Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study.

PURPOSE: Antibiotic prophylaxis is given to children at risk for urinary tract infection. However, evidence concerning its effectiveness in grade I to III vesicoureteral reflux is lacking. The objective of this study was to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infection in young children with low grade vesicoureteral reflux. MATERIALS AND METHODS: Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months. A urinary tract infection constituted an exit criterion. Infection-free survival rates were calculated using the Kaplan-Meier method and compared using the log rank test. RESULTS: A total of 225 children were enrolled in the study. Distribution of gender, age at inclusion and reflux grade were similar between the 2 groups. There was no significant difference in the occurrence of urinary tract infection between the 2 groups (17% vs 26%, p = 0.2). However, a significant association was found between treatment and patient gender (p = 0.017). Prophylaxis significantly reduced urinary tract infection in boys (p = 0.013), most notably in boys with grade III vesicoureteral reflux (p = 0.042). CONCLUSIONS: These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux. However, such a strategy may prevent further urinary tract infection in boys with grade III reflux.

A previously undescribed autosomal recessive multiple congenital anomalies/mental retardation (MCA/MR) syndrome with growth failure, lip/palate cleft(s), and urogenital anomalies.

In four children from the same family, we have observed an association of mental retardation, dwarfism, hypertelorism, facial clefting and urogenital abnormalities. Clinical and laboratory data suggest that it is a previously undescribed genetic syndrome, ie, a pleiotropic autosomal recessive trait.

[Cardiac involvement during classic hemolytic uremic syndrome]. / Atteinte cardiaque au cours du syndrome hémolytique et urémique typique.

BACKGROUND: Cardiac involvement rarely occurs in classic hemolytic uremic syndrome (HUS); it is often fatal. CASE REPORTS: The first patient, a 21-month-old boy, developed classic HUS with acute renal failure. Peritoneal dialysis was performed for 20 days. On the 10th day of dialysis, myocardial infarction occurred, probably related to coronary thrombus. The patient was given heparin and antibiotics because of an unexplained fever. The outcome was favorable despite antero-apical cardiac necrosis, and moderated chronic renal failure. The second patient, a 24-month-old girl, also showed a classic HUS, which required peritoneal dialysis for 10 days. Dilated cardiomyopathy with cardiac failure appeared on the 4th day of dialysis, not related to the volume overload and metabolic consequences of the acute renal failure, such as systemic hypertension or ineffective dialysis. On the 5th day of dialysis neurological involvement appeared. Neurological, cardiac and renal outcome was favorable. The third patient, a 25-month-old girl, developed a classical HUS, requiring peritoneal dialysis for 25 days. No cardiac insult appeared during the acute phase of the disease. After dialysis, the child had chronic renal failure (creatinine clearance: 15 mL/min/1.73 m2). Dilated cardiomyopathy appeared 3 months later, without definite etiology. The outcome was favorable with digoxin treatment. CONCLUSION: A cardiac involvement should also be searched for in the acute phase of HUS and several months later.

[Verotoxin-producing Escherichia coli infections: study of its prevalence in children in the Auvergne region]. / Les infections à Escherichia coli producteurs de vérotoxines: étude de la prévalence chez l'enfant dans la région Auvergne.

Verotoxin producing Escherichia coli (VTEC) have been associated with disease outbreaks of diarrhea hemorrhagic colitis and hemolytic-uremic syndrome in humans. Contamination occurs mainly by ingestion of beef and dairy products, but water and person to person transmission have also been described. Most of the clinical signs are due to the production of Stx1 and/or Stx2 Shiga toxins, also called verotoxins. Other virulence factors include enterohemolysin, and the product of the eae gene, intimin, involved in the attaching and effacing adherence phenotype. The predominant serotype is O157:H7, but VTEC strains of more than one hundred serotypes can cause human disease. In order to determine the prevalence of VTEC infections among children in the central part of France, stool samples from hospitalized children were examined for stx1 and stx2 genes by using a polymerase chain reaction (PCR) technique. From October 1997 to September 1998, 658 stool samples were analysed: among them 19 (3%) were stx-PCR positive. Only 8 children out of 19 had diarrhea, and for 5 of them, an enteric pathogen other than VTEC was isolated. VTEC strains were isolated from 10 samples: most of the isolates did not produce verotoxins at a high level, and they did not belong to serotypes associated with pathogenicity, which might explain the absence of relationship between VTEC isolation and pathogenicity in our study.

