L'absence de style est le meilleur style en rédaction médicale

The author describes this conception of medical writing. Based upon a critical analysis of articles recently published in the Archives de Pédiatrie, he underlines the main principles which have to be respected for the writing of a medical article. This paper will be completed in an article entitled « The different redactional forms in medicineto be published in the next issue (January 1988) of the journal.     

Abord psychosomatique de l'encoprésie

Encopresis most often results from functional constipation and a behaviour disorder characterised by retention of faeces. Rarely it is a passive or active expulsion of normal faeces. It indicates a failure in the education of sphincter control, often with a preferential development of autoerotic versus relational investments. A depressive component is frequent. We propose a bidisciplinary approach with a somatic and psychological evaluation of the encopretic child from the first visit. The physical examination assesses constipation and stercoral stasis. Associated psychopathological symptoms or a pathogenic psychosocial situation must be sought. The therapeutic means must be directed towards the different etiologic features. Explanations of the physiopathology of the symptom and discussion with the child and the parents on the origin of the dysfunction must be accomplished first. A medical treatment of the constipation is generally indicated. Psychotherapy is initiated according to the background and associated psychopathological symptoms.     

Liver disease in children with cystic fibrosis

Identification, evaluation and treatment of liver disease are increasingly important challenges in children with cystic fibrosis (CF). Liver disease usually presents at puberty and is receiving more attention with improved life expectancy. The abnormal CF transmembrane regulator protein in the apical surface of the biliary epithelium causes the disease. Hyperviscous bile accumulates in the biliary tree causing cholangiocyte and hepatocyte injury, stimulating focal fibrosis. Fibrosis is thought to lead on to cirrhosis over a period of years, a process which is usually asymptomatic. Steatosis and biliary tree anomalies including cholecystitis also occur. Clinical signs of liver disease appear late, by which time cirrhosis may be established. Early diagnosis would allow interventions to be evaluated but there is no gold standard for screening. Currently, regular clinical assessment, measurement of liver enzymes, ultrasound and liver biopsy are all used to evaluate liver disease in CF. Bile acid therapy reverses many markers of the disease but there is no good evidence that progression to cirrhosis can be prevented. A few children with cirrhosis decompensate (demonstrated by falling plasma albumin or coagulopathy) but they do well with liver transplantation. Children with portal hypertension as the sole manifestation of CF liver disease can be effectively managed with a programme of variceal obliteration or porto-systemic shunts.     

La lithiase urinaire du nourrisson : étude de 14 cas

Background

Diagnosis of urolithiasis in infancy is uncommon. It imposes rational exploration resting on medical history, clinical features, radiologic assessment, metabolic investigation and stone analysis.

Aim

The aim of this study is to evaluate epidemiologic and etiologic features of the urolithiasis in infancy.

Methods

It's a retrospective study including 14 cases of urolithiasis in infants, enrolled in pediatric department of Charles-Nicolle Hospital during fourteen years (1995–2008).

Results

The median age was 13 months. Thirty five percent of the patients had a positive family history of urolithiasis. The main presenting symptoms were urinary tract infection (four cases) and macroscopic hematuria (three cases). Radio-opaque urolithiasis were diagnosed in nine patients (64%), multiple stones in four patients (28%). Six of patients were diagnosed as having metabolic urolithiasis, four anatomic, two infectious and two idiopathic.

Conclusion

In our study, metabolic causes remain the first cause of urolithiasis in infancy.     

What's new in respiratory allergy?

The past 10 years have seen important advances in our understanding of allergic respiratory disease and the targets for potential therapies. Sensitisation and triggering of allergic reactions now appear to be better understood at a clinical and molecular level. Environmental intervention studies are underway attempting to reduce the sensitisation and the triggering of symptoms. Therapeutic intervention studies targeting key pathways in the allergic cascade are also taking place. This paper will assess both of these aspects of respiratory allergy, updating readers on the new evidence in our quest to understand how and when sensitisation occurs and also how we might be able to control triggered reactions using targeted therapeutics against specific elements of the allergic cascade.     

Rhinitis,sinusitis and asthma: one linked airway disease

Understanding the relationship between upper and lower airways has greatly increased through epidemiological and pharmacological studies. Scientific evidence supports the concept that rhinosinusitis and asthma may be the expression of an inflammatory process which appears in different sites of the respiratory tract at different times. The implications are not only academic but are important for diagnostic and therapeutic purposes.     

