[Pyomyositis in children: Two cases of Staphylococcus aureus infection]. / Pyomyosite de l'enfant : deux cas d'infection à Staphylococcus aureus.

Pyomyositis is a term used to denote primary pyogenic infection of a skeletal muscle. It is a rare disease that was first described in immunodeficient patients living in tropical climates. Lately, however, cases involving healthy children have been described in temperate climates. The origin of primary pyomyositis remains unclear, although it is thought to be caused by seeding from transient bacteremia. Onset of disease is insidious, therefore necessitating rapid diagnosis to successfully select appropriate antibiotic therapy and avoid complications. The signs and symptoms of pyomyositis are nonspecific, which highlights the importance of maintaining a broad differential diagnosis including disease entities such as osteomyelitis and septic arthritis. Magnetic resonance imaging is considered the best imaging modality for distinguishing pyomyositis from other potential etiologies. Here, we present two cases of primary pyomyositis of the lower limb muscles in an 8-year-old boy and in an 11-year-old girl.

[Acute leukemia revealed by bone magnetic resonance imaging: Two pediatric case reports]. / Leucémie aiguë découverte par imagerie par résonance magnétique osseuse : deux observations pédiatriques.

Bone and joint pain are common causes of pediatric consultation for a variety of etiologies. The causes are mostly traumatic or infectious or have an inflammatory origin. Acute leukemia (AL) can sometimes begin with osteoarticular signs and radiological investigations such as magnetic resonance imaging (MRI) can help guide the diagnosis. We report on two cases of pediatric AL revealed by osteoarticular signs, with MRI helpful in the diagnostic procedure. In these children, the first signs were recurrent joint pain, with no blood count anomalies. There was a delay between the onset of arthralgia and diagnosis due to atypical presentation of the disease. MRI guided the investigations to the diagnosis of AL. The persistence of pain or inflammation must lead to considering a bone MRI and a complete blood count must be repeated in case of persistent inflammatory bone pain to avoid a missed diagnosis of blood disease.

[Prevalence of teenage sleeping disorders]. / Troubles du sommeil chez les lycéens : prévalence et facteurs associés.

Teenage sleeping disorders can have short- and long-term consequences such as learning disorders, accidents, depression, and type 2 diabetes. OBJECTIVE: To assess the prevalence of sleeping disorders in high school students in the southwest of Brittany (Finistère), France. To search for family and social factors causing these disorders and drug use. METHOD: Observational multicenter study that took place in May, 2015, asking high school students to anonymously complete a questionnaire during school time. A variable was created: sleep disorders (TrS+) when teenagers responded "often" or "very often" to at least one of the six questions concerning sleeping disorders. RESULTS: The prevalence of TrS+ was 73 % (4170/5556). These teenagers had difficulty falling asleep (36 %), woke up during the night (33 %), or had nightmares (10 %). Their sleep routine was disrupted (35 %), they did not feel rested the following day (49 %): 9 % were late for class related to their sleeping disorders. TrS+ were more recurrent among females (OR: 2.64; P<0.0001). A negative atmosphere in high school (OR: 2.64; P<0.0001), tobacco use (>10 cigarettes per a day) (OR: 2.39; P<0.0001), alcohol (OR: 1.4, P=0.009), marijuana (<1 time per day; OR: 2.05; P=0.009), and time spent using a computer or watching television (>8h per a day; OR: 2.7; P<0.0001) had an impact on their sleep quality. Ten percent of TrS+ individuals consume medications and 9 % cannabis to help them fall asleep. CONCLUSION: Technology, drugs, and well-being at school have an impact on sleep quality. Screening of teenagers with sleeping disorders and information programs for teenagers must be provided by the teaching and medical staff.

[Adolescents in the Pediatric Emergency Department: Detection of risk behavior and depression]. / Repérage des conduites à risque et des symptômes dépressifs chez les adolescents admis en service d'accueil des urgences.

