Favorable nutritional outcome after isolated liver transplantation for liver failure in a child with short bowel syndrome.

A patient with short gut syndrome presented with end-stage liver disease. She underwent an isolated liver transplantation at the age of 3.5 years. Parenteral nutrition was discontinued 1.5 years after surgery. At 7 years of age, the patient has maintained normal nutritional indices and growth while on a normal oral diet. This observation suggests that liver transplantation alone can be a valuable alternative to the combined small bowel/liver transplantation in short bowel syndrome when intestinal adaptation is expected and if the ileocecal valve is present and that improvement of gut function can occur after successful liver transplantation.

[Labor epidural analgesia for a woman with a pityriasis versicolor in the lumbar region]. / Analgésie péridurale obstétricale chez une femme ayant un pityriasis versicolor de la région lombaire.

Epidural analgesia is usually contraindicated in case of infection at the site of needle insertion. Tinea versicolor is a benign superficial cutaneous fungal infection caused by the proliferation of a skin commensal yeast of low pathogenicity. We report the case of a pregnant woman with a tinea versicolor in the lumbar region, who benefited from a labor epidural analgesia, realised with reinforced antiseptic measures. No neurological or infectious complication occurred.

Anesthesiologists' practices for late termination of pregnancy: a French national survey.

BACKGROUND: Approximately 6600 cases of medical termination of pregnancy are performed in France annually, of which 78% are performed during the second or third trimester of pregnancy. There are few data and no recommendations regarding anesthesia and analgesia for these late terminations. The aims of this study were to determine the role of anesthesiologists and analgesia and anesthesia practices used for late terminations in France. METHODS: An electronic mailing survey was sent to all obstetric anesthesia teams working in hospitals with a prenatal diagnosis center in France. The same survey was also sent to a sample of obstetric anesthesia teams working in hospitals near Paris without a prenatal diagnosis center. RESULTS: The response rate was 96% (45/47) for those with and 85% (23/27) for those without a prenatal diagnosis centre. Anesthesiologists at units with prenatal diagnosis participate on a regular or frequent basis on multidisciplinary prenatal committees in 36% of responding centers and are involved in 69% of centers in case of maternal health problems. Epidural or more rarely combined spinal-epidural analgesia is performed in more than 90% of cases. The block is performed after fetocide in 22% of centers and after the start of labor in 38% of centers. Sedation or general anesthesia is used at delivery in every case or at patient request in 2% and 60% of centers, respectively. Minor differences were found when comparing practices of high-volume centers with prenatal diagnosis and small volume centers without. CONCLUSIONS: French anesthesiologists do not participate routinely in the decision and planning of all late terminations. Overall, very similar analgesic and anesthetic practices are observed in high- and low- volume centers, with epidural techniques being the most common.

[Pregnancy and pandemic influenza A(H1N1) 2009. Current concepts for anaesthesia and critical care medicine]. / Grossesse et grippe pandémique A(H1N1) 2009. Actualités pour les anesthésistes réanimateurs.

Pregnant women are particularly vulnerable to the pandemic influenza A(H1N1) 2009. Indeed, they are at high risk of developing a severe or fatal form of the disease. The physiological changes and the "immune deviation" from cellular to humoral immunity occurring during pregnancy are hypotheses to explain this vulnerability. Severe forms, mainly viral pneumonias, require an urgent prescription of an effective antiviral therapy. Preventive measures, mainly vaccination, are essential to avoid the appearance of these severe forms.

[Cow's milk proteins intolerance disclosed by ulcero-necrotizing enterocolitis in a full-term infant]. / Intolérance aux protéines du lait de vache révélée par une entérocolite ulcéro-nécrosante chez un nourrisson né à terme.

BACKGROUND: Necrotizing enterocolitis associated with milk protein intolerance is rare. CASE REPORT: A girl, born at term, weighing 3,150 g, was fed several different formulas because of persistent vomiting and diarrhea; some of these formulas contained cow's milk proteins. At 5 weeks of age, the patient developed acute abdominal distension and obstructive manifestations. Laparotomy showed intestinal distension and perforation of the distal small bowel, requiring resection with temporary ileostomy. Histological examination of the resected segment of the small bowel showed extensive necrosis of the mucosa and submucosa with involvement of the muscular layers. The patient was given parenteral nutrition for 3 weeks then refed with human milk. Cow's milk was introduced at the age of 2 1/2 months; this was immediately followed by vomiting and an anaphylactic reaction, with increased ileostomy fluid volume and blood and sugars in stools. A jejunal biopsy performed 3 weeks later showed moderate villous atrophy with a dense infiltrate of eosinophils below the epithelium. The RAST test was positive to beta-lactoglobulin and negative to casein and lactalbumin. The patient tolerated cow milk by the age of 18 months. CONCLUSIONS: Cow's milk protein tolerance should be evaluated when necrotizing enterocolitis occurs in the absence of classical risk factors.

Influence of recombinant interferon alpha on nutritional status and growth pattern in children with chronic viral hepatitis.

UNLABELLED: Anorexia and weight loss are frequently reported as adverse effects during recombinant interferon alpha (rIFN-alpha) treatment. The aim of the present study was to assess both nutritional status and growth of children and adolescents treated with rIFN-alpha for chronic viral hepatitis. Eleven patients aged 4-16 years with histologically proven chronic active hepatitis (hepatitis B, n = 9; hepatitis C, n = 2) receiving rIFN-alpha subcutaneously thrice a week for 6 months were studied. Weight and height increments were assessed during the 6 months before starting rIFN-alpha. Weight and height were measured every 3 months (M0, M3, M6) during the 6 months of rIFN-alpha treatment, then every 6 months during the follow up period (6-36 months). Weight decreased in every child during rIFN-alpha treatment (weight loss varies from 0.5 to 2.6 kg after 3 months of treatment). Weight/age Z-score decreased from 0.12 at M0 to -0.69 at M3 (P < 0.01), then increased between M3 and M6 (-0.33) (P < 0.01), but normalized (0.02) only 6 months after completion of treatment. Nutritional status was significantly impaired during treatment (Z-score for weight/height decreased from 0.18 at M0 to -0.74 at M3, P < 0.01) and recovered progressively thereafter. Height and height velocity were not modified by rIFN-alpha treatment. A reduction of the caloric intake observed between M0 and M3 might explain these features. CONCLUSION: Significant but transient abnormalities of the nutritional status are encountered constantly at the beginning of rIFN-alpha therapy without any deleterious effect on growth. Information of the families and nutritional intervention during treatment should be required, in order to limit the importance of weight loss.