[Children and adolescents at risk. A Study by the Child Psychiatry Department of Armand Trousseau hospital in Paris]. / Enfants et adolescents en danger. Etude de l'unité de psychopathologie de l'enfant et de l'adolescent de l'hopital Armand Trousseau.

Along the 12 months of 2002, our Child Psychiatry Department received 109 young patients "at risk", under 17 years old. A detailed study of 103 files evaluates the danger they ran in three fields, suicide, abuse and neglect, and psychiatric pathology. With an original "danger scale", the multidisciplinary team completes three assessments: the danger before hospitalisation (background), the present professional action (diagnosis, care, police and justice connections...), estimation of the risk after treatment. In most cases, patients situations are severe, they have lasted for a long time (more than 6 months), and they were already taken on charge. The hospital psychiatric intervention, even for a short time, means to us to interfere whatever the proceedings: medical care, institutions, justice...

[Pediatric proctology]. / Proctologie infantile.

The approach to proctologic disorders has been little studied in the child. The region is, however, easily accessible for direct examination, and the predominant abnormalities are the rectal consequences of passing hard and/or voluminous stools that are often responsible for pain and bleeding. Other lesions are also observed (pseudo-haemorrhoidal vascular swelling, abscess, dermal scar proliferation, prolapsus) but are generally easily diagnosed and treated, although in a paediatric context.

Sucrase-isomaltase deficiency: changing pattern over two decades.

Twenty-two cases of sucrase-isomaltase deficiency (SID) were observed over a period of 20 years. Since 1977 delay of introduction of sucrose and its decrease in infants' diets have modified the symptomatology. In general, onset of diarrhea has not taken place immediately but 15 days to 2 months after introduction of sucrose. Out of 12 cases with dehydration, five occurred 3 to 7 months after the beginning of sucrose diet. Hypotrophy was not constant (11 of 22 cases), thus diagnosis was delayed in 17 of 22 cases. A yellow complexion due to rising carotene levels in the blood is a striking feature. Because of falsely positive sucrose load tests (four out of 14 nonSID infants) and failure of the hydrogene breath test (one out of five studied cases), disaccharidase determination remains the key to diagnosis. Despite the genetic difference symptoms seem to depend on infant feeding practices.

[Sarcoidosis in children with digestive manifestations]. / Sarcoïdose de l'enfant à révélation digestive.

BACKGROUND: Gastric involvement is the least rare among digestive localizations of sarcoidosis, as well in adults as in children. When it is to be seen at the beginning of the disease, it may cause difficulties in the diagnostic, especially with Crohn's disease. CASE REPORT: Gastric ulcers were detected in a 12 year-old girl, of African origin, who complained about epigastric pain. Eighteen months later, diarrhea, poor growing, uveitis and inflammatory biological signs led to a probable diagnostic of Crohn's disease. Endoscopy seemed to confirm this diagnostic with granulomatous lesions on gastric biopsies. The absence of radiological anomalies of the digestive tract and the poor efficiency of the medical treatment led to question this diagnosis and to assert that of sarcoidosis. CONCLUSIONS: This case allows to emphasize the rare involvement of the digestive tract in sarcoidosis and the aspects common both to Crohn's disease and sarcoidosis.

[Therapeutic evaluation of Mormoiron attapulgite in acute diarrheas of infants and children. A multicenter study in controlled liberal practice versus placebo in 113 patients]. / Evaluation thérapeutique de l'attapulgite de Mormoiron dans les diarrhées aiguës du nourrisson et de l'enfant. Etude multicentrique en pratique libérale contrôlée versus placebo chez 113 patients.

