Annales de pédiatrie
-
Annales de pédiatrie · Oct 1993
Multicenter Study[A prospective study on the behavior of pediatric intensive care unit nurses, concerning the care given to suicidal children].
Pediatric intensive care units use sophisticated medical technology and are staffed by deeply committed nurses who are subjected to significant psychological stress. This stress varies with the type of patient and influences the style and quality of care. With this respect, children and adolescents admitted after a suicidal attempt are considered catalysts. ⋯ Children under 16 years of age admitted after attempted suicide were studied comparatively with same age children admitted for status asthmaticus or encephalopathy with seizures. Results highlighted the differences in nurses' psychological responses to these situations and their difficulties in interacting with patients. This study provides strict methodological guidelines for investigating an issue often discussed emotionally or on the basis of anecdotal data.
-
In normal adults eating diets with standard protein contents, urinary excretion of NH4 approximates 40 mmol/24 hours and urinary pH is variable. In patients with metabolic acidosis, a urinary pH under 5.5 suggests an extra-renal cause whereas a urinary pH above 5.5 suggests a renal disorder, although there are many exceptions to this rule of thumb. However, urinary excretion of NH4 is always above 70 mmol/24 hours in extra-renal acidosis and less than or equal to 40 mmol/24 hours in renal acidosis; the two situations can readily be differentiated by determining the urinary anion gap which is absent in the former case and present in the latter. ⋯ In the latter case, decreased serum potassium levels suggest distal tubular acidosis due to defective H(+)-ATPase or H+/K(+)-ATPase pump function (no increase in urinary PCO2 after oral NaHCO3 loading) or to inability of the kidney to develop a normal H+ gradient (normal increase in urinary PCO2). Increased serum potassium levels suggest conditions involving either hypoaldosteronism or alterations in transepithelial voltage or pseudo-hypoaldosteronism. The incidence of distal tubular acidosis with increased serum potassium levels is rising, whereas tubular acidosis with low serum potassium levels remains infrequent.
-
Annales de pédiatrie · Jan 1993
Review Case Reports[Ischemic cerebrovascular accidents in homozygous sickle cell anemia. Two case reports].
Two cases of ischemic stroke in children of Tunisian descent with sickle cell anemia are reported. Patients were aged 3 years and 14 years, respectively. Periodic partial exchange transfusions with sedimented red blood cells of identical phenotype prevented further episodes of ischemic stroke. Transplantation of HLA-identical bone marrow from a family member offers a chance of complete cure of the hemoglobin disorder in these children who are at risk of recurrent stroke.
-
The diagnosis of pustular dermatosis occurring during the first months of life is usually based on clinical findings. However, some cases may require a few simple investigations including cytological studies, cultures, and skin biopsies. ⋯ Lastly, rare causes of neonatal pustulosis are reviewed. The need for investigating every neonate with skin pustules for an infectious disease, especially due to a bacterium, is emphasized.