[Pneumomediastinum in a young girl with anorexia nervosa]. / Pneumomédiastin chez une jeune fille anorexique.

BACKGROUND: Pneumomediastinum is a rare complication of anorexia nervosa. It may occur in patients with severe weight loss and a history of induced vomiting. CASE REPORT: A 14 year-old girl was admitted suffering from severe anorexia nervosa. Shortly after admission, she complained of anterior thoracic pain. Examination showed subcutaneous emphysema of the supraclavicular fossae and the base of the neck. Thoracic X-ray showed pneumomediastinum without pneumothorax. At the time, the patient admitted to a history of surreptitious chronic induced vomiting. Gastrografin esophagography ruled out an oesophageal tear. The pneumomediastinum gradually disappeared over a period of several days with simple clinical and radiological monitoring. CONCLUSIONS: This case, along with seven others reported in the literature, confirms that pneumomediastinum in anorexia nervosa is usually not accompanied by pneumothorax. An oesophageal perforation must always be ruled out. Spontaneous pneumomediastinum invariably has a favorable outcome.

Acquired sideroblastic anaemia during treatment of Wilson's disease with triethylene tetramine dihydrochloride.

We report one case of acquired sideroblastic anaemia in a patient treated for Wilson's disease with triethylene tetramine dihydrochloride (TTH). No other cause of acquired sideroblastic anaemia was found, and neither iron nor pyridoxine therapy could correct this anaemia. In contrast, decreasing the dose of TTH led to disappearance of ringed sideroblasts. Thus TTH should be added as a further cause of secondary acquired sideroblastic anaemia. The pathophysiology of this finding, probably linked to an abnormality of mitochondrial iron metabolism, is briefly discussed.

Thrombosis in systemic lupus erythematosus: a French collaborative study.

A retrospective study was undertaken of 120 children with systemic lupus erythematosus (SLE) seen in Paris and its immediate suburbs who fulfilled at least four of the American College of Rheumatology diagnostic criteria for SLE, and in whom the disease was diagnosed before the age of 16 and between January 1975 and December 1987. Eleven of these children (eight girls and three boys) all more than 10 years of age (mean follow up 8.1 years; range 3-13) had thrombotic episodes (9%). Thrombosis was one of the presenting signs in seven patients; in five it was associated with typical symptoms of SLE, and in the other two the thrombotic episode was isolated and diagnosis of SLE was delayed one and three years. Of a total of 16 thrombotic episodes (six of which were recurrent), 14 involved the leg veins, and in four there was associated pulmonary embolism. There were two episodes that affected cerebral arteries. The American College of Rheumatology diagnostic criteria for SLE as well as the incidence of lupus anticoagulant, positive direct Coombs test, and vasculitis in this group of patients was compared with the incidence in patients with SLE but no thrombosis. Only lupus anticoagulant was significantly associated with thrombotic episodes: eight of 11 (73%) of patients with SLE and thrombotic (arterial or venous) episodes had lupus anticoagulant compared with only 10 of 74 patients (14%) with no history of thrombotic events in the same age group.

[Visceral candidiasis in 2 children treated for acute leukemia]. / Candidose viscérale chez deux enfants traités pour leucémie aiguë.

The authors report two cases of splenic and hepatosplenic candidiasis occurring during a protracted neutropenia induced by chemotherapy for acute leukemia (lymphoblastic and myeloblastic respectively). Fungal infection was revealed by persistent or recurrent fever after correction of neutropenia. Diagnosis was suggested by findings at abdominal ultrasonography. It was confirmed by histological analysis which, in the first case, required open liver biopsy. In both cases, lack of improvement of splenic lesions despite treatment with Amphotericin B followed by fluconazole led to splenectomy. Both patients received postoperative anti fungal therapy with Ampho B and at one year's follow up, the patient who had the hepatosplenic candidiasis seems to have recovered.

[Pregnancy and motherhood after liver transplantation in terminal autoimmune active hepatitis with primary amenorrhea]. / Grossesse et maternité après transplantation hépatique pour hépatite active auto-immune terminale avec aménorrhée primaire.

We report the case of a young patient with end-stage auto-immune chronic active hepatitis and primary amenorrhea who became pregnant 18 months after orthotopic liver transplantation. She continued an uncomplicated pregnancy on treatment with ciclosporin A and spontaneously gave birth to a full term and healthy child.

