[Demonstration of immune complexes in blood serum by laser nephelometry in a capillary cell]. / Mise en évidence dans le sérum sanguin des complexes immuns par néphélométrie laser sur colonne capillaire.

By means of an original method of laser nephelometry with a capillary cell, it is possible to detect the immune complexes in human sera. For instance, the detection of antigen and immune complex during the course of the whooping-cough allows a pathological study of the disease.

[Purulent Staphylococcus aureus meningitis]. / Méningites purulentes à Staphylococcus aureus.

Retrospective study of 14 cases of Staphylococcus aureus meningitis and of data from the literature shows that this as yet infrequent disease which carries a high mortality rate (40%) is always related to neurosurgery, primary or iatrogenic septicemia, or local infection, usually in the lumbar area (spinal, abscess, spondylitis). The major clinical problem is the search for the meningeal lead point of Staphylococcus aureus penetration, whose eradication is more essential than in usual bacterial meningitis. Prognosis is mainly dependent upon the eventual existence of associated severe septicemia. Antibiotics active on Peni-M resistant Staphylococcus aureus and meningeal infection are reviewed.

[Comparison of high-frequency jet ventilation and conventional ventilation in the adult respiratory distress syndrome]. / Comparaison de la jet ventilation à haute fréquence et de la ventilation conventionnelle dans le syndrome de détresse respiratoire de l'adulte.

Sixteen adult patients with respiratory distress syndrome requiring mechanical respiratory assistance entered this study, the purpose of which was to obtain the same blood gas values under high frequency jet ventilation as under conventional ventilation. When high frequency jet ventilation without spontaneous breathing was compared to continuous positive pressure ventilation, peak airway pressure was the same, but mean airway pressure, positive end-expiratory pressure and pleural pressure were higher and cardiac index lower. When high frequency jet ventilation with spontaneous breathing was compared to intermittent mandatory ventilation, peak airway pressure was lower, mean airway pressure and positive end-expiratory pressure were higher, and pleural pressure and cardiac index were not different.

[Varicella-zoster virus infections in the immunosuppressed child. Treatment with Acyclovir and controls]. / Les infections à virus varicelle-zoster chez l'enfant immunodéprimé. Traitement par Acyclovir et contrôles.

Sixty minutes intravenous infusions of Acyclovir were given at 5 to 10 mg/kg 3 times daily for 6 to 11 days in 20 immunodeficient children with varicella (9 cases) and herpes zoster (11 cases) in a controlled open study. Twelve patients had a life-threatening illness. All patients who received therapy before the first 4 days had a more rapid cessation of new vesicles formation and more rapid scarring. Fourteen controlled children had accelerated clearance of viral antigens from vesicles. In 19 cases, virus was no longer isolated after the 3rd day. Eighteen patients recovered within 6 to 10 days. No relapse of varicella zoster virus infections had been observed 1 to 18 months after the end of treatment. Two children with varicellous interstitial pneumonia died 8 and 32 days after the end of treatment. In 3 cases, zoster pains reappeared 8 days after Acyclovir therapy was stopped. The drug was well-tolerated, but control of renal functions is necessary.

[Permanent mechanical ventilation at home via a tracheotomy in chronic respiratory insufficiency]. / La ventilation mécanique à domicile définitive par trachéotomie de l'insuffisant respiratoire chronique.

This study describes our experience from 1960 onwards of 222 patients suffering from terminal chronic respiratory failure; we report our results of domiciliary mechanical ventilation for 11-17 hours per day using tracheotomy. The method was easy to use at home at a reasonable cost and was far less than in a medical environment. The results were excellent both for length of survival and quality of life for all cases where respiratory failure was due to chest wall problems (neurological, muscular or restrictive syndromes due to chest deformity). The majority of cases were sequelae of polio, myopathies, kyphoscoliosis or tuberculosis. The results were less good for patients with intrinsic pulmonary disease such as chronic airflow obstruction; for this the superiority of mechanical ventilation compared to long term oxygen therapy is not proven. The results were very poor for patients suffering from bronchial dilatation. However, a positive correlation between the efficacy of the method and the duration of a normal PaO2 during a 24 hour period seemed to exist, both during periods of mechanical ventilation and weaning from the machine.

