[Group B streptococcal infection with 2 recurrences in a newborn]

Group B III streptococcus (GBS) is a predominant pathogen in neonates in France. Relapse is rare and two successive relapses are exceptional: only three cases have been yet reported.

CASE REPORT

A newborn infant of 18 days of age presented a first episode of invasive group B III streptococcal infection with meningitis and ventriculitis. At 53 days of age, a second episode with bacteriemia and parotidis appeared. At 63 days of age, she presented a third episode with meningitis. Genome analysis of the three bacterial strains isolated during the three episodes showed the same clonal origin.

COMMENTS

We discuss the incidence of the treatment, the eventual presence of a penicillin-tolerant GBS, the possible relapse or recurrence of the pathogen and the role of the relative immunodeficiency in infant.

[Micrometastases in pediatric oncology]

Metastatic relapse in children with solid tumors is mainly caused by systemic pretreatment dissemination of occult tumor cells. Therefore the initial detection of undetected metastases could have a clinical impact on the prognosis (i.e. new initial staging) and therapy for children with cancer. At later stage it is useful to determine the presence and change in the number of residual malignant cells in order to adjust and/or select adjuvant therapies and techniques (i.e. autologous bone marrow transplantation, leukapheresis.). Over the past decade, sensitive immunocytochemical and molecular assays have been developed which permit the identification of disseminated cancer cell. Actually tumor cell contamination can be detected in bone marrow or in peripheral blood of children with following cancers: neuroblastoma, Ewing tumor, alveolar rhabdomyosarcoma, PNETs. In this review, focus is on the recent technical achievements in the detection of occult cancer cells in bone marrow and in blood and a discussion of their usefulness for clinical trials.

[Acute myelitis of an unusual cause in a child: the lymphocytic choriomeningitis virus]

Acute transverse myelitis is a rare disorder in childhood. It usually occurs as a post-infectious disease, but a precise infectious agent is identified in only 20% of cases.

OBSERVATION

The diagnosis of acute transverse myelitis was made in a 5.5-year-old girl who initially presented with left Claude-Bernard-Horner syndrome and meningitis. A few days later, motor and sensory tetraparesia with bladder dysfunction was observed. Magnetic resonance imaging showed a diffuse lesion in the medulla, with a hypersignal in the T2 and a hyposignal in the T1 sequences. Serum analysis showed the presence of a viral infection due to the lymphocytic choriomeningitis (LCM) virus. The outcome was marked by complete recovery of the sensorimotor deficit, but a persistence of the left Claude-Bernard-Horner syndrome.

CONCLUSION

In rare cases, the LCM virus is responsible for myelitis. In the present case, the Claude-Bernard-Horner syndrome was secondary to the cervico-medullary lesion. Recent reports in the literature have been discussed, in particular as regards the use of immunomodulatory therapy, which clearly improves patient prognosis.

Comparison of ultrasound and dimercaptosuccinic acid scintigraphy changes in acute pyelonephritis

The strategy for morphological investigations in children with acute pyelonephritis (APN) remains debatable. We studied 70 children (median age 2.0 years) admitted with a first episode of pyelonephritis using a high-resolution ultrasound technique (RUS) and compared the results with 99m technetium-dimercaptosuccinic acid (DMSA) renal scintigraphy. The DMSA scan was abnormal in 62 children (89%). However, using a high-frequency transducer we found abnormal sonogram changes in 61 children (87%), consisting of an increased kidney volume in 42, and/or a thickening of the wall of the renal pelvis in 42, and/or a focal hyper- or hypoechogenicity in 36, and/or a diffuse hyperechogenicity in 31 children. Micturating cystourethrography was performed in all children, revealing vesicoureteral reflux (VUR) in 22 (31%). Among those children with VUR, 4 had a normal DMSA scan, 2 an abnormal RUS, and 2 a normal DMSA scan and RUS. Our data suggest that B-mode RUS performed with a high-frequency transducer by a trained radiologist is nearly as sensitive as the DMSA scan in diagnosing renal involvement in children with unobstructed APN and in predicting VUR.

[Mycoplasma pneumoniae meningoencephalitis]

BACKGROUND

Severe central nervous system diseases, such as encephalitis, have been reported in association with Mycoplasma pneumoniae infections.

CASE REPORT

After an ENT infection, a 9-year-old boy with Down's syndrome developed encephalitis revealed by an acute alteration in consciousness. Head computed tomography showed, after 2 weeks, an infiltration in the basal ganglia region. The diagnosis of Mycoplasma pneumoniae encephalitis was made; recovery was complete in a few weeks.

