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Traitement diététique de l'allergie aux protéines du lait de vache 牛奶蛋白过敏的饮食治疗
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.07.002
S. Viola (Chef de clinique-assistante) , F. Sarrio (Diététicienne)

Prevalence of cow milk allergy is high, affecting 2 to 3% of infants in unselected cohorts. This allergy begins early in life, after the introduction of cow milk in the food of babies, but the affected children often become tolerant for cow milk later on. Prevalence of food allergy (soy, fish, egg, especially) associated with cow milk allergy is increasing. Specific diet is the only treatment; it consists in the exclusion of any cow milk protein from the nutrition until the age of 1 to 2 years which is the period when, usually, immunotolerance is acquired.

牛奶过敏的患病率很高,在未选择的队列中影响了2%至3%的婴儿。这种过敏在生命早期就开始了,在婴儿的食物中引入牛奶之后,但受影响的儿童通常会在以后对牛奶产生耐受性。与牛奶过敏相关的食物过敏(尤其是大豆、鱼、鸡蛋)的患病率正在上升。特殊饮食是唯一的治疗方法;它包括在1至2岁之前从营养中排除任何牛奶蛋白,这通常是获得免疫耐受性的时期。
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引用次数: 3
Tétralogie de Fallot
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.07.003
B. Friedli (Professeur)

The Tetralogy of Fallot refers to the most common cyanotic congenital heart defect. Anatomically, this is essentially a perimembranous subaortic ventricular septal defect, together with a right ventricular outflow obstruction, resulting from an infundibular and often valvular pulmonary stenosis. The pathophysiology is a right to left shunt at ventricular level. Clinical signs include cyanosis, which is often progressive with age, squatting, and often hypoxic spells. The natural history is characterized by progressive cyanosis, erythrocytosis, and complications such as cerebrovascular accidents and brain abscesses. Death occurs in the second decade as a mean. Surgical correction is therefore mandatory and lifesaving. The operation includes closure of the ventricular septal defect with a patch, and relief of pulmonary infundibular and valvular stenosis. This may often require patch enlargement of the right ventricular outflow tract, including the pulmonary valve annulus, leaving the pulmonary orifice partially unguarded. As a consequence, pulmonary valve regurgitation is very often observed. If it is important, it may compromise right ventricular function in the long term. Rhythm disturbances are another common complication in the late follow-up of operated tetralogy of Fallot. For these reasons, medical follow-up is indicated. Despite these possible complications, it is obvious that longevity and quality of life have been considerably improved by surgical repair.

法洛四联症是指最常见的紫绀型先天性心脏缺陷。从解剖学上讲,这本质上是一种膜周主动脉下室间隔缺损,同时伴有右心室流出梗阻,由漏斗状和瓣膜状肺动脉狭窄引起。病理生理表现为心室水平右至左分流。临床症状包括紫绀,常随年龄增长而加重,常下蹲,常伴有缺氧。自然史的特点是进行性紫绀、红细胞增多和并发症,如脑血管意外和脑脓肿。死亡平均发生在第二个十年。手术矫正因此是强制性的和挽救生命的。手术包括用补片封闭室间隔缺损,以及缓解肺小叶和瓣膜狭窄。这通常需要右心室流出道斑块扩大,包括肺动脉瓣环,使肺口部分不受保护。因此,肺动脉瓣反流是非常常见的。如果它很重要,它可能长期损害右心室功能。节律障碍是法洛四联症术后随访的另一常见并发症。由于这些原因,需要进行医疗随访。尽管存在这些可能的并发症,但手术修复显然大大提高了患者的寿命和生活质量。
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引用次数: 4
Reflux gastro-œsophagien et affections respiratoires chez l'enfant 儿童胃食管反流和呼吸系统疾病
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.06.001
A. Baculard (Ancienne attachée-consultante des hôpitaux de Paris)

Gastroesophageal reflux (GER)-associated respiratory disorders are frequent and varied: chronic cough, asthma, bronchitis, pneumonia, laryngitis, sinusitis, otitis, stridor. A cause/ effect relationship between GER and respiratory disorders has never been demonstrated and identifying the exact role of GER in respiratory pathology remains difficult. The "gold standard" for the diagnosis is the 24-hour continuous esophageal pH monitoring, but clinical data and pulmonary check-up should be considered for the elimination of other respiratory diseases. Following GER diagnosis, medical therapy including prokinetic and antisecretory agents is recommended since the efficacy of these drugs has been shown; indications for surgery are rare in children.

