[Effectiveness of chest physiotherapy in ventilated children with acute bronchiolitis]. / Efficacité de la kinésithérapie respiratoire chez des enfants intubés ventilés atteints de bronchiolite aiguë

OBJECTIVES: Despite the lack of clinical studies, chest physiotherapy (CP) is widely used in children with acute bronchiolitis. The main goal of this study was to evaluate its short-term efficacy in children under mechanical ventilation for acute bronchiolitis. METHODS: Twenty children were studied. All were under mechanical ventilation on a pressure-controlled mode. Oxygen saturation, transcutaneous PCO2 and tidal volume were measured before any intervention, after endotracheal suction, after CP and endotracheal suction and 1 h later. RESULTS: Thirty-eight analyses were performed. Baseline tidal volume, oxygen saturation and transcutaneous PCO2 were not modified after endotracheal suction. Immediately and 1 h after CP, SpO2 (98% vs. 94.5%), and tidal volume (66 vs. 55 ml) significantly increased. CONCLUSION: The increase of O2 saturation and tidal volume may be linked to the improvement of bronchial sputum clearance. Further studies are needed to estimate the long-term efficacy of CP in acute bronchiolitis.

[Fungal contamination detection in cornea preservation media]. / Détection de la contamination fongique des liquides de conservation de cornées.

PURPOSE: Fungi can cause major complications following corneal grafting. In this study we aimed to verify the efficiency of a fungal contamination detection protocol for human corneas in preservation before clinical use. MATERIALS AND METHODS: The 12 most frequently found species of fungi responsible for keratitis and endophthalmitis were inoculated to preservation medium used by most French eye banks. A protocol used by several centers, including a daily visual control, was followed in order to check that it showed the presence of all microorganisms, particularly slow-growing filamentous fungi. RESULTS: Every species was detected in a time from 2 to 4 days. CONCLUSION: This microbiological contamination detection protocol of detection for human corneas in organ culture at +31 degrees C, seems to effectively detect the main agents responsible for fungal contamination.

[Neonatal hyperparathyroidism secondary to unknown maternal hypoparathyroidism]. / Hyperparathyroïdie néonatale secondaire à une hypoparathyroïdie maternelle méconnue.

UNLABELLED: Vitamin D or its analogue (calcitriol) is an effective treatment for hypoparathyroidism during pregnancy. Normal babies are delivered and very few cases of associated neonatal hyperparathyroidism are reported. CASE REPORT: We report the case of a baby born to a mother suffering unknown hypoparathyroidism. He was delivered prematurely by cesarean section for birth asphyxia. His mother had had recurrent bouts of impetigo herpetiformis for several months. Severe demineralization associated with decreased plasma calcium level were observed at birth. The PTH level was very high (955 ng/mL) in the baby and very low in the mother, leading to the diagnosis. The baby was given intravenous calcium gluconate, oral 1 alpha-hydroxyvitamin D and mechanical ventilation. Normal plasma calcium level was reached on day 2. PTH level improved by one month of age. Because of impaired respiratory mechanics and bronchopulmonary dysplasia, the baby was kept on ventilation for 58 days. By 20 months of age, he was in good health despite a small height for his age. CONCLUSION: In such cases 1 alpha-hydroxyvitamin D seems to be very effective but plasma and urinary calcium levels need careful monitoring.

Plasmid-mediated resistance to antimicrobial agents among listeriae.

