[Gastritis caused by Helicobacter heilmannii probably transmitted from dog to child]. / Gastrite àHelicobacter heilmannii probablement transmise à l'enfant par ses chiens.

Gastric infection with Helicobacter heilmannii is rare but is known to be associated with chronic active gastritis, peptic ulcer, and low-grade mucosa-associated lymphoid tissue lymphoma in humans. In contrast to H. pylori, various H. heilmannii species colonize the stomachs of domestic animals, which might be a reservoir for transmission to humans. We report the case of a 12-year-old boy presenting with chronic gastritis caused by H. heilmannii. Endoscopic examination reveals H. heilmannii-like infection on biopsy samples in his two pet dogs. Sequencing of the 16S and 23S ribosomal DNA by PCR was used to compare the H. heilmannii-like bacterial samples isolated in the boy and his dogs. These DNA amplification methods suggest that the boy was infected by his pet dogs (zoonosis). Our patient was cured by treatment with proton-pump inhibitor and antibiotics. Endoscopic follow-up of the boy showed a complete cure of gastritis and eradication of the bacterium.

[Macroamylasemia: one pediatric case]. / A propos d'un cas pédiatrique de macroamylasémie.

We report a case of macroamylasemia in an 11-year-old boy. We compare our clinical and paraclinical data with those described in pediatric literature. Macroamylase resulted in a complex of amylase and immuglobulin. Its fortuitous detection did not reveal, up to now, any associated pathology, in particular any autoimmune disorders or celiac disease. Identification of this biochemical abnormality is essential in order to avoid invasive investigations and/or unnecessary therapies.

[Semi-invasive necrotic aspergillosis in a child with cystic fibrosis]. / Aspergillose nécrosante semi invasive chez un enfant de 14 ans atteint de mucoviscidose.

INTRODUCTION: Aspergillosis colonisation in cystic fibrosis (CF), usually due to Aspergillus fumigatus (AF), classically presents as allergic bronchopulmonary aspergillosis. However, aspergillus infection can produce a range of manifestations: from minor colonization to an invasive infection. CASE REPORT: A 14-year-old CF patient, chronically colonized with Staphylococcus aureus and Pseudomonas aeruginosa, presented with acute right-sided chest pain, a moderate fever and no modification of the sputum. The chest X-ray showed a 5 cm round opacity. Laboratory parameters were WBC 24,500 G/l, CRP 27 mg/l, Total IgE 1527 UI/l, Specific Aspergillus fumigatus IgE 31 UI/l. Bronchoscopy revealed external compression of the middle lobe bronchus with mucopurulent secretions coming from apical segment of the lower lobe. Bronchoalveolar lavage revealed the presence of pseudomonas aeruginosa 103 CFA/ml, staph aureus 107 CFA/ml and one colony of AF. Chest CT scan showed a large necrotic mass with an air-fluid level located in the apical segment of the right lower lobe. Initial therapy with itraconazole and corticosteroid was replaced by voriconazole, caspofungin, metronidazole and linezolide. Treatment was well tolerated and after 8 weeks the chest X-ray appearances had returned to normal. CONCLUSIONS: The possible diagnoses and therapeutic options are discussed. Conventional antifungal treatment with amphotericin B is limited by nephrotoxicity. These newer antifungal agents appear to be effective and well-tolerated.

Cornstarch thickened formula reduces oesophageal acid exposure time in infants.

BACKGROUND: Infant regurgitation is a phenomenon causing worldwide parental distress and anxiety. Parental reassurance and dietary advices regarding feeding techniques and volumes are helpful in the management. Guidelines also recommend the use of thickened formula. However, the impact of thickened feeding on the frequency of acid reflux is still a matter of debate. Therefore, we evaluated the effect of a casein predominant formula thickened with a specifically selected and treated cornstarch on the frequency and duration of acid reflux episodes. METHODS: Ninety-six formula-fed infants with a mean age of 93 days, presenting with episodes of regurgitation and vomiting occurring more than five times a day and with an abnormal oesophageal pH monitoring, were randomised to a regular infant formula (n = 45) or cornstarch thickened casein predominant formula (n = 51) for 28 days. A second pH monitoring was performed at the end of the study period (26+/-5 days). Symptoms were daily recorded in a diary by the parents for 28 days. RESULTS: At inclusion, the pH-metric parameters did not differ between the control and the intervention group. Results of pH monitoring at baseline and at the end of the study did not differ in the control group on the regular infant formula. However, in the group with the casein dominant cornstarch thickened formula, all pH-metric parameters (reflux index (% of the investigation time with a pH < 4.0), number of reflux episodes >5 min, duration of the longest reflux episode) decreased significantly. The frequency of vomiting and regurgitation did not differ between both groups at baseline, remained unchanged in the control group, but decreased significantly in the intervention group. CONCLUSION: A casein dominant formula thickened with a specifically treated cornstarch reduces oesophageal acid exposure, and reduces the frequency of clinical symptoms.

