Neurological and cardiac symptomatology in a teenager in the context of chronic nitrous oxide use: A case report.

Chronic use of nitrous oxide can lead to motor complications. We report the case of a 15-year-old boy with rapid onset of lower limb paralysis after massive nitrous oxide intake. He had been previously hospitalized for the same symptoms, but did not mention the use of nitrous oxide and no etiology was found. During hospitalization, he presented with two consecutive self-limited episodes of ventricular tachycardia. Currently, no routine tests are performed to confirm nitrous oxide toxicity. This case highlights the recurrent nature of the motor deficits and suggests a possible association between motor deficits and cardiac rhythm disorders in the setting of nitrous oxide intoxication.

[Perinatal management and neurological outcome of newborns hospitalized with Rhesus hemolytic disease]. / Prise en charge périnatale et devenir neurologique à moyen terme des nouveau-nés hospitalisés pour maladie hémolytique par immunisation anti-D.

OBJECTIVES: To evaluate perinatal management and neurological outcome in a group of infants born with Rhesus fetomaternal allo-immunization. PATIENTS AND METHODS: Between 1 January and 31 December 2005, all newborns admitted to neonatal unit of Rouen tertiary centre for Rhesus hemolytic disease were included in a retrospective study and divided in two groups. The newborns who were treated with intrauterine transfusion are in the group 1 and those who needed only postnatal treatment in the group 2. In each case, were considered antenatal management (ultrasonographic data, middle cerebral artery peak systolic velocity, intrauterine transfusion), postnatal treatment (phototherapy, exchange transfusion, transfusion requirements) and neurological outcome. RESULTS: Among 42 cases of Rhesus allo-immunization observed in six years, 28 newborns (67%) were admitted for neonatal cares. No case of fetal hydrops was noted. But 16/28 (57%) were preterm with a median term of 35 weeks gestation (32-36 weeks). In group 1 of six infants who had received intrauterine transfusion (IUT), only one (17%) needed postnatal exchange transfusion, and all six received one to three blood transfusions after their birth. In group 2 of 22 infants who did not receive IUT, 6/22 (27%) needed postnatal exchange and 18/22 (82%) of them received one to four blood transfusions. Phototherapy duration and albumin requirements were similar in both groups. Three deaths occurred, one due to necrotizing enterocolitis and the other two later on due to sudden infant death and fulminant meningococcemia. Neurological outcome of the remaining 25 children was normal. DISCUSSION AND CONCLUSION: Rhesus alloimmunization remain a situation at risk. Neonatal clinical presentation is less severe than previously described due to improvement in antenatal management. Infants required less postnatal exchange transfusion when they received intrauterine transfusion but more frequent blood transfusions.

[Who is it necessary to vaccine against whooping-cough?]. / Qui faut-il vacciner contre la coqueluche?

Whooping-cough is one of the rare diseases for which vaccine prevention has been available for many years. However, in spite of good vaccine coverage in the infant, the pertussis infection remains a frequent disease in the teenagers and adults partially immunized. The missing diagnosis of the infection, added to its often clinical banal expression, contributes to support the circulation of Bordetella pertussis and explains the contamination of the young infants in whom the disease remains a true danger as the few declared deaths show it every year. Control of the disease must go through reinforcement of vaccination as a practitioner of booster vaccine in preadolescents, teenagers and adults. Instituted since 1998 in the French vaccine calendar, the 2nd booster in preadolescence between 11-13 years olds or 5th dose of vaccine is not enough carried out and must be encouraged like the installation of another additional vaccine dose for adults and certain professional categories. The protection of infants too young to have received the 3 doses goes through the vaccination of their entourage, family and socio-professional alike. The new recommendations thus preach to begin vaccination in children from the age of 2 months, a reinforcement of the vaccine boosters in preadolescents, in adults likely to become parents and in the medical and paramedical personnel in contact with very young infants.