Biomedical subjects
Publications and source records attributed to G Krim.
The authors treated two groups of children in Zaire with two different regimens: chloroquine vs chloroquine-spiramycin. Chloroquine alone was successful in 83% of cases and chloroquine-spiramycin in 95% of cases (statistically significant). The tolerance of both regimens was excellent.
A case of acute epiglottitis complicated by pulmonary edema, after intubation in a 30 month-old child is reported. The pathophysiology of this complication and its treatment associating oxygen therapy and positive end expiratory pressure are discussed.
We report two exceedingly unusual and severe cases of Marfan syndrome with neonatal manifestations. Clinical features were caricatural. The skin was of the cutis laxa type. Both infants died shortly after birth as a result of severe cardiovascular lesions. Histologic examination of the aortic media confirmed the diagnosis. Because this genetic connective tissue dysplasia is inherited on an autosomal dominant basis with strong penetrance, and because in both instances the two parents had a negative family history, a dominant mutation seems likely in our cases and prompted us to be optimistic when giving genetic counseling. We point out the characteristic features of these exceptional early forms and describe the results of a detailed histologic examination of the skin that completes data from the literature.
During acute oligoanuric renal failure in neonates and infants, arteriovenous or veno-venous continuous hemofiltration is a simple, useful technique when peritoneal dialysis or hemodialysis cannot be used. It allows fluid removal, optimal calorie intake and mild blood purification, when waiting for diuresis to stabilize. It does not give any control over hypercatabolism; the use of continuous dialysis increases epuration.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors report a familial case of carnitine insufficiency presenting in two out of seven children as a severe, isolated, hypertrophic and hypokinetic cardiomyopathy. The etiology was confirmed by histological study and measurement of carnitine concentrations in the blood and muscle. The evolution was spectacular with specific therapy. Left ventricular hypokinesia regressed completely within 18 months (fractional fibre shortening increased from 10 to 33% and the SCI from 26 to 55% in the more severe of the two cases). Hypertrophy and dilatation decreased significantly. This is a so-called intermediary form of carnitine insufficiency and very unusual because of the isolated cardiac involvement. These cases underline the value of systematic muscle biopsy with measurement of carnitine concentrations in the investigation of all cases of supposed primary cardiomyopathy, especially as a rapid improvement can be obtained by specific replacement therapy.
The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p less than 0.001), coma (p less than 0.05), ecchymotic or necrotic purpura (p less than 0.01), temperature less than 36 degrees C (p less than 0.05), no clinical meningism (p less than 0.001), white cell count less than 10,000/mm3 (p less than 0.05), thrombocytopenia less than 100,000 (p less than 0.01), fibrinogen less than 1.5 g/l (p less than 0.001), kalemia greater than 5 mEq/l (p less than 0.01), spinal fluid cell count less than 20/mm3 (p less than 0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.
Explore the source record for details and available documents.
Presenting symptoms in an 8-year-old child, subjected to high pressure in the upper respiratory and digestive tracts following bursting of a truck inner tube, were initially only pleuropulmonary in nature. A secondary diagnosis of rupture of the thoracic esophagus was established by radiological follow-through examination using a water soluble medium. The presence of an esophagopleural fistula led to repair of the esophageal tear on the 5th day. Operation involved wide mediastinal and thoracic drainage, protection of the esophageal suture by a minimal pharyngostomy, and the performance of an evacuation gastrostomy and an alimentation jejunostomy. Bipolar esophageal exclusion can be avoided by the use of this technique. When confronted with closed thoracic injuries due to high pressures exerted on the upper respiratory and digestive tracts, radiological examination of the esophagus employing water-soluble media should be conducted, therefore, to enable early diagnosis of any esophageal rupture. Furthermore, from the therapeutic point of view, even after secondary discovery of an esophageal tear, suturing is not contraindicated by the direct approach as long as protection is provided by minimal pharyngostomy and a gastrostomy, this avoiding the need for bipolar exclusion.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.