OBJECTIVES: The main objective of this study was to estimate the prevalence of social and psychological problems, risk behaviors, and depression symptoms in a population of adolescents consulting in a Pediatric Emergency Department of a general hospital, and compare these according to the reasons for consulting. METHODS: Observational monocentric study, in the Pediatric Emergency Department of a general hospital in Britany, France, between January and September 2013, using a questionnaire dispensed to 12- to 18-year-old adolescents. The questions covered habits, school, symptoms, risk behaviors, and depression symptoms. Patients were classified into three groups based of the initial aim of the consultation: medical, traumatologic, and acute psychiatric. RESULTS: A total of 379 adolescents, median age: 15 years, were included. Adolescents from the "psychiatric" group resided significantly more often with only one of their parents or in a residential home; they were more often followed by an youth worker and/or a mental health professional such as a psychologist or a psychiatrist; consumed alcohol, cannabis, and/or tobacco more often; they complained more often of headache or abdominal and lumbar pain, dizziness, and sleep disorders; they consumed anxiolytic and hypnotic drugs more often; they ran away more often; and had signs of depression and/or suicidal ideation and behaviors. The prevalence of all these psychosocial and behavioral risks was also high in the two other groups. CONCLUSION: The Pediatric Emergency Department is a good place to detect adolescents with behavioral problems and/or depression symptoms, even if this is not the initial purpose of admission.

[Testicular mass in a teenager: a case report of embryonic carcinoma discovered late]. / Masse testiculaire de l'adolescent : à propos d'un cas de carcinome embryonnaire de découverte tardive.

Testicular cancer is a rare disease in adolescents but is the leading cause of solid cancer in 15- to 30-year-old men. We report a clinical case of a 16-year-old who presented to the pediatric emergency unit with a testicular mass that had been enlarging for several months and the diagnosis turned out to be multimetastatic testicular cancer. However, early diagnosis largely determines the prognosis of this disease. A literature review enabled us to update the prognostic factors, the reasons for diagnostic delay, and current screening practices for this disease. There are currently no formal guidelines in France.

[Chlamydia trachomatis Fitz-Hugh-Curtis syndrome in a female adolescent]. / Syndrome de Fitz-Hugh-Curtis à Chlamydia trachomatis chez une adolescente.

One of the numerous causes of abdominal pain, Fitz-Hugh-Curtis syndrome (FHC) can occur in the pediatrician population. Its rapid diagnosis and treatment can avoid long-term complications, such as extra-uterine pregnancy and infertility. We report a case of FHC in a 16-year-old female caused by Chlamydia trachomatis. We discuss the diagnosis, which can be easier with noninvasive methods including CT and laboratory tests.

[Staphylococcal tracheitis and toxic shock syndrome in a child]. / Laryngotrachéite à staphylocoque doré compliquée d'un syndrome de choc toxique.

Bacterial tracheitis should be raised as a possible cause in cases of severe febrile dyspnea. It can be life-threatening due to airway obstruction or, less frequently, due to toxic shock syndrome. We report the observation of toxic shock syndrome-complicated bacterial tracheitis in a 14-year-old boy. We describe the signs and symptoms of these conditions as well as the principles of treatment.

Non-classic cystic fibrosis associated with D1152H CFTR mutation.

BACKGROUND: Limited knowledge exists on phenotypes associated with the D1152H cystic fibrosis transmembrane conductance regulator (CFTR) mutation. METHODS: Subjects with a D1152H allele in trans with another CFTR mutation were identified using the French Cystic Fibrosis Registry. Phenotypic characteristics were compared with those of pancreatic insufficient (PI) and pancreatic sufficient (PS) cystic fibrosis (CF) subjects in the Registry (CF cohort). RESULTS: Forty-two subjects with D1152H alleles were identified. Features leading to diagnosis included chronic sinopulmonary disease (n = 25), congenital absence of the vas deferens (n = 11), systematic neonatal screening (n = 4), and genetic counseling (n = 2). Median age at diagnosis was 33 [interquartile range (IQR, 24-41)] years in D1152H subjects. Median sweat chloride concentrations were 43.5 (39-63) mmol/l in D1152H subjects and were markedly lower than in PI and PS CF subjects (p < 0.05). Bronchiectasis was present in 67% of D1152H subjects, but Pseudomonas aeruginosa colonization and pancreatic insufficiency were present in <30% of subjects. Estimated rates of decline in forced expiratory volume in 1 s (FEV(1)) were lower in D1152H subjects vs PI CF subjects (p < 0.05). None of the D1152H subjects identified since 1999 had died or required lung transplantation. CONCLUSIONS: When present in trans with a CF-causing mutation, D1152H causes significant pulmonary disease, but all subjects had prolonged survival.

