Prevention of relapse by mesalazine (Pentasa) in pediatric Crohn's disease: a multicenter, double-blind, randomized, placebo-controlled trial.

AIM: This study aimed to test the efficacy of mesalazine in maintaining remission in pediatric Crohn's disease (CD) following successful flare-up treatment. METHODS: In this double-blind, randomized, placebo-controlled trial, 122 patients received either mesalazine 50mg/kg per day (n=60) or placebo (n=62) for one year. Treatment allocation was stratified according to flare-up treatment (nutrition or medication alone). Recruitment was carried out over two periods, as the first period's results showed a trend favoring mesalazine. Relapse was defined as a Harvey-Bradshaw score more than or equal to 5. Time to relapse was analyzed using the Cox model. RESULTS: The one-year relapse rate was 57% (n=29) and 63% (n=35) in the mesalazine and placebo groups, respectively. We demonstrated a twofold lower relapse risk (P<0.02) in patients taking mesalazine in the medication stratum (first recruitment period), and a twofold higher risk in patients taking mesalazine in the nutrition stratum (second recruitment period), compared with the other groups. None of the children's characteristics, which differed across the two recruitment periods, accounted for the between-period variation in mesalazine efficacy. One serious adverse event was reported in each treatment group. CONCLUSION: Overall, mesalazine does not appear to be an effective maintenance treatment in pediatric CD.

[Histiocytosis X and sclerosing cholangitis]. / Histiocytose X et cholangite sclérosante.

The case of a seven-year-old with multifocal (type II) Langheran's cell histiocytosis since the age of two years is reported. Despite therapy, biliary cirrhosis with portal hypertension developed gradually. Histologic studies of liver biopsy specimens, computed tomography, and transhepatic cholangiography disclosed dilatation of the bile ducts, suggesting sclerosing cholangitis, a specific complication of Langherans' cell histiocytosis which precipitates the development of biliary cirrhosis.

[Vaccination against hepatitis B virus]. / La vaccination contre le virus de l'hépatite B.

More than 200 million people infected with hepatitis B virus worldwide, with high risk of developing hepatic disease ranging from chronic hepatitis to hepatocellular carcinoma, underline an imperative need for an efficacious vaccine. Many studies have provided repeated assurance on the safety and efficacy of hepatitis B vaccines derived from plasma pooled from carriers. However, alternative methods for vaccine production are necessary and DNA recombinant vaccines are currently available. Recombinant hepatitis B vaccines are safe, antigenic, and free from side effects. The immunogenicity of yeast hepatitis B vaccine is similar to that of the plasma-derived vaccine. In the mammalian recombinant vaccine, pre-S2 region is added to S region and should confer quicker and stronger efficacy in hepatitis B protection.

[Value of barium transit of the small intestine in research on Meckel's diverticulum]. / Intérêt du transit baryté du grêle dans la recherche du diverticule de Meckel.

Twelve children were diagnosed as having a bleeding Meckel diverticulum upon laparotomy. Before surgery, barium small bowel examination was performed according to the Bret technique (J Radiol Paris [1980] 61, 753-758) in 8 cases; the Meckel diverticulum being apparent in all 8 cases. By contrast, a classical technique of barium small bowel examination used in 4 cases, and 99m TC pertechnate scan performed in 7 cases, yielded only negative results. We conclude that barium small bowel examination, when performed according to the Bret's technique, is a very effective method for the diagnosis of Meckel diverticulum.

[Metastatic neuroblastoma with secondary hypersecretion of vasoactive intestinal peptide]. / Neuroblastome métastatique avec hypersécrétion secondaire de peptide intestinal vaso-actif.

A 18-month-old boy with stage 4 neuroblastoma needed intensive care because of prerenal acute renal failure related to an intractable watery diarrhoea syndrome occurring 10 months after the diagnosis of the primary tumor. This diarrhoea was in relation with a late hyperproduction of vasoactive intestinal peptide by the relapsing neuroblastoma itself and stopped with intravenous somatostatin administration.

