Subject(s)
Crohn Disease/diagnosis , Lung Diseases/etiology , Adolescent , Enteral Nutrition , Humans , Lung Diseases/diagnostic imaging , Male , RadiographyABSTRACT
INTRODUCTION: Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS: In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS: Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS: This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.
Subject(s)
Bronchoscopes , Bronchoscopy , Bronchoscopes/statistics & numerical data , Bronchoscopy/statistics & numerical data , Child , Equipment Design , France , Humans , Practice Patterns, Physicians' , Retrospective Studies , Surveys and QuestionnairesABSTRACT
A retrospective survey concerning all patients ages 12-19 who had registered themselves at the admitting service of the paediatric emergency unit in the university hospital centre of Amiens was carried out in 1995. 2812 adolescents were received (18% of total admissions). The male/female sex-ratio was 1 to 3. The average age was 13.2 years old. Hospitalisations were more frequent in the spring and were predominantly on Mondays (17%). More than 2/3 of the adolescents were accompanied by their parents and 20% were referred by their doctors or by the SAMU (mobile emergency medical service). Two percent arrive alone. Traumatic pathology is the main reason for admission (1960 patients). Organic pathologies represent 24% of admissions and are essentially digestive pathologies (40%). "Suffering" adolescents (defined as those requiring an intervention with a psychotherapist as a matter of priority) only represent 6% of visits to the emergency unit, of which 2/3 correspond to suicide attempts. 24% of adolescents are hospitalised at the university hospital centre of Amiens within the paediatric services or specialised services (ENT, stomatology, etc.).
Subject(s)
Adolescent Behavior , Emergency Service, Hospital/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Patient Admission/statistics & numerical data , Pediatrics/statistics & numerical data , Academic Medical Centers , Adolescent , Adolescent Behavior/psychology , Age Distribution , Child , Female , France , Health Services Research , Humans , Male , Patient Acceptance of Health Care/psychology , Retrospective Studies , Seasons , Sex Distribution , Time FactorsABSTRACT
In the last decades chlamydial infection of the respiratory tract have been described in children. Chlamydia trachomatis, the most common identifiable cause of neonatal infections conjunctivitis is also a recognised cause of pneumonia in newborns and is responsible for about one third of sexually transmitted disease. Chlamydia psittaci is mainly pathogenic for birds and occasionally for human. More recently Chlamydia pneumoniae has been found associated with pulmonary abnormalities, nasopharynx and pulmonary oropharynx infections. Microbiologic diagnosis can be difficult. Several non culture methods are now available such as the direct fluorescent antibody test and enzyme immuno-assays. X ray chest show a reticulated and (or) nodular pattern. Treatment is mainly macrolide based with erythromycin.
Subject(s)
Chlamydia Infections/diagnosis , Lung Diseases/microbiology , Adolescent , Child , Child, Preschool , Chlamydia Infections/epidemiology , Chlamydia Infections/therapy , Humans , Infant , Infant, NewbornABSTRACT
We present a general method of statistical evaluation for expert systems, applied to a system for the diagnosis of child's meningitis. Fifty difficult clinical cases of child's meningitis were submitted to the system, to seven senior specialists and to seven young physicians. Multidimensional analysis of the diagnosis of the infection category reveals that the two groups of physicians separate naturally and that the system is located among the group of experts. The study of the agreement of the microbiological diagnosis and therapeutic advice shows that the advice of the two groups of physicians is significantly different and that the advice of the system is significantly closer to that of the experts. This result is confirmed by the study of therapeutic errors. This type of study allows one to classify the performance of the system among physicians having different levels of expertise without referring to an objective solution.
Subject(s)
Diagnosis, Computer-Assisted , Expert Systems , Meningitis/diagnosis , Child , Diagnostic Errors , Evaluation Studies as Topic , Humans , Meningitis/drug therapy , Meningitis, Bacterial/diagnosis , Meningitis, Viral/diagnosisABSTRACT
Posterior and upper mediastinal localization of the thymus gland is uncommon in young children. Presenting symptoms and signs are very variable from incidental diagnosis to bronchopneumonial with atelectasias of the left upper Chest X-Ray and CT Scan are sufficient to make the diagnosis. Treatment of complicated forms with bronchial compression requires thoracotomy and surgical excision.
