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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.

Ultrasound was established as a remarkable means of recognizing dysplasia of hips or dislocations in the neonatal period following the work of R. Graf and later in France of H. Gomes and J. Schirrer et al. All the same, different techniques have been suggested and the role of the examination has been debated. Those who advocate routine screening of all pregnancies are in opposition to those who employ it selectively in cases that are known to be abnormal or at risk. The authors report a study carried out in their maternity department using ultrasound of the hip as an examination complementary to clinical screening. Echography has been shown to be able to give more information than radiography of the pelvis which cannot usefully be employed for screening until the age of 4 months. In 1781 newborns examined consecutively the indication for ultrasound of the hip was suggested in 201 cases (11%) and showed an abnormality in 42 patients (21% of the examinations carried out). Exenteration in 2, dysplasia in 8, failure to ossify correctly in 25, and endoscopic laxity without a morphological abnormality in 7 cases. The clinical signs that were used to predict an abnormality on ultrasound were: feminine sex. Clinical appearance of instability and the association of 2 risk factors. 3 cases of dislocation were found. Two of them occurred early and one at the age of 5 months who was a girl delivered by the breech and in whom a delay in ossification was noted at birth.(ABSTRACT TRUNCATED AT 250 WORDS)

We report the beneficial effects of calcium infusions in a child with hereditary resistance to 1,25(OH)2D and alopecia. This patient after transient responsiveness to vitamin D derivatives became unresponsive to all therapy despite serum 1,25(OH)2D concentrations maintained at levels approximately 100-fold normal. A 7-mo trial with calcium infusions led to correction of biochemical abnormalities and healing of rickets. Bone biopsies (n = 3) showed a normal mineralization and the disappearance of the osteomalacia. Cultures of bone-derived cells demonstrated a lack of activation of 25-hydroxyvitamin D 24-hydroxylase and osteocalcin synthesis by 1,25(OH)2D3 (10(-9) and 10(-6) M). These results demonstrate that even in the absence of a normal 1,25(OH)2D3 receptor-effector system in bone cells, normal mineralization can be achieved in humans if adequate serum calcium and phosphorus concentrations are maintained; and calcium infusions may be an efficient alternative for the management of patients with this condition who are unresponsive to large doses of vitamin D derivatives.

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. The carbohydrate and protein nutrients are prepared in the pharmacy and should be adapted daily. The complexity of this technique requires a close collaboration between physicians, surgeons, pharmacists and biochemists. The iatrogenic and metabolic complications may be multiple and severe, but can be reduced to a minimum by a rigorous methodology.

Pneumococcal sepsis and pneumonia in the neonate are rarely reported. They appear either as an early-onset respiratory distress with a high mortality rate or as a delayed infection. The authors describe 3 term neonates with an early respiratory distress syndrome and recall the main points of this severe foeto-maternal infection. Neonatal pneumococcal sepsis is strikingly similar to early-onset group B streptococcal infection. The isolation of the germ in the mother's vaginal flora is hazardous. Such cases suggest that early respiratory support and intensive circulatory resuscitation lead only to a slight decrease in the mortality rate, and thus preventive antibiotherapy is a necessity.

We report for the first time a case of Crohn's enteritis associated with a chronic tubulo-interstitial nephritis in an adolescent. The illness started insidiously in an 11 year-old boy who had suffered from failure to thrive and protracted watery diarrhea. At presentation the patient had an inflammatory bowel disease located to the left colon but no renal dysfunction. Until the age of 15, the intestinal symptoms were stable but a progressive renal insufficiency developed. A percutaneous renal biopsy was then performed which showed a widespread chronic tubulo-interstitial nephritis. Following a 6 months corticosteroid treatment, renal dysfunction seemed to be stabilized. However, delayed growth and corticosteroid dependency led to total colectomy. Pathologic examination showed granulomatosis involvement of the entire colon and severe interstitial nephritis with neither linear nor granulous deposits along tubular basement membranes. After a 2 year-delay following the colectomy, renal function was stabilized and a catch up growth was achieved.

A case of intestinal pseudo-obstruction in a 4 1/2 year-old boy is reported. All etiologic investigations remained negative. Management successively required continuous enteral feeding, ileostomy then total parental nutrition. The proof of a chronic barbiturate intoxication, induced by the mother, was made only after 2 1/2 years of follow-up, when the patient was in a critical condition. Separation of the child from his family led to complete disappearance of symptoms within a few days.

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. These were observed during the four winter outbreaks which occurred during the study period and were extensive in 1980-1981 and 1982-1983. A virus was demonstrated in 13.5% of the 515 RSV negative specimens: 25 Rhinovirus, 21 Myxovirus parainfluenzae 3, 19 Adenovirus, 3 Myxovirus influenzae A, 2 Myxovirus influenzae B. RSV is the predominant pathogen as it is the most frequent and is responsible for more severe forms. However, epidemics vary from year to year and from one town to another. Rhinovirus, Myxovirus parainfluenzae 3 and Adenovirus infections are less frequent. Rhinovirus infections occur throughout the year and are certainly underestimated as isolation of the virus is difficult. Most Myxovirus parainfluenzae 3 cases occur in winter, and IF largely facilitates their diagnosis. Adenovirus infections are endemic and serotype 7 is frequent.

In order to specify the factors responsible for the hepatic changes occurring during total parenteral nutrition (TPN) and to propose a preventive treatment, 30 infants treated for severe protracted diarrhea were prospectively distributed into 4 groups: I (n = 10): controls; II (n = 7): oral administration of human milk since the 15th day of TPN; III (n = 5): oral metronidazole since the 15th day; IV (n = 8): parenteral antibiotic therapy for septicemia since the 1st day. Contrary to group IV, the first 3 groups were randomly constituted on the 15th day. Liver function tests, bile and serum biliary acids, duodenal flora, hepato-biliary ultrasonography and, in 12 cases, liver histology were sequentially studied. Liver function changes were observed on the 15th day in all groups. An improvement occurred 15 days later in the infants treated, when the control group worsened (p less than 0.02). A significant increase of bile chenodeoxycholic acid levels was observed in the control group only (p less than 0.01), without change in lithocholic acid levels. These results lead the authors to recommend the preventive use of metronidazole or human milk during prolonged TPN in infants.

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.