Long-term immunosuppressive treatment of a child with Takayasu's arteritis and high IgE immunoglobulins.

A 7-year-old child presented with a severe form of Takayasu's arteritis, with two consecutive episodes involving the right testis and then the left kidney 6 months later. The renal artery obstruction was accompanied by severe hypertension. An aortography showed a complete obstruction of the left renal artery and a narrowing of the right subclavian artery. Plasma renin activity was high. Serum immunoglobulins were within the normal range, except for an increase in IgE (880 mu/l). Despite 4 months', treatment with antihypertensive drugs, prednisone, cyclophosphamide, and anticoagulant, the blood pressure never returned to normal and the left renal function remained completely absent. A nephrectomy was performed which immediately normalized plasma renin activity and blood pressure. The child was subsequently treated with alternate-day prednisone for 3 months, alternating with 3 months of cyclophosphamide or, later, azathioprine. Persantine (dipyridamole) and acetylsalicylic acid were administered continuously. The right radial pulse returned to normal within 2 years. An 8-year follow-up failed to detect any new episode of arteritis. The right kidney showed signs of compensatory hypertrophy. Finally, a recent arteriography demonstrated not only a normal right renal artery blood flow but almost total disappearance of the right subclavian artery obstruction. However, the IgE remained abnormally high (2,023 micrograms/l).

The use of alternative medicine by children.

OBJECTIVE: Alternative medicine (AM) is of growing interest to the general public. Although several studies have been published concerning its use in adults, the use by children is less well known. The purpose of this study is to determine the frequency with which alternative medicine is employed in a pediatric population that also uses conventional medicine. A second goal is to investigate the sociodemographic factors that influence the choice of these forms of therapy. METHODS: Parents of children consulting the general outpatient clinic of a university hospital completed a self-administered questionnaire asking about previous use of AM for themselves or their children. RESULTS: Based on 1911 completed questionnaires, 208 children (11%) previously consulted one or more AM practitioners. Chiropractic, homeopathy, naturopathy, and acupuncture together accounted for 84% of use. Children who used AM differed significantly from those who only used conventional medicine in that they were older than the nonusers, their mothers were better educated, and their parents also tended to use AM. CONCLUSION: The findings indicate that AM is an aspect of child health care that no longer can be ignored. Being aware of these practices will enable physicians to discuss alternative therapies with parents in order to ensure the continuity of essential conventional treatments.

[Influence of follow-up education of mothers about too early introduction of solid food to infants]. / Influence d'une éducation suivie auprès des mères sur l'introduction trop rapide des solides dans l'alimentation du nourrisson.

We developed a program intended to modify maternal attitudes towards feeding in order to delay the introduction of solids to infants until they are 2 months of age. The program was provided by nurses using an individualized, educational approach. To evaluate its efficacy, a randomized trial design was used. The results in the 2 groups were comparable. The educational trial's lack of success when compared to others and the reasons for this are discussed.

Changing pattern of neonatal streptococcal septicemia.

In recent years viridans streptococcus has emerged as a new and significant cause of neonatal septicemia. This article reports our experience over a 6-year period with respect to the prevalence and clinical presentation of viridans streptococcal vis-à-vis Group B streptococcal septicemia in neonates. Viridans streptococcus was the organism most frequently isolated taking into account all positive blood cultures for streptococci in newborns. Although some similarities were observed between the two groups, viridans streptococcal septicemia was associated with a later onset of symptoms and with a lower incidence of respiratory distress and leukopenia. Clinical findings suggest that viridans streptococcus is a less virulent organism than is Group B streptococcus. The viridans streptococcus should be considered a pathogen in the sick neonate.

[A case of malignant hyperthermia occuring in a dental clinic]. / Un cas d'hyperthermie maligne survenu en clinique dentaire.

Malignant hyperthermia, a life-threatening complication of anaesthesia, occurred in a 5 1/2-year-old girl undergoing dental surgery in a dental clinic. During induction, after 20 mg of succinylcholine, the anaesthetist noted a moderate rigidity of the mandible that did not interfere with the tracheal intubation. However, after 45 minutes, the temperature rose to 38.8 degrees C, pulse was rapid at 160 per minute and the child was slightly cyanosed. The diagnosis of malignant hyperthermia was made (the temperature eventually reached 40.8 degrees C). The child was immediately treated with refrigeration, procainamide and sodium bicarbonate. She was then moved to a hospital centre where the treatment was continued and she recovered completely. After extensive investigation, we found that the paternal grandfather of the child died at age 58, several hours after a bilateral lumbar sympathectomy under general anaesthesia. The cause of the death, as confirmed by hospital records, was malignant hyperthermia. No genetic counselling was given at that time; this omission has since been corrected. Early diagnosis and the availability on the premises of the necessary drugs and equipment to treat such a complication probably saved this child's life. In 1975, "La Corporation Professionnelle des Médecins du Québec" published standards for practice of anaesthesia outside a hospital setting. The compliance of the dental clinic with such standards has contributed to the avoidance of a catastrophe.