Biomedical subjects
Publications and source records attributed to D Dupont.
Malignant hyperthermia is a potentially fatal complication of general anesthesia that may occur with greater frequency in ptosis and strabismus surgery. The case of a two-year-old girl who suffered a malignant hyperthermia crisis during strabismus surgery is reported. The pathophysiology, clinical features, treatment and pre-anesthetic diagnosis are reviewed in detail.
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Eighty-two children, class ASA I, between four months and 14 years of age, all undergoing elective subumbilical surgery, were randomly assigned to two groups: a control "halothane anesthesia" group (n = 35) and a 0.25% bupivacaine "caudal anaesthesia" group (n = 47). In the control group, there was a significant peroperative increase in heart rate, respiratory rate, systolic blood pressure and plasma adrenaline levels (p less than 0.05). There was no significant difference in the noradrenaline levels. In the "caudal anaesthesia" group, the haemodynamic response was less pronounced, this being concomitant with a decrease in adrenaline and noradrenaline levels (p less than 0.05 and p less than 0.001, respectively). During surgery, there were significant differences between the groups in heart rate, respiratory rate, noradrenaline levels (3 +/- 0,30 nmol X l-1 vs 1.68 +/- 0.18 nmol X l-1; p less than 0.001) and adrenaline levels (1.67 +/- 0,28 nmol X l-1 vs 0.78 +/- 0.08 nmol X l-1; p less than 0.01). It is concluded that the catecholamine response in children undergoing minor abdominal surgery has been blocked by caudal anaesthesia.
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Walker-Warburg syndrome is a fatal cerebro-ocular malformation. It appears to be of autosomal recessive inheritance, but materno-fetal infection cannot be excluded as a possible etiology. Antenatal diagnosis consists in screening for fetal hydrocephalus. The authors report one personal case of this syndrome and a review of 34 previous observations in the literature.
The authors report one case of Guillain-Barré syndrome which occurred on the 8th day of chicken-pox eruption in a 2.5 year-old non-immunodepressed child and which completely receded. The Guillain-Barré syndrome is an exceptional neurological complication of chicken pox. The course of the polyradiculonevritic syndrome is not influenced by the infection and its prognosis is usually good.
An 11 day-old neonate presented with bilateral renal venous thrombosis in the course of Salmonella Ibadan infection. 36 hours thrombolytic treatment with urokinase was associated with an immediate favorable outcome. Heparin and antibiotic treatment were pursued for 3 weeks. A 6 month follow-up and results of renal ultrasonography, urography and renal scanning allow to assess recovery, with restoration ad integrum for both kidneys.
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A 4,000 g male infant two hours old, product of normal pregnancy and delivery was admitted in our hospital because of bladder intussusception though umbilico vesical fistula (persistent foetal bladder). The anomaly coexisted with hernia in the umbilical cord. The whole upper part of the bladder was everted and could not be brought in. The surgical correction was performed on the fourth hour. The everted bladder was reduced from inside, severed from abdominal wall and closed in two layers. Pan endoscopy revealed no lower urinary tract obstruction. The post-operative course was uneventful. A bilateral vesico-ureteral reflux grade II was observed on post-operative cystography. On sixth month follow up the infant was growing well and there was no more reflux on cystography. Diagnostic and treatment of this unusual malformation are discussed.
A four month old baby presented one morning a quiet, hypotonic, areflexive coma without any signs of localization, which vanished without any sequelae. Hepatic cytolysis and an isolated proteinuria with a maximum at about three days after the initial neurological problems completed the picture. A new interview with the parents looking for a toxic cause revealed without any doubt poisoning by tetrachloro-ethylene. Following this particular case, the main signs of poisoning by halogenated aliphatic hydrocarbons are recalled. One should always have in mind the possibility of poisoning at all ages, even with young babies.
Mediastinal tumor is a rare cause of severe respiratory distress in the newborn. A recent patient was transferred++ to our intensive care nursery with severe distress due to a large mediastinal teratoma. The presence of calcifications on the plain chest roentgenogram suggest the diagnosis. At two hours of age the tumor developed in the left hemi-thorax was completely removed. Microscopically it was a typical well differentiated+ benign teratoma, but the postoperative course was marked by a continuing respiratory distress due to a paralysed left diaphragm. This situation was surgically corrected by infolding the diaphragm at twenty days of life. At the fourth postoperative day the endotracheal tube was removed and the baby is now well with a normal chest. X-ray at six month of age. Because the rarity of this tumor in the newborn, because the possibility of antenatal echographic diagnosis, we record this experience and review the literature.
Four cases of neonatal listeriosis issued from the same maternity during the period of ten days are reported in this paper. Three newborns suffered from a delayed listeriosis meningitic form with complete recovery. The fourth newborn suffered from early septicemic form and died. This is a new observation of post-natal cross infection with listeria monocytogenes in the same maternity. The reported cases remain rare up to now, although this is a classic notion.
In the case of a strangulated prolapsed ureterocele on lone kidney, the authors discussed briefly the management of this complication found solely in the feminine gender. The central point to remember is that the care giving in emergency must be of a limited nature and secondly that the patient must be explored and prepared carefully before reconstructive surgery.
The hallmark of the Capgras Syndrome is delusional misidentification of persons, objects or animals. It can occur in organic syndromes and in functional disorders. Hence there are adherents of organic as well as dynamic factors in the genesis of this disorder. The authors report the occurrence of the Capgras Syndrome in a brother and sister and elaborate on the interplay of both genetic and dynamic factors in the etiology.
Carbamazepine has been used in the treatment of temporal lobe epilepsy since 1963. It has also been found effective in the treatment of psychiatric disorders accompanying epilepsy. Patients with nonspecific EEG abnormalities without overt epilepsy but with behavioral problems, including gross psychopathology and violent behavior, improve on carbamazepine. These findings prompted us to use it in the treatment of aggressive behavior in a schizophrenic patient. Due to the frequency and severity of aggressive behavior in this patient, maintenance ECT was given. However, when carbamazepine was instituted, ECT was discontinued and the patient has been virtually free from aggressive behavior since this medication has been instituted. The authors conclude that carbamazepine may be used in the treatment of aggressive behavior in schizophrenic patients.
A population suffering from a serious form of malnutrition was examined. The effectiveness of nutritional rehabilitation is demonstrated by the statistically significant changes observed in clinical and laboratory indicators. Several anthropometric measurements related to nutritional status are also compared with total body potassium (TBK) in patients with a positive nitrogen balance during the process of nutritional rehabilitation. It is concluded that weight (W), arm circumference (AC), middle arm muscle circumference (MAMC) and skinfold thickness (ST) measures are useful, and sufficiently accurate and precise to follow the evolution of nutritional status and body compartments.
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