[Abuse in adolescence. Incest. Apropos of 21 cases]. / Sévices à l'adolescence. L'inceste. A propos de 21 observations.

While violent behavior and delinquency in youth have been extensively described, the different patterns of violence that adolescents are subjected to in their families are far less known. Physical abuse is probably as frequent as in childhood and offers some distinctive features because of its appearance or prolongation in adolescence. Moreover, sexual assaults become more important, especially in girls. From review of the literature and the experience of 21 cases of incest observed in the Adolescent Medicine Unit of Hospital Bicêtre, we discuss the circumstances, impact on adolescents and role of the professionals involved. The majority of these cases of incest occur in an impoverished atmosphere, both on psychological and social levels. Intervention strategy is often very delicate.

[Child health in the school environment]. / La santé de l'enfant en milieu scolaire.

The authors studied the consequences of the present school system on children's health. They emphasize the causes of failures, mostly related to a misappreciation of children's individual differences and inequalities of the rate of physical and psychoaffective development. Overloaded school days, the lack of respect of sleep and extra-curricular needs, the overlooking of attention capacities were also studied.

[Acquired immunodeficiency syndrome in an adolescent hemophiliac]. / Syndrome immunodéficitaire acquis chez un adolescent hémophile.

In an adolescent with hemophilia B, the diagnosis of AIDS was established in face of cachexia, orodigestive candidiasis, associated with lymphopenia, major decrease in T4/T8 ratio with marked decrease in T helper cells and presence of LAV-antibodies. The patient died rapidly from a cerebral infection due to Toxoplasma gondii. Difficulties in diagnosis and treatment of cerebral toxoplasmosis are discussed.

[Risk-taking behavior and accidents in adolescence in developed countries]. / Comportement de prise de risque et accidents à l'adolescence dans les pays développés.

Injuries due to accidents are the primary cause of fatalities among adolescents. Between the ages of 10 and 19, mortality caused by accidents augments significantly, and there is an excess of male mortality, increasing with age. This mortality has remained virtually unchanged over the past 25 years, except for a small narrowing of rate differences by sex. Traffic accidents, particularly those involving motorcycles, are the leading cause of accident fatalities. Though not easily assessed, morbidity due to accidents is probably very high, especially among males. Sports accidents are the most frequent. Adolescents appear to be particularly exposed to some risks, but also tend to be careless about safety. Risk-taking is a source of rewards: pleasure, self-affirmation, sense of independence; but it is described by some authors as self-destructiveness, death from accidents reflecting suicidal tendencies. Paradoxical results of prevention have been observed in this age group.

[Suicide attempts in adolescent girls. Epidemiological aspects]. / Les tentatives de suicides de l'adolescente. Aspects épidémiologiques.

The authors report the results of a study undertaken in 27 adolescent girls hospitalized for suicide attempts, interviewed according to the same procedure as 46 adolescent girls hospitalized during the same time period for other reasons. A statistical study of the questionnaire used showed answers significantly different, especially concerning grandparents, intra-familial relationships, parental picture, behaviours of adolescents outside their family, school attendance. The whole of these results suggests a disturbance in the communication systems of the suicidal adolescent.

[Medicine without boundaries, or the adolescent in the hospital]. / Médecine sans frontières, ou l'adolescent à l'hôpital.

Some of the most common problems set by the hospitalization of adolescents are summarized and the general conditions and specific problems attendant to this activity are analyzed. Answering the health requirements of adolescents implies that a pluridisciplinary staff be permanently prepared to take action. Strict requirements concerning the distribution of tasks between staff members are necessary. However, close communication between the different departments (practitioners, psychiatrists, social workers, outclinics) must be given attention in order to evolve truly therapeutic actions.

[Adolescent medicine: who cares for what?]. / Une médecine d'adolescents: qui soigne quoi?

The expression of adolescence can be defined as a psychic maturation crisis. The purpose of this study was to better understand the specific institutional and health care needs this particular age group requires. The authors have analysed the nature of adolescent care within a pediatric ward, using data obtained from interview material. There was a growing awareness among the staff that feelings of rejection and alienation often jeopardize the delivery of optimal care to adolescents. This idea helped define the final formation of a unit designed for adolescents. The particular characteristics of such a practice are illustrated in the paper. In doing so, an effort was made to remain objective and to respect the ideas originated by the staff.