An ESPGHAN Position Paper on the Use of Low-FODMAP Diet in Pediatric Gastroenterology.

Excluding oligo-, di-, monosaccharides and polyols (FODMAPs) from the diet is increasingly being used to treat children with gastrointestinal complaints. The aim of this position paper is to review the available evidence on the safety and efficacy of its use in children and provide expert guidance regarding practical aspects in case its use is considered . Members of the Gastroenterology Committee, the Nutrition Committee and the Allied Health Professionals Committee of the European Society for Pediatric Gastroenterology Hepatology and Nutrition contributed to this position paper. Clinical questions regarding initiation, introduction, duration, weaning, monitoring, professional guidance, safety and risks of the diet are addressed. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. The systematic literature search revealed that the low-FODMAP diet has not been comprehensively studied in children. Indications and contraindications of the use of the diet in different pediatric gastroenterological conditions are discussed and practical recommendations are formulated. There is scarce evidence to support the use of a low-FODMAP diet in children with Irritable Bowel Syndrome and no evidence to recommend its use in other gastrointestinal diseases and complaints in children. Awareness of how and when to use the diet is crucial, as a restrictive diet may impact nutritional adequacy and/or promote distorted eating in vulnerable subjects. The present article provides practical safety tips to be applied when the low-FODMAP diet is considered in children.

[Post-dental extraction tetanus. About an observation]. / Tétanos post-avulsion dentaire. A propos d'une observation.

UNLABELLED: The authors report a case of tetanus diagnosed in the aftermath of tooth extraction, in the absence of any other front door. OBSERVATION: A patient showed a persistent trismus several days after the extraction of tooth 38 performed at the dental office. The diffusion of tension and the appearance of paroxysms allowed the diagnosis of tetanus. DISCUSSION: The possibility of occurrence of tetanus after a tooth extraction should be kept in mind before a persistent trismus with rapid expansion in the neck and limbs. The dentist should be aware of the symptoms of tetanus to refer the patient to a specialized department.

[Factors of failure of prosthetic restoration of the acquired losses of substance of the jawbone and the mandible in sub-Saharan Africa]. / Facteurs d'échec de la restauration prothétique des pertes de substances maxillaires et mandibulaires acquises en Afrique subsaharienne.

The obturating prostheses of the jawbone and the prostheses of rebuilding of the mandible make it possible to restore the losses of substance of the jawbone and of the mandible and to cure the functional and Aesthetic disorders which result from these losses of substance. The success of these prosthetic restorations can be compromised by technical, economic and cultural factors. The principal factors are the importance of the losses of substance, the reduced number of teeth, the poverty of the technical plate, the persistence of certain traditional concepts. The fight against these factors requires the promotion of therapeutic associations in maxillo-facial cancerology, the sensitizing of the populations to the early hospital consultations, the improvement of the technical plate of the prosthesis of the jawbone and the face, the facilitation of the access of the most underprivileged groups to the prosthetic restorations, the promotion of multi-field collaboration, the whole co-operation of the patient throughout the treatment and the follow-up postprothetic.

[Diagnostic and therapeutic aspects of parotid tumors in the Maxillofacial Surgery Department of the University Hospital Center in Treichville, Abidjan]. / Les aspects diagnostiques et thérapeutiques des tumeurs parotidiennes en chirurgie maxillo-faciale au CHU de Treichville Abidjan.

INTRODUCTION: Taking charge of parotid tumors in an African setting is difficult because of the weakness of the technical, delayed consultation, treatment of traditional healers, tumor volume, secondary infection and ulceration of some of them. OBJECTIVE: Identify the epidemiological, clinical, evolutive and therapeutic in order to propose an adapted scheme to the management of these tumors in our African conditions. MATERIALS AND METHODS: This is a retrospective study of 38 patients with parotid tumors operated and hospitalized in the department of stomatology and maxillofacial surgery university hospital of Treichville (Abidjan), during the period from January 2005 to December 2009 included, so a period of 5 years. RESULTS: The study involved 21 (55.3%) men for 17 (44.7%) women aged between 8 and 75 years came to 76.31% for parotid tumor. In 55.26% patients consulted between 1 and 5 years. Clinically: general condition was preserved in 91.1%, tumor size ranged between 5 and 10 cm in 60.53%, they were in the form of nodules in 78.9%, were covered with healthy skin in 78.95%, appeared as isolated tumor in 72.06%. Ultrasound examination was the most paraclinical exam used (65.79%). The tumors were benign in 76.3% dominated by pleomorphic adenoma (63.2%). The most common malignant tumor was muco epidermoid carcinoma (7.9%). Exo-facial parotidectomy was the most common technique used (60.52%). The rate of patient follow-up at 2 years was 5.26%. CONCLUSION: Social and cultural conditions of the management of tumors and lack of technical platform lead us to propose the total parotidectomy for a better cure rate of patients.

