Pediatrie最新文献

The authors report the results of a retrospective study concerning 100 children with immune thrombocytopenic purpura who were referred between January 1981 and January 1991. Twenty-seven children had a chronic evolution with a significantly high risk: girls aged 9 years or more, hospitalization longer than 10 days, or patients with a history of frequent ecchymoses. The risk of haemorrhage was highest at the early phase of the disease and when the platelet count was below 25 G/l. The need for laboratory tests has been controversial and the authors suggest a simplified list of tests after having demonstrated the limited value of tests attempting to document the prepurpuric infectious episode or associated disease. The number of responders was comparable in the group receiving corticosteroids (78%) and in that receiving intravenous immunoglobulins (76.5%), as was the number of complete remissions in both groups (40.4% and 50%, respectively). 20.5% of the patients receiving intravenous immunoglobulins experienced a chronic evolution versus 29.8% in the group receiving corticosteroids (no significant difference). Seventeen patients underwent splenectomy with excellent result, particularly in one child who underwent urgent splenectomy because of intracranial haemorrhage.

A 24 hour pH-metry was performed in children younger than 3 months divided in 4 groups: group 1: 37 infants who presented an apparent life-threatening event (ALTE), group 2: 45 infants with an ALTE and chronic digestive symptoms (recurrent vomiting), group 3: 33 infants with digestive symptoms only, group 4: 32 sudden infant death syndrome (SIDS) siblings. The percent duration of oesophageal pH below 4 (% pH < 4) was measured during 24 hours and 12 nocturnal hours (8 PM-8 AM). In addition the mean duration of nocturnal episodes of reflux (MDNR) was calculated (duration of pH < 4 per 12 nocturnal hours/number of reflux episodes). No significant difference was found in the 4 groups for % pH < 4. Nocturnal reflux was present in all groups (40% in group 1, 55% in group 2, 49% in group 3 and 63% in group 4). The MDNR was higher in group 1 (12.3 +/- 7.8 min) vs group 2 (6.8 +/- 5.1 min) and group 3 (6.7 +/- 3.2 min) (P < 0.05). High MDNR did not appear to be related to an history of ALTE since the MDNR in group 2 was identical to group 3. Nocturnal pH metry profile failed to show a relationship between gastro-oesophageal reflux and ALTE.

The birth and subsequent hospitalization of very low birth weight premature infants can be a psychological shock for parents which may disturb further relationships between infant and parents. The parents' memories from the birth period of 94 very low birthweight premature infants (< 32 weeks of gestational age) have been analyzed by way of an interview. This study has shown the painful aspect of the birth and of the parents' first meeting with the infant. However, despite these first difficulties, the relationship normally improves with time.

This review examines the ethical problems of liver transplantation from living parental donors regarding the main ethical principles. It appears that this method of transplantation is a new possibility offered to patients that cannot be subtracted from the parents' choice without interfering with their liberty. Moreover, there is a social decisiveness to ensure the offering of this option which is limited by the conditions of realisation, timing and personal situations of the parents. The considerations of risks, benefits, advantages and prejudices between donor and recipient show a favourable balance for this type of transplantation provided that adequate medical indications are respected. However, the considerations of psychological cost and burden deserve special attention and are detailed in this paper especially regarding the motivations and the long-term effects on the donor. Futility and ethical generalisation examinations favour such a procedure. Moral justice will generally be respected. The consideration of autonomy required special attention owing to the situation pressure upon the donor's consent. Consent deserves adapted solicitation according to variable situations: whether the donor explicitly specifically wanted to donate part of his liver or only required information. Excessive solicitation of parents' participation to liver donation represents qualified "forced choice"; in some situations where the parents cannot effectively refuse their participation, paternalistic action is ethically acceptable. A general procedure is proposed to ensure the psychological, legal and ethical protection of the donor and recipient.

We report the case of a 13 year-old white teenager who was referred for chronic bone pain. Physical examination showed a swelling of the anterior part of the neck and biological findings clearly evoked a primary hyperparathyroidism. The surgical treatment was successful and confirmed the diagnosis of parathyroid adenoma. Primary hyperparathyroidism being unusual in childhood, the eventuality of a multiple endocrine neoplasia is discussed.

A considerable improvement in the management of congenital malformations results from early prenatal diagnosis. In most cases, the diagnosis is made in utero with such precision that a prognosis can be made before birth. Specific investigations such as fetal blood sampling, prenatal biology and cytogenetic studies may be necessary. Diagnosis, prognosis evaluation and management require a high degree of specialization and a multidisciplinary and well coordinated team in selected specialized centres. The management depends upon the type of malformation (gastro-intestinal, urinary, cardiac, pulmonary, osseous, parietal, etc), its importance, whether it is isolated or not, the postnatal surgical possibilities and the parents' opinion.

The case of a 13 year old boy with a severe form of visceral leishmaniasis (VL) mimicking portal hypertension and of unfavorable outcome is presented. The authors stress the usefulness of investigating humoral immune response by using Western Blot assay in order to confirm the diagnosis when the parasite cannot be isolated. Since VL may be responsible for death if the treatment is delayed, screening of the disease in children presenting with chronic liver disease is important in endemic area.

The authors report on an 8-year-old girl who experienced bilateral subdural frontoparietal and interhemispheric empyema following sinusitis. The child improved after initial treatment with a 3 weeks course of parenteral antibiotics. Surgical drainage was further required because of clinical aggravation; however, this evolution was related to bilateral frontoparietal brain edema and abscesses fluid was sterile.