Les premix : répercussions systémiques et buccodentaires

Alcopops are highly-sweetened premixed spirit-based drinks. Ready to drink and sold in small bottles, it contains between 3 and 5 % alcohol by volume, sugars, citric and malic acid with a pH around 3. Their success is attributed to the fact that spirits are more palatable and better tasting with a fruity flavour, similar to non alcoholic beverages. Especially aimed at female teenagers in search for the alcohol effect while disliking its strong taste, it has been sold in Europe for 15 years. So called “designer drinks” are often consumed during the weekend, binge-drinked with some friends. The frequent consumption has severe consequences on general health, which includes body overweight due to the amount of sugar, and alcohol-related consequences of utmost importance considering consumer's young age. Moreover, alcopops may introduce to the consumption of alcohol and induce addiction. Consequences on oral health may include dental erosion. Erosion is a premature loss of mineralized tissues (enamel and dentin), due to the contact with acids. The low pH of these drinks and the increased risk of vomiting because of an excessive alcohol intake could potentially lead to substantial damage to the teeth. The treatment depends on the erosion stage. The medical professionals should be aware of the possible implications relating to alcopops’ consumption. Some preventive advices can be given to the teenagers and to their parents: reduce acids consumptions, do not brush the teeth immediately after an acid drink and regularly visit a dentist.     

Ostéomyélite chronique multifocale récurrente. À propos d'un cas de la mandibuleChronic recurrent multifocal osteomyelitis of the mandible. A case report

Chronic recurrent multifocal osteomyelitis (CRMO) is a disorder rarely localized to the lower jaw.Case report. – A fourteen-year-old boy complained of a swollen of his lower jaw. After a CT Scan, a bone biopsy was performed and yielded S. oralis against which an adapted intravenous antibiotherapy was administered without efficacy. The absence of malignant process and the revelation of an other focus of fixation at the Tc bone scan localized on humerus called to mind the diagnosis of CRMO.Conclusion. – The diagnosis of this disease is difficult and based on a number of concording arguments:clinical and radiological signs of osteomyelitis, multifocal presentation, recurrent relapses and remissions, inaction of antibiotics, elimination of the other differential diagnosis, in particular the infectious osteitis.     

Ostéomyélites aiguës de l’enfant drépanocytaire en zone tropicale : intérêt de l’utilisation des fluoroquinolones par voie oraleAcute osteomyelitis in children with sickle cell disease in a tropical country : benefit of the use of oral fluoroquinolones.

Aim. – This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country.Patients and methods. – This study was non comparative, including twelve children (eight SS, three SC and one SE°thalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons : financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient).Results. – The mean age of patients was 9,5 ± 2,6 years. The long bones were the predominantly site. Salmonella species were present in 75 % of cases, followed by other enterobacteriaceae (16,7 %), and Staphylococcus aureus (8,3 %). Successful outcome occurred in all cases after three to four weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient.Conclusion. – In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.     

Évaluation de la réponse antipyrétique à 30 minutes de l'ibuprofène suspension aux urgences pédiatriquesAntipyretique activity of ibuprofen syrup in children emergency unit

The ibuprofen, a synthesis inhibitor of prostaglandin, has antipyretic effectiveness considerably studied and proved in the child.Objective. – The purpose of this study is to rate the precocious, total antipyretic effectiveness and in high fever (T ≥ 39.5 °C), of the pediatric population attending a children emergency unit. It is about a prospective study of 1120 feverish children collected between 1st August and 31st December 2001, at the Casablanca children emergency unit. The criteria of inclusion consisted of, the age between 6 months and 12 years old, a temperature ≥ 38 °C and the absence of previous use of antipyretics. The rectal temperature has been taken by a mercury thermometer. The posology used was about 10 mg/kg once. The rectal temperature has been controlled 30 min after the administration of the ibuprofen.Results. – The mean age was 40.8 months and the average of initial temperatures was 38.76 °C. The average of temperature decreased from 38.76 to 38.15 °C in 30 min (P < 0.05). In the group of children (n = 203) who suffered from high fever (T ≥ 39.5 °C), the average of temperatures went down from 39.83 to 38.93 °C in 30 min (P < 0.05). We did not notice any difference of effect concerning age.Conclusions. – This study confirms the effectiveness and the precocity of the antipyretic effect of the pediatric suspension ibuprofen in a children emergency unit.     

Infections cutanées sévères à Streptococcus pyogenes chez l’enfant : résultats d’une enquête multicentriqueSevere cutaneous infections due to streptococcus pyogenes in children.

To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein.Patients and Method. – A retrospective (1990-2000) survey was carried out in pediatric hospital centers.Results. – Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30 % of the cases, varicella lesions were associated ; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases ; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey.Conclusions. – Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.     

Mécanismes moléculaires du syndrome néphrotique idiopathiqueMolecular basis of idiopathic nephrotic syndrome.

Steroid-sensitive idiopathic nephrotic syndrome is a T-cell disorder associated with a functional renal impairment. The molecular mechanisms leading from the stimulation of the immune system to the clinical expression of the renal disease can be analyzed according to five biological events: 1) a Th2 activation of T-cells by interleukin-13; 2) a yet unidentified glomerular permeability factor from immune origin; 3) a molecular disorientation of slit diaphragms or glomerular basement membrane responsible for proteinuria; 4) a podocyte cytoskeleton rearrangement responsible for foot process effacement; and 5) renal avidity for sodium and edema formation resulting from a primary stimulation of tubular Na,K-ATPase and an increase of endothelial permeability.     

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.     

Somatostatin for intractable postoperative chylothorax in a premature infant

A premature infant of 31 weeks gestation underwent repair of an oesophageal atresia, distal tracheo-oesophageal fistula and anal stenosis. A lymphatic leak was noted at the time of surgery. Chylous drainage persisted and an intravenous infusion of somatostatin was begun. The volume of chyle drained fell dramatically within the first 24 h and was negligible by the 5th day of treatment. No reaccumulation of the chylothorax was seen after the cessation of somatostatin. To our knowledge this is the youngest reported child in whom somatostatin has been used successfully in treating a postoperative chylothorax.     

Post‐operative chylothorax in children: An evidence‐based management algorithm

Aim: To develop an evidence‐based algorithm for the therapeutic approach to the management of post‐operative chylothorax. Methods: Review and analysis of published literature sourced from Medline from 1964–2007. Results: Understanding the pathophysiology of chylothorax and the anatomical structure of the thoracic duct assisted clinical decision making in the management of a patient with chylothorax. Treatment options for post‐operative chlothorax include conservative management with medium chain triglyceride‐enriched diet or total parenteral nutrition in combination with adequate drainage of pleural fluid, somatostatin or octreotide therapy or surgical intervention. Based on analysis of the available evidence an algorithm for therapeutic approach to the management of post‐operative chylothorax has been developed. Conclusion: Post‐operative chylothorax is associated with significant morbidity and prolonged hospitalization. An evidence based algorithm to guide the therapeutic approach to management of post‐operative chylolthorax is proposed.