CASE REPORTA 31-year-old patient was referred to our prenatal diagnostic center at 24 weeks of amenorrhea because of an abnormal intra-abdominal image on ultrasound examination. Her medical history notably included mixed connective tissue disease, requiring treatment with hydroxychloroquine, corticoids and aspirin.Ultrasound examination at 12 weeks' gestation was normal, as were the serum marker tests for the risk of trisomy 21 taken in the second trimester. At 24 weeks, a routine ultrasound examination revealed a round, midline intra-abdominal thin-walled mass, 21 mm in diameter, located below the liver. These findings were confirmed at repeat ultrasound examination at 28 weeks (Figure 1). Color Doppler ultrasound examination showed venous-type turbulent flow inside the mass. Connections with the portal vein upstream (Figure 1) and the umbilicus downstream (Figures 2 and 3) were visualized. The suggested diagnosis was that of umbilical vein varix. No other abnormalities were found. Uterine and umbilical artery Doppler were normal. Doppler ultrasound imaging of the ductus venosus showed a slight acceleration in blood flow velocity (0.8-0.9 m/s), possibly indicating increased resistance in the portal venous system. Amniocentesis followed by karyotype analysis revealed a normal 46,XY karyotype.Follow-up ultrasound examinations were carried out at 15-day intervals and revealed a gradual increase in the size of the vein (30/40 mm at 25 weeks', 35/48 mm at 28 weeks' and 36/54 mm at 32 weeks' amenorrhea respectively), with no sign of heart failure or velocimetric changes.The patient delivered a 2100-g boy vaginally at 34 + 3 weeks' gestation, with Apgar scores of 8, 10 and 10 at 1, 5 and 10 min respectively, and an umbilical cord pH of 7.26. No immediate resuscitation procedures were needed. Anatomical and pathological examination of the placenta revealed no abnormalities.On the first postnatal day the newborn developed isolated thrombopenia (25 000 platelets/mm 3 ) requiring

We report the fourth case of combined D-and L-2-hydroxyglutaric aciduria presenting with neonatal encephalopathy and subependymal cysts.

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The symptoms of acute poisoning after accidental administration of ten times the usually prescribed dosage of caffeine in a premature infant included the following neurological signs: incessant tremors, hypertonia, continuous opisthotonos posture, whining and crying and digestive disturbances. The very high serum caffeine levels, 160 mg/l, determined 66 hours after the first administration was confirmed by the very high cerebrospinal fluid caffeine concentration 115 mg/l. Two exchange transfusions performed at an interval of 16 hours produced a large decrease in serum caffeine levels of approximately 40 mg/l each time, and a similar decrease in the cerebrospinal fluid concentration. The clinical status of the infant improved very rapidly and the child's psychomotor development was normal at 3 months of age.

SUMMARY We report an infant of 35 weeks' gestation who developed severe respiratory distress and pneumonitis due to perinatal mumps virus infection.It is unusual that mumps virus should be responsible for neonatal respiratory distress. To our knowledge only one case has been described