[Neonatal pneumococcal septicemia]. / Septicémies néonatales à pneumocoque.

We report two cases of neonatal pneumococcal septicemia, including one fatal case in a 32-week-gestational-age premature infant. Neonatal pneumococcal septicemias account for less than 1% of all neonatal infections. Diagnosis is provided by simple and rapid methods for identifying pneumococci. Clinical features have little specificity (respiratory distress) and resemble those found in B streptococcus infections. The mother rarely exhibits symptoms at delivery. The severity of the prognosis is not related to resistance to the antimicrobial agents currently used in neonatal infections but to the infectivity of the organism itself and to the specific immunologic characteristics of premature neonates. The current use of amoxicillin and aminoglycosides in neonatal infections does not therefore need to be revised.

[Metabolic and cardiovascular effects of beta-blockers taken by the mother in newborn infants]. / Effets métaboliques et cardiovasculaires chez le nouveau-né des bêtabloquants pris par la mère.

The effects of beta-blockers administered to mothers with arterial hypertension were investigated in 38 neonates of varying gestational age and weight. During the first 48 hours of extra-uterine life, heart rate was continuously monitored and blood pressure and glycaemia were measured every 3 hours. Left ventricular function was studied by echocardiography on the first day post-partum, once again between the 5th and 10th days. Hypoglycaemia was observed in 42% of the neonates; 47% had one or several episodes of bradycardia and 2 had arterial hypotension. Most important, a significant improvement of left ventricular function was observed between the first and the 5th-10th days. This time-related change was not found in a control group. The cardiac dysfunction was more pronounced in neonates who had an episode of bradycardia, and although it is usually asymptomatic, it probably accounts for the fortunately rare cardiovascular collapses observed in some newborn babies.

[Value of continuous Doppler velocimetry for the diagnosis of patent ductus arteriosus]. / Intérêt de la vélocimétrie Doppler continu pour le diagnostic de la persistance du canal artériel.

A study of the curve of wave Doppler ultrasonography of 3 arterial axes (carotid, subclavian and femoral) was performed in 32 children in whom the diagnosis of patent ductus arteriosus was suspected. A continuous 8 MHz wave directional ultrasonic Doppler apparatus was used. At the level of subclavian and femoral arteries, patent ductus arteriosus is associated with a negative holodiastolic wave on the curve. At the carotid level, disappearance of the physiologic diastolic elevation may be the only change observed. Three groups were studied (1) 15 premature neonates with isolated murmur, (2) 15 premature neonates with respiratory distress and (3) 2 older children. In group 2, diagnosis of patent ductus arteriosus relies on clinical signs. A good correlation between Doppler and clinical data and/or TM ultrasonography was observed in 93% of cases.

[Evaluation of the search for soluble antigens in the cerebrospinal fluid from 31 cases of purulent meningitis in children]. / Evaluation de la recherche des antigènes solubles dans le liquide céphalo-rachidien de 31 cas de méningites purulentes de l'enfant.

Soluble antigens were looked for in 31 cases of purulent meningitis in children aged one day to 16 years. The latex technique was used in this study. Negative cases were controlled by counter-immune electrophoresis and by ELISA. From the results of our study and after a review of the literature, it appears that the latex technique is the best method at present to identify soluble antigens in purulent meningitis. This technique is better than a direct microscopic examination (p less than 0.02), especially in cases of meningitis due to H. influenzae and to S. pneumoniae. Latex technique kits used in the identification of type B meningococcus should be improved, and additional kits are needed if a wider range of bacteria are to be identified.

[Vein graft for thrombophlebitis of the lateral sinus following mastoiditis in a 14-year-old boy (author's transl)]. / Pontage veineux pour thrombophlébite du sinus latéral au décours d'une mastoidite chez un garçon de 14 ans.

A boy 14 years is described who had partial agenesis of the right lateral sinus. Following thrombophlebitis of the left lateral sinus secondary to mastoiditis he developed progressive visual impairment due to papilledema. This was cured by vein graft between the right lateral sinus and the right external jugular vein.

[Case of giant intra-petrous and intra-cavernous internal carotid aneurysm in a child]. / Un cas d'anévrysme géant intra-pétreux et intra-caverneux de la carotide interne chez l'enfant

The authors report the case of an eight-year-old girl hospitalised for severe headache with paroxysmal left otalgia, vomiting, aprexia, paralysis of the left 6 th cranial nerve and slight left facial weakness. Left carotid arteriography revealed a very large aneurysm of the internal carotid, involving its entire intra-petrous and intra-cavernous course. Treatment consisted of ligation of the internal carotid in the neck. Postoperative angiographic studies showed complete exclusion of the aneurysm, and it was unecessary to carry out "trapping" by ligation of the supra-cavernous carotid, as had initially been envisaged. The postoperative course was uneventful : immediate disappearance of otalgia, secondary complete recovery of the oculo-motor involvement and facial paresis. The absence of any infections or traumatic past history, together with the young age of the patient, represent arguments in favour of the congenital origin of this intra-petrous carotid aneurysm.