[Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department]. / Traitement aux urgences des crises d'asthme par nébulisations vs chambres d'inhalation.

OBJECTIVE: To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. METHODS: In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 microg/kg or terbutaline 125 microg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. RESULTS: Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P<0.02). The overall length of stay in the emergency department was significantly shorter (148+/-20 vs 108+/-13 min, P<10(-9)). CONCLUSIONS: The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.

[Central nervous system tumor: an unusual etiology for limb pain]. / Tumeur cérébrale: une cause inhabituelle de douleurs des membres inférieurs.

Limb pain in children is one of the most frequent reasons to refer to the emergency unit. Most often it suggests an orthopaedic, a muscular, a peripheral neurologic or a spinal affection. We report two cases of recurrent limb pains revealing a central nervous system tumor.

[Effect of racecadotril in the management of acute diarrhea in infants and children]. / Effet du racécadotril sur le recours aux soins dans le traitement des diarrhées aiguës du nourrisson et de l'enfant.

BACKGROUND: The treatment of diarrhoea relies on the maintenance or restoration of hydration with maintenance of an adequate nutritional intake. Racecadotril has been shown to reduce the stools output during acute diarrhoea. The present work was aimed at measuring the number of emergency department visits for acute diarrhoea either the children received racecadotril or not. METHOD: Racecadotril and rehydration were compared with rehydration alone in children aged three months to three years who had acute diarrhoea and were evaluated in the emergency department (ED). The primary end point was the number of medical exams during the week after starting treatment. Secondary end points were the number of stools during the first 48 hours, the duration of the diarrhoea and the weight on day 7. RESULTS: One hundred and sixty-six children were alternatively randomized to the treated and the control groups. There was no difference for age, degree of dehydration and length of illness before the first visit between the groups. Whatever type of rehydration (oral or i.v.), the treated group had a significant lower number of stools (p < 0.001) and a faster recovery (p < 10(-9)). The children receiving racecadotril needed less additional ED visits for the same episode (p < 0.05). There was no difference for the weight-gain on day 7. CONCLUSIONS: This study demonstrates the efficacy of racecadotril as adjuvant therapy to oral and i.v. rehydration in the treatment of acute diarrhoea and a fewer emergency department second visit before recovery.

[Benefits of ipratropium bromide in the management of asthmatic crises in the emergency department]. / Apport du bromure d'ipratropium dans la prise en charge des crises d'asthme aux urgences.

BACKGROUND: To determine if the addition of ipratropium bromide in the emergency department (ED) for the treatment of childhood asthma reduces rates of hospitalization and relapses for moderate and severe exacerbations. METHODS: Patients were given an oral corticosteroid treatment (2 mg/kg) and received every 20 minutes either three nebulizations with albuterol (0.15 mg/kg) and ipratropium bromide (250 micrograms) or six nebulizations with albuterol alone (control group). The primary end point was the need for hospitalization, additional nebulizations or a relapse during the following week. Secondary end point included the effect of age. RESULTS: One hundred and forty three children, two to 15 years old, were randomized to ipratropium or control groups and 121 were evaluated on day seven. As a whole, the control group was less often hospitalized or in relapse than those treated with three nebulizations of albuterol and ipratropium (17.5% vs 37.9%, p < 0.02). The ipratropium group reached the same result after three additional albuterol nebulizations. The benefit of anticholinergic therapy was observed for children less than six years of age who had a similar rate of success (73.5 vs 75.7%). CONCLUSION: The association of ipratropium bromide to the first three doses of the albuterol protocol for acute asthma did not act as well as six nebulizations of albuterol alone. The effect was age dependent and two to six years old children needed more attention. Nevertheless the hospitalization rate did not support the use of ipratropium compared with repeated albuterol nebulizations.

[Assessing the cost of the first episode of bronchiolitis]. / Evaluation du coût du premier épisode de bronchiolite.

