[Motivations for a consultation before adoption: A multicenter study]. / Étude multicentrique sur les motivations d'une consultation avant adoption.

INTRODUCTION: While the number of international adoptions in France is decreasing, adopted children are older and in poorer health than they used to be. This phenomenon has resulted in an increase in the demand for preadoption consultations over the past several years. This study analyses the reasons for these consultations. METHOD: Prospective multicenter study conducted from 1 January to 31 December 2013. RESULTS: Ten centers contributed to the study, i.e., 196 preadoption consultations. Seeking medical advice was the reason for 88% of the consultations, whether the advice was based on the study of an identified child's medical file (32%) or a country's healthcare characteristics, whether the country was identified (34%) or not (23%). In 6% of cases, the motive for preadoption consultations was social and familial, and in the last 5% it was to obtain general information about adoption and its procedures. In more than 40% of the cases, whether the child or the country identified, Russia is the subject of the consultation because of the complexity of the files and because of the dreaded but rarely mentioned fetal alcohol syndrome. CONCLUSION: The deterioration of adopted children's health is an additional worry for future adoption applicants. To provide them with the best information possible without making choices for them, specialists should have substantial experience in adoption before going into these preadoption consultations.

[Catch-up vaccination of worldwide newcoming (adopted, refugee or migrant) children in France]. / Mise à jour des vaccinations de l'enfant arrivant de l'étranger (adopté, réfugié ou migrant) en France.

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child.

[Update on vaccine research. Proceedings of the 15th annual conference on vaccine research organized by the National Foundation for Infectious Diseases]. / Actualités en matière de recherche vaccinale. Compte-rendu de la 15(e) conférence annuelle sur la recherche vaccinale organisée par la National Foundation for Infectious Diseases.

Every year, the National Foundation for Infectious Diseases brings together more than 300 participants to review progress in vaccine research and development and identify the most promising avenues of research. These conferences are among the most important scientific meetings entirely dedicated to vaccine research for both humans and animals, and provide a mix of plenary sessions with invited presentations by acknowledged international experts, parallel sessions, poster sessions, and informal exchanges between experts and young researchers. During the Fifteenth Conference that took place in Baltimore in May 2012, various topics were addressed, including the scientific basis for vaccinology; exploration of the immune response; novel vaccine design; new adjuvants; evaluation of the impact of newly introduced vaccines (such as rotavirus, HPV vaccines); vaccine safety; and immunization strategies. The new techniques of systems biology allow for a more comprehensive approach to the study of immune responses in order to identify correlates of protection and to design novel vaccines against chronic diseases such as AIDS or malaria, against which natural immunity is incomplete.

Homozygous SMN1 exons 1-6 deletion: pitfalls in genetic counseling and general recommendations for spinal muscular atrophy molecular diagnosis.

We report on a rare homozygous intragenic deletion encompassing exons 1-6 of the SMN1 gene in a patient with spinal muscular atrophy (SMA) born into a consanguineous family. This exceptional configuration induced misinterpretation of the molecular defect involved in this patient, who was first reported as having a classic SMN1 exon 7 deletion. This case points out the possible pitfalls in molecular diagnosis of SMA in affected patients and their relatives: exploration of the SMN1 exon 7 (c.840C/T alleles) may be disturbed by several non-pathological or pathological variants around the SMN1 exon 7. In order to accurately describe the molecular defect in an SMA-affected patient, we propose to apply the Human Genome Variation Society nomenclature. This widely accepted nomenclature would improve the reporting of the molecular defect observed in SMA patients and thus would avoid the commonly used but imprecise terminology "absence of SMN1 exon 7."

[A review of questionnaires exploring driver's exposure and risk factors in road crashes]. / Cuestionarios sobre factores de riesgo de la exposición y la accidentalidad por tráfico en conductores. Una revisión.

Given the diversity of questionnaires currently being used in the study of the analytic epidemiology of traffic injuries, we made a review of studies on this question published between 1989 and 2011 in order to identify their advantages and disadvantages. We were able to observe that most of the questionnaires were focused on the human factor regarding the risk of road crashes, but very few of them included intensity of exposure and its association with other risk factors in road crashes. Many questionnaires have a high number of items and complex rating scales. Furthermore, in Spain there are few validated questionnaires which contain complete information about exposure and road crashes. In Spain we should work on the design and validation of questionnaires containing questions aimed at obtaining complete and easy information about the epidemiology of traffic injuries. In this way we would be able to increase our awareness of traffic injuries and how to prevent them.

The pituitary stalk interruption syndrome: endocrine features and benefits of growth hormone therapy.

