Urinary tract infections in hospital pediatrics: many previous antibiotherapy and antibiotics resistance, including fluoroquinolones.

OBJECTIVE: We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population. METHODS: We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record. RESULTS: One hundred and ten patients (73 girls), 11 days to 12 years of age, were included in 10 months. Ninety-six percent presented with pyelonephritis, associated to uropathy for 25%. Escherichia coli was predominant (78%), followed by Proteus spp. and Enterococcus spp. The antibiotic resistance rate of E. coli was high and close to that reported for adults with complicated UTIs: amoxicillin 60%, amoxicillin-clavulanate 35%, cefotaxim 5%, trimethoprim-sulfametoxazole 26%, nalidixic acid 9%, ciprofloxacin 7%, gentamycin 1%, nitrofurantoin and fosfomycin 0%. The antibiotic exposure in the previous 12 months involved 62 children (56%) most frequently with ß-lactams (89%) for a respiratory tract infection (56%). A clear relationship between exposure and resistance was observed for amoxicillin (71% vs. 46%), first generation (65% vs. 46%) and third generation (9% vs. 3%) cephalosporins, or trimethoprim-sulfamethoxazole (36% vs. 15%). However, antibiotic exposure could not account alone for the results, as suggested by the 7% of ciprofloxacin resistance, observed without any identified previous treatment. CONCLUSION: Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved (previous antibiotic therapies and fecal-oral or mother-to-child transmission).

[Benefit of seasonal use of a rapid diagnosis of influenza virus in a paediatric emergency unit]. / Bénéfice de l'utilisation saisonnière d'un test de diagnostic rapide (TDR) de la grippe aux urgences pédiatriques.

Influenza virus infections are current in viral infections of childhood. The quick test is now available and we want to assess its clinical and economical benefit through an unicentric study and during two seasons of influenza pandemic. An hospitalization avoided due to a quick test is equivalent to 20 to 30 general practitioner fixes fees. For social security, it is equivalent to 55 to 83 quick tests per child per hospitalization avoid. We plead for free test during influenza pandemic.

[Neurosurgical embryology. Part 8: Post-natal angiogenesis and remodeling]. / Angiogenèse post-natale et remodelage. Un stimulus majeur: les contraintes hémodynamiques.

Post-natal angiogenesis (microvascular proliferation) and remodeling (modifications of diameter and wall thickness) occur in various physiological circumstances including adaptation to exercise or wound healing. The formation of a new vessel is submitted to the combinative action of growth factors. New endothelial cells migrate, proliferate, differentiate and attract pericytes and future smooth muscle cells to create the new vessel. Powerful stimuli leading to remodeling and to the creation of new vessels are mainly represented by hemodynamic forces generated by pressure and blood flow, and by hypoxia. Our purpose is to overview the molecular mechanisms and the stimuli giving rise to these processes.

Adaptive common carotid arteries remodeling after unilateral internal carotid artery occlusion in adult patients.

OBJECTIVE: This study was undertaken in human adults to examine modifications in common carotid internal diameter (ID), intima-media thickness (IMT), cross-sectional area (CSA) and wall shear stress (WSS) occurring both on the ipsilateral side of an internal carotid artery (ICA) occlusion and on the non-occluded contralateral side. METHODS: Seventeen patients with unilateral ICA occlusion had repeated echo-Doppler examinations during 1 year and were compared to 12 volunteers with control non-occluded common carotid arteries (CCA). RESULTS: The cause of ICA occlusion was atherosclerosis in nine patients, dissection in five, and undetermined in three. The results showed a significant reduction in ID on the occluded side (5.15 +/- 0.30 mm) compared with the non-occluded side (5.96 +/- 0.20 mm, P < 0.05) and with control arteries (5.55 +/- 0.10, P < 0.05). A significant reduction in blood flow was observed on the occluded side (404 +/- 58 ml/min) compared with the non-occluded side (703 +/- 51 ml/min, P < 0.0001) and with controls (567 +/- 27 ml/min, P < 0.0001). Wall cross-sectional area was found to be positively correlated to blood flow (r = 0.35, P < 0.01), without any significant difference in mean CSA between both sides. Interestingly, wall shear stress values were identical on both sides whatever the cause of ICA occlusion, and did not differ from those in controls. CONCLUSIONS: Our results suggest that in humans, the internal diameter of the common carotid artery decreases in response to chronic decrease in blood flow, in order to maintain a constant wall shear stress even in pathological arteries.

[Familial Romano-Ward syndrome. Apropos of 2 new observations]. / Syndrome de Romano-Ward familial. A propos de deux nouvelles observations.

BACKGROUND: Congenital long QT syndrome is rare, usually revealed by bouts of syncopal attacks secondary to effort or strong emotions, and more rarely by atypical epileptic crisis. CASE REPORTS: We report a family history of two boys whose mother and grandmother both died suddenly a few days after delivery. The oldest child was 10 years old when admitted to hospital for recurrent loss of consciousness. Neurological examination and biological assays were normal; electrocardiography (ECG) revealed a prolonged QT interval of 0.59 seconds and episodes of torsades de pointe on the 24 hour ECG recording. The inefficacy of beta blocker treatment alone led to the implantation of a pacemaker; no recurrence has occurred since. The family investigation permitted to recognize the same syndrome in his asymptomatic 8-year-old brother for whom a prophylactic treatment was started. CONCLUSION: Both cases remind us of the necessity to carry out systematically an ECG in every child seen for unexplained malaise related or not to stress or for an atypical epileptic crisis. This is the only way for an early diagnosis on which the entire prognosis depends.

Influence of posture on middle cerebral artery mean flow velocity in humans.

