Pédiatrie
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With few exceptions in extremely rare circumstances, such as sign of raised intracranial pressure, a lumbar puncture must be performed whenever the diagnosis of meningitis is suspected in a child. It serves to confirm a diagnosis of purulent meningitis, to identify the bacteria and to test its sensitivity to antibiotics. If the child responds appropriately to therapy, some authors recommend no further examination of cerebrospinal fluid (CSF). ⋯ Apart from its bacteriological interest, this second lumbar puncture seems to be a prognostic indicator of the incidence of neurological abnormalities. No further CSF examination is necessary when the patient's course of illness is uncomplicated. On the other hand, the presence or appearance of neurological abnormalities during the daily physical and neurological examination compels a new lumbar puncture and a CT scan to search for a persistent central nervous system infection or a complication of the meningitis.
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Medulloblastoma is a frequent brain tumor in childhood. Recent advances in histogenesis, management of early and late side-effects, and prognosis are discussed in this review.
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The increasing aggressivity of the modern technology connected with neonatal resuscitation had led to the recognition by paediatricians of the existence of pain in the newborn, and of the necessity to treat this condition. The neurophysiological development of the neonate is such that it allows pain perceptions even in premature infants; a number of clinical parameters have therefore been described for pain recognition in neonates. An antalgic therapeutic scheme to be used for treatment of pain in the intensive care unit is proposed.
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Lissencephaly is a rare brain anomaly characterized by a lack of cerebral sulci and gyri. We report 2 cases of lissencephaly syndrome with infantile spasms diagnosed by CT-Scan. We discuss the relationship between lissencephaly and infantile spasms, and attempt to estimate the frequency of infantile spasms in lissencephaly and the frequency of this cerebral abnormality among other etiologies of infantile spasms. The prognosis of infantile spasms is indeed variable, according to the presence of underlying cerebral abnormality.
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Recent advances in neurophysiology and neurochemical management of pain has lead to a new concept in pain relief in the post-operative period. After a review of the pain perception mechanism and of the effects of antinociceptive drugs, the authors present simplified protocols for the management of post operative pain in pediatric surgery.