Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children.

OBJECTIVES: To assess the safety of a polyethylene glycol (PEG) 4000 laxative without additional salts in pediatric patients. STUDY DESIGN: This was a 3-month multicenter, randomized, double-blind, double-dummy, lactulose-controlled, parallel study enrolling 96 ambulatory constipated children aged 6 months to 3 years, treated daily with 4-8 g PEG or 3.33 g-6.66 g lactulose. Total protein, albumin, iron, electrolytes, and vitamins B9 (folates), A and D (25OHD3) were measured in blood before and after treatment (day 84) in a central laboratory. RESULTS: The percentage of children with at least one value out of normal range at day 84 with respect to baseline status (with or without at least one value out of normal range), i.e. the primary endpoint, was 87% and 90% in the PEG and lactulose groups, respectively, without any difference between groups. The whole blood parameters showed no qualitative or quantitative treatment-related changes. Vitamin A values were above normal range in 56% and 41% of children at baseline versus 33% and 36% at day 84 in the PEG and lactulose groups, respectively. Iron values were similarly under normal range in 47% and 51% at baseline versus 42% and 51% at day 84. Clinical tolerance was similar for both treatments except for vomiting and flatulence, which were significantly higher with lactulose. Significantly higher improvements were evidenced with PEG regarding stool consistency, appetite, fecaloma and use of additional laxatives. CONCLUSION: This 3-month study in 96 constipated children aged 6 months to 3 years confirms the long-term tolerance of PEG 4000 in pediatrics and indicates a PEG efficacy similar to or greater than that of lactulose.

Congenital extra-hepatic portocaval shunt. Concerning a case of antenatal diagnosis.

The authors report a case of congenital extra-hepatic portocaval shunt in a two-year-old girl. While pointed out antenatally by ultrasound and suspected by a follow-up ultrasound at the age of two years, this anomaly could be confirmed only by coupled ultrasound scanning and color Doppler, which allows for dynamic anatomic and morphologic evaluation. Comments concern mainly the embryologic hypothesis and the clinical tolerance of this malformation (because no therapeutic measures were adopted).

[Esophageal pH monitoring in children. Methodological aspects and a review of the literature related to indications]. / La pH-métrie oesophagienne chez l'enfant. Aspects méthodologiques et étude de la littérature en fonction des indications.

Because it offers high sensitivity and specificity, esophageal pH monitoring has become the reference method for the diagnosis of gastroesophageal reflux. This review was undertaken to evaluate methodologic problems raised by this method, involving selection of the electrode, selection of equipment, and criteria of normality according to the patient's symptoms. In some instances, multiple recordings are needed to detect correlations between clinical symptoms and esophageal pH, cardiac and respiratory tracings and esophageal pH, or oxygen saturation and esophageal pH. These studies allow improved qualitative interpretation of results. Emphasis is put on the value of esophageal pH recordings for the evaluation of medical or surgical therapies.

[Screening for hepatitis B carriers at the maternity unit of Besançon teaching hospital]. / Dépistage du portage de virus de l'hépatite B à la maternité du CHU de Besançon.

There are more than 280 carriers of the hepatitis B virus worldwide. The risk of chronic carriers, and a fatal outcome due to hepatocarcinoma, is estimated to be about 50% in Asian children contaminated by materno-fetal transmission. Serovaccination of the neonatal infant born to a HBV carrying mother provides protection in nearly 100% of cases. Routine screening for HBV carriers at the Besançon teaching hospital maternity unit led to the vaccination of 1.12% of the babies born in 1990, which corresponds to the current national average.

[Value of simultaneous monitoring of esophageal and gastric pH in infants]. / Intérét de l'enregistrement simultané des pH oesophagien et gastrique chez le nourrisson.

Simultaneous monitoring of esophageal and gastric pH in infants makes clear some peculiarities of digestive physiology and improves the sensibility of the simple method, usual mean of diagnosis of GER. In that way, a gastro-esophageal pH gradient is showed; gradient absolutely necessary to a good interpretation of this test. In twenty-two infants, younger than one year, continuous and extended monitoring of esophageal and gastric pH was realised with a specially-designed-combination microelectrode. Results pointed out that, after a meal, especially a milked meal, the post prandial period isn't suitable for the diagnosis of GER. Indeed, the gastric acidity is buffered, sometimes during many hours: that decreases or cancels the gastro-esophageal pH gradient. Besides, transient neutralisation periods of gastric acidity may occur, perhaps related with duodenogastric-biliary reflux. Before two months, the gastric pH is less acid that involves, one more time, on insufficient gastro-esophageal pH gradient for the diagnosis of GER.

[Primary malignant tumor of the liver in children]. / Les tumeurs malignes primitives du foie chez l'enfant

Primary malignant tumours of the liver in children are rare. They occur in more than 50% of cases before the age of 2 years. The clinical signs are very often limited to a large mass in the right hypochrondrium. A search for alphafoetoprotein and arteriography are the most useful investigations for diagnosis. The pathology leads one to distinguish hepatoblastomas and hepatocarcinomas. The prognosis in these tumours remains poor for, in spite of progress in liver surgery, a cure is rarely possible. It is important for doctors to recognize the existence of this tumour pathology in order to give a chance for surgery to succeed in these young children. To illustrate this, 5 cases from Besançon are reported here.