Biomedical subjects
Publications and source records attributed to D Floret.
The report is dealing with a 10 year-old girl. The diagnosis of Albright's type II osteodystrophy relied on clinical, radiological and biological symptoms: evocative dysmorphic syndrome and absence of disturbances in the phosphocalcic metabolism. Hypothyroidism was secondary to an isolated defect in TSH, and a TRH stimulation test did not induce an increase in plasma TSH.
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Five patients with Bartter's syndrome were investigated. Sodium restriction (less than 10 mEq/day for at least 5 days) showed a renal sodium wastage in only two patients (I and II) in spite of increased aldosterone secretion rate (from 151-427 to 680-842 mug/day). The effect of angiotensin II (A II) 80ng/kg/min for 30-180 min, on plasma renin activity (PRA), plasma aldosterone, and urinary sodium excretion was compared with the effect of a previous infusion of 5% dextrose given at the same rate, 0.5 ml/min for 1 hr. A II infusion resulted in increased plasma aldosterone levels: from 236-330 pg/ml to 800-881 pg/ml in 30 min. This increase was also observed in patient II (from 139 to 600 pg/ml). PRA was decreased by A II infusion (from 1,142-2,462 to 121-1,625 ng/liter/min). In patient IV, this decrease in PRA was also observed when he was on a salt-restricted diet (from 1,934 to 370 ng/liter/min); but the minimal PRA was still higher (370 ng/liter/min) than with a normal diet (121 ng/liter/min). In no case could normal PRA level be obtained. A II infusion induced an increase in urinary sodium excretion only in the two patients with renal sodium wastage (from 80-90 to 265-230 muEq/min in 30 min). Urinary sodium excretion decreased in the other patients from (37.5-213 to 4.30-46 muEq/min) and fractional sodium excretion was reduced in patient V (from 0.56% to 0.45% at 30 min and to 0.29% at 120 min). No significant change with A II infusion was observed in patient IV when he was on a sodium-restricted diet (from 1 to 2.5 muEq/min in 30 min). Urinary potassium excretion was similar to sodium excretion. No change was observed in plasma potassium and sodium.
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Two cases of alopecia areata coexisting with trisomy 21 are reported. In the first case, the two diseases were associated with Hashimoto's thyroiditis and in the second, with vitiligo. Pathogenic implications are discussed.
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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Our experience concerns 36 infants ventilated for bronchiolitis over the last five years. Among the infants admitted in the pediatric department during the same period 11% have been ventilated. Their age ranged between 1.5 and 49.5 weeks (mean 9.2 weeks) and their weight between 2,700 and 8,000 g (mean 3,841 g). Fourteen were premature born infants. 16 patients have been intubated for apneas, 13 for clinical deterioration and 10 for hypercarbia. The duration of ventilation ranged between 1 and 18 days (mean 6.5 days). No death occurred. Neither neurological nor respiratory sequelae could be related to ventilation. Mechanical ventilation is a safe method able to suppress mortality in infants bronchiolitis.
A 14 days old neonate presented an occlusion of the right internal carotid artery complicating a Streptococcus B meningitis. We discuss the mechanism of this rare complication of purulent meningitis, usually due to hemophilus influenzae.
A protocol of rationalized management of the first non complicated febrile seizure was used in 42 children and the results were compared with those observed in the past without the new protocol. The quality of medical data collected from the parents and those given to the family and their practitioner have been improved; the duration of the hospitalization was shorter, the examinations were fewer and the savings realised per child were 3,175 francs.
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