Biomedical subjects
Publications and source records attributed to F Despert.
The authors report a case of severe growth retardation in a 4 year-old boy. A microphallus and ectopic testis located at the inguinal point were present in the neonatal period. A panhypopituitarism was related to a transection of the pituitary stalk. Treatment with thyroid hormone and growth hormone allowed excellent catch up of growth.
Counts of aerobic faecal flora were done using serial dilutions of stools cultured on selective media in order to estimate the ecological effects of ceftriaxone. Twenty children were studied (24 courses of treatment), 17 of them with post-chemotherapy agranulocytosis. Enterobacteriaceae disappeared in all cases. After treatment, they rose again, unless another antibiotic was administered. No Pseudomonas could be found, due to the protective isolation. Streptococci D disappeared in 6 children. Staphylococcus aureus was present transiently at a low level in one case. Candida persisted in two cases at the same level in spite of antifungal therapy.
A 5 year-old child presented with prolonged fever, severe impairment of general condition and a pleuro-pericardium effusion. Echocardiography revealed a "bell-clapper-like tumor" in each ventricle, developed from the ventricular septum. Presence of a staphylococcal sepsis and early disappearance of the echocardiographic signs after antibiotic treatment allowed for diagnosis of bacterial endocarditis with abscess of the ventricular septum. Sinusitis and IgA deficiency were later found to be also present.
LH-RH analogs, substituted in position 6 by D-tryptophane, D-serine(tBu), D-leucine or D-alanine induce a strong stimulation of the gonadotrophs, followed by a desensitization of the LH-RH receptors, which leads to a blockade of the gonadotropin secretion and to a hypogonadism. A delayed release preparation of D-Trp-6-LH-RH (Decapeptyl in microcapsules), designed to release the peptide for 28 days after intramuscular injection, was given to 69 girls and 18 boys with precocious puberty. In both, plasma levels of gonadotropins and gonadal steroids were suppressed within 3 weeks, whilst pituitary responses to LH-RH were almost abolished within 7 weeks. A significant improvement of secondary sex characteristics, as well as gonadal size, was obvious within 6 months. Growth velocity was markedly lowered and, more, in most of children, bone maturation was blocked. This study shows that Decapeptyl in microcapsules is more rapidly and more constantly efficient than LH-RH agonists given discontinuously by subcutaneous or intranasal route.
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Cefotaxime has a good meningeal diffusion and is effective at low concentrations on many bacteria, especially ampicillin resistant Enterobacteriaceae and Hemophilus influenzae. We have therefore used cefotaxime (150 mg/kg/24 h, continuous infusions lasting 30 minutes q. 6 h.) in meningitis due to gram negative bacilli. Twenty eight infants and children have been treated within 4 years. The 13 Hemophilus influenzae meningitis (including 2 beta-lactamase producers) have been cured without immediate sequelae. The duration of treatment could be reduced from 3 weeks to 2 weeks. The 7 infants with Enterobacteria meningitis (6 E. coli and 1 Serratia) have been cured of their infection with a 21 to 28 days treatment. The C.S.F. was sterile 2-3 days after treatment except a case of E. coli persisting during 7 days in C.S.F. contrasting with a normal ventricular fluid. A case of relapse with E. coli remaining sensitive was cured with a new course of the same treatment. Five meningitis complicated with hydrocephalus needed external drainage: the fluid was sterile 1 day after treatment in 4 of them. Two superinfections of ventriculo-peritoneal shunt due to Enterobacteriaceae have been cured. To obtain a good result, the need for a careful drug monitoring must be emphasized.
