[Acute poisoning by pesticides in children]. / Intoxications aiguës par des produits phytosanitaires chez l'enfant.

Acute pesticide poisoning in children is rare but potentially serious. Some clinical patterns (toxidromes) are suggestive of the drug class: cholinergic crisis for organophosphate or carbamate insecticides; neurological syndrome for rodenticides; digestive and respiratory syndrome for herbicides. Treatment is symptomatic and only a few patients are treated with an antidote: atropine and pralidoxime for organophosphate insecticides, vitamin K for anticoagulant rodenticides.

[Pediatric emergency department policy. Implementation and management of the resuscitation room]. / Recommandations concernant la mise en place, la gestion, l'utilisation et l'évaluation d'une salle d'accueil des urgences vitales pédiatriques.

The pediatric resuscitation room is the place where children suffering from vital distress are cared for in the emergency unit. Recommendations for its organization, functioning and evaluation have been ruled on by experts from six medical societies involved in these emergencies. They concern all the hospital's physicians, nurses and administrative directors.

[Anesthesia and techniques for the resuscitation of drowned persons]. / L'anesthésie et les techniques de réanimation des noyés.

Close relations between anaesthesia and resuscitation technology are mutual. The concept of medical emergency took place around the history of respiratory resuscitation which allowed the growth of insuflation technology. The anaesthetist used those ways of respiratory resuscitation in order to interfer with anaesthesia complications; he introduced the artificial ventilation into the operating theatre and, later on, into future intensive care rooms.

Roles of platelet-activating factor, interleukin-1beta and interleukin-6 in intestinal barrier dysfunction induced by mesenteric arterial ischemia and reperfusion.

BACKGROUND: Platelet-activating factor (PAF), cytokines, proteases, and other factors are probably involved in the development of gut barrier dysfunction following intestinal ischemia and reperfusion (I/R), although the act underlying pathophysiological mechanisms has not yet been fully clarified. The aim of the present study was to clarify the relationship of intestinal barrier integrity to systemic levels of interleukin-1beta, interleukin-6, and protease inhibitor levels and local leukocyte accumulation in a rat model of intestinal ischemia for 40 min followed by 3 or 12 h reperfusion, with or without treatment with a PAF inhibitor. METHODS: Myeloperoxidase (MPO) content in the small intestinal mucosa, serum levels of interleukin-1beta and -6, and plasma protease inhibitors, and intestinal endothelial and epithelial permeability were assessed, with or without treatment with the PAF antagonist lexipafant. RESULTS: Intestinal I/R resulted in intestinal barrier dysfunction with pronounced plasma leakage to the intestinal lumen, the leakage being aggravated following a longer reperfusion period. Proteolytic plasma activity was evident by low levels of the plasma protease inhibitors measured. MPO content increased significantly after I/R, as did serum levels of interleukin-1beta and -6, without difference between the two periods of reperfusion. Treatment with the PAF inhibitor lexipafant partly, though not fully, restored the changes caused by I/R. CONCLUSION: PAF seems to be involved in the release of cytokines, such as interleukin-1 and -6, consumption of protease inhibitors, and impaired intestinal barrier integrity seen following intestinal I/R. Treatment with a PAF antagonist was effective in restoring the changes caused by intestinal I/R, though not reaching complete normal levels.

Treatment with lexipafant ameliorates the severity of pancreatic microvascular endothelial barrier dysfunction in rats with acute hemorrhagic pancreatitis.

CONCLUSION: Treatment with lexipafant reduced the severity of pancreatitis-associated endothelial barrier compromise, also associated with a decrease in systemic concentrations of interleukin (IL) 1. Thus, the present findings imply that platelet-activating factor (PAF) may play an important role in the pathogenesis of pancreatic endothelial dysfunction by signaling and triggering the production and release of certain cytokines. BACKGROUND: Pancreatic capillary endothelial barrier dysfunction is an initial and characteristic feature of acute pancreatic injury and pancreatitis. PAF, a proinflammatory mediator and an intercellular signaling substance, has been considered to be involved in the inflammatory reaction and the systemic endothelial dysfunction of acute pancreatitis. METHODS: The development of pancreatic capillary endothelial barrier dysfunction was monitored by tissue edema and exudation of plasma albumin into the interstitium, 3 and 12 h after induction of acute pancreatitis by intraductal infusion of 5% sodium taurodeoxycholate in rats. Pancreatic leukocyte recruitment was reflected by measuring myeloperoxidase activity. Serum levels of IL-1 beta and IL-6 were determined by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Pretreatment with lexipafant, a potent PAF receptor antagonist, significantly reduced the pancreatitis-induced increase in pancreatic endothelial barrier dysfunction, pancreatic leukocyte recruitment and serum levels of IL-1 beta, although a difference persisted between animals with sham operation and pancreatitis.

