[Treatment of severe forms of posterior urethral valve in the infant by primary cutaneous ureterostomy (author's transl)].
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Biomedical subjects
Publications and source records attributed to G Lasfargues.
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The case of a 2 year old girl with myasthenia gravis is reported. Immunological investigations did not show any major abnormalities of the thymocytes. High levels of acetylcholine receptor antibodies were present before thymectomy. After surgery they decreased significantly and there was a clear clinical improvement.
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A neonate with pneumonia due to Chlamydia trachomatis is reported. The infection was probably generalized because there was hepato-splenomegaly and a granuloma was found on liver biopsy. The frequency of this infection in neonates is probably underestimated in view of the importance of Chlamydia in adult genital disorders. Recent advances in the methods of detection of this organism in cell culture and by serological means should make it easier to diagnose routinely.
In order to study the value of the tetrazolium nitroblue test (TNB) in the localisation of urinary tract infections, the authors performed this test in 33 patients with a urinary tract infection and in 20 control children suffering from no bacterial infection. The 33 infected children were divided into three groups on the basis of clinical and bacteriological criteria (dysuria, frequency, fever, abdominal pain, inflammatory syndrome, immunofluorescence of bacteriuria, serum antibody levels): -- group A (8 children): upper urinary infection -- group B (14 children): lower urinary infection -- group C (11 children): urinary infection of undetermined site. The number and percentage of TNB positive polynuclears was significantly higher in the children of group A than in the children of group B (p 0.001). By contrast there was no significant difference between the results obtained: in the non-infected control group and in group B -- in group A and group C. These results, confirming a previous study by Bjorksten and de Chateau, show the value of the TNB test in the localisation of urinary tract infection in the child.
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An assessment has been made of renal growth and of the incidence of recurrent urinary tract infection in 116 children who had bilateral re-implantation of the ureters. Although reflux was prevented, 28% of the children continued to have infections long after the operation. The infections were mostly of the lower urinary tract whereas before the operation there was a significant incidence of acute pyelonephritis. After operation 82% of the kidneys grew normally and in 4,5% growth rate increased which is a smaller proportion than that reported in other series. In contrast 13,5% of the kidneys grew more slowly but they were usually abnormal radiologically before the operation.
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Serum antibodies were measured repeatedly in 176 cases of urinary tract infections in children. The method used, passive haemagglutination with the bacterial antigen of the patient's urinary infection, gives a positive reading from 1/160. Antibodies were found in 139 cases and the lower limit compatible with a diagnosis of pyelonephritis was 1/2560. The result may, however, be negative in infants of less than one year. As in the first publication, the authors describe three types of curves of progression. Analysis confirms the relationship between persistent antibodies and evolutive pyelonephritis. Experimental results and a comparison of clinical and pathological findings are discussed and support the notion of the value of a persistent high antibody level in the diagnosis of chronic pyelonephritis.
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