CONCLUSION

Mycoplasma pneumoniae infection should be considered in all cases of acute encephalopathy; yet the pathogenesis of the disorder is unknown and the treatment uncertain.

[Sinus histiocytosis (Destombes-Rosai-Dorfman disease) revealed by extranodal spinal involvement]

BACKGROUND

Sinus histiocytosis with massive cervical lymphadenopathy (Rosai-Dorfman disease) is a non-neoplastic lymphoproliferative disorder. Extranodal involvement, especially of the nervous system, is unusual. We report a case revealed by neurological symptoms.

CASE REPORT

A 10-year-old girl presented with paraparesis due to a dural extramedullary mass on magnetic resonance imaging. Massive cervical lymphadenopathy appeared secondarily. Radiological investigations showed mediastinal, paranasal sinus and lower eyelid involvement. The diagnosis of Rosai-Dorfman disease was established histologically and by immunohistochemical studies of nodal lesions by the demonstration of characteristic sinus histiocytosis with sheets of S-100 protein and CD-68 positive large histiocytes displaying lymphocyte phagocytosis. A dramatic response occurred with complete resolution of all clinical findings after treatment with corticosteroids and etoposide, although neurological lesions were unchanged on magnetic resonance imaging.

CONCLUSION

Despite its rarity, this case underlines the unknown pathogenesis of this disease (immune dysfunction?) and the difficulties of treatment (choice of chemotherapeutic agents, duration).

Analysis of oral antibiotic treatment that failed to prevent the development of Haemophilus influenzae meningitis: consequences on mortality

One hundred and four children suffering from Haemophilus influenzae meningitis were studied in a multi-centre study in France between October 1991 and June 1993. The clinical and bacteriological findings were similar to those usually found in this condition. Fifty three per cent of the H. influenzae strains cultured produced beta-lactamase and 98% were of type b. Forty-six children who had been prescribed oral antibiotics before hospitalisation were analysed in this study. This analysis took into account the nature of the antibiotic and whether it was prescribed as the treatment of first or second intention. Treatment failures, defined according to pre-established criteria, were found to be independent of whether or not the incriminated strain was beta-lactamase producing and whether or not it was sensitive in vitro to the antibiotic prescribed. None of the 46 children who had received pre-hospital oral antibiotics died while three of the 58 who had received pre-hospital oral antibiotics died. However, it is difficult to establish in our study a clear relationship between the reduction of mortality and previous oral antibiotic treatment in bacteriologically proven cases of H. influenzae meningitis.

Chemotherapy-induced nuclear alterations of morphologic and genomic characteristics in a human colon cancer grafted onto nude mice

PURPOSE

A human Dukes B colonic adenocarcinoma was grafted onto 40 nude mice. The mice were divided into four groups, one control and three representing experimental conditions. Animals in the three experimental groups received either adriamycin (ADR), 5-fluorouracil (5-FU), or camptothecin (CPT) over a 25-day period beginning 34 days after grafting. Control animals received saline on an identical schedule. Animals were killed 105 days after grafting.

METHODS

The effect of therapy was assessed by three techniques: 1) tumor size was periodically measured during the life of the animals, 2) modifications of APC, Ki-ras, and p53 genes were studied by polymerase chain reaction, dot-blot analysis, restriction analysis, and DNA sequencing, and 3) image cytometry of Feulgen-stained material was used to characterize 15 parameters describing morphometric, densitometric, and textural features of tumor nuclei.

RESULTS

When compared with controls, tumor growth (size) was maximally suppressed by treatment with CPT (P < or = 0.001). Growth was inhibited significantly by treatment with 5-FU (P < or = 0.01); no statistical difference in tumor size was observed between controls and animals treated with ADR. Modifications of APC, Ki-ras, and p53 genes were not observed; however, treatment did inhibit amplification of APC and p53 genes.

CONCLUSIONS

The 15 morphonuclear parameters were assessed to define populations of cell nuclei altered by chemotherapy. Although CPT maximally suppressed growth, it did not alter nuclear morphology when compared with controls. Treatment with either 5-FU or ADR resulted in nuclear morphologic alterations defined as distinct populations using multivariate analysis. Nonsupervised linear discriminant analysis was used to quantify the relative proportions of these populations. Four morphonuclear parameters were identified, which discriminated nuclei exposed to either ADR or 5-FU from controls.

