Early changes in cutaneous bilirubin and serum bilirubin isomers during intensive phototherapy of jaundiced neonates with blue and green light.

We measured the changes in cutaneous bilirubin (Br) and serum Br photoisomers in two groups of 5 jaundiced newborn infants treated by intensive phototherapy (IP), one with blue light and the other with green light. Cutaneous Br was measured with a transcutaneous jaundice meter and photoisomers were measured by HPLC. Cutaneous Br decreased in the two groups as soon as IP began, and the skin was completely bleached within 3 h with blue light only. Rebound occurred which was more marked after blue light IP. The main serum photoproduct was the 4Z-15E isomer, which reached a steady-state level within 1 h in both groups, whereas the lumirubin and 4E-15Z Br concentrations were slightly higher after green light IP. These data indicate that blue light is more suitable for IP, although this is not clearly explained by the production of more lumirubin.

[Agenesia of the canal of Arantius. A case report]. / Agénésie du canal d'Arantius. A propos d'un cas.

Looking for the etiology of hydramnios which became symptomatic at 21 weeks' gestation ultrasonography revealed a hepatic vascular abnormality without other symptoms. The suspected diagnosis was agenesis of the ductus venosus with creation of a high grade arteriovenous shunt between the umbilical vein and the inferior vena cava. Agenesis of the ductus venosus may be one expression of the different possible systemic-portal-umbilical abnormalities. Physiological consequences vary according to the type of substitutive anastomoses.

Study of mother-to-child Epstein-Barr virus transmission by means of nested PCRs.

The aim of this study was to investigate the possibility of vertical Epstein-Barr virus (EBV) transmission. We developed two nested-PCR methods for amplifying distinct regions of EBV DNA (BNRF1 and BamHI W) in circulating lymphocytes. Nested PCR was applied to samples obtained from 67 mother-infant pairs within 1 week of birth. We also tested samples from 16 neonates born to human immunodeficiency virus (HIV)-infected mothers to determine whether HIV increases the potential risk of vertical EBV transmission. About half of the 67 women in the first population were positive by nested PCR. Two neonates born to EBV PCR-positive women were also PCR positive. One of the 16 neonates born to HIV-infected women was PCR positive for EBV. These results strongly support the possibility of EBV transmission in utero or during delivery but do not suggest that HIV infection increases this risk. Further studies are required to confirm these findings, to identify the precise mode of vertical EBV transmission, and to determine the outcome for infants who are positive at birth for EBV DNA by nested PCR.

Obstetrical advantages and perinatal risks of indomethacin: a report of 818 cases.

In a series of 818 patients treated with indomethacin during pregnancy, the rate of perinatal complications was 1.8%. The risk was increased to 13% if indomethacin was being taken at the time of delivery, and when treatment was prolonged. The serious nature of certain complications (persistence of fetal circulation and oligo/anuria) means that indomethacin should only be used in cases in which betamimetic drugs are formally contraindicated or if there is a risk of unacceptable prematurity. Even in such cases, indomethacin should only be given for short period (< 1 week).

[Lobectomies enlarged to the main bronchus in the conservative treatment of lung carcinoma. Apropos of 75 cases]. / Lobectomies élargies à l'axe bronchique principal dans le traitement conservateur du carcinome bronchique. A propos de soixante-quinze cas.

From february 1965 to march 1990, 70 squamous cell carcinomas, 3 adenocarcinomas and 2 undifferentiated lung cancer were operated by lobectomy extended to the main bronchus: 44 right upper lobectomies, 22 left upper lobectomies, 5 left lower lobectomies, 2 right lower lobectomies, 1 middle lobectomy and one lower and middle bilobectomy. Respiratory function prevented pneumonectomy in 1 out of 3 patients. The postoperative mortality related to surgery (2.7%) has been eliminated since the introduction of systematic protection of the pulmonary artery from the bronchial suture (1976). The sutures are performed with very fine suture material. Endoscopic follow-up is essential: 11 cases of suture granuloma (1 laser) and 4 cases of fibrotic stenoses, including 1 post-irradiation stenosis (2 lasers). Fifty-three patients were N0 (28 T1, 22 T2, 3 T3) and 22 were T+ (including 4 N2). The actuarial survival for the N0 was 91% at 1 year and 60% at 5 years and decreased to 63% and 40% for N+. Eighty-three percent of the late cancer-related deaths had metastatic disease. Lobectomies extended to the main bronchus do not appear to compromise the oncological value of the resection and they offer the possibility of resection in some respiratory failure patients.

[Value and dangers of indomethacin used in pregnancy. Apropos of 304 treated patients]. / Intérêt et dangers de l'indométacine utilisé en cours de grossesse. A propos de 304 patientes traitées.

When Indomethacin in a dosage of 175 mg/day was used to treat threatened premature labour more than 70% of cases carried on until 37 weeks. This treatment therefore is an interesting alternative treatment to beta-mimetics whose the maternal side effects can be serious. As far as the cardiovascular systems of the fetus and neonate are concerned the effects in the dosage used are negligible. On the other hand there may be renal failure which is transitory at birth when delivery has taken place while treatment was going on. The treatment should not be prolonged for more than three weeks because Indomethacin causes oligohydramnios and this can cause in its place malpositions and maldevelopment of the lungs. Finally, it is not certain whether this treatment has any effect on fetal growth causing diminished growth, possibly.

