Pediatrie最新文献

A health education action for childhood injuries prevention took place from october 1988 to march 1989 in the town of Chambéry (Savoie), a town of 95,000 inhabitants. The health education concerned 21,950, 0 to 15 years old children and their close relatives (parents or educators). Two assessment means were applied: 1) a questionnaire submitted to the parents and the children before and after the intervention; 2) a comparison with the evolution of chosen indicators in a control town (Annecy, Haute-Savoie, 112,000 inhabitants), the informations being supplied by private doctors, hospital, clinics, pupils insurance and anti poison centres. The comparison between the action and the control areas shows a tendency towards a decrease in the action area of the frequency of home accidents and calls to the anti-poison centres. However the overall impact of the action looks weak and possible variations appears difficult to ascertain. This work highlights the methodological difficulties of the evaluation of community health education actions.

Bed-wetting is a frequent feature in school-age children. A pilot transversal study was carried out in school-children from the city of Villeurbanne in order to study the prevalence of bed-wetting in school-age children. Answers to a questionnaire were exhaustively obtained from 1,677 children in primary school before school-camp. An other questionnaire was given to parents of children from nursery-school: answers were obtained for 386 children, i.e. 95% of the sample. The rate of children suffering from bed-wetting was 49% between 3 and 4 years of age, 4% between 7 and 6 years of age and 1% between 11 and 12 years of age. These results are comparable to those reported in the literature. Within the range 4-7 years of age, the estimation of bed-wetting exhibited a lower frequency in the school-camp questionnaire probably reflecting its speculated social inconvenience, as compared with the answers to the nursery-school questionnaire rather reflecting a close estimation of property attainment. The reported prevalence rates provided no discriminant criteria regarding the mechanism of bed-wetting.

Ultrasound guidance is usual and has improved the morbidity and the efficacy of percutaneous renal biopsy in children. New needles and gun device are now available and make the biopsy safer. These improvements should not eliminate the contra-indications.

In vitro fertilization has obtained a foreground position in therapeutics proposed to infertile couples. Technical developments could be improved in the obstetrical and pediatric field through a better understanding of events occurring in embryos implantation, and through a specific management of the subsequent pregnancies.

The increased prevalence of tuberculosis during the past years incites to a rigorous attitude in screening and treatment of primary tuberculosis. The authors underlines the importance of the prevention by BCG vaccination and of careful screening using correctly performed Mantoux test. The treatment of primary tuberculosis is different whether it is latent (tuberculin positive children without evidence of disease) or patent (with clinical or radiological signs, mycobacterium tuberculosis identification). For latent tuberculosis a two drugs therapy with isoniazid an rifampicine during 6 months is recommended. For patent tuberculosis the author recommands a four drugs therapy (isoniazide, rifampicine, ethambutol, pyrazinamide) for 2 months (3 months in case of hematogenous dissemination with acute miliary or meningitis) followed by a two drugs regimen (isoniazide, rifampicine) for 4 to 9 months. Corticosteroids are indicated when atelectasis resulting from bronchial obstruction is present.

The authors report on a case of cardiomyopathy with congestive heart failure in an infant with severe hypocalcemia related to vitamin D deficient rickets. The heart failure was successfully treated with calcium gluconate and vitamin D, associated with dobutamide.

During a 15 month-period, 63, 10 to 59 month-old children, with pica habits were collected in a day care centre of the Caisse nationale de sécurité sociale in Tunis. Anemia was the main alert sign. They were compared with 43 non pica children presenting with a similar degree of anemia. The male to female ratio was 1.42. A family history of pica was present in 57% of the cases. Most children ingested earth but 50% of the patients ingested multiple substances. The beginning of the eating disorder was observed between 12 and 18 months in 71% of the cases. 95% of pica patients were from low income parents and urban status. No differences were observed between the pica children and the anemic children without pica habits in term of anamnestic, clinical and biological data. Treatment with iron supplements led to cessation of pica in most patients. The physiopathological hypothesis were dominated by iron and zinc deficiency of which geophagia can be, at the same time, the cause and the consequence. From our study, pica appears to remain very frequent among Tunisian children. Its prevention requires information of parents and dietary prevention of early iron deficiency.

A case of right unilateral pulmonary interstitial emphysema in a compromised premature infant was managed by right selective bronchial occlusion with a favorable outcome. Occlusion with a Rashkind catheter occurred on day 8 and was well-tolerated. The balloon was deflated 10 hours later and no recurrence was observed. Right occlusion is easier than left selective intubation and seems to be the best method for treatment of unilateral interstitial emphysema in infants in extremely poor conditions.

A follow-up study of 179 cases of human immunodeficiency virus (HIV) seropositive neonates born from HIV seropositive mothers is reported. At the time of the present study, HIV infection resulting from maternofetal transmission was found in 50 cases, while 108 infants were not infected; HIV infection remained uncertain in 16 cases; 5 infants were lost for follow-up. Out of the 50 infected cases, 20 were less than two-year old, 17 were 2-5 year old and 13 were older than 5 years. Very few remained asymptomatic after the age of 6 months, the most common symptoms being adenopathies and/or hepatomegaly and/or splenomegaly. Twenty-six had an acquired immunodeficiency syndrome (AIDS). Six died, from pneumocystosis (3), cytomegalovirus infection (1) and septicemia (2). Virus culture and polymerase chain reaction were the most efficient laboratory methods for early diagnosis of HIV infection, both being positive in more than 95% of the infected cases after the age of 3 months. A close clinical and biological supervision is recommended in these infants and children because of the permanent threat of infectious diseases in relation to their immunodeficiency. Treatment associates: 1) antiviral therapy with AZT as soon as the HIV infection is diagnosed; 2) primary prophylaxis against pneumocystosis with trimethoprim-sulfamethoxazol; 3) IV immunoglobulins in the case of repeated bacterial infection; 4) regular evaluation of the nutritional status and psychological assistance.(ABSTRACT TRUNCATED AT 250 WORDS)