胃食管反流(GER)相关的呼吸系统疾病是常见和多样的:慢性咳嗽、哮喘、支气管炎、肺炎、喉炎、鼻窦炎、中耳炎、喘鸣。GER与呼吸系统疾病之间的因果关系从未被证实,并且确定GER在呼吸系统病理中的确切作用仍然很困难。诊断的“金标准”是24小时连续监测食管pH值,但要排除其他呼吸系统疾病,应考虑临床资料和肺部检查。在GER诊断后,药物治疗包括促动力和抗分泌药物,因为这些药物的疗效已被证明;儿童很少有手术适应症。
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引用次数: 0
Infections à pneumocoque 感染:肺炎
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.06.003
P. Brisou (Spécialiste du service de santé des Armées) , J.-M. Chamouilli (Praticien hospitalier, chef de service de pédiatrie) , T. Gaillard (Assistante du service de santé des Armées) , Y. Muzellec (Spécialiste du service de santé des Armées)

Currently, pneumococcal infections are a public health problem. Streptococcus pneumoniae is a leading cause of community acquired invasive and non invasive bacterial infections in infants and young children, more specifically among those under five years. Pneumococcal invasive infections, in particular meningitis, carry a mortality upper than 8 % and a high risk of sequelae. Atypical clinical expression is frequent in youngest children. Membrane immunochromatography for rapid detection of urinary C-polysaccharide antigen is one of the advances for biological diagnosis, but it remains to be evaluated in children. Due to the increasing prevalence of penicillin-resistant pneumococci, treatment has to be adapted to clinical and epidemiological features. Frequent, serious, antibiotic-resistant characters of pneumococcal infections plea for vaccine. In France, Pneumo 23® indications were extended in 1998, and pneumococcal conjugate vaccine Prevenar® indications were modified in 2002. Local, national and international surveys are needed to adapt treatment and vaccine strategies.

目前,肺炎球菌感染是一个公共卫生问题。肺炎链球菌是婴幼儿社区获得性侵袭性和非侵袭性细菌感染的主要原因,特别是在五岁以下的儿童中。肺炎球菌侵袭性感染,特别是脑膜炎,死亡率超过8%,并有很高的后遗症风险。不典型临床表现常见于幼童。膜免疫层析快速检测尿c -多糖抗原是生物诊断的进展之一,但在儿童中的应用仍有待评估。由于耐青霉素肺炎球菌的流行率越来越高,治疗必须适应临床和流行病学特点。肺炎球菌感染频繁,严重,耐抗生素的特点要求疫苗。在法国,1998年延长了Pneumo 23®的适应症,2002年修改了肺炎球菌结合疫苗Prevenar®的适应症。需要进行地方、国家和国际调查,以调整治疗和疫苗战略。
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引用次数: 5
Index des mots cles 关键词索引
Pub Date : 2004-11-01 DOI: 10.1016/S1762-6013(04)00051-5
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引用次数: 0
Céphalées de l'enfant et de l'adolescent 儿童和青少年的头痛
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.06.002
D. Parain

Headache is one of the most frequent symptoms in neuropaediatrics. Numerous types and causes of headache exist, and precise diagnosis is sometimes difficult. The primary headache (migraine and tension headache), without brain lesion are the main types. Secondary headaches are less frequent. The classification of the International Headache Society (IHS) is a good tool for the diagnosis, although it is not fully adapted for children. According to the recent epidemiologic surveys, migraines represent 90% of headaches. About 20% of migraines begin by an aura, with visual symptoms in most cases. Non habitual migraines or migraine equivalents (basilar, abdominal, confusional migraines, or migraines with prolonged aura, benign paroxystic vertigo, and visual aura without headache) are more frequent in children than in adults. Tension headaches are far less frequent in children than in adult. These different types of headache may turn to chronic daily headaches, especially in case of prolonged drug abuse. The management of patients with headache, in terms of investigations and therapy, must therefore be based on the diagnosis hypothesis that results from the neurological exam data and, above all, from the patient's questioning which allows to analyse headaches history, context and characteristics. The identification of anatomic structures and mechanisms responsible for headaches and migraines has improved these past decades, but many uncertainties remain. The availability of new drugs, such as the triptans, with a specific activity on those serotoninergic receptors which participate in the migraine process, has improved the therapeutic management of the disease.