The overall safety of oral roxithromycin in paediatric clinical studies

In two multicentre, non-comparative studies, a total of 477 children, aged 2 months to 15 years, suffering from respiratory tract infections or skin and soft tissue infections were treated with roxithromycin (50 mg sachets). The mean duration of treatment was 9 days and the mean daily dose was 6 mg/kg/day administered b.i.d. The overall safety of roxithromycin was assessed by analysing the adverse events reported by the patients or investigators, the discontinuation of treatment because of adverse events, and the laboratory data. Adverse events reported by 20 (4%) children were considered to be possibly drug related. These adverse events were mainly digestive in nature and mild or moderate in severity. Treatment was discontinued because of adverse events in six (1%) children. Analysis of laboratory data revealed a few variations without any clinical significance.

Comparative study of human expertise and an expert system: application to the diagnosis of child's meningitis

We present a general method of statistical evaluation for expert systems, applied to a system for the diagnosis of child's meningitis. Fifty difficult clinical cases of child's meningitis were submitted to the system, to seven senior specialists and to seven young physicians. Multidimensional analysis of the diagnosis of the infection category reveals that the two groups of physicians separate naturally and that the system is located among the group of experts. The study of the agreement of the microbiological diagnosis and therapeutic advice shows that the advice of the two groups of physicians is significantly different and that the advice of the system is significantly closer to that of the experts. This result is confirmed by the study of therapeutic errors. This type of study allows one to classify the performance of the system among physicians having different levels of expertise without referring to an objective solution.

Characterization of the hormone-sensitivity of three human non-small-cell lung cancers grafted onto nude mice

The in vivo hormone sensitivity of three human NSCLCs grafted onto female nude mice (labelled KLX7, KLX9 and KLX14) was characterized on a dynamic level, i.e. on the level of both the macroscopic growth and the proliferative fraction (PF = percentage of cells in the S+G2+M Fractions). Two sets of experiments were performed. The first set showed the influence on the macroscopic growth of the NSCLC xenograft of castration performed either before or after tumor grafting. The second set showed the influence of a pulse of 6 different hormones or growth factors on the PF index magnitude recorded 36 h after their administration to the xenograft-bearing mice. These 6 hormones or growth factors were EGF, estradiol-17-beta (E2), gastrin (G), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and bombesin (B). The results show that the KLX7 model grew definitely faster on the nude mice than the other two models. Ovariectomy before or after tumor grafting did not significantly modify the growth pattern of the KLX7 model, while castration before tumor grafting significantly increased the macroscopic growth of both the KLX9 and the KLX14 tumors. In contrast, E2, bFGF, G and B significantly increased the proliferative activity of the KLX7 model 36 h after their administration to the tumor-bearing mice while remaining without any apparent statistically significant effects in both the KLX9 and the KLX14 models.

The use of nuclear-DNA content to monitor the chemosensitivity of human non-small-cell-lung (nsclc) and colorectal cancers xenografted onto nude-mice

The chemosensitivity of human lung and colorectal tumours grafted onto nude mice was assessed at the individual tumour-bearing mouse level. The results show that various pieces of a given tumour grafted onto a number of animals exhibit different profiles of sensitivity to the same chemotherapy. We used the nuclear DNA content to subtype the clonal tumour heterogeneity of these models. This monitoring was performed by means of the digital cell image analysis of Feulgen-stained nuclei. The data show that the nuclear DNA content of human lung and colorectal models vanes markedly not only over serial transplantations onto animals on the one hand, but also within one and the same xenografted tumour during its spontaneous growth on the other. Such nuclear DNA content variations might explain the variability of the chemosensitivity within a given human xenograft model.

Ophthalmologic findings in biotinidase deficiency

Biotinidase deficiency is an autosomal recessively inherited metabolic disorder characterized by neurological and cutaneous manifestations and metabolic abnormalities. We studied 78 symptomatic children and found that 51% had ophthalmologic abnormalities. These include infections (30%), optic neuropathies and visual disturbances (13%), motility disturbances (13%), retinal pigment changes (4%) and pupillary findings (1%). The most commonly reported findings are optic atrophy and keratoconjunctivities. Although the disorder can be effectively treated with biotin therapy, untreated children are at risk of developing permanent neuro-ophthalmic damage.

Axonal response to traumatic brain injury: reactive axonal change, deafferentation, and neuroplasticity

Axonal injury appears to be a feature common to all traumatic brain injuries, and has been linked to much of the morbidity seen in head-injured patients. We consider how such axonal injury contributes to morbidity and also sets the stage for CNS reorganization postinjury. Efforts should continue to determine the correlates of such reorganization and to find therapeutic strategies to expedite it.

