Biomedical subjects
Publications and source records attributed to J Bourgeois.
The authors report an unusual mode of onset of diffuse mesangial sclerosis in a newborn. Fatal neonatal renal failure, and not infantile nephrotic syndrome, was the main symptom after birth. In utero, ultrasonography revealed hypertrophy and hyperechogenicity of the kidneys associated with oligoamnios.
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The prognosis of high risk congenital diaphragmatic hernia and eventration diagnosed in the early neonatal period (before 24 h) is studied based on a series of 64 cases. Eventration has a poor prognosis with 5 deaths out of 7 cases. The replacement of the hemidiaphragm by an abdominal muscular flap seems to be the best surgical procedure (2 recoveries on 4 cases). A high mortality rate remains in the diaphragmatic hernias which are undiagnosed before birth. Out of 54 operated cases with systematic homolateral drainage, there were 35 survivors (65%). Post-operative alveolar-arterial PO2 difference less than 53 kPa appears to be a reliable criterion of good prognosis with a survival rate of 91% in this series. Thus, despite major progresses in post-operative resuscitation, the recovery rate in high risk neonatal congenital diaphragmatic hernia and eventration is only 75%. This seems to be partly related to the existence of lethal forms due to bilateral pulmonary hypoplasia and structural anomalies of the pulmonary arteries.
In 210 surviving cases of oesophageal atresia treated by anastomosis, 34% presented a gastro-oesophageal reflux. Half of these patients needed surgical treatment of the reflux to prevent complications.
Forty-two term and 106 preterm appropriate for gestational age (AGA), and 43 term and 31 preterm small for gestational age (SGA) children were observed from birth to age 5 years. Parents' weight and height were also measured in 193 subjects including 97 couples. The percentage of short children was higher in SGA (17%) than in AGA (3.4%) children (P less than 0.01). This difference was significant in the preterm but not in the term children, suggesting that early failure of growth in utero can result in reduced growth in children. The findings were similar for weight and head circumference, but microcephaly was more frequent in term SGA (30%) than in preterm SGA (6.4%) children (P less than 0.05), suggesting that late impaired growth in utero can result in poor growth of the head. Height at the age of 5 years correlated with the parents' height only in AGA children, and with length at birth in SGA children. Weight of the 5-year-old children correlated with the mother's weight only in AGA children. Multivariate analysis in 66 couples and their children confirmed a greater tendency toward the influence of parental factors in AGA children and a more significant relationship with perinatal factors in SGA children.
The authors report a case of respiratory distress secondary to inhalation of meconial amniotic fluid treated by mechanical ventilation, which was complicated by severe interstitial emphysema. Treatment by pleurotomy allowed a favorable evolution. The various therapies of interstitial emphysema of the neonate, in particular surgical technics are described.
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Three cases of septo-optic dysplasia are related in infants. A neurogenic diabetes insipidus and an central adrenocortical insufficiency is proved. An growth hormone deficiency is founded in one case. The other anterior pituitary functions are normal. The pneumo-encephalography with congenital absence of septum lucidum and the ophtalmologic anomalies are typical. The treatment is envisaged. In one case an autopsy sustains the radiologic aspect.
The authors report the experience which the have acquired since 1970 in the use of posterior pituitary extract as part of the treatment of gastrointestinal bleeding in cirrhotics. 100 cases have been collected, in 73 patients. These may be divided into two groups: one of 32 patients, who did not receive posterior pituitary extract, with 31 deaths, and one of 41 patients who did receive the extract, with 6 deaths. These figures should be viewed in parallel with the results obtained by other techniques, and it would seem that comparison with other statistics is feasible. In addition, emphasis must be placed upon the simplicity of the administration and surveillance of treatment. Attention is also drawn to the absence of any inherent complication associated with the use of the drug, despite the administration, in certain cases, of high doses.
Ten term and eleven preterm newborn infants with appropriate weights for their gestational age were infused for one minute with L-alanine (150 mg/kg) at the age of 29 to 76 hours (mean 48 hours) and circulating levels of glucose, lactate, pyruvate, D-betahydroxybutyrate (D-BOHB), insulin and glucagon were monitored. Plasma glucose concentrations increased from 2.7 +/- 0.16 (mean +/- S.E.M.) to 3.7 +/- 0.2 mmol/l after 50 min (p less than 0.01) in term infants. In preterm infants, after an initial decrease of the glucose level from 3.1 +/- 0.16 to 2.6 +/- 0.16 mmol/l (p less than 0.05), it returned to the baseline level at 50 min: 3.0 +/- 0.2 mmol/l. The blood concentration of D-BOHB decreased in term infants from 192 +/- 37 to 112 + 6 micrometer/l (p less than 0.01) after 40 min. In preterms, its decrease was not significant (p greater than 0.05). Plasma glucagon level rose from 53 +/- 5 to 70 +/- 8 pmol/l after ten minutes (p less than 0.01) in terms infants and from 61 +/- 6 to 75 +/- 9 after 20 min (p less than 0.01) in preterm infants. There were no significant changes in plasma insulin concentrations in either group. Forty minutes after L-alanine infusion, I/G ratios were lower in preterm infants (1.26 +/- 0.14) than in term infants (1.71 +/- 0.25) (p less than 0.01). There was no relationship between the glycemic responses to L-alanine and the basal levels of D-BOHB. The data suggest that the glycemic effect of L-alanine infusion and circulating glucagon depends upon a specific stage in maturation. The antiketogenic effect of L-alanine infusion is observed in term infants as in adults.
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A case of congenital rickets of nutritional origin is described in a light-for-date premature infant (gestational age 34 weeks, birthweight 1 100 g). X-rays of the long bones showed spread, frayed and cupped metaphyses at birth and at the age of 16 days. Serum calcium was 8.2 mg/100 ml, phosphorus 3.4 mg/100 ml and alkaline phosphatase (A.P):323 IU/ml (N less than or equal to 200) at the age of 3 days. Very high level of serum immunoreactive parathroid hormone (iPTH) was found at the age of 16 days=295 micronlEq/ml (N less than or equal to 50). Evidence of maternal vitamin D deficiency was demostrated by low plasma 25-hydroxycholecalciferol (25-OH-CC):1.0 ng/ml (N:13.2+/-4.2) soon after delivery; it was found to be normal (10.2 ng/ml) six months later. Ca infusion (15 mg/kg/3 h) resulted in a marked fall of serum iPTH (280 to 84 micronlEq/ml). Administration of vitamin D2 (2400 IU/day for 10 days) induced some healing of the metaphyses; A. P. remained elevated (400 IU/ml); plasma 25-OH-CC was normal 10.2 ng/ml and serum iPTH was 115 micronlEq/ml. When 25-OH-CC was given orally for ten days (15 microng/day), plasma 25-OH-CC rose to 64.5 ng/ml with a minor change of serum iPTH (94 micronlEq/ml); X-rays of the bones showed osteoporosis. These results suggest a reduced convertion of 25-OH-CC into 1-25-(OH)2-CC.
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The seromucoid concentration was estimated in 131 newborn infants who were divided into four groups (controls, dysmature-postmature, infected, miscellaneous). Elevation of seromucoids suggested neonatal bacterial infection. The non-specific nature of the elevation is compensated for by the ease and the speed of obtaining a result.
A methodology is described, entirely based on common commercial components with minor modifications, and allowing one to determine in vitro the saturation of whole blood in a photometric cell.