INTRODUCTION: Childhood anterior-pituitary insufficiency has many causes (malformative, genetic, traumatic, tumoral...). One particular entity can be clearly identified: pituitary stalk interruption syndrome (PSIS). The aim of our study was to analyse the long-term evolution of patients with PSIS. PATIENTS AND METHODS: The records of all the children followed at Dijon University Hospital between 1990 and 2008 who underwent brain magnetic resonance imaging (MRI) and endocrinological evaluation that revealed a growth hormone (GH) deficiency were analysed. We thus selected 14 children diagnosed with PSIS according to the results of MRI. We studied the perinatal characteristics of these patients, then the auxological and the endocrine evolutions, before the initiation of GH therapy and then after 1 and 3 years of treatment and during the last evaluation. RESULTS: Fourteen children were diagnosed with PSIS at a mean+/-sd age of 3.2+/-3.5 years, five of whom being diagnosed during the first 2 months of life. Growth, as well as other anterior-pituitary deficiencies, was systematically followed up two to four times a year depending on the clinical context. The results in terms of endocrinology were analysed in all 14 children, and with regard to auxology in the 10 children who received GH therapy for at least 12 months, with a mean of 8.3+/-4.2 years and at a mean maintenance posology of 0.22+/-0.02mg/kg per week. Among the 14 children, 12 had complete GH deficiency while two had a partial deficiency. Nine had multiple anterior pituitary deficiencies, diagnosed at the same time or later in five and four of them respectively. A clinical picture of panhypopituitarism was found in the infants who were diagnosed with PSIS in their first months of life. In the 10 children who were treated for at least 12 months, the height before treatment was -3.1+/-0.8 standard deviation score (SDS). At the last consultation, the total gain in height was +2.5+/-0.9 SDS compared to the distance to target height of +2.7+/-0.6 SDS. The height gain after 1 year of treatment corresponded to 60% of the total gain. CONCLUSION: In children with PSIS, the other anterior pituitary deficiencies are often associated with GH deficiency and sometimes during the first month of life. These functions therefore require to be carefully followed early, periodically and in the long term. Growth in these children responds particularly well to GH therapy, in particular during the first year.

Cáncer y gestación / No disponible

El objeto de este trabajo es revisar la actuación en los cánceres asociados a la gestación, y tratar el manejo en cada uno de los posibles diagnóstico. Los más frecuentes son los cánceres de cérvix, mama, tiroides, melanoma y ovario. La aparición de una neoplasia maligna durante la gestación (0,07%) supone una situación compleja y ambivalente que requiere grandes dosis de formación científica para su manejo, pero también un importante apoyo psicológico y una profunda preparación ética. Entendemos como cáncer y embarazo toda neoplasia maligna que se produzca durante la gestación o hasta un año después del parto, y deberemos tratarla en principio como si la mujer no estuviera embarazada, sin olvidar por ello su estado y el momento de su gestación. Es indispensable disponer de un diagnóstico certero, para lo cual nos basaremos en la clínica y las características concretas de cada tipo de cáncer. Podremos emplear en general los métodos de imagen convencionales (tomografía computarizada, resonancia magnética, etc.) para realizar un estudio de extensión, con mayores limitaciones durante el primer trimestre, donde el feto es más sensible. Tampoco en el tratamiento suele haber limitaciones insalvables, teniendo en cuenta que la regla básica será posponer el tratamiento hasta finalizar la gestación cuando ésta esté avanzada y centrarnos sólo en la madre cuando sea muy incipiente. Siempre que fuere posible, será preferible el tratamiento quirúrgico, aunque a partir del segundo trimestre se pude asociar radioterapia y quimioterapia (AU)

The present article aims to review the approach to cancer in pregnancy and discuss the management of each of the possible diagnoses. The most frequent diagnoses are cancer of the cervix, breast, thyroid and ovary and melanoma. The development of a malignant neoplasm during pregnancy (0.07%) represents a complex and uncertain scenario. Its management requires large doses of scientific training as well as considerable psychological support and deep ethical awareness. The present article defines cancer and pregnancy as all malignant neoplasms developing during pregnancy and up to a year after delivery. In general, these neoplasms should be treated as though the woman were not pregnant, although the pregnancy and its stage should be kept in mind. An accurate diagnosis is essential, based on symptoms and the specific characteristics of each type of cancer. Conventional imaging techniques (computed tomography, magnetic resonance imaging...) can be used to perform extension studies, with greater limitations during the first trimester when the fetus is most sensitive. Treatment is usually feasible. The basic rule is to postpone treatment until the end of gestation in advanced pregnancies and to concentrate only on the mother when incipient. Whenever possible, surgery is preferred but radiotherapy and chemotherapy can also be associated from the second trimester (AU)