[Cardiac massage: the evolution of techniques]. / Le massage cardiaque: évolution des techniques.

Up to the 19th century, reanimation of persons apparently dead just included respiratory managing. Cardiac reanimation was born with the accession to anesthesia and their severe cardiac complications. Although closed-chest cardiac massage had been described from the outset of our century, bloody techniques of direct cardiac massage was especially used until the end of the fifties. Methodically, Kouvenhoven has demonstrated closed-chest cardiac massage effectiveness, and has known to lay down this technique in cardiac reanimation.

[The evolution of respiratory reanimation as seen by the drowned]. / Evolution de la réanimation respiratoire vue à travers celle des noyés.

In addition to anecdotal techniques born from Galen reasoning, the method of recovering apparently drowned persons in the XVIIIth century surprises by the use of present techniques of artificial respiration. However, for over a century, these techniques was left on behalf of manual methods until the sixteens. In the XVIIIth century, resuscitation involves two principles: stimulation and artificial respiration. Amid stimulation, in addition to warmth, the choice treatment was to blow tobacco smoke into the rectum, which was used until the beginning of the XXth century. Inflation of the lungs was practised with mouth-to-mouth, and endotracheal or nasal intubation or tracheostomy with bellows, pistons or bladders, and the use of oxygen. But J. Leroy d'Etiolles, in 1827, demonstrated to the académie des Sciences the iatrogen peril of the inflation of the lungs, and the risk to leave the people sophistical techniques without education. This transaction gave the alarm to the european philanthropic Societies which stood down the inflation of lungs in the method of recovering apparently drowned persons. Between 1830 and the sixteens, inflation was put in the place of "forced expiration" techniques: the famous Sylvester or Schaeffer methods. From the outset of the XXth century, oxygen is used widely by helpers, and physicians have elaborated subcutaneous and intravenous ways of infusion to this oxygen. It is only in 1958 that Safar and al. demonstrated mouth-to-mouth superiority in relation to chest compressions.

Alterations in intestinal motility and microflora in experimental acute pancreatitis.

CONCLUSION: A delay in intestinal transit time appears as an early event in acute pancreatitis, preceding intestinal bacterial overgrowth and translocation. BACKGROUND: Septic complications, primarily caused by bacteria of enteric origin, are frequent in severe acute pancreatitis. Impairment in intestinal motility probably plays a pathophysiological role in the development of bacterial overgrowth and ensuing translocation. METHODS: In the present study, the influence of acute pancreatitis on intestinal motility was evaluated by measuring small intestinal transit time in the rat. Acute pancreatitis was induced by the retrograde intraductal infusion of 0.2 mL taurodeoxycholate. Intestinal transit time was studied by intraduodenal injection of Krebs' phosphate-buffered solution labeled with Na2(51)CrCO4, and 1 h small intestinal transit was measured at 1, 3, 12, and 24 h, after induction of pancreatitis. Bacterial overgrowth was evaluated by measuring Escherichia coli counts in the colon and distal small intestine, and bacterial translocation to mesenteric lymph nodes, the liver, spleen, and pancreas was determined. RESULTS: A delayed small intestinal transit time was noted from 3 h on after induction of acute pancreatitis, with most of the radioactivity retained in the first two intestinal segments. Overgrowth of E. coli was noted 12 h after induction of pancreatitis in both the colon and distal small intestine, and at the same time-point, a significant increase in the incidence of bacterial translocation to mesenteric lymph nodes was seen.

Gut origin sepsis, macrophage function, and oxygen extraction associated with acute pancreatitis in the rat.

It has been suggested that the gut plays a role in the development of bacterial complications, which are important contributors to morbidity and mortality in patients with acute pancreatitis. The present study evaluated the enteric bacterial translocation, bacterial homeostasis, and reticuloendothelial system function in experimental acute pancreatitis induced by intraductal injection of 5% sodium taurodeoxycholate in the rat. The incidence of bacterial translocation from the gut to mesenteric lymph nodes (MLNs) and lungs significantly increased after 12 hours and to the systemic circulation, ascites, and pancreas at 24 hours. The number of anaerobic bacteria and lactobacilli decreased in the colon and distal ileum from 6 or 12 hours, whereas the number of Escherichia coli increased from 12 hours. The systemic uptake rate of radiolabeled bacteria decreased from 6 hours after induction of acute pancreatitis. The uptake of radiolabeled bacteria by Kupffer cells decreased from 6 hours, whereas the uptake by macrophages from blood, lungs, and the intestine increased. A decrease in macrophage killing capacity was noted, reflected by an increase in the number of cultured viable bacteria from isolated macrophages. The whole-body oxygen extraction rate increased 4 to 24 hours after induction of pancreatitis, whereas the gut oxygen extraction rate decreased at 2 and 4 hours, followed by an increase at 12 to 24 hours. These data show that translocation of enteric bacteria occurs during the early stage of acute pancreatitis and that the MLN-thoracic duct-circulation may be a major route of bacterial dissemination. Compromised gut oxygen metabolism, overexaggerated intestinal macrophages, and impaired host immune function may be involved in the development of infectious complications associated with acute pancreatitis.

