[Pediatric medical emergencies: clinical classification on basis of severity of illness, distribution between work days and non-working days]. / Urgences médicales pédiatriques: classification clinique en stades de gravité, répartition entre jours fériés et ouvrables.

OBJECTIVES: Assess one year of activity in a pediatric medical emergency unit of a non-university hospital to detail the degree of gravity of patients admitted to pediatric wards and the distribution of non-programmed activity between and work days and non-work days. METHODS: Prospective classification into 5 degrees of emergency of all admitted children and count of non-programmed medical and surgical activity. RESULTS: A significantly growing number of consultations for minor problems was observed during non-work days. Most hospitalizations were for problems of a rather relative emergency nature. CONCLUSION: The creation of a "day-hospital" would allow evaluation and/or treatment of a large number of pediatric patients without requiring hospitalization. The problem of controlling the flow of consultations to the hospital remains a difficult problem. The many reasons leading to hospital consultation are poorly assessed. It appears indispensable to promote population "education" and development of closer physician's office-hospital collaboration.

[Portal venous gas and necrotizing enterocolitis. Apropos of a case diagnosed by x-ray computed tomography]. / Aéroportie et entérocolite nécrosante. A propos d'un cas diagnostiqué par le scanner.

Hepatic portal vein gas is defined as the presence of gas in the portal system. Its presence is exceptional in adults and indicates severe disease. The prognosis depends on the cause of the pathology and not on the portal vein gas itself. We report the case of a patient with acute abdominal pain associated with vascular and neurological symptoms; abdominal C.T. scan revealed hepatic portal vein gas and supported the diagnosis of necrotizing enterocolitis.

[A new electrocardiographic technic: voluntary, sequential ambulatory recording]. / Etude d'une nouvelle technique électrocardiographique: l'enregistrement ambulatoire séquentiel volontaire.

Voluntary sequential ambulatory electrocardiographic is a new electrocardiographic diagnostic method. The recorder weighs 300 g and measures 156 X 95,5 X 19 mm. The electrodes, which are an integral part of the device, record the cardiac potentials from the hands and chest wall for a programmed interval of 40 or 20 seconds which can be repeated four or eight times. The recordings are in a solid memory and restituted on an electrocardiograph directly using a cable or by telephonic transmission. The bandpass ranges from 50 Hz to 0.05 Hz (analysis of the ST segment). Our experience after several hundreds of recordings shows: - that the recordings obtained are of good quality and perfectly interpretable (even the ST segment) when the patient cooperates satisfactorily; - that the "diagnostic return" is high because the patient only records when he experiences symptoms (the small size of the recorder enables the patient to wear it continuously for periods of several days); - that the need for the patient to play an active role always requires detailed instructions, a condition which sometimes limits the use of this technique (very old or very young patients). These results indicate that voluntary sequential ambulatory electrocardiography is a very promising technique for diagnosing some paroxysmal symptoms (palpitations, episodes of dizziness, chest pain). It does not supplant continuous electrocardiographic recording (Holter method), a more exacting and costly technique, but could significantly reduce its indications.

[Enteral nutrition by tube in burn patients]. / Alimentation entérale par sonde chez le brulé.

The authors report a year's experience off artificial feeding (A.F.) in the Regional Burns Centre of Marseille. 28 patients have benefited from an A.F. of longer than 10 days. It consisted of four cases of parenteral feeding, six cases of enteric feeding and eighteen cases of combined parenteral and enteric feeding. The efficiency of the techniques of A.F. is demonstrated by the results: a weight loss greater than 10% was observed in only three patients. However, the phenomena of digestive intolerance in this type of patient is a significant limiting factor in tubal feeding.

[Anesthesia for primary excision and grafting in the severely burned patient (author's transl)]. / Anesthésie pour excision-greffe primitive du grand brûlé.

Through a retrospective study of 81 anaesthesias for primary excision with immediate grafting (performed within the first 72 hours after burning), the authors, using in most of the cases an anaesthetic procedure including neuroleptanalgesia and nitrous oxyde, with controlled ventilation, tried to determine: --the incidence of such a type of anaesthesia on the patient condition, --the period during which anaesthetic risk is the least. Studies of hemodynamic, respiratory and thermic changes, related with anaesthesia, and a study of coagulation changes, related with surgical procedure, have been performed. It appears that neuroleptanalgesia is a method available for primary excision with immediate grafting and that the elective period for anaesthesia and surgical procedure is situated within 12 hours after burning.