[Diagnostic and surgical approach to an hourglass-shaped nasopalatine glioma in an infant]. / Approche diagnostique et chirurgicale d'un gliome naso-palatin "en sablier" chez un nourrisson.

The authors report a case of glioma nasopalatine Multifoil in wallet, location-intra nasal and palatal left. The nasal glioma is a rare congenital malformation presenting as a nasal mass composed of neuroglial tissue heteropias resulting from an abnormality in embryonic development. It is a benign tumor that fits into the nosology of the masses of the midline. This abnormality arises primarily a diagnostic problem because often mistaken for a meningo-encephalocele or a nasal dermoid cyst. Localization nose and palate, an hourglass, is extremely rare if not exceptional; The computed tomography (CT) has enabled the accurate assessment of injury and has guided the choice of surgical technique. The resection was done successfully without recurrence. Histology examination of the surgical specimen confirmed the nature of astrocytic neuroglial tumor. The location of the tumor pedide palate to that of the left nostril is special and especially histological diagnosis of this congenital malformation.

Demyelinative brainstem encephalitis responsive to intravenous immunoglobulin therapy.

We describe 2 patients with acute demyelinating brainstem encephalitis who were treated with intravenous immunoglobulin (IVIG). Both patients improved rapidly, concomitant with the course of therapy. To the best of our knowledge, these are the first reported cases of brainstem demyelinating lesions in children treated with IVIG. Our experience suggests that IVIG should be considered as first-line treatment for similar cases.

[Ameloblastoma of the maxillary sinus. Apropos of a case]. / Améloblastome du sinus maxillaire. A propos d'une observation.

The ameloblastoma is benign odontogen tumour developed from epithelial remains of MALASSEZ. Because of the inclination to invade in an inexorable way all the surrounding tissues and of the faculty of recurrence after removal, one attributes him the qualifier of good-hearted tumour to local wickedness. The mandibulary localization is the most frequent. Toward the maxillary, it is mostly observed in the tuberosity region. The authors report in the work one case of ameloblastoma developed from the pericoronal cyst of an intrasinusal ectopic canine tooth.

Biomass axial distribution in airlift bioreactor with yeast and plant cells.

This study was aimed at determining the degree of biomass homogeneity in the various parts of an internal loop airlift bioreactor, thus verifying the assumption, often made in bioreactor studies, of a well-mixed liquid-biomass system. Following characterization of the hydrodynamics of the vessel with water, the axial biomass distribution in the riser and downcomer was determined for plant and yeast cell suspensions of 5.8, 8.5, and 12.5 g DW/L Phaseolus vulgaris and of 30 and 46 g DW/L Saccharomyces cerevisiae. The airlift bioreactor with a surface ratio A(D)/A(D) of 1.04 and aspect ratio of 4.95 was investigated under various aeration rates. The yeast cells were found to be distributed practically uniformly throughout the vessel at the aeration rates of 0.1-1.45 vvm. However, in the case of the denser and cluster-forming plant cells, a clear trend of a gradual bio-mass accumulation in the downcomer, a slightly lower but uniform biomass loading in the riser, and a slightly higher biomass concentration in the gas-liquid separator was observed at the lower aeration rates of 0.1-0.61 vvm. In the case of powderized calcium carbonate (55 g/L) often used in fermentations of organic acids, a slight trend of a gradual accumulation of solids towards the bottom parts in both the downcomer and riser was observed. A better representative sampling location, in terms of solids and biomass loading, seems to be in the middle part of the vessel. It is suggested that airlift bioreactors with higher aspect ratios (>5) may be prone to a more significant inhomogeneity of solids (biomass and particles).