We determined middle cerebral artery, common carotid artery and temporal superficial artery Doppler derived flow velocities in ten subjects for 10 min after change in posture. Maximal changes were observed after about 3 min. The 10 degrees head-down tilt position increased blood velocities in the common carotid artery by 13% (SD 4)% (P < 0.001), in the middle cerebral artery by 6% (SD 3)% (P < 0.001) and in the superficial temporal artery by 70% (SD 26)% (P < 0.001). In the standing position, there was an 18% (SD 9)% (P < 0.001) decrease in the common carotid blood velocities, with 14% (SD 6)% (P < 0.001) and 53% (SD 23)% (P < 0.001) reductions in the middle cerebral and superficial temporal artery velocities, respectively. At 9 min after the changes in posture, velocities in the middle cerebral artery were at the value of supine rest, whereas the common carotid blood velocity was not completely restored and deviations in the temporal artery velocity persisted. The data would suggest that cerebral blood flow is regulated with some delay and that such regulation is partially reflected in the common artery blood flow, since changes in a branch of the external carotid artery flow velocity remained.

[QT prolongation and circulatory arrest after an injection of erythromycin in a newborn infant]. / QT long et arrêt circulatoire après une injection d'érythromycine chez un nouveau-né.

A 8 day-old full-term newborn showed severe cardiac disturbances after intravenous injection of erythromycin. The neonate, suspected of having Chlamydia pneumonitis because of tachypnea and rhinitis, had been given 5 injections of erythromycin without clinical effect. Pallor, vomiting and bradycardia developed a few minutes after the 6th injection, and ECG showed ventricular arrhythmia, prolonged QT interval and an atrioventricular block. The infant died in intensive care unit. This case and the analysis of other published cases of cardiac disturbances following the parenteral use of erythromycin, indicate the potential arrhythmogenic risk of this drug. It is suggested that newborns treated with erythromycin should be monitored by ECG.

[Perinatal hemochromatosis]. / Hémochromatose périnatale.

Perinatal hemochromatosis (PHC) is a rare disorder presumably autosomal recessive, responsible for foetal death or severe liver failure during the neonatal period. It is fatal in nearly all cases. Diagnosis relies on histologic examination, generally post mortem, which shows numerous iron deposits in the liver as well as other organs (pancreas, heart, thyroid...). The study of iron and of its ligands may have a diagnostic interest. The authors report 2 cases of PHC in one family, of whom one concerned child presented with biological signs evoking PHC on foetal blood at 31 weeks of pregnancy.

[Bilateral thalamic hemorrhage following severe asphyxia in a 9-month-old infant]. / Hémorragie thalamique bilatérale au décours d'une asphyxie sévère chez un nourrisson de 9 mois.

We report a case of post-asphyxic bilateral thalamic hemorrhage in a 9 month-old infant, consecutive to a hemophilus hypopharyngitis. The neuropathologic study revealed that it was in fact a hemorrhagic necrosis associated to diffuse necrosis of the hemispheres. This case is compared to the other reported cases of thalamic hemorrhage and the physiopathologic mechanism is discussed.

Sonographic hepatic arterialisation in newborns receiving parenteral nutrition.

Two cases of severe liver disease with portal hypertension in the newborn are reported. Such complications occurred after necrotizing enterocolitis requiring total parenteral nutrition and digestive exclusion for a long time. Ultrasonography showed an hepatic arterialisation with portal hypertension.

[Triosephosphate isomerase deficiency. Familial survey and prenatal detection]. / Le déficit en triose phosphate isomérase. Enquête familiale et dépistage anténatal.

Triose phosphate isomerase catalyses dihydroxyacetone phosphate to glyceraldehyde 3 phosphate isomerism. Its deficiency associates hemolytic anemia, neurologic abnormalities, relapsing infections and results in encephalopathy or early death. On the occasion of 2 new cases, we report one of the most important familial surveys as 93 subjects were studied, confirming the autosomal recessive transmission of the deficiency and the first results of antenatal diagnosis which could be performed in one of the families.

Presence of an acid-labile alpha-interferon in sera from fetuses and children with congenital rubella.

In congenital rubella an acid-labile alpha-interferon was present in sera collected from fetuses between weeks 21 and 29 of gestation and from children with active congenital rubella. This interferon was different from the interferon detected in normal amniotic fluid and was not found in sera from uninfected fetuses or from children with postnatally acquired rubella. The fetal interferon is of interest as a complementary marker to confirm the virus contamination of the fetuses during maternal rubella. The role of the prolonged synthesis of this interferon in congenital rubella disease and its immune defects are discussed.

[Status epilepticus in the infant. Semeiologic, etiologic and prognostic aspects]. / Etats de mal convulsifs du nourrisson. Aspects sémiologiques, étiologiques et pronostiques.

During a 4 year period, 79 infants aged from 1 month to 2 years suffered a status epilepticus (SE). The seizures were most often either generalized of tonic-clonic or clonic type, or unilateral clonic; they lasted or were repeated with persistent unconsciousness between the seizures for periods ranging from 30 min to several days. All the cases of SE lasting over 6 h resulted from a recognizable acute brain injury, whereas 11 of 14 cases lasting 1 h or less were cryptogenic. In 2 cases only, the neurological status was worse after the status, apparently as a result of the seizures themselves. The authors discuss the hypothesis of purely febrile HH syndrome and point out the importance of detailed clinical ictal and interictal characteristics for the etiological approach.

[Intracranial hypertension in pneumococcal meningitis. Reality, risks, treatment]. / Hypertension intra-crânienne dans les méningites à pneumocoques. Sa réalité, ses risques, son traitement.

The authors report the results of intracranial pressure measurements in 3 cases with pneumococcal meningitis. Severe intracranial hypertension should be quickly investigated and treated in cases rapidly leading to coma.