Los hábitos alimentarios de jóvenes deportistas necesitan ser mejorados / Foods habits of sport young men need to be improved

Objetivo: El propósito de este trabajo ha sido determinar en qué medida un equipo de ciclistas jóvenes sigue las pautas recomendadas sobre hábitos nutricionales y estilo de vida. Método: Evaluación nutricional basada en la información reportada en un cuestionario de frecuencia de consumo de alimentos y un cuestionario sobre hábitos alimentarios por un colectivo de 45 ciclistas varones jóvenes. Resultados: La mayoría de los ciclistas estudiados realizaba las 5 ingestas diarias recomendadas. El mayor tiempo se dedica generalmente al almuerzo (unos 34 min.) y a la cena (unos 33 min.), la ingesta de mayor aporte calórico (un 30% del total), seguida por el almuerzo (un 28% del total). El almuerzo representa 38% de proteínas, 32% de hidratos de carbono (HdeC), 33% de grasas, 32% de colesterol, 24% de sodio y 45% de la fibra diaria. La cena representa el 33% de proteínas, 28% de HdeC, 39% de grasas, 38% de colesterol, 45% de sodio y 26% de la fibra diaria. Todos ciclistas hacen ejercicio físico porque les gusta (100% de los jóvenes) y en menor medida por que lo crean fundamental para su salud (31% de los jóvenes) o para perder peso (15% de los jóvenes). Creen que deben de tomar más cereales, legumbres, verduras, frutas y agua que la población en general. Conclusiones: La cena es la comida más desequilibrada del día con un aporte excesivo de grasas, colesterol y sodio y un déficit relativo de fibra. Este trabajo ha contribuido a un mejor conocimiento de los hábitos que siguen jóvenes que son muy activos físicamente. Los ciclistas desconocen en gran medida la importancia de mejorar su alimentación e incrementar la ingesta de ciertos grupos de alimentos como pescado, frutas, cereales integrales, lácteos y frutos secos. Para mejorar esta situación se recomienda realizar campañas de educación nutricional, sobre todo a los jóvenes, sus entrenadores y a sus familiares(AU)

Objective: To analyse the nutritional knowledge and the life style reported by a young cyclists team, and to assess the degree of adherence to the recommended patterns to life. Method: Food consumption was assessed by means of a Food Frequency Questionnaire and a questionnaire about food habins on a group of 45 young cyclists. Results: Most of the young cyclists usually had the recommended 5 meals every day. The time spent in consuming the lunch is greater than time for dinner (34 min. and 33 min. respectively). Dinner provide more calories than lunch (30% and 28% of the daily intake respectively). Lunch provided for 38% of proteins, 32% of carbohydrates, 33% of lipids, 32% of cholesterol, 24% of sodium, and 45% of daily fibre. Dinner instead, provides for 33% of proteins, 28% of Carbohydrates, 39% of lipids, 38% of cholesterol, 45% of sodium, and 28% of daily fibre. The young people in the study perform physical activity by pleasure, and in a leaser degree because of fitness (31% of cyclists), or to control their weight (15% of cyclists). Cyclists estimate that they should increase the intake of cereals, legumes, vegetables, fruits and water. Conclusion: Dinner is the most unbalanced meal of the cyclists; because of its excessive intake of fats, sodium and cholesterol; and deficit in dietetic fibre. This work contributes to the knowledge of the nutritional habits of young cyclists. In general those people do not know the importance of improving their nutrition by increasing the intake of certain type of foods, such as fish, fruits, whole cereals, milk and nuts. There is an urgent need to promote educational campaigns among the youth, their parents, teachers, and coaches to reverse this situation, in order to recover healthier lifestyle(AU)

Estudio de los hábitos alimentarios de jóvenes deportistas / Study of dietary habits of young sportsmen

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Spinal anaesthesia in a child with hypoplastic left heart syndrome.

