[Fitting hearing aids in early childhood based on auditory evoked potentials in steady states]. / La adaptación audioprotésica pediátrica precoz a partir de registros de potenciales evocados auditivos de estado estable.

The purpose of the Newborn Hearing Screening Program is to achieve early. Identification and appropriate intervention for hearing loss. Hearing aids are the most frequent intervention for deafness. Paediatric specific clinical protocols for fitting hearing aids always recommend accurate characterisation of hearing thresholds in newborns. In this sense, electrophysiological procedures are specially indicated in determined hearing sensibility from the first age of life since it is an objective and reliable procedure. 20 normal hearing subject and 17 hearing loss subjects participated in this study. Auditory Steady State Responses (ASSR) were obtained from all of them. Hearing aid fitting was established from the electrophysiological responses. Dynamic range, gain, compression ratio and maximum output of the hearing aid were obtained from the intensity amplitude function of the ASSR. The procedure discussed in this study is specially indicated in newborns and very young children in which other test are not suitable.

Demonstration of T lymphocytes in leprous granuloma using the acid alpha naphtyl acetate esterase activity. An attempt at quantitative analysis.

In nine leprosy patients (1 TT, 1 BT, 4 BL and 3 LLp), esterase positive lymphocytes (T Lymphocytes) were studied in frozen sections of skin biopsies by alpha naphtyl acetate esterase pH 5.8 method (ANAE) Four patients had never been treated previously and five patients exhibited clinical and bacteriological evidence of relapse for inadequate therapy at first biopsy. There was an increase in ANAE (+) lymphocyte density in granulomas when second biopsies were done after efficient treatment, evaluated by bacillary index for the eight bacilliferous patients, and clinical improvement. The significance of T cells in granulomas is discussed.

[Pulmonary infections caused by Pneumocystis carinii]. / Les infections pulmonaires à Pneumocystis carinii.

The following topics are discussed: 1. Pneumocystis carnii: appearance, antigenic structure, pathogenicity...; 2. Human pneumocytosis: clinical, diagnostic, prognostic and therapeutic aspects; 3. Pneumocystis carnii and the pneumocystoses: coexistence, theoretical and practical consequences, difficulties in interpretation of bronchiolo-alveolar lavage.

[Pneumocystis carinii pneumonia in chronically immunosuppressed patients. Apropos of 33 cases]. / Pneumonie à Pneumocystis carinii dans les maladies chroniques immunodéprimantes. A propos de 33 observations.

The availability of drugs that are active against Pneumocystis carinii has renewed interest in and underlined the difficulties of the early diagnosis pneumocystis pneumonia. A retrospective study of 33 cases was undertaken to define the optimal management. It is necessary to take into consideration the high mortality of the untreated condition and the risks of investigation and of treatment. Pneumocystis pneumonia affects only those patients who are immunologicaly incompetent, particularly those with defects of cellular immunity. Early symptoms are common but they are insidious. Indirect immunofluorescent tests were positive in 75% of our cases and were useful as screening tests. However it is necessary to identify the parasite (in our cases it was detected in 29 patients) and this requires invasive techniques such as lung puncture, lung biopsy or bronchial brushing. The best method for the rapid diagnosis of pneumocystis is endobronchial brushing, because it is simple, effect and has few complications.

Susceptibility of mice to bacterial infections after chronic exposure to cadmium.

Susceptibility to bacterial infections after chronic exposure to cadmium was studied in mice. Cadmium chloride was injected intraperitoneally three times a week for 4 weeks. After this treatment, mice displayed splenomegalia, hyperplasia of the B-dependent areas of spleen. Virulence of bacteria considered as usually having extracellular sites of multiplication (Klebsiella pneumoniae, Pseudomonas aeruginosa), or intracellular (Listeria monocytogenes), was determined. Only L. monocytogenes showed an increased virulence in cadmium-treated mice.

Factors of increase in serum triglyceride-rich lipoproteins in uremic rats.

