[Knowledge and experience of 2- to 15-year-old children's parents consulting in pediatric emergency departments for asthma]. / Évaluation des connaissances et du vécu des parents d'enfants asthmatiques âgés de 2 à 15ans consultant en service d'accueil des urgences pédiatriques.

INTRODUCTION: This study aimed at assessing parents' knowledge and perception in relation to their child's condition when arriving at the emergency ward following an asthma attack. The overall objective was to determine how parent education could be improved. MATERIALS AND METHODS: This study was conducted over 9 months as a multicenter descriptive and qualitative study based on a self-administered questionnaire for parents of asthmatic children, aged 2-15 years. RESULTS: The questionnaire was delivered to 88 children out of 1472 (6%). Approximately 69% of the children included in the study presented with partially controlled or uncontrolled asthma. Fifty percent of the patients were insufficiently monitored and without therapy. Half of the parents said they had never received any information concerning their child's condition. The majority (86%) did not know the basic cause of the disease, 30% percent were unable to detect the features of clinical exacerbation, and 17% were not using an adequate emergency protocol. The illness experience was relatively easy for two-thirds of the children and the parents' perceptions were in line in 50% of the cases. DISCUSSION: Knowledge of parents and their children suffering from asthma is insufficient for optimal control and disease management. Instructions on detecting the signs of asthma severity as well as the establishment of an individualized emergency protocol and medical follow-up should be of prime concern and could reduce emergency department use. CONCLUSION: Doctors have a key role to play in educating and explaining disease characteristics to patients and their families. Therapeutic education also needs to be intensified.

[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.

[Subphrenic abscess due to ectopic appendicitis]. / Abcès sous-phrénique révélateur d'une appendicite ectopique.

BACKGROUND: Idiopathic subphrenic abscesses are uncommon in children. Standard chest X-rays may provide the suspicion of this diagnosis. Initial percutaneous drainage of the collection is usually performed. Surgery is required when the underlying cause remains unknown. CASE REPORT: A 12-year-old boy presented signs of pulmonary abscess. Chest X-rays, ultrasonography and computed tomography established the diagnosis of a right subphrenic abscess, which was percutaneously drained. Surgery disclosed an ectopic appendiceal perforation. CONCLUSION: In children, appendicitis is the main etiology of primary or postoperative subphrenic suppurations. Ectopic appendicitis is an important predisposing factor to this complication.

[Recurrent osteitis and Coxiella burnetii: the relation to chronic recurrent multifocal osteomyelitis]. / Ostéites récidivantes et Coxiella burnetti: relation avec l'ostéomyélite chronique récurrente multifocale.

UNLABELLED: Chronic recurrent multifocal osteomyelitis (CRMO) is a disorder of suspected--but unproved-infectious etiology. OBSERVATION: A girl presented with a typical CRMO involving successively the left fibula, radius, humerus and the right carpus. A Coxiella burnetii infection was indicated during the first attack. Two recurrences occurred in spite of suitable antibiotic treatment and with negative infectious investigation. Two months after stopping antibiotic treatment, a new recurrence associated with antibodies increase and positive bone culture occurred. CONCLUSION: Coxiella burnetii can initiate a CRMO. The mechanism involved is probably a delayed hypersensitivity. CRMO would therefore be the first type of reactive osteitis.

[Dwarfism, arterial hypertension and hyperkalemic acidosis corrected with thiazides. A case of type II pseudohypoaldosteronism]. / Nanisme, hypertension artérielle et acidose hyperkaliémique corrigés par les thiazidiques. Un cas de pseudohypoaldostéronisme de type II.

