RESUMO
BACKGROUND: Post-bronchoscopy and bronchoalveolar lavage (BAL) fever in children has been described by several authors. OBJECTIVES: This study aimed at assessing the occurrence of fever after these examinations and associated risk factors. METHODS: The study was performed in the Bronchoscopy Unit of Hôpital Necker-Enfants Malades, Paris, France, from June 2004 to July 2005. 148 children who underwent fiberoptic bronchoscopy and BAL, and remained in the Unit for 24 h, were included. RESULTS: 37.8% of the patients presented post-BAL fever. In the multivariate analysis of the selected factors (age, immunodeficiency, general or local anesthesia, mucosal biopsy, inflammation and suppuration at the moment of the examination, abnormal bronchoalveolar fluid cellularity and infection), only age <2 years and presence of infection remained associated with fever. CONCLUSIONS: The occurrence of fever is a frequent event in children who underwent BAL. In order to reduce post-BAL fever, antibiotic strategies should be devised based on prospective studies assessing identification of predictive air-way infection criteria and/or rapid bacteriological result analysis.
Assuntos
Lavagem Broncoalveolar/estatística & dados numéricos , Febre/epidemiologia , Adolescente , Distribuição por Idade , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/estatística & dados numéricos , Causalidade , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Síndromes de Imunodeficiência/epidemiologia , Incidência , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Estudos Retrospectivos , Fatores de Risco , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
We report 22 cases of alternating hemiplegia of childhood. In addition to repeated episodes of hemiplegia lasting from a few minutes to several days, the disease was characterized by an onset before 18 months of age, the occurrence of tonic or dystonic attacks, nystagmus, dyspnea and other autonomic phenomena, and the development of cognitive impairment and of a choreoathetotic movement disorder. All the patients also had episodes of quadriplegia that occurred either when a hemiplegia was shifting from one side to the other or as an isolated manifestation. Such episodes were often severe and followed by developmental deterioration. In all children, sleep consistently relieved both weakness and associated paroxysmal phenomena, but these would reappear 10 to 20 minutes after the children awakened, during long-lasting episodes. Although six patients also had epileptic seizures, the condition seems to be distinct from epilepsy, and the clinical features and poor outcome differentiate it from migraine. Treatment with the calcium-entry blocker flunarizine was partially effective.
Assuntos
Hemiplegia/fisiopatologia , Diagnóstico Diferencial , Feminino , Hemiplegia/diagnóstico , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
Little information is available on the energy expenditure of infants with increased work of breathing from respiratory distress syndrome (RDS). A study was carried out to determine whether surfactant replacement therapy modifies respiratory gas exchange in newborn infants with RDS and an arterial-alveolar oxygen tension ratio of less than 0.22. In a double-blind, placebo-controlled, rescue trial, infants received either two 5 ml/kg doses of a synthetic surfactant, Exosurf Neonatal, or air placebo. Of 23 infants ventilated for RDS, 11 were randomly assigned to receive air and 12 to receive surfactant. Oxygen consumption, carbon dioxide production, respiratory quotient, and metabolic rate were measured by computerized, closed-circuit, indirect calorimetry. Concomitantly, transcutaneous oxygen and carbon dioxide tension were continuously recorded. Oxygen consumption and carbon dioxide production remained constant during the period infants received surfactant. In patients randomly assigned to surfactant, a decrease in respiratory quotient was observed after the first (p less than 0.025) but not the second dose. This decrease was possibly related to a change in substrate utilization. The improved clinical outcomes reported among infants receiving surfactant were not accompanied by changes in energy expenditure.
Assuntos
Metabolismo Energético/efeitos dos fármacos , Álcoois Graxos/uso terapêutico , Fosforilcolina , Polietilenoglicóis/uso terapêutico , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Síndrome do Desconforto Respiratório do Recém-Nascido/metabolismo , Calorimetria Indireta , Combinação de Medicamentos , Humanos , Recém-Nascido de Baixo Peso , Recém-NascidoAssuntos
Crime , Psiquiatria Legal , Adolescente , Adulto , Idoso , Alcoolismo/complicações , Crime/legislação & jurisprudência , Psicologia Criminal , Prova Pericial , Feminino , Homicídio , Humanos , Incesto , Masculino , Martinica , Pessoa de Meia-Idade , Delitos SexuaisRESUMO
Psychiatry in French Guyana. The authors describe Psychiatric hospital and psychiatric practice in French Guyana, with special attention to clinical and statistical datas.