[Changes of erythrocyte and lymphocyte membrane fluidity after plasma extraction in children with type II homozygous hypercholesterolemia]. / Modifications de la fluidité membranaire érythrocytaire et lymphocytaire après épuration plasmatique chez des enfants hypercholestérolémiques homozygotes de type IIa.

Two young girls with type IIa homozygotic familial hypercholesterolemia were treated by plasma exchange to reduce circulating cholesterol levels, values prior to treatment being abnormally elevated (greater than 10 mmol/l). Simultaneous determination of membrane fluidity (by fluorescence polarization) of erythrocytes and lymphocytes showed marked decreases due principally to an increase in the intramembrane cholesterol/phospholipid ratio. Values after treatment showed a tendency to return to physiologic levels without, however, attaining normal values. In vitro studies of cholesterol incorporation in these membranes demonstrated the primordial role of cholesterol in these processes of membrane rigidity, and their reversibility. It is suggested that certain physical membranal properties could provide a useful index to assess need for more or less frequent plasma exchanges.

[Arhinencephaly detected by a pitressin-sensitive diabetes insipidus]. / Arhinencephalie revelee par un diabete insipide pitresso-sensible.

A 4-month old child presented with facial malformations and severe hypernatremia. Hypernatremia was secondary to diabetes insipidus due to a disorder of ADH secretion, associated with cerebral malformations. Clofibrate treatment was ineffective. However, after the patient was treated by a low osmotic residue diet, an increased water-intake and hydrochlorothiazide, natremia became normal and growth resumed.

[Monoarthritis with positive Yersinia pseudotuberculosis serology in an 18-month-old girl]. / Mono-arthrite avec sérologie positive á Yersinia pseudo-tuberculosis chez une fillette de 18 mois.

A case of Yersinia pseudo-tuberculosis arthritis is reported in a 18 month-old girl. The authors emphasize the rarity of such cases, the value of testing for Yersinia antibodies in cases with arthritis of unknown origin and the uncertain long-term outcome.

[Diagnosis of deficiency in cofactor of phenylalanine hydroxylase: a metabolic emergency]. / Le diagnostic des déficits en cofacteur de la phénylalanine hydroxylase: une urgence métabolique.

We report on two cases of children suffering from biopterin synthetase deficiency. Both were treated with the same treatment schedule with biopterin and neurotransmitters: 6-hydroxytryptophan and dihydrophenylalanine (DOPA). The only difference between the two cases is the time of diagnosis and therefore of treatment. The child who was treated early has a normal neurologic development. The other one has been treated since he was 7 months old and is mentally deficient (DQ = 0.60). This older child also suffers from dystonia probably secondary to Levodopa treatment. The authors emphasize the uncertainty of these patient's evolution owing to complications of the disease itself or those due to prolonged treatment by neurotransmitters.

[Outcome of the kidney with vesico-ureteral reflux. Apropos of 129 cases]. / Le devenir des reins soumis à un reflux vésico-urétéral. A propos de 129 dossiers.

The final status of the kidneys of 129 children suffering from vesico-ureteric reflux was studied. The growth of the kidneys was comparable in the surgically treated and in the medically treated group. However, growth was better when the kidneys had been normal initially than when they presented renal scars. New scars were more frequent in the medically treated group, and/or when scars were already present at diagnosis of vesico-ureteric reflux. Our results are in agreement with those in the literature.

Sjögren syndrome and lupus erythematosus nephritis.

A 9 year old girl with symptoms of the Sjögren syndrome showed interstitial lymphocytic infiltrate on renal biopsy. Two years later she had clinical and biological evidence of systemic lupus erythematosus, associated with a typical glomerulonephritis.

