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Scurvy, a disease related to ascorbic acid deficiency, remains rare in industrial countries. Ascorbic acid is a vitamin that intervenes most notably in the synthesis of collagen and catecholamines. We report the case of a 2-year-old boy hospitalized in a pediatric oncology unit because of an unusual presentation of scurvy revealed by pain and a significant increase in urinary catecholamine levels, raising fear of a neuroblastoma.

We report a case of idiopathic hypereosinophilic syndrome in a young child with favorable outcome after treatment with alpha-interferon.A 5-month-old boy presented with major eosinophilia (187 G/l) associated with splenomegaly. There was no evidence for parasitic or allergic disease. Acute leukemia was suspected but bone marrow smear and medullary caryotype were not compatible. Idiopathic hypereosinophilic syndrome was thus diagnosed. Corticotherapy was started and failed. Finally, complete remission was obtained with alpha-interferon treatment.Idiopathic hypereosinophilic syndrome is uncommon in children. Significant complications like cardiac dysfunction or hematologic malignancies can occur. Treatment has to be quickly started, in order to reduce eosinophilia. Haematological and echocardiographic follow-up are required.

The aim of this prospective study was to evaluate the prevalence of anaphylactoid reactions (AR) in patients dialysed with cellulose or synthetic membranes and the possible link with ACE inhibitors. Survey was conducted for six months (Jan, 1 to July, 1 1993). Thirty dialysis units treating 1573 patients (899 M and 674 F) were participating to the study. At the end of the period under study, only 1536 patients were included in the analysis. Prevalence of AR was calculated from 122 694 hemodialysis sessions. Thirty-three AR in 21 patients (1.3%) (8 M, 13 F), of which 8 severe AR in 5 patients (0.25%) were observed. Annual incidence of AR was 0.17 per 1000 sessions with cellulose membranes and 4.2 per 1000 sessions with synthetic membranes. Relative risk of the occurrence of AR was 10 to 20 times higher with synthetic membranes than cellulose membranes, and 3 to 4 times higher in patient treated with ACE inhibitors than in those no treated. Prevalence of AR with AN69 membrane (3.2%) was not significatively different from that with other synthetic membranes (1.6%). However, treatment with ACE inhibitors increased strongly the risk of AR in AN69 patients (7.2%) in comparison to patients treated with other synthetic membranes (1.6%) (0.1). Prevalence of severe AR was 0.25% in total dialysed population, 0.5% in patient treated with synthetic membranes, 1.1% in AN69 patient and 4.9% in AN69 patients treated with ACE inhibitors. Relative risk of AR is at least 20 times higher in dialysed patients with ACE inhibitors (1.7%) than other dialysed patients without ACE inhibitors (0%). Seventy-two percent of AR occurred in 2/30 dialysis units, thus demonstrating the role of a "un effect". That suggest the role of a "third factor" in the occurrence of AR.

Twelve patients with chronic renal failure, on maintenance hemodialysis have a stereotyped illness. The dialysate was made up from a high level aluminium tap water. After having been on haemodialysis for 10 to 12 months, they suffer from more and more acute osteodystrophic, osteomalacic symptoms. Then, distinctive EEG abnormalities appear. These first symptoms allow an early diagnosis of the progressive dialytic encephalopathy. The neurological symptoms appear some months later. Eight patients died from this encephalopathy. Four patients are still alive and are, from at least two years, on maintenance haemodialysis with a free aluminium water. In these 4 cases, the evolution of the disease is good: osteomalacic symptoms disappear in a year; the neurological symptoms are still present though transient. EEG abnormalities remain and blood aluminium level is about 100 micrograms/L. These cases show, once more, the significant role of aluminium as an aetiological factor in "progressive dialysis encephalopathy".