Biomedical subjects
Publications and source records attributed to G Teyssier.
Three cases of shaken baby syndrome are presented with acute neurologic symptom, retinal haemorrhage, subarachnoidal haemorrhage and subdural hematoma of predominant interhemispheric localisation. Whiplash injury is not always child abuse and one must be informed about its bad consequences.
Thirty-six brain-dead children were managed to allow organ harvesting, which was possible in 21 (7 multi-organ). Optimal ventilation allowed for normal PaO2 and PaCO2 (mean +/- SEM FiO2 = 0.50 +/- 0.05). The management of hemodynamics was quite difficult and cardiac arrest may be due to patient transport, electrolyte disorders and dehydration. Vascular filling was of main importance and required standard solutes (5 or 2.5% glucose, normal saline, Ringer lactate) at a rate of 3.0 +/- 0.5 ml/kg/h, adapted for electrolytes (mainly KCl); sometimes, other solutes may be used: blood (17 patients), human 20% serum albumin (17 patients), plasma (9 patients). This filling was sufficient for 15 patients; the others required inotropic agents: dopamine (17 +/- 8 micrograms/kg/min), dobutamine (42 +/- 18 micrograms/kg/min). Diuresis was more than 3 ml/kg/h in 38% of the patients and desmopressin was used in 3 cases. Hypothermia (minimum 31.2 degrees) had no major consequence. No infection was found. Quality of management of brain-dead patients is of main importance; the possibility of organ harvesting must be evoked in such situations and is the first step in organ transplantations.
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We report four cases of fulminant hepatitis in children (4 to 15 years) who developed an hepatic encephalopathy grade III to IV, 4 to 13 days after the onset of their illness. Three patients recovered without sequelae. The complications were neurological: one child showed elevation of the intracranial pressure, successfully treated after monitoring of extra-dural pressure; one suffered from cerebral death. Hepatitis A was diagnosed by the presence in serum of the IgM component of hepatitis A antibody, but another etiologic factor was present in two cases: an halothane anesthesia and an Epstein Barr virus infection which could explain the severity of the hepatitis.
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Eighteen neonates were investigated for antibodies directed against acetylcholine receptors. No antibody was detected in 3 cases of congenital myasthenic syndrome, whereas positive results (3.5 to 250 nM) were obtained in 7 cases of transitory neonatal myasthenia and in 7 of 8 asymptomatic infants born to myasthenic mothers. The neonatal antibodies are fully cleared within 1 to 6 months (half-life: 9 days to 2 and a half months). The prognostic value of the maternal and infantile antibody titers is limited: maternal titer at the end of pregnancy, though usually higher in the mothers of myasthenic children, do not predict or preclude the occurrence of transitory myasthenia, and there is no clear correlation between the severity and duration of the myasthenia and the initial titer or the level of the child's antibodies. The assay which measures antibodies against acetylcholine receptors is useful in that it confirms the diagnosis of transitory myasthenia and excludes congenital myasthenic syndromes.
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A 5-year-old girl with severe deafness (90 dB) had two successive attacks of bacterial meningitis. A vesicular cochlea was found on polytomography, and a bilateral defect in the stapes footplate with cerebrospinal fluid leakage during surgery (Mondini dysplasia). Although rare, the eventuality of this malformation emphasises the utility of polytomography of the inner ear in children with congenital deafness.
Transient neonatal hypothyroidism was found in a boy whose mother was treated for hypothyroidism due to Hashimoto's thyroiditis. During the neonatal period the infant had antithyroid microsomal and antithyroglobulin antibodies and immunoglobulins inhibiting cyclic AMP production by thyroid cells in vitro. After one year of treatment, all antibodies disappeared. Thyroid scintiscan and fixation in the neonatal period was negative and became positive 2 months after stopping treatment with normal fixation and cervical thyroid picture. The mother's serum contained the same antibodies: they crossed the placental barrier and were responsible for neonatal pathological manifestations.
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Seventy-five children with bacterial meningitis were included in a multicentre trial for evaluation of cerebrospinal fluid (CSF) pharmacokinetics and clinical efficacy of cefotaxime. Mean age of patients was 4 years. Causative pathogens were Haemophilus influenzae in 28 patients (37%), Neisseria meningitidis in 27 patients (36%), Streptococcus pneumoniae in 10 patients (13%), group B streptococcus in 2 patients (2%) and unknown in 8 patients. All isolated pathogens were susceptible to cefotaxime. Seven ampicillin-resistant H. influenzae (9.4%) were found. Cefotaxime was 50 mg/kg intravenously, 4 times daily. The duration of treatment ranged from 5 to 22 days (mean: 13.8). Blood and CSF concentrations of cefotaxime were performed in 50 patients 3 h after infusion at day one and seven cefotaxime levels were determinated both by microbiological assay procedure and high pressure liquid chromatography. On day 1, CSF levels ranged from 0.39 to 2.0 mg/l by microbiological assay procedure (median 3.6) and from 0.0 to 17.4 mg/l (median 2.2) for cefotaxime and from 0.0 to 11.5 mg/l (median 2.2) for desacetyl-cefotaxime by HPLC. We observed a decrease in CSF levels of cefotaxime on day 7. They ranged from 0.3 to 7.0 mg/l (median 1.1) by microbiological assay and from 0.0 to 3.3 mg/l (median 0.8) for cefotaxime and from 0.0 to 6.0 mg/l (median 1.0) for desacetyl-cefotaxime by HPLC. On day 1 and day 7, CSF levels determined by microbiological assay and HPLC were correlated as follows: day 1:r = 0.59 (P less than 0.001). All children (100%) were cured and efficacy of cefotaxime was excellent in 72 cases (96%).(ABSTRACT TRUNCATED AT 250 WORDS)
Neutropenia developed in 3 pediatrics patients during treatment with oxacillin. The time of onset ranged from 18 to 24 days after beginning treatment with dose of 150 mg/kg/24 h. Concomitant symptoms were fever and rashes. During treatment with oxacillin it is necessary to monitor blood cell count every week.
16 bacterial meningitis on 150 observations of purulent meningitis have clear or normal CSM at the initial lumbar puncture. Neisseria meningitidis is the principal germ and there is often purpura and moderate shock. Bacteremia is present in three of the six observations with normal CSF. CSF in controlled a second time 9 to 48 h after the first control. In 14 cases CSF is purulent. Treatment is delayed in eight cases.
8 cases of methemoglobinemia are observed in infants of 28 days to 138 days of age, who have all acute diarrhea. They are divided in two groups. --4 infants who have eaten for a long time a rich nitrate and nitrite content carrot soup. --4 cases of severe diarrhea with probable endogenous nitrification due to microbial proliferation. The methemoglobinemia level is here not very high and represents more a witness that an alarming symptom. Those infants are compared with 10 infants who have diarrhea without methemoglobinemia. Symptoms and treatment of methemoglobinemia are revisited.
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