[Extra-pulmonary tuberculosis in childhood]. / Les atteintes extrapulmonaires de la tuberculose de l'enfant.

Extra-pulmonary tuberculosis (EPT) accounts for around 25% of cases of the disease, and around 20% in children. In Pott's disease and other forms of bone and joint involvement (globally 10-15% of EPT cases), modern imaging techniques like MRI scan have improved diagnosis and follow-up of treatment outcomes. Tuberculous meningitis has not disappeared even in BCG vaccinated children and remains a severe form of the disease. Techniques like the polymerase chain reaction and MRI contribute to an early diagnosis and controversy persists regarding the role of corticosteroid therapy in the treatment strategy. Other localisations are rare in children, including tuberculosis of the urogenital tract, infection of the digestive tract or pericarditis.

Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group.

OBJECTIVE: To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study. RESEARCH DESIGN AND METHODS: We enrolled 2,579 patients aged 1-19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables. RESULTS: Mean HbA1c value for the whole population was 8.97 +/- 1.98% (normal 4.7 +/- 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables. CONCLUSIONS: Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.

Comparison of two oral rehydration solutions in eutrophic infants with moderate acute diarrhea: results of an interim analysis.

A randomized, multicenter clinical trial comparing two oral rehydration solutions (ORS) with different sugar content and total osmolality was carried out in France. Solution A had 168 mmol/L of sugar and a total osmolarity of 326 mosm/kg; solution D had 90 mmol/L of sugar and a total osmolarity of 240 mosm/kg. Weight gain, stool output, and biologic variables were analyzed. This interim analysis included 49 infants (27 in group A and 22 in group D). Patients in both groups gained weight without any significant difference between the two ORS. Between admission and day 4, the overall number of stools and the number of liquid stools decreased. Laboratory values were within the normal range on admission and remained unchanged. The weight increase during the first 24 hours and the reduced frequency of stools was similar in both groups.

Case report: insulin-dependent diabetes mellitus in childhood associated with scleroderma.

A 14-year-old boy presented with Type I diabetes mellitus and subsequently developed pancreatic exocrine insufficiency and systemic sclerosis (SSc). His diabetes had been diagnosed when he was about 5 years old, after the onset of ketoacidosis. Insulin treatment was provided from then until the time he was treated in our department. Exocrine pancreatic insufficiency, which occurred at age 9, was treated with pancreatic extracts. Cystic fibrosis was excluded after a chloride sweat test. The diagnosis of SSc was confirmed at age 14 on the basis of skin sclerosis, sclerodactyly and oesophageal and pulmonary involvement and then at age 18 by the occurrence of Raynaud's disease. Thus, this patient demonstrated a rare and previously unreported association of Type I diabetes mellitus and systemic scleroderma. Limited joint mobility and skin abnormalities are frequent in childhood diabetes mellitus but should not be misdiagnosed as systemic scleroderma.

[Inhaled bronchodilators and mucolytic agents in cystic fibrosis]. / Traitements inhalés bronchodilatateurs et fluidifiants dans la mucoviscidose.

Poor clearance of airway secretions contributes to the pulmonary disease in cystic fibrosis (CF). Bronchodilator therapy might benefit in CF, but the efficacy is controversial. Effects of mucolytic agents have not been demonstrated conclusively. Only, efficacy of recombinant human deoxyribonuclease (rhDNase) is established with a rapid onset of benefit.