[Recurrent pharyngitis. Indications for tonsillectomy]

In the absence of proven facilitating factor, recurrent tonsillitis occurs at all ages but it is particularly frequent in children aged from 6 to 12 years. Anatomical changes in the tonsils and the presence in their tissue of a complex beta-lactamase-producing bacterial flora explain the difficulties and failures of antibiotic therapy and the need for tonsillectomy in many cases. This operation is also increasingly performed for reasons that have nothing to do with infections. It is often necessary in the hypoventilation syndrome due to upper pharyngeal obstruction when the responsibility of the tonsils is either obvious or demonstrated by more or less complex investigations. Constitutional allergy is no longer a formal contra-indication to tonsillectomy.

[Efficacy and tolerance of a new formulation of amoxicillin 100 mg--clavulanic acid 12.5 mg in acute otitis in infants]

A multicenter study of the new pediatric formulation of Augmentin (containing 100 mg amoxicillin and 12.5 mg clavulanic acid per ml) in acute otitis media (AOM) in patients aged three months to three years was carried out by hospital-based pediatricians. Study patients seen at the hospital outpatient clinics were given the drug in a daily dosage of 80 mg in three (83% of cases) or four (15%) divided doses for 6 to 10 days; 28% of patients were also given an antiinflammatory agent. A total of 83 patients with a mean age of 13.5 months were included (89% of patients were less than two years of age); one-third of these patients were included after failure of another antimicrobial agent (macrolide 46%, cephalosporin 23%). The AOM was bilateral in most patients (69.5%) and 46% of patients had a history of previous AOM. Temperature was elevated in 85% of cases and more than half the patients had gastrointestinal symptoms (vomiting, diarrhea) prior to initiation of the study drug. At the interim evaluation on the fourth treatment day, tympanic membranes were normal in 43.5% of cases and improved in 22% of cases. Over 92% of patients achieved resolution of their AOM by the end of the treatment period, regardless of whether or not myringostomy had been performed on Do. Among the 27 patients given the study drug as rescue therapy after failure of another antimicrobial, 24 (89%) recovered fully.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of bacterial meningitis in children]

The initial treatment of infantile and childhood bacterial meningitis is now well standardized, but three current aspects are discussed in this paper. Although classically, ampicillin can still be given as the initial treatment of bacterial meningitis in children, current epidemiologic data demonstrate the emergence of resistant strains of Haemophilus and Pneumococcus, and consequently use of a third-generation cephalosporin should be preferred. Concerning duration of treatment, 4 to 5 days seem adequate for meningococci and 7 days for Haemophilus influenzae and pneumococci. Lastly, the usefulness of adjunctive antiinflammatory treatment is considered. The purpose of this treatment is to lower the risk of cerebral complications and neurosensory impairment. Current data suggest that use of corticosteroids as early as possible may be helpful. Improved understanding of the pathophysiology of pediatric bacterial meningitis has led to other forms of treatment being proposed, but their value remains to be proven.

Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow

Two processes account for most instances of ulnar neuropathy at the elbow: compression in the retroepicondylar groove, and compression by the humeroulnar aponeurotic arcade joining the two heads of the flexor carpi ulnaris. While conventional electrodiagnostic criteria may localize an ulnar neuropathy to the elbow, separating retroepicondylar compression from humeroulnar arcade compression is more difficult. In 130 cadaver elbows, we examined the relationships between the medial epicondyle, flexor carpi ulnaris, and ulnar nerve. The humeroulnar arcade lay from 3 to 20 mm distal to the medial epicondyle, the intramuscular course of the nerve through the flexor carpi ulnaris ranged from 18 to 70 mm, and the nerve exited the flexor carpi ulnaris 28 to 69 mm distal to the medial epicondyle. In 6 specimens, dense fibrous bands bridged directly between the medial epicondyle and the olecranon proximal to the cubital tunnel proper; accessory epitrochleoanconeus muscles were present in 14 specimens: both may cause ulnar neuropathy at the elbow. Anatomical variations may contribute to the difficulty in separating causes of ulnar neuropathy at the elbow.

