Comparison of two new tests for rapid diagnosis of respiratory syncytial virus infections by enzyme-linked immunosorbent assay and immunofluorescence techniques.

The sensitivity and the specificity of two new commercial reagent tests, an indirect fluorescent antibody test (FAT) with a mouse monoclonal antibody (MAb) against respiratory syncytial virus (RSV) and an enzyme-linked immunosorbent assay (ELISA) RSV antigen detection kit, were determined by a comparison of results from these tests with those of tissue culture isolation and an indirect FAT with bovine polyclonal antibody (BPA). Of 251 nasal aspirates from infants with suspected RSV infection, positive results were found for 99 (39%) by the FAT-MAb, 93 (37%) by the FAT-BPA, and 87 (35%) by the ELISA; 69 of 240 (29%) were positive by cultures. The FAT-MAb was a more sensitive technique than cultures, with 87% sensitivity for the FAT-MAb and 84% for the ELISA.

[Rhinovirus and acute respiratory infections in infants].

Human leucocytary interferon (IFN) in a concentration of 2,000 Ul/ml stops the development of 9 Rhinovirus (RV) strains. The use of serum IFN antibodies (SAIF) reverses this effect. Of 256 nasal aspirates culture negative for other respiratory viruses, 40 RV were isolated with SAIF as opposed to 19 without serum anti IFN.

[Acute mitral endocarditis in a 4-month-old infant].

The authors report a case of bacterial endocarditis from unidentified bacteria, responsible for a rupture of chordae of the mitral valve in a 4 month-old infant with a previously normal heart. Bidimensional echocardiography led to diagnosis. The importance of the mitral loss thus created made a mitral plasty necessary with cardiopulmonary by-pass at age 2 years.

Nutritional treatment of congenital heart disease.

Twelve of 13 patients with congenital heart disease given continuous enteral nutrition displayed normal growth; cardiac function remained stable or improved in 10 in spite of the water load (146 +/- 22 ml/kg/day). This is safe treatment for malnutrition in congenital heart disease.

[Nutritional management of neonates and infants with cystic fibrosis of the pancreas detected at birth].

From a systematic neonatal screening for cystic fibrosis in the Basse-Normandie area and to prevent disorders of the intestinal transit related to malabsorption, neonates then infants were given a semi-elemental hypercaloric diet, with supplements in nitrogen, MCT, minerals, vitamins and low in LCT. Diets were adjusted every month during a consultation using clinical and biological parameters. Results in the first 14 children showed that clinically as well as biologically, these children may remain within the normal range, avoiding the previously reported growth retardation and mineral or vitamin deficiencies.

[Fast diagnosis of whooping cough in the infant. Contribution of the immunofluorescence technic].

Clinical and biochemical data of 22 children admitted from May 1982 to May 1983 were reviewed to study their values for early diagnosis of pertussis. Direct immunofluorescence for Bordetella pertussis was positive in 9 of the 12 confirmed cases and seems to be a reliable test.

Deep dysphasia in a case of phonemic deafness: role of the right hemisphere in auditory language comprehension.

Deep dysphasia, an analogue of deep dyslexia in the auditory modality is a rare and peculiar pattern of repetition disturbance, which has been used to validate Morton's (Deep Dyslexia, pp. 189-196. Routledge & Kegan Paul, London, 1980) logogen theory.

[Anal prolapse in the child].

Two different conditions are contrasted: mucosal prolapse in children aged between 2 and 5 years and total prolapse, which is very rare. Mucosal prolapse has become very rare in industrialised countries because of the excellent improvement in nutrition since the war, while this remains a very serious condition in under-developed countries. It is rapidly cured, provided the therapeutic errors are avoided, in particular cerclage.

[Di George's syndrome complicated by graft versus host reaction].

On the occasion of a case of Di George syndrome, complicated by a post-transfusion lethal graft versus host reaction, the authors review its main clinical and biologic criteria. This case also shows that immune deficiencies should be diagnosed early in order to adopt preventive measures before transferring the patient in a specialized unit, where immunorestitution will be discussed.

[Extensive resection of the small intestine in children].