The possible mechanisms of the increase in serum triglycerides (TG) and TG-rich lipoproteins were studied in chronically uremic (U) rats by comparison with either ad-lib fed control (C) rats or diet-restricted (DR), sham-operated pair-fed control rats. A first series of animals was studied in the fed state and a second series after a 16-hr fast. In U animals the concentration of serum TG and TG-rich particles was lower than that of C rats in the fed state but significantly higher than that of C and DR rats after a 16-hr fast. Serum glucose and lactate concentrations in the fed or fasted state were unchanged by uremia. Serum insulin concentration was significantly decreased in U rats as compared to C and DR rats in both series. The fast did not increase the concentration of serum nonesterified fatty acids (NEFA) in U or DR animals to the same extent as in C rats, whereas the serum concentration of beta-hydroxybutyrate (BOB), which was higher than that of C rats in the fed state, was significantly lower after a 16-hr fast. In U animals, as compared to control rats of either series, a significant decrease of epididymal lipoprotein lipase (LPL) activity was observed during both nutritional states when expressing the enzymic activity per number of cells. In conclusion, our data provide evidence against hepatic over-production of TG-rich lipoproteins in rats with chronic renal failure and strongly point to an LPL-mediated defect of their peripheral catabolism, probably related to the insulin deficiency state.

Diagnosis of pneumocystis carinii pneumonia using an endobronchial brushing technique. A report on twenty-one cases in immunocompromised children.

By examining the endobronchial brushings from 65 infants and children with interstitial pneumonia--characterized by a severe hypoxia and diffuse lung infiltrates--we have detected the cysts of pneumocystis carinii in 17 of 21 subsequently confirmed cases. The rapid diagnosis and subsequent specific treatment have allowed the recovery of 18 of these children. The particular significance of this article is the youth of the patients, whose ages ranged from 4 months to 15 years.

[Results of a protocol for etiologic diagnosis of pneumopathies on immunosuppressed children (author's transl)]. / Résultats d'un protocole d'enquête étiologique des pneumopathies chez les enfants immunodéprimés.

A protocol for etiologic diagnosis has been used on 40 immuno suppressed children with pulmonary infiltrate. The purpose of this protocol is to permit an early etiologic diagnosis, concomitant infections by several pathogen agents being frequently seen. An endobronchial brushing is first performed; the results being obtained between 24 to 48 hours. If the results are negative and the patient's condition worsens we propose an open lung biopsy. Thus pathogenic agent has been established in 24 cases, in 17 cases by endobronchial brushing, in 3 cases by open lung biopsy and in 2 cases by endobronchial brushing and open lung biopsy. In 3 cases several opportunistic organisms were responsible of the pneumopathy. Pneumocystis carinii is the most often established (19 cases); it was also present in one out of 6 post mortem examinations. In 14 cases the pneumopathy occured in children treated for acute leukemia; Pneumocystis was the organism responsible in 6 of them; the evolution was favorable in 13 of the 14 cases. One patient died from a pulmonary infection by the measles virus.

[Results of bronchial scrapings in interstitial pulmonary diseases in immunodeficient children (author's transl)]. / Résultats du brossage bronchique dans les atteintes pulmonaires interstitielles chez l'enfant immunodéprimé.

Endobronchial scraping was used in 53 immunodeficient children, aged 4 months to 15 years, and divided into three categories (37 receiving immunosuppression treatment, 8 with marasmus, and 8 with immunodeficiency), in order to determine the etiology of their interstitial pneumopathy. The examination was made under blind conditions in 21 cases using an intubation tube (under assisted ventilation), and with bronchoscopy under general anesthesia in the other 32 cases. Three scrapings were required for cytological, bacteriological, and virological and mycological examinations. In 32 cases (60%), the etiology of the interstitial pneumopathy was discovered; in 18 patients it was due to pneumocystis carinii, in 10 cases to bacterial infection, in 7 cases a viral infection, and in 3 others a fungal infection. An association of infective agents was reported in 6 cases. The major incident observed was a pneumothorax in 17% of the cases, more especially in 45% of the children under 20 months of age. Bronchial scraping is a valid examination the results and complications of which compare well with other non-vascular methods of diagnostic evaluation of such lesions.

[Diagnosis of Pneumocystis carinii pneumonia by indirect immunofluorescence. Technic, value of limitations of the method]. / Le diagnostic de la pneumonie à Pneumocystis carinii par l'immunofluorescence indirecte. Technique, intérêt et limites de la méthode

The diagnosis of Pneumocystis Pneumonia can be established by indirect immunofluorescence test performed on the sera of the patients. This investigation has proved to be valid since it gives 50 p.cent of positive results in 16 confirmed cases. The false negative results can be imputed in some patients, to the extreme severity of the immune deficiency.

[Congenital syphilis, malnutrition and Pneumocystis carinii pneumonia]. / Syphilis congénitale, dénutrition et pneumopathie à Pneumocystis carinii.

