[Mediastinal form of cat-scratch disease]. / Forme médiastinale de la maladie des griffes du chat.

The authors reported a case of Cat--Scratch Disease (CSD) in a 14-year-old boy; it was an unusual CSD by its mediastinal mass location. Histopathological lesions which appeared as pseudo-tubercular folliculi mislead us. Disease was finally diagnosed by biological exams: a strongly positive Hanger-Rose reaction and serological assays used for the diagnosis of psittacosis, ornithosis, lymphagranuloma venereum and trachoma. CSD is a common cause of chronic lymphadenopathy in children. In the majority of patients, CSD is a mild illness. Some unusual forms as Parinaud's oculoglandular syndrome, neurological lesions, osteomyelitis and exceptionaly mediastinal lymphadenopathy have been reported. 2 cases of the latest ones were already described.

[Pharmacokinetic of cyclosporin A]. / Pharmacocinétique de la ciclosporine A.

Pharmacokinetic studies of 13 children treated with cyclosporine A (CyA) were retrospectively analysed (9 renal transplants, 1 combined liver-kidney transplant, 1 heart transplant; 2 were treated for a nephrotic syndrome). The patients were separated into 2 groups: patients 0-15 years (group 1), patients 15-18 years (group 2). In comparison with adults (group 3), children of the 2 groups required higher CyA doses, related either to body weight or to body surface area. CyA dosage was performed by high performance liquid chromatography on whole blood samples. Despite higher doses, trough CyA levels were lower in groups 1 and 2 compared with group 3. Nephrotoxicity occurred in the only 2 children treated with CyA doses higher than 10 mg/kg/d.

[Familial form of hypoglycemia due to leucine hypersensitivity]. / Forme familiale d'hypoglycémie par hypersensibilité à la leucine.

The authors report on a boy and his mother showing signs of hypoglycemia due to hypersensitivity to leucine that is related to a that dominant autosomal. The cyclic inheritance glycemia test shows hyperinsulism; oral as well as intravenous loading dose of leucine tests showed that this hyperinsulism is due to hypersensitivity to leucine. The clinical picture, outcome of the disease dietary and medical treatment with diazoxide, and the role of GIP in insulin secretion is discussed.

[Uncommon clinical aspects of Plasmodium falciparum malaria]. / Aspects cliniques inhabituels de paludisme à Plasmodium falciparum.

An attack of malaria can be lethal; however, besides this classic form, clinical cases are less brutal, often with blood disorders, related to Plasmodium falciparum infection resistant to chloroquine. Because of the importance of chloroquinoresistance through the world, chemoprophylaxis is very difficult, and the fight against mosquitoes' bites is once again very important.

[Fusobacterium necrophorum septicemia in an infant]. / Septicémie à Fusobacterium necrophorum chez un nourrisson.

In a 9 month-old infant admitted to hospital for a fever with chilles, anaerobic blood cultures isolated Fusobacterium necrophorum. On the 5th day of intravenous treatment with amoxicillin and metronidazole clinical signs of mastoiditis, the likely source of the sepsis, became apparent. Septicemias with Fusobacterium necrophorum are usually observed in teenagers and young adults during an acute bout of tonsilitis. This type of infection is exceptional in infants and requires a careful search for a primary focus in facial cavities and in the base of the skull.

[Maternal-child transmission of Chlamydia trachomatis. A prospective inquiry in 168 pregnant women]. / Transmission materno-infantile de Chlamydia trachomatis. Enquête prospective chez 168 parturientes.

A prospective study was performed in 168 pregnant women in order to evaluate the frequency of perinatal transmission of Chlamydia trachomatis and to measure its effects on the child's health during his first 3 months of life. The micro-organism was detected by an immunoenzymatic method specific to Chlamydia antigens, and microimmunofluorescence was used for serological testing. Cervical smears taken at the end of pregnancy were positive in 3 women (1.7 per cent), while the sera of 37 women were positive for Chlamydia trachomatis. Altogether, 26.8 per cent of the women explored had had a contact with the micro-organism. Conjunctival smears taken from 1 month old infants were all negative, but 4 infants (out of 126) had positive nasal smears. The mothers of 2 of these had been exposed to the bacterium, but all 4 mothers had negative cervical smears. Antibody titres in 3-month old infants were 1.2 dilution on average below those found in the mothers. Women exposed to Chlamydia trachomatis are frequently unmarried; their pregnancies tend to shorter than normally, and their infants have more frequent episodes of rhinitis. These peculiarities are insufficiently pronounced to single out a population at risk that might benefit from detection of the bacterium.

