[Vagal hyperreactivity and sudden infant death. Study of 15 families]. / Hyperréactivité vagale et mort subite dans la fratrie. Etude des 15 familles.

Prone sleep position is obviously the main risk factor for sudden infant death. Other risk factors, such as vagal overactivity particularly in the familial form, are still discussed. We here report 15 families characterized by the coexistence of vagal overactivity and sudden infant death. At least, 1 child for each family had documented [Holter or occulo-cardiac reflex (OCR)] vagal overactivity. In 5 families 2 children were affected; in 2 families 3 children were affected and in 1 family 4 children were affected. Sudden death occurred in the elderly of the family in 8 cases, in the twin in 3 cases, in the 2nd in 3 cases and in the 5th child in 1 case. Within the 15 families, at least 1 parent had experienced vagally-induced fainting or syncope in 10 cases. Familial pattern of vagal overactivity is underlined. Possible links between vagal overactivity, risk factor for suddden death and sudden death are discussed. We suggest an Holter-ECG and OCR follow-up for sudden infant death siblings with history of familial vagal overactivity (3 examinations during the 1st year of life, at 1, 3 and 9 months).

[Sustained ventricular tachycardia in older children. Spontaneous regression in 3 cases]. / Tachycardie ventriculaire en salve soutenue du grand enfant. Guérison spontanée de 3 cas.

Extensively described since Gallvardin's reports, the electrical features of salves of ventricular tachycardia in an apparently healthy heart are now well known. The usual benign nature of this arrhythmia is acknowledged, seldom contradicted by isolated clinical cases. Although chronicity is the rule in young adults, there have been a few publications concerning the natural history of these tachycardias in the paediatric age group. The authors report three cases of episodic sustained ventricular tachycardia in older children, presenting at an average of 7 years of age (range 5 to 9 years) and followed up for an average of 7 years (range: 5.5 to 9 years). These three children were treated for an average of 4.5 years (range: 3 to 5.5 years). All treatment was finally withdrawn when stable permanent sinus rhythm without ventricular extrasystoles was restored and confirmed over an average period of 2 years (range 10 months to 3.5 years), an average of 4 (range 3 to 7) successive normal Holter recordings at several months' interval. The outcome in children to spontaneous regression after several years would seem to make radiofrequency ablation more dangerous than useful given the benign nature of the arrhythmia and its good response to pharmacological intervention.

Flumazenil in the treatment of hepatic encephalopathy in children with fulminant liver failure.

OBJECTIVE: To evaluate the effect of flumazenil on hepatic encephalopathy complicating fulminant liver failure in children. DESIGN: Uncontrolled prospective study. SETTING: Pediatric Intensive Care Unit, tertiary care center. PATIENTS: 9 children with fulminant liver failure and hepatic encephalopathy awaiting emergency liver transplantation. INTERVENTIONS: Changes in hepatic encephalopathy grade and in electroencephalogram were recorded during the injection of a bolus of flumazenil (0.01 mg/kg/i.v. bolus) followed by a continuous infusion of flumazenil (0.01 mg/kg/h). MEASUREMENTS AND MAIN RESULTS: Before flumazenil, 7 children had grade 2 and 2 had grade 3 hepatic encephalopathy. Flumazenile injection mediated an arousal effect in 1 child in whom encephalopathy improved from grade 3 to grade 2. This effect lasted 30 min. No clinical response was observed in other children. An improvement of EEG anomalies was observed lasting 3 min in one child. Despite continuous infusion of flumazenil, encephalopathy worsened in all children. CONCLUSION: The effect of intravenous administration of flumazenil on hepatic encephalopathy in children with fulminant liver failure is inconsistent. Its efficacy is transient. The therapeutic value of flumazenil in children with fulminant liver failure awaiting a liver graft is minimal at this dosage.

Combretodendron Africanum bark extract as an antifertility agent. I: Estrogenic effects in vivo and LH release by cultured gonadotrope cells.

An aqueous extract from the stem bark of Combretodendron africanum was prepared to investigate its potency as a regulator of fertility. The intraperitoneal LD50 in mice was 95.2 +/- 4.3 mg/kg. Daily i.p. injections of 50 mg/kg promoted a significant increase in the uterine weight of 25 day-old female rats while pituitary weight remained unaffected. Similar injections for 21 days to mature females blocked the estrous cycle in the luteal phase with a mean length of efficiency of 15 days and decreased plasma LH and FSH levels. Regular cycles were restored 10 days following the last injection. C. africanum extract was shown to compete with estradiol and with progesterone on uterine receptors. Consequently, it is thought to contain substances exhibiting estrogenic (and possibly anti-estrogenic) potency. The effects of the extract on LHRH-induced release were investigated on cultured pituitary cells. Although gonadotropin release was amplified, the extract itself appeared as to be a potent secretagogue not requiring LHRH receptors. It follows that the active molecules contained in C. africanum extracts may be different from classical steroid estrogens.

[An unusual echographic evolution of an adrenal hematoma in a newborn infant]. / Evolution échographique inhabituelle d'un hématome de la surrénale chez un nouveau-né.

We report a case of adrenal hematoma whose ultrasound features ran an unusual course suggestive of a neuroblastoma. Surgical removal was finally performed at two months of age. We describe the unusual ultrasound features in this case and emphasize the value of ultrasonographic monitoring that is the only means for eliminating other diagnoses, particularly a neuroblastoma.

Spectrum of complications of measles in Afghanistan: a study of 784 cases.

Seven hundred and eight-four patients with measles admitted to the Institute of Child Health, Kabul (Afghanistan) between April 1980 and March 1982 were studied. Almost three-quarters (73.6%) of children (4 months to 12 years) with measles were below the age of 3 years. The maximum number of cases occurred in the 1 to 2 years age group (43.1%). Eighty-nine patients (11.3%) contracted the disease before 1 year of age whereas only 13 infants had developed measles before the age of 7 months. Measles occurred throughout the year and there was no significant seasonal variation. Bronchopneumonia was the commonest complication (85.4%) followed by enteritis (30.2%) and laryngotracheobronchitis (22%). The overall mortality was 10.8%. Respiratory complications including bronchopneumonia and laryngotracheobronchitis were the commonest causes of death followed by encephalitis and gastroenteritis. However, the case fatality rate was highest among patients who suffered from encephalitis and laryngotracheobronchitis. In our study, there was no significant difference in the incidence of mortality between well-nourished and moderately undernourished children. It is recommended that in developing countries measles vaccination should be given around 8-9 months of age and must be completed before the age of 1 year.

[Natural substances regulating fertility. Effect of plant extracts in the Ivory Coast pharmacopoeia on the release of LH by hypophyseal cells in culture]. / Substances naturelles régulatrices de la fécondité. Action d'extraits de plantes issues de la pharmacopée ivoirienne sur la libération de LH par des cellules hypophysaires en culture.

The in vitro action of hydro-alcoholic extracts of plants from Ivory Coast pharmacopoeia was analyzed on cultured rat pituitary cells. Cells were treated for 24 hours with various doses of extracts and then stimulated for 4 hours with 10(-8) M LHRH. Extracts from Afrormosia laxiflora, Cola nitida, Pterocarpus erinaceus and Tetrapleura tetraptera inhibit the LHRH-induced release of LH. On the contrary, extract from Combretodendron africanum stimulates the basal release of LH and this increase is added to the LHRH-induced release. Therefore, the natural substances contained in these plants may in vitro exert a regulation of the gonadotropin release.