A Korean child aged six months with congenital syphilis and malnutrition developed pneumocystis carinii pneumonia. He recovered after treatment with trimethoprin/sulphamethoxazole with assisted ventilation. There was no evidence of immune deficiency. The role of congenital syphilis and malnutrition predisposing the baby to this infection is discussed.

Thyroid fine needle aspiration: the morphological features on ThinPrep slide preparations. Eighty cases with histological control.

This study had several purposes: to define cytomorphological features of thyroid cells that might be modified by alcohol fixation; to optimize May-Grünwald-Giemsa (MGG) staining on ThinPrep(R) (TP; Cytyc Inc., Bexborough, MA, USA) slides and to compare the diagnostic accuracy of slides prepared by a liquid-based method with those obtained by conventional technique. This study included 120 cases of ultrasound-guided fine needle aspiration (FNA) of the thyroid and 55 FNAs performed on surgically resected thyroid specimens. Histological control was available in 80 cases. In the first group of 120 FNAs, a split-sample technique was used for the TP. Three screenings were performed: first, an individual screening of the conventional smears (CS) and of the TP, a second screening to compare cells observed on the TP with the histological control and a third screening to assess the previously defined diagnostic criteria. Twenty-seven TP cases (22%) were considered unsatisfactory for diagnosis compared with 10 in CS (8%). The high rate of unsatisfactory cases with TP is likely to be due to the use of the split-sample technique. The sensitivity was 94% for CS and 81% for TP. The specificity was 67% and 60% for CS and TP, respectively. Two occult papillary carcinomas were missed by both methods. As for the MGG staining, the modified technique used for TP resulted in the same quality as the standard procedure. Conversely, TP did however induce uncommon morphological features. In this study, sensitivity and specificity levels are higher for CS than for TP; the difference may be explained by the fact that the methanol fixative used for TP induces some cytological alterations, especially in oncocytic tumours and lymphocytic thyroïditis.

[Bronchial brushing in severe lung diseases in children]. / Le brossage bronchique dans les pneumopathies graves de l'enfant.

A distal bronchial brushing was performed in 25 children having severe lung diseases. The age of the patients ranged from 7 days to 14 years. Seventeen children were immuno-depressed. Bacteria were isolated five times (2 Staphylococcus aureus, 1 Streptococcus pneumoniae, 1 Serratia marcenscens, 1 Acinetobacter lwoffi), viruses twice (cytomegalovirus, syncytial respiratory virus), Pneumocystis carinii, four times. Cytologic study revealed malignant cells, and cells with intranuclear inclusions, evoking a viral infection. This procedure appears to be harmless in children over 2 years of age. In younger children there is a risk of pneumothorax. the principal indication for distal bronchial brushing is lung disease in immuno-depressed children. It may, however, also be useful in prolonged, treatment-resistant, severe lung diseases.

[Retrospective study of 56 congenital diaphragmatic hernias. Prognostic factors, therapeutic deductions]. / Etude rétrospective de 56 hernies diaphragmatiques à révélation néo-natale. Facteurs pronostiques, déductions thérapeutiques.

Fifty-six neonates were treated for congenital diaphragmatic hernia (48 left and 8 right) in our intensive care unit from 1972 to 1980. Because of the high mortality, we studied the factors which could predict the outcome. Early onset of symptoms (before the 2nd hour of life) and low post-ductal shunt (PAO2/FiO2 less then 15) after the 3rd postoperative hour appear to be signs of poor prognosis. Our present attitude is early surgical procedure, controlled ventilation with a FiO2 1 with Pancuronium, prevention of pneumothorax and different use of pulmonary arterial vasodilatators.

[Neonatal hernias of the dome of the diaphragm. Why a gloomy prognosis?]. / Les hernies de la coupole diaphragmatique néo-natales. Pourquoi un pronostic si sombre?

The prognosis is neonatal hernias of the dome of the diaphragm remains extremely gloomy. Associated malformations, prematurity or dysmaturity, cannot explain it. The surgeon is now faced with conditions diagnosed in the labour room, which he previously never saw (and which therefore did not figure in his statistics). Those forms in which the lung gas exchange area is reduced are above all those in which there is a syndrome of persistence of foetal circulation. The association of drugs from the alphalytic group (tolazoline) and curarising agents (pancuronium) is often effective without having completely resolved the problem.