Pneumatic otoscopy in pediatrics]

Pneumatic otoscopy is based upon the reaction of the tympanic membrane after sending a small air volume. A normal mobility means that air is present in the middle ear. Instead absent or reduced mobility means that effusion is present. This technique improves the quality of ears clinical examination and is particularly useful for the diagnosis of suppurative and serous otitis media.     

Nosocomial bacteremias in pediatrics]

OBJECTIVES: To identify pathogenic microorganisms responsible for hospital-acquired bloodstream infections and to evaluate the associated risk factors in pediatric units, in a case-control study over 30 months from January 1st 1997 to June 30th 1999. RESULTS: Forty-six of 855 (5.4%) positive blood cultures were attributed to nosocomial infections. They were related to 32 infectious episodes in 28 patients hospitalized for more than 48 hours. The incidence rate was 0.11 per 100 admissions. Gram-positive cocci (n = 14; 38.8%) were the most frequently isolated pathogens (7 cases of Staphylococcus aureus, 5 of coagulase-negative staphylococci), followed by enterobacteria (n = 9; 25%), Pseudomonas aeruginosa (n = 5; 13.8%) and yeasts (n = 5; 13.8%). The major risk factors for hospital-acquired bloodstream infections were: length of stay before positive blood culture (32 +/- 51 days in cases vs 15 +/- 43 days in controls, p < 0.01), presence of central venous catheter [odds ratio (OR): 6.05, 95% confidence interval (CI): 1.87-20.42], number of days with central venous catheter (p < 0.001) and parenteral nutrition (OR: 9.44, 95% CI: 2.03-50.05). CONCLUSION: Central venous catheter use, length of stay, parenteral nutrition and particularly intravenous lipids are major risk factors for the acquisition of bloodstream infection in hospitalized children.     

Prion diseases in pediatrics]

Prion diseases are rare neurologic affections with a poor prognosis, occurring in both humans and animals. Creutzfeldt-Jakob disease (CJD) secondary to human extracted growth hormone treatment is the most frequent condition in pediatrics. In 1994, a new type of CJD (variant CJD) was described in young adults in the United Kingdom, only 10 years after the bovine spongiform encephalopathy epidemic, with recent works showing a direct relationship between the bovine epidemic and the human cases. An accumulation of a single protein called the prion protein (PrP) has been discovered in the brain in all of these cases, animal and human, leading to the hypothesis that a new infectious agent could proceed without any nuclear acid information; another hypothesis is that of a still unknown viral agent. The PRNP gene encoding for this PrP protein is well described: some mutations and a polymorphism in the 129th codon have been shown to be implicated in many cases of CJD. PrP is a ubiquitous protein, with yet unknown physiological function. There are still many questions to be answered: shall we expect new pediatric cases of variant CJD? Assuming that animal-human contamination is related to alimentation, are there other ways of contamination.     

Interventional digestive endoscopy in pediatrics]

Interventional endoscopy concerns the therapeutic acts carried out by endoscopic way at the level of the digestive tract. It is realized under general anaesthesia and it has profited from recent progress of the material (endoscopes and accessories). Some acts are realized in a current way in paediatrics: extraction of foreign body, dilation of oesophageal stenosis, gastrostomy. Other indications are rarer. In these cases, interventional endoscopy is usually done with the collaboration of the adult endoscopists, whose field of activity in interventional endoscopy is far much broader.     

Proton pump inhibitors in pediatrics]

For the past ten years or so, proton pump inhibitors (PPI) such as omeprazole, lansoprazole, or pantoprazole, have become the reference treatment for peptic disorders in adults. PPIs have recently begun to be used in pediatrics, and this use is likely to expand. They act on the final step of gastric acid secretion by completely inhibiting the ATPase (proton pump) at the surface of the gastric parietal cells, thus yielding long term inhibition which is not correlated with the plasma concentration of the drug, in contrast to the effects of H2-blocker drugs. Our knowledge of this new class of treatment in pediatrics is still fragmentary, but the reported pharmacokinetic and clinical data indicate that they are suitable for use in children. While the short-term risk of complications appears to be minimal, the tolerance of these drugs in chronic use requires careful monitoring because of the potential consequences of prolonged inhibition of acid secretion.     

Value of ultrasound diagnosis in pediatrics]

Due to its easy applicability, lack of invasiveness, and high yield of information, ultrasound performed by the experienced examiner has become an indispensable diagnostic tool in many areas of clinical pediatrics. This is reflected by the large numbers of ultrasound studies both in pediatric private practice and in children's hospitals. Therefore, quality standards and quality control are of paramount importance. For many clinical problems, ultrasound has led to new diagnostic and even therapeutic concepts. In the German-speaking countries, ultrasound has officially been established as a screening method for the hip, but in clinical practice also for other organ systems. Due to technological developments of the last few years, the diagnostic yield has significantly been improved, and new areas of application have been established.