The use of poly(ethylene glycol) hydrogels to investigate the impact of ECM chemistry and mechanics on smooth muscle cells.

Hydrogels based on poly(ethylene glycol) (PEG) are of increasing interest for regenerative medicine applications and are ideal materials to direct cell function due to the ability to confer key functionalities of native extracellular matrix (ECM) on PEG's otherwise inert backbone. Given extensive recent evidence that ECM compliance influences a variety of cell functions, PEG-based hydrogels are also attractive due to the ease with which their mechanical properties can be controlled. In these studies, we exploited the chemical and mechanical tunability of PEG-based gels to study the impact of ECM chemistry and mechanics on smooth muscle cells (SMCs) in both 2-D and 3-D model systems. First, by controlling the extent of crosslinking and therefore the mechanical properties of PEG-based hydrogels (tensile moduli from 13.7 to 423.9kPa), we report here that the assembly of F-actin stress fibers and focal adhesions, indicative of the state of actin contractility, were influenced by the compliance of 2-D PEG gels functionalized with either short adhesive peptides or full-length ECM proteins. Varying ECM ligand density and identity independent of gel compliance affected the physical properties of the focal adhesions, and also influenced SMC spreading in 2-D. Furthermore, SMCs proliferated to a greater extent as gel stiffness was increased. In contrast, the degree of SMC differentiation, which was qualitatively assessed by the extent of smooth muscle alpha-actin bundling and the association of calponin and caldesmon with the alpha-actin fibrils, was found to decrease with substrate stiffness in 2-D cultures. In 3-D, despite the fact that their viability and degree of spreading were greatly reduced, SMCs did express some contractile markers indicative of their differentiated phenotype when cultured within PEG-RGDS constructs. Combined, these data suggest that the mechanical and chemical properties of PEG hydrogels can be tuned to influence SMC phenotype in both 2-D and 3-D.

Can endobronchial biopsy analysis be recommended to discriminate between asthma and COPD in routine practice?

BACKGROUND: International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease (COPD). Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed. METHODS: Endobronchial biopsy (EBB) specimens from patients with a clear clinical diagnosis of asthma and COPD (50 per group) were examined by three pathologists in a double blind manner. They were asked to propose a pathological diagnosis of either asthma or COPD and to analyse qualitatively the most frequent abnormalities reported in the literature. RESULTS: The sensitivity and specificity of EBB ranged from 36% to 48% and from 56% to 79%, respectively. Eosinophils strongly biased the pathological diagnoses in favour of asthma, whereas their estimated prevalence was similar (11-37% in asthma and 13-41% in COPD). Metaplasia (11-39% in COPD, 1-18% in asthma) and epithelial inflammation (28-61% in COPD, 11-38% in asthma) tended to be specific to COPD, whereas epithelial desquamation (80-98% in asthma, 61-88% in COPD) and basement membrane thickening (71-94% in asthma, 53-88% in COPD) tended to be associated with asthma. There was acceptable intra- and inter-observer agreement only for metaplasia and epithelial eosinophils. CONCLUSIONS: Specific histopathological features of asthma and COPD probably exist, but current routine analysis procedures to assess EBB specimens are not sufficiently discriminatory. This might be rectified by improving pathological definitions.