[History of respiratory intensive care with reference to first aid for nearly-drowned persons]. / Histoire de la réanimation respiratoire vue à travers celle des noyés.

In addition to anecdotal techniques originating from Galen's reasoning, the methods for the treatment of nearly-drowned persons from the XVIIIth century to the first quater of the XIXth century, are surprising as they still include the artificial internal ventilation techniques of today. Nevertheless for more than one century, these techniques were abandoned. External manual methods generating a forced expiration were preferred until 1958, when Peter Safar and coworkers demonstrated the value of mouth-to-mouth ventilation in comparison with manual methods. This eclipse finds its origin mainly in Leroy d'Etiolles's 'alarming' dissertation produced in 1827, underlining the pleuro-pulmonary risks of endotracheal insufflation and recommending the external manual methods, considered as being easy to use by everybody, without risk, and however improperly given as being efficient. As a result, the European philantropic societies abandoned bellows and positive pressure ventilation in their official resuscitation scheme for the nearly-drowned and asphyxiated.

[Passive smoking in children. Its detection by the assay of urinary cotinine]. / Le tabagisme passif de l'enfant. Son dépistage par le dosage de la cotinine urinaire.

BACKGROUND: Passive tobacco smoking is responsible for increased respiratory morbidity in young children. This point is not always understood by parents and the use of a sensitive marker for nicotine exposure may help them to smoke less. POPULATION AND METHODS: Urinary cotinine concentration was measured in 72 children, aged from 1 to 5 years, that had been admitted to our unit during October and November 1991 for various causes. The results were correlated with the smoking habits of their parents. Urine samples were obtained during the first hours after admission and the cotinine concentration was measured by HPLC. Concentrations > 5 micrograms per liter were considered to be positive. RESULTS: A total of 67 urine samples were analysed: 43 (64.2%) were positive with cotinine concentrations of 5 to 77 micrograms/l (mean: 19.7). Both parents of 21 children were smokers; the fathers of 18 children and the mothers of 11 children, alone, smoked. There was therefore at least one smoker in the environment of 50 children. There was a highly positive correlation between parental smoking and urinary cotinine (p < 0.0001). For the infants with only one parent who was a smoker, their urinary cotinine was higher when the smoker was the mother rather than the father. CONCLUSIONS: An urinary cotinine of > 6 micrograms per liter is a precise, sensitive, test for passive smoking in young children. This test is well accepted by families and its result may persuade parents to stop or moderate their use of tobacco. This test also could be used, as part of a pulmonary check-up, as a public health indicator.

[Risk factors for allergy to hymenoptera stings]. / Facteurs de risque dans l'allergie aux piqûres d'hyménoptères.

Hymenoptera stings are common and potentially serious. The clinical, paraclinical and therapeutic aspects of allergy to hymenoptera venom are being better and better understood. A retrospective descriptive enquiry of hymenoptera stings in 270 consultations in a Central General Hospital has established three risk factors in the possibility of a serious reaction (R.A.G.): Men: 2.4 times more allergic reactions (R.A.). Severity of R.A. increases with age, especially after 50 years. Hornet stings have a risk 5 times greater than that of bees and 4.3 times greater than wasp.

[Duplication of the complete lumbosacral spine. Apropos of 1 case]. / Duplication complète du rachis lombo-sacré. A propos d'un cas.

The rare case of a 6 year old child with spinal cord duplication and malformations is reported. The malformation was probably related more to a double monster context than to a notochordodysraphism.

[Atypical meningocele localization in the new-born. A report on one case (author's transl)]. / Méningocèle de localisation atypique chez le nouveau-né. A propos d'un cas.

A case is reported of a new-born infant presenting with a voluminous laterofacial tumor which had literally blown up the right side of the face. The tumor was found to be a meningocele. Treatment was applied in such a way as to cause the least surgical trauma possible and to use the natural flexibility of the tissues in an infant of this age. The rare nature of this localization is emphasized.