Postural tachycardia syndrome among adolescents.

Postural tachycardia syndrome (PoTS) is a polymorphic clinical syndrome that is underdiagnosed, especially in adolescents. It is a form of dysautonomia, but its exact physiopathology remains elusive. Several pathologies can mimic PoTS; it is characterized by heterogeneous symptoms that accompany a disproportionate tachycardia upon the upright position. It can significantly impact the patients' quality of life. Only a Schellong test is useful for making the diagnosis. Treatment in PoTS is primarily symptomatic with the main goal being to restore the patient's condition as quickly as possible. We report here the diagnosis and management of seven adolescents, aged 11-16, who have been followed up since 2015.

[Adolescent health: collaborative effort between school health services, medical practitioners and adolescents or specialized clinics]. / Santé des adolescents: te rôle essentiel de la collaboration entre santé scolaire et institutions de soins.

Adolescents have complex health needs, that require consistent answers between the health and education sectors. This article describes the existing structures and collaborations in Geneva, between medical practitioners, specialized clinics and school health. School health doesn't make any routine health screening, but strengthens its role for guidance of adolescents. Priority health activities for school health include protection of victims of abuse, integration of youth living with a chronic condition, and mediation for students with repeated absences. In any of these cases, collaboration between health services and school health services is essential. In the case of drug abuse, collaboration with teachers is necessary.

[Management of children with fever without localizing signs of an infection]. / Prise en charge des enfants fébriles sans signes localisateurs d'un foyer infectieux.

The management of infants and young children with fever without source (FWS) is a difficult challenge for pediatricians. Of 100 children with FWS, ten to 20 will have a serious bacterial infection (SBI) and 4 to 5% bacteriemia. Because no single aspect of the medical history, physical examination and laboratory parameters can reliably identify a child at increased risk for SBI, most management strategies now focus on identifying infants that are less likely to have SBI. The negative predictive value for 'low-risk criteria' SBI is close to 100%. Therefore, if it is possible to carry out a daily clinical examination, antibiotic treatment can be withheld from these children. For children who do not fulfill the low-risk criteria, antibiotics must be administered until the results of blood and urine samples and possibly CSF cultures have been obtained.

[Management of adolescents in pediatric hospitals. A national survey]. / La prise en charge des adolescents en pédiatrie hospitalière. Une enquête nationale.

UNLABELLED: Hospital care of adolescents is a challenge for pediatric teams because of the characteristics and specific problems of this age group. METHODS: In 1996, a questionnaire was sent to all French public pediatric wards, 300 (i.e., 78%) of which participated. The goal of this survey was to investigate the facts and limitations encountered with hospitalization of patients 12 years and older. RESULTS: Data show that for more than half of the pediatric wards, the adolescent patient admission rate is higher than 10%. The upper age for hospitalization shows a shift towards adulthood, with 73% of the wards admitting adolescents up to 18 years of age. The main reasons for pediatric admission in this age group are somatic complaints, chronic diseases and suicide attempts. Psychosocial problems and psychiatric disorders are perceived as the most difficult to manage. However, a majority of pediatric wards appears to have an environment suitable for multidisciplinary networking. At the time of the survey, 39 wards (16%) had beds specifically destined for adolescents. These wards differed from others by their higher number of suicidal and anorexic inpatients. CONCLUSIONS: Our study shows that pediatric wards are in the avant-garde of adolescent hospital care and it brings new data on the various problems encountered in these patients. It stresses the special needs of pediatric teams today in the field of adolescent medicine and calls for the development of specific educational programs.

[Septic sacroiliac arthritis in an adolescent]. / Arthrite septique sacro-iliaque chez une adolescente.

BACKGROUND: Septic sacroiliitis is often difficult to diagnose because the clinical findings can be misleading and the radiological signs delayed. CASE REPORT: A 16-year-old adolescent was hospitalized with a history of fever and painful hip. The initial hypothesis of hip osteoarthritis was not confirmed by ultrasonography or CT-scan. The bone scan was also normal. The definitive diagnosis of sacroiliitis was made 1 week later based on the clinical evolution and a positive blood culture. It was confirmed by a second bone scan and MR imaging. CONCLUSION: Examination of the sacroiliac joint needs several different tests. Although the initial bone scan may be normal, an osteoarticular infection cannot be definitively ruled out and iterative radiological investigation is warranted. MR imaging may be an additional diagnostic tool for detecting sacroiliitis.

Locked-in syndrome in an adolescent patient with pneumococcal meningitis.

A 15-year-old adolescent with pneumococcal meningitis and increased intracranial pressure presented clinical and neurophysiological evidence of the locked-in syndrome. MRI studies showed an area of infarction involving the ventral part of the medulla.

Rapid and sensitive detection of enteroviruses in specimens from patients with aseptic meningitis.

A 5-h PCR assay (Amplicor enterovirus test) was compared with viral culture for the detection of enteroviruses in cerebrospinal fluid. Of the cerebrospinal fluid specimens collected during a summer outbreak of aseptic meningitis, 34% were positive by viral culture whereas 66% were positive by the Amplicor PCR, suggesting that this technique improves the diagnosis of enteroviral meningitis.

Guillain-Barré syndrome following immunisation with Haemophilus influenzae type b conjugate vaccine.

The Guillain-Barré syndrome (GBS) is an immune-mediated disease often associated with viral or bacterial infections and with immunisation. IgM antibodies have been implicated as the main trigger event in GBS. So far, only four cases of GBS have been observed following immunisation with a conjugate vaccine against Haemophilus influenzae type b. We report another patient with GBS after this vaccination. We measured immunoglobulins against the H. influenzae type b polysaccharide (PRP) component of the vaccine. Surprisingly the anti-PRP IgM antibody level was markedly elevated (100 micrograms/ml) in the plasma of this patient. We speculate that an excessive anti-PRP IgM antibody response to the vaccine might be the cause of GBS.

Cough and converting enzyme inhibitors.

Persisting cough developed in three children treated with converting enzyme inhibitors. The symptoms disappeared within 3-7 days after withdrawing medication. These observations in children complement previous reports in adults and indicate that cough may be induced by treatment with these agents.