[Reduction of antibiotic treatment of bacterial meningitis in children. Value of C-reactive protein monitoring]

The duration of antibiotic treatment of bacterial meningitis is always a topical issue. In our study (58 children), 21 of 24 meningococcal meningitis were treated for 4 or 5 days, 16 of 22 Haemophilus influenzae and 4 of 6 pneumococcal meningitis were treated for 7 days without increase in neurologic sequelae. A return of blood CRP levels to normal values was observed in all these patients simultaneously. Thus, CRP seems to be a good biological parameter for discussing treatment discontinuation. Furthermore, in some complications such as subdural effusion, a new increase of CRP levels was observed after the 5th day. A sequential follow-up of CRP levels at days J0, 5, 7, 10, seems a very useful tool for management of bacterial meningitis.

Sparing of the flexor carpi ulnaris in ulnar neuropathy at the elbow

A common misconception attributes sparing of the flexor carpi ulnaris (FCU) in ulnar neuropathy at the elbow (UNE) to its innervating branch arising "at or above the elbow." We examined the relationship of FCU branches to the medial epicondyle (ME) and humeroulnar aponeurotic arcade (HUA) in 30 cadaver elbows. In only three did the first FCU branch arise at or proximal to the ME. In 36 UNE cases with fibrillations in the first dorsal interosseous, the FCU was normal in 10, mildly abnormal in 11, and severely abnormal in 15. FCU involvement correlated with the severity of the neuropathy and with whether compression was retroepicondylar or at the HUA. We conclude that sparing of the FCU in UNE is unrelated to the level of origin of its innervating branch, but rather is related to the internal neural topography and to the severity and level of compression.

[Materno-fetal infections caused by unusual germs. Apropos of 9 cases]

A retrospective study carried out from January 1981 through August 1988 identified nine cases of materno-fetal infections (Staphylococcus aureus, 1 case; Klebsiella pneumoniae, 3 cases; enterococcus, 3 cases; Hemophilus influenzae, 1 case; and Pneumococcus, 1 case) in six girls and three boys; four premature infants developed respiratory distress requiring mechanical ventilation. In four cases, maternal history found risk factors for infection. All patients developed circulatory failure and one had purulent meningitis. Diagnosis was confirmed upon recovery of the microorganism from a central sample in six cases; in three cases, only the peripheral cultures were positive but diagnosis was supported by the positive maternal history and by clinical findings. Bacterial species were not associated with specific clinical or biological features, but infections due to Hemophilus influenzae, Klebsiella pneumoniae and pneumococcus were particularly severe (two deaths and two infants with neurologic sequelae). In some studies, unusual microorganisms account for 46% of septicemias and 36% of purulent meningitis. Group D streptococci are the most common bacteria in this category and may account for 10% to 15% of early neonatal septicemias. Organism-specific features are analyzed on the basis of data from the literature. Concerning therapy, this epidemiologic aspect of materno-fetal infections complicates the choice of the initial antimicrobial agents; because third-generation cephalosporins are not effective on listeria and group D streptococci, we advocate more widespread use of the ureidopenicillins instead of ampicillin.

[Extracardiac malformations in tetralogy of Fallot]

The purpose of our study was to determine the incidence and type of malformations associated with tetralogy of Fallot (TF). Among 133 patients followed up for 12 years, 30 who had either complete TF (n = 26) or pulmonary atresia and interventricular septal defect (n = 4) presented with another, extracardiac malformation. These malformations were part of a malformative syndrome in 21/30 patients, including 4 trisomies 21, 6 embryofoetopathies unquestionably (antiepileptics n = 2, alcohol n = 1) or possibly (hormonal treatment n = 1) of environmental origin, 6 branchial arch pathologies and 5 miscellaneous syndromes. The extracardiac malformation was isolated in the remaining 9 patients, including 5 cases of skeletal anomaly and one case each of omphalocele and microcephaly. Altogether, in these 30 patients skeletal and neurosensory anomalies were largely predominant. Skeletal anomalies involved the vertebral column in 8 cases (cervical 3, thoracic 4, lumbar 1) and the limbs in 5 cases (2 of which were phocomelias). The 4 patients with pulmonary atresia and interventricular septal defect also presented with an early embryopathy: Shprinzen's velocardiofacial syndrome (n = 2), DiGeorge syndrome (n = 1) and situs inversus (n = 1). We compared TF with other congenital heart diseases in our population and found that the incidence of associated malformations was about average. The various associations are discussed. In genetic syndromes, trisomy 21 predominates and TF is less frequent than atrioventricular canal. In syndromes of environmental origin, the role of antiepileptic drugs (chiefly phenytoin and trimethadione) is well-known, alcohol is less often responsible and the TF-phocomelia association is suggestive of progesterone. In branchial arch syndromes, TF is the usual cardiopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ceftazidime in the treatment of purulent meningitis]

