Pédiatrie
-
The authors report on a case of cardiomyopathy with congestive heart failure in an infant with severe hypocalcemia related to vitamin D deficient rickets. The heart failure was successfully treated with calcium gluconate and vitamin D, associated with dobutamide.
-
With few exceptions in extremely rare circumstances, such as sign of raised intracranial pressure, a lumbar puncture must be performed whenever the diagnosis of meningitis is suspected in a child. It serves to confirm a diagnosis of purulent meningitis, to identify the bacteria and to test its sensitivity to antibiotics. If the child responds appropriately to therapy, some authors recommend no further examination of cerebrospinal fluid (CSF). ⋯ Apart from its bacteriological interest, this second lumbar puncture seems to be a prognostic indicator of the incidence of neurological abnormalities. No further CSF examination is necessary when the patient's course of illness is uncomplicated. On the other hand, the presence or appearance of neurological abnormalities during the daily physical and neurological examination compels a new lumbar puncture and a CT scan to search for a persistent central nervous system infection or a complication of the meningitis.
-
Comparative Study
[Extracorporeal oxygenation and extracorporeal respiratory assistance in newborn infants].
The authors present the principle and discusses the indications and contraindications of two technics of extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure, respectively veno-arterial and veno-venous. The two technics appear to give comparable results. They are indicated in neonates with refractory hypoxemia after failure of other methods such as surfactant, high frequency oscillatory ventilation and nitrous monoxyde.
-
The authors report on the case of a 7 week-old boy, in whom a renal mass was discovered after general symptoms were observed. Within 48 h, cardiac failure secondary to systemic arterial hypertension occurred, requiring intensive care. After a few days of mechanical ventilation and alternating elevated and low blood pressure, improvement was obtained with captopril and frusemide enabling further investigations to be carried out which lead to the diagnosis of Wilms tumor. ⋯ Several authors have reported on the association between arterial hypertension and nephroblastoma as being the result of hyperreninism due to hilar compression; however severe hypertension was uncommon. Renin activity determination from the tumoral tissue had led to a different interpretation, ie primary hyperreninism: in the case of mesoblastic nephroma, only the non tumoral but compressed tissue contains a large quantity of renin; in the case of nephroblastomas, only the tumoral tissue contains renin. The question now is whether all or only certain nephroblastomas secrete renin.
-
In 1988 and 1989, 79 children have been treated for induction of acute leukemia. 68 presented an acute lymphoblastic leukemia (ALL) and 11 an acute non-lymphoblastic leukemia (ANLL). The complete remission rate was 92% (96% in ALL, 73% in ANLL). Fever occurred in 50% of the children, with positive blood cultures in 11 of them. ⋯ Four patients were transferred into the intensive care unit. After 8 days, the treatment of ALL was continued in the outpatient clinic in more than 50% of the cases. The treatment of ANLL is frequently complicated by hemorrhages and sepsis and needs adapted supportive care in a specialized unit.