Collagenous gastritis in children: A national cohort.

BACKGROUND: Collagen gastritis is a rare disease that manifests in children mainly as isolated gastric involvement associated with martial deficiency anemia. There are no recommendations for the management and follow-up of these patients. We aimed to describe the clinical data, endoscopic findings, and treatments deployed in France's children with collagenous gastritis. METHODS: All French pediatric gastroenterology centers and pediatric centers for rare digestive diseases (Centres de Maladies Rares Digestives) were contacted to collect cases of collagenous gastritis, defined on gastric biopsies and diagnosed before 18 years of age. RESULTS: A total of 12 cases diagnosed (4 males and 8 females) between 1995 and 2022 could be analyzed. The median age at diagnosis was 12.5 years (7-15.2). The most frequent clinical presentation was abdominal pain (6/11) and/or nonspecific symptomatology attributed to anemia (8/10). Anemia was present in all children (11/11; Hb 2.8-9.1 g/dL). Nodular gastritis was present in 10 patients (antrum: 2; fundus: 4; in antrum and fundus: 4). All patients had a basement membrane thickening (from 19 to 100 µm). The treatments received were PPI (11), oral or intravenous martial supplementation (12), budesonide (1), and prednisone (1). Martial supplementation improved anemia in all cases. At discontinuation, nine of 10 patients had a recurrence of anemia. CONCLUSION: Collagenous gastritis is an exceptional condition, clinically manifested in children as abdominal pain and iron deficiency anemia probably of hemorrhagic origin. Patients require long-term follow-up and monitoring of their disease to describe the risk of progression better.

Quantification of Chaotic Intrinsic Variability of Sea-Air CO2 Fluxes at Interannual Timescales.

Chaotic intrinsic variability (CIV) emerges spontaneously from nonlinear ocean dynamics even without any atmospheric variability. Eddy-permitting numerical simulations suggest that CIV is a significant contributor to the interannual to decadal variability of physical properties. Here we show from an ensemble of global ocean eddy-permitting simulations that large-scale interannual CIV propagates from physical properties to sea-air CO2 fluxes in areas of high mesoscale eddy activity (e.g., Southern Ocean and western boundary currents). In these regions and at scales larger than 500 km (~5°), CIV contributes significantly to the interannual variability of sea-air CO2 fluxes. Between 35°S and 45°S (midlatitude Southern Ocean), CIV amounts to 23.76 TgC yr-1 or one half of the atmospherically forced variability. Locally, its contribution to the total interannual variance of sea-air CO2 fluxes exceeds 76%. Outside eddy-active regions its contribution to total interannual variability is below 16%.

[Eosinophilic esophagitis. Clinical presentation, allergology and treatment: a series of 22 children]. / L'œsophagite à éosinophiles. Présentation, bilan allergologique et traitement : à propos de 22 cas.

BACKGROUND AND AIMS: Eosinophilic esophagitis (EE) is a disorder characterized by severe eosinophilic infiltration of the esophagus, with dysphagia and gastroesophageal reflux disease (GERD) symptoms unresponsive to acid blockade therapy but responsive to the removal of dietary antigens. We report information relating to children diagnosed with EE in Nice, France, over a 6-year period. PATIENTS AND METHODS: We conducted a retrospective study between January 1, 2004, and July 31, 2009, evaluating all children diagnosed with EE. Clinical and demographic data, endoscopic and histological findings, allergology data, and results of treatment were collected and evaluated. RESULTS: A total of 22 patients, 19 males, median age 9.5 years (range: 0.8-19 years) were reviewed: 7 presented isolated dysphagia, 6 presented GERD symptoms, and 9 both dysphagia and GERD symptoms. Endoscopically, 14 had multiple esophageal white plaques, 7 had linear furrowing, 5 had circular "tracheal" rings, and 5 esophageal narrowing. The median number of esophageal eosinophils/high power field (×400) was 30 (range: 15-80). Eosinophils were localized in the distal, middle, and upper esophagus. Immunoallergy analysis findings were: high peripheral eosinophil count (74%), high total IgE level (65%), high eosinophil cationic protein (ECP) level (90%) with a median value of 69.5 µg/l and high urinary leukotriene E4 (88%). Food antigen sensitization was positive in skin-prick testing in 11 of 18 and in atopy-patch testing in 9 of 17. Dietary restriction improved clinical symptoms in 5 of 10 and local corticotherapy with viscous budesonide improved clinical symptoms in 9 out of 10. CONCLUSION: EE diagnosis must be considered in children with dysphagia or GERD who do not respond to acid blockade therapy. ECP may be used to guide diagnosis. Local corticotherapy is effective.