The resistance to 14 antiseptic-disinfectant and dye compounds of 208 strains of Listeria (132 L. monocytogenes, 63 L. innocua, 8 L. seeligeri, 1 L. ivanovii, 1 L. welshimeri, and 3 Listeria spp.) was tested by the agar-dilution procedure. The Listeria strains were isolated from different varieties of foods, environments of cheese dairies, humans, and wild birds. A total of 14 (6.7%) Listeria strains (12 L. monocytogenes and 2 L. innocua) were resistant to benzalkonium chloride, hexamidine diisethionate, and ethidium bromide. This multiple resistance was observed more frequently from strains of Listeria spp. detected on carcasses of poultry (47%) than strains isolated from human listeriosis cases or carriers (11.5%), red meats (10%), cheeses (5.4%), wild birds (0.9%), and environments of cheese dairies (0%). Among resistant strains, 10 groups of strains (71.5%) were differentiated by serogroup, phage typing, and sensitivity or resistance to cadmium. Extrachromosomal DNA was found in all resistant strains and was transferred at a high frequency among Listeria spp. (8.7 x 10(-6) to 1 x 10(-3) transconjugant CFUs per one donor CFU). These resistances were also transferable between L. monocytogenes and Staphylococcus aureus with similar transfer frequencies (7.8 x 10(-6) to 1 x 10(-4) and between strains of Staphylococcus aureus with similar transfer frequencies from 8 x 10(-7) to 3.3 x 10(-6). These results suggest that emergence of this multiple resistance in Listeria spp. could be due to acquisition of a replicon originating in staphylocci.

Prevalence of Listeria sp. in droppings from urban rooks (Corvus frugilegus).

Droppings from 112 urban rooks (Corvus frugilegus) were cultured for the presence of Listeria sp. Overall, 46% of rooks sampled harboured one or more Listeria species. Of all birds examined, 33%, 24% and 8%, respectively, were infected with Listeria monocytogenes, Listeria innocua and Listeria seeligeri. Differentiation of L. monocytogenes and L. seeligeri carried out by several phenotypic typing methods proved the diversity of strains and the major role of rooks which widely contribute to spreading this bacteria in our environment. The results also suggest that the ability to recover specific Listeria strains from the same sample is at least partially dependent on the methodology. These findings reinforce the need for strain-specific typing of multiple L. monocytogenes isolates from the same sample.

[Spontaneous neonatal arterial thrombosis treated with tissue plasminogen activator]. / Thrombose artérielle néonatale spontanée traitée par activateur tissulaire du plasminogène.

BACKGROUND: Spontaneous neonatal arterial thrombosis is a rare entity with serious and potentially fatal complications. A wide spectrum of management has been proposed. CASE REPORT: Ophélie was born after premature delivery at 33 weeks. She was referred soon after birth in the neonatal intensive care unit for respiratory distress syndrome. Spontaneous acute ischemia of the right lower limb was noted soon after admission. Iliac thrombosis was confirmed by ultrasonography and colour coded doppler. Thrombolysis was achieved with systemic infusion of recombinant tissue plasminogen activator (rtPA). Full recovery was obtained within 12 hours of treatment without any complication. No rethrombosis occurred with heparin prophylaxis. No predisposing disorder to thrombosis was found. CONCLUSION: Systemic rtPA is an alternative to thrombectomy and urokinase in critically ill neonates. This treatment should be considered if no major risk of bleeding is found during the pretherapeutic screening.

Optimization of the detection of bacteriophages induced from Listeria sp.

It is necessary to isolate new phages in order to improve the rate of typeability of Listeria monocytogenes strains. We propose a method which increases the detection of induced phages in the presence of inhibitory substances synthesized or liberated by the cells during phage production. Of the 29 phages isolated, 11 (38%) were detected by the spot-on-the-lawn technique and 18 (62%) were revealed by the soft-agar technique. To increase the rate of phage detection, both techniques appear useful. Listeria cultures were subjected to phage typing procedures utilizing these newly isolated phages and the French International set of phages. It appears that the newly isolated phages are good tools for the differentiation of Listeria strains. Among them, one phage seems to be complementary to the French International set.

Flumazenil in the treatment of hepatic encephalopathy in children with fulminant liver failure.

OBJECTIVE: To evaluate the effect of flumazenil on hepatic encephalopathy complicating fulminant liver failure in children. DESIGN: Uncontrolled prospective study. SETTING: Pediatric Intensive Care Unit, tertiary care center. PATIENTS: 9 children with fulminant liver failure and hepatic encephalopathy awaiting emergency liver transplantation. INTERVENTIONS: Changes in hepatic encephalopathy grade and in electroencephalogram were recorded during the injection of a bolus of flumazenil (0.01 mg/kg/i.v. bolus) followed by a continuous infusion of flumazenil (0.01 mg/kg/h). MEASUREMENTS AND MAIN RESULTS: Before flumazenil, 7 children had grade 2 and 2 had grade 3 hepatic encephalopathy. Flumazenile injection mediated an arousal effect in 1 child in whom encephalopathy improved from grade 3 to grade 2. This effect lasted 30 min. No clinical response was observed in other children. An improvement of EEG anomalies was observed lasting 3 min in one child. Despite continuous infusion of flumazenil, encephalopathy worsened in all children. CONCLUSION: The effect of intravenous administration of flumazenil on hepatic encephalopathy in children with fulminant liver failure is inconsistent. Its efficacy is transient. The therapeutic value of flumazenil in children with fulminant liver failure awaiting a liver graft is minimal at this dosage.