Adenocarcinoma villoglandular de cérvix: descripción de cuatro casos clínicos y revisión de la bibliografía / Villoglandular adenocarcinoma of the cervix: report of four cases and literature review

El adenocarcinoma villoglandular de cérvix es una variedad de adenocarcinoma caracterizado por su buen pronóstico y su aparición en mujeres jóvenes. Presentamos 4 casos de adenocarcinoma villoglandular de cérvix. La edad media de presentación era de 36 años (intervalo de 25-47 años). Las pacientes fueron tratadas respectivamente con los siguientes procedimientos: histerectomía abdominal simple, histerectomía radical tipo Wertheim-Meigs en 2 pacientes y conización cervical. En todos los casos el tumor estaba confinado al cérvix. Las pacientes permanecen sin enfermedad tras un seguimiento de 5-48 meses (con una media de 31,2 meses) (AU)

Estudio comparativo de inducción del parto en gestantes con cérvix inmaduro. Dinoprostona frente a oxitocina / Comparative study of induction of labour in patients with unripe cervix. Dinoprostone vs oxitocyn

Objetivo: comparar la eficacia de la dinoprostona vaginal frente a la oxitocina intravenosa en la inducción del parto con cérvix inmaduro y rotura prematura de membranas. Diseño: estudio prospectivo, comparativo de dos grupos homogéneos. Ámbito: Servicio de Obstetricia del Hospital Universitario Maternal La Fe. Material y métodos: en cada grupo, de forma aleatoria, se incluyen 40 pacientes con indicación de finalizar gestación mediante inducción, con menos de tres partos previos, con gestación única en cefálica, test de Bishop menor de 4 y rotura prematura de membranas o amniorrexis precoz. El grupo estudio se induce con liberación controlada de dinoprostona vaginal y el grupo control mediante perfusión intravenosa de oxitocina. Análisis estadístico: test de Student para muestras independientes, test de chi cuadrado. Resultados: la tasa de éxitos fue del 77,5 por ciento en el grupo dinoprostona frente al 55 por ciento en el grupo oxitocina (p<0,05) (AU)

Comparison between two cord blood collection strategies.

BACKGROUND AND OBJECTIVES: Collection strategy is the first step for collecting good quality cord blood (CB) units. There are two principal different techniques to collect CB from the umbilical vein: in the delivery room while the placenta is still in the uterus by midwives and obstetricians or in an adjacent room after placental delivery by CB-bank trained personnel. In this study, the benefits and disadvantages between two different CB collection strategies were evaluated in order to improve CB bank methodology. DESIGN AND METHODS: Valencia CB bank maintains the two different collection strategies aforementioned. Before processing CB units, volume was calculated and samples were drawn for cell counts. After processing and before cryopreservation, samples for cell counts, CD34 analysis, viability, clonogenic assays and microbiology were drawn directly from the bags. We compared the efficiency of the two collection techniques. RESULTS: Obstetric date and umbilical CB was obtained from 848 vaginal (484 collected in uterus and 364 collected ex uterus). The proportion of excluded CB units before processing was 33% for ex uterus and 25% for in uterus. The difference was statistically significant. A larger volume and a higher number of total nucleated cells, CD34+ cells and CFUs were harvested in the in uterus collection group. INTERPRETATION AND CONCLUSIONS: Based on our findings, we conclude that the mode of collection influences the hematopoietic content of CB donations. Collection before placental delivery is the best approach to CB collection and allows optimizing CB bank methodology.

Comparison between two strategies for umbilical cord blood collection.

The use of cord blood (CB) for transplantation has increased greatly in recent years. The collection strategy is the first step in collecting good-quality CB units. There are two main techniques for collecting CB from the umbilical vein: in the delivery room while the placenta is still in the uterus by midwives and obstetricians or in an adjacent room after placental delivery by CB bank trained personnel. In this study, the benefits and disadvantages between the two different CB collection strategies were evaluated, in order to improve CB bank methodology. Valencia CB bank maintains the two different collection strategies. CB was obtained from 569 vaginal and 70 caesarean deliveries and obstetrical and clinical charts were reviewed. Before processing CB units, volume was calculated and samples were drawn for cell counts. After processing and before cryopreservation samples were drawn for cell counts, CD34+cell analysis, viability, clonogenic assays and microbiology were drawn directly from the bags. We compared the efficiency of the two collection techniques. Obstetric data and umbilical CB were obtained from 569 vaginal (264 collected in utero and 305 collected ex utero) and 70 caesarean deliveries. The proportion of excluded CB units before processing was 33% for vaginal ex utero, 25% for vaginal in utero and 46% for caesarean deliveries. Differences were statistically significant. For vaginal deliveries a larger volume and a higher number of nucleated cells, percentage of CD34+ cells and colony-forming units (CFUs) were harvested in the in utero collection group. There was no statistical difference between CB collected after placental expulsion from vaginal and caesarean deliveries. Comparison between all vaginal and caesarean deliveries did not show any difference. We conclude that the mode of collection influences the haematopoietic content of CB donations. Collection before placental delivery is the best approach to CB collection and allows optimisation of CB bank methodology. Caesarean deliveries seem to contain similar progenitor content to vaginal deliveries.

