Pediatrie最新文献

Sodium alginate (Gaviscon) is used in the management of gastro-oesophageal reflux in infants. No digestive disadvantages have as yet been reported with the use of the Gaviscon formula available in France, which contains neither aluminium hydroxide nor thickener. Twenty-two healthy neonates were prospectively studied before and after Gaviscon treatment in order to characterize their whole gut transit time with the use of a carmine index. The head of the marker appeared within the same time in both experiments but the appearance of the tail was earlier in the treated infants (P < 0.05), without any subsequent clinical consequences. The slight increase shown in the rate of the clearance of the marker from the gut, is likely to be related to a less proximal to distal dispersion of the marker, subsequently to physical changes occurring in the viscous alginate. Frequency and consistency of the stools were unmodified by treatment and accordingly Gaviscon can be regarded as having no deleterious effect on transit time in neonates.

The author comments on the main aspects of the evolution of methods of diagnosis and treatment in pediatric urology during the past 20 years. In the field of diagnosis, ultrasounds have been a major break-through allowing early detection of uropathies and an easy supervision of their evolution. In the therapeutic field, improvements in surgical techniques and anesthesia have been numerous leading to both better results, and considerably reduced duration of hospitalization.

Intrafamilial violence represents a vast topic, even if one limits the subject to the nuclear family. Indeed it includes violence from parents to the child, violence between brothers and sisters, conjugal violence and violence exercised by the child to his parents. Although one can differentiate the types of violence (physical, sexual, and psychological), they often coexist within the same family. Adolescence favors the onset or the reactivation of familial violence; this violence often has repercussion on the psychological equilibrium of the adolescent. Very little is written about parents abused by one of their children (usually an adolescent). This phenomenon is relatively unrecognized and its frequency probably under-estimated. It points to a distortion in parent to child relationship. Therapeutic and/or socio-educational approach must be directed toward both the victim and the aggressor.

The authors report on two cases of renal cell carcinoma in boys of 8 and 13 years of age revealed by gross hematuria. Following nephrectomy the evolution remains good after 8 and 17 years of follow-up. Despite the fact that renal cell carcinoma is rare in children, it must be evoked as a possible etiology in the presence of spontaneous and relapsing hematuria in a child older than 8 years of age. Early nephro-ureterectomy with regional lymph nodes resection is the only efficient treatment, chemotherapy and radiotherapy having not yet demonstrated their efficiency.

The general principles of treatment of epilepsies in children are summarized: control of seizures without compromission of the physical or intellectual capabilities of the patients, owing to normal family and social life. The basic principles of drug treatment, the choice and monitoring of antiepileptic drugs, and the place of the electroencephalogram are discussed.

The author present a new method of assessment of bone age derived from the analysis of carpal osseous development of 5,225 Spanish children and adolescents. The method is based upon the determination of a carpal index from the measurement of the largest diameter of the eight carpal bones, the proximal epiphysis of the first metacarpal and the distal cubital and radial epiphyses. There is a highly significant correlation of this carpal index with chronological age (P < 0.0001). From this index the author has set up an equation defining an index of evaluation of carpal ossification which helps to estimate bone age according to six different ranges of significance: significant retardation, moderate non significant retardation, borderline normality, complete normality, moderate non significant advance, significant advance. The method is simple to realize. It reduces the risk of errors in the evaluation of bone age due to asynchronisms of maturation of the ossification centres and to the individual subjective factor occurring with a morphologic assessment. Furthermore it takes into account the physiological variations of bone age on both sides of the mean normal value.

Auto-immune diseases (AID) represent an heterogeneous group of chronic inflammatory diseases which do not seem to result from the direct pathogenic effect of microorganisms or xenobiotics. Some AID are associated with the production of autoantibodies which, in some patients, may be involved in the development of tissue damages. In other AID, as in most experimental models of AID, T cells are responsible for the generation of tissue lesions by their cytotoxic activity or by the synthesis of cytokines. Mechanisms by which T and B cells are educated to tolerate self antigens are numerous and operate both in central lymphoid organs (thymus, fetal liver, bone marrow) and at the periphery. They imply either the destruction of autoreactive lymphocytes (clonal deletion) or their inactivation (clonal anergy). Recent advances in analyzing the mechanisms of autoimmunity have opened new therapeutical possibilities which are evaluated in spontaneous and experimental animal models of AID. Among the most promising approaches are the intervention on the cytokine network, T cell and peptide vaccination, oral tolerance and non depleting monoclonal antibodies.

The pathogenesis of Langerhans cell histiocytosis (LCH) is unclear, but there is increasing evidence that an immunological dysfunction is present. We describe an infant who presented a LCH associated with myasthenia gravis. The thymus is known to play an important role in the pathophysiology of myasthenia gravis and is often involved in LCH. Infancy and signs of organ dysfunction are predictive of poor prognosis: immunotherapy is to be investigated (thymic hormone, cyclosporin, alpha interferon), as well as allogeneic bone marrow transplantation.