Villemaire J.-M.,Jesus University
Journal of Oral and Maxillofacial Surgery | Year: 2013
Purpose: The purpose of this article is to describe a new technique to perform a high condylectomy using a γ-probe. Materials and Methods: A 15-year-old female patient presented with right condylar hyperplasia. Because the condition was active, a high condylectomy was performed to stop the abnormal growth of the affected condyle. To resect an adequate amount of bone and prevent relapse, a γ-probe was used to guide bone removal. The patient was injected with technetium-99m methylene diphosphate 25 mCi 2 hours before she was brought to the operating room. Bone was removed from the superior aspect of the right condyle until the reading with the γ-probe was equivalent to normal bone. Results: Seven millimeters of bone was removed from the top of the condyle before the γ-emission from the remaining condyle was equivalent to the mandibular parasymphysis used as a control. No relapse was noted 9 months after surgery. Conclusion: The γ-probe may help a surgeon remove the correct amount of bone when performing a high condylectomy, especially in type II (vertical pattern) condylar hyperplasia.© 2013 American Association of Oral and Maxillofacial Surgeons.
Gomez B.,Cruces University Hospital |
Bressan S.,University of Padua |
Mintegi S.,Cruces University Hospital |
Mintegi S.,University of the Basque Country |
And 7 more authors.
Pediatrics | Year: 2012
BACKGROUND AND OBJECTIVE: Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and speci fi cally invasive bacterial infections (IBIs) in well-appearing infants aged <3 months with fever without source (FWS). METHODS: Well-appearing infants aged <3 months with FWS admitted to 7 European pediatric emergency departments were retrospectively included. IBI was defined as the isolation of a bacterial pathogen in blood or cerebrospinal fluid culture. RESULTS: We included 1112 infants who had PCT measured and a blood culture performed. IBI was diagnosed in 23 cases (2.1%). In the multivariate analysis including clinical and laboratory data, PCT was the only independent risk factor for IBI (odds ratio 21.69; 95% confidence interval [CI] 7.93-59.28 for PCT ≥0.5 ng/mL). Positive likelihood ratios for PCT ≥2 ng/mL and C-reactive protein (CRP) >40 mg/L were 11.14 (95% CI 7.81-15.89) and 3.45 (95% CI 2.20-5.42), respectively. Negative likelihood ratios for PCT <0.5 ng/mL and CRP <20 mg/L were 0.25 (95% CI 0.12-0.55) and 0.41 (95% CI 0.22-0.76). Among patients with normal urine dipstick results and fever of recent onset, areas under the receiver operator characteristic curve for PCT and CRP were 0.819 and 0.563, respectively. CONCLUSIONS: Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test. Copyright © 2012 by the American Academy of Pediatrics.
Yang J.H.,Inje University |
Yang B.S.,Jesus University
Qualitative Health Research | Year: 2011
In this study we explored the perspectives of older Korean women on the principles and meanings of health behavior. Participants were 12 women age 65 and older, with no serious illnesses requiring hospitalization, who were living independently. We used an interpretative phenomenological approach for data collection and analysis. Seven themes emerged: (a) eating well in accordance with one's physical requirements; (b) maintaining one's inherited health; (c) controlling one's illness properly; (d) maintaining good relationships with close relatives and friends; (e) being modest and free from greed; (f) staying in harmony with nature; and (g) regaining energy and vitality. These experiences were mainly based on the traditional Korean concept of health promotion, "food is medicine," rather than on Western concepts of health promotion. In providing optimal geriatric nursing care for Korean older women, the results will be significant because they are based on older women's traditional Korean perspectives of health promotion rather than existing perspectives of Western medicine. © The Author(s) 2011.
