Une dacryocystite aiguë peut compliquer l'obstruction congénitale du canal lacrymal. L'infection aiguë du sac lacrymal est rare chez le grand enfant et son origine tuberculeuse encore plus exceptionnelle.Observation. - Un garçon de 4 ans 12 a été hospitalisé pour dacryocystite aiguë gauche avec fièvre et adénite sous angulomaxillaire. L'atteinte de la glande lacrymale et ganglionnaire a persisté en dépit d'une antibiothérapie associée à des corticoïdes. Une biopsie à l'aiguille du ganglion a montré la présence de Mycobacterium tuberculosis et la biopsie ganglionnaire a révélé l'existence de granulomes caséeux. Le test cutané à la tuberculine était positif tandis qu'une tuberculose pulmonaire était découverte chez le pòre de l'enfant. L'enfant aa été traité par isoniazide, rifempicine pendant 9 mois et pirazinamide pendant 2 mois. L'évolution a été favorable mais a néanmoins nécessité un drainage de l'abcès 1 mois après le début du traitement puis une dacryocystorhinostomie.Conclusion. - Cette observation, rare, de dacryocystite est l'occasion de préciser les difficultés du traitement ophtalmologique.Background. - Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it.Case report. - A 4 12 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessory after 1 month of treatment followed by dacryocystorhinostomy.Conclusion. - This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.

The immature fetal kidney can be affected by many drugs given to the mother during pregnancy, including angiotensin converting enzyme (ACE) inhibitors which can cause lasting or irreversible life-threatening postnatal anuria. In the light of previously published data and of a personal case of fatal anuria in a premature infant born to a mother treated by enalapril throughout pregnancy, the adverse effect of ACE inhibitors on the fetal kidney are discussed. These drugs should be used during pregnancy only if they are essential to the mother's survival.

The authors report two cases of citrullinemia in siblings which add to 68 observations from the literature. They overview the clinical presentation, diagnosis and therapeutic management of the disease. The prognosis of severe neonatal form remains poor but an early adequate management may contribute to an acceptable outcome.

The authors report two cases of citrullinemia in siblings which add to 68 observations from the literature. They overview the clinical presentation, diagnosis and therapeutic management of the disease. The prognosis of severe neonatal form remains poor but an early adequate management may contribute to an acceptable outcome.

The authors report on the extraction of a piece of peanut impacted into the antero-internal bronchus of the right middle lobe, inaccesible to rigid bronchoscopy. After 4 months, this foreign body was visualised by flexible endoscope and removed by this technique under general anesthesia. We initially used a brush to pull the foreign body out of the distal bronchus and then used a biopsy forceps to remove it. Three months later, the chest-X-ray is normal and the child is asymptomatic.

A 3-year old child was admitted for a third relapse of nephrotic syndrome associated with intracranial hypertension related to dural sinus thrombosis (tomodensitometry). The treatment consisted in the association of low dose heparin and fresh frozen plasma. After a 3 year-follow-up, there was no neurologic sequelae, and the nephrotic syndrome was on complete remission. The radiologic features and the management of sinus thrombosis are discussed.

The authors report on a 1-year old girl who presented with transient hypotonia and polydipsia related to renal-concentrating defect. Renal magnesium and calcium wasting were noted when the subject was 3.5 years old, in association with distal tubular acidosis and nephrocalcinosis. Hypocalcemia and hypomagnesiemia persisted when the patient was 9.5 years old. About 50 cases of tubular defects with renal magnesium loss have been reported in the literature and show that magnesium loss may be either isolated or associated with potassium and/or calcium wasting. This hereditary defect may be due to an alteration in magnesium reabsorption in the thick ascending limb of the loop of Henle.

In attempt to evaluate the vitamin D status of the infants of our area under the mode of prophylaxis of carential rickets actually used in France, serum 25 hydroxyvitamin D (25 OHD) levels were measured in 65 infants (age 3 - 32 months) during their hospitalisation for acute illness. Most infants were receiving vitamin D either in daily doses (1,200 - 1,600 u) or in unique loading doses (200,000 - 600,000 u every 4 - 6 months). With this prophylaxis serum concentrations of 25 OHD were elevated, i.e. above 75 nmol/l, in more than 50% of the infants, reaching 474 nmol/l in one case. Calciuria estimated by the calcium/creatinine urinary ratio tended to increase in parallel with the serum 25 OHD level. From these data it is concluded that the actual prophylaxis of carential rickets in France frequently uses excessive doses of vitamin D and that new rules have to be established.

Good clinical results are well known with the use of immunosuppressive therapy in children with idiopathic nephrotic syndrome; more recently, biological data have enhanced immunological anomalies, concerning mainly T helper lymphocytes. The need for steroids may decrease when relapsing nephrotic syndrome is associated with steroid intoxication and is absent when corticoresistance occurs. In these cases, the use of immunosuppressive agents is justified, but limited by side effects and toxicity. In patients treated with alkylating agents and now cyclosporine, good responses are often seen in frequently relapsing children whereas the course of steroid-resistant nephrotic syndrome is not significantly modified. However, the definite appreciation of such therapeutic results has to be further precised by both histological data and multicentric studies concerning new protocols.

Transient neonatal hypothyroidism was found in a boy whose mother was treated for hypothyroidism due to Hashimoto's thyroiditis. During the neonatal period the infant had antithyroid microsomal and antithyroglobulin antibodies and immunoglobulins inhibiting cyclic AMP production by thyroid cells in vitro. After one year of treatment, all antibodies disappeared. Thyroid scintiscan and fixation in the neonatal period was negative and became positive 2 months after stopping treatment with normal fixation and cervical thyroid picture. The mother's serum contained the same antibodies: they crossed the placental barrier and were responsible for neonatal pathological manifestations.

HLA profile was determined in 121 caucasoid children with rheumatoid purpura: out of those 55 developed nephropathy, of variable severity. HLA A and B were studied in all children, DR in 87. HLA BW 35 was more frequently found in total group of rheumatoid purpura (28,9%) and especially in nephropathies: 38,2% vs 20,4% in controls. However the increase is not significative even in nephropathy. On the other hand BW 35-DR 4 association is significatively higher in rheumatoid purpura with or without nephropathy than in controls. Analysis of 3 families with 2 affected sibs and 7 families with 1 affected child does not show any linkage with HLA. Determination of HLA profile does not allow to predict that the disease will be complicated by a nephropathy.

Typical rickets were observed in a 13 year old Turkish girl and in a 14 year old Moroccan girl. Hypocalcaemia was present in one case. Symptoms have easily regressed with vitamin D2. Seric 25 OH D3 was very low; seric 1-25 OH D3 was normal before treatment and increased very much with vitamin D. In the second case vitamin D deficiency was familial. Study of 15 immigrant children living in or near Saint-Etienne has shown low seric concentrations of 25 OH D3 in 9 (8 undetectable).

Observation 2 filles de 13 et 14 ans ayant un rachitisme typique, avec chez la deuxieme une hypocalcemie. Regression des symptomes sous vitamine A2. Taux serique de 25 OH D3 effondre, celui de 1,25 OH D3 normal avant traitement. Dosage chez 15 grands enfants migrants montre des taux seriques bas de 25 OH D3