[High-risk airway management in pediatric prehospital emergency medicine]. / Une gestion des voies aériennes à haut risque en médecine pédiatrique préhospitalière.

We report the case of high-risk airway management performed in prehospital conditions in a 3-year-old boy suffering from a severe head and maxillofacial trauma. Tracheal intubation was decided because of a comatose status associated with an acute upper airway obstruction resulting in severe hypoxaemia. One minute after a rapid sequence induction, difficult laryngoscopy was encountered. Two tracheal intubation attempts failed. During maintained laryngoscopy, a pediatric angulated Eschmann-like stylet was blindly blocked into the trachea using a rotational maneuver. A tracheal tube was railroaded over the stylet while a hypoxic bradycardia installed. The young child was tracheostomized upon arrival in the hospital, and recovered without neurological complication. In the present case, neither facemask nor laryngeal mask ventilation would have been efficient because of oral cavity jaw and sub-mental pharyngeal open wounds. Since most paediatric emergency medicine physician are not familiar with infraglottic airway techniques, our observation questions the safety of rapid sequence induction in case of severe maxillofacial trauma and reinforces the value of pediatric Eschmann-like stylet. Minimal airway tools equipment for difficult paediatric airway management is discussed.

Influence of resident Salmonella on contamination of broiler flocks.

An epidemiological survey was made of 5329 samples from 10 poultry operations to determine the relationship between total poultry farm environment and incidences of Salmonella contamination of broiler flocks. Samples were analyzed from walls, drinkers, feeders, litter, insects, water, chicks, broilers, and feed to determine the effect of common sanitary practices on Salmonella contamination of flocks. Results indicated that although similar hygienic practices had been taken on the 10 poultry farms examined, great variation exists in Salmonella contamination among the farms. Among the sources studied, the most important source of contamination was determined to be the resident Salmonella of the flock i.e., the strain isolated on chicks' first day in the poultry house. This source was more important than Salmonella isolated during the rearing period. However, the precise conditions of Salmonella contamination in poultry flocks remain to be elucidated.

[Ocular complications of porphyria. A case of Günther's disease]. / Complications oculaires des porphyries. A propos d'un cas de maladie de Günther.

On a case of Günther congenital porphyria with late ophthalmic complications, the authors study clinical and haematological manifestations of this disease (clinical signs are related to light sensibilisation: sclerodactily, hyperpigmentation, non cicatrisating wounds, long standing scars of reposed areas; they begin in the early childhood by hemolytic anemia and emission of dark port urines too). The various porphyries are then studied and their ophthalmologic signs are related either to the light sensibilisation either to angiopathy and neuropathy (acute porphyria). These are always spontaneously reversible after the acute onset; on the contrary, light sensibilisation involvements go worth and worth and in some cases (Günther disease; late cutaneous porphyria) induce irreversible damages: they begin by eyelids and conjunctival scars then involve scleral and corneal tissues (scleral malacia perforans). In fact, they have a bad prognosis: ophthalmologic surgical repair, after a little success, fails, because of the non cicatrisating tissues. Best treatment is preventive: --in case of light sensibilisation: eviction of sunlight or light sensibilisating drugs; --in case of acute porphyria: eviction of some drugs (barbiturates); surgical action.

[Dacryocytography in traumatology (author's transl)]. / La dacryocystographie en traumatologie.

Radiological technique in the investigation of the lacrimal system has greatly benefited from various advances in radiology; techniques of catheterisation, contrast media, seriography, subtractions, associated complex tomography (dacryocystotomography), tomodensitometry. To these may be added the dynamic nature of isotope studies (cinegammadacrycystography). These different techniques may be used in the precise analysis of the morphology of the lacrimal system, from the canaliculi to the meatuses. After reviewing normal radiological anatomy, the authors describe morphological abnormalities, according to different forms of obstruction, according to their site. This morphological discovery requires possible changes in technique (additional tomography, for example). The quality of the preoperative morphological exploration influences the quality of the therapeutic results obtained.