Viqueira A.Q.,Jesus University |
Caravaca G.R.,Foundation Medicine |
Quesada Rubio J.A.,Jesus University |
Frances V.S.,Jesus University
Pediatric Infectious Disease Journal | Year: 2014
BACKGROUND: The objective of the study is to study surgical site infection (SSI) rates and risk factors in a pediatric population. METHODS: We conducted a prospective cohort study to estimate the SSI rate at a national pediatric referral center, covering all patients managed at the Orthopedic Surgery Department of the Niño Jesús Children's University Teaching Hospital from January 2010 through December 2012. Risk factors and antibiotic prophylaxis were monitored. A comparison between Spanish and US data was performed, with a breakdown by National Nosocomial Infection Surveillance risk indices. We also conducted a comparative study of SSI rates from 2010 to 2012 to assess the impact of the epidemiologic surveillance system. RESULTS: The study population of 1079 patients had a SSI rate of 2.8%. SSI rates were calculated for spinal fusion and other musculoskeletal procedures according to the National Nosocomial Infection Surveillance risk index. In the case of other musculoskeletal procedures, our SSI rates were 0.8 times lower than the overall Spanish rate, but higher than US rates for all risk categories. For spinal fusion procedures, our SSI rates were 1.2 times higher than the Spanish rates and 3.5 times higher than National Nosocomial Infection Surveillance rates. This latter finding should be interpreted with caution because it was based on a small sample. The multivariate analysis indicated that the only predictive factors of SSI were American Society of Anesthesiologists score and age. CONCLUSIONS: The surveillance program showed that for clean procedures, SSI incidence decreased from 4% in 2010 to 3.2% in 2011 and to 2.4% in 2012. Copyright © 2013 by Lippincott Williams & Wilkins.
Pendergrast J.,University of Toronto |
Willie-Ramharack K.,University of Toronto |
Sampson L.,University of Toronto |
Laroche V.,Jesus University |
Branch D.R.,Center for Innovation
Transfusion | Year: 2015
Intravenous immune globulin (IVIG) therapy has shown great success in a number of autoimmune and inflammatory conditions and its use continues to increase worldwide. There is growing awareness of significant side effects of high-dose IVIG: however, particularly severe hemolysis in patients that are non-group O. It has been proposed that IVIG-associated hemolysis may be heralded by an existing inflammatory condition. In the work presented herein, we have provided a review of the pathophysiology of inflammation, particularly as it applies in immune-mediated red blood cell hemolysis, and a summary of previous publications that suggest an association between IVIG-mediated hemolysis and a state of existing inflammation. In addition, preliminary results from a prospective study to address the mechanism of IVIG-associated hemolysis are provided. These preliminary data support the idea of an existing inflammatory condition preceding overt hemolysis after high-dose IVIG therapy that: 1) is restricted to non-group O patients, 2) is seen when using IVIG doses of more than 2 g/kg, 3) involves an activated mononuclear phagocyte system, 4) may be presaged by a significant increase in the anti-inflammatory cytokine interleukin-1 receptor agonist, and 5) is independent of secretor status. © 2015 AABB.
Epeldegui T.,Jesus University
Journal of Pediatric Orthopaedics Part B | Year: 2012
Clubfoot is a complex congenital deformity. Midtarsal joint is a key point to understand the deformity in clubfoot as a consequence of the malalignment of the osseous columns. Talar and calcaneal deformities affecting the normal alignment of the medial and lateral osseous columns in the foot can be the factors that determine the difficulty in the management of clubfoot. We report observations of two clubfeet of one stillborn. Our observations in the head of the talus report two different articular areas: the histological section of medial area facing the navicular shows active articular cartilage and the lateral area shows an atrophic articular cartilage suggesting a difference between the anatomical declination angles of the talus from a functional declination angle. Observing the calcaneous, we report a twisting rotational deformity along the longitudinal axis of the calcaneous. These observations may contribute to a better understanding of the clubfoot relapse, and also the treatment of complicated cases of clubfeet. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Noguera-Morel L.,Jesus University |
Hernandez-Martin T.,Jesus University |
Torrelo A.,Jesus University
Pediatric Clinics of North America | Year: 2014
Cutaneous adverse drug reactions (ADRs) constitute a major pediatric health problem frequently encountered in clinical practice, and represent a diagnostic challenge. Children are more susceptible than adults to errors in drug dosage because of their smaller body size; moreover, ADRs can mimic other skin diseases of children, especially viral exanthems. Most ADRs with cutaneous involvement are mild and resolve on withdrawal of the causative drug. The most common forms of cutaneous ADRs, maculopapular exanthems and urticarial reactions, have excellent outcomes. Less frequent but more severe reactions may incur a risk of mortality. © 2014 Elsevier Inc.