[The value of comparison of echography and sialo-tomography in the preoperative evaluation of parotid tumors]. / Intérêt de la confrontation de l'échographie et de la sialotomographie dans l'exploration pré-opératoire des tumeurs parotidiennes.

Studying information provided by sialo-tomography and parotid ultrasonography in the pre-operative investigation of parotid tumors, the authors compare results provided by the two types of investigation. Whilst ultrasonography, a non-invasive technique, provides more detail concerning the topography and appearance of the tumor than sialography, it cannot yet be used as a substitute for this radiological investigation. The two would appear to be complementary, leading the last word to histopathology.

Recording slope and curvature contours of flexed plates using a grating shearing interferometer.

A diffraction grating shearing interferometer is presented which, depending on the recording procedure, can be used to measure directly the slopes and curvatures of specularly reflecting flexed plates. Three system arrangements are described: two for slope measurement and one for curvature. One slope arrangement yields results in real time but, in general, does not compensate for initial model curvature. The second requires an additional spatial filtering step but does compensate for the initial curvature. A diffraction theory approach is used to arrive at expressions for the complex field amplitude of the light at the output plane. This leads to expressions for the fringe values. Experimental results for three types of model are also presented. Errors of 2-4% were found for the various system arrangements. In addition, an analytical expression is derived and verified experimentally, which shows that when the system is used for measuring slope, the curvature of the model limits the measuring sensitivity. The theoretical analysis shows that this is a fundamental property of grating interferometers in general. This property is then exploited as the basis of the curvature measuring technique.

[The temporal muscle flap. Its use in transmaxillary oro-pharyngectomy]. / Le lambeau du muscle temporal. Son utilisation dans les buccopharyngectomies transmaxillaires.

Results are reported of the use of four temporal muscle flaps for reconstruction of the floor of mouth and the velo-amygdalo-palatine region after transmaxillary buccopharyngectomy for malignant tumor. The good vascularization of the temporal flap ensured very satisfactory immediate and long term results.

[Cryopreserved allografts in orthognathic surgery]. / Allogreffes cryoconservées en chirurgie orthognathique.

After more than two years' use of cryo-preserved allografts in orthognathic surgery, the authors show the value of the use in a General Hospital of material from a cryo-preserved bone bank supplied with femoral heads by the Orthopedic Traumatology Dept.

[Extra-osseous mandibular ameloblastoma]. / Améloblastome mandibulaire extra-osseux.

Gingival ameloblastoma is a rare odontogenic tumor which shares the same histology as endo-osseous ameloblastoma but from which it differs in terms of its course by the absence of "local malignancy". There would appear to be two probable origins concerning this lesion: Serre debris and the epithelium of the gingival mucosa. However, the etiopathogenesis remains controversial, raising problems of pathological distinction from gingival basal cell carcinoma.

[Burkitt's disease in the Ivory Coast in 1988]. / La maladie de Burkitt en Côte-d'Ivoire en 1988.

Burkitt's lymphoma, or endemic hematosarcoma, is the major cancer in childhood and the 6th most common cancer in the Ivory Coast. The authors review classical ideas regarding the disease and stress some recent findings.

[Pleomorphic adenoma of the salivary glands. Analysis of 41 cases and the causes of recurrence in the Ivory Coast]. / Adénomes plémorphes des glandes salivaires. Analyse de 41 cas et des causes de récidive en Côte-d'Ivoire.

Based on a study of 41 cases, the authors report the high incidence of myxo-chondroid varieties on histological examination and their relationship to recurrences attributed to potential changes in myo- epithelial cells.

[Cylindroma of the salivary glands. Various aspects apropos of 10 cases from the Ivory Coast]. / Cylindromes des glandes salivaires. Quelques aspects à propos de 10 cas observés en Côte-d'Ivoire.

It was found that accessory salivary glands involvement, in particular intra-maxillary, was most frequent in a study involving 10 cases. Only basaloid varieties have a very poor prognosis and surgery remains the only treatment available.