Paludisme sévère de l'enfant au Togo

Background

The definition of severe malaria is no longer limited to cerebral malaria, but is as well extended to other clinical forms of the disease. This work analyses epidemiological, clinical and evolutive aspects of severe malaria in Togo.

Patients and methods

This study included 549 children, aged from O to 15 years, hospitalized in 1994–5 in the pediatric department of the Lome-Tokoin University Teaching Hospital for severe malaria as defined by World Health Organization (WHO) criteria.

Results

The hospitalization frequency was 7.44%; the maximum frequency was from 1 to 5 years of age, but 6.56% of patients were more than 10 years old The most frequent clinical form was that of severe anemia, fallowed by cerebral complications, as seen in many African countries. The death rate was 18.94% and the proportional mortality was 8.21%; 2.73% of the patients had neurological sequelae (behaviour disturbances in five cases, aphasia in four, hemiplegia in three, munchment in one, oculomotor paralysis in one, and cerebellar ataxia in one). Hypoglycemia was fairly frequent (11.6%) and was associated with a poor prognosis.

Conclusion

It is possible to improve severe malaria prognosis in Africa by insisting not only on better equipment in intensive care wards, but also on improved and early management of hypoglycemia.     

Comportements des mères face à la position de couchage de leur bébé : effets de la dernière campagne de prévention concernant la mort subite du nourrissonMothers’ behaviors regarding infant sleeping position: effects of the last public education campaign for sudden infant death syndrome.

BACKGROUND: To define infant care practices in maternity units and those subsequently adopted at home. Using these data, we evaluated the acceptance and application of recommendations issued by the previous public education campaign on infant sleeping position as related to sudden infant death syndrome. PATIENTS AND METHODS: A survey was carried out in two maternity units (Port-Royal and Créteil) and in one pediatric consultation unit (affiliated with Port-Royal maternity). RESULTS: The mixed position (side or back) is used equally with, respectively, 47% at Port-Royal and 45% at Créteil. The supine sleeping position (French public health recommendations) is used by 12% of the mothers at Port-Royal and by 40% at Créteil. It appears that hospital nurseries play an important role in determining the mother's preference for the sleeping position (64% at Port-Royal and 54% at Créteil), but it does not adequately explain all mothers' responses. However, as the infants mature (> two months old), the more spontaneously they changed their sleeping position. All the infants placed in a side sleeping position moved to a supine sleeping position during the night. Upon awakening, infants were found mostly in the supine position (in contrast to the national public education campaign). CONCLUSION: Our results show that mothers and hospital nurseries were distressed in terms of ensuring the supine sleeping position of the infant. New choices of sleeping positions were initiated by mothers. For example, they used the side position after feedings essentially in the case of reflux or during the daytime. The supine position was used when the mothers were assured that any problems had been avoided or only during the night.     

Syndrome de hennekam

Hennekam syndrome is a disorder comprising intestinal lymphangiectasia, facial anomalies and moderate mental retardation. Eight cases have been previously reported

Case report

A 17-month-old girl was admitted to hospital for peripheral edema. On physical examination, she presented with a normal mental development. Facial anomalies were noted including a flat face, depressed and broad nasal bridge, puffy eye lids, mild down-slanting palpebral fissures, hypertelorism, epicanthat folds, bulbous nasal tip, small mouth, and low set ears. A simian line and haemangiomas on the arms, trunk and left limb were also noted. There was no organomegaty. Laboratory investigations showed iron deficiency anemia, hypoproteinemia, hypogammaglobulinemia and an elevated level of alpha-1 antitrypsin excreted in thefeces. Endoscopic investigation and the small bowel biopsy showed findings consistent with lymphangiectasia. The patient did well on 24 hour enterai nutrition including medium-chain triglyceride rich diet and infusion of human albumin.

Conclusion

We have aimed to remind that Hennekam syndrome should be included in differential diagnosis when intestinal lymphangiectasia are associated with facial anomalies.     