头痛是神经儿科最常见的症状之一。头痛有多种类型和原因,有时很难精确诊断。原发性头痛(偏头痛和紧张性头痛),无脑损伤为主要类型。继发性头痛较少发生。国际头痛学会(IHS)的分类是一个很好的诊断工具,尽管它并不完全适用于儿童。根据最近的流行病学调查,偏头痛占头痛的90%。大约20%的偏头痛由先兆开始,大多数情况下伴有视觉症状。非习惯性偏头痛或类似偏头痛(基底偏头痛、腹部偏头痛、迷乱性偏头痛、先兆延长的偏头痛、良性阵发性眩晕和无头痛的视觉先兆)在儿童中比在成人中更常见。紧张性头痛在儿童中的发病率远低于成人。这些不同类型的头痛可能转变为慢性每日头痛,特别是在长期滥用药物的情况下。因此,在调查和治疗方面,头痛患者的管理必须基于诊断假设,诊断假设来自神经学检查数据,最重要的是,来自患者的提问,可以分析头痛的历史、背景和特征。在过去的几十年里,对头痛和偏头痛的解剖结构和机制的识别已经有所改善,但仍然存在许多不确定性。新药物的可用性,如曲坦类药物,对参与偏头痛过程的血清素能受体具有特定活性,改善了该病的治疗管理。
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引用次数: 1
Strabisme chez l'enfant 儿童斜视
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.07.004
E. Bui Quoc (Interne des hôpitaux de Paris) , M.-A. Espinasse-Berrod (Ancien interne des hôpitaux de Paris, ancien chef de clinique à la Faculté, assistant des hôpitaux de Paris, ophtalmologiste attaché des Hôpitaux)

Strabismus is a highly plural and many-sided pathology. The classification of such diseases is very difficult due to the intricacy of clinical signs and pathophysiological mechanisms. The prognosis of strabismus is correlated to the age of onset, due to the influence of visual experience on the development of vision. Examination by an ophthalmologist is mandatory in case of strabismus evidence or strabismus suspicion. Strabismus may reveal an organic ocular disease, such as in the rare but fearsome case of retinoblastoma. By impairing vision, any strabismus can lead to an amblyopia, which can itself be responsible for strabismus in some cases. In early strabismus, monocular amblyopia can be cured, but binocular vision remains impaired; in late strabismus, the treatment must restore both monocular vision of each eye and binocular vision. Priorities must be defined in the treatment of strabismus; satisfactory visual function must be restored first. Optical correction is always essential, and in case of amblyopia, occlusion and optical or pharmacological penalizations may be considered. Most of the time, surgery for ocular deviation is considered only secondarily, after restoration of satisfactory sensorial status. Specialized management as early as possible is necessary in all cases, to improve functional results of the treatment.

斜视是一种高度多元和多方面的病理。由于临床症状和病理生理机制的复杂性,此类疾病的分类非常困难。由于视觉经验对视力发育的影响,斜视的预后与发病年龄有关。如果有斜视的证据或怀疑斜视,眼科医生的检查是强制性的。斜视可能显示器质性眼部疾病,如罕见但可怕的视网膜母细胞瘤。通过损害视力,任何斜视都可能导致弱视,在某些情况下弱视本身就是斜视的原因。在早期斜视中,单眼弱视可以治愈,但双眼视力仍然受损;在晚期斜视,治疗必须恢复单眼视力和双眼视力。必须确定斜视治疗的重点;首先要恢复满意的视觉功能。光学矫正总是必不可少的,在弱视的情况下,可以考虑闭塞和光学或药物处罚。大多数情况下,手术治疗眼偏只被认为是次要的,在恢复满意的感觉状态之后。在所有病例中,尽早进行专门管理是必要的,以提高治疗的功能效果。
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引用次数: 0
Index des auteurs 作者索引
Pub Date : 2004-11-01 DOI: 10.1016/S1762-6013(04)00050-3
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引用次数: 0
Syndrome hémolytique et urémique chez l’enfant 儿童溶血性和尿毒症综合征
Pub Date : 2004-11-01 DOI: 10.1016/j.emcped.2004.08.001
P. Niaudet (Professeur)

