Biomedical subjects
Publications and source records attributed to E Bodart.
We report early carotid involvement by retropharyngeal abscess in a 4-year-old boy. MR imaging showed enhancement of the wall and narrowing of the lumen of the internal carotid artery, which were thought to reflect spasm and/or arteritis. Prompt treatment may have prevented hemorrhagic and neurologic complications.
UNLABELLED: Castleman disease (CD) is a benign lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. Most observations focus on adult patients. In children the disease is rare, usually localized and may be symptomatic or asymptomatic. We reported two children, 7 and 14 years old respectively, affected by unifocal cervical CD of the hyaline vascular type. CONCLUSION: Two cases illustrate that CD may mimic a neoplasm and should be considered in presence of a solitary neck mass with specific features on CT and MRI.
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Between September 1989 and June 1994, 21 children (17 boys, 4 girls) with moderate to severe symptoms due to laryngomalacia underwent endoscopic surgery using the CO2-laser micropoint manipulator (shot-by-shot, 0.1 s, super-pulse, 2-3 W power; 280 microns beam; 400 mm working distance). Mean age of the children was 5 months (range, 1-11 months). The procedure was performed under high-frequency jet ventilation and consisted in the resection and/or vaporization of the aryepiglottic folds. This tissue removal could be extended to the laryngeal mucosa of the arytenoids and the lateral edge of the epiglottis. Results of surgery were excellent with normalization (8 patients) or, at worst, a very definite improvement of symptoms (4 patients). Furthermore, no complications occurred due to the technique used. These results have convinced us that the CO2-laser micropoint manipulator technique, with the "super-pulse" shooting mode and high-frequency jet ventilation, is by far superior to microsurgery with cold instruments when endoscopic treatment of laryngomalacia is indicated.
BACKGROUND: Some cases of left-sided appendicitis related to malrotation or situs inversus have been reported. Another type of left-sided appendicitis is reported. CASE REPORT: A 9 year-old boy was admitted suffering from a 2-day history of severe left-sided abdominal pain of the lower quadrant with fever at 38 degrees C. He presented abdominal tenderness and guarding, maximal in the left lower quadrant. His leukocyte count was 22,000/mm3. Ultrasonography showed a digestive tubular structure with thick walls in the left lower quadrant. CT scan revealed a dilated right-sided appendix with localized perforation, whose extremity was located in the left lower quadrant along the lateral wall. The diagnosis was confirmed by median laparotomy. CONCLUSION: Left-sided appendicitis can also be related to a dilated right appendix with its extremity in the left lower-quadrant near the lateral wall. CT scan can then be helpful for diagnosis when ultrasonography remains unconclusive.
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BACKGROUND: Idiopathic subglottic stenosis is a rare cause of acute respiratory distress, that is difficult to treat (corticosteroids, tracheotomy). CASE REPORT: A nine-year-old boy presented with acute respiratory distress due to tracheal stenosis. The symptoms recurred after the endotracheal inflammatory membranes had been removed with forceps, despite 6-months of degressive corticotherapy. Absence of other causes of tracheal stenosis and biopsies led to diagnosis of idiopathic subglottic stenosis. The patient was treated by CO2 laser followed by degressive corticotherapy. The respiratory distress recurred within 3 months of discontinuing corticosteroids, requiring two further CO2 laser treatments. The patient became corticodependent. CONCLUSIONS: CO2 laser is an effective, wise alternative treatment of acute respiratory distress due to idiopathic subglottic stenosis that can be repeated if necessary.
From October 1991 through April 1992, 16 infants aged 5 to 25 months (mean age 14.3 months) underwent bronchoscopy with a flexible fiberoptic bronchoscope, under local anesthesia. The technique is described in detail. Reasons for bronchoscopy included recurrent or persistent pneumonia (n = 4), persistent atelectasia (n = 4), lymphadenopathy and/or airway compression (n = 2), suspected foreign body (n = 2), bronchoalveolar lavage to investigate diffuse interstitial lung disease (n = 2), and severe recurrent wheezing (n = 2). The procedure established the accurate diagnosis in 14 cases. Adverse events (32%) were minor (transient hypoxia, n = 3; moderate fever, n = 1; and laryngospasm, n = 1) and resolved completely. Flexible fiberoptic bronchoscopy under local anesthesia is a simple procedure which is safe in patients under 30 months of age when performed by a experienced operator in an adequate facility. This method is useful for the diagnosis and/or treatment of a broad spectrum of conditions.
