André Kahn

Head stability during whole body movements in spastic diplegia.

Head angular stability is essential for postural control in whole body movement. Using the opto-electronic ELITE system, we have studied head orientation during the movements of squatting from the standing position and straightening-up from the squatting position in 12 children with spastic diplegia and 12 age-matched controls. Although no instruction was given regarding the head, diplegic children consistently performed excessive neck flexion in the squatting movement and excessive hyperextension in the straightening-up movement, whereas normal children maintained the initial orientation throughout both movements. We discuss pathophysiological implications.

Incongruent cerebral growth in sudden infant death syndrome

Sudden infant death syndrome remains a leading cause of postneonatal mortality in developed countries. Its etiopathogenic mechanisms are unknown. In this neuropathologic study, we noticed that the weights of the brains of infants who died from sudden infant death syndrome (n = 97) were invariably heavier in comparison with those of a group of age-matched controls (n = 23) issuing from the same local population. Brain edema was not a major element, and there were no significant microscopic or macroscopic cerebral anomalies in the brains from either of the study groups. Head circumference did not show a parallel increase in infants with sudden infant death syndrome. The excessive brain weight might reflect abnormal cerebral development and could be detrimental to vital neural control. In a previous study, we disclosed cytokine overexpression in the brains of these victims. Whether increased brain weight is linked to cytokine up-regulation remains, however, a moot case and merits further exploration.

Detection of obstructive apnea events in sleeping infants from thoracoabdominal movements

The aim of the study was to determine whether in infants, the evaluation of thoracoabdominal movements alone, with no measurement of airflow, could be used to identify obstructive sleep apnea events (OA). Two different methods were used: first, we initially quantified thoracoabdominal asynchrony. Although 79.3% of OAs showed a significant increase of thoracoabdominal asynchrony, only 10.9% of the events scored by the identification of phase opposition were true OAs. Next, we developed two artificial neural networks (ANNs) as classifiers for the study of the thoracoabdominal signals. The first network was trained to locate obstructive and central apnea events. It correctly detected 75% of the OAs; however, only 6.2% of the detected events were true OAs. When a second network was used, OAs could not be discriminated from other portions of the signals showing similar phase characteristics. It was concluded that the information available in uncalibrated signals of thoracic and abdominal respiratory movements was insufficient to unambiguously detect OA events in sleeping infants.

Accidental Ingestion of Mercuric Sulphate in a 4-Year-Old Child: Management with BAL and Peritoneal Dialysis

From the Department of Pediatrics, Université Libre de Bruxelles, Brussels, Belgium. Correspondence to: D. Blum, M.D., Department of Pediatrics, Université Libre de Bruxelles, Hôpital Universitaire Saint-Pierre, Rue Haute 322-1000 Brussels (Belgium). ACUTE ACCIDENTAL INTOXICATION after c>ral intake of inorganic mercury salts is a rarity nowadays, as the chances of coming across such toxin is exceedingly si-nall. Tli is is particularly true for.children:to our knowedge not a single case has been reported for the last five years. Recently we had the opportunity to treat a child who gained access to mercuric sulphate in a pharmacy where mercuric salts are still sometimes used for the preparation of topical antiseptics.

Sudden infant death syndrome from epidemiology to pathophysiology

Despite the dramatic decline in the incidence of sudden infant death syndrome (SIDS) by 50–90% over the past two decades, SIDS continues to be the leading cause of death in infants aged between 1 month and 1 year in developed countries.

La mort subite du nourrisson(MSN) Données récentes en physiologie

Resume Les campagnes de prevention contre la Mort Subite du Nourrisson (MSN) ont conduit a une diminution significative du nombre de deces inattendus et inexpliques du nourrisson pendant le sommeil. Malgre une recherche intensive dans ce domaine, la comprehension des mecanismes responsables d’une MSN est encore incomplete. Les resultats des recherches epidemiologiques, genetiques, efectrophysio-logiques et anatomopathologiques les plus recentes seront revus. De ces donnees, un modele pour la MSN peut etre elabore : le deces resulterait de la survenue concomitante de trois facteurs (une vulnerabilite prenatale, une periode critique du developpement et des facteurs de stress postnataux) et de 3 mecanismes potentiels (une deficience respiratoire, autonome et des mecanismes d’eveil). Le reveil etant souvent la derniere chance de survie d’un individu soumis a un stress vital, une deficience de ce mecanisme pourrait etre un des facteurs cles du processus conduisant a une MSN. Un nourrisson dont les controles cardiorespiratoires et les mecanismes d’eveil sont alteres peut etre a risque de MSN. Des facteurs genetiques, metaboliques, nutritionnels ou toxiques pourraient etre responsables de lesions prenatales du systeme nerveux central et en particulier du tronc cerebral. Ces deficiences resteraient latentes dans les premieres semaines de vie, jusqu’a une periode du developpement particulierement critique entre 2 et 6 mois, quand des changements significatifs surviennent au niveau de la structure du sommeil, des controles respiratoire et cardiaque. L’incident a de grande chance de survenir lorsque l’enfant est expose a une infection ou a un milieu environnemental defavorable qui aggravera l’instabilite des controles cardiorespiratoires et d’eveils.

Hydrocortisone prevents the increases in permeability and PGE synthesis induced by endotoxin in the isolated rat mesentery

AbstractWe have shown earlier that endotoxin (ETX) increases the permeability coefficient of albumin (PA), and the synthesis of prostaglandin E (PGE) in the rat mesentery (Brachet & Kahn, 1981). As these effects could be inhibited by indomethacin, we had suggested that most, if not all, of the early actions of endotoxin in the mesentery could be ascribed to the local triggering of PGE synthesis. The present experiments were designed as a complement to those cited above. We investigated whether hydrocortisone (HC) might also block the rises in PA and PGE production, induced by ETX. Glucocorticoids eventually inhibit phospholipase A2 (Flower, 1981). and block PG synthesis through other mechanisms than indomethacin.