[Giant cell hepatitis and autoimmune hemolytic anemia: efficacy of splenectomy on hemolysis]. / Hépatite à cellules géantes et anémie hémolytique auto-immune: efficacité de la splénectomie sur l'hémolyse.

BACKGROUND: The previously reported cases of giant cell hepatitis with autoimmune hemolytic anemia were improved by prednisone plus azathioprine. CASE REPORT: A 14-month-old boy suffered from giant cell hepatitis with auto-immune hemolytic anemia and positive direct Coombs test. Prednisone and azathioprine administration improved the liver disease but failed to control hemolysis so that repeated blood transfusions were necessary. Persistance of severe degree of hemolysis required splenectomy that was promptly and definitively effective. Azathioprine and prednisone were pursued for a total duration of five years. Twelve years after the onset of the disease, the child is well without any treatment. CONCLUSION: This is the first reported case of such an association in which poorly controlled auto-immune hemolytic anemia benefited from splenectomy.

[Idiopathic thrombocytopenic purpura: long-term outcome]. / Purpura thrombopénique idiopathique chez 87 enfants: évolution à long terme.

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) has usually an excellent prognosis even when no specific therapy is given. We studied, in 1996, the outcome of 87 patients with ITP observed between 1973 and 1995. PATIENTS AND METHODS: These 87 cases represented all the thrombocytopenic purpura observed during 23 years in the same pediatric unit not specialized in hematology. The outcome of these children was investigated in 1996 by phone or writing to the patients themselves or to their physician. Adequate information was obtained for 63 patients (72.4%). RESULTS: Two cerebral hemorrhages were observed, one was lethal while the other, observed after several years of course, healed completely. All these patients became free from clinical signs but 11 were not cured in 1996. None of these 63 patients had developed autoimmune disease. One patient died in a traffic accident, his thrombocytopenic purpura had been cured. CONCLUSION: In spite of two cerebral hemorrhages, ITP remains in the great majority of cases a benign disease not requiring grave therapeutic decisions.

[Adoption and chronic hepatitis B carrier state]. / Adoption et portage chronique du virus B.

AIM: Because there are few adoptable children in France, parents, for the last 20 years, have turned to international adoption. Alerted by the generally poor health of these children, we paid particular attention to their health problems and especially to infection by hepatitis B virus (HBV). POPULATION AND METHODS: The 60 internationally-adopted children seen from June 1993 to June 1997 were included in this study. All had hemogram and serum iron dosage, and search for intestinal parasites and tuberculosis was performed in each child, as were HBs antigen and HBs antibody screening. When HBs antigen was positive, HBe antigen and antibodies, HBV DNA and hepatitis C and delta serology were also studied. RESULTS: Six out of the 60 children were HBV chronic carriers. The six presented HBs antigen and five out of the six presented viral DNA. One child was co-infected with delta virus. Serum aminotransferase was normal in three children and increased in the three others. DISCUSSION: Some internationally adopted children are exposed to chronic infection by HBV. This concerns children coming from countries known for the high frequency of the disease, but also children with long stay in Eastern European nurseries. Chronic HBV carriage puts the child, as well as the family and other children in institutions and/or schools at risk, thus necessitating preventive measures.

[In utero treatment of fetal tachycardias with a digitalis-beta blocker combination. Apropos of 2 cases]. / Traitement in utero des tachycardies foetales par l'association digitalique-bêta-bloquant. A propos de deux cas.

The authors report two cases of fetal tachycardia treated in utero by digitalis (Digoxin) and a beta-blocker (Sotalol). The first case did well on treatment but the second case gave rise to difficulties in treatment both before and after delivery. A study of the literature and an analysis of our findings makes it possible for us to point out the following: echotomography is valuable in screening for fetal cardiac rhythm troubles and echocardiography is useful to work out the cause and to follow the progress of the case, this condition can be treated in utero and Sotalol, a beta-blocker, is valuable in overcoming the troubles of the rhythm, it is difficult to follow up the treatment by relying on maternal blood levels of the drugs used, finally the cause of the abnormal rhythm possibly alters the expectation of success from the treatment.

[Overdose of anticholinergic agents and confusional syndrome]. / Surdosage en atropiniques et syndrome confusionnel.

We report a case of behavior disorders due to ingestion of two closely spaced oral doses of chloride of oxybutynin in a six-year-old. This drug is not indicated in isolated enuresia. More rigid dosage schedules with longer time intervals between doses are needed.

[Acquired giant lobar emphysema in an artificially ventilated premature infant. Cured by corticosteroid therapy]. / Emphysème lobaire géant acquis chez un prématuré sous ventilation artificielle. Guérison par la corticothérapie.

A case of acquired giant lobar emphysema in a premature triplet born at 31 weeks gestational age and treated by artificial ventilation is reported. Corticosteroid therapy was remarkably successful.

[Immunoallergic tubulo-interstitial nephritis following ingestion of carbamazepine]. / Néphrite tubulo-interstitielle immuno-allergique secondaire à la prise de carbamazépine.

One month after taking carbamazepine for pain relief, a 13 year-old child with Friedrich's ataxia presented with an allergic rash and digestive and cardiac symptoms. Two weeks later, non-oliguric renal failure suggestive of interstitial nephritis was present. Acute renal failure resolved with pulse methyl prednisolone injections relayed with prednisone orally, for 2 months. Allergic manifestations with carbamazepine should lead to immediate withdrawal of treatment.

[Acute parvovirus myocarditis with fatal outcome]. / Myocardite aiguë à parvovirus d'évolution létale.

We report a new complication related to parvovirus B 19: acute lethal myocarditis in the context of a familial epidemic. Serological studies confirmed the existence of a recent infection and the B 19 structural proteins were detected by immunocytochemical techniques on myocardial sections.

[Hematologic anomalies and triploidy]. / Anomalies hématologiques et triploïdie.

Major macrocytosis seems to be suggestive of triploidy in dysmature infants with multiple malformations. This marker may prove ethically useful since its presence may justify withholding special therapies until results of the karyotype are obtained.

[Bilateral newborn testicular torsions]. / Les torsions testiculaires néonatales bilatérales.

A case of bilateral spermatic cord tension in a neonate is reported. Clinical findings are compared with those in 22 previously published cases. Obstetrical history is usually unremarkable. Torsion occurs prior to birth or immediately after birth. The two cords are involved simultaneously or successively. Edema of the scrotum is found in recent spermatic cord tension, whereas subsequently the tests are extremely hard and occasionally severely atrophied. Prognosis is poor since castration or poor testicular viability was the outcome in most cases.

[Nycthemeral gastric secretion in children under parenteral feeding]. / Sécrétion gastrique nycthémérale chez l'enfant en nutrition parentérale.

The nycthemeral basal gastric secretion was studied in 11 children under continuous or cyclic total parenteral feeding (TPF). The suppression of the prandial stimulation shows nycthemeral changes in the secretory flow with a nocturnal minimum and a diurnal morning maximum, independent of the TPF infusion-conditions. The role of the infused aminoacids and lipid emulsion, as well as the duration of TPF is suggested to explain the increase or decrease in the basal acid flow. The authors suggest that an H2 antihistaminic should be used if the morning secretory peak induces a significant functional impairment.