Archives francaises de pediatrie最新文献

BACKGROUND. Dengue is an acute febrile illness caused by several arthropod-born viruses and characterized by biphasic fever, myalgia or arthralgia, rash, leukopenia and lymphadenopathy. Its diagnosis is based on knowledge of the geographic distribution of dengue viruses. CASE REPORTS Case no 1: A 11 year-old boy suffered from sudden onset of fever accompanied by retro-orbital headache, arthralgia and diffuse myalgia. There was no rash. Hemogram showed: hemoglobin: 11.6 g%; leukocytes: 3,400/mm3 (PMN: 76%); platelets: 190,000/mm3. A diagnosis of viral infection was considered, but, as the boy had recently been to the French West-Indies, a serologic study was performed. This was negative 2 days after the onset of disease and positive (specific IgM for the 4 dengue types), 13 days later. Case no 2: A 7 year-old boy suffered from sudden onset of fever. Severe calf muscle pain 4 days later led to his admission. Creatine phosphokinase activity was very high: 83,100 units (N: 30-120). Hemogram showed: hemoglobin: 11.4 g%; leukocytes: 2,500/mm3 (PMN: 60%); platelets: 124,000/mm3. A diagnosis of acute myositis was considered, but as the patient had recently visited Venezuela, a serologic study was performed. This was negative 8 days after the onset of disease and positive (specific IgM for the 4 dengue types) 16 days later. CONCLUSION. The first case is characteristic of the classical form of dengue fever. The second patient presented with very localized myalgia. The diagnosis in both cases was facilitated by the knowledge that the patient had recently stayed in an endemic area.

Background: Very few people have no Kell antigens (phenotype Ko). They can develop antibodies to Kell antigens after transfusion, or the abortion of a Kell-positive fetus. This paper describes a case of immunization that may have been due to amniocentesis.

Case report: The eighth pregnancy of a woman required an amniocentesis on the 17th week for chromosomal study because she was 41 years old. She had 4 prior abortions. Her blood group was A Rh+. Her red cells were not tested for rare blood groups and antibodies to blood groups were not screened before and after amniocentesis. The newborn baby developed hemolytic anemia. On her 10th hour of life, her hemoglobin was 10.7 g% and her bilirubinemia 308 mumol/l. Her blood group was A Rh+. Indirect Coomb's test was positive in the mother, and the baby was given 3 exchange transfusions of O+, Ccee, K- blood. Further studies showed that the mother had phenotype Ko (A+, Ccce, K-, k-, Kpa-, Kpb-, Jsa-, Jsb-). The baby's phenotype was K-, k+, Kpa-, Kpb-, Jsa-, Jsb+. The mother was found to have a high titer of Ku antibodies.

Conclusion: This mother belongs to one of the 3 families known in the Reunion Island to have phenotype Ko. She had never been given transfusions, and prior abortions are unlikely to have played a role since no hemolysis was seen in further newborns. While amniocentesis is probably a major factor, its role cannot be determined because no pre-amniocentesis samples were analysed immunologically.

Background: Subclinical medical complications frequently occur during the follow-up of anorexia nervosa and bulimia. This paper describes some of these.

Population and methods: Charts of 99 adolescent patients (89 girls and 10 boys), aged 11.8 to 22 years (mean: 16.6 +/- 2.1 years), admitted for anorexia nervosa (N:92) or bulimia (N:7), were analyzed retrospectively. All severe or potentially severe, clinical and non-clinical, findings at admission were included in the study.

Results: Anorexic patients had a mean weight loss of 31.5% (22 of them were also vomiters or laxative abusers). Initial nasogastric tube feeding was necessary in 19 patients and parenteral nutrition in 2. Bradycardia and hypotension were common. A variety of ECG abnormalities were seen in 86% of the patients. Mitral valve prolapse was present in 14 of the 43 patients examined by echocardiography. Electrolyte imbalance was also common: hyponatremia in 7 patients, hypokalemia in 21, hypochloremia in 10 of the 12 vomiters, hypophosphatemia in 7, hyperazotemia in 24 and hypoglycemia in 22. Bone marrow hypoplasia was frequent, with leukopenia in 29 patients, anemia in 21 and thrombocytopenia in 5. No patient developed infectious complications. One patient presented with an acute gastric dilatation and another with spontaneous pneumomediastinum. One patient, 14 year-old, died 3 years after the onset of anorexia from acute water intoxication.

