The place of a pediatric intensivist in our society.
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Biomedical subjects
Publications and source records attributed to G Huault.
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Paralytic poliomyelitis were observed in two healthy children who both had previously received four doses of standard inactivated poliovaccine (IPV). These children, whose immune defenses were normal, failed to respond to IPV. This absence of antibody response might be related to an insufficient antigenicity of inactivated vaccines, justifying the extensive use of the more potent IPV, now produced on continuous cell lines.
In order to establish criteria for early cerebral prognosis after acute cerebral hypoxic ischemic insult, we studied 31 cases of patients presenting, during their first year of life, cardio-respiratory arrests due to SIDS (21 cases), anesthesia (4 cases), other causes (6 cases). A favourable evolution was observed in 5 cases where coma lasted less than 8 hours. Conversely unfavorable evolution was seen in the 26 patients (21 deaths, 5 sequellae) where coma lasted more than 8 hours. Among 12 patients of this group surviving after the 4th day, 9 expressed seizures or status epilepticus. The poor evolution was correlated with hyperproteinorachia during the first 24 hours and with cortico-subcortical hypodensity on CT scan. Early EEG and transfontanellar echography seemed less useful to establish a prognosis, specifically to discriminate children surviving with and without sequelae.
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The authors report a case of extensive spinal epidural staphylococcal abscess responsible for spinal compression. All symptoms regressed after conservative management consisting of parenteral antibiotic therapy with Gentamycin and Vancomycin.
CSF and sera from 238 newborns and children with various neurological diseases were assayed on bovine cells for the presence of alpha-interferon (IFN). An intrathecal synthesis of pH 2-resistant alpha-IFN was recovered in all newborns and in more than 90% of children with herpes encephalitis. It was also observed in one case of mumps encephalitis and in one case of encephalitis associated with Influenza A infection. An acid-labile alpha-IFN production was detected in CSF from more than one half of patients with viral meningitis or active congenital rubella and in those with neurological complications of systemic lupus erythematosus. This alpha-IFN subtype was also detected in CSF from only 2/37 children with measles encephalitis. In contrast, no alpha-IFN (less than 2 IU) in CSF was found among patients with subacute sclerosing panencephalitis, Guillain-Barré syndrome, Reye's syndrome, acute cerebellar ataxia, infantile spasms or facial paralysis of unknown origin.
Pulmonary function tests were performed in a 7 year-old girl with central alveolar hypoventilation syndrome treated with mechanical ventilation during sleep. Results showed: 1. during wakefulness decrease in residual functional capacity, in dynamic lung compliance and in lung transfer factor for CO; 2. during sleep the characteristics of the syndrome as reported in the neonatal period i.e. central alveolar hypoventilation in stages 2 and 3-4 which justified maintenance of mechanical ventilation when asleep.
The authors report 2 cases of water intoxication. These clinical cases show the importance of neurological signs during the acute period. Hyponatremia is constant and responsible for the clinical signs. A rapid treatment is necessary.
Infantile and childhood lobar pulmonary emphysema (LPE) has finally become a rather straightforward problem after 28 years experience and the important statistics published. Contrary to adult emphysema, and leaving aside the particular aspects of causal lesions, the pediatric form is usually a unilateral lobar or infralobar disorder, and therefore lends itself to surgical treatment.
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The authors report on their experience in 322 cases of aortic arch anomalies surgically treated in infants and children. The progress recently achieved through improved diagnosis and resuscitation care have made possible to obtain good results in the great majority of cases.
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