Hypoplastic left heart syndrome (HLHS), a complex congenital heart disease, is the most common lethal cardiac defect in neonates. Its treatment includes cardiac transplantation and/or surgical palliation. Associated extracardiac congenital abnormalities are exceptional. We report the case of a neonate with HLHS and anorectal atresia who required urgent surgical management to relieve intestinal obstruction. The surgery was successfully performed under spinal anaesthesia.

Use of albumin, blood transfusion and intraoperative glucose by APA and ADARPEF members: a postal survey.

BACKGROUND AND METHODS: A postal survey was mailed to the members of Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) (n=187) and French-Language Society of Paediatric Anaesthesiologists (ADARPEF) (n=220) to primarily investigate the impact of a recently published Cochrane report on the clinical use of albumin solutions in paediatric anaesthetic practice. At the same time, information regarding blood transfusion strategies and the use of intraoperative glucose containing maintenance solutions was gathered. RESULTS: The response rate of the survey was 38% and 25% for APA and ADARPEF members, respectively. Forty-one percent of APA members reported a reduced use of albumin containing solutions following the publication of the Cochrane report compared to eight percent in the ADARPEF group (P < 0.0001). Albumin continues to be the most frequently used plasma expander in premature babies and neonates, whereas many colleagues use alternative colloids in infants and older children. A clear difference was observed in the 1-12-year-old age group between APA members favouring the use of gelatines and ADARPEF members who instead frequently use hetastarch solutions. ADARPEF members appeared to have a slightly more restrictive attitude towards blood transfusion and also reported more widespread use of erythropoetin (56% versus 9%, P < 0.0001) and predilution techniques (40% versus 23%, P < 0.04) compared with APA members. Regarding intraoperative maintenance solutions, a large proportion of both APA and ADARPEF members still use high concentrations of glucose intraoperatively, even in older children.

[Children also die]. / Les enfants meurent aussi.

Palliative care has recently been developed in adults. However, children die as well and quite a few articles have been published on this special issue. The object of this article is to summarize the available literature in order to call for the development of clinical policies and minimum standards adapted to French pediatrics.

[Palliative care in pediatric oncology]. / Soins palliatifs dans une unité d'oncohématologie pédiatrique.

Improving the management of dying children has always been a common desire among staff who take care of children with incurable life-threatening diseases. Pediatric oncologists are beginning to structure their practice based upon the approach to palliative care given to adults. In the first part of this report, the authors focus on technical care: comfort control and symptoms. The second part is devoted to pain management, a major aspect of pediatric palliative care. In the third part, psychosocial issues are developed, taking into account the point of view of children, siblings, parents and staff.

[Testicular biopsy at the stopping of the treatment in acute lymphoblastic leukemia: value of the immunohistochemical detection of residual blasts]. / Biopsie testiculaire à l'arrêt du traitement des leucémies aiguës lymphoblastiques: intérêt de la détection immunohistochimique des blastes résiduels.

BACKGROUND: The prognostic value of clinical and histological detection of testicular leukemia after completion of therapy is still debated. Immunohistochemical study could improve the results of this detection. PATIENTS AND METHODS: Between 1982 and 1992, 70 consecutive boys with acute lymphoblastic leukemia (ALL) and treated with the same therapeutic regimen were included in the study. Testicular biopsy (TB) was surgical and bilateral. One piece of tissue was fixed and analysed by conventional microscopy. An immunohistochemical study was performed on the other sample with a panel of anti-T and anti-B Mc Ab, including JCB 117 (anti-CD79a) which stains early pre B lymphoblasts. RESULTS: Twenty-five children relapsed while on treatment and did not undergo TB. Among the 45 boys who underwent routine TB, one had a diffuse infiltration seen in conventional histology. Thirty-nine had normal morphological and immunohistochemical study: among them, six relapsed subsequently in bone marrow; in this group, event free survival (EFS) was 85 +/- 10% with a median follow-up of 80 months after the biopsy. In the five remaining boys, anti-CD79a was found positive on blasts in four cases and anti-CD3 in one case; four of those relapsed, including two in the testes during the year following the biopsy; EFS was 20 +/- 36% (P = 0.001). CONCLUSIONS: New Mc Ab such as JCB 117 (anti-CD79a) might detect a minimal residual disease in the testes of children treated for ALL, particularly on routine histological material. These results, if confirmed in larger series, might influence further therapeutic strategy.

