[Sleeping position, prevention of sudden death syndrome and gastroesophageal reflux]. / Position de sommeil, prévention de la mort subite du nourrisson et reflux gastrooesophagien.

Based on results of epidemiological studies, dorsal or lateral sleeping positions are now recommanded in the prevention of sudden infant death syndrome (SIDS). This raises an ethical question about the attitude towards the ventral positioning therapy for gastroesophageal reflux (GOR). The consensus conference considers that the ventral position should only be recommanded in GOR when the benefit appears to outweigh the risk of SIDS that it induces. The conference proposes that for infants with simple uncomplicated reflux, sleeping in the prone position should not be introduced in the first line treatment. Prone positioning should be restricted to complicated cases resistant to dietary and medical measures.

[Endoscopic retrograde cholangiopancreatography in children and adolescents]. / Cholangio-pancréatographie rétrograde endoscopique chez l'enfant et l'adolescent.

Nineteen children and adolescents, mean age 9.6 +/- 1.2 years, underwent endoscopic retrograde cholangiopancreatography (ERCP). Indications for ERCP were cholestasis in 11 cases, suspected pancreatic disease or trauma in 8 cases. Equipment and technique used for papilla catheterisation were similar to those routinely used in adults. Bile duct or pancreatic opacification were successfully obtained in all cases. Transient acute pancreatitis following the procedure was observed in one patient, and resolved spontaneously. ERCP confirmed diagnosis suspected after ultrasound study and abdominal CT scan in 9 patients. In the remaining 10 cases, diagnosis was only made by ERCP. Twelve patients were operated based on ERCP results. We conclude that ERCP is rarely performed in children, but remains as useful as in adults in biliary and pancreatic examination.

[Multicenter study of sodium alginate in the treatment of regurgitation in infants]. / Etude clinique multicentrique de l'alginate de sodium dans le traitement des régurgitations du nourrisson.

An open multicenter study was performed to assess the efficacy and safety of alginic acid in two different dosages in 76 pediatric patients with gastroesophageal reflux confirmed by pH monitoring. Among the 69 patients in whom endoscopy was carried out before treatment, 18 had erythematous esophagitis and 5 had erosive esophagitis. Irrespective of the dosage used, the frequency of regurgitation and vomiting decreased significantly (p < 0.00001 and p = 0.01, respectively). Clinical and biochemical tolerance were outstanding and no adverse effects were recorded. On the basis of these data, the recommended dosage is 1 to 2 ml/kg/day in divided doses after meals.

[Esophageal pH monitoring in children. Methodological aspects and a review of the literature related to indications]. / La pH-métrie oesophagienne chez l'enfant. Aspects méthodologiques et étude de la littérature en fonction des indications.

Because it offers high sensitivity and specificity, esophageal pH monitoring has become the reference method for the diagnosis of gastroesophageal reflux. This review was undertaken to evaluate methodologic problems raised by this method, involving selection of the electrode, selection of equipment, and criteria of normality according to the patient's symptoms. In some instances, multiple recordings are needed to detect correlations between clinical symptoms and esophageal pH, cardiac and respiratory tracings and esophageal pH, or oxygen saturation and esophageal pH. These studies allow improved qualitative interpretation of results. Emphasis is put on the value of esophageal pH recordings for the evaluation of medical or surgical therapies.

[Pharmacologic efficacy of sodium alginate suspension on gastro-esophageal reflux in infants and children]. / Efficacité pharmacologique de l'alginate de sodium suspension sur le reflux gastro-oesophagien du nourrisson et de l'enfant.

Eighty-three children presenting with symptomatic gastro-esophageal reflux (GER) (48 males, 35 females, aged 15 days to 57 months (mean = 7 months) were assessed by pH monitoring. All showed acid pathological GER on the 3 hours post-prandial esophageal pH measurement (% of time at pH less than 4 greater than 4.2) and all had a second pH measurement within the following 3 hours after intake of a single (5 ml) dose of sodium alginate (AGS). AGS administration was followed by a highly significant reduction (p less than 0.00001) of all pH measurement variables: a) Percentage of time spent at pH less than 4 returned to normal with a mean 11.7% to 4.8%; that is a 52.5% improvement (median); b) Total number of reflux reduced on average from 8.9 to 5.0: that is a 35% improvement (median); c) Mean duration of reflux reduced on average for 4 to 2 min; that is a 60% improvement (median). In 76 patients hourly monitoring of % of time spent at pH less than 4 shows that hourly improvement persists.

[Immunological profile of Whipple's disease evolving over a period of 17 years]. / Profil immunologique d'une maladie de Whipple évoluant depuis 17 ans.