[Acute polyvisceral lupus erythematosus in a young 12-year-old girl. The value of plasma exchange]. / Lupus érythémateux aigu polyviscéral chez une jeune fille de 12 ans. Intérêt des échanges plasmatiques.

The authors report on the case of a 12 year old girl, presenting with severe systemic lupus erythematosus. Skin, joints and kidney were involved. The treatment associated steroids, plasma exchanges and cyclophosphamide. Remission has been obtained and remains one year later.

Complement activation during low-density lipoprotein apheresis.

Complement system activation was investigated in two girls with familial homozygous hypercholesterolemia undergoing two monthly sessions on LA15 or LA40 (Kaneka liposorber). We determined blood levels of C3c and C3a, leukocyte counts, and plasma levels of C3c and C3a in the extracorporeal circulation device at the start of the sessions and 15 and either 60 or 120 min into them. Sequential eluates were collected from LA40 at the end of the sessions (0.5M NaCl, 1M hydroxylamine). Anaphylatoxin C3a increased throughout, especially with LA40. As previously reported, C3a was trapped in the dextran column but was noticeably present in efferent plasma. Besides many proteins, nonnative complement fragments bearing C3a and C3d antigens were detected in almost all the eluates, suggesting possible in situ complement activation. Practically, complement activation induced by the first filter is a risk; long-term side effects may arise from this extracorporeal circulation device.

[Association, in the same subject, of deletion of the short arm of chromosome 4 (4p-) and of complete deficiency of parahydroxyphenyl-pyruvate oxidase activity in the liver (tyrosinosis)]. / Association, chez le même sujet, d'une deletion du bras court du chromosome 4 (4p-) et d'un deficit complet en parahydroxyphenylpyruvate oxydase hépatique (tyrosinose).

The authors report the association in a child of monosomy 4p- and tyrosinosis. They discuss the localization of the para-hydroxyphenylpyruvate oxidase locus on the short arm of chromosome 4. They suggest the study of para-hydroxyphenylpyruvate oxidase activity in each child with monosomy 4p-.

[Hemolytic-uremic syndrome and Escherichia coli enterocolitis. Apropos of 2 cases]. / Syndrome hémolytique et urémique (SHU) et entérocolite à colibacille. A propos de 2 cas.

The authors report two cases of HUS that presented as colitis due to E. Coli. They emphasize the interest--from an epidemiological point of view--of looking for E. Coli in stools of children with HUS and serotyping them.

[Farber's lipogranulomatosis. Apropos of a case]. / Lipogranulomatose de Farber. A propos d'un cas.

A case of Farber's lipogranulomatosis is described in an 18 month-old girl. There was clinical evidence for diagnosis, which was confirmed by a ceramidase activity assay on cultured fibroblasts. A study of the conjunctiva by electron microscopy was performed. The authors emphasize the clinical and biological characteristics of such cases.

[Hereditary renal adysplasia. Apropos of 2 families]. / Adysplasie rénale héréditaire. A propos de deux familles.

Two families with hereditary renal adysplasia are reported. Transmission is dominant autosomal. There were no genital abnormalities.

[Olfactory neuroblastoma disclosed by blindness in a 9-month-old girl]. / Neuroblastome olfactif révélé par une cécité chez une fillette de 9 mois.

A case of olfactory neuroblastoma in a 9 month-old girl is reported. Blindness and purulent meningitis were the first symptoms. Radiological examinations including CT scan revealed a sphenoidal tumor with penetration of the meninges. Surgery revealed an ethmoido-sphenoidal tumor mass extending into the pituitary fossea which consisted of malignant cells with the histological aspect of esthesioneuroblastoma. The rarity of this tumor in early childhood and its clinical polymorphism are emphasized.

[Pyridoxin-resistant homocystinuria. Apropos of a case with early thromboembolic complications]. / Homocystinurie pyridoxino-résistante. A propos d'un cas avec accidents thromboemboliques précoces.

The authors report a case of homocystinuria diagnosed in a 2 year-old boy presenting with psychomotor retardation and with widespread cerebral vascular thromboses, unusually severe at that age. The disease was of the pyridoxin-resistant type, for which use of remethylation activators led to a good biological result.