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The first patient suffered from a very severe atopic dermatitis with intense pruritus and thickened skin. He had also recurrent infections, particularly related to Staphylococcus coagulase +, and axillary and inguinal lymphodermopathy. The use of tetracosactide given intramuscularly allowed controlling the evolution of his atopic dermatitis. After several months of treatment, the skin became less infiltrated, lymphodermopathy disappeared and no severe infection had happened. The second patient had a less severe atopic dermatitis and recurrent infections without any particular severity. Topical corticosteroids allowed to control the atopic dermatitis. These two patients had high levels of circulating IgE and an important deficiency of polymorphonuclear chemotaxis which was evaluated by migration through boyden room. Study of the family showed atopic manifestations in several members, but with lower levels of IgE. The most characteristic abnormality of this syndrome is the according to considerable increase of IgE. The deficit in polymorphonuclear chemotaxis may vary according to time and even become normal. The prognosis over long periods remains to be determined.
The surfaces of the epiphyses of the knees were calculated in 34 neonates with hypothyroidism detected with a systematic screening and in 32 normal neonates. In the group of neonates with hypothyroidism, the surface of the lower femoral point was 12.7 +/- 0.9 mm2 and that of the upper tibial point 1.8 +/- 0.9 mm2. There was a significant difference (P less than 0.01) for both epiphyses between children of the 2 groups. The use of mathematical formula excluding non specific factors showed significant correlation between the corrected values for lower femoral points, and T4 and T3 plasma levels. These corrected values were higher in neonates with thyroid ectopia than in neonates with thyroid aplasia. There was also a significant correlation between the corrected values for lower femoral points and the IQ at 6 months and 2 years. Thus, the calculation of the surface of the epiphyses of the knee may be considered as a criterion of duration and severity o hypothyroidism and may be an index for the determination of the ante- or post-natal onset of the disease.
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Two cases of subdural empyema are reported. One occurred after sinusitis, the other after otitis media. In both cases, the diagnosis was suggested by a combination of symptoms indicating infection and neurological disease, which occurred soon after treatment of an ENT infection. Diagnosis was established, either by CAT scan, or by arteriography. Treatment consisted of surgical drainage and optimal antibiotherapy. The clinical course was favorable: complete recovery took place in both cases and clinical status remains unremarkable after two years. The current literature is reviewed and the main clinical features and diagnostic tools (especially CAT scan) are recalled.
Gastro-intestinal (G-I) disorders were studied in 95 premature neonates. Each child presented with at least one of the features usually associated with mesenteric ischemia. Nearly all the children had been fed early with tyndallized maternal milk. No certain necrotizing enterocolitis (NEC) was observed; however, it was suspected in 4 children (4.2%) and in 7 (7.3%), minor changed occurred. Among the 13 factors examined which might be responsible for inducing NEC, only 2 were correlated with G-I disorders: low birth weight (less than 1,500 gm) and occurrence of secondary apnea or asphyxia incidents during mechanical ventilation. This study led to the following practical conclusion: maintenance of early enteral feeding in prematures theoretically at risk for G-I disorders, taking into account the low incidence of severe G-I impairments and of the advantages of such a feeding method, while carefully supervising intestinal symptoms; preventative and temporary interruption of feeding in low weight prematures, in case of acute asphyxia or hypoxia episodes.
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Five meningitis due to Haemophilus influenzae and 6 meningitis due to Enterobacteria were treated with cefotaxime. The antibiotic was administered at a dose of 150 to 200 mg/kg/day in four 1 hour infusions. The pathogens were eradicated in all patients. Cefotaxime activity was efficient either against resistant pathogens (Haemophilus, Enterobacter) or against organism susceptible to ampicillin. Because cefotaxime is active at low concentration and has a good diffusion in the CSF, it provides a particularly effective treatment in Gram-negative meningitis in children. The initial use of cefotaxime should result in rapid eradication of the pathogen, with consequent improvement in the prognosis.
The authors report a case of Fanconi's disease equilibrated for a period of 8 years by androgen therapy. The patient died after interruption of treatment; the clinical picture comprised hepatomegaly, jaundice, pancytopenia. The autopsy showed hepato-splenic peliosis and acute tuberculosis. The subject of peliosis is brought up to date by a thorough review of current literature and the relationships between steroid treatment and hepatic complications are discussed.