BACKGROUND: Each year, a quarter of the children younger than 24 months has respiratory syncytial virus bronchiolitis. The morbidity among high-risk infants and the possible association with the development of asthma lead to propose preventive measures whose cost-effectiveness relationship is unknown. The present work was aimed at measuring costs of a first attack of bronchiolitis. METHOD: For children less than two years visited in the emergency department, direct and indirect costs were measured according to the 'Sécurité Sociale' prices. Associated morbidity, the management of care (inpatient versus outpatient), outpatients' outcome two weeks after the visit, socioeconomic data were recorded. RESULTS: One hundred eighty three children have been studied. The length of stay for 40 hospitalizations was 7.6 +/- 4.3 days. Direct costs were 37,200 +/- 22,000 FF for inpatients, and 1286 +/- 633 F for outpatients. For 113 outpatients' families, indirect costs were 49 working days lost. The way the child was looked after and the unemployment rate in the study were similar to data provided by the National Institute of Statistics and Economic Studies. CONCLUSION: Because of the variability of the hospitalization rate from one setting to another, overall costs of the epidemic cannot be evaluated. For the policymaker, the greatest costs come from the outpatient care. Others studies will be necessary to evaluate the price of future preventive measures.

Acute megakaryocytic leukemia (AMKL) with major myelofibrosis in an infant. Diagnosis by liver biopsy and response to treatment.

An infant presented with enlarged liver and spleen and profound pancytopenia. Severe marrow fibrosis impeded the diagnosis which was achieved by liver biopsy: Fibrosis surrounded foci of blasts which were shown by immunologic markers to originate from the megakaryocytic lineage. Complete sustained remission was obtained by low-dose aracytine therapy. The child was disease-free at 40 months' follow up.

[Transverse leukonychia and anti-leukemia chemotherapy]. / Leuconychies transversales et chimiothérapie antileucémique.

We describe the development of transversal white bands on all the nails in a three-year-old receiving chemotherapy for leukemia. The various nail changes reported during anti-cancer chemotherapy are reviewed.

[Portal system obstruction of delayed onset following neonatal Staphylococcus aureus infection]. / Obstruction du système porte d'apparition retardée après infection néonatale à Staphylococcus aureus.

Two neonates underwent staphylococcal septicemia with multiple intrahepatic abscesses, following umbilical catheterization in one case and due to superinfected heel puncture in the other case. At the first examination, liver ultrasonography showed multiple hypoechogenic areas and assessed patency of the portal vein flow. In spite of clinical, biological and sonographic recovery within the following weeks, portal hypertension due to seemingly late portal vein thrombosis occurred. These clinical reports indicate the need for a protracted echosonographic supervision of neonatal intrahepatic abscesses and portal vein patency before asserting complete recovery.

[Streptococcus group B tardive meningitis revealing chronic septic granulomatosis]. / Méningite tardive à streptocoque du groupe B révélatrice d'une granulomatose septique chronique.

A first-born boy operated on D20 for an abscess of the anal margin (E. Coli, Klebsiella) developed purulent meningitis due to a group B serotype III streptococcus on D35. The outcome was rapidly fatal. Results of immunologic investigations done on the day before death were suggestive of chronic granulomatous disease (CGD) as complete absence of reduction of nitroblue tetrazolium (NBT) was evidenced. Studies of polymorphonuclear cells from the mother showed normal production of oxygen, chemiluminescence and NBT reduction. During the subsequent pregnancy, fetal blood was sampled 19 weeks after the last menstrual period; results showed the fetus was male and the polymorphonuclear cells were incapable of reducing NBT and exhibited decreased chemiluminescence and oxygen production. The pregnancy was terminated. This case shows that delayed group B streptococcus infection can occur as the first manifestation of CGD, although this condition is usually responsible for infections due to staphylococci, enterobacteriaceae and yeasts.

[Acquired polydipsia in infants]. / Polydipsie d'entraînement chez un nourrisson.

The authors report a case of acquired polydipsia in an infant. The case was unusual in its presentation, its late onset (without anorexia, nor vomiting), and the normal salt-water balance contrarily to what is observed in water intoxication. The course was favourable after progressive conditioning.

[Neonatal myocardial infarct associated with maternal-fetal infection due to Coxsackie B4 virus]. / Infarctus du myocarde néonatal associé à une infection materno-foetale à virus Coxsackie B4.

Heart failure with myocardial infarction occurred in the course of a neonatal infection with aseptic meningitis. Coxsackie B4 infection was found in the child and its mother. The unusual myocardial action of the virus, coronary embolus, intermediate role of a pancreatitis. By age 8 months, under digitalis glycosides treatment, growth and psychomotor development were normal.