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Succinylcholine is a neuromuscular block whose duration of action depends on rapid hydrolysis by butyrylcholinesterase (BChE). In patients with common BChE activities, succinylcholine duration of action is short (10min). BChE deficiency induces a slower hydrolysis of the drug and consequently prolonged neuromuscular block, leading to apnea. We report a case of prolonged neuromuscular block after administration of succinylcholine in a 14-year-old boy. Biological investigations revealed a marked BChE deficiency (1099U/L) related to the presence of three point mutations in the BCHE gene in a compound heterozygous state: p.Asp70Gly (rs1799807), p.Ala539Tyr (rs1803274), and p.Phe118Valfs*12 (rs398124632). The diagnosis of genetic BChE deficiency (OMIM 177400) was retained. This case is intended to present the pathophysiology of genetic BChE deficiency, its management, and the diagnostic strategy to be implemented., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Whilst underwater, the body is submitted to significant variations of the surrounding pressure according to the depth. These conditions modify the hemodynamic and the ventilatory mechanics considerably. Some repercussions, like pulmonary barotrauma, are related to simple physical phenomena. Others, like decompression sickness, are due to more com- plex processes. Breath-hold diving disrupts haematosis and can be complicated by alveolar haemorrhage and loss of consciousness. Acute pulmonary oedema during scuba-diving, breath-hold diving and swimming has been reported more recently. In case of pulmonary disorders scuba-diving is contraindicated most of the time. It is therefore highly recommended to seek medical advice to prevent problems.

Introduction: Apnea of prematurity develop during the first days of life and usually resolve by the time the infant reaches 36-37 weeks postmenstrual age. In a few cases, they persist beyond term, especially in infants delivered at the youngest gestational ages (24-28 GA), and require specific care. In our unit, those preterm babies are discharged home with caffeine citrate treatment. Discontinuing the treatment is performed in hospital when they achieve a postmenstrual age of at least 42 weeks., Objective: To identify predictive factors of persistent apnea in preterm babies., Material and Methods: Retrospective study comparing a population of 41 preterm infants discharged with treatment to 123 preterm babies discharged without treatment to identify predictors of persistent apnea., Results: Factors significantly associated were: birth weight<1500 g, initial hypotension, gastroesophageal reflux, need for continuous positive airway pressure and multiparity. At home, no infant died and no adverse effect was reported by parents., Conclusion: Persistent apnea can be responsible for prolonged hospitalization. Risk factors can be identified in some children. Discharging with treatment can be an alternative to their hospitalization.

Unlabelled: We conducted a case control study during six and a half years with the objective to analyse the risk factors for NEC., Population and Methods: All cases of confirmed NEC matched to controls for identical gestational age and period of hospitalization; apnoeas-bradycardias prospectively counted., Results: Forty-five cases were compared to 89 controls. The isolated risk factors were: an intra-uterine growth retardation (OR = 3,65, 95% confidence interval [CI] 95%: 1,54-8,63); a birth weight < 1000 g (OR = 8,16, CI 95%: 1,17-56,62), compared to a weight >/= 1500 g; a triple antibiotherapy (OR = 6,15, CI 95%: 1,16-32,45); an umbilical venous catheterization (OR = 2,64, CI 95%: 1,09-6,44); a number of simple apnoeas-bradycardias >/= 3rd tercile (n = 27) (OR = 4,54, CI 95%: 1,29-15,93), or severe (stimulated or with hypoxia) apnoeas-bradycardias >/= 3rd tercile (n = 8) (OR = 6,15, CI 95%: 1,59-23,75); an haemoglobin level lower than the 1(st) tercile (95 g/L) (OR = 5,90, CI 95%: 1,20-20,13); and milk thickening by Gumilk (OR = 2,78, CI 95%: 1,11-6,90)., Conclusion: In the present practices, anoxo-ischemic factors during the first week of life do not represent an important risk of NEC; a great vigilance must be exercised for indications of the triple antibiotherapy and the treatment of apnoeas-bradycardias.