Third generation cephalosporins have modified the first-line treatment of bacterial meningitis in adults and children. Among these compounds, ceftazidime has a particularly wide antibacterial spectrum, and clinical results have confirmed its superiority, notably in the treatment of meningitis caused by Pseudomonas spp. It is an excellent first-line empirical treatment while awaiting bacteriological results, but in view of the severity of these diseases and of the dangerous pathogens that are often involved, it seems preferable to combine ceftazidime with an aminoglycoside. Route of administration (systemic or in situ) and duration of treatment must be tailored to each individual case.

Salla disease in one non-Finnish patient

In a 5-year-old boy, an early onset psychomotor retardation with non-progressive ataxia and without dysmorphic features, associated with lysosomal storage disease found on ultrastructural examination of the conjunctiva, led to the diagnosis of Salla disease. This was supported by a tenfold excretion of urinary free sialic acid, without abnormal oligosacchariduria or anomaly in lysosomal enzymes. This boy is a native of Southern France. Screening of urinary sialic acid has to be introduced in aetiological investigations of patients with apparently non-progressive psychomotor retardation associated with ataxia or dystonic movements.

Skin test reactivity in infancy

Skin tests represent a major tool in the diagnosis of reaginic allergy; however, their interpretation does not appear to be without difficulty in children under the age of 3 yr. Seventy-eight infants from birth to 24 mo were prick tested and compared with 30 nonallergic adult subjects. Skin tests were performed without bleeding by use of two strengths of histamine hydrochloride (1 and 10 mg/ml), a mast cell degranulating agent (codeine phosphate, 50 mg/ml), and allergenic extracts. Negative control solution elicited a small wheal (less than 1.5 mm) in two infants who were excluded from further results. A clear and significant (p less than 0.001) hyporeactivity to both histamine and codeine phosphate was observed in infancy, especially before the age of 6 mo. Six infants were allergic and presented positive prick tests to either food or inhalant allergens. These tests were confirmed by serum specific IgE and a suggestive clinical history. The size of the allergen-induced prick test wheal ranged from 2 to 5 mm in diameter, suggesting that prick test wheals may be smaller in infants. This study confirms that prick tests can be performed and interpreted without difficulty in infants, keeping in mind the small wheal size induced by both positive control solutions and allergen-induced prick tests.

[Use of cefotaxime in severe infections in newborn infants]

Twenty-seven septicemia, 2 urinary tract infections and 2 meningitis were treated with Cefotaxime. The pathogenic organisms were most often entero-bacteria (16 E. coli, 2 Klebsiella, 2 Enterobacter cloacae, 1 Proteus, 1 Acinetobacter); sometimes they were Streptococcus (5 Streptococcus D, 3 Streptococcus B, 1 Streptococcus Salivarius). Cefotaxime was given alone to 16 patients, in association to an aminoglycoside in 15 cases. It was administered by infusion over 30 minutes every 8 hours in a daily dose of 150 mg/kg (during 10 days in case of septicemia and during 18 days if it was a meningitis). A clinical and bacteriological success was obtained in 86% of the 22 cases caused by Enterobacteria, in one of the 5 septicemia due to Streptococcus D and in the 3 infections caused by Streptococcus B. It may be concluded from these results that cefotaxime may be used in neonate infection due to a Gram-. But when a Listeria or a Streptococcus D is discovered the ampicillin classically prescribed must be maintained.

[Use of diazepam in the preventive home treatment of recurrent febrile convulsions]

Parents with children who had presented with a simple febrile convulsion were advised to give their children rectal diazepam, in case of fever. The results (21 families with an average follow-up of 2 years) were compared with those in two groups of controls. The efficacy and inocuousness of prophylactic treatment are remarkable. However, its indication should be more precisely stated, after a better information of families and practitioners, since the expected effect on familial apprehension was not satisfactorily obtained.

Congenital muscular dystrophy and rigid spine syndrome

In three patients with muscular dystrophy, the unexpected occurrence of spinal stiffness suggested a diagnosis of rigid spine syndrome. One case belongs to the benign form of the congenital muscular dystrophies; in the other cases however, the severity and the distribution of the muscular process, associated with neurological abnormalities, seems to correspond to a unique variant of congenital muscular dystrophy. These observations underline the heterogeneity of the rigid spine syndrome.