[Peripheral gangrene during acute severe hypernatremic dehydration and disseminated intravascular coagulation in an infant].
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Biomedical subjects
Publications and source records attributed to J Lavaud.
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A distal bronchial brushing was performed in 25 children having severe lung diseases. The age of the patients ranged from 7 days to 14 years. Seventeen children were immuno-depressed. Bacteria were isolated five times (2 Staphylococcus aureus, 1 Streptococcus pneumoniae, 1 Serratia marcenscens, 1 Acinetobacter lwoffi), viruses twice (cytomegalovirus, syncytial respiratory virus), Pneumocystis carinii, four times. Cytologic study revealed malignant cells, and cells with intranuclear inclusions, evoking a viral infection. This procedure appears to be harmless in children over 2 years of age. In younger children there is a risk of pneumothorax. the principal indication for distal bronchial brushing is lung disease in immuno-depressed children. It may, however, also be useful in prolonged, treatment-resistant, severe lung diseases.
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A child with a complete absence of thymus and parathyroids (Di George's syndrome) associated with a cardiac malformation (truncus arteriosus and abnormal caval venous return) is described ; the child died at the age of 1 month. An exchange-transfusion, performed at 4 days of age induced a mild graft versus host reaction which could only be recognized histologically and distorted the results of immunological tests. On this occasion, the main clinical, anatomical and immunological features of the Di George's syndrome are reviewed. They suggest a possible relationship between the severity of the cardiac malformation and the more or less complete character of the dysgenesia of the thymus and the parathyroids.
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Accidental ingestion of caustic in childhood is not frequent but severe. It result in oesophagal burns progressing to stricture formation. 18 children with severe oesophagal burns were admitted during the six past years in the Intensive Care Unit of "Hôpital des Enfants-Malades" in Paris. The authors report mainly two cases. They recommend oesophagoscopy and they propose a protocol of treating applied since 1974 in France and foreing countries. The present problem consists mainly in a preventive program to avoid kind of accidents and their sequels in children and their families and finally in the community.
Four children were treated for acute tuberculous meningitis. One child died and 2 others were left with severe neurological sequellae. The diagnostic and clinical signs of tuberculous meningitis are reviewed. Treatment includes the administration of an association of INH-rifampicine and ethambutol orally, or INH-ethambutol-ethionamide intravenously when oral administration is impossible. Intrathecal injections of rifamycine SV can be given for acute forms. Corticoids have only one indication: intracranial hypertension with cerebral edema, which requires surgical decompression if no improvement is obtained. The fact that cases of tuberculous meningitis are still notified, is a justification for early BCG vaccination and regular control of the tuberculin allergic reaction.
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A Korean child aged six months with congenital syphilis and malnutrition developed pneumocystis carinii pneumonia. He recovered after treatment with trimethoprin/sulphamethoxazole with assisted ventilation. There was no evidence of immune deficiency. The role of congenital syphilis and malnutrition predisposing the baby to this infection is discussed.
Pediatric emergency medical service is available since 1976 in France. Presently, 4 such services are available in the Paris area for neonatal and pediatric emergencies. Coordination of these services was established in 1980, to establish a close collaboration between the various medical teams by linking them in a synergic way. This resulted, in 1985, in 6,740 transports of children, 83% of which in an emergency. Neonatal pathology accounted for 70% of the transports and 53% of transported children required assisted ventilation. The importance of these pediatric emergency services, their specificity and their level of technicality suggest that they contributed to the decrease of the pediatric and neonatal morbidity and mortality recorded in the past decade.
The authors report four cases of acute mercury poisoning in children ranged from one week to twelve years of age. All were of favourable course and one of them is particularly well-documented with regard to mercury excretion. Case reports are followed by a clinical study of mercury intoxication with a review of literature about recent therapeutic advances.