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A portable device for the generation of co-feeds of water vapor has been designed, constructed, and evaluated for flexible use as an add-on component to laboratory chemical reactors. The vapor is formed by catalytic oxidation of hydrogen, which benefits the formation of well-controlled minute concentrations of ultra-pure water. Analysis of the effluent stream by on-line mass spectrometry and Fourier transform infrared spectroscopy confirms that water vapor can be, with high precision, generated both rapidly and steadily over extended periods in the range of 100 ppm to 3 vol. % (limited by safety considerations) using a total flow of 100 to 1500 ml/min at normal temperature and pressure. Further, the device has been used complementary to a commercial water evaporator and mixing system to span water concentrations up to 12 vol. %. Finally, an operando diffuse reflective infrared Fourier transform spectroscopic measurement of palladium catalysed methane oxidation in the absence and presence of up to 1.0 vol. % water has been carried out to demonstrate the applicability of the device for co-feeding well-controlled low concentrations of water vapor to a common type of spectroscopic experiment. The possibilities of creating isotopically labeled water vapor as well as using tracer gases for dynamic experiments are discussed.

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OBJECTIVE: The purpose of the present study was to determine the main schedules of a visit in a paediatric emergency ward. PATIENTS AND METHODS: A prospective survey concerning the main schedules of the children examined in the paediatric emergency ward of the Lenval's hospital in Nice in 1999 was implemented. The study was conducted over a period of 84 days, one week per month, and included 6038 children analysed recording to the following criteria: 1) duration of the waiting; 2) duration of the radiological period; 3) duration of the medical advice and/or treatment period; 4) total time course of the visit. RESULTS: Data were collected in 66.6% of all cases for waiting (n = 4022), 52.1% for medical advice (n = 3149), in 44.1% for radiological time (n = 833 of 1888 children having radiological examination), in 58.1% for the total time course of the visit. Waiting for not severe emergencies was about one time out of three less than five minutes, more than one time out of two less than 15 minutes, and more than three times out of four less than 30 minutes. Mean radiological time course was 20 to 25 minutes. Mean medical advice was 15 minutes, for medical consultations such as surgical ones. Total time course of the visit was less than 30 minutes in 23.1% of all cases, 30 to 60 minutes in 38.5%, one to two hours in 31.3%, two to four hours in 6.8%, and more than four hours in 0.3% of all cases. Mean total time course of the visit was 45 minutes for medical emergencies and 55 minutes for surgical ones. CONCLUSION: This study shows the main schedules of a visit in a paediatric emergency ward which took care of 26,726 children in 1999. The results of this survey confirmed that waiting before consultation, for not severe emergencies, is sometimes long or very long because of a constant increasing number of patients and their preferential breakdown according to specific periods (weekends, public or school holidays, winter) which are the result of demographic, social and economic changes. At present, the only available possibility to control both phenomena consists in adjusting and adopting medical tools and staffs to crowds and flows. This study also confirms the usefulness for paediatric emergency ward to have a short hospitalization unit.

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OBJECTIVE: The goal of this survey was to investigate adolescents' health through their utilization of a pediatric emergency unit. METHODS: Prospective survey performed one week of each month in 1999 concerning the adolescents' (12 to 18 years) visits to the Lenval's children emergency care unit in Nice. RESULTS: During the study period, 1,096 adolescents were examinated and accounting for 18.6% of the children admitted in the year. The main reasons for visits were injury-related visits (55.5%), non-accidental somatic complaints (38.7%), psychiatric disorders (5.5%), and psychosocial problems (0.4%). Most adolescent visits (68.6%) were not severe emergencies requiring hospital technical equipment support; about one-third of the visits (28.6%) were non urgent consultations; severe emergencies were fewer than 1%; there was no death. Compared with the other pediatrics age groups, adolescents more often used the hospital technical equipment (65.1% vs 45.4%), required a longer visit (62 +/- 33 vs 57 +/- 37 min), and had a higher hospitalization rate (13.4% vs 10.1%). CONCLUSIONS: Adolescent emergency care requires multidisciplinary skills, such as traumatologic, gynecologic, psychiatric, and psychosocial compentence. Two units, absent at Lenval at the time of this survey, seem to be important for good care: space for very short hospitalization in the emergency unit and an adolescent-specific unit in the pediatric ward.

