Antibody avidity measurement and immune complex dissociation for serological diagnosis of vertically acquired HIV-1 infection.

Differences in avidity between HIV-1 antibodies transmitted passively and antibodies synthesized by children born to HIV-1-positive mothers can be measured using a commercially available competitive enzyme immunoassay kit. The avidity determination method is based on the competition between an anti-HIV-1-peroxidase-labeled antibody at a stable and known concentration and the anti-HIV-1 antibodies (IgA, IgG, IgM) present in the child's serum at various and increasing dilutions. The shift in the competition/dilution curves between serum samples taken at the third and the sixth month of the child's life showed either the loss or the synthesis of anti-HIV-1 antibodies. The antibody avidity determination combined with a test detecting free or complexed p24 antigen is a workable and inexpensive serological method for the follow-up of children born to seropositive mothers. Combining these two complementary methods, HIV-1 infection has been established at 6 months of age in 13 of 13 infants, and positive results were confirmed by coculture and by PCR. An HIV-1 infection was excluded at 6 months of age in 17 of 17 infants, results otherwise confirmed by virological and clinical follow-up. These new and convenient approaches to the diagnosis of vertically acquired HIV-1 could be used worldwide, including in developing countries.

Constriction of the fetal ductus arteriosus during prenatal betamethasone therapy.

BACKGROUND: Constriction of the fetal ductus arteriosus occurs with maternal indomethacin treatment and has been suggested with corticosteroid therapy as well. CASE: Fetal ductal constriction was diagnosed by Doppler echocardiography at 29 weeks' gestation after a third and fourth course of betamethasone was administered to a pregnant woman with placenta previa. Doppler echocardiography showed a patent ductus arteriosus 3 days after the treatment. CONCLUSION: The risk-benefit ratio of betamethasone should be assessed by large-scale studies when repeated courses or chronic maternal administration of betamethasone are required.

[Ethnic predisposition of the severity of HELLP syndrome. Retrospective study of 12 cases including 5 during post-partum]. / Prédisposition ethnique de la sévérité du HELLP syndrome. Etude rétrospective de 12 cas dont 5 survenus en post-partum.

HELLP syndrome is characterized by association of haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). From 1989 to 1991, we studied retrospectively 12 cases of HELLP syndrome cases that occurred during the third trimester for 7 cases and during post-partum for 5 cases. 83% of patients (10/12) were black people (African or Creole). The most frequent sign of HELLP syndrome during pre- and post-partum was epigastric or dorsal pain, present in 91% of the cases (11/12) and in all cases of preeclampsia. Aggressive treatment was always performed, leading to 12 births: 7 of the 12 children were hypotrophic for gestational age. There were no maternal or neonatal deaths. Post-partum HELLP syndrome occurred 28.8 hours (mean) after delivery. Whether HELLP syndrome occurred during pre- or post-partum, laboratory findings returned to normal levels after equivalent delays: platelets 57 hours, ASAT 68 hours and ALAT 65 hours.

[Sub-tentorial cerebral abscesses in children; a report of 22 cases]. / Les abces cerebraux sus-tentoriels chez l'enfant a propos d'une serie de 22 cas.

Twenty-two cases of sub-tentorium cerebral abscesses were observed in children. The first clinical symptoms were those of intracranial hypertension, disorders of consciousness, specially somnolence, fever and low general condition. Focal neurological signs were frequent but appeared later. A cerebral abscess should be suspected when such symptoms occur in children with heart disease or with respiratory infection. Simple investigations like examination of the fundi, X-ray of the skull and EEG give valuable clues. In case of such a clinical picture, lumbar puncture is useless and often dangerous. The best diagnostic test is a cerebral scintigram.

Emergency cervical cerclage after 20 weeks' gestation: a retrospective study of 6 years' practice in 34 cases.

The aim of this study was to evaluate the outcome of late emergency cervical cerclage, after 20 weeks' gestational age (GA). This report describes a retrospective study from January 1, 1988 to December 31, 1993, of 34 patients with intact membranes who required emergency cervical cerclage after 20 weeks of GA, on observing significant cervical changes such as 'cervix dilated at least 2 cm and bulging membranes', in the Department of Obstetrics and Gynecology (Bichat-Claude Bernard Public Hospital, Paris, France). Eight patients were primigestae, and 3 had twin pregnancies. After 48 h resting under tocolysis infusion, emergency cervical cerclage (MacDonald technique) was performed with general anesthesia and prophylactic antibiotic administration. Out of 34 patients, 19 (73.1%) had a past history of one or more previous obstetrical events capable of causing cervical incompetence (CI). Mean duration of pregnancy at emergency cervical cerclage was 22.1 weeks of GA, and at delivery was 35.7 weeks of GA. The mean prolongation of pregnancy obtained was 13.9 weeks. There was a significant negative linear relationship between term at time of cerclage and the prolongation of pregnancy. In this series, 6 patients (17.6%) delivered before 28 weeks of GA, and 6 further patients (17.6%) delivered between 28 and 37 weeks of GA. Chorioamnionitis was observed in 5 cases (14.8%). Overall the neonatal survival rate was 86.5%, with 5 deaths among a total of 37 newborn. Two fetuses died in utero as a consequence of chorioamnionitis, 2 twins died shortly after birth at 24 weeks of GA, and 1 died after failure of emergency cervical cerclage (peroperative rupture of membrane). Out of 32 alive newborn, 7 were admitted to intensive care and were followed up at age 1 year with no signs of major handicap. On observing significant cervical changes with bulging membrane through an open cervix after 20 weeks of GA, an 'aggressive' multifactorial approach including cervical cerclage is legitimate and is associated with a satisfactory fetal survival rate with a minimum of maternal complications. However, in the absence of a controlled study and regardless of the major ethical problems this might entail, these beneficial effects described cannot be considered as proved.