Incidence and severity of apnea and bradycardia in preterm infants may be related to the immaturity of the respiratory control mechanisms. In addition, there is a steadily increasing risk for sudden death with decreasing birth weight or gestational age during the first year of age, justifying the search for a specific preventing strategy for very low birth weight (VLBW) infants. The purpose of this paper is to define practical preventive guidelines for VLBW infants at the time of discharge from the neonatal intensive care units. Polysomnography appears as a useful method to detect those among the VLBW infants who are at risk of life threatening events and may need home monitoring.

To date, pulmonary oedema in breath hold divers has only been reported after dives below 50 meters, hypoxaemic syncope being the most common risk. We recently observed a 35-year-old well-trained breath hold diver who was unable to achieve deep inspiration during a high-level competition. After two hours of repeated dives to a depth of 25 meters for approximately 2-minute periods with intermittent recovery the patient developed cough and haemoptysis. The chest X-ray revealed lung images suggestive of intra-alveolar haemorrhage. The patient had taken 1 g of aspirin per os for three days prior to diving. Symptoms subsided spontaneously in 48 hours and one month later all haematology tests were normal except for minimal alteration of platelet aggregation. Pulmonary oedema in breath hold divers is usually attributed to blood shift to the pulmonary circulation related to the lowered intra-thoracic pressure. In our case, oedema was secondary to intra-alveolar haemorrhage favoured by aspirin which should be avoided before breath hold diving.

The authors have taken an interest in isolated vertiginous symptoms observed from free diving patients. In order to achieve a current bibliographic synthesis, they resume, on basis of 6 cases, the basic principles of the physics theories and the etiopathogenic mechanisms. They try so to help in the understanding of the vestibular clinical signs observed in this successful sport.

This sudden death of a new-born baby, which had been thriving up to then, is a dramatic but not exceptional event. A systematic search for the etiology must be made, and this should include an autopsy in order that the diagnosis of "sudden and unexplained death" is confirmed only after eliminating all other possible causes. Knowledge of this syndrome has benefited from epidemiological surveys which have defined the previous clinical condition, but none of the many etiollotical hypotheses envisaged can take into account the total number of cases reported. One of the most recent cases developed apnoea during sleep, which could explain some unexpected deaths in new-born babies. This was discovered by polygraphic sleep recordings and confirmed by pathological examinations. These demonstrated indirect signs of chronic hypoxia which could have been related to the sudden death of the baby. Though there does not appear to be any relationship between the apnoea syndrome during sleep and these sudden and unexpected deaths, this hypothesis has opened up a new promising line of research which could help to identify new-born babies at risk from "sudden death", and to propose preventative measures.

The supine distal esophageal pH was recorded over 24 hours, in low birth weight infants. Forty-seven of them were asymptomatic (group T) and 93 presented with digestive symptoms (regurgitations and/or vomiting) associated (group DA; n = 49) or not (group D; n = 44) with a history of apneas, bradycardias, cyanosis or pallor fits. On the recording day, post-natal ages (weeks), conceptional ages (weeks) and weights (g) were not different among the 3 groups (T: 4.8 +/- 2.6; 40.1 +/- 2; 2,590 +/- 210. DA: 4.7 +/- 3.3; 40 +/- 3.3; 2,980 +/- 640. D: 4.7 +/- 2.8; 41.1 +/- 3.3; 2,710 +/- 620). In the 3 groups all the features of the acid and highly acid gastroesophageal refluxes (GER) were significantly more marked in late post-prandial stages (LPPS) than in early post-prandial stages (EPPS) (p less than 0.001). Slightly acid GER were more frequent in LPPS than in EPPS for groups T and DA (p less than 0.01). No significant difference could be found when comparing group T with groups D, DA and with a sample of 21 infants presenting with vomiting.

