Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence.

Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. METHODS: Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naïve asthma and/or respiratory allergy. RESULTS: The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. CONCLUSION: The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.

Congenital dislocation of the hip: optimal screening strategies in 2014.

A prospective multi-centre nationwide study of patients with congenital dislocation of the hip (CDH) diagnosed after 3 months of age was conducted with support from the French Society for Paediatric Orthopaedics (Société Française d'Orthopédie Pédiatrique [SoFOP]), French Organisation for Outpatient Paediatrics (Association Française de Pédiatrie Ambulatoire [AFPA]), and French-Speaking Society for Paediatric and Pre-Natal Imaging (Société Francophone d'Imagerie Pédiatrique et Prénatale [SFIPP]). The results showed inadequacies in clinical screening for CDH that were patent when assessed quantitatively and probably also present qualitatively. These findings indicate a need for a communication and educational campaign aimed at highlighting good clinical practice guidelines in the field of CDH screening. The usefulness of routine ultrasound screening has not been established. The findings from this study have been used by the authors and French National Health Authority (Haute Autorité de Santé [HAS]) to develop recommendations about CDH screening. There is an urgent need for a prospective randomised multi-centre nationwide study, which should involve primary-care physicians.

[Use of muscle free flaps in lower limbs reconstruction in children]. / Utilisation de lambeaux libres dans la reconstruction des membres inférieurs chez l'enfant.

A series of 12 muscle free flaps was performed from 2000 to 2005 in 11 children 3 to 15 years of age (mean: 10.6): seven serratus anterior, four latissimus dorsi and one rectus abdominis. The defects (acute or as a result of sequelae) were always located in lower limbs: seven in feet, three in the lower third of the leg and one in the knee. None of the children was re-operated within 72 hours. Total necrosis due to venous thrombosis occurred at Day 5 in one case. After mean follow-up of 2.5 years (minimum: 1 year), the flaps show good integration. Functional or esthetic sequelae are considered acceptable by the health-care team as well as the children's parents. No repercussions on growth have been observed. Our series confirms the results of previous studies, indicating that free flaps should be part of the therapeutic arsenal in pediatric surgery.

[Late results of the treatment of the slipped upper femoral epiphysis (26 cases with follow-up study over 10 years)]. / Résultats tardifs du traitement de l'épiphysiolyse fémorale supérieure (26 cas avec un recul minimum supérieur à 10 ans).

PURPOSE OF THE STUDY: The treatment of slipped capital femoral epiphysis (SCFE) has been well described by many authors. However, few studies report the results of treatment at very long term. The purpose of this study is to observe late results and to distinguish which factors can influence the development of osteoarthrosis. MATERIAL: Twenty-six patients (30 hips) with SCFE treated between 1945 and 1980 were reviewed with a minimal follow-up of 10 years. The measure of the displacement was done in 3 groups: slipping inferior to 30 degrees, slipping between 30 degrees and 60 degrees and slipping superior to 60 degrees. There were 14 cases in group 1, 12 in group 2 and 4 in group 3. Four cases had bilateral involvement. 24 hips underwent surgical treatment: 10 in situ fixation, 10 orthopedic reduction and screw fixation, 2 cervical osteotomies and 1 Dunn's operation. 5 cases had no treatment or simple traction in bed and 2 cases had reduction and spica cast. METHODS: Clinical evaluation was done with the Merle d'Aubigné hip score and the radiographical revision on anteroposterior and Lauenstein projections. Osteoarthrosis was assessed according to the narrowing of articular space and the flattening of the head. RESULTS: Early complications: 4 cases of chondrolysis appeared 3 times after orthopedic reduction and fixation. Two material effractions and one hyperreduction of the displacement were observed. Radiographic degradation was constant. 2 cases of segmental collapse were also seen, once associated with hyperreduction and once with material fixation. Revision: the average follow-up was 19 years (11 to 46 years). 20 hips (66 per cent) had very good functional results. 18 hips (60 per cent) had radiographic arthrosis. No statistic tests were done because of the small number of cases. However 9 out of 10 in situ fixation and 6 out of 10 reduction and fixation had very good results. When the residual slip was less than 40 degrees (12 cases), osteoarthrosis was never seen. 40 degrees represented the limit between arthrosic and non arthrosic evolution. The mean time of development of arthrosis was 25 years. DISCUSSION: The worst results appeared to happen after reduction and spica cast, cervical osteotomy and traction in bed. Best results after in situ fixation, Dunn's operation and no treatment. Reduction and fixation gave divided results. The osteoarthrosis increased with time. The limit of 40 degrees as factor leading to osteoarthrosis was found to be nearly similar to that of others authors. Discrepancy was superior to 1 cm in 84 per cent of cases, but most of the time neglected or unknown by patients. CONCLUSION: In our series, osteoarthrosic hips are seen in 60 per cent cases. Radiographic degradation was constant after 25 evolution years. The hips with less than 40 degrees slipping after treatment have the best results and no arthrosis. Thus, in situ fixation is recommended for slipping inferior to 40 degrees. If displacement is greater than 40 degrees, Dunn's operation or trial orthopedic reduction to obtain a reduction of slipping is preferred, according to the character (chronic or acute) of the slip.

