Biomedical subjects
Publications and source records attributed to P Cochat.
Bone infection caused by Kingella kingae (Kk) is rare since there are only 15 published cases. We report 5 additional cases with isolation of Kk from fluid or bone aspiration. Kk was sensitive to the most common antibiotics. The outcome was favorable in every case.
The kinetics of zimeldine (Z) and its demethylated metabolite, norzimelidine (NZ), were determined after administration of a single 200 mg oral dose of Z to 6 healthy volunteers (Group I), and to patients with mild (Group II) and severe renal failure (Group III). Z and NZ concentrations were assayed by HPLC in serial plasma and urine samples over 6 days following the dose. In Group I Z was rapidly absorbed and metabolized into NZ, and then the plasma concentrations declined with apparent elimination half-lives of 8.4 h and 24.9 h for Z and NZ respectively, whilst the renal clearance of both compounds was low, Z 15.7 ml/min and NZ 33.0 ml/min. The plasma level of Z differed little between Groups I and III, but the area under the curve was significantly higher in Group III than in Group I subjects (AUC0-144 = 17.3 and 6.8 mumol X l-1 X h, respectively). Severe renal failure did not affect the peak plasma concentration of NZ but it did significantly increase peak time, apparent elimination half-life, and the area under the plasma concentration curve. A significant inverse relationship was found between renal clearance of NZ and plasma creatinine. Since NZ is as pharmacologically potent as Z, the results suggest that the dose of Z should be reduced in patients with severe renal insufficiency.
On the occasion of a new case and review of 9 others in the literature, the authors seek to establish the hallmarks of the nephritis occurring after M. pneumoniae infection. It often consists of an acute nephritic syndrome, 10 to 40 days after a respiratory tract infection; hematological abnormalities are not constant. Histological examination of the kidney shows a type I membranoproliferative glomerulonephritis in 2, dense deposit disease in 2 and tubulo-interstitial nephritis in one. Immunofluorescence studies have shown the microbial antigen 3 times out of 4. Specific antibiotherapy does not charge the prognosis of the extrarespiratory manifestations, for which an immunologic mechanism is likely.
A Raynaud's phenomenon was observed in a 72 year-old man affected by progressive systemic sclerosis. Few months later, the patient was readmitted to the Hospital because of acute renal failure, and a retroperitoneal fibrosis was first suspected on the basis of typical urinary tract alterations, and subsequently confirmed at the post-mortem examination. Such association does not appear fortuitous on histological data, but it has been rarely described. HLA B27 antigen is not always present. Symptomatic therapy includes association between prednisone and percutaneous nephrostomy.
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We studied the effects of prolonged pancuronium administration in 10 neonates under assisted ventilation for hyaline membrane disease. Pancuronium bromide was administered from the time of intubation with a load dose of 0.1 mg/kg followed by a continuous infusion of 0.03-0.07 mg/kg/h. Tolerance, especially cardiovascular, was excellent after 72 to 525 h of therapy (mean 173 h). Oxygen needs, incidence of mechanical complications and the general evolution of idiopathic respiratory distress were not significantly affected by muscle relaxation. The benefits of systematic pancuronium administration during respiratory intensive care in neonates with hyaline membrane disease appear to be of little value when considering the necessary constraints (corneal, cutaneous, vesical and tracheal supervision).
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Today, chemiluminescence detection reactions have become popular in analytical biochemistry essentially due to their high sensitivity. A chemiluminescent synthetic system (luminol/porphyrin) was successfully used to measure serum oxalate by determination of hydrogen peroxide generated through oxalate oxidase (EC 1.2.3.4.). This new method is efficient and simple, highly sensitive and the results obtained in normal adult subjects are in good agreement with those of approved methods. This original application of such a chemiluminescent system allowed us to achieve a sensitive serum oxalate assay (detection limit of 0.2 mumol/L) characterized by a low serum volume (200 microL) required for analysis.
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A multicentric study was performed in France and Spain: 490 children were evaluated with a previously validated questionnaire including open-ended questions and structured response format questions. Children are either in good health or suffering from somatic diseases, psychological problems or social difficulties; 38% of the children are Spanish, 62% are French; the questionnaire validation was checked again, and confirmed. Children are happy about their leisure, and unhappy when separated from their families. Among the factors affecting the answers to the structured format questions the most important are the social difficulties and to a lesser extent the psychological problems. Somatic diseases impair the child's quality of life in Spain. Children differ according to the country where they live. Among children in good health, Spanish children report a better quality of life than French children. Open-ended answers were only studied in France. They were very different when children with social difficulties or psychological problems filled out the questionnaire and were compared to children in good health or with somatic diseases. Both children with psychological and social difficulties mention more often the relationship domain. Children with social problems never mention their activities as a source of happiness.
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Recruitment of patients in a clinical trial is often difficult and probably more difficult in pediatrics where parents are asked to give the informed consent. In order to recruit infants in a randomized clinical trial we organized group meetings with families (4 to 40 at a time) in order to describe the study procedures: random allocation to treatment or placebo and double blind assessment, and ask them to allow their child to participate. All meetings were conducted by both a pediatrician and a RCT specialist. Parents asked questions about the effects of the drug, the evaluation process and the follow-up procedures. Forty nine % of all eligible infants participated in the study. The success rate was related to franc and open communication with the family, provided by highly qualified physicians.
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Over a 6 years period, 51 autopsies have been performed in infants dead after severe sepsis. One third of them had renal damages, consisting mainly in haemorrhagic infiltration. Pathological and clinical data are not always well correlated, but some parameters may enhance a poorer renal prognosis, such as the duration of shock and anuria, or exchange transfusion. The clinical presentation of the infection and the encountered germs are the same in both groups, with or without renal damage. A better management of intensive haemodynamic cares in these neonates increases their survival rate and raises the problem of chronic renal failure or hypertension in this situation. It seems very useful to state precisely the surveillance and protection of the renal function in such patients.
Hypomelanosis of Ito is a rare neurocutaneous syndrome and several abnormalities are often associated. Malignant hypertension and polycythemia are very unusual; their occurrence in a 12 year-old girl is not related to any classical etiology and their place in Ito disease is discussed.