Pediatrie最新文献

Whereas clinical and preventive aspects of father-daughter incest are now better-known, mother-child incest remains mysterious. Reporting four recent cases, the authors attempt to describe its main clinical features, particularly those which could allow earlier diagnosis. An original "constructive" therapeutic approach of the most severely mentally disturbed children among these victims is then developed: the emphasis is put on how medical, social and legal procedures might be coordinated.

Three cases of diffuse subcortical gray matter heterotopias in children are reported. Generalised seizures and mild mental retardation were the most frequent signs. No specific electroencephalographic pattern was recognized. Magnetic resonance imaging scans showed the thick diffuse layer of heterotopic gray matter which was surrounded by normal white matter. Gyration was normal, and no associated malformation was observed. This neuronal migrational disorder happens between the 10th and 16th gestational week. Nineteen observations (17 girls) are reported in the literature. The filiation with agyria-pachygyria and the possible genetic transmission are discussed.

Cervical tumors of thymic origin are considered to be uncommon lesions in the differential diagnosis of neck masses. They can be either cystic or solid. The authors present one case of solid cervical thymic tumor in a 2 month-old baby. The embryogenesis of the thymus explains the cervical location of these tumors. Theories of physiopathology are presented. The clinical presentation is variable and their nature is often recognized only upon surgery and preoperative pathologic examination. Some cases of thymoma and respiratory complications resulting from ectopic thymus have been described in the literature, so that total excision of the mass must be performed. This lesion may be more common than suggested in the literature.

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.

In a multicentre trial we compared the clinical efficacy of amoxicillin/clavulanate used as a single-agent therapy with that of the three-agent combination usually prescribed in the post-operative period for appendicular peritonitis in children. Only bacteriologically documented peritoneal infections were included. Sixty-four patients were randomly distributed between two groups: Group A (29 cases) treated with amoxicillin/clavulanate, first administered iv (100 mg/kg/d), followed by conversion to the oral route (50 mg/kg/d) once the patient had been afebrile for 48 hours; Group B (35 cases) first treated by the iv route with benzylpenicillin (100,000 IU/kg/d) plus netilmicin (5 mg/kg/d) plus metronidazole (30 mg/kg/d), followed by conversion to the oral route for metronidazole (30 mg/kg/d). In both groups, the total duration of parenteral and oral treatment was not less than 5 days. One hundred and seventy nine bacterial strains were recovered from peritoneal fluid samples obtained during surgery; 86% of these were sensitive to amoxicillin/clavulanate. Clinical efficacy, assessed on the basis of time until return to normal temperature and gut transit and duration of hospitalization, was identical in both groups, with follow-up monitoring on day 30 showing recovery in all cases. Cure was obtained without any problems of infection in 25/29 patients in group A and in 34/35 patients in group B (non significant difference). Tolerance was excellent and identical in the two groups with the exception of three cases of thrombophlebitis which occurred in group B. The results of this study suggest that amoxicillin/clavulanate may be useful as single-agent therapy as a first-line curative treatment for appendicular peritonitis in children.

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.

The authors report a case of aortic arch thrombosis in a neonate probably related to perinatal placental emboli. However the finding of a fibroblastic endarteritis raised the possibility of a primitive lesion of the aortic wall. The evolution was complicated by cerebral ischemia. A surgical thrombectomy was performed. The outcome was favourable with persistence of a moderate right motor deficiency at 9 months. The authors advise the addition of an enlargement patch and the use of anticoagulation therapy in case of intimal lesion or very adherent thrombus.