BACKGROUND: Type II pseudohypoaldosteronism is a rare tubulopathy defined by abnormal renal potassium excretion. CASE REPORT: A 12 1/2 year-old girl, was admitted for dwarfism. Her parents were not consanguineous and her 5 living sibs were normal. At admission, she had moderate hypertension: systolic 130-150 mmHg; diastolic 80-100 mmHg and no pubertal development. LABORATORY DATA: pH (arterial): 7.34; bicarbonates: 18-20 mEq/l; chloride: 112-120 mEq/l; potassium: 5.6-7 mEq/l; aldosterone: 200-700 pg/ml (N < 60); plasma renin activity: 0.4 ng/ml/hr (N 2.2 +/- 0.2). The bone maturation was 8 1/2 years. All the other renal function tests were normal. The titratable acidity was 22 mEq/day (N 20-40) and the ammonia excretion 15.2 mEq/l (N 44-61). The fractional excretion of potassium was 6.5% (N 11.8 +/- 1.9). This girl was given polystyrene sulfonate resin followed by hydrochlorothiazide (1 to 3 mg/kg/day). There was a subsequent improvement in all data, a growth spurt and pubertal development. CONCLUSION: This is the fifth case of type II pseudohypoaldosteronism reported in childhood and the first one with hypertension. The beneficial effect of hydrochlorothiazide is underlined.

[Congenital tuberculosis. Apropos of a case disclosed after necrotizing enterocolitis]. / Tuberculose congénitale. A propos d'un cas révélé au décours d'une entérocolite nécrosante.

The authors report on the observation of a premature infant (gestational age 31 weeks, birth weight 1440 g) who experienced a necrotizing enterocolitis and a congenital tuberculosis. Congenital tuberculosis is a rare infection; transmission of Koch's bacilli is achieved through hematogenous route or more frequently through inhalation or ingestion of infected amniotic fluid. The diagnosis was done when miliary patterns were found on the mother's chest X-ray. At the same time, the newborn presented with a chronic lung disease, a poor clinical status with biological signs of inflammation. Usual antibiotics were unsuccessful. A rapid improvement was obtained with a specific antituberculous treatment.

[Study of risk factors for recurrence in severe life-threatening conditions in infants]. / Etude des facteurs de risques de récidives dans les malaises graves du nourrisson.

In a prospective study, 180 infants, mean age 2-6 months, hospitalized for apparent life threatening events between October 1985 and September 1988 (for 7,261 infants admitted into the pediatric unit during the same period), were submitted to the following investigations: careful anamnesis, complete clinical examination, systematic paraclinical investigations (standard biological studies, infectious and metabolic tests, investigations for gastro esophageal reflux (GER) and vagal hyper-reflectivity (VHR), polysomnography) or adapted to the clinical situation (toxic tests, brain computed scan, laryngoscopy, etc). Pathologies were mainly functional with neuro-vegetative immaturity (67.5%): gastro esophageal reflux (49%), vagal hyper-reflectivity (8.5%) or both (10%). An incidental pathological factor (breath holding spell, convulsion, intoxication, infection) was found in 18.5% of the infants, and 14% had normal results. Diphemanil 10 mg/kg/24h corrected the VHR and Metoclopramide 1 mg/kg/24h controlled 52% of the GER. The recurrence rate of illness in the GER and VHR groups was statistically lower with efficient therapy (12% vs 48%); no recurrence occurred in other groups.

[Prevention advice for families]. / Conseils de prévention pour les families.

SIDS is in most cases unforeseeable and unavoidable. However, present progress in knowledge about this syndrome allows practitioners to give preventive advice, for two types of infant: for all neonates--simple advice of infant care and hygiene--for some at risk babies (siblings of SIDS cases, ALTE, premature), advice on tests, or treatment or more specific medical care.

[Apropos of 100 cases of malaise in infants]. / A propos de cent malaises du nourrisson.

Among 4,411 children hospitalized from May 1985 through April 1987, 100 infants (mean age three months) had exhibited an apparently life-threatening event. Management included careful history taking by interviewing parents, a thorough physical evaluation, routine laboratory tests, and cardiorespiratory monitoring. A variety of further investigations were usually performed to look for gastroesophageal reflux (GER), vagal hyperreflectivity, or sleep-related cardiorespiratory disorders. Leading causes, that often occurred in combination, included GER (66 per cent of cases), and vagal hyperreflectivity (13%). Atypical breath-holding spells, ENT causes, and neurological causes were documented in 8%, 6% and 5% of cases respectively. Medical treatment of the GER proved effective in 90% of cases. Metoclopramide (Primperan, 10 drops/kg/d) was effective in 62% of infants with GER and was well tolerated. Diphemanil methylsulfate (Prantal, 10 mg/kg/d) satisfactorily controlled vagal hyperreflectivity. Monitoring was prescribed in 43% of cases.