Clinique de la dyslexie

Dyslexia is characterized by a severe, persistent reading disorder occurring in an intelligent child. In the large field of learning disabilities, dyslexia is related to a cerebral dysfunction well described with Imagery and genetic studies. Nevertheless the diagnosis of dyslexia cannot be done by another way than clinical symptoms. Optimizing the management of children with dyslexia is a critical issue and is now possible, thanks to the improvement of neurosciences data and the mobilization of the key stakeholders. The knowledge of the precise symptoms is essential in order to lead the child's doctor able to improve coordination and harmonization of teaching and care and guidance of parents.     

Transplantation hépatique chez une adolescente atteinte de mucoviscidose

Background.

Orthotopic liver transplantation (OLT) is an effective treatment for patients with cystic fibrosis end stage liver disease, especially those with only mild pulmonary involvement. Long-term follow-up in such transplanted patients is still lacking.

Case report.

A 15-year-old girl with cystic fibrosis received an OLT because of severe decompensated cirrhosis. She had been colonized by Pseudomonas aeruginosa for 3 years and had pancreatic insufficiency; she also had mild glucose intolerance. Postoperatively she developed diabetes mellitus requiring insulin therapy for 9 months. Oral ciclosporin was poorly absorbed so that she was given a new emulsion of ciclosporin (Neoral^®) that was better absorbed. A rapid pubertal catch-up was obtained but the patient remained colonized by Pseudomonas aeruginosa.

Conclusion.

This 3-year post-operative follow-up confirms that OLT can represent a good alternative in those patients with severe liver disease and mild pulmonary involvement.     

Connaissances et pratiques de mères sénégalaises vivant en milieu rural ou suburbain sur l’alimentation de leurs enfants, de la naissance à l’âge de six mois

Breastfeeding practice is very common in Senegal. Indeed, it is the way nearly 100% of women feed their child. However, in 42% of cases, this practice is accompanied by early water administration (before sixth months). This is very often because of socio-cultural representations. Our work aimed to describe and analyze knowledge and practices of a sample of women on children feeding, from birth to six months of age.

Population and methods

It was a cross-sectional prospective study carried out from May 1st to June 30th, 2009. Qualitative data were recoded by face-to-face interviews with the mothers of six to 12 months old infants who frequented the two sites of the Institute of social and preventive paediatrics of the Cheikh Anta Diop university of Dakar (Senegal): the one being in the suburbs of Dakar (Pikine) and the other in a rural area (Khombole). Several topics were addressed: general knowledge on infants feeding, exclusive breastfeeding and the difficulties encountered in its practice, food introduced during exclusive breastfeeding and factors associated with their use.

Results

The study dealt with 44 mothers. The average time of first breastfeeding after birth was 6 ± 12 h (range: 1 to 72 h). The first food received by the newborn was the mother's milk for 64% of the mothers (n = 28). The 16 other mothers (36%) administered the “Tokental” (traditional drink for the newborn) before the first breastfeeding. Thirty-eight mothers held information about exclusive breastfeeding. Early breastfeeding was carried out by 22 mothers (50%). Exclusive breastfeeding up to six months was done by 29 mothers (66%). The reasons put forward by the 15 other mothers to choose another food are various. Among the factors influencing the practice of exclusive breastfeeding, the educational level of the mothers appeared, even if the difference were not statistically significant.

Conclusion

The practice of exclusive breastfeeding and early breastfeeding do not seem to be limited by knowledge but by sociocultural representations. Among the factors limiting the early breastfeeding, the most important seems to be the “Tokental”. To improve the practices on infants feeding, it would be important to reinforce information by healthcare professionals about newborn babies.     

Le syndrome de Smith-Magenis

Smith-Magenis syndrome is caused by a 17p11.2 deletion. It associates mental retardation, facial dysmorphism and brachydactyly; aberrant behavior and major sleep problems are present in 70% of the cases. It is probably under-diagnosed because the facial abnormalities are mild and the behavioral problems with hyperactivity and self-injuries are dominant, leading to the diagnosis of psychiatric pathology. However these behavioral problems are sufficiently characterized to allow the diagnosis of the syndrome and look for a 17p11.2 microdeletion. Otorhinolaryngologic, ophtalmologic, cardiac and renal abnormalities can be associated and their evaluation is necessary. Smith-Magenis syndrome is considered as a contiguous gene syndrome. Genes have been mapped and isolated to the critical region, but their participation in the pathogenesis of the syndrome remains unclear.     

