Ductus arteriosus aneurysm: Case report and review of the literature.

We report the case of an infant boy born at 39 weeks and 5 days who presented a cleft lip and palate. During the assessment to detect associated malformations, cardiac auscultation revealed a systolic heart murmur. Echocardiography and subsequent thoracic computed tomography angiography identified an aneurysm of the ductus arteriosus. Ductus arteriosus aneurysm, a complicated form of patent ductus arteriosus, may not be as rare as once considered. A clear majority of ductus arteriosus aneurysms are asymptomatic and physiologically resolve after birth. Nevertheless, severe complications can occur, primarily during the postnatal period.

[The CHARGE association]. / L'association CHARGE.

The CHARGE association is a polymalformative disease associating coloboma, heart disease, atresia of choanae, retarded growth and development, genital hypoplasia and ear anomalies, CHARGE being an acronym based on these different malformations. The diagnosis requires at least four of these malformations including necessarily coloboma and/or atresia of choanae. The various clinical aspects, the genetics and the therapeutics implications are described.

[Severe head injuries in neonates and infants: physiopathological and therapeutic aspects]. / Traumatismes crâniens graves du nouveau-né et du nourrisson: particularités physiopathologiques et thérapeutiques.

Severe head injuries in infants have specific circumstances such as obstetrical injury, battered infant, shaken infant. Pediatric scales must be used for neurological evaluation, the Bicêtre scale being a sensitive index of clinical course. Transfontanellar ultrasound can be useful as first line tool of evaluation of brain injury, but computerized tomography scan is necessary to correctly assess the brain lesions and the presence of hematoma. Hemorragic lesions can rapidly lead to hypovolemic state which must be prevented, or treated without delay. Treatment requires hemodynamics and hydroelectrolytic support, measures to control intracranial hypertension, sedation, and neurosurgical intervention according to the hemorragic lesions.

[Focalized multiple beam radiotherapy: an alternative in the treatment of deep cerebral arteriovenous malformations]. / Radiothérapie multifaisceaux focalisée: une alternative pour le traitement des malformations artérioveineuses cérébrales profondes.

BACKGROUND: Cerebral arteriovenous malformations are usually treated by excision or selective embolization. Some untreatable malformations may be presently cured by radiosurgery. CASE REPORT: A 10-year-old girl without previous illness suffered from a sudden quadriventricular hemorrhage due to arteriovenous malformation. Initially the child recovered with symptomatic treatment. Neurosurgery and arterial embolization being impossible, Gamma-Unit treatment was performed. Treatment was first well tolerated but 8 months later, left hemiparesis and language disorders occurred, due to radionecrosis. These complications were dramatically improved by corticosteroids. CONCLUSION: Gamma-Unit treatment can be successfully proposed for treating those malformations that are inaccessible to surgery or embolization.

[Neonatal diabetes mellitus associated with an autoimmune disease]. / Diabète néonatal vrai associé à une maladie auto-immune.

BACKGROUND: Insulin-dependent diabetes mellitus can be associated to an auto-immune disease. A similar association may be seen in the neonate. CASE REPORT: A one-day-old boy was admitted for ketoacidosis due to diabetes mellitus. Investigation showed that he also suffered from an auto-immune enteropathy with several types of autoantibodies, particularly anti-enterocytes antibodies. Immunotherapy was ineffective. Multi-organ lesions developed subsequently, particularly a pulmonary disease responsible for the death at the age of 2 years. CONCLUSION: Physiopathology of this association remains unclear and the report of further cases should help improve our knowledge.

[Rehospitalization and early discharge in neonatology: retrospective evaluation]. / Réhospitalisation et sortie précoce en néonatologie: évaluation rétrospective.

This retrospective study compared discharge summary data in neonates discharged from the Brest Teaching Hospital Neonatology Unit between May 1, 1980 and April 30, 1981 (Period I) or between May 1, 1990 and April 30, 1991 (Period II). Birth weight, gestational age, duration of hospitalization, corrected age at discharge and rehospitalization rate were compared. Among infants with intrauterine growth retardation (IUGR) with or without prematurity, weight at discharge was 2,500 g or less in none of Period I patients (n = 144) versus 67.8% of Period II patients (n = 87). Four Period II infants weighted 2,000 g or less at discharge (1,850, 1,930, 1,960, and 2,000 g). Among premature infants without growth retardation, weight at discharge was 2,500 g or less in 2.2% of Period I infants versus 52.5% of Period II infants (p < 0.0001). Period II infants were not rehospitalized more often or earlier than Period I infants. Early discharge reduces the duration of separation of the child from his or her parents without increasing the rehospitalization rate.