Thirteen children aged 2 to 16 years have had a subtotal resection of small bowel, following a mid-gut volvulus in 10 cases. All children are still alive, and their growth was normal; 36 cumulative patient-years of parenteral nutrition and 11 years of constant rate enteral nutrition were performed. In 7 cases, where residual small bowel varied between 30 to 120 cm, termination of all artificial nutritional support was possible at a mean of 30 months after intestinal resection.

[The surgical form of the hemolytic-uremic syndrome].

The hemolytic-uremic syndrome consist of micro-angiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis. The syndrome can present in dramatic fashion with severe abdominal pain and signs of peritonitis suggesting an acute surgical crisis. In some cases, laparotomy is necessary, and we report a case with colectomy.

[Prolonged parenteral nutrition in pediatrics: technics and indications].

Prolonged parenteral nutrition is an indispensable technique in a number of gastro-intestinal and non-gastro-intestinal indications in the field of paediatrics. The catheter should be placed in the superior vena cava either percutaneously or surgically. The maintenance of the infusion line, the dressings and the monitoring of the child should be conducted by a specialised nursing team.

[Apparently primary hematoma of the sylvian fissure in an infant].

A 7 month-old infant presented suddenly in coma with left hemiplegia and hemorrhage on ophthalmoscopy. No vascular anomaly was found at surgery; however, examination of the clot showed an abnormal vessel. This case calls for a review of the diagnostic attitude in cases of spontaneous intracerebral hemorrhage in infants.

[Malignant histiocytosis of the intestine. An anatomo-clinical case report].

Clinico-pathological case report of a 11 year-old girl who successively presented persistent abdominal pain, pneumoperitoneum, repeated intestinal hemorrhages, superficial intestinal ulcerations, first localized on the jejunum and later extended to the all gut. After a course of 13 months, the child died from diffuse and repeated hemorrhages. The morphologic studies revealed a diffuse and homogeneous cellular infiltrate made of large round "lymphomatous" cells scattered within the lamina propria and submucosa.

[Contribution of direct immunofluorescence diagnosis to the epidemiology of acute viral respiratory infections in young children].

Rapid diagnosis by immunofluorescence (IF) has enabled us to study the epidemiology of acute viral respiratory diseases in infants admitted to the CHRU at Caen between January 1980 and December 1982. 809 nasal aspiration samples were examined. Respiratory Syncytial Virus (RSV) was recovered in 36% of cases.

[Systematic neonatal screening for mucoviscidosis using an immunoreactive trypsin blood assay. Evaluation of 80,000 tests].

The development of a simple and reliable technique of trypsin radioimmunoassay in blood eluates allowed the neonatal screening for cystic fibrosis in a province of France. The study of the distribution of blood immunoreactive trypsin levels in 79,880 five day-old neonates led to choose a cut-off value of 900 micrograms/l; this choice gives a false positive rate of 3 in 1,000. The evolution of trypsin levels according to age during the first weeks of life leads to select a "two-phase" screening strategy: only neonates whose high neonatal trypsin levels persist after the second week of life (4 in 10,000) will undergo sweat test.

[Hyperammonemia during total parenteral nutrition in children].

Twenty-one children presenting with severe malnutrition were fed with total parenteral nutrition using 2 different aminoacids solutes containing 19% and 42% branched chain aminoacids respectively. With the 42% branched chain aminoacids solute a dysregulation of ammonia metabolism and changes in protein synthesis were observed. Several factors probably accounted for these changes.

[Pulmonary arteriovenous aneurysm].

A case of large arteriovenous aneurysm in the right upper lobe of a 27-year old man is reported. The pulmonary angioma was responsible for a 30% shunt with hypoxia and polycythaemia but was only discovered while looking for the origin of a cerebral abscess. A few weeks after surgical treatment of the cerebral abscess, the right upper lobe was excised with immediate correction of the hypoxia.

[Hyperthermia caused by ultrasonics: trials of mathematical modelling].

We describe preliminary results concerning the mathematical modelling of the hyperthermia induced by an ultrasound transducer. The developed method should allow to predict in advance the local temperatures in every clinical case, as well as to conceive and optimize more complex ultrasound generators.