[Asthma in infants and young children. Prevention, challenge of the 21st century?]. / Asthme du nourrisson et du jeune enfant. Prévention, défi du XXIe siècle?

Many studies have been dedicated to the prevention of infant and childhood asthma in recent years. Primary prevention begins during intra uterine life (maternal smoke, diet, allergen exposure). During the first year of life, prolonged breastfeeding has been found to be a protective factor against the development of allergy and asthma. The role of infections and lifestyle is controversial and it is not clear whether these factors reduce or increase the risk of asthma. Environmental measures such as avoidance of tobacco smoke and reducing allergens exposure must be recommended to infants with high risk of asthma.

[Sarcoidosis and goiter. A case report in an adolescent]. / Sarcoïdose et goitre. A propos d'un cas chez une adolescente.

UNLABELLED: Sarcoidosis is a systemic granulomatous disease of uncertain etiology which can affect different organs in the body. In this study, we report a case with both lung and thyroid involvement. CASE REPORT: A 12-year-old girl with goiter was referred for dyspnea. Lung CT scan showed diffuse interstitial disease. The diagnosis of sarcoidosis was made following a histological study of lung specimens obtained via video-assisted thoracoscopy. CONCLUSION: Lung biopsy is important in establishing the diagnosis of interstitial lung disease. In this study, the various forms of granulomatous lesions in the thyroid gland and in the lung have been described. However, it should be emphasized that the association of thyroid gland disorder and lung involvement in cases of sarcoidosis is a rare occurrence in children and adolescents. The necessity of establishing a certain diagnosis justifies the use of these invasive procedures.

[Use of interferon in a case of hepatic hemangioma]. / Utilisation de l'interféron dans un cas d'hémangiome hépatique.

UNLABELLED: Hepatic hemangioendothelioma can have a fatal outcome. After failure of classic therapies, and when surgery or arterial embolization are not possible, those benign tumours may benefit from interferon alpha treatment. CASE REPORT: We report a case of a 14-month-old infant who presented with hepatic hemangiomatosis and cardiac failure. The disease can neither be controlled by steroids nor by radiotherapy associated with digitalo-diuretic treatment. Due to the important vascular volume of the tumour, neither surgical care nor arterial embolization were possible. Thus this infant was treated for ten months by interferon alpha. The evolution was favourable: cardiac failure, calcifications and volume of the angiomatosis were regressive. CONCLUSION: Interferon alpha treatment helps to control cardiac failure and the course of hepatic hemangioma in childhood.

[Epidemiology of infantile asthma in the Le Havre region]. / Epidémiologie de l'asthme infantile dans la région du Havre.

BACKGROUND: Prevalence of asthma is influenced by environmental factors which may be different from area to area. POPULATION AND METHODS: A cross-sectional epidemiological survey was carried out among 1,395 children attending primary schools in the city of Le Havre and the canton of Fécamp (Haute-Normandie). Questionnaires including data about the disease, family history, environmental and socio-economic factors were completed by the school physician in presence of the parents. RESULTS: Prevalence rate of asthma calculated from 1,193 questionnaires was 7.8%. The logistic regression curves pointed out four risk factors: family history of asthma (odds ratio: 2.52) or hay fever (OR: 1.98), atopic dermatitis (OR: 3.96), and parental smoking (OR: 1.79). Sex, socioeconomic status of parents, type of housing, presence of pets in the house were not related to prevalence of asthma. Frequency of cough during the day was only significantly different between both areas. CONCLUSIONS: The high level of school absence (21.1%) and frequency of hospitalizations for acute asthma (20.4%) should lead health professionals and educators to improve management of asthma in these areas.

[Nosocomial viral infections in a pediatric service: example of rotaviral gastroenteritis and respiratory syncytial viral bronchiolitis]. / Infections nosocomiales virales dans un service de pédiatrie: l'exemple des gastroentérites à rotavirus et des bronchiolites à VRS.