[Neonatal screening for sickle cell disease at the Nice University Hospital: the last 8 years]. / Dépistage néonatal de la drépanocytose au CHU de Nice : bilan des 8 dernières années.

INTRODUCTION: Screening for sickle cell disease, the most common of recessive autosomic hemoglobin disorders, allows detection of sickle cell disease SCD (homozygous sickle cell disease, compound heterozygote SC, and S ß-thalassemia) in a target population. Our objective was to evaluate its effectiveness at the Nice University Hospital. POPULATION AND METHODS: This prospective study was conducted between 1 January 2000 and 31 December 2008. The national targeted newborn screening, run together with the Guthrie test on the 3rd day of life, offered at-risk newborns (based on ethnicity and family history), allow the detection of qualitative hemoglobin abnormalities. A confirmatory test is performed when positive. Gender, ethnicity, type of hemoglobin found, zygosity, age at diagnosis, the presence at a 2nd consultation of the families identified, and acceptance of the confirmatory test were collected and analyzed. RESULTS: A total of 19,775 children were born in Nice University Hospital during this period, among whom screening detected 151 hemoglobinopathies: 139 heterozygotes and 12 major sickle cell syndrome (9 SS and 3 S ß-thalassemia). The prevalence of SCD on the targeted and the total population was, respectively, 1 out of 659 and 1 out of 1648 and the prevalence of heterozygotes was 1 out of 57 and 1 out of 142. The sex ratio was close to 1. Hemoglobin S predominated (74% of pathogens Hb). The Maghreb and sub-Saharan Africa were the 2 main areas of origin. One hundred and four of 151 families, including 12 cases of SCD, returned to consultation after they received a letter requesting attendance at a 2nd consultation. For 80 children, the confirmatory test was accepted. Feedback was possible for 72 of the 80 families. DISCUSSION: The number of children screened is increasing, thanks to better awareness among medical staff. The prevalence of SCD and heterozygotes found in Nice University Hospital is similar to what is described in the literature. With screening, early diagnosis allows early treatment at the age of 2 months before the occurrence of complications, reducing morbidity and mortality. CONCLUSION: Screening for sickle cell disease appears effective in Nice. It seems necessary to continue focusing on the importance of screening among maternity healthcare actors.

[Abdominal aortic injury in a child: seat-belt syndrome]. / Traumatisme de l'aorte abdominale : « le syndrome de la ceinture de sécurité ¼

Traumatic injuries of the abdominal aorta are rare, especially in the pediatric population, but they must be sought when the clinical signs are associated with a severe traumatic context. We report the case of a 7-year-old child who presented with a partial transection of the abdominal aorta following a traffic accident. The optimal management is based on the detection of the less striking but suggestive clinical signs, such as a belt hematoma in the abdominal wall or a decreased pulse in the lower limbs, as well as a systematic precise X-ray examination, and an urgent surgical intervention. The risk is complete rupture, whose time of occurrence after the accident is unpredictable. The abdominal aorta is anatomically protected, so injury in children is traditionally associated with seat belt wear. Lesions are related to the shearing of the abdominal aorta between the spine and the seat belt.

Erythromycin as a prokinetic agent: risk factors.

Erythromycin (ER) is an antibiotic with prokinetic activity. This property has led to its clinical use to improve gastric emptying in patients with gastroparesis. Several papers have reported the effectiveness of ER in such patients; however few of these studies have been well-conducted methodologically with evaluation of clinical endpoints and their results are often contradictory. A benefit/risk analysis prior to prescription of ER should take into account the numerous medication interactions of this drug as well as the prevention of cardiovascular complications, most notably torsade de pointes and cardiac arrest. The aim of this paper was to provide new insights into these adverse events and allow for better-informed prescription. Risk prevention requires prescription guidelines and effective communication among surgeons, anesthesiologists and pharmacists.

Changes in culturability and virulence of Salmonella typhimurium during long-term starvation under desiccating conditions.

