Fluid and electrolyte management in preterm infants with patent ductus arteriosus

Optimal fluid management of preterm babies with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is frequently challenging for neonatal care physician because of paucity of clinical trials. There is wide variation in practice across neonatal units, resulting in significant impact on outcomes in Extremely Low Birth Weight (ELBW) babies with hemodynamically significant PDA. A delicate balance is required in fluid management to reduce mortality and morbidity in this population. The purpose of this review is to lay out the current understanding about fluid and electrolyte management in ELBW babies with hemodynamically significant PDA and highlight areas for future research.

[Muscular manifestations in periodic disease]

Between 1976 and 1983, the authors studied 50 new patients affected with periodic disease. 16 of them-mean age: 29-presented muscular manifestations. They may be grouped into two clinical aspects: muscular pain and contractures. The authors consider that these symptoms, first described in 1945, are an inherent part of the clinical picture of the disease. They discuss their relationship with periarteritis nodosa and remind the fact that their pathogenesis remains unknown.

[Ossification of the posterior longitudinal ligament of the lumbar spine]

The authors present five cases (4 men, 1 women) of ossification of the posterior lumbar longitudinal ligament. The mean age is 61 years. They emphasize the extreme rarity of this location, its association with ankylosing spinal hyperostosis and diabetes in three patients; they also give a reminder of the characteristics of this radiological symptom. They discuss the etiology on the basis of three hypotheses (disc deterioration, hyperostosis, disease described by Japanese authors).

[Behçet's disease. Apropos of 32 cases]

The study of 32 cases of Behçet's disease has enabled the authors to ascertain that the disease presents no particular characteristics in Lebanon, except certain variations in the frequency of the symptoms. Their study includes two familial cases, or approximately 3 p. cent and confirms the severity of these forms. Colchicine proves to be an effective treatment able to cure cutaneous and articular symptoms and perhaps stabilize the ocular lesions. The long-term efficacy of steroid therapy in ocular manifestations is not certain. Chlorambucil caused a stabilization of ocular lesions in four patients.

[Familial paroxysmal polyserositis. Previously unpublished peritoneal complications. A case]

A young unmarried Lebanese woman presenting with periodic disease (familial paroxysmal polyserositis) since she was 3 months old developed recurrent abundant ascites at the age of 21 years. Several hundred millilitres of strongly eosinophilic fluid were evacuated. Exploratory laparotomy unexpectedly disclosed an encapsulating peritonitis with adhesions involving the small bowel and the ascending colon; there were masses of lipid-laden cells, clusters of cholesterol/crystals and marked mesoepithelial reaction. In view of the patient's dramatic response to colchicine 2 mg/day, these findings were regarded as being related to the periodic disease.

[Periodic disease (familial paroxysmal polyseritis). 52 cases]

On the basis of well defined diagnostic criteria, the authors conclude that periodic disease affects males in particular. It commences before the age of 20 years in 80 percent of cases. In particular it occurs in Armenian and Shiite communities. Its evolution is normally benign ; amyloidosis is found in only 8 percent of cases. Joint manifestations are found in 48 percent of cases and may take on different aspects and occur in several different sites : myaglia or arthralgia, monoarthitis, oligoarthritis, polyarthritis, neck or sacroiliac pain. The authors have not noted prolonged peripheral joint episodes. No cases of amyloidosis were diagnosed before the appearance of the clinical signs of the disease. An autosomal, dominant heredity with incomplete penetration seems to be the most likely hypothesis.