Pediatrie最新文献

With few exceptions in extremely rare circumstances, such as sign of raised intracranial pressure, a lumbar puncture must be performed whenever the diagnosis of meningitis is suspected in a child. It serves to confirm a diagnosis of purulent meningitis, to identify the bacteria and to test its sensitivity to antibiotics. If the child responds appropriately to therapy, some authors recommend no further examination of cerebrospinal fluid (CSF). However, most prefer to control CSF sterilization after about 48 h of therapy. Apart from its bacteriological interest, this second lumbar puncture seems to be a prognostic indicator of the incidence of neurological abnormalities. No further CSF examination is necessary when the patient's course of illness is uncomplicated. On the other hand, the presence or appearance of neurological abnormalities during the daily physical and neurological examination compels a new lumbar puncture and a CT scan to search for a persistent central nervous system infection or a complication of the meningitis.

We describe here a two-way teleconferencing system which links the sterile and pediatric units of the Center for Cancer Treatment in Lyon to a secondary school and the pediatric unit of the University Hospital Edouard-Herriot where primary teaching is given. Léon-Bérard Center and Edouard-Herriot Hospital are 300 m apart. Elie-Vignal secondary school is 6 km from the first site; all three institutes are connected through hyperfrequency aerials. With the help of this system, communication (voice and image) between children in hospital and pupils or teachers in school is instantaneous. Children in bed can listen to the lesson, break in on the conversation in school, ask questions or answer those of teachers. After school time, the system can also be used to organize games between children, or friendly contacts between children in each institute, children in the college, brothers, sisters or friends who may have access to one of those institutes. The system aims are: 1) to improve the education delivered to children and teenagers who spend long periods in hospital; 2) to establish a relationship between both worlds of healthy or sick children through teaching and playing in common; 3) finally, to facilitate the social insertion of sick children at leaving hospital.

The choice of antibiotics in bacterial meningitis must integrate several parameters. i) The bacterial epidemiology of community acquired meningitis: Haemophilus influenzae (Hi) Neisseria meningitidis (Nm), Streptococcus pneumoniae (Sp) represents more than 95% of cases; ii) The increase of antibiotic bacterial resistance, particularly preoccupying for Sp; iii) The microbiological properties and pharmacokinetics of antibiotics, especially their penetration in CSF: the concentrations achieved must be several times higher than the MBC. In fact, CSF is not favourable to the antibiotic activity; iv) The results of clinical comparative trials; v) The contribution of animal models to the knowledge of meningitis physiopathology. Third generation cephalosporins (cefotaxime, ceftriaxone) satisfy this objective for Hi, Nm, and penicillin sensitive strains of Sp. For penicillin resistant Sp, no treatment can achieve antibiotic CSF concentrations higher than ten times the MBC. An increase in dosage of cephalosporins, the use of an other regimen (Vancomycin or imipenem) and antibiotic association (rifamycin, fosfomycin) are needed.

Renal tubular acidosis represents a heterogenous group of disorders with various etiologies and mechanisms. The physiopathologic basis of each type of renal tubular acidosis is reviewed, focusing on the laboratory investigations necessary to define the nature of the hyperchloremic renal tubular acidosis. Clinically, the four types of renal tubular acidosis can be associated with complications such as osteomalacia, urolithiasis and failure to thrive. Very often, the chronic administration of alkali results in normal growth and development, and greatly reduces the risk of stone formation or nephrocalcinosis.

The authors report on the case of a 5,8 year-old girl whose father died of medullary thyroid carcinoma. When she was 4,5 year-old, her physical examination was normal but plasma calcitonin and katacalcin (PDN-21) levels were abnormally high in response to pentagastrin infusion. Total thyroidectomy was performed and immunohistochemical staining showed confluent C-cell hyperplasia. No recurrence occurred in this patient over four years on follow-up.

The authors report on three cases of staphylococcal cerebrospinal fluid (CSF) infection with normal white blood cell count and normal CSF glucose level in repeated lumbar CSF examination. All three children (2 months, 17 months and 4 years old) have been operated for neonatal hydrocephalus with setting of a ventriculo-peritoneal shunt one to two months before. Infection was suspected because of fever without evocative clinical signs. In two cases plasma C reactive protein level was increased, and in all three cases a leucocytosis was present. The diagnosis was made by bacteriological examination of the ventricular CSF. Both surgical and medical management were required and the bacteriological outcome was favourable. Since neurological sequellae may occur if the treatment is delayed such atypical infection needs to be promptly assessed.

Urinary calcium/creatinine ratio (U Ca/creat) was studied in infants, term and preterm newborn babies. In 31 1.5-24 months old healthy infants, the median U Ca/creat was 0.16 mmol/mmol (range 0.013-1.17) and was similar to the value obtained in children older than 4 years. In 55 healthy full-term newborns studied in the first week of life, the median U Ca/creat was 0.12 mmol/mmol. However the range of values was extremely wide (0.0006-4.75), suggesting that the U Ca/creat ratio is of little interest to screen for hypercalciuria during the neonatal period. In 31 premature newborns, the median U Ca/creat was 1.08 mmol/mmol, a value significantly higher than in the two other groups (P < 0.001); as in the term newborns there was a very wide range of values (0.057-6.83). However after excluding the premature babies with elevated serum 25 OHD level, this difference was not statistically significant.