[Acid gastroesophageal reflux in the child with intubation, artificial respiration and continuous nutrition. Apropos of 28 cases]. / Reflux gastro-oesophagien acide chez l'enfant intubé, ventilé et alimenté. A propos de 28 cas.

Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.

[Gastroduodenojejunitis disclosing Crohn disease in a child]. / Gastroduodénojéjunite révélatrice d'une maladie de Crohn chez un enfant.

In a 12-year-old girl, a duodenojejunitis associated with systemic manifestations led to the diagnosis of Crohn's disease. Continuous enteral alimentation and steroid-therapy has induced remissions of the acute disease.

[Generalized BCG infection, with a favorable outcome, in a 3-month-old immunocompetent infant]. / Infection généralisée à BCG d'évolution favorable chez un nourrisson de 3 mois sans déficit immunitaire reconnu.

A 3 month-old infant vaccinated with BCG at birth presented with granulomatous hepatitis with BCG isolated in the liver. Splenomegaly, infiltrates in both pulmonary apices and hilar adenopathies were simultaneously present. No immune deficiency could be found. Complete recovery followed specific polychemotherapy. Parenchymal calcifications appeared in the liver, spleen, lungs and mesenteric ganglia.

[Acute generalized exanthematic pustulosis in children. Apropos of a case]. / Pustulose exanthématique aiguë généralisée de l'enfant. A propos d'un cas.

A seven year old girl without any personal or familial history of psoriasis presented with a maculo-papular then pustular, uniformly generalized eruption. She also had fever, neutrophilic granulocytosis, conjunctivitis and vulvitis. There was no evidence for bacterial or viral aetiology. Skin biopsy showed spongiform multilocular pustules and a vasculitis. The child recovered spontaneously within one week without further relapse.

[Role and aspects of lymphography in juvenile chronic polyarthritis]. / Place et aspect de la lymphographie dans la polyarthrite chronique juvénile.

The authors report two cases of Still's disease with unusual presentation, characterized by important paraaortic lymphatic nodes. The findings of the lymphography could not distinguish between Hodgkin's disease, lymphoma, or inflammatory hyperplasia. Lymphography is usually of little interest for the diagnostic of Still's disease. However the knowledge of such misleading aspects is important when unusual clinical manifestations lead to perform a lymphography.

Pigment gallstones of the common bile duct in infancy.

Ten infants of less than 6 months of age presented with cholestatic jaundice and gallstones. Jaundice occurred after a lag period, and sepsis was present in three children. Ultrasound examination showed dilatation of intrahepatic and extrahepatic bile ducts in eight patients and detected cholelithiasis in three. Percutaneous transhepatic cholangiography and/or surgery allowed separation of the patients into two groups: (i) six children with lithiasis in the distal common bile duct, and (ii) four children with lithiasis associated with bile duct perforation at the junction between the cystic and common bile ducts with gallstones probably secondary to bile stasis and infection. Surgical treatment was confined to removal of calculi and drainage in eight children; biliary reconstructive surgery was necessary in the other two who had serious biliary duct lesions. No recurrence was observed after 1 to 7 years. The pigmentary nature of cholelithiasis was established by stone morphology in all cases, and by bile and stone analysis in several cases.

[Comparative study of 4 groups of gastroduodenal ulcers in children]. / Etude comparée de 4 groupes d'ulcères gastro-duodénaux chez l'enfant.

A retrospective cooperative survey allowed analysis of 151 cases of ulcers diagnosed by endoscopy (106), surgery (40), or autopsy (5). There were 58 primary ulcers, 21 aspirin-induced ulcers, 23 steroid-induced ulcers, and 49 stress ulcers. Up to the age of 7, the majority of ulcers (80%) were secondary; after 7 years, only 47.6%. The higher incidence was found in boys of all groups, especially after 7 years of age. Only aspirin-induced ulcers were located more often in the stomach (52.3%). A family history was present in parents and siblings of children with primary ulcers (31%) and aspirin-induced ulcers (23.8%). The secondary ulcers were often complicated: hemorrhage was nearly always present with aspirin induced ulcers (95.2%); perforation occurred principally in steroid-induced ulcers (30.4%), and stress ulcers (42.8%). Death occurred only in steroid-induced ulcers (8) and stress ulcers (21). Secondary ulcers rarely became chronic.

