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Unlabelled: Spinal epidural hematoma is an uncommon complication in hemophilia., Case Reports: The cases of an extensive epidural hematoma in two boys with severe hemophilia are reported., Conclusion: Acute onset of severe neck pain or backache leads to the diagnosis of epidural hematoma in children with hemophilia, even in the absence of neurologic symptoms. Early diagnosis is important and relies on magnetic resonance imaging. Replacement therapy is mandatory and must be prescribed before neuroradiologic imaging. Generally, children have a good neurologic outcome.

This is a case report of a 74-year old woman who from March 1994 to April 1995 was admitted to our hospital because of three episodes of syncope. Each general physical examination was normal except for a grade 2/6 systolic murmur. No abnormalities were disclosed after several resting electrocardiograms and Holter monitoring. The Schellong and the tilt tests were normal. During the last admission the patient had a syncope 30 minutes after a meal. Blood pressure reduction was documented and postprandial hypotension was diagnosed. Postprandial decreases in systolic blood pressure in the elderly may predispose the subject to symptomatic hypotension and to falls, dizziness, weakness, angina pectoris, stroke and syncope. The mechanism of postprandial hypotension is not fully understood. It is defined as a decrease in postprandial systolic blood pressure of 20 mmHg or more. Because postprandial hypotension is a common problem in older, frail, institutionalized patients, all physicians caring for elderly patients should be aware of the hypotensive effects of food intake and should consider postprandial hypotension in the evaluation of falls, syncope and other ischemic cerebral symptoms.

Background: Acute bilateral striatal necrosis complicating the course of a post-infectious encephalitis is rare., Case Report: A previously healthy 5-year-old boy presented with an atypical pneumonia; he rapidly developed, encephalitis revealed by a generalized status epilepticus. After transient improvement, he became confused and mutic, with dystonic postures of his limbs. Painful stimulation resulted in prolonged facial grimacing and doleful cry. CT scan and MRI showed abnormal signals in the whole basal ganglia, typical of bilateral striatal necrosis. Serologic tests for Mycoplasma pneumoniae were positive. The child recovered almost completely., Conclusion: A parainfectious process is probably responsible for the transient bilateral striatal necrosis seen in this patient who had Mycoplasma pneumoniae infection several days before the onset of neurologic symptoms. MRI seemed more reliable than CT-scan for the diagnosis of this condition.

The second population survey of the Swiss MONICA project took place in 1988-89 in the cantons of Vaud, Fribourg and Ticino. Blood lipids (total, LDL, and HDL cholesterol as well as apolipoproteins A-I and B) were measured in 3341 individuals aged 25-74 years belonging to a representative sample of the three cantons' population. Total and LDL cholesterol values were high on average, especially among patients aged 45 and over: total cholesterol was > 6.5 mmol/l in 27% (age 25-34) to 58% (age 45-54) and in 15% (age 25-34) to 64% (age 65-74) of men and women, respectively. HDL cholesterol values were relatively stable with age, at a higher level in women (median 1.5 mmol/l) than in men (median 1.2 mmol/l). To summarize, about 1 out of 5 people had cholesterol values placing them at low risk for the development of coronary heart disease, whereas 1 out of 4 were at increased risk. Apolipoprotein B, a component of LDL cholesterol, and apolipoprotein A-I, a component of HDL cholesterol, were measured for the first time in a large representative sample of the Swiss population. The distribution of both apolipoproteins was, in the aggregate, very similar to the distribution of the corresponding LDL and HDL cholesterol. A comparison of cholesterol values measured in 1988-89 with values previously measured in the same population (MONICA population survey 1984-85) did not show any reduction with time.

A 6 week-old boy whose mother and sister present with hereditary hemorrhagic telangiectasia (HHT) presented suddenly with listlessness, hypotonia, and acute anemia. Cerebrospinal fluid was grossly hemorrhagic. Brain CT scan was compatible with subarachnoid and intracerebral hemorrhage. Operative investigation diagnosed a ruptured aneurysm of one branch of the right middle cerebral artery. A large clot was removed from the right frontal lobe. The ruptured artery was clipped. Further cerebral and abdominal angiographies did not show other aneurysms. The infant died 18 days later, with bilateral subdural hematoma. The family history and review of the literature suggest that the rupture of a cerebral aneurysm in this infant may have been an early manifestation of HHT. Brain CT scan study seems mandatory in every infant born to a mother with HHT.

A breast-fed boy, born to first-cousin parents, had been vomiting since birth; his general condition remained good until age 6 weeks when vomiting became more frequent, and his status suddenly worsened, with polypnea, shock, hypothermia, jaundice, presence of blood in urine, gastric juice, stool, and bleeding tendency during veno-punctures. There was an huge hepatomegaly and a splenomegaly. Hypoglycaemia, metabolic acidosis, severe blood coagulation disturbances, elevated liver enzymes, hypoalbuminemia, pointed to an acute liver failure. He was resuscitated with current supportive measures, and was given a wide spectrum antibiotherapy. Because serologic tests for syphilis were positive in the child and his mother, including the presence of specific IgM the infant was then given Penicillin G therapy only, which resulted in a complete recovery. One month later, a needle liver biopsy showed residual signs of hepatitis. Other possible infectious or metabolic causes of acute liver failure occurring early in life had been excluded.

Report of a case of laryngitis beginning within the first 10 hours of life. The epiglottis was red, swollen, and covered by a membrane. Culture of laryngeal swabs isolated Streptococcus pneumoniae. Complete recovery was obtained with antibiotic therapy.