[Acyclovir therapy of varicella-zoster virus infections in the immunosuppressed children ]. / Traitement par acyclovir des infections à virus varicelle-zoster chez l'enfant immunodéprimé.

We evaluated Acyclovir therapy in 16 immunodeficient children with varicella (7 cases) and zoster (9 cases) in a controlled open study. infections were serious in 12 patients. Each patient had daily clinical, biological and virological tests. Sixty minutes intra-venous infusions of Acyclovir were given three times a day (5 to 10 mg/kg/8 hours) for 6 ou 11 days. All patients who received therapy before the first four days, ahd a more rapid cessation of new vesicles formation and more rapid scaring, than those with delayed treatment. Ten controlled children had accelerated clearance of viral antigens from vesicles. In 15 cases, virus was not isolated after the third day. Two children with varicellous interstitial pneumonia died, 8 and 25 days after the end of treatment. Fourteen patients recovered in 8 to 10 days. No relapses of varicella-zoster virus infections had been observed 1 to 14 months after therapy. The drug was well-tolerated, but supervising of renal functions is necessary. Acyclovir had a good therapeutic efficacy to treat chickenpox and shingles in the immunocompromised patients.

Determination of body fluid compartments by impedance measurements: differences in the repartition of water between Duchenne muscular dystrophy and some neurological diseases.

Body fluid volumes were determined by impedance measurements in several groups of patients. Boys with Duchenne muscular dystrophy had decreased intracellular and extracellular fluid volumes. Patients with severe sequelae of poliomyelitis and with other severely disabling neurological diseases did not exhibit such profound alterations of their body fluid compartments.

[Estimation of normal body volumes in children by the measurement of total electrical impedance (author's transl)]. / Estimation des volumes corporels normaux chez l'enfant pra la mesure de l'impédance électrique globale.

The theoretical fluid volume of 41 normal children (mean age 8 years 9 months) was estimated from anthropometric data: height, weight, wrist circumference, and body surface. The correlation between this method and the conventional methods of determining total body water using tritiated water or of extracellular fluid volume using stable bromide or bromide 82 is very good. The real fluid volumes have been measured using total body electrical impedance at low frequency (Z5 kHz) and high frequency (Z1 MHz). The correlation of these results with those obtained by anthropometry is very satisfactory (r = 0.89; p < 0,001).

[Investigation of orthostatic hypotension by the provoked hypercapnia test (author's transl)]. / Exploration de l'hypotension orthostatique par le test d'hypercapnie provoqueé.

Orthostatic hypotension results from an alteration in the baroreflex at any level with subsequent disturbance in blood pressure homeostasis in response to variations. The second part of this reflex arc, from the bulbar vasopressor centre to the peripheral effector sites, can be explored directly by studying the hemodynamic response to an increase in arterial CO2 levels. Normally the response is an increase in blood pressure, but under abnormal conditions there is a reduction. Orthostatic hypotension with a normal hemodynamic response to increased CO2 levels indicates that the first part of the reflex arc is involved, an abnormal response is due to the second part being affected. The CO2 test was conducted in 8 subjects with orthostatic hypotension (bulbar lesions, medullary lesions, idiopathic orthostatic hypotension, polyradiculoneuritis, primary amylosis). Comparing the typical anatomoclinical characteristics of each of the lesions explored with the results of the hemodynamic response to CO2 test suggests that the interpretation proposed is a valid one.

[Bullous varicella. Association of varicella and a childhood scalded-skin syndrome]. / Varicelle bulleuse. Association d'une varicelle et d'un syndrome des enfants ébouillantés.

A boy, aged 18 months, presented with bullous chickenpox due to simulutaneous skin infection with varicella and staphylococci. Two strains of staphylococci phage type II were identified. The child was treated with strict asepsis and antistaphylococcal therapy. Systematic steroids are contra-indicated.