Microbial and mycotoxic contamination of peppers and food safety.

Twelve random samples of pepper powders were analyzed for contamination by microorganisms of public health significance (bacteria, moulds) and for aflatoxin B1 concentration. Black peppers were more heavily contaminated than white peppers but the most important bacteria causing foodborne diseases were not isolated; The mould flora was dominated by xerophilic species, particularly Aspergillus fumigatus, A. flavus, A. niger and A. ochraceus. These potentially pathogenic species can be dangerous for predisposed patients. The most striking result concerns aflatoxin B1 which was detected in every sample analyzed and could not always be correlated with the occurrence of a mycotoxinogenic strain of Aspergillus, suggesting the use of a sterilizing treatment previously. So, the detection of aflatoxin B1 must be a necessary criterion to be added to microbial criteria to appreciate the quality of peppers.

Evaluation of two new chromogenic media for detection of Salmonella in stools.

A clinical collaborative study was conducted to compare two new chromogenic agar media, Rambach agar and the Salmonella Detection and Identification Medium (SMID) (bioMérieux, France), with two conventional media, Salmonella-Shigella agar and Hektoen agar. Thirty-nine Salmonella strains involving 14 serotypes were isolated from 1,454 stool specimens. After enrichment in a selective broth, 100% sensitivity was obtained with each medium. The SMID and Rambach agars are considerably more specific than the conventional media. Although SMID agar detects all Salmonella serotypes, it is not as specific as Rambach agar, which requires a complementary test (C8 esterase test) to detect all serotypes.

Ultrasound diagnosis of thymic hemorrhage in an infant with late-onset hemorrhagic disease.

Thymic hemorrhage related to coagulopathy by vitamin K deficiency is a rare condition. We report a case in a 4-week-old boy presenting with acute onset of respiratory distress and anemia. Ultrasound examination of a compressive anterior mediastinal mass established the diagnosis of thymic hemorrhage and allowed us to follow resolution under medical treatment.

[Pre- and postoperative intensive care after liver transplantations]. / Réanimation pré- et postopératoire au décours des transplantations hépatiques.

Physiological and metabolic disorders must be identified and treated prior to liver transplantation (if necessary plasmaphaeresis, hemofiltration in the case of severe hepatic failure). Postoperatively, the goal is to restore and maintain metabolic functions, to prevent any organ failure and to detect early complications. Primary liver dysfunction must be recognized as soon as possible in order to decide upon retransplantation. Hepatic artery thrombosis must be detected by doppler ultrasonography and managed surgically. Acute liver rejection must be identified and treated. Nosocomial infection should be avoided and specifically treated. The success of liver transplantation depends on the indications, patient selection, and the close cooperation between the members of the transplantation team.

[Intra-osseous route. Administration route of drugs in cardiac arrest]. / La voie intra-osseuse. Voie d'administration des médicaments au cours de l'arrêt cardiaque.

We describe the case of a 6 month-old infant suffering from cardiac arrest and successfully resuscitated after epinephrine had been administered through the intraosseous route. During emergency care, vascular access is critical but may be very difficult in young children. Therefore intraosseous infusion appears to be a very efficient alternative for quick administration of drugs and fluids when vascular access is not easily obtained.

Penicillin-binding proteins and carboxypeptidase/transpeptidase activities in Proteus vulgaris P18 and its penicillin-induced stable L-forms.

