[Scintigraphy in infectious bone pathology in children. Value and limitations].
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Biomedical subjects
Publications and source records attributed to E J Raynaud.
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A prospective study was made of levels of lactate and hydroxybutyrate dehydrogenase in the blood and cerebrospinal fluid of 57 term neonates, in relation to the time elapsed since delivery, neonatal examinations (Apgar score, neurological symptoms and EEG findings) and psychomotor outcome at one year of age. Serum determinations revealed no significant relationship with clinical assessments. CSF measurements showed significant differences near to the time of delivery between the normal and handicapped groups at age one, which supports the hypothesis of a causal link between neonatal brain damage and CSF enzyme levels.
The occurrence of brain damage in 57 full term neonates was investigated. The infants were submitted to a prospective protocol involving clinical (neurological and electroencephalographical) and biological examinations, including the determination of the fibrin-fibrinogen degradation products in the blood and cerebrospinal fluid on D1, D3, D8 and D15. Psychomotor events were followed up for a year. Traumatic lumbar taps did not disturb the results significantly. Blood samples were not found to contain noticeable amounts of FDP. Conversely, the existence of FDP in CSF was not infrequent near to delivery and was shown to be closely related to brain damage as evaluated by the psychomotor events.
The authors report a double blind study on 57 full-term neonates prospectively subjected to clinical, electroencephalographical, cerebrospinal fluid and developmental examinations. Usual neonatal pleiocytosis depends on histiomonocytic cells which probably are a reflection of constant small brain damage during delivery. Infants suffering neurological sequelae at age one are recognizable as early as the 60th to 84th hours of life in view of persisting high histiomonocytic counts greater than 10 M. elements/l) and granulocytic peaks (greater than 2 M. elements/l) in clear samples. This method is then of interest, despite its invasive nature and limits (traumatic punctures, time-limits).
The authors report a double-blind study of 57 full-term newborn infants prospectively subjected to clinical, electroencephalographical, blood and cerebrospinal fluid, and developmental examinations. Four enzymatic activities were measured in blood and CSF: aminotransferase (ASAT), creatine kinase (CK), lactate dehydrogenase (LD) and hydroxybutyrate dehydrogenase (HBD). Close relationships of enzymatic levels with psychomotor outcome are reported. In blood, ASAT and CL seemed to be the most important determinations, allowing threshold-values to be suggested. In CSF, LD and HBD were the determinations the most closely related to psychomotor events at age one. This method seems to be of theoretical as well as practical importance in evaluating neonatal brain injury.
Results of a prospective study on neonatal brain damage are reported. 57 full term newborns were subjected to clinical examination with a one year follow-up. Blood and CSF were sampled for FDP determinations on days J1, J3, J8 and when necessary, J15. Traumatic punctures do not alter results. FDP measurement were negative in the whole blood samples and most CSF ones. High FDP values in early samples are linked to brain damage and values above 4 micrograms/ml are significantly correlated to neurological sequelae.
A new method for carrying out the nitroblue tetrazolium test (NBT) has been used on micro-specimens taken from 116 newborn infants for the purpose of carrying out a prospective enquiry into neonatal infection. 44 children aged from 1 to 6 days were selected at random from a population that was said to be normal in the maternity unit and were the control group. 72 children of less than 48 hours of age were made to object of a prospective study of neonatal infection, an enquiry that allowed them to be divided into 3 groups: non-infected, infected and suspect. The study showed a very strong correlation between raised scores (higher than 100) and the presence of an infection, whereas scores in the controls and the non-infected infants were low. This test, which is hardly invasive and easy to introduce as a routine when carried out early is a good screening test for infection and can be best used on the newborn population in a maternity unit.
The authors report five cases of premature newborns whose mothers had been treated with indomethacin. In all patients, clinical and biological symptoms were those of pulmonary hypertension with persistence of the fetal circulation. In two cases, autopsy showed an important reduction of the lumen of pulmonary arterioles due to a thickening of the tunica media. The role of indomethacin in such respiratory syndrome is very likely. Therefore, indications for that treatment in pregnant women should be reduced.
One hundred and one echocardiograms were performed in children 8 days to 15 years old. The values measured were : end-diastolic and end-systolic left ventricular diameters, aortic root diameter, left atrial diameter, end-diastolic septal and posterior wall thickness, mitral valve excursion. There is a good correlation of these values with the square root surface area. The indices of left ventricular performance are : mean velocity of circumferential fiber shortening (correlated with heart rate), ejection fraction and shortening fraction. These indices are not correlated with body surface area. These data can be used in the echocardiographic investigation of infants or children with heart diseases.
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A 16 year old boy with Bruton type agammaglobulinaemia developed acute encephalitis. Echo virus type 3 was isolated on two occasions from the same sample of CSF. Clinical improvement occured after treatment with gammaglobulin with high anti-Echo virus titers given intramuscularly and intrathecally. However the C.S.F. protein is still raised so that it is not certain he has been completely cured.
Surgical exploration of a 7-week-old infant with a diagnosis of 'pulmonary artery sling' (left pulmonary artery arising from the right) revealed the true nature of the abnormality to be persistence of the ductus arteriosus which connected the right pulmonary artery to the aortic isthmus. This malformation has not been described previously. It has the same symptomatology as 'pulmonary artery sling' and it may be treated by surgical ligation and division. We suggest the term 'ductus arteriosus sling' to describe this rare congenital anomaly.
A variant of metachromatic leukodystrophy (MLD), Austin disease, is characterized by a multiple isozyme deficiency of arylsulfatase. A 3 1/2-year-old girl with progressive mental and physical deterioration had decreased activities of arylsulfatases A and B in the leukocytes, shown by acylamide gel electrophoresis. Under the electron microscope, biopsy specimens of the brain and the peripheral nerve showed lamellar structures with socalled zebra bodies in the cytoplasmic processes of glial cells, granulo-membranous inclusions with fingerprint configurations in neurons, and myelinlike material in Schwann cells. Results from our study suggest an intricate nature of this dysmetabolic disorder, which shows ultrastructural changes usually seen in classic MLD, a deficiency of arylsulfatase A only, concomitant with those seen in mucopolysaccharidoses such as Hurler and Sanfilippo syndromes.
Report of a case of renal papillary necrosis in an infant, following acute dehydration with cardio-vascular failure. Evolution was favourable and diagnosis was established retrospectively by I.V. urogram.
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