[Malignant arterial hypertension and Ito's hypomelanosis]

Hypomelanosis of Ito is a rare neurocutaneous syndrome and several abnormalities are often associated. Malignant hypertension and polycythemia are very unusual; their occurrence in a 12 year-old girl is not related to any classical etiology and their place in Ito disease is discussed.

[Osteoarthritis and osteomyelitis due to Kingella kingae in children. Apropos of 5 cases and review of the literature]

Bone infection caused by Kingella kingae (Kk) is rare since there are only 15 published cases. We report 5 additional cases with isolation of Kk from fluid or bone aspiration. Kk was sensitive to the most common antibiotics. The outcome was favorable in every case.

Cerebral atrophy and nephropathic cystinosis

The management of end stage renal failure in cystinotic children is correlated with a longer survival, sometimes complicated with neurological abnormalities. Cranial computed tomography was performed in 10 patients and showed a significant atrophy; the pathogenesis of this damage remains unclear.

[Anatomical study of the kidneys of newborn infants dying after a septic state]

Over a 6 years period, 51 autopsies have been performed in infants dead after severe sepsis. One third of them had renal damages, consisting mainly in haemorrhagic infiltration. Pathological and clinical data are not always well correlated, but some parameters may enhance a poorer renal prognosis, such as the duration of shock and anuria, or exchange transfusion. The clinical presentation of the infection and the encountered germs are the same in both groups, with or without renal damage. A better management of intensive haemodynamic cares in these neonates increases their survival rate and raises the problem of chronic renal failure or hypertension in this situation. It seems very useful to state precisely the surveillance and protection of the renal function in such patients.

[Membranoproliferative glomerulonephritis and Mycoplasma pneumoniae infection]

On the occasion of a new case and review of 9 others in the literature, the authors seek to establish the hallmarks of the nephritis occurring after M. pneumoniae infection. It often consists of an acute nephritic syndrome, 10 to 40 days after a respiratory tract infection; hematological abnormalities are not constant. Histological examination of the kidney shows a type I membranoproliferative glomerulonephritis in 2, dense deposit disease in 2 and tubulo-interstitial nephritis in one. Immunofluorescence studies have shown the microbial antigen 3 times out of 4. Specific antibiotherapy does not charge the prognosis of the extrarespiratory manifestations, for which an immunologic mechanism is likely.

Influence of renal failure on the kinetics of zimeldine and norzimelidine

The kinetics of zimeldine (Z) and its demethylated metabolite, norzimelidine (NZ), were determined after administration of a single 200 mg oral dose of Z to 6 healthy volunteers (Group I), and to patients with mild (Group II) and severe renal failure (Group III). Z and NZ concentrations were assayed by HPLC in serial plasma and urine samples over 6 days following the dose. In Group I Z was rapidly absorbed and metabolized into NZ, and then the plasma concentrations declined with apparent elimination half-lives of 8.4 h and 24.9 h for Z and NZ respectively, whilst the renal clearance of both compounds was low, Z 15.7 ml/min and NZ 33.0 ml/min. The plasma level of Z differed little between Groups I and III, but the area under the curve was significantly higher in Group III than in Group I subjects (AUC0-144 = 17.3 and 6.8 mumol X l-1 X h, respectively). Severe renal failure did not affect the peak plasma concentration of NZ but it did significantly increase peak time, apparent elimination half-life, and the area under the plasma concentration curve. A significant inverse relationship was found between renal clearance of NZ and plasma creatinine. Since NZ is as pharmacologically potent as Z, the results suggest that the dose of Z should be reduced in patients with severe renal insufficiency.

[Neonatal ulcero-necrotizing enterocolitis and aspergillosis]

A preterm infant of 33 weeks of gestation and very small birthweight 1040 g developed on the third day of life a necrotizing enterocolitis with spontaneous perforation. Peritoneal fluid and small bowel meconium was cultured and revealed Aspergillus Niger. The literature is reviewed with seven cases of aspergillosis in newborn period. The infant is dead on the tenth day of life from periventricular haemorrhage. Necropsy was performed and revealed no secondary aspergillosis localisation.

[Prolonged curarization in the newborn infant under assisted ventilation for idiopathic respiratory distress]

We studied the effects of prolonged pancuronium administration in 10 neonates under assisted ventilation for hyaline membrane disease. Pancuronium bromide was administered from the time of intubation with a load dose of 0.1 mg/kg followed by a continuous infusion of 0.03-0.07 mg/kg/h. Tolerance, especially cardiovascular, was excellent after 72 to 525 h of therapy (mean 173 h). Oxygen needs, incidence of mechanical complications and the general evolution of idiopathic respiratory distress were not significantly affected by muscle relaxation. The benefits of systematic pancuronium administration during respiratory intensive care in neonates with hyaline membrane disease appear to be of little value when considering the necessary constraints (corneal, cutaneous, vesical and tracheal supervision).