Adipose tissue may release mediators that induce a chronic inflammatory state and alterations in coagulation, which contribute to insulin resistance, atherosclerosis, and thrombosis. We investigated ...whether inflammatory and/or prothrombotic states exist in obese children and assessed their interrelationship. Sixty‐one subjects were recruited, aged between 6 and 16 years, to participate in a cross‐sectional study at Children's University Hospital of Geneva. Selected pro/anti‐inflammatory cytokines/chemokines and hemostasis parameters were measured in obese children and lean controls. Cardiovascular risk factors in the family were indexed. Fasting glucose level, insulin, prothrombin time (PT), fibrinogen, activated partial thromboplastin time (aPTT), D‐dimer, endogenous thrombin potential (ETP), C‐reactive protein (CRP), interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), interferon‐γ‐inducible‐protein (IP‐10), monocyte chemoattractant protein 1 (MCP‐1), and interleukin‐1 receptor antagonist (IL‐1Ra) were measured. We estimated insulin resistance by homeostatic model assessment (HOMA). Anti‐ (IL‐1Ra) and proinflammatory cytokines (MCP‐1, IL‐6) were significantly increased in obese children in comparison to the control group, even before puberty. Hemostasis was also altered in obese children with a significantly increased fibrinogen level, increased D‐dimer, a shortened PT, as well as an increased ETP. No correlation was found between cytokine levels and hemostasis parameters, except for IL‐6 and fibrinogen. Obese children present with inflammatory and prothrombotic states as early as 6 years of age and these states are similar in prepubertal and pubertal obese children. The cytokines IL‐1Ra and MCP‐1 were most significantly increased in obese children. Further investigation is necessary to determine if these cytokines, together with ETP, can reliably predict the development of diabetes and atherosclerosis.
Hyperglycemia after cardiac surgery and cardiopulmonary bypass in children has been associated with worse outcome; however, causality has never been proven. Furthermore, the benefit of tight glycemic ...control is inconsistent. The purpose of this study was to describe the metabolic constellation of children before, during, and after cardiopulmonary bypass, in order to identify a subset of patients that might benefit from insulin treatment.
Prospective observational study, in which insulin treatment was initiated when postoperative blood glucose levels were more than 12 mmol/L (216 mg/dL).
Tertiary PICU.
Ninety-six patients 6 months to 16 years old undergoing cardiac surgery with cardiopulmonary bypass.
None.
Metabolic tests were performed before anesthesia, at the end of cardiopulmonary bypass, at PICU admission, and 4 and 12 hours after PICU admission, as well as 4 hours after initiation of insulin treatment. Ketosis was present in 17.9% patients at the end of cardiopulmonary bypass and in 31.2% at PICU admission. Young age was an independent risk factor for this condition. Ketosis at PICU admission was an independent risk factor for an increased difference between arterial and venous oxygen saturation. Four hours after admission (p = 0.05). Insulin corrected ketosis within 4 hours.
In this study, we found a high prevalence of ketosis at PICU admission, especially in young children. This was independently associated with an imbalance between oxygen transport and consumption and was corrected by insulin. These results set the basis for future randomized controlled trials, to test whether this subgroup of patients might benefit from increased glucose intake and insulin during surgery to avoid ketosis, as improving oxygen transport and consumption might improve patient outcome.
Background. End‐stage renal failure increases with advancing age and renal transplantation should be considered in end‐stage renal failure patients older than 60 years. However, there is a paucity of ...data on long‐term patient and graft survival in this population. Methods. From October 1983 to March 1999, 310 renal transplantations were performed at Geneva University Hospital in 283 patients, of which 49 were done in 48 patients older than 60 years (mean age 65.6±4.1 years). The following data were analysed at 1, 5, and 10 years, and compared between the patients >60 years and <60 years old: actuarial patient and graft survival, serum creatinine, causes of graft loss, and patient death. Results. Patient survival at 10 years was 81% for patients <60 years and 44% for patients >60 years. Graft survival at 10 years was 59% for patients <60 years and 32% for patients >60 years. Graft survival at 10 years censored for death with functioning graft was 65% for patients <60 years and 81% for patients >60 years. Main causes of mortality in the older patients were related to cardiovascular events (47%), neoplasia (41%), and sepsis (18%). Overall, recipient and donor age were not predictive factors for graft survival, as shown by multiple logistic regression. Conclusions. Renal transplantation should be considered in patients older than 60 years, since graft survival is excellent in this population. Although these patients have a shorter life expectancy, they benefit from renal transplantation similarly to younger kidney transplant recipients.
Au corps des mots, à l'ouest du soleil Saudan-Henny, Sylvie; Brusset, Bernard; Gutton, Philippe ...
Adolescence (Paris, France),
1/2012, Letnik:
T. 29 n°4, Številka:
4
Journal Article
Résumé Justine est une adolescente qui présente un fonctionnement limite et dont les symptômes principaux sont des vomissements provoqués et répétés. Elle expulse les aliments comme elle évacue la ...pensée. Elle investit les actes en se débarrassant de la tension interne. L’effraction de la sexualité renforce l’impossibilité d’investir une position passive comme si elle réactivait le temps originaire de la séduction. L’auteur décrit la difficulté à trouver sa place dans l’espace de la psychothérapie, alors qu’il y a échec de la mise en scène psychique chez la patiente. Condamnée à l’expulsion dans un premier temps, et cherchant à contrer son vécu de passivité, elle évoque l’épreuve périlleuse que représente l’approche mélancolique vers la reconnaissance de l’altérité de l’objet, dans les traces internes qu’il lui a laissées.
Au corps des mots, à l'ouest du soleil Saudan-Henny, Sylvie; Brusset, Bernard; Gutton, Philippe ...
Adolescence (Paris, France),
2011, Letnik:
T. 294, Številka:
4
Journal Article
RésuméJustine est une adolescente qui présente un fonctionnement limite et dont les symptômes principaux sont des vomissements provoqués et répétés. Elle expulse les aliments comme elle évacue la ...pensée. Elle investit les actes en se débarrassant de la tension interne. L’effraction de la sexualité renforce l’impossibilité d’investir une position passive comme si elle réactivait le temps originaire de la séduction.L’auteur décrit la difficulté à trouver sa place dans l’espace de la psychothérapie, alors qu’il y a échec de la mise en scène psychique chez la patiente. Condamnée à l’expulsion dans un premier temps, et cherchant à contrer son vécu de passivité, elle évoque l’épreuve périlleuse que représente l’approche mélancolique vers la reconnaissance de l’altérité de l’objet, dans les traces internes qu’il lui a laissées.
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