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At one month, the acetabular depth from a standard lateral coronal section is 4.6 ± 1.0mm. The correlation between experienced and junior radiologists is high (kappa 0.795). A treshhold of 6mm with a Δ (difference between right and left) less than 1.5mm provides a sensitivity of 100% for the detection of DDH at one month. Universal US screening at one month of all high-risk infants in 2009 resulted in a reduction of delayed diagnosis of DDH (zero girls, two boys) in Ille-et-Vilaine due to continuous medical education of general radiologists., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)

We report the first known case of a successful pregnancy in a 22-year-old white woman suffering from hepatic Byler's syndrome, a familial fibrogenic cholestasis observed in children and usually leading to death during adolescence or to liver transplantation. A first pregnancy was unsuccessful with intrauterine death. Medical surveillance of the second pregnancy was reinforced due to major cholestasis and itching sensation. Plasmapheresis was employed weekly from the 19th week of gestation. Within 2 weeks of treatment onset, plasma alkaline phosphatase levels returned to normal; pruritus completely disappeared after the second session. Delivery was decided at 33 weeks gestation with uterine section. The female baby weighed 2,090 g and outcome was excellent. This is the first reported case of Byler's syndrome with successful pregnancy. We underline the efficacy and safety of apheresis in this very particular disease.

Objective: To determine the interest of plasmapheresis in the management of cancer-associated microangiopathic haemolytic anaemia (MHA) not due to cancer treatment., Material and Methods: [corrected] National retrospective study using the file of the French Hemapheresis Society., Results: We isolated 6 patients (5 men and a woman aged 32 to 69-year-old) who had prostatic (4 cases) or breast carcinomas or Hodgkin's disease. Diagnosis of cancer preceeded MHA in 3 patients (from 2 to 4 years). Bone or bone marrow metastases were demonstrated in 5 patients. The clinical presentation included anuria (4 cases), bleeding (4 cases), and laboratory findings were consistent with microangiopathic haemolysis and thrombopenia in all cases and intravascular coagulation (2 cases) and/or renal failure (4 cases). MHA symptomatic treatment included 4 to 10 courses of plasmapheresis, extra-renal epuration (4 patients), anticoagulation (4 patients) and/or antiagregant (3 cases), haemodialysis (4 cases) and vincristine (2 cases). Cancer treatment consisted of antitumoural chemotherapy (2 cases) and/or hormonotherapy (5 cases). In all cases, haemolysis, thrombopenia and intravascular coagulation were controlled within 30 days. MHA treatment was effective alone in 3 patients. No relapse were observed in 3 patients whereas the course of cancer continued in 2 patients. Two patients relapsed and died from MHA after 4 and 36 months. Two patients relapsed and died from MHA within a few months and 1 was lost to follow-up., Conclusion: Symptomatic treatment of cancer-associated MHA including plasmapheresis may be useful while waiting for an aetiologic management of the tumour.

Since 1983, 28 patients with a rapidly progressive glomerulonephritis were treated with apheresis. Seventeen patients had a primary glomerulonephritis, while 11 had a secondary form. Pathological pattern showed crescentic glomerulonephritis in all cases but one. In 23 cases of 28, renal survival was compromised within a few months. Apheresis were performed with the filtration technique, using a single needle device and central venous catheter. Plasmafilters were reused since 1984. In 1987, cascade filtration was introduced. The procedure was under permanent medical control. Mean reuse rate was 6 time. Renal actuarial survival curve showed a 60%, 42% and 21% survival rate at respectively 1, 2 and 5 years. Five deaths were noted. No death occurred during the apheresis procedure. The mean cost of filters and blood lines was 490 French francs (FF) per session; the mean cost of an haemodialysis session was 1900 FF. When the real survival time was compared to the expected renal failure without apheresis (assuming a linear progression of the disease), patients with a positive response to apheresis saved 488 dialysis months. The amount saved was 12 MFF. The additive cost of inefficient apheresis was 0.06 MFF. These data have to be considered on a 0.5 M inhabitants population basis during a 10 year survey.

The rate of neonatal referral from the site of birth to a special care centre is generally related to the conditions of the pregnancy and the status of the neonate. The purpose of this study was to investigate other factors affecting referral including obstetric procedures, and equipment and personnel environment. A prospective survey of the neonatal population in 9 maternity hospital in the Loire-Atlantique area in France was conducted. There were, 1.316 births and the referral rate was 10.3% with a range of 1 to 24% depending on the originating hospital. After adjustment for gestational age, multivariate analysis revealed that the medical variables were the main factors affecting referral rate (positive gastric smear, adjusted odds ratio, ORa = 62.6; disease, ORa = 37.7; Apgar score 1 min < 7, ORa = 9.4; monitoring abnormality, ORa = 3.2; coloured amniotic fluid, CORa = 2.7; birthweight, ORa = 0.3). A high risk of referral was observed in only one maternity hospital (ORa = 9.4) related to a poor environment index. This center was in close vicinity to another maternity hospital. In a regional referral programme, high risk neonates should be delivered in maternity hospitals near a special care centre. But, in order to keep the rate of referral, with its adverse effect on the mother-baby relation, low, care for neonates with minor disease or only slightly underweight at birth should be cared for in these centers without referral.