Les infections nosocomiales en réanimation néonatale et pédiatrique. Intérêt de la ciprofloxacineNosocomial infections in neonatal and pediatric intensive care. The appeal of ciprofloxacin.

Nosocomial infections, caused by multiresistant bacteria, are very common in neonatal intensive care units (NIU) and they engage the vital prognosis. MATERIAL AND METHODS: From January 1994 to December 1995, 29 children suffered from nosocomial infections due to multiresistant bacteria. RESULTS: Bacteria were isolated in blood cultures and/or in cerebrospinal fluid and included Klebsiella (14 cases), Enterobacter (eight cases), Pseudomonas (three cases), Acinetobacter (one case), Stenotrophomonas maltophilia (one case) and Flavobacterium odorantum (one case). After preliminary antibiotic therapy, ciprofloxacin was introduced and associated with another antibiotic for 10 days. Outcome was favorable in 25 cases with sterilization of blood culture. Four deaths were due to acute respiratory failure. One case of skin rash and five cases of transient thrombocytopenia were observed during the six days of ciprofloxacin therapy. No articular complication and no dental abnormalities were observed during the 14-38-month follow-up. Ciprofloxacin appears to be a good therapeutic choice for the treatment of severe nosocomial infections in NICU. Side effects are rare, mild, and transient. However, the prevention of nosocomial infection remains essential.     

Phenotype of CF and the effects of possible modifier genes

Cystic fibrosis is an inherited multi-system disease, characterised by progressive lung disease and pancreatic insufficiency that is classically attributed to the dysfunction of a single gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). The widely diverse phenotypic expression of CF is likely influenced by other genetic traits separate from the CFTR locus or modifier genes. Many of the genes currently under study as potential modifiers of CF, particularly those which influence the severity of lung disease, are involved in the control of infection, immunity and inflammation. Some of these include HLA class II antigens, mannose-binding lectin, alpha(1)-antitrypsin and alpha(1)-antichymotrypsin, glutathione-S-transferase, nitric oxide synthase type I, TNF-alpha, TGF-beta, IL-1beta and IL-1Ra.     

Chylothorax congénital et hypothyroïdie : à propos d’une observation

Congenital chylothorax, an uncommon disorder, is a therapeutic challenge without satisfactory results. When classical medical approaches fail (such as thoracosynthesis, total parenteral nutrition, and fasting followed by oral medium-chain triglycerides), some medical teams introduce somatostatin or octreotide in cases of recurring chylothorax. We report a case of recurring chylothorax treated with somatostatin at day 27 correlated with an unfortunate discovery of hypothyroidism on day 34. Clinical signs of chylothorax on somatostatin clearly improved with the introduction of levothyroxine. This article points out the relation between the two diseases based on a review of the literature.     

Torsion testiculaire périnatale : à propos de dix cas

Perinatal testicular torsion (PTT) is a rare disease. Two entities have been described: prenatal or postnatal. The aim of this study is to recall the different etiopathogenic and histological features of this disease, to highlight the difficulties of diagnosis and discuss treatment modalities and finally to establish a treatment protocol of PTT.

Patients and methods

This is a retrospective study through which we studied 10 patients admitted in the pediatric surgery department of Monastir hospital between 1990 and 2009.

Results

Seven newborns had the antenatal testicular torsion form and three had the postnatal form. The main clinical symptom was the scrotal swelling. The controlateral vaginal hydrocele was found in 50% of cases. Doppler ultrasonography was performed in five cases and found a PTT with no blood flow in four of the five cases. The no surgical treatment was opted for a single patient and semi-urgent surgical treatment by scrotal incision has been practiced for the nine other cases. The PTT was extravaginal in all the cases. The surgical procedure consisted of an ipsilateral orchiectomy in 100% of cases and we have realized a contralateral orchiopexy in six of the nine cases operated. Pathological examination found a hemorrhagic infarction in seven cases and testicular necrosis in three cases. The postoperative and subsequent evolution was favorable in all cases.

Conclusion

The PTT is a rare disease occurring in utero and during the first month of life. Its pathogenesis is still poorly understood and the therapeutic approach is controversial.