Biomedical subjects
Publications and source records attributed to A Lachaux.
We report two observations of intrahepatic cholestasis with normal serum levels of gamma-glutamyl-transpeptidase. These cases fit the diagnostic criteria of benign recurrent cholestasis and show that it, like Byler disease, is another form of pediatric intrahepatic cholestasis with a normal gamma-glutamyl-transpeptidase level in the infant.
BACKGROUND: Neonatal necrotizing gastritis is rare. It is usually a complication of acute anoxia or shock and its diagnosis is essentially radiological. CASE REPORTS: Case no. 1: a boy was born at the 36th week of a pregnancy complicated by preeclampsia. Perinatal asphyxia necessitated delivery by cesarean section. He presented with neonatal respiratory distress which was complicated by pneumothorax. On the 5th day of life, the abdomen was distended and the newborn had still not been fed. On the 6th day, X-rays showed pneumatosis of the gastric wall associated with pneumoperitoneum. Surgery showed an area of necrosis on the posterior surface of the stomach with a small perforation, which was stitched. The child was fed 5 days later and was in good condition at the age of 6 months. Case no. 2: a girl was born at the 35th week of a pregnancy complicated by asthma during the second trimester. Perinatal asphyxia and abnormal fetal rhythm led to delivery by cesarean section. At 24 hour of life, she vomited blood and fibroscopy confirmed the presence of blood in the stomach. On the 3rd day, blood vomiting appeared again, associated with abdominal distension. X-rays showed pneumatosis of the gastric wall; fibroscopy showed necrosis of the lower 2/3 of the stomach. Feeding was stopped and the child was given cimetidine. Refeeding was possible when the girl was 10 days old, and she was in good condition at the age of 6 months. CONCLUSION: Neonatal gastric necroses and necrotizing enterocolitis have many similar features. Medical therapy is often effective, but surgery is mandatory when necrotizing gastritis is complicated by perforation.
Autoimmune hepatitis is one of the major etiologies of chronic hepatitis in children. Chronic hepatitis may present with numerous hepatic clinical manifestations, associated with extrahepatic disorders. The etiology is unknown and the disease is characterized by the auto-antibody pattern and the positive response to immunosuppressive treatment.
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Interleukin 1 (IL-1) is a polypeptide cytokine produced by various cell types that mediates a broad range of biological activities and possesses a wide spectrum of immunologic and non immunologic properties. Interest has recently focussed on the role of IL-1 as an inflammatory mediator in chronic and acute diseases. The production of IL-1 inhibitors may be a part of a homeostatic mechanism regulating IL-1 effect on immune and inflammatory cell function. Recent reports concerning the purification, characterization, and expression of a cDNA for an IL-1 receptor antagonist (IL-1ra) have been published. Further study of this protein should be valuable in determining the role of IL-1a in man. The protein should also be useful for studying the list of IL-1 activities. Finally, IL-1a is a potentially useful therapeutic agent for the treatment of IL-1-mediated disease in man.
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Twelve children were diagnosed as having a bleeding Meckel diverticulum upon laparotomy. Before surgery, barium small bowel examination was performed according to the Bret technique (J Radiol Paris [1980] 61, 753-758) in 8 cases; the Meckel diverticulum being apparent in all 8 cases. By contrast, a classical technique of barium small bowel examination used in 4 cases, and 99m TC pertechnate scan performed in 7 cases, yielded only negative results. We conclude that barium small bowel examination, when performed according to the Bret's technique, is a very effective method for the diagnosis of Meckel diverticulum.
A 2-year-old boy was operated on for a left ureteral duplication with bilateral vesicoureteric reflux. Ten years later, he experienced two episodes of transient ascites following abdominal traumatism. A cystogram disclosed a peritoneal fistula. The fistulous orifice was localized by cystoscopy, and surgery was undertaken with success.
The authors report an unusual case of zona in a 6-month-old infant whose mother was affected by varicella on the fourth month of pregnancy. The course and outcome were benign.
A 10 year-old girl presented with a progressive left ureteral colic with abdominal tenderness. Ultrasonography revealed pyelocalyceal dilatation and an intravenous pyelogram showed lateral deviation of the left ureter. Computed tomography confirmed retroperitoneal mass distinct from psoas. Laparotomy revealed an encapsulated retroperitoneal hematoma. No particular aetiology was found and the patient's health remained stable after treatment.
We report the case of a 27 month-old girl with recurrent Salmonella typhi murium infections. The study of the neutrophil cells showed a transitory selective deficiency of the chemiluminescent response. After 5 months of pefloxacine therapy, recovery was obtained.
Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.
The study of 414 measles cases, admitted in several childrens' hospitals in the Lyons area, underlines the important cost of this disease. Moreover, the occurrence of complications (in 56% of children hospitalized with measles), some of which as severe as encephalitis (n = 9) and/or death (n = 4), shows that an improvement of preventive measures is indispensable. Vaccination appears to be the most effective way, but the actual immunization level remains insufficient in France. This situation could be optimized either by intensifying the sensibilization fields or by rendering vaccination compulsory before entrance to school and collectivities.
Three familial cases of congenital intrinsic factor deficiency are reported: the stress is put on the interest of gastric investigations and especially of the quantity of intrinsic factor in the gastric juice when investigating megaloblastic anemia due to vitamin B12 deficiency. The study of the level of intrinsic factor in the gastric juice is proposed as a test for identifying carriers.
Seventeen pediatricians and 34 general practitioners (GP) randomly selected in the closest area around Edouard-Herriot hospital (Lyon, France) were questioned regarding socio-economic status of families of infants who were treated for non severe acute diarrhea (loss of weight less than 10% of the initial body weight, no dehydration), and gave a copy of their prescription. During the same period, information was collected on outpatients as well as hospitalized cases of non severe acute diarrhea. Results show that in 3 months, GPs treated approximately 500 cases of non severe acute diarrhea, pediatricians 230 and the hospital 64. Oral rehydration was prescribed in 16% of diarrhea treated by GPs and 50% of those treated by pediatricians. The socio-economic status of families treated by pediatricians differed widely from those treated by GPs as well as those cared for in hospital. Vomiting as an argument for admission was found in 55% of referrals.
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