Conclusion: These well-known complications are more common in anorexic than in bulimic patients. Their prevention requires rigorous and continuous medical supervision.

Background: Primary hyperparathyroidism is rare in children and adolescents. Bone changes may produce pain in the back or extremities, but this is rarely the first symptom of the disease.

Case report: A 13 year-old girl suffered from pain in the back and lower extremities. Progressive bilateral genu valgum appeared. One year later, she became lame because of the deformity. ECG showed cardiac arrhythmia with atrial extra systoles. The serum calcium concentrations were 3.36 and 3.8 mmol/l, phosphate 0.76 mmol/l and alkaline phosphatases 6,612 U/I (N: 90-300). Urinary excretion of calcium was 17 and 26 mg/kg/day and the renal tubular reabsorption of phosphate was 77%. Radiological studies revealed resorption of subperiosteal bone, best seen along the margins of the phalanges, demineralization of the skull vault, bilateral coxa vara and zones of calcification on knee metaphyses. The serum concentration of parathyroid hormone (PTH) was 1,066 pg/ml (N: 10-55) and that of 1-25(OH)2D3 was 125 ng/ml (N: 20-80). Ultrasonography showed a heterogeneous mass, 23 x 15 mm, suggesting a parathyroid adenoma. This adenoma was independent of the left inferior parathyroid. It was removed and the biochemical findings gradually returned to normal. Bone demineralization also disappeared and the knee deformities were surgically corrected 9 months later.

Conclusions: Bone changes may occasionally cause severe pain, indicating demineralization and hypercalcemia: hyperparathyroidism is one cause of such changes.

BACKGROUND. Post-operative chylous effusion is rare in infants. It may result from venous thrombosis, thoracic duct injury or lymphatic vessel obstruction. This paper describes 2 cases of diaphragm hernia with post-operative chylous effusion. CASE REPORTS Case 1: A newborn developed chylous ascites two weeks after repair of a left posterolateral diaphragm hernia. Abdominal paracentesis showed milky fluid containing numerous lymphocytes (98%). Ascites was rapidly reduced by feeding with medium-chain triglyceride-rich (MCT) formula. Case 2: A chylothorax was seen 7 days after surgery to repair a left posterolateral diaphragm hernia. Thoracocentesis showed serous fluid containing numerous lymphocytes (93%). The chylothorax was resolved after two thoracocenteses, parenteral nutrition and feeding with MCT formula. CONCLUSION. These cases are the third report of chylothorax and the second report of chylous ascites after surgical repair of a diaphragm hernia. The exact cause of the chylous effusion is not clear.

Background: Heart failure is a rare manifestation of neonatal hypocalcemia. This paper describes such a case resulting from maternal vitamin D deficiency.

Case report: A full-term boy, born in December after a normal pregnancy, was admitted at the age of 6 weeks because of dyspnea that appeared during suckling. Examination showed heart failure. Electrocardiogram showed that the corrected QT-interval was lengthened (0.54 s, normal < 0.45 s). Echocardiogram showed dilated, hypokinetic myocardiopathy. His serum calcium concentration was low (1.40 mmol/l) and phosphate was high (2.8 mmol/l); his alkaline phosphatase was 513 Ul/l. His blood PTH concentration was high (120 pg/ml) and his 25 (OH) D was low (5 ng/ml). The patient was given calcium (1 g/m2/day) and 1.25 (OH)2 D (2 micrograms/day orally). His serum calcium returned to normal within 4 days, and his cardiac abnormality was resolved within 3 months. His mother's blood 25 (OH) D concentration was very low (3 ng/ml), 6 weeks after birth.

Conclusion: Neonatal hypocalcemia appears to have been compounded in this case by a maternal vitamin D deficiency. Hence, all pregnant women at risk of deficiency should be given vitamin D.