The survival of Salmonella typhimurium under desiccation and starvation conditions commonly associated with farm buildings was investigated in a desiccation model system: filtration onto polycarbonate membranes placed in a sealed desiccator with 0.0067 g/m3 absolute humidity. Heterogeneities within bacterial populations in relation to time of desiccation were investigated on a single-cell basis by epifluorescence microscopy coupled with an image analysis system in conjunction with fluorescent dyes Chemchrome V6 and DAPI. Changes in cellular states were compared to the results of plate counts (colony forming units, CFU) on selective (modified semi-solid Rappaport Vassiliadis (MSRV)) and non-selective (nutrient agar (NA) and R2A agar) media, and to the measurements of infectivity and virulence using two animal models (chicks and mice). During 9 weeks of experimental desiccation, total cell counts (DAPI) of starved S. typhimurium remained stable, as did esterase activity (Chemchrome V6), but DAPI fluorescence intensity decreased slowly. Bacterial cells entered gradually into non-culturable states (decrease of CFU counts on MSRV, NA and R2A agar media) and the total loss of culturability on NA (defined as probability of presence of 1 CFU on the membrane inferior to 10 (-6)) was obtained after 9 weeks. Loss of chick infectivity and mice virulence in animal models occurred more rapidly, within three weeks of experimental desiccation.

Crystallization and preliminary structural analysis of catalase A from Saccharomyces cerevisiae.

Yeast peroxisomal catalase A, obtained at high yields by over expression of the C-terminally modified gene from a 2 mu-plasmid, has been crystallized in a form suitable for high resolution X-ray diffraction studies. Brownish crystals with bipyrimidal morphology and reaching ca. 0.8 mm in size were produced by the hanging drop method using ammonium sulphate as precipitant. These crystals diffract better than 2.0 A resolution and belong to the hexagonal space group P6(1)22 with unit cell parameters a = b = 184.3 A and c = 305.5 A. An X-ray data set with 76% completeness at 3.2 A resolution was collected in a rotating anode generator using mirrors to improve the collimation of the beam. An initial solution was obtained by molecular replacement only when using a beef liver catalase tetramer model in which fragments with no sequence homology had been omitted, about 150 residues per subunit. In the structure found a single molecule of catalase A (a tetramer with accurate 222 molecular symmetry) is located in the asymmetric unit of the crystal with an estimated solvent content of about 61%. The preliminary analysis of the structure confirms the absence of a carboxy terminal domain as the one found in the catalase from Penicillium vitalae, the only other fungal catalase structure available. The NADPH binding site appears to be involved in crystal contacts, suggesting that heterogeneity in the occupancy of the nucleotide can be a major difficulty during crystallization.

[Proximal fractures of the femur. Economic analysis of hospital treatment]. / Les fractures proximales du fémur. Analyse économique du traitement hospitalier.

The cost of hospital treatment of cervical and intertrochanteric fractures of femur is studied in 218 patients aged 70 and over, treated during 1985 in a specialized university department. Real costs show little difference from contractual prices as established by the hospital administration. They depend mainly on the length of hospital stay (a function of the type of treatment) and only indirectly on the type of fracture. The only hope of reducing costs is to shorten the number of days spent by these patients in costly university departments. The physician should therefore try to use methods of treatment that render patients rapidly independent, but the administration should provide enough rehabilitation wards and homes to admit semi-dependent patients rapidly after acute care of the fracture and of any associated pathology.

Adjusted subcutaneous heparin versus heparin plus dihydroergotamine in prevention of deep vein thrombosis after total hip arthroplasty.

In a prospective randomized study, two different antithrombotic regimens were compared with regard to their effects on the incidence of deep vein thrombosis (DVT) in 102 patients undergoing elective total hip arthroplasty. Fifty patients (group 1) received heparin subcutaneously three times daily in doses adjusted as a function of activated partial thromboplastin time (APTT), and 52 patients (group 2) received a fixed dose of 5,000 IU heparin plus 0.5 mg dihydroergotamine twice daily. Both treatments were started 2 days before operation and continued for 7-9 days after operation, when venography of the operated leg was performed in all patients. The overall incidence of DVT was 22% in group 1 and 19.6% in group 2. Eight patients (16%) in group 1 and four (7.6%) in group 2 developed proximal DVT. These differences were not statistically significant. Hemorrhagic complications occurred more frequently in group 1. Heparin plus dihydroergotamine is a simple and effective method of preventing DVT in patients undergoing total hip arthroplasty. Daily APTT-adjusted subcutaneous heparin remains the best method of prevention of DVT in patients with contraindications to the use of dihydroergotamine and those with two or more DVT risk factors.