[Children arthropod bites protective measures: insecticides and repellents]. / Protection antivectorielle de l'enfant: insecticides et insectifuges.

Vector transmitted diseases are often a serious threat for child health, especially for children traveller in tropical regions. Few arthropod borne diseases are preventable by immunization or chimioprophylaxis. Prevention of most of them is based on personal protection against arthropod bites. The evidence of its efficacy has been established by the use of impregnated bed nets, impregnated clothes with permethrin or mosquito repellent which reduced significantly child malaria morbidity and mortality in endemic countries. These personal protective measures are able to minimize arthropod bites and prevent Chikungunya infection, dengue fever and Lyme disease. The choice of a repellent among the commercialised products need to be efficacy and safety evidence based. This article propose to raise this issue and to give pragmatic recommendations, with a focus to children below 30 months who are at a high toxicological risk. Severity of these diseases allowed to use potentially toxic repellents if misused.

High-dose carmustine for high-grade gliomas in childhood.

Carmustine (BCNU) has proved to be of value against a variety of primary brain tumors. This agent exhibits a steep dose-response curve in in vitro and animal tumor models and has been proposed for use in high-dose chemotherapy as a single agent or in combination. We conducted a phase II study to assess high-dose BCNU in children with high-grade gliomas. A total of 13 children with high-grade gliomas were treated in a phase II study using high-dose BCNU (800 mg/m2) followed by autologous bone marrow transplantation. Eight patients were newly diagnosed, and five were treated at the time of tumor recurrence. Seven patients had diffuse intrinsic brain-stem gliomas. The response was assessed at 1 month after treatment. Only one objective effect was observed. Five patients had stable disease and seven progressed. The immediate toxicity was mild; however, one patient developed fatal respiratory distress at 50 days after treatment with high-dose BCNU. Dose escalation of BCNU does not seem beneficial in children with high-grade gliomas.

[Prolonged remission in a child with late brain metastasis of retinoblastoma]. / Rémission prolongée chez un enfant présentant une métastase cérébrale tardive de rétinoblastome.

BACKGROUND: Outcome of patients with retinoblastoma is strongly related to the extent of the disease at diagnosis. Thus, prognosis of extra-ocular retinoblastoma is poor and metastases to central nervous system are usually fatal. CASE REPORT: An 8-year-old child presented with a late recurrence of bilateral retinoblastoma. Initial treatment had associated enuclation of the left eye and radiation therapy on the right. At time of tumour recurrence, clinical examination showed cervical lymph nodes. There was a large frontal metastasis on the CT scan and bone marrow examination showed a minimal involvement by malignant cells. The patient achieved complete remission with high dose etoposide and carboplatin; he subsequently underwent massive chemotherapy followed by bone marrow rescue, and received additional radiation therapy on the frontal and cervical areas. He is well, five years after relapse. CONCLUSIONS: This case highlights efficacy of chemotherapy in advanced retinoblastomas. Intensive chemotherapy is a promising and potentially curative approach in the management of advanced or metastatic retinoblastomas.

Selenium content in wheat and estimation of the selenium daily intake in different regions of Algeria.

In this work, we have measured the selenium content in wheat produced locally in eight different regions of Algeria from east to west, and we have established the annual consumption of selenium for five socio-professional categories. Instrumental neutron activation analysis is used. The selenium levels in wheat samples varied from 21 (Tiaret) to 153 µg/kg (Khroub), with a mean value about 52 µg/kg. The mean of selenium daily consumption from ingestion of wheat per person in the eight regions varied from 32 to 52 µg/day which is close to the minimal FAO recommendation.

The role of chemotherapy in orbital involvement of retinoblastoma. The experience of a single institution with 33 patients.

BACKGROUND: Orbital involvement is a rare occurrence in retinoblastoma but still carries a bad prognosis. The aim of this study was to define more clearly the role of chemotherapy in this advanced disease. METHODS: Between 1977 and 1991, 33 patients were treated at the Services de Pédiatrie at Institut Curie (Paris, France) for orbital involvement of retinoblastoma, which was isolated in 20 patients and associated with metastases in 13 patients (outside the central nervous system [CNS], 6; within the CNS, 7). Treatment included chemotherapy for 33 patients, irradiation of the orbit for 23 patients, and intrathecal chemotherapy and/or CNS irradiation in selected patients. RESULTS: The plateau phase of the survival curve was reached at 15 months, with a survival of 34% plus or minus 8%. The disease free interval was longer when patients had no CNS disease (P < 0.05). Twenty of the 21 recurrences (95%) occurred within 1 year after diagnosis of orbital involvement. CONCLUSIONS: Intensive chemotherapy using cyclophosphamide, platinum compounds, epipodophyllotoxins, doxorubicin, and vincristine was effective in orbital involvement of retinoblastoma even with associated extra-CNS metastases. However, associated CNS disease still carries a bad prognosis, and long term follow-up is necessary to evaluate the risk of a second tumor.

Histopathologic risk factors in retinoblastoma: a retrospective study of 172 patients treated in a single institution.

BACKGROUND: Microscopic extrascleral involvement and involvement of optic nerve resection line are accepted risk factors for orbital and/or metastatic disease from retinoblastoma. Conversely, choroidal and retrolaminar optic nerve involvement are questionable risk factors. The aim of this retrospective study was to define the histopathologic risk factors for orbital and/or metastatic disease in patients treated by first-line enucleation. METHODS: Histopathologic review of 172 evaluable patients treated at Institut Curie between 1977 and 1990 determined the degree of choroidal (minimal or massive), scleral (intra- or extrascleral), optic nerve (prelaminar, retrolaminar with or without resection line involvement), and anterior chamber invasion. The degree of differentiation was also analyzed. The log rank test was used for univariate analysis and the Cox regression model was used for multivariate analysis. RESULTS. Eighty-seven percent of the 172 patients were disease free at 3 years. Twenty-three patients developed retinoblastoma recurrence. The disease-free survival was significantly different among the five subgroups of choroidal or scleral invasion (P = 3 x 10(-3). The differences among the four subgroups of optic nerve invasion were also significant (P = 10(-4)). Classical factors were confirmed in our series (extrascleral involvement and involvement of optic nerve resection line). Multivariate analysis of the 149 patients without these classical risk factors revealed two factors that increase the risk of orbital and/or metastatic disease: massive choroidal invasion and postlaminar optic nerve involvement. CONCLUSIONS: In our experience, retrolaminar optic nerve involvement, with free resection line, and massive choroidal invasion significantly increase the risk for orbital and/or metastatic disease.