ABSTRACT
Renal arteriovenous fistula (RAVF) is an uncommon vascular malformation of the kidney, which can be congenital, acquired or idiopathic. Although most patients are asymptomatic, RAVF can lead to hypertension, heart failure, renal insufficiency, hematuria, and progressive increase in size of renal vessels. Diagnosis is aided by radiological studies, with digital subtraction angiography as a gold standard. Besides, ultrasound with color Doppler and computed tomography angiography are noninvasive imaging techniques and can be useful for planning the treatment. A large fistula are generally treated by nephrectomy. Intervention can ameliorate the hemodynamic effects of high flow and to preserve the renal parenchymal function. Although endovascular therapy may be challenging due to the large size and high flow of fistula, this report describes a case of huge RAVF was successfully treated by embolization instead of surgery.
ABSTRACT
OBJECTIVES: To analyze the characteristics of the salmonella meningitis in new-borns and infants in France and sum up the complications and treatments. PATIENTS AND METHODS: The observations were taken from the national observatory of bacterial meningitis in children. The medical reports from paediatric and neo-natal departments have been analysed for each patient. RESULTS: The case reports concern 9 newborn babies and infants aged from twelve days to fifteen months (median 4 months). The initial clinical and biologic signs were not specific. Three children had had a digestive infection in the previous weeks, with a positive coproculture for salmonella in two of them. Two infants developed convulsions : 1 of them was hospitalized in intensive care unit ; he also had osteo-articular localisation. All nine children have been treated with third-generation cephalosporins (C3G) and seven of them with quinolones. A newborn who only had cefotaxime and amoxicilline relapsed when the treatment stopped. He showed serious neurological complications and died at the age of eight months. DISCUSSION: Salmonella meningitis are rare in France (our estimation is 0.2 % of all bacterial meningitis). They are more frequent in "emergent countries" (between 1 to 10 %). In such countries, there are important neurological complications and high relapse rates, often followed by death. Literature study and our observations show that the use of ciprofloxacine reduce the frequency of complications and risk of relapse. CONCLUSIONS: The treatment currently advised for salmonella meningitis is to combine in first C3G with quinolone for at least three weeks. Risks of meningitis in case of digestive salmonellosis in infants urge discussion for preventive use of quinolones, particularly before the age of 6 months.
