[Obstructive sleep apnea syndrome and hypertrophic tonsils in infants]. / Le syndrome d'apnées obstructives du sommeil et hypertrophie amygdalienne chez le nourrisson.

BACKGROUND: Even if failure to thrive in infants suffering from obstructive sleep apnea syndrome (OSAS) due to hypertrophic tonsils is well documented in the literature, the surgical act is often delayed due to the lack of diagnostic evidence. CASE REPORTS: We report three cases which share the common characteristic of age of onset, tonsillar hypertrophy, growth retardation and growth catch-up after tonsillectomy. Authors emphasize the importance of clinical diagnosis as a sufficient tool in making the decision of surgery, thus avoiding unnecessary and expensive investigations. CONCLUSION: The diagnosis of OSAS in infants and children is essentially clinical, depending mainly on a history provided by the parents, laying stress on nocturnal symptoms and clinical examination. Growth retardation is frequent in this syndrome and should be systematically sought. Tonsillectomy, which is effective in relieving respiratory manifestations, also allows growth recovery.

[Post-traumatic pulmonary pseudocysts]. / Les pseudokystes pulmonaires post-traumatiques.

BACKGROUND: Pulmonary pseudocyst is an unusual complication of chest trauma. CASE REPORT: A 12-year-old boy suffered from a non penetrating chest trauma. Examination was normal except mild hemoptysis. Chest X-rays and tomodensitometry showed several cystic lesions surrounded by areas of pulmonary contusion in the right lower lobe. X-rays performed a few years before the trauma were normal. The cystic lesions progressively disappeared within a few months. CONCLUSION: This is a new case of post-traumatic pulmonary pseudocyst whose diagnosis may be difficult until spontaneous cure.

[A severe form of vitamin D deficiency with hypocalcemic cardiomyopathy]. / Une forme sévère de carence en vitamine D avec cardiomyopathie hypocalcémique.

The authors report on a case of cardiomyopathy with congestive heart failure in an infant with severe hypocalcemia related to vitamin D deficient rickets. The heart failure was successfully treated with calcium gluconate and vitamin D, associated with dobutamide.

[Trial of initial non surgical treatment of subdural empyema]. / Tentative de traitement non chirurgical d'emblée d'un empyème sous-dural.

The authors report on an 8-year-old girl who experienced bilateral subdural frontoparietal and interhemispheric empyema following sinusitis. The child improved after initial treatment with a 3 weeks course of parenteral antibiotics. Surgical drainage was further required because of clinical aggravation; however, this evolution was related to bilateral frontoparietal brain edema and abscesses fluid was sterile.

[Fatal cerebral aspergillosis in acute megakaryoblastic leukemia]. / Aspergillose cérébrale mortelle lors d'une leucémie aiguë à mégacaryoblastes.

A 13 year-old girl was diagnosed as having acute megakaryoblastic leukemia. A serious infectious syndrome appeared during the chemotherapy, not improved by broad spectrum antibiotic therapy. A pulmonary aspergillosis was diagnosed one month later by a second bronchoalveolar lavage. A treatment with Itraconazole, a new antifungal triazole, was started. Despite this treatment, the child died after 3 days. Death was due to multiple aspergillus abscesses disseminated in the brain leading to coma and transtentorial herniation. Autopsy confirmed the cerebral aspergillus abscesses and showed also the dramatic dissemination of aspergillosis in the body. Diagnosis and treatment to aspergillosis in immunosuppressed patients should be made early to improve prognosis.

[Acute hydrocephalus drained in emergency. Consequence of cerebellar infarction in Haemophilus meningitis]. / Hydrocéphalie aiguë drainée en urgence. Conséquence d'un infarctus du cervelet au cours d'une méningite à Haemophilus.

A 2 year-old child admitted for Haemophilus meningitis was immediately treated by adequate antibiotic treatment. Three days later multiple hypertonic strokes and periodic respiration occurred; a resuscitation was necessary. CAT scan showed an acute hydrocephalus with non visible 4th ventricle and low-density areas in both cerebellar hemispheres allowing the diagnosis of cerebellar infarction. External drainage of CSF was rapidly performed and maintained for 11 days with success. The child was secondarily discharged with temporary cortical blindness and persistent moderate static cerebellar signs. The etiology of the cerebellar infarction was likely to be an arterial thrombosis in the vertebro-basilar area, probably secondary to cerebral arteritis related to Haemophilus.

[Contribution of direct immunofluorescence diagnosis to the epidemiology of acute viral respiratory infections in young children]. / Contribution du diagnostic direct en immunofluorescence à l'épidémiologie des infections respiratoires aiguës virales du jeune enfant.

Rapid diagnosis by immunofluorescence (IF) has enabled us to study the epidemiology of acute viral respiratory diseases in infants admitted to the CHRU at Caen between January 1980 and December 1982. 809 nasal aspiration samples were examined. Respiratory Syncytial Virus (RSV) was recovered in 36% of cases. These were observed during the four winter outbreaks which occurred during the study period and were extensive in 1980-1981 and 1982-1983. A virus was demonstrated in 13.5% of the 515 RSV negative specimens: 25 Rhinovirus, 21 Myxovirus parainfluenzae 3, 19 Adenovirus, 3 Myxovirus influenzae A, 2 Myxovirus influenzae B. RSV is the predominant pathogen as it is the most frequent and is responsible for more severe forms. However, epidemics vary from year to year and from one town to another. Rhinovirus, Myxovirus parainfluenzae 3 and Adenovirus infections are less frequent. Rhinovirus infections occur throughout the year and are certainly underestimated as isolation of the virus is difficult. Most Myxovirus parainfluenzae 3 cases occur in winter, and IF largely facilitates their diagnosis. Adenovirus infections are endemic and serotype 7 is frequent.

[Multiple extremities gangrene as complications of meningococcemia (author's transl)]. / Gangrène des extrémités, complication du purpura fulminans.

Five limb extremities gangrene are reported in 54 meningococcemia. Prognosis depends first on early medical treatment. Extremities ischemia require large early aponeurotomy for limb preservation.