[Postoperative peritoneal irrigation in generalized peritonitis treated in an intensive care unit]. / L'irrigation péritonéale post-opératoire dans les péritonites généralisées traitées en unité de réanimation.

Over a period of four years, 16 patients with generalized peritonitis have been treated by postoperative peritoneal irrigation in an Intensive Care Unit. The majority of cases involved postoperative peritonitis accompanied by severe visceral failure. The irrigation liquid, containing an antibacterial agent, was perfused for between one and eleven days at a high flow rate (mean 16.5 I). The overall mortality in the series was extremely high (75 p. 100), and even greater (85 p. 100) if only the cases of postoperative peritonitis were considered. Anatomical examination of the peritoneum, performed on reintervention or at autopsy, revealed an abnormally high incidence of residual abscesses. These are responsable for the continuation or recurrence of infection, and explain the high mortality. These observations, combined with the frequent occurrence of local or general complications, led the authors to reject peritoneal irrigation in postoperative peritonitis in the presence of severe visceral failure, and to use it, in selected cases, only for periods not exceeding 48 hours.

[Traumatic intoxication by an anticholinesterase agent]. / Intoxication "traumatique" par un anticholinestérasique.

An unusual observation is reported concerning intoxication by an anticholinesterasic. In this case a traumatic blow was caused by an industrial liquid projected under high pressure and resulted in a true parenteral injection. This product, presumed not to be toxic, lead to the delayed appearance of a massive and eventually fatal intoxication. The problemes of prevention, diagnosis and treatment of this type of intoxication are commented on.

[Circulating lipids in prolonged postoperative parenteral feeding: their changes depending on the nature of energy intake]. / Les lipides circulants au cours de l'alimentation parentérale post-opératoire prolongée; leurs modifications selon la nature de l'apport énergétique.

Repeated estimations of circulating total lipids and various fractions were made during the postoperative period in patients receiving parenteral nutrition for more than ten days. The patients were paired in relation to the underlying pathology and divided into two group : the first receiving energy supplements in the form of carbohydrates alone, whilst the second received part of this supply in the form of lipid emulsions (Trive 1000). Total lipids and various plasma fractions, with the exception of free fatty acids, increased progressively during the postoperative period, regardless of the inital values and independently of the lipid content of the nutrition fluids given. There was no significant difference between those patients who received lipid emulsions and those who did not. Free fatty acids remained at levels slightly greater than normal in the group which did not receive lipids. They were significantly higher in the group given lipid emulsions, though it was not possible to precisely define their orgin.

[Blood coagulation during prolonged postoperative parenteral feeding containing lipids]. / Evolution de la coagulation sanguine au cours des alimentations parentérales post-opératoires prolongées comportant des lipides.

Blood coagulation was studied in two groups of fifteen patients of the same type during parenteral nutrition lasting for more then ten days and given during the postoperative period. The first batch of patients, taken as a control group, received parenteral nutrition with carbohydrates and proteins, whilst the second group received lipids in addition. Study of blood coagulation, carried out every three days, involved : thromboelastogen on whole blood and plasma, platelet count, platelet adhesiveness and the estimation of factors II, V, VII and X, fibrinogen, plasminogen and fibrinogen break-down products. In the patients not receiving lipids, the normal alterations seen during the postoperative period occurred : normalisation in plasminogen levels and in F.B.P., and an increase in the number of platelets and in fibrinogen level. The presence of lipids in the nutritional fluids resulted in changes in the same direction, but the increase in platelet count was slighter and fibrinogen level, after a slight increase, returned to initial values on the 20th day of parenteral nutrition. Fibrinogen was the only factor which showed any significant difference between the two groups.

[Criteria for reoperation in abdominal surgery (exclusive of surgical and nephrological criteria)]. / Les critères de réintervention en chirurgie abdominale (en dehors des critères chirurgicaux et néphrologiques)

In summary, 40 p. 100 of 104 reinterventions carried out in 71 patients from the Resuscitation sector were decided upon in the absence of surgical and nephrological criteria. The authors emphasize the value of the infectious syndrome (74 p. 100 of the cases), of water and electrolyte disorders (60 p. 100 of the cases), and of hypercatabolism (83 p. 100 of the cases).