El concepto de primípara añosa / The concept of the older primipara

Nuestro objetivo es demostrar que el concepto de "primípara añosa" no se corresponde en la obstetricia actual con su significado real y debe ser sustituido por otro concepto estadístico independiente de la modificación de la edad del parto de la mujer. En un estudio retrospectivo entre 1980 y 1999 observamos un aumento continuo de hasta el 7 per cent de las "primíparas añosas" en el último año. La población discriminada está más relacionada con la media aritmética + 2 DE que con el percentil 90. Se analiza el empleo de 3 DE, en vez de 2 DE. Por tanto, proponemos cambiar el concepto de "primípara añosa" utilizando los valores obtenidos con la media aritmética + 2 DE de la edad de la mujer en el parto (AU)

[Breastfeeding and culture]. / Allaitement maternel et culture.

Pediatricians consider that breast-feeding is the most appropriate means of nourishing infants. However, in cultural terms, lactation far outweighs this purely dietary function. The act of breast-feeding is very often regarded as being of prime importance and is accordingly strictly controlled. In human societies the choice, duration, and mode of lactation, are governed by various prohibitions or beliefs. Infant feeding habits are transformed by major social changes, such as women working outside the home, female emancipation or the emergence of a consumer society, although this is not always noticed by physicians and health systems. Rather than being organic in origin, most cases of inadequate milk production are due to social causes. Hence, when promoting breast feeding, in addition to argue on the basis of scientific knowledge, physicians must take into account the changes in the social context.

Edad y paridad de la mujer en el momento del parto / a woman age and parity at the time of delivery

Se estudian 152.470 partos con feto único habidos en la maternidad La Fe entre el 1 de enero de 1980 y el 31 de diciembre de 1999. Al clasificarlos según la paridad de la mujer, se observó que 77.877 (51,1 por ciento) eran nulíparas y 74.593 (48,8 por ciento) multíparas. Se comparan los partos habidos en este centro entre las fechas indicadas, observando una disminución progresiva que alcanza significación entre los valores extremos. Esta disminución no se produce de forma uniforme, sino con un aumento relativo de las nulíparas en detrimento de las multíparas, siendo en la actualidad de 51,1 y 48,8 por ciento, respectivamente, frente al 46,6 y 56,4 por ciento, que eran los valores al inicio del estudio. Las multíparas se clasifican con arreglo a la paridad observando un aumento de las primíparas y una disminución del resto con el paso del tiempo. Se observa una disminución del número de partos por mujer, que ha pasado de 2,0 a 1,5, existiendo entre ambos valores diferencias estadísticamente significativas. Al clasificar las nulíparas según la edad en el momento del parto se observó en la actualidad una tendencia a mayores edades, sin que alcanzara significación estadística; esto mismo ocurría al considerar a todas las mujeres, por lo que recurrimos a hacerlo por paridades. Podemos afirmar que en nuestro medio, la edad de la mujer en el momento del parto ha aumentado con el tiempo, de forma que las nulíparas y las primíparas muestran valores que alcanzan significación estadística respecto a lo que ocurría al principio del estudio, no alcanzándose en las secundíparas, tercíparas y cuartíparas (AU)

[Bullous cutaneous mastocytosis revealed by acute disease secondary to morphine administration]. / Mastocytose cutanée bulleuse révélée par un malaise grave secondaire à la prise de morphinique.

UNLABELLED: Mastocytosis in children shows in three clinical forms. The rarest is the diffuse or bullous form. CASE REPORT: Since one month of age an infant showed a diffuse erythema and vesicle rash. At four months of age, serious discomfort after morphinic absorption led to the diagnosis of bullous cutaneous mastocytosis. Histologic examination confirmed this diagnosis. The clinical severity led to intravenous corticosteroid and antihistamine therapy. COMMENTS: Bullous cutaneous mastocytosis is unusual in children. However, it should be considered if there are any doubts because of its serious complications and iatrogenic therapeutic risks. Some serious cases require intravenous corticosteroid therapy. Appropriate care enables a normal development with a disappearance of the disease before the teenage years.