[Information recorded by maternity ward staff in permanent pediatric health records]. / Informations portées dans les carnets de santé en maternité.

OBJECTIVES: To study the frequency with which maternity ward staff complete the perinatal information section of infants' permanent pediatric health records. METHODS: In 2000, 71 pediatricians in private practice and on staff in a general pediatric ward in a tertiary hospital in Paris carried out an observational study to assess which indicators were reported at what rates. Pediatricians were also asked which information about the perinatal admission they would find helpful in these records. RESULTS: One thousand seven hundred and eighty-five pediatric health records were studied. The frequency of completed information varied from 5 to 100%, depending on the item. Of the items reported rarely, some, such as thoracic circumference, were obsolete, while others were very important (response to noise, light reflex). The new information desired by office-based pediatricians involved mainly risk factors for vertical infections (maternal fever during delivery, prolonged rupture of the membranes). CONCLUSION: Although the rate of completion of information in the pediatric health record was globally good, some important data should be reported more often (sensorial screening), while other items could be deleted. New information about the pregnancy and delivery would be useful.

Antivertigo medications and drug-induced vertigo. A pharmacological review.

The approach to drug treatment of vertigo is almost exclusively symptomatic. There are 3 major goals for drug treatment of vertigo. The first one is to eliminate the hallucination of motion. Drugs with vestibular 'suppressant' properties are used for this purpose. The major vestibular suppressants are anticholinergic and antihistamine drugs. The second goal is to reduce the accompanying neurovegetative and psychoaffective signs (nausea, vomiting, anxiety). Antidopaminergics are used for this purpose. The third goal is to enhance the process of 'vestibular compensation' to allow the brain to find a new sensory equilibrium in spite of the vestibular lesion. Until now, the pharmacological manipulation of vestibular compensation has been assessed in animals but not in humans with vestibular lesions. Vestibular suppressant drugs delay rather than enhance compensation. A variety of other drugs is also used in the treatment of vertigo, including benzodiazepines, histaminergic agents, sympathomimetics and calcium antagonists. Their mechanism of action is poorly understood. The data base derived from clinical trials evaluating antivertigo medications is often questionable because of methodological limitations. This explains why habits of prescription are mainly empirical, and why striking differences can be noticed from one country to another. We can hope that new treatments may emerge from the present interest in receptor subclasses and neuromodulators of the vestibular system, and we must be ready to evaluate these potential new pharmacological agents with reliable clinical methods in humans.

[Glucose intolerance and post-stimulatory hypoglycemia secondary to a probably congenital intrahepatic portacaval anastomosis]. / Intolérance au glucose et hypoglycémie post-stimulative secondaires à une anastomose porto-cave intrahépatique vraisemblablement congénitale.

Recurrent malaise in a 63 year old woman were found to be due to hypoglycaemic episodes. During a 5 hour oral glucose tolerance test, the "impaired glucose tolerance" type initial hyperglycaemic wave was followed by a post-stimulative hypoglycaemia. Serum C-peptide levels were normal during the test, but the insulin response which was initially normal became excessive, with a consequent decrease of the C-peptide/insulin ratio, similar to that usually observed in hepatic malfunction. An hepatic ultrasonography, a cavography and a selective superior mesenteric arteriography showed an intra-hepatic porto-caval anastomosis, probably congenital in origin. This vascular abnormality accounts for the blood glucose problems: the porto-caval shunt explains the early hyperglycaemia by defective liver uptake of glucose and secondary hyperinsulinism occurs because of the reduced hepatic degradation of the insulin secreted in normal quantity. The late hyperinsulinism then leads to secondary hypoglycaemia.

[The concept of protein profile]. / Le concept du profil protéique.

From their own experience of the simultaneous immunonephelometry of eight serum proteins, the authors propose a definition of protein profile from the point of view both of laboratory technique and interpretation. The assay should be performed quickly and the results expressed diagrammatically in normalised values, in such a way that the relative variation in protein levels can be easily visualised. A protein profile should thus comprise a minimum of proteins to be measured, chosen according to protein physiopathology and the type of abnormality under investigation. Interpretation is based on inter-protein correlations that may appear or disappear depending on the underlying physiopathology. This makes it possible to study inter-protein variation and thus avoid the probabilistic "interpretation" of single proteins taken in isolation. From this approach syndromes can be divided into two groups, elementary or complex. The authors provide examples of each, and propose an interpretation model based on this dichotomy.

[Neonatal renal papillary necrosis]. / Nécrose papillaire rénale néo-natale.

Renal papillary necrosis was detected early by plasma and urine analyses in a neonate with the respiratory distress syndrome. The intravenous urogram demonstrated characteristic features of the condition. Initial symptoms were polyuria, urinary salt loss and haematuria, but the only residual abnormality was a mild defect in urinary concentrating ability.