Migraine de l’enfant et de l’adolescent

Migraine is the most frequent recurrent headache syndrome in children. It is characterized by attacks of intense, throbbing, mostly bilateral head pain, often accompanied by nausea, vomiting, photophobia and phonophobia. Efficacy of drugs for the acute treatment of migraine has not been studied in well-controlled trials. Ibuprofen and nasal spray sumatriptan may effectively alleviate migraine in children and adolescents.     

Perspective de l’enseignement de la médecine d’urgence

Emergency medicine will progress in France from a non-qualifying medical sub-specialty to a full qualifying medical specialty. This progression makes us reconsider the teaching of emergency medicine to all the future emergency physicians in order to ensure the quality of their practice. This article focuses on the scope of practice of emergency medicine and presents the academic aims of the training that should be provided to the future physicians.     

Effet de Parietaria officinalis sur la cristallisation de l’oxalate de calcium, dans l’urine

In Algeria, the traditional medicine is still widely sought by people with the use of medicinal plants based on recommendations made by it and thereby. The Parietaria officinalis known in Algeria as the common name of Jigsaw stones “fattatet l’hdjar” is commonly recommended in the treatment of urinary stones, whatever the type. This study aims to determine the effect of Parietaria officinalis on oxalo-dependent calcium oxalate crystallization, induced by addition of oxalate in urine of healthy subjects. It appears that in this biological model which is the total urine, the infusion of Parietaria taken at different concentrations, has properties controversial: it is inhibiting the crystallization of monohydrate calcium oxalate and enhances the crystallization of dihydrate calcium oxalate.     

Effet antimicrobien et sur le mal de gorge d’un spray à base d’extraits de sauge et de sureau,d’huile essentielle de menthe poivrée,de miel et de zinc

Sore throat is one of the most common reasons for consultation in general medicine. Besides the usual allopathic drugs, phytotherapy can be envisaged for its management. To assess the relevance of a product combining extracts of sage and elder, peppermint essential oil, honey and zinc for the management of sore throat, its effect was evaluated in vitro against the main pathogens involved in sore throat (broth microdilution method) and in a prospective observational study carried out in pharmacies. Bactericidal activity was observed against all Gram-negative (Branhamella catarrhalis, Fusobacterium nucleatum and Haemophilus influenzae) and Gram-positive (Streptococcus pyogenes) bacteria strains; antiviral activity was also tested against type 3 para-influenzae virus. Product activity was maintained at 1:64 dilution ratio. Data collected during the observational study suggest that the product can relieve pain and other symptoms such as dry throat sensation and erythema within 17 minutes on average after spraying. While eliminating possible pathogens involved, the product could relieve pain and symptoms associated with sore throat. These results will have to be confirmed in a clinical trial.     

Les échecs de l’extubation

Extubation failure is defined as the need for the reinstitution of ventilatory support within 24 to 72 hours of planned endotracheal tube removal. It occurs in 2 to 25% of extubated patients depending of studied population and modalities used. More often, it is associated to a higher morbidity and mortality. The causes of extubation failure are different of those of spontaneous ventilation trial failure. Compared with patients who tolerated extubation, those who require reintubation have prolonged duration of mechanical ventilation, increased length of ICU and hospital stay, and a higher incidence of mortality in some studies. For these reasons, it is very important to better identify patients at risk to present extubation failure and try not to delay reintubation. Tests designed to identify these patients such as to assess for upper airway obstruction, secretions volume and the effectiveness of cough can help to improve the management of extubation failure. Moreover, rapid identification of patients at elevated risk of extubation failure followed by rapid reinstitution of ventilatory support can improve outcome. These last years, studies showed that use of non invasive ventilation and helium–oxygen mixtures after extubation in patients whose develop respiratory distress can be helpful.     

L’adénomyome de l’ampoule de Vater: un vrai piège diagnostique

Adenomyoma of ampulla of Vater is a benign neoplasm but its clinical and radiological features are similar to pancreatic or biliary cancer. These similarities lead to the realization of unnecessary pancreaticoduodenectomy. We report here two cases of adenomyoma of the ampulla of Vater treated by pancreatoduodenectomy. The analysis of these two cases and the review of literature show that radiological and pathological knowledge of this disease, associated with pre- and intra-operative evaluation (echoendoscopyguided biopsy, intraoperative biopsy), can achieve diagnosis and thus may avoid inappropriate resection.     

