Eleven newborns admitted consecutively to the neonatal unit with respiratory failure and severe persistent pulmonary hypertension (PPHN) were included in a clinical trial to assess the efficacy of magnesium sulphate (MgSO4) in the treatment of PPHN. A loading dose of 200 mg/kg MgSO4 was given over 20 minutes, followed by a continuous infusion of 20-150 mg/kg/hour to obtain a magnesium blood concentration between 3 5 and 5 5 mmol/l. Mean (SD) duration of treatment was 75-5 (19.8) hours. No other vasodilatory drug was administered before or during the treatment and patients were not hyperventilated. Mean (SEM) PaO2 values significantly increased from 42-6 (8.8) before treatment to 70*3 (24.1) mm Hg after 24 hours, with no change in pH or Pco2. Oxygen index and alveolar-arterial oxygen gradient (A-aDo2) were significantly lower after 24 hours; respectively, 46-8 (15.2) to 28-0 (9.0) and 624-3 (11-3) to 590 (58) nmn Hg. Mean airway pressure could be significantly reduced from 19*5 (3-1) to 13-9

Purpose. To correlate the radiological aspects of metastases, the response to chemotherapy, and patient outcome in disseminated childhood medulloblastoma. Patients and Methods. This population-based study concerned 117 newly diagnosed children with disseminated medulloblastoma treated at the Institute Gustave Roussy between 1988 and 2008. Metastatic disease was assessed using the Chang staging system, their form (positive cerebrospinal fluid (CSF), nodular or laminar), and their extension (positive cerebrospinal fluid, local, extensive). All patients received preirradiation chemotherapy. Results. The overall survival did not differ according to Chang M-stage. The 5-year overall survival was 59% in patients with nodular metastases compared to 35% in those with laminar metastases. The 5-year overall survival was 76% in patients without disease at the end of pre-irradiation chemotherapy compared to 34% in those without a complete response (P = 0.0008). Conclusions. Radiological characteristics of metastases correlated with survival in patients with medulloblastoma. Complete response to sandwich chemotherapy was a strong predictor of survival.

Zidovudine (ZDV) treatment during pregnancy, delivery and the postnatal period is effective in reducing the maternal-infant transmission of the human immunodeficiency virus. Reported adverse effects in the neonate during this longterm treatment are bone marrow suppression and elevation in aspartate aminotransferase activity. We report a case of severe ZDV-associated lactic acidosis in a neonate, which resolved rapidly following discontinuation of ZDV. The mechanisms leading to this side effect are poorly understood.

Resumen:La política ambiental de México se estableció durante los años ochenta y noventa, pasó por la etapa de reformas neoliberales de la economía y transitó progresivamente hacia formas de operación que la integran al mercado ambiental global. Pero la escala regional de la crisis ambiental es el espacio concreto en el cual interactúan los actores del mercado ambiental. En el caso de México, existen escenarios claramente diferenciados que se reseñan para ilustrar la complejidad de ese fenómeno característico de la globalización: su doble vertiente global/local. Más allá de un asunto teórico, mi propuesta es que una política dirigida hacia la crisis ambiental debe considerar lo que denomino el "saber geográfico", es decir, la particularidad social y económica en que se produce geográficamente dicha crisis.Palabras clave : política ambiental; globalización; mercado ambiental global; saber geográfico; crisis ambiental. Abstract:Mexican environmental policy was established during the 1980's and 1990's, went through the stage of neoliberal reforms in the economy, and moved progressively towards operating forms through which it integrated into the global environmental market. However, the regional scale of the environmental crisis is the specific place where the players of the environmental market interact with one another. In the case of Mexico, there are clearly differentiated scenarios that are described so as to illustrate the complexity of this phenomenon which characterizes globalization: its global and local significance. Besides being a theoretical question, my proposal is that a policy aimed at solving the environmental crisis must take into account what I call "geographic knowledge", that is to say, the social and economic situation where the environmental crisis takes place geographically.Key words: environmental policy; globalization; global environmental market; geographic knowledge; environmental crisis.

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