[Evaluation of soluble bacterial antigens detected by electrosyneresis in infectious diseases in children]. / Evaluation de la recherche d'antigènes bactériens solubles par électrosynérèse en pathologie infectieuse de l'enfant.

The diagnostic interest of the search for soluble bacterial antigens, using counter-current immunoelectrophoresis (CIE) has been evaluated in 109 children hospitalized with acute infection. In meningitis, CIE was well correlated with cerebrospinal fluid (CSF) culture and allowed a rapid diagnostic orientation in 82% of meningitis which were confirmed by classical bacteriology (CIE has to be performed using CSF and concentrated urine). False positive results were observed with type B meningococcus, especially on urine samples. In respiratory infections, the search for soluble antigens was of no interest except for focal pneumonitis; in that case, CIE was more frequently positive (35%) than blood culture (28%) and led to a 31% increase of correct diagnosis (CIE must be performed using concentrated urine). Serum and pleural fluid investigations were less sensitive. CIE was not useful in case of upper respiratory or nonfocal broncho-pulmonary infection, due to its very low efficiency.

[Chlamydia trachomatis in pediatrics]. / Chlamydia trachomatis en pédiatrie.

In developed countries, Chlamydia trachomatis (CT) is found on the cervix of the uterus in 2-8% of pregnant women. Two thirds of neonates from infected mothers are contaminated at delivery at the level of ocular, respiratory and digestive mucosal surfaces. This infection is responsible for 40% of neonatal conjunctivitis and afebrile pneumonitis in the second and third month after birth. In older children and adolescents, CT is responsible for genital infections contracted by venereal contact. The treatment requires taking a macrolide orally for 15 days. Prevention requires the detection of high-risk women, and hygiene in sexual intercourse.

[Cutis marmorata telangiectatica congenita with body asymmetry]. / Cutis marmorata telangiectatica congenita avec asymétrie corporelle.

One case of Cutis marmorata telangiectatica congenita (CMTC) is reported with cutaneous signs, corporal asymmetry, macrocephaly and cerebral vascular malformation. This syndrome allows to recognize a particular type of CMTC and its relationship with other angiomatosis.

[The role of Mycoplasma pneumoniae in acute pneumopathies in children]. / Rôle de Mycoplasma pneumoniae dans les pneumopathies aiguës de l'enfant.

Among 199 cases of bronchopulmonary infection in children observed over a 2-year period, 22 cases (11%) were due to Mycoplasma pneumoniae. The diagnosis was based upon the complement fixation test on whole serum in half of the children and the research of specific IgM by complement fixation test on fractioned serum and/or indirect immunofluorescence on the others. The mean age of children with Mycoplasma pneumoniae was 6 years. The clinical and radiographic appearance of the affection was non specific, often similar to pneumococcal pneumonia.

[Neuromeningeal hypodermyiasis complicated by hydrocephaly. Value of nuclear magnetic resonance imaging]. / Hypodermose neuroméningée compliquée d'hydrocéphalie. Intérêt de l'imagerie par résonance magnétique nucléaire.

A 9-year old country boy developed blepharitis with inflammation of the face and, 1 month later, eosinophilic meningitis with paralysis of 3 limbs and of an abducent nerve. Nuclear magnetic resonance imaging of the central nervous system disclosed a lesional signal beneath the floor of the 4th ventricle, which was compatible with the presence of a larva of fly. Treatment with thiabendazole was tried, and the clinical signs regressed. Six months later, an asymmetrical hydrocephalus due to obstruction of Monroe's foramen by an inflammatory granuloma was discovered. Human hypodermyasis, due to migration in tissues of larvae of flies, is not rare in cattle-breeding areas. Neuromeningeal disorders are observed in 12% of the cases, consisting of eosinophilic meningitis sometimes associated with neurological deficit or seizures. Such complications as intracerebral haematoma or meningeal haemorrhage may occur during the usually benign course of the disease.

[Hydranencephaly and congenital toxoplasmosis. Apropos of 4 cases]. / Hydranencéphalie et toxoplasmose congénitale. A propos de quatre observations.