Mise au point sur les traitements de l’hypertension artérielle pulmonaire de l’enfant

Treatment of pediatric pulmonary arterial hypertension (PAH) has dramatically changed with the recent availability of specific oral drugs. These new treatments have been exclusively approved in PAH that should be differentiated from other causes of pulmonary hypertension particularly frequent in intensive care unit (ICU) patients. In pediatrics, data assessing efficacy and safety of these drugs do not exist in other settings than PAH. Consistently, these drugs are not recommended in persistent pulmonary hypertension of the newborn or during the postoperative course of cardiac surgery, even if routinely used. Treatment of PAH associated with congenital heart diseases represents a major concern and designing trials is challenging due to the possible benefits for children. Endothelin receptor antagonists and phosphodiesterase-5 (PDE-5) inhibitors have been approved in Europe for children use. Prostanoids including epoprostenol are largely used in the ICU, mostly by intravenous route. Specific PAH drugs may be used alone or in combination. Several trials are ongoing to test the best combination strategy with preliminary hopeful results suggesting significant improvement for the future. Creation of right-to-left shunts (atrioseptotomy and Potts’ anastomosis) as well as lung transplantation should be indicated when children’s clinical situation worsen despite optimal PAH pharmacological management.     

Évaluation de l’activité antioxydante de Berberis vulgaris L.

Natural substances from plants have multiple interests exploited in biotechnology industry both in food, cosmetic and pharmaceutical. These compounds include a large proportion of secondary metabolites that are illustrated in many areas and even in therapy. In this context, we investigated the antioxidant activity of Berberis vulgaris, a plant used in Algeria, and it is particularly used in the Tlemcen region. After preparation of extracts from the root bark of Berberis vulgaris, total alkaloids were analyzed by thin layer chromatography, indicating the presence of six tasks. A quantitative analysis of polyphenols and flavonoids in methanolic extract was carried out, showing a content of 10.48 mg GAE/g of total polyphenols and 2.05 mg CEQ/g of flavonoids. The antioxidant activity of hydromethanolic extracts under reflux and total alkaloids was evaluated using two methods: reducing power and DPPH free radical scavenging. The results showed a high activity of methanolic extract than the total alkaloids, with an IC₅₀ of 1.40 mg/ml.     

Lésions traumatiques de l’aorte

Traumatic disruption of the aorta is the most frequently observed vascular lesion during blunt chest trauma. The medical and surgical management of such traumatic lesions is in constant evolution. Trans-oesophageal echocardiography is the procedure of choice for mechanically ventilated patients. Its routine use in some emergency departments has permitted the recognition some aorta disruptions ignored up to that point. The reliability of the diagnosis presupposes, however, a certain experience. The principle of early surgery remains valid in the majority of the cases. Initial medical treatment is however sometimes possible, and surgery could be postponed when the rupture is incomplete and hemodynamics are stable.     

Mécanismes de l’effet placebo

Résumé  De nombreuses données indiquent que l’analgésie placebo est sous-tendue par la mise en jeu des systèmes opio?des endogènes. Premièrement, la naloxone, un antagoniste des récepteurs des opio?des, est capable de bloquer la réponse analgésique placebo, qu’il s’agisse d’une douleur surenant dans un contexte clinique ou d’une douleur expérimentale. Deuxièmement le proglumide, un antagoniste des récepteurs de la cholécystokinine (CCK), dont les propriétés anti-opio?des sont bien établies, potentialise l’analgésie placebo vis-à-vis des douleurs postopératoires, et des douleurs expérimentales induites par une ischémie du bras. Troisièmement, une étude en imagerie cérébrale a montré que l’analgésie provoquée par les opio?des et l’analgésie placebo activent exactement les mêmes régions du cerveau. Les opio?des endogènes sollicités par un placebo agissent non seulement sur les mécanismes de la douleur mais aussi sur les centres respiratoires. En outre, nous avons établi récement que l’analgésie placebo vis-à-vis de stimulations nociceptive tant phasiques que toniques s’accompagnait d’une réduction de la fréquence cardiaque. La naloxone bloque complètement et l’analgésie placebo et la réduction concomitante de la fréquence cardiaque. L’ensemble de ces données suggèrent que les systèmes opio?des endogènes activés par un placebo sont capables d’affectur, directement ou non, diverses fonctions, comme les processus douloureux, la respiration et le système cardiovasculaire. La mise en jeu de substances endogènes par les placebos survient également dans d’autres situations pathologiques, comme les troubles moteurs.      

Fractionnement et valorisation de l’huile essentielle de la sciure de bois de Tetraclinis articulata (Vahl) Masters du Maroc

With a view to contributing to the evaluation of Moroccan flora through the identification of new potentially interesting substances at a biological and therapeutic level, we have undertaken a study of the essential oils in the sawdust of the Tetraclinis articulata (Vahl) Masters originating from the Khemisset region (Morocco). The study of the sawdust’s essential oil, completed by CPG and CPG/SM, identified 22 components, the main five being: α-acorenol (20.9%), cedrol (17.9%), totarol (8.8%), α-cedrene (8.7%) and β-acorenol (7.4%). This essential oil was fractionated on an open silica column using an eluent of increasing polarity. Five fractions were collected in this way. The fraction (FH) eluted with the pentane comprised sesquiterpene hydrocarbons whereas the four oxygenated fractions (FO₁ to FO₄) eluted with a diethyl oxide/pentane mix of increasing polarity were dominated by a diterpenoid phenol and two sesquiterpene alcohols respectively: totarol in the FO₁ fraction (42.4%), α-acorenol in the FO₂ (34.9%) and FO₃ (54.0%) fractions, and cedrol in the FO₄ fraction (58.2%). The sawdust’s oil and its chromatographic fractions were tested in vitro against four bacterium: Escherichia coli, Bacillus subtilis, Staphylococcus aureus and Micrococcus luteus, and three funghi: Penicillium parasiticus, Aspergillus niger and Trametes pini. The unfractionated essential oil and oxygenated fractions, particularly FO₁, comprising mainly of totarol, were the most active. Therefore, the FO₁ fraction would be recommended for optimising the antimicrobial activity of the Tetraclinis articulata’s essential oils.     