The haemolytic and uremic syndrome is caracterized by the association of hemolytic anemia with schizocytes, thrombopenia and renal involvement secondary to thrombotic microangiopathy. The typical form is the most frequent in children occuring after an episode of diarrhea caused by Escherichia coli. Other germs may be responsible for HUS such as Shigella dysenteriae or Streptococcus pneumoniae. Acute renal failure is reversible in most cases, but long term renal sequelae are seen in one third of patients when anuria at onset of disease has lasted more than one week. Treatment of typical HUS is only supportive (blood transfusion, treatment of acute renal failure). Atypical HUS is less frequent but of poorer prognosis. Atypical HUS may be associated with factor H gene mutations, von Willebrand factor-cleaving protease deficiency, congenital intracellular defects of vitamine B12 metabolism or may be of unknown origin. Familial forms are frequent. Recurrence of HUS following renal transplantation is exceptional in typical forms but is frequent in atypical HUS.

溶血性和尿毒症综合征的特点是溶血性贫血与分裂细胞、血小板减少症和继发于血栓性微血管病的肾脏受累有关。典型的形式是最常见于儿童腹泻发作后由大肠杆菌引起。其他细菌如痢疾志贺氏菌或肺炎链球菌也可能引起溶血性尿毒综合征。急性肾功能衰竭在大多数情况下是可逆的,但当发病时无尿持续超过一周时,三分之一的患者会出现长期的肾脏后遗症。典型溶血性尿毒综合征的治疗只是支持性的(输血、治疗急性肾衰竭)。非典型溶血性尿毒综合征发病率较低,但预后较差。非典型溶血性尿毒综合征可能与因子H基因突变、血管性血友病因子切割蛋白酶缺乏、维生素B12代谢的先天性细胞内缺陷或可能原因不明有关。家族型很常见。肾移植后溶血性尿毒综合征的复发在典型形式中是罕见的,但在非典型溶血性尿毒综合征中是常见的。
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引用次数: 12
Pathologie urinaire fœtale 胎儿泌尿病理学
Pub Date : 2004-08-01 DOI: 10.1016/j.emcped.2004.02.003
P Diallo, F Jacquemard, F Kieffer, V Mirlesse, S Romand, P Thulliez

Renal agenesia refers to the lack of one or the two kidneys, arising from an agenesis of the metanephros blastema. Paediatric renal or hepato-renal polycystoma is an autosomic recessive hereditary disease concerning 1% of renal or hepato-renal malformative uropathies. It is characterized by a micro-polycystic ectasy of collecting tubules. Polycystic dysplasia is due to abnormal metanephros embryonic development, and represents about 1% of congenital malformative uropathies. Most of the time, such abnormality is unilateral and is defined by an abnormally increased renal volume. Pyelectasia refers to abnormal dilatation of the renal pelvis. Hydronephrosis is the most frequent urinary tract disorder, with an occurrence rate of 30 to 50% among congenital malformations of the kidney and the urinary tract. It is characterized by the dilatation of renal pelvis and calyxes. Megalo-ureter refers to abnormally dilated ureter. In the mega bladder disease, the bladder capacity may vary from an examination to another, or during a single examination, depending on the urinary pathology. Main aetiologies are the posterior ureter abnormalities, and the Prune- Belly syndrome.

肾发育不全是指由于肾后胚芽发育不全而导致的一个或两个肾脏缺失。小儿肾脏或肝肾多囊瘤是一种常染色体隐性遗传性疾病,约占肾脏或肝肾畸形泌尿系统疾病的1%。它的特征是集合小管的微多囊性扩张。多囊性发育不良是由于后肾胚胎发育异常引起的,约占先天性尿路畸形的1%。大多数情况下,这种异常是单侧的,由肾容量异常增加来定义。肾盂增生是指肾盂异常扩张。肾积水是最常见的尿路疾病,在先天性肾脏和尿路畸形中发生率为30 - 50%。它的特点是肾盂和肾盏扩张。大输尿管是指输尿管异常扩张。在巨大膀胱疾病中,膀胱容量可能随检查而变化,或在单次检查期间,取决于泌尿病理学。主要病因是后输尿管异常和梅干-腹部综合征。
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引用次数: 1
期刊
EMC - Pédiatrie
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