The originally penicillin-induced, wall-less stable L-forms of Proteus vulgaris P18, isolated by Tulasne in 1949 and since then cultured in he absence of penicillin, have kept the ability to synthesize the seven penicillin-binding proteins and the various DD- and LD-peptidase activities found in the parental bacteria and known to be involved in wall peptidoglycan metabolism. The stable L-forms, however, secrete during growth both the highly penicillin-sensitive, DD-carboxy-peptidase-transpeptidase penicillin-binding protein PBP4 (which in normal bacteria is relatively loosely bound to the plasma membrane) and the penicillin-insensitive LD-carboxypeptidase (which in normal bacteria is located in the periplasmic region).

[The importance of Lancefield Group B streptococci (S. agalactiae) in gynaecology and obstetrics (author's transl)]. / Importance de streptocoque du groupe B de Lancefield (S. agalactiae) en gynécologie-obstétrique.

A bacteriological study of 10,962 vaginal swabs has made it possible to work out the percentage of women who are carriers of Group B streptococci in their vaginas. The count varies between 9.43 and 17.25 per cent according to the different populations that were studied. Serotyping of the strains of 1,030 vaginal specimens was carried out and it was found that serotypes II and III predominated. We have been able to study 27 strains responsible for infection in the early neonatal period such as septicaemia or meningitis at the same time as we were studying the vaginal flora. The distribution of the serotypes illustrates a predominance of types 1c and III in 70 per cent of cases. Contamination between the mother and the child is obvious but in 95 per cent of cases the strain isolated in the infected child was of the same serotype as that which was isolated in the mother. Group B streptococci are still very sensitive to antibiotics and particularly to the penicillins. It does seem to us to be unrealistic to treat with antibiotics prophylactically in pregnancy. On the other hand careful attention to the newborn and careful bacteriological study of multiple specimens taken from the skin and the orifices gives easy screening for the germ and the possibility of treating infants that are grossly contaminated.

Ultrastructure of pheromone-producing eversible vesicles in males of Chrysopa perla L. (Insecta, Neuroptera).

During courtship, males of Chrysopa perla extrude from the genital aperture two eversible vesicles that bear approximately 50 sclerotized tubercles with a long, apical hair. Ultrastructural study reveals within each tubercle two juxtaposed subunits: a sensory subunit formed by a mechanoreceptor neuron, a glial cell, two enveloping cells, and a glandular subunit consisting of a glandular cell provided with an extracellular reservoir, a duct cell and an enveloping cell. The glandular-cell cytoplasm is characterized by extensive RER, a large amount of SER, probably involved in lipid elaboration, and voluminous myeloid bodies encircling the reservoir. The secretion is released to the outside by a cuticular duct that opens into the side of the tubercle. The function of the mechanoreceptor associated with the glandular subunit is discussed.

[Group B streptococci: serotyping data and susceptibility to antibiotics (author's transl)]. / Le streptocoque due groupe B: sérotypie et sensibilité aux antibiotiques.

A study of the prevalence of group B streptococci in women (covering 6,000 samples) shows the vaginal presence to be comprised between 6.34 and 16.8%. The highest rate is found in a Centre for venereal diseases. The use of selective media results in a 50 to 75% increase in the number of germ-carries. The distribution found after serotyping of 1,469 strains has been studied. Over half of the strains isolated from the vagina and from infants belong to serotype II and III, one third of the strains causing serious infections are of type III; however, there is a wide dispersion of the serotypes found in neonatal infections. The test for pigmentation on Columbia medium offers an excellent approach for the diagnosis of group B streptococci. MIC testing of 7 antibiotics for 782 strains of various serotypes demonstrates high susceptibility to the beta-lactam antibiotics and makes it possible to detect rare strains with features of polyresistance to chloramphenicol and some macrolide antibiotics.

[Polyradiculoneuritis in visceral cancer. Review of the literature. Apropos of 2 cases]. / Les polyradiculonévrites au cours des cancers viscéraux. Revue de la littérature. A propos de 2 cas

One should distinguish two types of polyradiculoneuritis during visceral carcinoma. Metastic polyneuritis and paraneoplastic polyneuritis. They fulfil distinct anatomical criteria and their pathogenesis is different. Both, however, have clinical analogies and a similar course. The survival time in both types is usually a few weeks. It rarely exceeds one year.