[Prenatal diagnosis of congenital cerebral tumors. Apropos of 3 cases]. / Diagnostic anténatal des tumeurs cérébrales congénitales. A propos de 3 observations.

BACKGROUND: The prognosis for congenital brain tumors is usually poor, so that their management during pregnancy is difficult. CASES REPORTS: Case 1. A large cystic mass was revealed by ultrasound at the 37th week of pregnancy; it was located near the brain stem and was associated with ventricular dilation. The newborn was delivered by cesarean section because of an abnormally enlarged head. The CT scan confirmed the presence of this mass containing a fluid that was found to be normal after needle aspiration. Surgical shunting of excess fluid was ineffective, and progressive deterioration prevented further exploration and/or treatment. The child is still living, confined to his bed, at the age of 5 years. Case 2. Ultrasonography at the 30th week of pregnancy showed a tumor located near the brain stem with dilation of the entire ventricular system. Post mortem examination after abortion revealed a capillary and cavernous hemangioma. Case 3. Ultrasonography at the 34th week of pregnancy showed dilation of the ventricular system. As a result, birth was induced. CT scan and MRI of the newborn showed a mixed, solid and liquid, mass in the posterior fossa. Post mortem examination showed a papilloma of the choroid plexus. CONCLUSION: These rare congenital tumors are usually revealed by ultrasonography showing ventricular dilation. Advances in imaging techniques, especially MRI of fetal brain, should help in the management of such tumors.

[Morbidity and psychomotor development at 2 years of age in children born in Puy-de-Dome in 1983. Study of children groups defined by perinatal risk]. / Morbidité et développement psychomoteur à deux ans des enfants nés dans le Puy-de-Dôme en 1983. Etude des groupes d'enfants définis par un risque périnatal.

All infants born in the Puy-de-Dôme area in 1983 and referred to a neonatal care unit were studied prospectively. Children were seen at their homes at 9 months and at 2 years of age and results were compared with those found in controls. High risk groups were defined on the basis of neonatal variables including prematurity, neurologic anomalies, respiratory distress, assisted ventilation, and growth retardation. At birth, prematurity was associated with an increased risk of respiratory distress and infections were more common in small-for-dates infants. Evaluations at 9 months and at 2 years of age showed increased prevalences of growth retardation and strabismus in the high-risk infants, and neurodevelopmental tests disclosed lower performances in these children. Conversely, infectious diseases and readmissions between birth and two years of age were not increased in the high risk groups, as compared with the control group.

Glucocorticoid receptor concentrations in human lung at different growth stages.

We measured glucocorticoid receptor concentrations in human lung at different stages of alveolar growth. Lung tissue was obtained from 9 surgically aborted or stillborn fetuses of 15 to 28 weeks gestational age, and from 6 infants and children, aged 2 months to 9 years, after lobar resection or at autopsy. Samples were taken from macroscopically healthy areas. Lung histology was performed in all cases. The receptor assay was done by establishing saturation curves for labeled dexamethasone in the absence or presence of a hundredfold excess of unlabeled dexamethasone. Total binding capacity and the dissociation constant were calculated from the saturation curves by the method of Scatchard. The receptor concentration in the fetuses was high (182 +/- 88 fmol/mg prot.), irrespective of gestational age. The lowest concentration (35 fmol/mg prot.) was found in a fetus with pulmonary hypoplasia. In the infants and children the mean receptor concentration was significantly lower (14.6 +/- 9.9 fmol/mg prot.); these included a case of sudden death in which the parenchymal structure was normal.

[Newborn infants of mothers with cardiopathy or nephropathy]. / Des nouveau-nés de mère atteinte de cardiopathie ou de néphropathie.

The prognosis for pregnancy in chronically ill women (mainly heart or kidney diseases) has improved dramatically. However, despite a decrease in the parent's mortality, foetal mortality and morbidity remains unchanged because of the consequences of the mother's disease and treatment on foetal physiology. The mother must be informed of the risks and the medical supervision during the pregnancy. The follow-up and the medical and/or surgical management during pregnancy and at birth are discussed. Pregnancies in women with heart diseases often have a favourable outcome. In women with renal failure, transplantation can result in a successful pregnancy and the birth of a healthy child. The pediatrician is involved in all decisions during pregnancy and must undertake long-term surveillance of the child in order to detect for any somatic or psychological abnormality which might appear later on in life.