[Organization of emergency pediatric surgery at the University Hospital in Nantes]. / Organisation des urgences chirurgicales pédiatriques au C.H.U. de Nantes.

A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. The activity of the unit over a 4 month period (from June to September 1992) was retrospectively examined. During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.

Effect of angiotensin II-induced changes in perfusion flow rate on chlorothiazide transport in the isolated perfused rat kidney.

Angiotensin II was used as a probe to study the effect of changes in perfusate flow rate on the renal clearance parameters of chlorothiazide in the isolated perfused rat kidney. Perfusion studies were performed in five rats with no angiotensin II present in the perfusate and in five rats with a 1-4 ng/min infusion of angiotensin II into the perfusate. Angiotensin II had a dramatic effect on the renal hemodynamics, resulting in a 43% decrease in perfusate flow, a 16% decrease in glomerular filtration rate (GFR), and a 45% increase in filtration fraction. Values for the fractional excretion of glucose were low and consistent, with or without angiotensin II. Although the unbound fraction (fu) of chlorothiazide was unchanged between treatments, the renal (CLr) and the secretion clearances were reduced by about 50% in the presence of angiotensin II; the excretion ratio [ER = CLr/(fu.GFR)] was reduced by 38% with angiotensin II present in the perfusate. Analysis of the data was complicated by the presence of a capacity-limited transport for renal tubular secretion. Transport parameters (+/- SD) were obtained and the corrected intrinsic secretory clearance [(Vmax/GFR)/Km] of chlorothiazide was 123 +/- 18 without angiotensin II vs. 72.8 +/- 30.0 with angiotensin II. These results demonstrate that alterations in organ perfusion can significantly reduce the clearance parameters of chlorothiazide in the rat IPK. These flow-induced changes in intrinsic secretory transport may reflect perturbations other than that of perfusion flow rate alone.

[Intraoperative and postoperative analgesia in pediatric surgery. 1 years' experience]. / Analgésie per et postopératoire en chirurgie pédiatrique. Expérience d'un an.

Operative and postoperative analgesia has become in a few years a major concern for pediatric anesthesiologists. The fact that pain can have dramatic metabolic and hemodynamic consequences has been well documented. This study shows the activity in our department in the field of analgesia during 1989. 82% of the 2,675 children having undergone surgery have received analgesia during the operative period either by the way of an i.v. narcotic or an regional block. No morbidity or mortality resulted from these techniques during the operative period. When a regional block was prolonged by the mean of a catheter, there were no major complication (2 seizures). The use of oral, rectal and i.v. analgesics follows the classic recommendations. Morphine by all routes of administration is used increasingly in our department. Two moderate respiratory depressions occurred in 1989 due to error in dosage with no consequence for the child. The authors underline the importance of well established protocols which have been discussed and approved by all, the importance of emergency procedures and treatment, which only can guaranteed the necessary safety.