A placebo-controlled multicenter study was carried out to evaluate the effectiveness and safety of Actapulgite in infants and children with acute diarrhea. One hundred and thirteen patients, with a mean age of 28 months, were enrolled by pediatricians in the office. As recommended during acute diarrhea, the dosage of Actapulgite was doubled during the first three treatment days (2 to 4 packets a day according to the patient's weight), and reduced by half thereafter. The main effectiveness criteria was passage of the first normally formed stool, which denotes normalization of intestinal transit time. The first normally formed stool was recorded after two days of treatment with Actapulgite and was followed, on the next day, by a second normal stool, denoting complete recovery. The greater effectiveness of Actapulgite as compared with the placebo was demonstrated by the fact that both the first and the second normally formed stools were passed one day earlier with the active treatment (p = 0.01 and p = 0.002, respectively). In addition, resumption of a normal diet occurred significantly earlier with Actapulgite (4.4 days) than with the placebo (5.1 days). In addition to being effective, the study drug proved remarkably well tolerated. This study is especially valuable because of its office setting and the use of exclusively clinical criteria with a strict methodology.

[Value of esogastroduodenal endoscopy with staged biopsies in children with Crohn's disease]. / Intérêt de l'endoscopie oeso-gastro-duodénale avec biopsies étagées chez des enfants suspects de maladie de Crohn.

An upper gastrointestinal endoscopy with multiple biopsies was performed in 19 children suspected of Crohn disease (CD) who had also undergone X-ray investigations and colonoscopy with multiple biopsies. Biopsies were performed in pathological and/or normal mucous areas. Upper gastrointestinal endoscopy showed macroscopic changes in 7 children (37%). Histologic examinations of the upper gastrointestinal tract were normal or showed only non specific changes in 12 cases (63%). Histopathologic changes specific for CD were found in 7 cases (37%), while specific histologic changes were identified at the rectal or colic level in 3 of these 7 cases only. Thus, upper gastrointestinal endoscopy with multiple biopsies was most useful for the diagnosis of CD, since it was the only diagnostic means in 4 cases. It should be systematically performed when CD is suspected.

Prolonged constant rate elemental enteral nutrition in Crohn's disease.

Constant rate enteral nutrition (CREN) has been used in 17 pediatric patients with Crohn's disease. Exclusive CREN was maintained from 2 to 7 months and progressively reduced to assure fractioned oral intakes from 12 to 22 months. From this preliminary study, CREN appeared to be as effective as steroid therapy in initiating remission of active Crohn's disease and was able to suppress steroid dependence. In some cases with prolonged CREN, reduction or disappearance of stenotic lesions of the bowel was observed. Two other positive points must be emphasized: the favorable psychological impact of the method and the ability to avoid growth suppression secondary to steroids. The long-term effects and longer remissions must be confirmed by a multicenter study in a larger group of patients.

[A study of immunoglobulin-producing cells in the colonic mucosa of children with Crohn's disease (author's transl)]. / Etude des cellules immuno-productrices de la paroi colique dans la maladie de Crohn de l'enfant.

The immunoglobulin-producing cells of the rectal and colonic mucosae were studied on 12 biopsies obtained from 6 children, aged from 13 to 18 years, suffering from Crohn's disease involving the ileum and colon or the colon only. After incubation with immune sera specifically directed against alpha, gamma and mu chains, the fluorescent plasmocytes present in a predetermined surface area of the chorion were counted in the patients and in a control group of 5 children. Compared with controls, children with Crohn's disease had less IgA-producing plasmocytes per surface area (mean: 32.3 and 44.3 respectively) and a lower ratio of these plasmocytes to total immunoglobulin-producing cells (patients: 79%, controls: 85%). The decrease in IgA-producing cells was more pronounced in the colon but was also observed in the rectum, despite normal histology.

[Constant rate enteral feeding in the patient's home. Clinical experience in paediatrics (111 children) (author's transl)]. / Nutrition entérale à débit constant à domicile. Expérience chez 111 enfants.

Constant rate enteral feeding in the patient's home considerably shortens the stay of children in a specialized pediatric unit. A study of 111 children treated by this method for the past 5 years shows that, provided close co-operation with the family is obtained, obvious psychological benefits can be expected with little risk of technical complications. From an economic point of view, the method provides an effective means of reducing costs.