This report describes an immunological study made on a 58 years old patient with a Whipple disease diagnosed in 1969 and treated with different antibiotics. All attempts to stop the antibiotherapy resulted in reappearance of clinical symptoms. Further, this patient suffered anguillulosis infection in 1954 and this persists despite thiabendazole therapy, as shown by periodical creeping lunear dermatitis (larva currens). Laboratory investigations displayed low IgM levels and lack of cutaneous reactivity to conventional antigenic challenge. In vitro studies on granulocyte and monocyte phagocytic activity did not display any clearcut deficiency. Finally, this patient displayed peripheral lymphopenia and decrease of the T4+ (CD4) lymphocyte subpopulation. The proliferative response of lymphocytes to phytohemagglutinin stimulation (a cellular T-cell function) was drastically decreased in assays performed during the 16 month duration of patient's exploration. This proliferative defect seems to be due to increased PGE2 release (a 3-5 fold increase was demonstrated), resulting in inhibition of interleukin 2 (IL2) synthesis and activity. Further, patient's lymphocyte normally expressed IL2 receptor. When the B lymphocyte dependent humoral response was assayed, normal B lymphocyte differentiation into plasmocytes was found. However the pokeweed mitogen induced proliferative response of B lymphocyte displayed major decrease in four sequential tests. This might be due to a lack of B cell growth factor (BCGF) activity, since this interleukin involved in T lymphocyte, B lymphocyte cooperation was not found in supernatants of patient's cell. Further, interleukin 1 (involved in macrophage lymphocyte cooperation) was normally produced. In conclusion, no deficiency of in vitro phagocytose was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Left micro-colon syndrome and hypothyroidism]. / Syndrome du micro-côlon gauche et hypothyroïdie.

We report a case of neonatal intestinal obstruction with left microcolon and congenital hypothyroidism. Total relief of symptoms was obtained after 45 days of treatment by L-thyroxine and enemas. Congenital hypothyroidism, frequently associated with motor disorders of the gastrointestinal tract in neonates, has not been previously reported in association with small left colon syndrome.

[Behçet's disease in a 2-year-old girl]. / Maladie de Behçet chez une fillette de 2 ans.

The authors report a case of gangrenous stomatitis with lingual and anal ulcers and pericarditis in a 2-year-old girl. They propose the diagnosis of Behçet's syndrome for this patient despite the absence of uveitis.

[Thoracic actinobacteriosis due to Actinomyces naeslundii]. / Actinobactériose thoracique à Actinomyces Naeslundii.

The authors report the first case of thoracic actinomycosis due to Actinomyces Naeslundii. A precostal abscess with a large mediastinal and thoracic collection on CT scan was the presenting symptom. Evolution was favorable without sequelae after 6 weeks of Penicillin therapy (10.000.000 U/day).

[Duodenal complications of rheumatoid purpura. Endoscopic aspects]. / Complications duodénales du purpura rhumatoïde. Aspects endoscopiques.

The aim of this work was to describe the endoscopic features and clinical outcome of the duodenal complications in anaphylactoid purpura. Over a 3-year period, 20 patients were hospitalized in our unit because of purpura rheumatica. Duodenal complications occurred in 5 cases warranting endoscopic assessment. All patients had bilious vomiting and epigastric pain, constantly associated with low-grade purpuric rash. Plasma factor XIII concentrations were always decreased. The duodenal complication was suspected radiologically in 2 cases when "thumbprint" impressions were seen. Petechiae, oedema and intramural hematoma with superficial erosions were present endoscopically in 3 cases. The lesions were severe and extensive, involving the entire duodenum in 3 cases and the jejunum in one case. In one patient, there was a stricture of the upper part of the second duodenum. Treatment consisted of parenteral nutrition (using a central catheter: 3 cases, or a peripheral vein: 2 cases) and cimetidine (30 mg/kg.bw). The clinical outcome was favorable in 4 patients; the symptoms vanished and the endoscopic lesions were reversible (including the stricture) with restitutio ad integrum after 10 days. The last patient died the 8th day of treatment, 3 days after digestive improvement; the cause of death was probably iatrogenic and related to accidental migration of the central catheter. These results suggest that endoscopic examination should be performed in all patients with anaphylactoid purpura presenting with bilious vomiting. Endoscopy seems to be of great value in deciding if parenteral nutrition is indicated--or not--and perhaps in order to contraindicate the use of steroid therapy in the case of ulcerated hematomas.

[Bacterio-parasitic interactions. Enterobacteria and schistosomes (Salmonella - schistosome association)]. / Interactions bactério-parasitaires. Enterobactéries et schistosomidés (salmonello-schistosomo-synusies).

The description of a case imported from Chad of an association of Salmonella typhi - Schistosoma haematobium and, in this connection, a new revised general account. The association Salmonella-Schistomas is wide-spread. It corresponds to a salmonello - schistosomo - micro - association by the fixation of precise bacteria in the case of a bacteriemia on the cutaneous surface of male schistosomes in clearly defined places. These Salmonella constitute a permanent antigenic solicitation and they are capable of mobilization and rejection (bacteriuria after passage through the blood-stream) whereas bacteriosis remains asymptomatic. In fact, on the practical level, a clear and absolute distinction must be made between:--the bacteriemia with the concomitant bacteriuria, which are largely physiological in nature, very frequent and originating from various germs, connected with the emunctory function of the kidneys and which can be observed in any subject.--the schistosomal bacteriuria which are specific entities and evidence of a veritable micro-association of a symbiotic nature between the Salmonella and the schistosome, a micro-association which the bacteriuria reveals unexpectedly whereas the clinical symptoms are absent, not clearly discernible or totally misleading.