[Traffic accidents involving children].
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Biomedical subjects
Publications and source records attributed to J Lavaud.
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In a newborn, the presence of an abdominal tumor due to hydrocolpos resulting from vaginal atresia, with polydactyly and a congenital heart disease suggest the diagnosis of McKusick-Kaufman syndrome. This syndrome is different from the Ellis Van Creveld syndrome, which also includes polydactyly and congenital heart disease, associated with "chondrodysplasia' and "ectodermodysplasia'.
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By examining the endobronchial brushings from 65 infants and children with interstitial pneumonia--characterized by a severe hypoxia and diffuse lung infiltrates--we have detected the cysts of pneumocystis carinii in 17 of 21 subsequently confirmed cases. The rapid diagnosis and subsequent specific treatment have allowed the recovery of 18 of these children. The particular significance of this article is the youth of the patients, whose ages ranged from 4 months to 15 years.
The prognosis is neonatal hernias of the dome of the diaphragm remains extremely gloomy. Associated malformations, prematurity or dysmaturity, cannot explain it. The surgeon is now faced with conditions diagnosed in the labour room, which he previously never saw (and which therefore did not figure in his statistics). Those forms in which the lung gas exchange area is reduced are above all those in which there is a syndrome of persistence of foetal circulation. The association of drugs from the alphalytic group (tolazoline) and curarising agents (pancuronium) is often effective without having completely resolved the problem.
The purpose of this study is to find, besides the determination of lactate in blood, a suitable and specific indicator of brain damage in newborn. Accordingly, we studied the total creatine kinase (CK) activity, by the method of Rosalki, and its subunit isoenzymes BB (CK BB) by fluorescence following electrophoresis on cellulose acetate. A first group (thirty newborns) without any disease represents our taest group. We havae found that the normal ranges for CK total were elevated (about 7 200 nkat/l). Electrophoresis of sera from these patients showed in addition to the normally migration isoenzyme (CK BB) was present in very small amounts, no sufficient for quantification. A second group was constituted to thirty ill newborns, with perinatal brain damage. In twenty-eight to thirty children, we find a significant correlation between the level of CK BB and brain insult. But, we have showed that it was necessary to take in consideration the time passed between the hypoxic insult and the blood puncture. Otherwise, we showed by immuno inhibition with specific antibody and by chromatography with gradient elution that identification of CK BB by electrophoresis cannot be misinterpreted. Furthermore, we demonstrated by this method, that position of CK 1 BB in blood is exactly the same that an purified human extract. This study concluded that a high level CK 1 BB in blood of newborn infants with perinatal brain damage has an accurately diagnosis value, if the blood puncture is done immediately during the severe CNS damage.
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The authors describe a 3 1/2 month old infant with hemangio-endothelioma and a severe blood coagulation disorder. The tumor was inoperable and the severe blood coagulation disorder posed considerable therapeutic problem. After treatment with massive amounts of blood clotting factors, an antifibrinolytic drug and radiotherapy, the child's condition improved.
The BB fraction of serum creatine kinase was estimated in 3 groups of newborn : 30 healthy newborn at term, 20 newborn ill but without cerebral distress, 17 newborn with acute perinatal or foetal distress. In the first two groups, BB fraction was negligeable or nil, in respectively 26 and 16 cases, and between 1 and 4% in 4 cases. In the third group, it was greater than 4% in 10 cases, nil in 6 and 4% in one. The lability of this isoenzyme over periods of time, and in relation to temperature, requires the use of clearly defined techniques of sampling, storage and estimation, which may explain the false negatives seen. The determination of this isoenzyme, virtually exclusively cerebral, would thus appear to be a reliable biological indicator of neonatal cerebral distress.