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Inhaled drugs became of great interest in the treatment of childhood asthma. They must be adapted now to age and each form of the disease. The primarily interest of an organ therapy is to lead to a maximal efficacy by bringing locally an optimal quantity of drug without or with very few side effects. The choice of the device depends upon age which determines drug tolerance and quality of the inhalation technique. In infants and young children the use of nebulizers appears to be the most suitable technique; preschool children are capable to use metered-dose inhalers (MDI) with spacers; in older children the use of MDI, without spacers, or dry powder inhalers is allowed. During attacks of asthma, inhaled therapy appears to be effective in most cases using either B2 agonists alone in moderate forms, or B2 agonists associated with oral or parenteral corticoids in more severe forms. For the preventive treatment of asthma, in order to prevent attacks, some inhaled drugs also belong to a first line therapy against either allergy or on specific bronchial hyperreactivity: cromolyn or nedocromil are often used in mild to moderate forms (in association with oral anti-histamine drugs in some cases); in more severe forms we can start with a bronchodilator B2 agonist long-term treatment (associated with sustain-released theophylline in some cases), except in infants before twelve or eighteen months of age; in the most severe forms of chronic asthma an anti-inflammatory long-term treatment with inhaled corticosteroids may be prescribed even in young children.
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The value (in terms of decreased numbers of attacks and of hospitalizations for attacks, decreased need for asthma medications, and improved tolerance to allergens) of rush immunotherapy to a mixture of allergens was studied in children with multiple sensitizations and severe asthma (as evaluated on the number of attacks, number of hospitalizations, and dependence on corticosteroids) already receiving optimal medical therapy. Because syndromic reactions are common, rush immunotherapy should be performed in the hospital and premedication with corticosteroids may be warranted in the most severe cases.
The case of a 7 year-old who presented with lymphangitic carcinomatosis revealed by lung biopsy and secondary to renal adenocarcinoma is described. This biopsy was performed because of radiologic and clinical signs associating bilateral interstitial infiltrates, mediastinal adenopathy and gradually increasing respiratory distress. Despite treatment, the child died two weeks later.
56 patients with primary retinal detachment were treated by pneumatic retinopexy. The overall success rate for reattachment with one operation was 66%. Postoperative complications included development of new tears (18%) and P.V.R. (16%). Pneumatic retinopexy is a valuable new technique, however careful patient selection and postoperative management is required.
Biological abnormalities simulating Bartter syndrome were observed in a preterm neonate with complex cyanotic congenital heart disease, for which ductus arteriosus was maintained open by high doses of prostaglandin (PG) until a Blalock shunt could be performed. These abnormalities spontaneously disappeared after cessation of PG administration. We postulate that the natriuretic effect of exogenous administered PG could further increase sodium wasting already induced by the cardiopathy thus leading to pseudo-Bartter syndrome.
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UNLABELLED: There is no therapy with proven effect on bronchiolitis outcome. This leads to large variations in its management between different countries. In order to evaluate how this disease was managed in our country, a questionnaire was sent to all Belgian paediatricians. With a response rate above 40% of active paediatricians, we found that bronchodilators (74.7% vs. 77.2%), physiotherapy (76.2% vs. 85.6%) and antibiotics (63.8% vs. 74.4%) were still largely prescribed in in- and outpatient settings respectively, corticosteroids (orally or intravenously) being prescribed more often in hospitals (54.3% vs. 17.0%). There were also some variations in admission criteria (minimal age 2 months (75%) to 6 months (8.2%), lower limit for oxygen saturation: 90% (21.5%) to 95% (26.5%)) and 1/3 of the respondents did not use pulse oxymetry to evaluate hypoxaemia in infants with bronchiolitis. Logistic regression analyses allowed us to identify patterns of prescription based on age, type and level of activity and language. CONCLUSION: Many therapies with no proven effect are still used by Belgian paediatricians to treat children with bronchiolitis. Based on these results, we believe that publishing national guidelines will allow a reduction in the cost associated with this disease.