[Listeriosis in obstetrical environment. Report on 10-year experience in a maternity hospital in Paris]. / La listériose en milieu obstétrical. Bilan de 10 ans dans une maternité parisienne.

Thirty six cases of listeriosis were seen in the hospital between 1975 and 1984. Ten aborted before the 28th week of pregnancy while 26 passed the 28th week of pregnancy. The incidence was about 1 per 1,000 deliveries. The bacteriological diagnosis depends on isolating the germ either from blood cultures or from multiple swabs from the child at birth, or from liquor amnii or from the placenta. The clinical events that occur in pregnancy were analysed in order to trace out the evolution of maternal listeriosis better and to work out from it a good preventive therapeutic approach. Twenty one out of the 26 women found in the month preceding delivery lassitude, often accompanied by a febrile illness which suggested a primary infection with the listeria. The blood cultures from four of them showed L. monocytogenes and treating these ladies with antibiotics enabled the pregnancy to go to term. Thirteen of the infants that were affected developed favourably but 8 died. Four of these died in utero and two (twins) died after being born healthy. The seriousness of the illness in the fetus seems to have a direct relationship to the time between the primary infection and the delivery. Blood cultures make it possible to diagnose the condition at the first sign of infection whatever the clinical features of the case are.

Variations of urinary Tamm-Horsfall protein in humans during the first thirty years of life.

A systematic study was undertaken to evaluate the urinary Tamm-Horsfall protein (THP), creatinine and total protein elimination in 76 normal subjects divided into five groups during the first 30 years of life. This shows that urinary THP flow, relating to body surface area, increases progressively up to adult age.

[Rupture of the membranes and amniotic infection. Apropos of 3000 cases]. / Rupture des membranes et infection amniotique. A propos de 3000 cas.

This work shows the effect of a policy of reducing the amounts of antibiotics prescribed, and reports on the effect on the rate of infection in a maternity unit where systematic antibiotic cover for patients with premature rupture of the membranes was stopped. Breaking of the waters with loss of liquor makes infection of the contents of the sac almost inevitable; but we have found over a period of five years that with the exception of certain strains of Group B streptococci infection with bacteria from vaginal flora rarely gives rise to severe infection in the infant. This balance sheet was drawn up: 350 infections of the liquor in 13.540 deliveries, which is 2.5%. Infection of the liquor by definition implies that the infant will be contaminated; but in fact the baby was infected in only 0.6% of births--which figure is no higher than in other series. Bacteria found in the vaginal flora: streptococci and anaerobes are responsible for 92% of amniotic infections, streptococcus B being first in frequency responsible for 41.36% of amniotic infections and 47.5% of neonatal infections. The low percentage, 5.4% of Gram negative Bacilli can be attributed to their absence when antibiotic cover is given. Neonatal infections usually improve quickly with a narrow-spectrum antibiotic and the one we gave most often was penicillin G. Careful watch on women with premature rupture of the membranes, accompanied by repeated bacteriological control makes it possible to avoid systematic antibiotic therapy and to allow the antibiotic sensitive bacteria to return to their primary role, if by chance infection of the amniotic contents, which is usually benign, occurs.

Variation of urinary melatonin excretion in humans during the first 30 years of life.

Urinary melatonin variation in humans were demonstrated to be a function of age. A radioimmunological assay was used. The values obtained, expressed as nmol x 24 h-1 x kg-1, progressively decreased from birth onwards, with a more accentuated and momentary inflection at the moment of the genital crisis in newborns and at puberty. The results obtained concern only melatonin and not its metabolites, as a result of the high specificity of the antibodies employed.

[Determination of fetal infectious risk by bacteriological examination of the amniotic fluid after premature rupture of the membranes]. / Appréciation du risque infectieux foetal par la surveillance bactériologique du liquide amniotique après rupture prématurée des membranes.

Amniotic fluid was obtained per vagina from 228 mothers with premature rupture of the membranes and examined bacteriologically. The aim was to assess the importance of amniotic fluid contamination and the risk of foetal infection in the absence of systematic antibiotic therapy in the mothers. The incidence of amniotic fluid contamination was apparently greater in those mothers who had received antibiotics although the proportion of neonates with a true infection (3%) was almost identical. The absence of selection of resistant organisms is indicated by the marked preponderance of streptococci and the scarcity of Gram negative enterobacteriacae. Thus it is reasonable not to give systemic antibiotics but to culture the amniotic fluid. Infection can then be anticipated and in affected neonates the appropriate therapy started immediately.

A case of ring Y chromosome.

Ring Y chromosome 45,X/46,X,r(Y) was identified by fluorescence in a child with ambiguous external genitalia, urogenital sinus, vagina, uterus, and Fallopian tubes. Testicular tissue was noted on gonadal biopsy.

[Risk of neonatal Streptococcus B infection]. / Risque infectieux néo-natal à streptocoque B.

23 cases of contamination with streptococcus group B have been seen after premature rupture of the membranes. Mothers and fetuses have been affected. The systematic study of swabs or liquor or cervical discharge carried out on the mother since the time her membranes had ruptured show that in 74 per cent of cases studied contamination existed within the first 24 hours. Giving antibiotics to the mother before delivery gave very variable results. These multiple tests, before and around the time of birth, made it possible to detect the children at risk of infection and to start antibiotic therapy with a narrow spectrum antibiotic of the type Penicillin G. The clinical progress of these children, which is usually favourable, gives no reason for postponing prophylactic cover antibiotic treatment when the membranes have ruptured prematurely.