resistant to topical therapy and that changed anti-TNF-α therapies once or twice developed recurring lesions. Overall, uncontrolled skin lesions caused 29 patients to stop taking TNF-α inhibitors. Conclusions: Inflammatory skin lesions following therapy with TNF-α inhibitors occurred most frequently among women and patients with a personal or familial history of inflammatory skin disease; lesions did not correlate with intestinal disease activity. Recurring and intense skin lesions caused 34% of patients in this study to discontinue use of anti-TNF-α agents. © 2010 AGA Institute.
Veereman-Wauters G.,University of Paris Descartes |
Veereman-Wauters G.,Cliniques Universitaires Mont Godinne |
De Ridder L.,University of Paris Descartes |
Veres G.,Erasmus Medical Center |
And 8 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2012
Combined immunosuppression by immunomodulators and biological therapy has become standard in the medical management of moderate-tosevere inflammatory bowel disease (IBD) because of clearly demonstrated efficacy. Clinical studies, registries, and case reports warn of the increased risk of infections, particularly opportunistic infections; however, already in the steroid monotherapy era, patients are at risk because it is accepted that a patient should be considered immunosuppressed when receiving a daily dose of 20mg of prednisone for 2 weeks. Prescriptions increasingly involve azathioprine, methotrexate, and various biological agents. The TREAT registry evaluated safety in >6000 adult patients, half of them treated with infliximab (IFX) for about 1.9 years. IFX-treated patients had an increased risk of infections and this was associated with disease severity and concomitant prednisone use. The REACH study, evaluating the efficacy of IFX in children with moderate-to-severe Crohn disease, refractory to immunomodulatory treatment, reports serious infections as the major adverse events and their frequency is higher with shorter treatment intervals. The combination of immunosuppressive medications is a risk factor for opportunistic infections. Exhaustive guidelines on prophylaxis, diagnosis, and management of opportunistic infections in adult patients with IBD have been published by a European Crohn's and Colitis Organization working group, including clear evidence-based statements. We have reviewed the literature on infections in pediatric IBD as well as the European Crohn's and Colitis Organization guidelines to present a commentary on infection prophylaxis for the pediatric age group. Copyright © 2012 by European Society for Pediatric Gastroenterology.
Rahier J.-F.,Cliniques Universitaires Mont Godinne |
Yazdanpanah Y.,Service University des Maladies Infectieuses et du Voyageur |
Viget N.,Service University des Maladies Infectieuses et du Voyageur |
Travis S.,Gastroenterology Unit |
And 2 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2010
Background: Infection with influenza A (H1N1)v (swine flu) has caused widespread anxiety, among patients who are potentially immunocompromised, such as those being treated for inflammatory bowel disease. Aim To provide guidance for physicians and their patients on the risk, prevention and management of influenza A (H1N1)v infection. Methods Medline was searched using the following key words: 'swine flu', 'immunosuppression', inflammatory bowel disease', 'recommendations', 'immunization', 'vaccination'. Organizations such as European Centre for Disease Prevention and Control, the Centers for Disease Control and Prevention and the World Health Organization were consulted for recent papers and recommendations regarding immunocompromised patients and influenza A (H1N1)v infection. Results Pandemic influenza A (H1N1) virus predominantly affects young patients. Those who are immunocompromised because of underlying disease or treatment are considered at higher risk of complications from influenza A (H1N1). They should be offered prevention (vaccination, postexposure prophylaxis) or treatment with antiviral drugs, if affected. Pneumococcal infection is a complication of influenza infection; therefore, pneumococcal vaccination appears advisable. Seasonal influenza vaccination is also recommended. Withdrawal of immunosuppressive treatment appears advisable during severe active infection if possible. Conclusions Pragmatic advice is the best that can be offered in the current circumstances because of paucity of evidence. Investigation into the impact of influenza A (H1N1)v infection in young people with chronic conditions is needed. © 2010 Blackwell Publishing Ltd.
Evaluation of the Xpert MRSA assay for rapid detection of methicillin-resistant Staphylococcus aureus from nares swabs of geriatric hospitalized patients and failure to detect a specific SCCmec type IV variant
Laurent C.,Cliniques Universitaires Mont Godinne |
Bogaerts P.,Cliniques Universitaires Mont Godinne |
Schoevaerdts D.,Cliniques Universitaires Of Mont Godinne Ucl |
Denis O.,National MRSA Reference Laboratory |
And 5 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2010
Rapid and reliable detection of methicillin-resistant Staphylococcus aureus (MRSA) carriers is crucial for control of MRSA nosocomial transmission. We aimed to evaluate the performance of the GeneXpert real-time PCR system using the Xpert MRSA assay on a collection of 40 representative Belgian MRSA strains and for MRSA screening of geriatric inpatients. Double nasal swabs were used: the first swab for the Xpert MRSA assay and the second for culture onto chromogenic selective medium and enrichment broth. All but 1 of the 40 collection strains were recognized as MRSA by the Xpert MRSA assay. Nares swabs were prospectively collected from 246 inpatients including 25 nasal MRSA carriers. Compared with enriched cultures, the sensitivity, the specificity, and the positive and negative predictive values of the Xpert MRSA assay were 69.2%, 97.7%, 78.3%, and 96.3% respectively. The 7 evaluable false-negative results according to the assay were due to its possible lack of sensitivity (n=3) and to the occurrence of a Belgian MRSA clone carrying a particular staphylococcal chromosomal cassette mec (SCCmec) type IV variant (n=4) not targeted by the current Xpert MRSA assay. Because of the evolution of SCCmec in MRSA, new primers should be designed and further studies are warranted to ensure continuous monitoring of this assay. © 2010 Springer-Verlag.