[Indications of home assisted ventilation by tracheostomy for non-paralytic chronic respiratory insufficient patients (author's transl)]. / Indications de la ventilation assistée à domicile par trachéotomie de l'insuffisance respiratoire chronique non paralytique.

Based on a 15-year study, the indication of assisted ventilation at home is discussed. It depends on the seriousness of the C.R.I. (dyspnea, repeated acute failures, PaCO2 greater than or equal to 55 Torr). The only possible course is ventilation by tracheostomy. The best indication is represented by pure restrictive syndromes. On the contrary, the indication should be considered with extreme caution in obstructive syndromes.

[Results of home assisted ventilation of non-paralytic and tracheostomized chronic respiratory insufficient patients (author's transl)]. / Résultats de la ventilation assistée à domicile (V.A.D.) de l'insuffisant respiratoire chronique (I.R.C.) non paralytique, trachéotomisé.

The following results have been obtained from a study of 118 tracheostomized patients ventilated at home: --Survival on the whole is generally prolonged. --The prognosis of tracheostomized subjects with restrictive syndrome is totally modified in length and quality when the patients are ventilated. --In the case of obstructive syndrome, the length and quality of survival are probably increased. However, it seems that assisted ventilation at home leads only to the disappearance of asphyxiating paroxysms and right cardiac failure. It does not seem to prevent the unrelenting evolution of the disease.

[Technic and supervision of home assisted ventilation (H.A.V.) in tracheostomized chronic respiratory insufficient (C.R.I.) patients (author's transl)]. / Technique et surveillance de la ventilation assistée à domicile (V.A.D.) des insuffisants respiratoires chroniques (I.R.C.) trachéotomisés.

With 200 patients during the last 15 years the daily use of apparatus and supervision modalities, as described in the present work, has shown that H.A.V. is entirely possible in tracheostomized C.R.I. patients. Rather strict conditions must be respected (as with hemodialysis at home) if H.A.V. is to be medically and materially successful. The expenses involved can vary greatly according to the medical and material management (choice of study material, economic maintenance, minimal oxygen consumption through proper adjustment...). Finally, the use of assisted ventilation requires a choice amont several adjustment possibilities which are still subject to evolution.

[Nutritional status in critically ill patients. Relationship with mortality (author's transl)]. / Etat nutritionnel des malades admis en réanimation. Relation avec la mortalité.

Plasma proteins, triglyceridemia, body composition and delayed hypersensitivity were determined in 154 critically ill patients after admission. Plasma proteins levels were significantly increased in patients that were subsequently discharged vs. those that died: albumin: 33 +/- 6 g/l vs 28 +/- 6 g/l (p < 10(-6)); transferrin 2,18 +/- 0,65 g/l vs. 1,54 +/0 0,55 g/l (p < 10(-7)); prealbumin: 14,32 +/- 7,79 mg/100 ml vs. 7,28 +/-5,36 mg/100 ml (p < 10(-7)) and triglyceridemia was decreased: 1,07 +/- 0,38 g/l vs. 1,66 +/- 1,12 g/l (p not equal to 10(-3)). Body weight, fat weight and lead body mass were not correlated to subsequent mortality. Muscle cell mass was decreased (-17%, p < 10(-2)) and extracellular water was increased (+14%, p < 10(-4)), in patients who subsequently died. Total body water and visceral cell mass did not change. Initial anergy (tested with 3 antigens: candidin, tuberculin, varidase) did correlate with mortality: 35/62 died when delayed hypersensitivity was negative vs. 13/71 when it was positive (p < 10(-4)). Mortality was associated with decreased total lymphocyte count: 884 +/- 1025 vs. 1270 +/- 870 (p < 0,02) and serum iron: 51 +/- 40 micrograms/100 ml vs. 74 +/- 45 micrograms/100 ml (p < 10(-2)). Sepsis correlated with mortality (p < 10(-3)) and could produce these changes. These results suggest that critically ill paients have a protein-calorie malnutrition syndrom marktly different from that observed in simple starvation. Nutritional therapy must be, in this group of patients, adapted to this concept.