Biomedical subjects
Publications and source records attributed to J Messer.
Separation of the left gastric artery from the gastric air shadow is a diagnostic sign of lesser curvature gastric lesions. This finding is especially helpful in patients with large exophytic wall lesions in whom barium examination, CT and ultrasound are not diagnostic. This was demonstrated in two patients with large leiomyomas of the stomach.
An outbreak of staphylococcal skin infection in neonates was investigated clinically, bacteriologically and epidemiologically with the following findings: (1) In 8 out of 13 cases, exfoliatin-producing staphylococci were present in the bullae, which is unusual with bullous lesions occurring at other ages; (2) exfoliatin producing staphylococci were present in all children with bullous lesions, as well as in carriers; (3) 39% of the phage II group staphylococci studied produced exfoliatin; (4) purulent lesions due to phage II staphylococci which did not produce exfoliatin were observed. The contaminating agent could be identified in most cases.
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C reactive protein (CRP) levels were measured in the serum of 2 groups of neonates before and after the 12th hour of life. One group consisted of controls, the other of children with neonatal sepsis. The means (+/- standard error) for CRP serum level were 6 +/- 0.7 mg/l and 7.7 +/- 0.8 mg/l respectively before and after 12 hours of life in controls (n = 100); they were 19.7 +/- 3.4 mg/l and 67.5 +/- 6.6 mg/l in the group of infected neonates (n = 54). For both times of sampling, levels were significantly higher (p less than 0.001) in infected neonates. The low percentage of false-positives and false-negatives suggests that this dosage is almost specific for neonatal sepsis.
Primary apnoea in premature infants can be treated by three categories of drugs. Drugs of the first category act on chemoreceptors and include doxapram and possibly almitrine if the latter proves non-toxic during the neonatal period. Phenobarbitone is so far the only representative of the second category of drugs which alter the pattern of sleep. As for the third category, it has the second messenger of respiratory centres for target and includes the phosphodiesterase's inhibitor (not yet tried in man) and the xanthines. At the moment, xanthines are the drugs of choice, since they are both effective and safe, provided dosage is adjusted to each patient.
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We have performed continuous recording of cutaneous PO2 (cPO2) together with a polygraphic recording of sleep in 12 normal premature babies, 36-38 weeks of post-conceptional age. In all babies, cPO2 was significantly lower (77.2 +/- 23.2) and more variable in active sleep than in quiet sleep (81.8 +/- 24.6). This difference is significantly related to the more numerous apneas, to the asynchronism of thoracic and abdominal movements, and to the motor activity with important irregularities of ventilation observed during the stage of active sleep.
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From 1964 to 1976, 20 cases of retrolental fibroplasia were recorded in the south of France while 38 cases were recorded in the north from 1970 to 1977. The more children are immature, the more they are liable to suffer from this disease. Etiological factors are apparently not limited to oxygen, which however plays the most important part in the process.
In three neonates with cardiac failure and coarctation the cutaneous PO2 (cPO2) has been measured during the administration of a high concentration of oxygen. One sensor was fitted to the skin just below the right clavicle (preductal) and the other on one of the legs (postductal). The difference in the cPO2 provided evidence for a large right to left shunt through the duct. This finding in conjunction with the clinical syndrome of co-arctation is characteristic, in our view, of atresia of the aortic arch. The results of the test, with clinical and echocardiographic details enable more accurate decisions to be made before catheterisation and surgery.
The periphery of the retina was examined with the use of contact lenses at the age of 5 years in children who were born prematurely and weighed less than 1,500 g at birth. In this retrospective series 65% of the children were found to have lesions similar to the classical findings in retrolental fibroplasia although only to a minor degree. Low oxygen levels with a short duration of the exposure cannot completely prevent these sequalae. This retinopathy which is limited to the periphery, may account for the frequency and severity of myopia in children who were premature. Later in childhood and more rarely retinal detachment or tears may occur which cause severe visual impairment.
The continuous monitoring of the PO2 with double sensors, pre- and post-ductal, is very interesting during the neonatal period; the magnitude of the right-to-left ductal shunting, related to high pulmonary vascular resistance, is well evaluated by the hyperoxemia test. This noninvasive method allows a reliable observation of the pulmonary vascular response to oxygen, alkaline solutions, or tolazoline infusion.
A national survey showed that retrolental fibroplasia still exists in France, as it does in other countries of the world. Retrolental fibroplasia is a condition that principally affects low birth weight premature babies in whom oxygen therapy has not been adequately controlled. The premature babies who have apnaeic attacks are most risk. Strict control of all oxygen therapy, preferably using continuous monitoring techniques together with other changes in the methods of treatment should reduce the incidence of this condition.
The retinal periphery of 60 premature children now between 5 and 8 years of age and with a weight at birth equal or less than 1,500 g has been investigated. In 20% of these children, pigmentary modifications were noted which were often associated with chorioretinal atrophy. Polymorphic vascular abnormalities were seen in 14% of the cases, i.e. sinuous vessels of irregular caliber or neovascularization. Abnormalities of the vitreous body were also noted in 12% of the patients with glial bags on the periphery and sometimes potentially dangerous tractions folds (4%). All these abnormalities could cause complications such as retinal tear, retinoschisis or retinal detachment. Even if these signs are discrete, they can later on be the source of complications. Refraction studies revealed 30% of myopic children. The most important group had myopias equal or higher than 8 d. The characteristics of the myopia of premature children are its constancy (all premature children are myopic at birth); its importance (it depends on birth weight and on the severity of the retinopathy), and its evolution (the myopia of premature children does not evolve or evolves very slightly).
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