Pediatrie最新文献

Acute neurogenic pulmonary edema (NPE) can dramatically complicate a serious brain injury. From bibliographic data and four personal cases documented by and haemodynamical study, the authors analyse the pathophysiological mechanisms and the haemodynamical changes resulting from massive sympathic outflow, the main mechanism of NPE being haemodynamical rather than lesional. This rare complication needs to be recognized in order to undergo an intensive care treatment generally leading to a favourable evolution. This treatment lies on circulatory and ventilatory supports with positive and expiratory pressure in order to maintain an optimal oxygenation and an optimal cerebral perfusion pressure. With this treatment the outcome of NPE is usually favourable with complete recovery within 2 to 5 days.

The authors describe the main characteristics of the Doppler method in the early diagnosis of chronic fetal distress, and report their personal results in the study of 51 high risk pregnancies. In their study the fetal doppler ultrasound findings were correlated with birth weight related to gestational age, and neonatal morbidity. The parameters established from the doppler ultrasound assessment were the placenta resistance (calculated from the formula of Pourcelot: R = S-D/S applied to the umbilical artery) and the cerebro-placental index, Rp/Rc, Rc being the index of cerebral arterial resistance. The diagnosis performance of the method appeared very good: the Rp index was found to be highly specific for hypotrophy (85,7%) and for neonatal morbidity (90%), the RCP index adding its own good sensitivity (85% for hypotrophy and 83,3% for neonatal morbidity). The authors conclude upon the interest to study simultaneously the fetal umbilical and cerebral arterial circulations. The pathological significance of the two indexes appears different so that they are to be complementary in the evaluation of fetal distress.

We report two cases of neonatal ascites. The first case is a 24 day old male referred for abdominal distention and edema. Peritoneal tap removed a transudative fluid. Ultrasonographic evaluation revealed obstructive posterior urethral valves. Bladder drainage led to resolution of the urinary ascites and renal function normalization. Long term follow-up after endoscopic resection of valves was good. The second case is a male infant who presented at birth with abdominal distention. Radiology revealed an urinoma and a left side hydronephrosis secondary to ureteropyelic junction syndrome which underwent a successful surgical treatment. Urinary ascites is a rare entity which calls for immediate diagnosis and management to preserve renal function.

Clinical, radiological and biological features of 19 cases of serologically proven Mycoplasma pneumoniae pneumonia were compared with those of 21 cases of other types of pneumonia. Some clinical features were more frequent in M pneumoniae: patients older than 5 years, association with upper respiratory tract infection, skin rashes, acute course, unsuccessful treatment with penicillin. There were no specific radiological features. When compared with the complement fixation method, the serological diagnosis using agglutination technique appears to be more sensitive.

Three children presented with an association of pains, infectious syndrome, acute renal failure, hepatitis and meningitis, that lead to the diagnosis of leptospirosis. The clinical spectrum of this rare disease are recalled.

Accidental bleach ingestion is frequent in children but there is no agreement on its management. The results of a survey among 11 French poison centres about their recommendations in this intoxication are reported. Most of the centres adapt their guidelines according to the quantity and the concentration of the ingested bleach. In case of diluted bleach, no centre recommends an hospitalization when the quantity is smaller than 100 ml, whereas four of the 11 centres recommend it when the quantity is greater than 100 ml. In case of concentrate bleach ingestion nine of the 11 centres recommend an hospitalization whatever the amount, eight of them performing an emergency upper gastro intestinal (GI) endoscopy if clinical signs are present. In case of large ingestion of concentrate bleach ten centres recommend the hospitalization, eight perform an upper GI endoscopy between 6 and 8 hours post ingestion according to clinical signs, and two perform a systematic emergency upper GI endoscopy. Tablets and new bleach are considered as concentrate bleach. From these informations and a review of the literature, the authors emphasize the importance of the clinical signs as criteria for prediction of GI lesions regardless of the quantity or the concentration of ingested bleach.

Oto-rhino-laryngologists usually deny the existence of infant chronic ethmoido-maxillary sinusitis, generally agreeing that the earliest signs of pneumatization of the maxillary sinuses cannot be observed earlier than 18 months of age. Based upon ten cases we present evidence that this notion of "late sinusal pneumatization" should be re-examined, pneumatized maxillary sinuses being possible as early as 11 months of age. Thus, at that age, radiodiagnosed apneumatosis which is considered as physiological, may express various conditions, such as true anatomical apneumatosis, chronic glue sinusitis, or simple inflammatory sinusitis of the mucous membrane. Because it is impossible to clinically differentiate these different conditions we believe that in some particular cases, a short course of combined corticoid-antibiotics treatment with sinus X ray before and after treatment, may be useful. In case of confirmed sinusitis (sinus visualization after treatment), a secondary preventive treatment may reduce the risk of chronic maxillary sinusitis. We suggest that further studies should be performed in order to better define the reality of chronic ethmoido-maxillary sinusitis in infants younger than 18 months of age, and to study the possible role of a phenomenon of immuno-inflammatory trapping in its pathologenesis.

The weight and height data of 9261 children from birth onwards were gathered on their admission to primary school in 1989 in the area of Lyon, and compared to French references. In comparison with the latter data, the weight and height for age were found to be higher, and there was an excess of children with a high weight for height. The weight for height was higher than the mean of the reference distribution plus two standard deviations in 6.2% of the children. Birth hypertrophy increased the risk of obesity at age six. A new criterion of neonatal hypertrophy, taking various constitutional characteristics into account, was found to be associated to a twofold risk of subsequent obesity, and was shown to be more appropriate in predicting subsequent obesity than classical definitions based on the weight or on the weight for gestational age or sex.