Four cases of congenital toxoplasmosis with hydranencephaly are reported. The anatomic lesions are the consequence of ischemic necrosis and foetal hydrocephalus. The risk of such lesions is highest during the second trimester of pregnancy. The preventive steps against congenital toxoplasmosis are recalled.

[Epstein-Barr virus encephalitis. Apropos of a case in a child]. / Encéphalite à virus d'Epstein-Barr. A propos d'un cas chez l'enfant.

Encephalitic illnesses with Epstein-Barr virus (EBV) only represent a small percentage of the causes of viral encephalitis. Clinical symptoms are not specific. Biological standards tests carry few elements of direction, only serologic test of infectious mononucleosis confirms the diagnostic of recent EBV infection. Previous observation shows that the initial study can present similarities with herpes simplex encephalitis, which forces the immediate start of treatment by Acyclovir.

[Polycystic kidney and Bourneville's tuberous sclerosis. Apropos of 2 cases]. / Polykystose rénale et sclérose tubéreuse de Bourneville. A propos de 2 observations.

Abdominal tumor is discovered in a 4 months old boy and a 2 years old another. The paraclinical exploration leads to the diagnosis of polycystic disease. But the clinical course permits to precise that the renal lesions are those of tuberous sclerosis. Indeed the children exhibit adenoma sebaceum at ages of 4 and 7 years.

[Bourneville's tuberous sclerosis of neonatal disclosure. Apropos of 2 cases]. / Sclérose tubéreuse de Bourneville à révelation néonatale. A propos de deux observations.

A cardiac murmur was found in a newborn, after 12 hours of life. It was related to an intracardiac tumor, and we made the diagnosis of tuberous sclerosis. The same diagnosis was made in another patient, with a tumor diagnosed by obstetrical echography. In these two cases, seizures occurred rapidly during the evolution. In one case, the heredity was dominant, in the other one, it was a "de novo" mutation. It is unusual to diagnose tuberous sclerosis during the neonatal period, so we report these two cases.

[Intracranial arachnoid cysts in children. Apropos of 8 cases]. / Les kystes arachnoidiens intracrâniens de l'enfant. A propos de 8 observations.

Eight cases of intracranial arachnoid cysts are reported. They are benign congenital lesions who result from an abnormal development of the earliest arachnoid. A subsequent development is possible. The macrocephaly is the first sign and other symptoms give evidence to the localization. Thanks to the C.T. scan one can make the diagnosis, appraise the repercussion and put the therapeutic indications. The surgical treatment is reserved to symptomatic forms. The peritoneal shunt takes the ablation's place. This method is easier and less liable to complications. The results depend on the localization, the pattern of operation and the precocity of the diagnosis.

[Giant axonal neuropathy. Apropos of a case]. / Neuropathie à axones géants. A propos d'une observation.

A new case of giant axonal neuropathy is reported about an 11 years old boy born with the Robin anomalad. The diagnosis is based on a peripheral nerve biopsy. This new observation can be added to 12 others ones which have already been published to study the characteristics of this peripheral neuropathy. The etiology and physiopathology are unknown.

[Complications of varicella as a function of the terrain. Apropos of 103 cases]. / Complications de la varicelle en fonction du terrain. A propos de 103 observations.

The complications of varicella have been studied in 103 cases of hospitalized children. The patients have been divided into two groups: group I comprises 94 previously healthy children; group II is made up of 9 children who have been treated by corticotherapy for a long time. The frequency of the complications is not statistically different between the two groups. On the other hand, all the fatal complications are observed in group II (3 deaths out of 9 patients). This investigation is in accordance with published data which allows us to characterize a high risk population for life threatening varicella: patients with congenital or acquired cell immunity deficiency. This group requires special therapy: vaccination, specific immunoglobulins and acyclovir.

[Haemophilus influenzae meningitis in infants. Apropos of 22 recent cases]. / Les méningites à Haemophilus influenzae du nourrisson. A propos de 22 cas récents.

In a three years retrospective evaluation, the authors point out an important increase of hemophilus influenzae meningitis. This germ, who seem to be actually the first cause in infants bacterial meningitis, set the problem of his Ampicillin resistance (10-15% of cases). It is therefore necessary to change first treatment of these meningitis. Cefotaxime which has been prescribed to 50% of cases gives satisfactory results.