UNLABELLED: Nosocomial infections are a preoccupation in a pediatric hospital mainly during the winter with bronchiolitis and gastroenteritis epidemics. We have examined the risk factors of nosocomial infections. MATERIAL AND METHODS: A prospective study was conducted between November, 1999 and March, 2000 in the infants units of the Le Havre hospital. We systematically listed the admissions and contacted the family after their discharge by phone. A geographic information system was implemented to display the epidemiological data; this software is able to illustrate the sectors at risk. RESULTS: During the study, 687 infants were hospitalized of whom 458 for bronchiolitis and community-acquired gastroenteritis. Mean age was 5.4 months old. No nosocomial bronchiolitis occurred. Prevalence of nosocomial gastroenteritis was 10% (68 cases including nine after discharge). Infants with nosocomial infection were younger than those with community-acquired infection (6.6 months vs. 11.2 months, P < 0.01). The mean length of stay was longer in nosocomial infection (7.7 vs. 4.1 days, P < 0.05). Among the infants with bronchiolitis, 16% have developed nosocomial intestinal infections (RR = 2.65, IC: 1.59-4.4; P < 0.01). The geographic analysis pointed the area with nosocomial risk (bedroom without water, nearness of nurse office and games room). CONCLUSION: Geographic information system is a part of the quality control system and may have some interaction effect on final decision making. Incidence of nosocomial infections showed the need for a prevention strategy in a pediatric hospital.

[Value of gastroesophageal scintigraphy for the detection of gastroesophageal reflux in infants]. / Valeur de la scintigraphie gastro-oesophagienne pour la détection du reflux gastro-oeophagien du nourrisson.

50 children with a strong clinical suspicion of gastroesophageal reflux and 10 control patients were evaluated with gastroesophageal scintiscans. 500 muCi à 1 mCi of Tc sulfur colloid mixed the patients' routine milk or formula feeding was administered and serial images of the abdomen and thorax were obtained. A positive scintiscan was found in 35 patients (sensitivity 70%) and none of the controls (specificity 100%). A comparison of findings in 34 patients referred for both radiographic and radionuclide studies showed that barium studies were positive in 38% and radionuclide in 64.7%. We found this examination to be more sensitive that the standard barium radiography particularly in patients with respiratory symptoms. We concluded that the GE scintiscan is complementary to barium studies in the diagnosis of GE reflux. Pulmonary aspiration of gastric contents was detected in only a case of the 35 patients with documented GE reflux. A T 1/2 emptying gastric longer than 90 minutes (linear calculation) or 105 minutes (exponential calculation) is an indirect GE reflux test. This procedure is simple, safe more physiologic than other available examinations.

[Symptomatic rickets in adolescents]. / Le rachitisme symptomatique de l'adolescent.

Although systematic vitamin D supplementation in adolescents remains debated, rickets is nevertheless a well recognized pathology in this age group. Adolescence is an at-risk period because of rapid growth, insufficient calcium intake and/or vitamin D status. Surveys have shown that calcium intake is insufficient (< 1000 mg a day) in 45% of boys and 71% of girls and that vitamin D status is deficient (25-OH-D < 10 ng/ml). The aims of the study carried out by the Calcium Group of the Société Française de Pédiatrie, were to evaluate the frequency of rickets, and to define the criteria for the adolescent population at risk. Forty-one adolescents with rickets were hospitalized between 1985 and 2000. Most of the cases were from the Northern France: 20 from Paris and suburbs, eight from the North-West, four from the North, four from the North-East; five were from the Center of France. The mean age was 13 years and two months for the 28 girls, and 14 years and four months for the 13 boys. Eighty per cent of the adolescents were from immigrant families (33/41): 15 were from sub-Saharan Africa, ten from North Africa, six from Pakistan and two from Turkey. Two thirds of the adolescents were hospitalized in the 2nd quarter of the year. Some adolescents suffered from lower limb pain, 16 had deformations of lower limbs, particularly genu valgum, associated with pain; seven others had either muscle spasms (4), tetany (3). Serum calcium level was low (average 1.84 mmol/l: [1.1-2.5]), and serum 25-OH D level was extremely low. Radiographic characteristics observed were metaphyseal strips on the knees, with condensed edges at times, with the presence of bone demineralization. The treatment combined calcium and vitamin D, and was often administered intravenously when a hypocalcemia was detected. Rickets is not frequent in adolescents, but nonetheless this pathology is not exceptional, and the number of cases is probably under-estimated. Rickets affects immigrant adolescents in particular but nevertheless could also present a certain risk period for the general population.

