Neonates with Down's syndrome have an increased risk for congenital leukaemia, particularly acute megakaryoblastic leukaemia (FAB, M7) which most often resolves spontaneously and is called transient leukaemia. It can be observed in non-constitutional trisomy 21 infants then presenting trisomy 21 on blasts cells.Observation. We report a transient leukaemia with an isolated pericardial effusion in a phenotypically normal neonate. Trisomy 21 was found on blasts cells. Complete remission remains after 32 months.Discussion. Congenital leukaemias, with trisomy 21 on blasts cells have a good prognosis that justifies observation before using chemotherapy. 0 2007 Elsevier Masson SAS. All rights reserved.

UNLABELLED:Neonates with Down's syndrome have an increased risk for congenital leukaemia, particularly acute megakaryoblastic leukaemia (FAB, M7) which most often resolves spontaneously and is called transient leukaemia. It can be observed in non-constitutional trisomy 21 infants then presenting trisomy 21 on blasts cells.OBSERVATION:We report a transient leukaemia with an isolated pericardial effusion in a phenotypically normal neonate. Trisomy 21 was found on blasts cells. Complete remission remains after 32 months.DISCUSSION:Congenital leukaemias, with trisomy 21 on blasts cells have a good prognosis that justifies observation before using chemotherapy.

Two cases of myocarditis and congestive heart failure in immunocompetent patients with seroconversion for toxoplasmosis are reported. Serological tests showed that in the first case the cardiac manifestations occurred at the time of seroconversion (low IgG, raised IgM and IgA), whereas in the second case they occurred several months after the initial infection when IgM was decreasing, IgG levels were very high (>1000 IU/ml) and IgG had high affinity for the antigen. The pathophysiological mechanisms underlying cardiac involvement in acute or chronic toxoplasmosis are discussed.

In emergency ambulance calls, agonal breathing remains a barrier to the recognition of out-of-hospital cardiac arrest (OHCA), initiation of cardiopulmonary resuscitation, and rapid dispatch. We aimed to explore whether the language used by callers to describe breathing had an impact on call-taker recognition of agonal breathing and hence cardiac arrest.We analysed 176 calls of paramedic-confirmed OHCA, stratified by recognition of OHCA (89 cases recognised, 87 cases not recognised). We investigated the linguistic features of callers’ response to the question “is s/he breathing?” and examined the impact on subsequent coding by call-takers.Among all cases (recognised and non-recognised), 64% (113/176) of callers said that the patients were breathing (yes-answers). We identified two categories of yes-answers: 56% (63/113) were plain answers, confirming that the patient was breathing (“he’s breathing”); and 44% (50/113) were qualified answers, containing additional information (“yes but gasping”). Qualified yes-answers were suggestive of agonal breathing. Yet these answers were often not pursued and most (32/50) of these calls were not recognised as OHCA at dispatch.There is potential for improved recognition of agonal breathing if call-takers are trained to be alert to any qualification following a confirmation that the patient is breathing.

Cyclosporin A (Cs A) is one of a family of fungal metabolites which has proved to be a potent immuno­ suppressive agent. It is extracted from the soil of fun­ gus Tolypocladium inflatum. Cs A has a molecular weight of 1200 daltons and comprises 11 amino acids, one of which is unique and most of which are hydro­ phobic. Thus the drug is only soluble in lipids or orga­ nic solvents. Although first developed as an antifungal agent, its antibiotic activity proved to be very restric­ ted; it was the routine screening of such agents for immunosuppressive activity by Borel et al. (1,2) that revealed this unexpected and powerful activity of Cs A in a variety of in vitro and in vivo assays of immunolo­ gical reactivity.

The modalities of left ventricular (LV) adaptation (dilatation and/or hypertrophy) to exercise are not as well known in children as in adults. Therefore, the authors followed up 11 national ice hockey players, initially aged 10, following an eight hour per week training schedule for a period of 5 years. M mode echocardiographic studies were carried out each year during the training period to measure LV internal dimensions, wall thickness, myocardial mass and contractility (fractional shortening and systolic stress index). The evolution of these parameters was evaluated (Student's test) by two year peripubertal periods (10-12 years: 12-14 years) and compared in absolute values and in rate of growth with the standardised values indexed to body surface area reported by Henry. Between 10 and 12 years of age, the LV internal dimensions (a good indicator of LV volume in healthy children) increased significantly (p less than 0.05) and LV mass increased very significantly (p less than 0.01). The LV internal dimensions were normal at the outset and remained in the upper limits of normality reported by Henry with a normal rate of growth. Myocardial mass was normal at the age of 10 and its rate of growth was also normal. Between 12 and 14 years of age, the increase in LV internal dimensions was not statistically significant but myocardial mass increased very significantly (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)