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Biomedical subjects

F Leclerc

Publications and source records attributed to F Leclerc.

At least 127 records · Page 7Linked to original sources

[Frequency of adrenal hemorrhage in fatal forms of purpura fulminans in children. Etiopathogenic and therapeutic considerations].

Between 1971 and 1985, 43 children died of purpura fulminans in our intensive care unit: 11 had autopsy and adrenal haemorrhage was observed in 8 (73%). All these patients had an extensive purpura and a severe disseminated intravascular coagulation. Our series confirms the findings of previous studies: 69 autopsies showed 51 cases (74%) of macroscopic adrenal haemorrhage. Adrenal haemorrhage may be only one manifestation of multiple system organ failure consecutive to septic shock; however, its association with low plasma cortisol levels (as previously reported) suggests that glucocorticoid replacement therapy should be reconsidered in purpura fulminans.

Adrenal Gland Diseases↗

[Value of C-reactive protein assay in severe infectious purpura in children].

Serum C-reactive protein (CRP) values were obtained in 24 children with infectious purpura: 8 were not shocked and survived, 10 were shocked and survived, 6 were shocked and died. On admission, mean CRP levels were significantly lower (P less than 0.001) in shocked patients who died (69 +/- 27 mg/l) than in shocked patients who survived (209 +/- 60 mg/l). In shocked patients the predictive value for death of a CRP level below 100 mg/l was 83%. The predictive value for survival of a CRP level above 100 mg/l was 90%. Steadily high values of CRP beyond the 8th day seem to be related to severe necrosis rather than to an unsuccessful treatment or superinfection.

Bacterial Infections↗

Ultrasonographic findings in thymic lymphoma in children.

The sonographic manifestations of thymic involvement by T lymphoblastic non-Hodgkin's lymphoma/leukaemia in 6 children are presented. The criteria which may help in its differentiation from a normal thymus gland are reviewed. Hypoechoic and non-homogeneous large masses are the most typical presentation of thymic infiltration. Fixity of tumour and compression of surrounding structures are the most important associated signs with pleural and pericardial effusions. In children, ultrasonography of the mediastinum can play a role by establishing the nature of anterior masses.

Child, Preschool↗

[Mycotic aneurysm after catheterization of the umbilical artery].

The finding of an abdominal mass in an 18-month old infant ultimately led to the diagnosis of mycotic aneurysm of a common iliac artery. The lesion was resected and the vessel was ligated. The short and long-term outcome was favourable. The child had been operated upon for cervical teratoma and had undergone catheterization of the umbilical artery complicated with Staphylococcus aureus infection. The presence of a mycotic aneurysm must be suspected in infants with a history of umbilical artery catheterization or neonatal staphylococcal infection, or presenting with a posterior mediastinal or abdominal mass, or arterial hypertension. The vessel most commonly involved is the aorta. Surgical resection, when performed, results in cure. The present case is remarkable on three points: the lesion involved an iliac artery, the diagnosis was delayed and calcifications were present around the aneurysm.

Aneurysm, Infected↗

Bacterial croup and toxic shock syndrome.

An 8-year-old boy with bacterial tracheitis, treated by endotracheal intubation, humidification, airway toilet and antibiotics, experienced a toxic shock syndrome on the day after his admission. The course was favourable. Staphylococcus aureus was isolated from tracheal secretions. Bacterial tracheitis is an infrequent cause of non-menstrual toxic shock syndrome. The diagnosis of bacterial tracheitis should be suspected in a child with toxicity and croup who is not responding to the usual therapy. Endoscopy should be performed allowing for removal of the secretions. The maintenance of a clear airway is the main purpose of the treatment.

Child↗

Plasma fibronectin in severe infectious purpura of children.

Plasma fibronectin levels were determined in 34 children admitted with severe infectious purpura. Fibronectin concentration was decreased in severe infectious purpura as in other sepsis, but there was no significant difference between shock and nonshock patients. Fibronectin levels were lower in children with ecchymotic or necrotic purpura on admission than in those with petechial purpura; they were lower in those who developed cutaneous sequelae, but it is not known if correction of fibronectin deficiency may limit the extent of purpura and prevent the cutaneous sequelae.

Child↗

Prognostic factors of severe infectious purpura in children.

The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p less than 0.001), coma (p less than 0.05), ecchymotic or necrotic purpura (p less than 0.01), temperature less than 36 degrees C (p less than 0.05), no clinical meningism (p less than 0.001), white cell count less than 10,000/mm3 (p less than 0.05), thrombocytopenia less than 100,000 (p less than 0.01), fibrinogen less than 1.5 g/l (p less than 0.001), kalemia greater than 5 mEq/l (p less than 0.01), spinal fluid cell count less than 20/mm3 (p less than 0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.

Child↗

[Staphylococcal toxic shock].

The authors report the case of a 5 year-old child who, after a sore throat, developed gastrointestinal problems, high fever, scarlatinaform rash, conjunctivitis, shock with renal failure and involvement of liver, pancreas and muscles. No infectious site was detected. However, he had positive blood culture for staphylococcus aureus. The child fully recovered after a period of desquamation of the palms and soles.

Age Factors↗