Biomedical subjects
Publications and source records attributed to P Viart.
An aneurysm of the left pulmonary artery developed in an infant during a staphylococcal generalized infection. The successful surgical treatment required a left pneumonectomy. In this report the causes of that rare lesion and the prognosis of pneumonectomy in infancy are reviewed.
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Several hemodynamic parameters were sequentially determined at rest in 19 African children recovering from marasmic kwashiorkor. Before treatment, the red cell volume averaged 160 ml, the circulation time: 6.6 sec, the cardiac output: 1.00 liter/min, the stroke volume: 9.7 ml/beat, the systemic vascular resistances: 79 units and the arteriovenous differences in blood oxygen content 5.1 volume %. On the 20th realimentation day, red cell volume averaged 169 ml, the circulation time: 5.8 sec, the cardiac output: 1.38 liter/min, the stroke volume: 11.4 ml/beat, systemic vascular resistances: 62 units and arteriovenous difference: 4.2 volume %. On the 60th realimentation day, red cell volume averaged 208 ml, circulation time: 5.6 sec, cardiac output: 1.53 liter/min, stroke volume: 11.8 ml/beat, systemic vascular resistances: 56 units and arteriovenous differences: 4.1 volume%; both red cell volume and stroke volume were still significantly lower than in the control group. The children recovering from marasmic kwashiorkor showed a rapid transition from a hypocirculatory state into a near normal circulatory state with delayed increase in both red cell volume and stroke volume.
Total drainage of systemic blood into the left atrium is an exceptional finding in absence of severe intracardiac malformation. In our patient, a boy 3 years and 4 months old, the left superior vena cava, the inferior vena cava, and the coronary sinus drained into the left atrium; there was no right superior vena cava, and the only associated anomaly was a large atrial septal defect. This rare form of cyanotic congenital heart disease was correctly diagnosed and successfully corrected.
This study was undertaken because circulatory distrubances had been advanced as a possible cause of death during initial renourishing of protein-calorie deprived children. Body weight, plasma albumin concentration, intravascular volumes (radiochromium), cardiac index (dye dilution technique), intravascular pressures (flow-guided catheterization), and related hemodynamic parameters were determined at rest in 43 infection-free African children with a form of protein-calorie malnutrition known as marasmic kwashiokor, and were compared with values observed in 24 convalescent children. The malnourished children showed a prolonged circulation time with a tendency to bradycardia and hypotension; cardiac index, stroke index, and heart work were significantly reduced, as were the intravascular volumes. Hemodynamic data correlated with either body weight or plasma albumin and cardiac index bore a direct relation to red cell volume. In the most severely malnourished subjects, ventricle filling pressures were low and vascular resistances were high. It is inferred that most patients were in an adaptive hypocirculatory state comparable to hypothroidism, while the most severely malnourished children showed frank peripheral circulatory failure comparable to hypovolemic shock. Circulatory failure on admission was associated with high death rate during treatment but the relation between cause and effect could not be clearly demonstrated.
Intravascular volmes were sequentially determined in 13 African children recovering from protein-calorie malnutrition. The red cell volume was measured by a radiochromium technique; the total blood volume and the plasma volume were calculated. The absolute volumes were related to body size and were compared with the control values. Before treatment, the total blood volume was low per unit of body size, the red cell volume was more reduced than the plasma volume. On the 20th realimentation day, the absolute red cell volume had increased less than the absolute plasma volume, the total blood volume was almost normal per unti of body size. On the 60th realimentation day, near recovery, the absolute red cell volume had again increased, but again less than the absolute plasma volume, and the venous hematocrit was lower than on admission; the total blood volume was normalized per unit of body size, the red cell volume was low with a supranormal plasma volume. The rehabilitation period was characterized by an aggravation of the hemodilution already present before treatment. The significance of the changes in volemia per unit of body size was unclear because of the changing body composition.
Demonstration of the exact visceral situs in ambiguous conditions such as asplenic syndrome may be impossible with routine investigations. In our patient the correct diagnosis was made possible by selective spleen scintigraphy.
The intravascular volumes were determined in 42 protein-calorie-depleted Shi children, and in 14 healthy patients. The red cell volume (RCV) was determined by a radiochromium technique; the total blood volume (TBV), the plasma volume (PV), and the total circulating albumin (TCA) were derived. The values were related to weight without edema, to expected weight for height, and to body surface area. Related values were averaged and were correlated with both the weight deviation and the plasma albumin level. Figures for healthy Shi children were comparable with American normal standards. Malnourished children were hypovolemic relative to their body size measurements; low TBV was the consequence of an absolute decrease in RCV and of a possible reduction of PV; TCA was lowered in the same proportion as albuminemia. RCV and TBV correlated well with albuminemia, but did not correlate with the weight deviation; the relationship between PV and albuminemia was not linear. Despite some quantitative discrepancies, similar results were obtained with each kind of related values. In a discussion of the results, stress is laid on risks of misinterpretation resulting from the use of anthropometric parameters as a basis of reference when studying intravascular volumes in marasmic kwashiorkor.
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106 cases of first attack of acute rheumatic fever were recorded during a decade (ending in 1974) in a Brussels pediatric clinic. 56 patients were Belgian and 50 were children of immigrants. The incidence of acute carditis was 23% among the former, 46% among the latter (P less than or equal to 0.01), and 34% among the whole group. The frequency of residual heart disease after a 3-yr antistreptococcal prophylaxis fell to 20% among the whole group. The difference in morbidity observed between Belgian children and children of immigrants calls for a prospective epidemiological study.
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The surgical experience in 13 infants with total anomalous pulmonary venous connection (TAPVC) between 1987 and 1991 is reviewed. The age vary from 2 days to 35 months with a weight at intervention from 2.130 kg to 5.400 kg. The types of TAPVC were supracardiac in 4 patients, cardiac in 4, and infracardiac in 5. Seven patients (54%) were operated on in emergency. Cardiopulmonary bypass consisted of profound hypothermia and total circulatory arrest in 8 patients (60%) and continuous hypothermic bypass with low flow for the remaining 5 patients (40%). There was no operative death. The follow-up ranges from 21 to 58 months, mean 40 months. There was one reoperation. All the patients were asymptomatic and the height growth percentile is less than 5% in 20%, and the weight growth percentile is less than 5% in 30%. The early repair of infants born with TAPVC can be done with low morbidity with a good prospect on medium term follow-up.