Biomedical subjects
Publications and source records attributed to M Félix.
We report a case of "spontaneous" bladder rupture in a child with type IV Ehlers-Danlos Syndrome phenotype. The clinical presentation was unusual with abdominal pain, urinary retention and recurrent rectal prolapse. We could not find other similar cases in the literature. We to the possibility of "spontaneous" rupture occurring in this type of patients.
Recombinant human erythropoietin (rHuEPO) was administered subcutaneously three times a week to 18 infants with the anaemia of prematurity at doses of 75, 150, 300, or 600 units/kg per week for 4 weeks, starting at 3-4 weeks of postnatal age. A significant and dose-dependent increase in reticulocyte count was observed from a mean baseline value of 71 x 10(9)/l to 200 x 10(9)/l after 3 weeks of therapy, compared with a change from 69 to 97 x 10(9)/l in 66 historical controls. The haematocrit value remained unchanged during rHuEPO treatment, whereas it steadily declined until 9 weeks of postnatal age in the controls. These effects were accompanied by a marked reduction in serum iron concentration and transferrin saturation in patients receiving standard-dose iron supplements, but not in those given larger doses. Only 3 of 18 patients required a red blood cell transfusion. These infants were among the most anaemic at entry into the study and 2 of them were unable to complete rHuEPO therapy, while the third developed iron deficiency anaemia. These data indicate that rHuEPO with appropriate iron supplementation may accelerate the recovery from anaemia of prematurity. Larger scale placebo-controlled studies are now needed to confirm these findings and verify their impact on transfusion requirements of premature infants.
In an attempt to stimulate endogenous erythrocyte production and thereby provide an alternative to erythrocyte transfusions, we administered recombinant human erythropoietin (rHuEpo) in doses of 75 to 300 units/kg/wk to seven infants with the anemia of prematurity. Treatment was started between 21 and 33 days of life, maintained for 4 weeks, and was well tolerated. All the patients had low baseline serum erythropoietin levels. After rHuEpo therapy, the number of reticulocytes increased from a mean baseline count of 75 x 10(9)/L to 95, 141, and 165 x 10(9)/L on days 7, 10, and 14 of therapy, respectively. Correction or stabilization of the anemia was observed in six of seven patients, whose estimated total erythrocyte volume increased by 49% during therapy (vs a predicted increment of 18% in the absence of rHuEpo). In one patient, however, the hematocrit declined during the treatment, and in three of the responders a secondary fall in hematocrit was noted either during therapy or after its discontinuation. Serum iron and ferritin levels rapidly decreased after the initiation of rHuEpo therapy, and in most patients transient early thrombocytosis and late neutropenia were observed. These data suggest that rHuEpo may correct or stabilize the anemia of prematurity. Its effects, however, may be limited by a variety of factors, among which iron availability probably plays an important role. Controlled studies will be needed to confirm these preliminary observations.
The authors report 12 personal cases and a bibliographic study showing the authenticity of acute pancreatitis and pancreatic pseudo-cyst following trauma. The clinico-pathological aspects, the course and the treatment are not specific. The medico-legal aspect is the most important for the secondary or late manifestations raise the problem of the imputability to the accident. Surgeons and judicial experts should be aware of the post-traumatic risk.
The authors present a clinical case of post-traumatic stenosis of the small intestine. The improvement in the quality of radiological diagnosis by the use of double contrast study of the small bowel after duodenal intubation is emphasised. On the basis of this case, together with a review of the literature, they review the various problems of diagnosis, physiopathology and histology which may be posed by these stenoses, which it would seem possible to integrate into a wider physiopathological group: ischaemic stenoses of the digestive tract.
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Pneumoperitoneum is rarely seen with bladder rupture. In blunt abdominal trauma this sign is strongly suggestive of gastric or bowel perforation. In our child, suspicion of bladder trauma was evoked by car belt marks in the hypogastrium and by gross hematuria. Preoperative diagnosis was not confirmed because immediate surgical exploration was required based on the presence of free air in the abdominal roentgenograph.