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BACKGROUND: Kasabach-Merritt syndrome is an infrequent combination of a giant hemangioma and severe thrombocytopenia. This syndrome may be life-threatening. There are various but no definitive methods of treatment. We describe here a neonatal case cured by total excision of the tumor. CASE REPORT: A boy was admitted at birth with a giant hemangioma of the back with thrombocytopenia. Tumor compression, corticosteroids, acetylsalicylic acid and ticlopidine were ineffective. Total surgical excision was performed on day 51, resulting in complete recovery. CONCLUSION: Total surgical excision of a localized hemangioma in a non-functional area is probably the most appropriate and justified treatment for the Kasabach-Merritt syndrome.

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We report 2 cases of familial hemophagocytic lymphohistiocytosis in two children, hétérozygous twins, born from consanguine parents. This disease is characterised by disseminated lymphohistiocytic infiltrates with hemophagocytosis, that most commonly involves bone marrow, spleen, lymph nodes, liver and central nervous system. Differential diagnosis is difficult with infection-induced hemophagocytic syndromes. The only distinguishing feature in pathology is the expression of CD21, CD30 and CD35 antigens by histiocytes. Differenciation is made by an association of clinical and pathologic characteristics: a familial history, lack of infection or neoplasm, and immunohistochemical results. Diagnostic must be rapidly made, because this disease is always fatal without treatment.

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BACKGROUND: Although in utero transfer seems actually the safest option when risk factors are identified, specialized transport teams remain important to consider for the neonatal overall management. SUBJECTS: From January 1988 through December 1992, 692 transports of 838 neonates were prospectively studied to determine effectiveness and safety of the Hospital Lenval's neonatal transport team. RESULTS: Neonatal transports were required respectively for prematurity (46.4%), acute fetal distress (13.8%), respiratory distress (10.1%), intrauterine growth retardation (7.8%), multiple pregnancies (5.2%), perinatal asphyxia (3.1%) and life-threatening congenital abnormalities (2%). Pediatric assistance was unplanned in most of the cases (80%). Assistance with a pediatrician before delivery was performed more frequently (70%) for premature babies (mean gestational age 34.1 +/- 3.1 wk) delivered by cesarean section in 66.4% of the cases; in this group, delivery room resuscitation was less aggressive. Assistance was performed after delivery less frequently (30%), approximately in one-half of the cases for neonatal distress: respiratory (33.9%) or neurologic (17.1%); in this group, delivery room resuscitation was more aggressive. In transit, ventilation support via endotracheal intubation was given to 17.9% of the babies. Neither death nor heavy complication occurred during transport. On arrival in the neonatal intensive care unit, hypothermia was noted in 9.6% of the cases, hypotension in 4.3%, hypoglycemia in 13.1% and metabolic acidosis in 10.4%. In our series, the overall mortality rate was 6%, and incidence of neurologic damage 3.3%. CONCLUSION: A skilled person in neonatal resuscitation available at every referring maternity and regional high-risk obstetric/neonatal combined centre are two recommendations which could provide improved neonatal management.

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Asthma is a common pediatric emergency. We report the results of a prospective investigation concerning asthma attacks observed in children aged more than 2 years at Lenval hospital (Nice) during a 12-month period, from September 1993 to September 1994. One hundred and thirty seven asthma attacks were observed in 122 children aged 6.9 +/- 3.4 years, representing 5.2% of children ranged from 2 to 6 years medical emergencies, and 10.3% of children greater than 6 years medical emergencies. In most cases (82.4%) the diagnosis of asthma was already known. The children were first seen, on the average, between 32.3 +/- 38.6 hours after the beginning of the attack, previously self-treated at home in one out of every two cases. Treatment was set in each case on the isolated administration of inhaled beta 2-adrenergic agonist. The decision whether or not to hospitalize was made, at the latest, one half hour after the second administration of the beta 2-agonist. One death occurred before hospital admission. Hospitalization was decided in 38.6% of the cases, two of which were immediately directed for reanimation. A majority of the children (60.7%) were able to return home after metered dose inhalation for 5 of them, after 1 nebulization of beta 2-agonist in 66 cases, after 2 nebulizations in 12 cases. The prevalence of asthma is increasing and can be estimated at approximately 10% in France. The pediatrics emergency wards have an important role to play in the evolution of this illness. They must guarantee the most favorable management of the attack. They must then participate decisively in the initiation of the necessary surveillance to be continued. They play a great part in the knowledge of the epidemiology.

