Douleurs chroniques de l’enfant: les pièges à éviter

Chronic pain in children or adolescents (abdominal, muscular or articular pains and chronic daily headaches) are frequently associated with a major handicap, school absenteism and isolation, at the very moment when they do not receive organic explanation. The classic medical approach, seek for diagnosis with explorations and treatment of the cause is not successful. It is necessary to clearly establish the diagnosis of unexplained pain, and to approach at once with the child and its family the psychological investigation (context of life, concerns and conflicts) at the same time as the physical exam. The objective is to obtain the beginning of activities, in spite of the pain. The psychological therapies, such as hypnosis, are the most effective.     

L’équilibre musculaire

Muscle imbalance is often cited in reference to the physiopathology of locomotors lesions. Muscle imbalance is thought to be a good indicator of recovery after surgery or injury. Insufficient eccentric muscular performance is important in the analysis of the physiopathology of muscular, tendinous and ligament lesions. Risk factors for arthritis are multifactorial, making muscle imbalance irrelevant. For the authors, muscular disequilibrium as measured by the antagonist-eccentric / agonist-concentric ratio may only explain the hamstring muscle injuries and those of the infraspinatus. After surgery, the objective is to obtain good muscle performance and not a particular ratio.     

Brûlure caustique et cancer de l’œsophage

La cancérisation des sténoses caustiques de l’œsophage est très rare, le risque serait de 6% et survient en moyenne 41 ans après l’ingestion de caustique. Nous rapportons la première observation marocaine de cancer développé sur une ancienne br?lure caustique de l’œsophage avec un délai de 26 ans tout en insistant sur l’absence des traumatismes liés aux dilatations répétées.     

L’échoendoscopie de contraste

Ultrasound contrast agents in combination with contrast-specific scanning techniques have opened up exciting possibilities of further improving the diagnostic capability of endoscopic ultrasonography (EUS). The main field of application is characterization of focal lesions. Pancreatic tumors are the targets studied most, but a lot of other applications will no doubt be developed. Among all the latest technological evolutions, it is certainly the most promising for development of EUS in the future.