Desciption d’un programme comportemental. Un centre de traitement de la douleur

Résumé  Les patients pris en charge par le INPUT, Pain Management Unit (Centre de gestion de la douleur) de l’h?pital St Thomas à Londres souffrent tous de douleur chronique, le plus souvent définie comme une douleur ayant duré six mois ou plus, bénigne, en majorité lombaire. Les patients sont envoyés par leurs médecins traitants ou par divers spécialistes. Un médecin spécialiste de la douleur et un psychologue les interviewent alors afin de déterminer si le traitement leur est adapté selon un certain nombre de critères d’inclusion et d’exclusion basés sur le travail de Fordyce. La douleur chronique a de larges répercussions dans de nombroux domaines comme la consommation de soins, la vie professionnelle, familiale et sociale ainsi que les niveaux de forme physique et émotionnelle. Toutes ces conséquences deviennent les cibles des différents aspects du programme. En accordance avec les principes cognitivo-comportementaux du traitement de la douleur, tous les patients suivent le même programme, que l’étiologie de leur douleur soit connue ou pas. INPUT accueille environ 300 patients par an. Ceux-ci suivent l’un des trois programmes proposés: un programme en internat de quatre semaines, un programme en internat intensif de deux semaines ou un programme combiné alliant une semaine en internat et cinq sessions en externat étalées sur sept semaines. Tous les programmes sont organisés selon les principes cognitivo-comportementaux, tels que les renforcements des comportements d’adaptation à la douleur et l’extinction des comportements de douleur (pain behaviours), ou la remise en question des croyances par rapport à la douleur. Les programmes consistent en un certain nombre de sessions de thérapie cognitive (animées par un(e) psychologue clinicien(ne)), d’exercises physiques (animées par un(e) kinésothérapeute), de relaxation (animées soit par un(e) psychologue soit par un(e) infirmier(ère) spécialisé(e)), d’éducation sur la douleur, ses mécanismes, ses traitements (animées par un médecin spécialiste de la douleur), de réduction de prise de médication (animées par un(e) infirmier(ère) spécialisé(e) et enfin des sessions de ?pacing?, de progrommation d’activités, d’organisation d’emploi du temps etc. (animées par un(e) ergothérapeute ou un(e) psychologue). Ce type de programme s’est révélé très efficace pour la grande majorité des patients qui le suivent. Les travaux publiés dans ce domaine seront passés en revue brièvement. Quelques mots seront ajoutés concernant le problèmes du maintien à long terme des progrès effectués pendant le programme par les patients.

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Summary  Patients treated at INPUT, a Pain Management Unit at St Thomas’ Hospital in London, are all suffering from chronic benign pain, which is commonly defined as pain lasting six months or more, mainly located in the lumbar region. Patients are referred by their GP or by a specialist. A medical pain specialist and a psychologist interview all referred patients in order to ascertain whether the treatment is adapted to their complaints, following a number of inclusion and exclusion criteria based on Fordyce’s work. Chronic pain has a wide-range of consequences in numerous areas, such as health care utilisation, professional, family and social life, as well as levels of physical and emotional health. The treatment aims at addressing each of these consequences. In accordance with cognitive and behavioural principles of treatment, all patients follow the same programme, whether or not the aetiology of their pain is known. INPUT treats about 300 patients per years who follow one of the three available programmes: a four-week inpatients programme, a two-week intensive inpatient programme or a combined programme which includes one week as an inpatient followed by five sessions as an outpatient spread over a period of seven weeks. Each programme follows cognitive-behavioural principles, such as reinforcement of adaptative behaviours, extinction of pain behaviours or challenging of pain-related thoughts. They consist of a number of cognitive therapy sessions (run by a clinical psychologist), exercise sessions (run by a physiotherapist), relaxation sessions (run either by a nurse specialist or a psychologist), educational sessions on pain, its mechanisms and treatments (run by a medical specialist), on reduction of medication intake (run by a nurse specialist) and lastly sessions on ?pacing?, activity planning etc. (run either by an occupational therapist or a psychologist). This type of programme has proven very effective for the vast majority of patients. A brief review of the published studies is included. Lastly the issue of long term maintenance of treatment gains is evoked.