[Respiratory manifestation of Crohn's disease. Apropos of a case in an adolescent]. / Manifestations respiratoires de la maladie de Crohn. A propos d'un cas chez un adolescent.

The authors report an original case of Crohn's disease in a teenager with breathlessness and alveolar lymphocytosis. This respiratory involvement is uncommon in pediatric. About the literature, the authors review the significant and the prognostic value of alveolitis in Crohn's disease.

[Incidence of symptomatic celiac disease in French children]. / Incidence de la maladie coeliaque symptomatique de l'enfant en France.

OBJECTIVE: The study was carried out by the GFHGNP to determine the annual incidence of symptomatic celiac disease in children. PATIENTS AND METHODS: The diagnostic criteria were: symptomatic patients diagnosed under 15 years of age during 1996, villous atrophy and positivity of antigliadin and/or other antibodies. Cases were collected from referral centers, general hospital pediatric departments and private pediatricians with endoscopic practice. RESULTS: The study involved roughly half of the French pediatric population in 41 out of the 95 French districts. In all, 124 patients were collected: 76 girls and 48 boys. By geographical areas, in 30 districts where collection of data was complete which counted 186,285 births, the yearly incidence varied from 1/1731 births to 1/3110. (0.57@1000 to 0.32@1000). On the whole there were 77 cases i.e. an annual incidence of 1/2419 or 0.41@1000 (confidence interval 95%: 0.32 to 0.50@1000). Lower incidences were observed in the district of Paris: 1/4865 (0.21@1000) and Lyon: 1/3310 (0.27@1000). Those lower incidences could be explained by the difficulties of collecting the data in the biggest urban areas. The first signs occurred before one year of age in 73% of the cases, during the second year of life in 20.5% and after 3 in only 6.5%. The diagnosis was made before 2 years of age in 77% of the cases and after 3 in only 13%. In order of frequency symptoms were: failure to thrive (80%), diarrhea (59%), anorexia (59%), abdominal distension (57%), weight under 2 standard deviations (43%), short stature (43%). CONCLUSION: Compared with previous studies in two French districts between 1975 and 1990, the annual incidence of symptomatic celiac disease in children appears to be on the rise. The usual clinical signs continue to be observed.

[Role of gastroesophageal reflux in acute recurrent laryngeal dyspnea in children]. / Rôle du reflux gastro-oesophagien au cours des dyspnées laryngées aiguës récidivantes de l'enfant.

Recurrent laryngeal croup (RLC) in children is rarely discussed unless permanent laryngeal obstruction is involved or there is an allergic basis. An atypical case is described where gastro-esophageal reflux (GER) was not only associated with but was also directly related to the provocation of each period. A series of 15 patients with RLC were investigated for the presence of GER, and this was confirmed in 7 cases. These findings suggest that GER may be responsible for the onset of RLC, as is now admitted for numerous respiratory manifestations in children. Moreover, GER may be implicated in the course of various laryngeal obstructive lesions, particularly subglottic angioma.

[Accelerated desensitization to Dermatophagoides pteronyssinus mites in children with asthma. Results of two years of immunotherapy]. / Désensibilisation accélérée aux acariens dermatophagoïdes pteronyssinus dans l'asthme de l'enfant. Bilan de deux années d'immunothérapie.

16 children with chronic asthma were given a rush immunotherapy with standardized Dermatophagoides Pteronyssinus extracts. For two years, the dose of 10 IR was injected monthly. Before this rush, six children have received a typical immunotherapy ineffective on asthma. Examination of clinical, medication, immuno-allergologic and functional parameters were recorded before and at 6, 12 and 24 months of the follow-up. Rush immunotherapy was well tolerated. Substantial improvement of asthmatic syndrome was seen in 12 children. Skin sensitivity decreased significantly since 6 months (p less than 0.001). Laboratory results were not changed. At 24 months, improvement of CRF Helium was showed (p less than 0.01). This study with two years follow-up shows that specific immunotherapy is efficacy and possible in children with severe asthma. Symptom, medication, functional scores were substantial improvement.