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BACKGROUND: Intussusception encephalopathy, a misleading form in which neurological symptoms are obvious, is classic but rarely described. CASE REPORT: A 21 month-old infant was admitted because he had suffered from fluctuating consciousness and apathy for a few hours. Vomiting occurred soon afterwards. Search for dehydration, meningitis, encephalitis, poisoning... was negative; the abdomen was tender leading to ultrasonography that showed a sausage-shaped tumor. The ileocolic intussusception was successfully reduced with a gas enema. CONCLUSION: A striking degree of lethargy associated with vomiting may overshadow to a considerable extent the classical intestinal manifestations. A possible endogenous opioid poisoning by massive secretion of endorphins during pain's paroxysm is one of the hypotheses explaining this type of presentation.

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During 1992, 541 sport injuries (6.3% of the 8641 surgical emergencies) were recorded at Lenval's hospital pediatric emergency ward in Nice. There were a majority of boys (62%), and the mean age was 11.2 years. Thirty one sports were represented, mainly soccer (18.5%), bicycle (12.2%), basketball (9.4%), gymnastics (9.4%), ski (9.2%) and equitation (7.8%). Injuries occurred during competition in 12.7% of the cases, school practice in 36.3%, and free practice in 51%. Lesions concerned head and face in 15.5% of cases, the trunk in 9.2%, and limbs in 75.3% with a majority of twists and benign contusions. The hospitalisation's rate was 14.4%, and a surgical intervention with anesthesia was performed in 7.6% of cases to treat one shoulder dislocation and 42 limb fractures. Thirty percent of children were confirmed sportsmen/women, 40% of them were involved in competitive sports, the most frequently concerned sports being soccer (24.6%), basketball (18%), fighting sports (11.4%; 7.2% = judo), gymnastic (10.1%), tennis (7.9%) and equitation (6.7%). From this study most sports injuries in children appears benign even if some fractures led to hospitalisation and orthopedic surgery; this is possibly related to the quality of education and coaching, particularly during physical training at school.

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Between July 3rd 1990 and January 4th 1993, directed blood transfusion was authorized in neonatology in France. In 1991 and 1992, anemia of prematurity was treated at Lenval hospital by directed blood transfusion. 60 preterm infants with non immune mediated anemia received 85 transfusions, 24.7% of them being provided from parental blood. 26.7% of these 60 infants were transfused only with familial blood. Although authors and parents found these preliminary results very encouraging, directed blood transfusion has been forbidden in France since January 4th 1993. It is believed that such a transfusion does not solve many problems (ie: methodological, material, moral, ethical), and the risk of transmitted infections diseases seems not to be decreased. Therefore traditional transfusion using anonymous donors is recommended.

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Two cases of postoperative intussusception (POI) are reported. Both children, 13 and 6 months old, had long and difficult surgery for abdominal neuroblastoma after four courses of chemotherapy. Obstruction of the small intestine occurred on the fifth postoperative day, after feeding had been started again, in the first child, and on the third day in the second one. Surgery revealed a loose ileo-ileal invagination of 10 and 15 cm respectively, which was easily reduced. The postoperative course was uneventful in both cases. Although POI is a classical complication of abdominal surgery, it is often forgotten. In the cases described, the first surgical procedure combined most causative factors for POI: young age, preoperative chemotherapy, prolonged general anaesthesia, extensive retroperitoneal dissection close to components of the neurovegetative system. The use of opioids for postoperative analgesia may be an additional risk factor, as they alter intestinal motility. Epidural analgesia with local anaesthetics should be preferred in such cases.

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A survey carried out by questionnaire was performed among parents accompanying their children to the emergency department of the Lenval's children hospital in order to determine their opinion on the quality of the reception and care. The questionnaire was distributed to 2,382 parents. A total of 719 questionnaires (30.2%) were returned. A large majority of the parents (99%) expressed their satisfaction with the care and reception in the emergency department. The necessary improvements following this survey concern the duration of waiting prior to the consultation and the quality of the reception in the radiological and admittance departments; it is hoped that the radiological and admittance areas will be included within the emergency department, in the future.

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