Smoke inhalation injury in a 2-year-old domestic fire victim

Smoke inhalation injury is common in victims of domestic fires, among whom children are the most vulnerable. Cyanide poisoning may occur in addition to carbon monoxide poisoning and is challenging to diagnose. In France, the recommended antidotes are hydroxocobalamin for cyanide and hyperbaric oxygen for carbon monoxide. We managed a 26-month-old girl who sustained smoke inhalation injury with both carbon monoxide and cyanide poisoning during a house fire. Despite hydroxocobalamin and sodium thiosulfate therapy combined with hyperbaric oxygen, she had residual neurological impairments 3 months after the injury. The treatment challenges and detailed neurological follow-up data are described.

Assessment of Interleukin-17A, Interleukin-10 and Transforming Growth Factor-Beta1 Serum Titers in Relapsing Remitting Multiple Sclerosis Patients Treated with Avonex, Possible Biomarkers for Treatment Response

INTRODUCTION

Individual response to interferon beta (IFN-β) 1a treatment is heterogeneous in multiple sclerosis (MS). Our objective was to find a connection between serum levels of interleukin (IL)-10, IL-17 and transforming growth factor beta (TGF-β)1 in MS patients treated with IFN-β in order to identify the nonresponders (NR).

MATERIAL AND METHODS

We included in the study 32 healthy subjects and 32 MS patients: 10 naive, 10 early treated and 12 late treated with INF-β1a. Serum determination of cytokines and brain MRI were performed at the beginning of the study, after 6 and 12 months. Rio score was calculated at the end of the study.

RESULTS

MS patients had initially a significant higher level of IL-17 and a lower level of TGF-β1 compared to healthy subjects. IL-17 level in early treated patients was significantly lower compared to the naive and late treated groups. INF-β1a treatment significantly increased IL-10 and decreased IL-17 levels. Initial low levels of IL-10 were associated with an increase in physical disability. IL-17 levels positively correlated with the number of relapses and MRI activity. Nine patients were NR to Avonex. Patients with a Rio score of 3 had higher initial levels of IL-17 and those with a Rio score of 0 had higher initial levels of IL-10 and TGF-β1.

CONCLUSION

IFN-β1a decreased IL-17 and increased IL-10 seric levels; IL-17 significantly correlated with MS activity; TGF-β1 activity is titer-dependent, increased levels were associated with IL-17 inhibition; NR patients to IFN-β1a will have initial high IL-17 and low IL-10 and TGF-β seric levels.

Cerebral biometry in fetal magnetic resonance imaging: new reference data

OBJECTIVES

To provide normal magnetic resonance imaging (MRI) reference biometric data of the fetal brain, to evaluate reproducibility and gender effect, to compare the two cerebral hemispheres and to compare MRI with ultrasonographic biometry, in a large cohort.

METHODS

Normal cerebral fetal MRI examinations were collected prospectively and several parameters were measured: the supratentorial space (bone and cerebral fronto-occipital and biparietal (BPD) diameters), the length of the corpus callosum (LCC), the surface area, height and anteroposterior diameter of the vermis, the transverse cerebellar diameter (TCD) and the anteroposterior diameter of the pons. We evaluated the interobserver reproducibility of measurements and the possible gender effect on measurements of bone BPD, TCD and LCC. We compared right and left hemispheres, right and left atria and ultrasound and MRI measurements.

RESULTS

The study included 589 fetuses, ranging from 26 to 40 weeks. Normal values (from 3(rd) to 97(th) percentile) are provided for each parameter. Interobserver agreement was excellent, with an intraclass correlation coefficient (ICC) > 0.75 for many parameters. The gender effect was evaluated in 372 cases and did not reveal any clinically meaningful difference. Comparison between the right and left cerebral hemispheres and between the right and left atria did not reveal any meaningful differences. Ultrasound and MRI measurements of BPD and TCD were compared in 94 cases and 48 cases, respectively, and the agreement was excellent (ICC = 0.85).

CONCLUSIONS

We present new reproducible reference charts for cerebral MRI biometry at 26-40 weeks' gestation, from a large cohort of fetuses.

Comparison between magnetic resonance imaging and fetopathology in the evaluation of fetal posterior fossa non-cystic abnormalities

OBJECTIVES

To compare magnetic resonance imaging (MRI) and fetopathological findings in the evaluation of non-cystic fetal posterior fossa anomalies and to describe associated abnormalities.

METHODS

This was a prospective study from 2000 to 2005 of fetuses identified on ultrasound as having sonographic suspicion of posterior fossa malformation. All underwent a thorough MRI examination of the fetal brain, after which we classified each fetus as presenting one of the following pathologies: vermian hypoplasia or agenesis, cerebellar and/or brain stem hypoplasia, destructive or dysplastic lesions. All of the pregnancies were then terminated, after which the whole fetus underwent fetopathological examination. We compared the findings from MRI and fetopathological examinations and recorded the associated cerebral and extracerebral abnormalities.

RESULTS

Twenty-five fetuses were included. MRI was performed at a mean gestational age of 31 weeks, and fetopathological examination at 33 weeks. In 12 cases we observed vermian hypoplasia, six had partial vermian agenesis, 11 had cerebellar hemisphere hypoplasia, seven had brain stem hypoplasia, four had destructive lesions and six had dysplastic lesions. The two techniques were similar in their performance with respect to the detection of vermian agenesis, brain stem hypoplasia and destructive lesions. There were four false-positive results of MRI for vermian hypoplasia and a poor agreement regarding cerebellar hemisphere hypoplasia. No dysplastic lesions were diagnosed by MRI. None of the posterior fossa malformations was isolated and many cerebral and extracerebral abnormalities were found.

CONCLUSION

A systematic analysis of the posterior fossa in fetal MRI makes it possible to diagnose accurately most posterior fossa malformations. These malformations never occurred in isolation in our study.