L'Her E.,Laval University |
L'Her E.,Jesus University |
L'Her E.,Brest University Hospital Center |
Annie R.R.,Jesus University
Respiratory Care | Year: 2011
BACKGROUND: It has been pointed out that in the wake of a virulent flu strain, patients with survivable illness will die from lack of resources unless more ventilators are made available. Numerous disaster-type ventilators are available, but few evaluations have been performed. OBJECTIVE: To compare simple, lightweight, and handy ventilators that could be used in the initial care of patients with respiratory distress. METHODS: We bench-tested 4 volume-cycled ventilators (Carevent ALS, EPV100, Pneupac VR1, and Medumat Easy) and 2 pressure-cycled ventilators (Oxylator EMX and VAR-Plus). We studied their general physical characteristics, sonometry, gas consumption, technical performance, ergonomy, and user-friendliness. With a test lung we assessed performance at FIO2 of 0.50 and 1.0, set compliance of 30, 70, and 120 mL/cm H2O, and set resistance of 5, 10, and 20 cm H2O/L/s. To study user-friendliness and ergonomy we conducted, in randomized order, 7 or 8 objective, quantitative tests and 2 subjective tests. RESULTS: Compliance and resistance strongly affected tidal volume with the pressure-cycled ventilators (from 418±49 mL to 1,377 ± 444 mL with the VAR-Plus, at the lowest pressure level), whereas the volume-cycled ventilators provided a consistent tidal volume in the face of changing test lung characteristics. CONCLUSIONS: We are concerned that the pressure-cycled ventilators did not provide a consistent tidal volume, and under certain conditions the volume delivered would be unsafe (too large or too small). Most of the volume-cycled ventilators proved to be technically efficient and reliable. Their reliability, portability, and ease of use could make them valuable in natural disasters and mass-casualty events. © 2011 Daedalus Enterprises.
Calderon M.A.,Imperial College London |
Rodriguez del Rio P.,Jesus University |
Demoly P.,Montpellier University
Revue Francaise d'Allergologie | Year: 2012
Although subcutaneous allergen immunotherapy (SCIT) is still considered the gold standard immunotherapy treatment for allergic diseases, due to the risk of severe adverse reactions and its limitations regarding practicality, allergen immunotherapy in the sublingual route (SLIT) has been suggested as an alternative to SCIT. In the last three decades an increasing number of studies assessing the efficacy and safety of SLIT have been published; however, not all of them bring the same degree of evidence. This paper aims to be a comprehensive review of the most outstanding and robust papers on SLIT in the paediatric population. We will discuss classical indications like rhinitis and asthma as well as novel possible indications like food allergy, conjunctivitis, latex allergy or atopic dermatitis. We used an evidence based medicine approach. We confirm that there is evidence supporting the efficacy and safety of SLIT mainly for allergic rhinitis, less for asthma and some other allergic conditions; there are still some pitfalls to go through, like immunologic mechanisms, optimal dosage, duration of treatment or long-term efficacy among others, before SLIT can be suggested as the first step in allergy treatment. © 2011 Elsevier Masson SAS.
Diaz M.A.,Jesus University
Bone Marrow Transplantation | Year: 2016
Haploidentical hematopoietic stem cell transplantation using T-cell-depleted grafts is a valid option for pediatric patients with hematological malignancies in need of an allogeneic transplantation and lacking an HLA-identical donor. Seventy-five transplantations were performed in 70 patients. Thirty-eight patients had ALL, 32 had AML, 3 had advanced myelodysplastic syndromes and 2 juvenile myelomonocytic leukemia; 19 were in first CR, 30 in second CR, 12 in greater than second CR and 14 were considered to be in refractory disease at time of transplantation. Four patients developed graft failure. Among engrafted patients, the median time to neutrophil and platelet recovery was 13 (range 8–20) and 10 days (range 8–70), respectively. In 64 (85%) cases, ⩾1 infections were diagnosed after transplant. The probability of nonrelapse mortality by day +100 after transplantation was 10±4%. With a median follow-up of 22 months, the probability of relapse was 32±6% and disease-free survival was 52±6%. Haploidentical transplantation using CD3/CD19 depletion is associated with encouraging results especially in patients in early phase of disease. Killer-cell Ig-like receptor B haplotype donors confer a rapid natural killer cells expansion early after transplantation, resulting in lower probability of relapse and suggesting a GvL effect apart from graft-versus-host reactions. Donor infusion of high numbers of CD34+ cells is recommended in order to improve T-cell reconstitution.Bone Marrow Transplantation advance online publication, 18 April 2016; doi:10.1038/bmt.2016.101. © 2016 Macmillan Publishers Limited