[Risk of accumulation of CO2 in the oxygen chamber in "HOOD" (Experimental study on test bed)]. / Risque d'accumulation du CO2 lors de l'oxygénothérapie sous enceinte « HOOD ¼ (Étude expérimentale sur banc d'essai).

OBJECTIVES: Oxygen hood is largely used to deliver O2 to newborn infants with respiratory failure in the northern region of France. The oxygen flow is set to obtain the target arterial blood oxygen saturation. Thus, O2 flow delivers into the hood may be below the recommended gas flow of 6L/min. However, gas flow below 6L/min exposes to CO2 rebreathing. The aim of this study was to evaluate the effect of various rates of gas flows on the values of partial pressure of CO2 into the hood. MATERIAL AND METHODS: We measured CO2 and O2 partial pressure into hoods of two different volumes (4 and 10L) under two experimental bench test conditions. Protocol 1: gas flow was constant at 6L/min, while oxygen fraction varied from 0.21 to 1. Partial pressure of CO2 and O2 were recorded. Protocol 2: while O2 fraction was kept constant, oxygen flow varied from 0.5 to 7L/min (by step of 0.5L/min). Partial pressure of CO2 and O2 were recorded. RESULTS: Partial pressure of CO2 increases proportionally to the decrease in the gas flow delivered into the hood, and reached 14 mmHg at gas flow of 0.5L/min. CONCLUSION: Risk of CO2 rebreathing exists as soon as the gas is delivered into the hood at minimal flow rates below 6L/min.

[Congenital deficiency of fibrin stabilizing factor [factor XIII)]. / Le déficit congénital en facteur stabilisant de la fibrine ou facteur XIII.

The authors report a new case of congenital deficiency of fibrin stabilizing factor. The defect is transmitted as an autosomal recessive trait. The earliest symptom is umbilical bleeding when the cord separates. The diagnosis is confirmed by the rapid dispersion of the clot in urea 5 M or monochloroacetic acid.

[Long-term outcome of congenital diaphragmatic hernia. A study of 17 patients]. / Devenir à long terme des hernies diaphragmatiques congénitales. Etude de 17 patients.

In order to better define the outcome of patients with neonatal congenital diaphragmatic hernia (CDH), 17 patients between 3 and 19 years of age, among 34 survivors from 100 CDH have been re-examined clinically. All had a lung radiography, lung function studies, and radionuclide (Technetium 99m, Xenon 133) lung scans. Three patients suffered from asthma, 2 had recurrent bronchitis, 4 poor tolerance to effort, 3 gastrooesophageal regurgitation leading to endobrachyoesophagus and oesophagitis in one, 3 had scoliosis. Lung scans demonstrated hypoperfusion of the herniated side (less than 40%) in 6 patients. Chest films showed hypovascularisation on the herniated side. Lung function studies, performed in 4 of these 6 patients, showed a restrictive syndrome in 1 patient. Our results confirm those in the literature: perfusion is more altered than ventilation. Chest films at one year of age, completed if necessary by radionuclide lung scans, allow identification of children who have important pulmonary hypoplasia. These children need a regular follow-up: respiratory, digestive and orthopedic complications must be treated in order to preserve the respiratory function in adulthood.

[Delayed appearance of left Bochdalek hernia disclosed by intrathoracic gastric perforation]. / Hernie de Bochdalek gauche révélée tardivement par une perforation gastrique intrathoracique.

Late onset congenital diaphragmatic hernia is a rare condition that is difficult to diagnose. Complications such as intestinal obstruction and digestive perforation may occur. A previously healthy three year-old girl was admitted to hospital with dehydration, shock, and ketoacidosis. A chest X-ray film showed a left hydropneumothorax with an indefinable left diaphragm, that was confirmed by ultrasonography. Hexabrix introduced through a nasogastric tube showed opacification of the left hemithorax attributed to an intrathoracic gastric perforation. She recovered after surgery. Gastrointestinal complications of delayed congenital diaphragmatic hernia must be promptly recognized since surgery should not be delayed.

[Congestive cardiomyopathy after chronic inhalation of trichloroethylene]. / Myocardiopathie congestive après inhalation chronique de trichloréthylène.

A congestive cardiomyopathy (associated with an atrial flutter) was observed in a 14 year-old boy who was a regular trichlorethylene sniffer. Regression occurred after stopping exposition to the toxic chemical. This complication hitherto not reported in children, may be fatal. Its origin would be ischemic because trichlorethylene is known to potentiate the effects of circulating catecholamines. This toxic cardiomyopathy has to be added to the list of congestive cardiomyopathies in children and adolescents.

[Frequency of adrenal hemorrhage in fatal forms of purpura fulminans in children. Etiopathogenic and therapeutic considerations]. / Fréquence des hémorragies surrénaliennes au cours des formes fatales de purpura fulminans de l'enfant. Considérations étio-pathogéniques et thérapeutiques.

Between 1971 and 1985, 43 children died of purpura fulminans in our intensive care unit: 11 had autopsy and adrenal haemorrhage was observed in 8 (73%). All these patients had an extensive purpura and a severe disseminated intravascular coagulation. Our series confirms the findings of previous studies: 69 autopsies showed 51 cases (74%) of macroscopic adrenal haemorrhage. Adrenal haemorrhage may be only one manifestation of multiple system organ failure consecutive to septic shock; however, its association with low plasma cortisol levels (as previously reported) suggests that glucocorticoid replacement therapy should be reconsidered in purpura fulminans.