[Neonatal spinal cord injuries and magnetic resonance imaging]. / Lésions médullaires néonatales et imagerie par résonance magnétique.

Two cases of spinal cord injury involving the lower cervical region are reported. In both, the delivery of a breech presentation was difficult. Severe hypotonia, areflexia and autonomic nervous system disturbances suggested a spinal cord injury. The evidence, type, and location of the cord lesion were given by nuclear magnetic resonance (NMR).

[Defect in pulmonary growth. Comparative study of 3 diagnostic criteria]. / Défaut de croissance pulmonaire. Etude comparative de 3 critères de diagnostic.

A systematic analysis was made of the autopsies of 74 newborns and fetuses (49 pathological cases and 25 controls) to detect defects in pulmonary growth. Radial alveolar count (RAC) and histological study were made in each case, as well as measurement of the ratio of pulmonary weight to total body weight (R). The ratio is of interest when lower than 0.012, but has no value if there is an intercurrent pathology. RAC decreases in pulmonary hypoplasia, but is not an entirely reliable indication since there is evolution of the values as pregnancy advances and a greater dispersion of results the earlier the gestational age. Histology disclosed an excess of bronchi, including distal bronchi, some of which exhibited delay in the differentiation of the distal aerian channel. The analysis of any two of the three above will enable diagnosis of pulmonary hypoplasia.

[C-reactive protein and orosomucoid determinations in a neonatal pathology unit]. / Dosages de C-réactive protéine et d'orosomucoïde dans une unité de pathologie néonatale.

We report the result of CRP and ORM assays performed at the admission in the unit, in 157 neonates (NN). The NN were divided into 3 groups: 122 "controls" (group I), 21 having septicemia with or without meningitis but with symptoms of infection (group II), 16 having a positive blood culture without symptom of infection (group III). In group I, the CRP level does not depend on gestational age at birth, neither on the age at the assay. The level of ORM depends on both factors. Neonatal infection leads to a very significant rise of the CRP rate (often above 100 mg/l). The rise of ORM is not so dramatic. These data suggest that the assay of these two proteins are useful in the diagnosis of neonatal infection if they are performed together and at several times.

[Farber's lipogranulomatosis. Apropos of a case]. / Lipogranulomatose de Farber. A propos d'un cas.

A case of Farber's lipogranulomatosis is described in an 18 month-old girl. There was clinical evidence for diagnosis, which was confirmed by a ceramidase activity assay on cultured fibroblasts. A study of the conjunctiva by electron microscopy was performed. The authors emphasize the clinical and biological characteristics of such cases.

Pharmacokinetics and clinical evaluation of cefotaxime in children suffering with purulent meningitis.

Seventy-five children with bacterial meningitis were included in a multicentre trial for evaluation of cerebrospinal fluid (CSF) pharmacokinetics and clinical efficacy of cefotaxime. Mean age of patients was 4 years. Causative pathogens were Haemophilus influenzae in 28 patients (37%), Neisseria meningitidis in 27 patients (36%), Streptococcus pneumoniae in 10 patients (13%), group B streptococcus in 2 patients (2%) and unknown in 8 patients. All isolated pathogens were susceptible to cefotaxime. Seven ampicillin-resistant H. influenzae (9.4%) were found. Cefotaxime was 50 mg/kg intravenously, 4 times daily. The duration of treatment ranged from 5 to 22 days (mean: 13.8). Blood and CSF concentrations of cefotaxime were performed in 50 patients 3 h after infusion at day one and seven cefotaxime levels were determinated both by microbiological assay procedure and high pressure liquid chromatography. On day 1, CSF levels ranged from 0.39 to 2.0 mg/l by microbiological assay procedure (median 3.6) and from 0.0 to 17.4 mg/l (median 2.2) for cefotaxime and from 0.0 to 11.5 mg/l (median 2.2) for desacetyl-cefotaxime by HPLC. We observed a decrease in CSF levels of cefotaxime on day 7. They ranged from 0.3 to 7.0 mg/l (median 1.1) by microbiological assay and from 0.0 to 3.3 mg/l (median 0.8) for cefotaxime and from 0.0 to 6.0 mg/l (median 1.0) for desacetyl-cefotaxime by HPLC. On day 1 and day 7, CSF levels determined by microbiological assay and HPLC were correlated as follows: day 1:r = 0.59 (P less than 0.001). All children (100%) were cured and efficacy of cefotaxime was excellent in 72 cases (96%).(ABSTRACT TRUNCATED AT 250 WORDS)