[Intramural hematoma of the duodenum and chronic pancreatitis after jejunal biopsy]. / Hématome intramural du duodénum et pancréatite chronique après biopsie jéjunale.

A 12 year-old boy presented with duodenal hematoma in the hours following small bowel biopsy. Two years later, he presented with abdominal pain and diarrhea. Investigations allowed to find a chronic calcified pancreatitis, which is suggested to be the consequence of the previous duodenal hematoma.

[Obstruction of the celiac trunk and the superior mesenteric artery]. / Obstruction du tronc coeliaque et de l'artère mésentérique supérieure.

Pancreatic, hepatic and intestinal troubles occurred in a 8 year-old acrogeria girl who was treated for Wilm's tumor by cobalt therapy at 2 1/2 years. Complete obstruction of the coeliac trunk and proximal superior mesenteric artery was shown, associated with hypoplasia of the abdominal aorta and its collaterals in the irradiated areas. Acrogeria might enhance the toxic effects of radiotherapy on vessels.

[Ileo-cecal tuberculosis. A difficult diagnosis]. / La tuberculose iléo-caecale. Un diagnostic difficile.

An ileocaecal tuberculosis suspected in an Algerian girl was confirmed only by operative findings and by the presence of caseum at histological examination. Mycobacterium tuberculosis could not be cultured from the lesions. Diagnostic problems between tuberculous enteritis and Crohn's disease are discussed.

[Primary gastroduodenal ulcers in children. A multicenter study of 58 cases of endoscopic or surgical diagnosis]. / Les ulcères gastro-duodénaux primaires de l'enfant. Etude multicentrique de 58 cas de diagnostic endoscopique ou chirurgical.

A retrospective cooperative survey allowed analysis of 58 endoscopically (56) or surgically (2) proven ulcers in children. Drugs or stress induced lesions and ulcers in neonates were excluded from the study. The distribution was as follows: 39 (67%) males, 19 (33%) females, 42 (72%) duodenal, 16 (28%) gastric; 45 children were older than 7 years; a family history of ulcer was present in parents and/or siblings of 12 patients (38%). Ulcer was diagnosed on the occasion of a complication in 39 children (67%). Endoscopy performed in 53 children first detected the ulcer in 51 (in 5 instances at the second examination only). In the remaining 5 children, ulcer was proven endoscopically after radiologic examination was performed. The endoscopic and radiologic data were compared at the time of diagnosis and during follow-up. 31 children were checked endoscopically 3 months after diagnosis and lesions were still present in 21. 10 children were operated on. In these children, evolution is unpredictable and endoscopic check-ups are necessary.

[Budd-Chiari syndrome caused by obstruction of the hepatic veins]. / Syndrome de Budd-Chiari par obstruction des veines sus-hépatiques.

A Budd-Chiari syndrome was observed in a 11 year-old girl who was admitted to hospital for abdominal pain and distension, soon followed by severe shock. X-ray investigations, surgery and autopsy showed partial stenosis of the common portion of the left hepatic veins associated with a complete obstruction of other hepatic veins but without alteration of the inferior vena cava.

[Hereditary pancreatitis. Two new kindreds ]. / Pancréatite héréditaire. A propos de deux nouvelles familles.

An acute pancreatitis was observed in 2 children belonging to two unrelated families in which a total of 8 kindreds also had pancreatitis. Evolution was so severe that it demanded parenteral feeding and partial pancreatectomy with Wirsung-intestinal shunting. The authors stress: the rarity of this condition (which has a dominant autosomal transmission), the lack of specificity, the severity in which pseudocysts predominate, the further occurrence of both diabetes and external pancreatic deficiency and finally, the risk of pancreatic carcinoma.