Subject(s)
Mediastinal Diseases/diagnostic imaging , Thymus Gland/abnormalities , Humans , Infant , Lung Diseases/etiology , Male , Mediastinal Diseases/complications , Thoracotomy , Thymus Gland/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Posterior and upper mediastinal localization of the thymus gland is uncommon in young children. Presenting symptoms and signs are very variable from incidental diagnosis to bronchopneumonial with atelectasias of the left upper Chest X-Ray and CT Scan are sufficient to make the diagnosis. Treatment of complicated forms with bronchial compression requires thoracotomy and surgical excision.
Subject(s)
Mediastinal Diseases/diagnostic imaging , Thymus Gland/abnormalities , Bacterial Infections/etiology , Humans , Infant , Male , Mediastinal Diseases/complications , Mediastinal Diseases/surgery , Thoracotomy , Thymus Gland/surgery , Tomography, X-Ray ComputedABSTRACT
We report the case of 3 1/2 year old child presenting a left pleuropericarditic cyst causing febrile cough and an opacity of the left lower lobe of the lung. We underline the importance of computed tomography of the thorax allows differential diagnosis with encysted effusion. Surgical treatment rarely indicated in pleuropericarditic cysts has stopped respiratory symptoms.
Subject(s)
Mediastinal Cyst , Child, Preschool , Diagnosis, Differential , Humans , Male , Mediastinal Cyst/pathology , Pleural Diseases/pathologySubject(s)
Anti-Bacterial Agents/pharmacokinetics , Cystic Fibrosis/metabolism , Amikacin/pharmacokinetics , Cystic Fibrosis/complications , Cystic Fibrosis/drug therapy , Female , Humans , Male , Pneumonia/complications , Pneumonia/drug therapy , Pneumonia/metabolism , Pseudomonas Infections/complications , Pseudomonas Infections/drug therapy , Pseudomonas Infections/metabolism , Tobramycin/pharmacokineticsABSTRACT
We report a case of respiratory arrest in a ten-year-old asthmatic girl under beta-2-agonists and theophylline. The possibility that hypokalemia plays a part in the sudden deaths seen in some asthmatic patients is discussed.
Subject(s)
Adrenergic beta-Agonists/adverse effects , Asthma/complications , Hypokalemia/complications , Respiratory Insufficiency/etiology , Theophylline/adverse effects , Adrenergic beta-Agonists/therapeutic use , Albuterol/adverse effects , Albuterol/therapeutic use , Asthma/drug therapy , Child , Death, Sudden/etiology , Drug Interactions , Female , Humans , Hypokalemia/chemically induced , Theophylline/therapeutic useABSTRACT
We report the case of a 14-year old African girl presenting with late-stage African T. gambiense trypanosomiasis. She was treated with eflornithine, an ornithine decarboxylase inhibitor which is a key enzyme in the biosynthesis of polyamine. Polyamines are essential to the multiplication of trypanosomes. Two treatment courses were necessary to achieve an apparent cure after one year; however, a longer follow up will be required to confirm whether or not the cure is permanent. Determination of drug concentrations in plasma and cerebrospinal fluid was performed during the second treatment course. Side-effects were easily controlled.
Subject(s)
Eflornithine/therapeutic use , Trypanosomiasis, African/drug therapy , Adolescent , Animals , Asthenia/etiology , Eflornithine/blood , Eflornithine/cerebrospinal fluid , Female , Headache/etiology , Humans , Sleep Wake Disorders/etiology , Trypanosoma brucei gambiense , Trypanosomiasis, African/complications , Trypanosomiasis, African/diagnosisSubject(s)
Meningococcal Infections/transmission , Adolescent , Adult , Child, Preschool , Female , France , Humans , Infant , Male , Neisseria meningitidis/isolation & purification , Religion , Saudi Arabia , TravelABSTRACT
Adrenocortical tumors are very rare, especially in their non secretory form. A 15 years old boy was hospitalized for evolutive fever since 6 weeks associated with asthenia and abdominal pain. Infections hematological, neurological and system diseases were eliminated. Abdominal ultrasonography reveal a poly-lobular mass adherent to the spleen and the posterior wall of the stomach. This is confirmed by fibroscopy and barium swallow. Abdominal scanner and scintigraphy did not give any new etiological argument. X Ray thorax is normal. Laparotomy reveals a retro-gastric mass adherent by its superior extremity to the spleen. A complete excision is done. The pathological examination shows all the histologic features of adrenocortical carcinoma. Its extension to the spleen grade this tumour with a height malignancy. No chemotherapy was undertaken, only a clinical, ultrasound and radiography observation with a follow up of 13 months.