From 1978 to 1985, 679 boys were operated for an inguinal hernia. 3 groups of patients must be considered. The bilateral inguinal hernias group (119 children) 73 patients were operated on both sides. 46 presented signs of hernia on the opposite side after the first operation and were operated again. In this group, there is a more important frequency of premature. But the classical notion that bilateral hernia are more common when the presenting hernia is on the left side, is not noticed. As a matter of fact, among the 46, there were 33 children operated at first on the right side. If a systematic bilateral exploration had been realised, it would here been useless in 82 per cent of the cases. The incarcerated inguinal hernia group 177 (26%) children were hospitalised for an incarcerated inguinal hernia diagnosis. 23 infants required emergency operation. Mostly, it was the first episode of a right hernia in a child under 3 months of age. 8 times a testicular infarction was noticed. The incidence of testicular lesion following incarceration of inguinal hernia is more important that the testicular atrophy after primary hernioplasty. This justify the surgical treatment for children of any age. The premature group 126 children were premature infants. In this group, a more important frequency of bilateral and incarcerated hernias are noted. 24 among these patients presented recurrent apnea episodes. To 8 of those children, the intervention was probably a benefit for the evolution of their apneas.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-seven subjects with insomnia or diurnal hypersomnolence presented a sleep apnea syndrome when their respiration was systematically checked during sleep. These sleep-induced respiratory abnormalities were completely occult and pulmonary function tests performed during wakefulness were normal. The patients, all non-obese, presented serious pulmonary artery pressure changes which were directly connected with the repetitive sleep apneas. Half of the patients also had systemic hypertension. Two children (aged 11 and 15) underwent tracheostomies which by-passed the sleep-induced obstruction. Systemic hypertension was reduced after surgery.

Sleep and respiration were recorded during two consecutive nights in 15 normal subjects, 18 patients suffering from narcolepsy and 9 with non-cataplectic hypersomnia. The normal subjects showed episodes of central apnea, the degree of which increased with age and periodic respiration. In both categories of hypersomniacs, the patients were divided into three groups according to the severity of disturbances in nocturnal respiratory rhythm:--group 1: identical to the normal subjects,--group 2: moderate qualitative or quantitative abnormalities,--group 3: presence of a large number of episodes of obstructive apnea. On the basis of these results, it was concluded that disturbances in nocturnal respiratory rhythm are not specific for any particular type of hypersomnia, nor were they the main cause of hypersomnia when present to a large extent, but that obstructive apnea could be an aggravating factor.

Twenty ASA I or II patients were studied to assess the safety of oxygenation for 4 min prior to intubing, so as to prevent the hypoxaemia related to tracheal intubation. The arterialized capillary blood saturation (Spo2) was continuously monitored with a pulse oximeter Nellcor 100 equipped with a finger probe. Patients spontaneously breathed oxygen (FIO2 = 1) while anaesthesia was induced with pancuronium bromide, thiopentone and fentanyl. Following apnoea, ventilation was manually controlled during 4 min (FIO2 = 1). The values of Spo2 were recorded before induction, at the end of the 4 min oxygenation period and after 5 min of apnoea. An arterial blood sample was withdrawn at the end of apnoea and analysed immediately using an OSM 2b hemoximeter. Apnoea was interrupted in case of desaturation below 95%, new arrhythmia or haemodynamic instability (blood pressure +/- 20% of control value). Mean saturation (+/- SD) before oxygenation was 98.6 +/- 1.35%. After oxygenating for 4 min, all the Spo2 reached 100%. After the 5 min apnoea period, no saturation was below 95% (mean +/- SD = 98.89 +/- 1.66); at this time, Sao2 and Spo2 did not significantly differ (p less than 0.001). In one case, apnoea had to be interrupted, because of the occurrence of arrhythmias, unrelated to a blood gas disorder (PaO2 = 225 mmHg; Paco2 = 34 mmHg; SaO2 = 100%; pH = 7.44). This study confirmed the efficacy and safety of oxygenating for 4 min before intubation.(ABSTRACT TRUNCATED AT 250 WORDS)