Morbidity using subcutaneous ports and efficacy of vancomycin flushing in cancer.

An evaluation of totally implanted venous access systems inserted in 163 consecutive children with cancer is reported. From 1988 to 1994, 180 subcutaneous ports were inserted in children more than 1 year old. Initial diagnosis was acute leukaemia (n = 79), non-Hodgkin's lymphoma (n = 33), and solid tumour (n = 51). Median age was 85 months. All venous procedures were performed through the device. Chemotherapy was either moderate (n = 13) or intensive (n = 119) or very intensive (n = 48), including 16 patients undergoing marrow transplantation. Cumulative venous access totalled 55,770 patient days with a mean of 305 days/subcutaneous port. The cause of device removal was, end of treatment (n = 111), death due to malignancy (n = 20), catheter related infection (n = 7), and occlusion of the system (n = 4). Mechanical complications occurred in 19 ports; 16 were due to clots, of which 14 were cleared with instillation of urokinase. Documented infectious episodes occurred in 47 ports, recurred once in 14, and twice in five cases. Among these infections, 47 were septicaemic; 31 due to Staphylococcus epidermidis. Twenty seven of initial septic episodes were considered to be catheter related; the rate was 15%/subcutaneous port or 0.05/100 catheter days. Risk factors for the development of a first infection were age below 4 years and the time of use. Since February 1993, vancomycin (50 micrograms/ml) has been given and this has reduced the rate of S epidermidis infection from 26/83 subcutaneous port to 4/97. Life table analysis showed that the infection free interval for staphylococcus was significantly better after this technique ws initiated (log rank rest=0.02). Time saved was approximately 30minutes/patient/week compared with external catheters, or 45 hours/month for the cohort of children treated. Subcutaneous ports in paediatric cancer patients are reliable, safe, and durable and may offer an attractive alternative to external catheters for prolonged venous access and intensive treatment.

Laparoscopic appendicectomy: case reports of vascular injury in 2 children.

The authors report 2 similar cases of serious vascular injury occurring during laparoscopic appendicectomy. These cases stress the potential risk of major accidents with laparoscopic surgery. There should be great care in the choice of indications and during the procedures.

[Evolution and treatment of 8 patients with Fournier's perineal-scrotal gangrene]. / Evolution et traitement de huit malades atteints d'une gangrène périnéo-scrotale de Fournier.

The authors present eight cases of Fournier's gangrene treated from 1987 to 1989 (3 years). There was no discernable cause for 5 patients (62.5%). Immediate aggressive surgical debridement of all necrotic tissue was performed. Intravenous antibiotics and resuscitation fluid and hyperbaric oxygenation were also administered to all patients. Skin grafting was performed for 4 patients (40%), 3 weeks after surgical debridement. One patient died (12.5%) and 2 subsequently developed an urethral stricture. Etiology, treatment and outcome of Fournier's gangrene are discussed and the results of the study are compared to other studies. This disease is still serious, its pathogenesis is not completely elucidated, but when immediate adequate treatment is performed, the outcome is generally favourable.

[Use of propofol in 1350 anesthetized patients for electroconvulsive therapy]. / Utilisation du propofol lors de 1,350 anesthésies pour sismothérapie.

Propofol was used for 1,350 sessions of electro-convulsive therapy (ECT). After 0.5 mg of intravenous atropine, patients received 1 to 1.5 mg.kg-1 bolus of propofol over a period of 20 seconds or less. This was convenient for loss of the eye-lash reflex. A bolus of 15 to 20 mg suxamethonium was given, in non allergic patients, to prevent trauma from the seizure. The patient was hyperventilated with pure oxygen through a facial mask. The electric shock was delivered bitemporally after a dental protection had been inserted. For each patient, the following data were noted: sex, use of tricyclic antidepressant drugs, atopy, amount of administered propofol and the effective intensity of the electric shock. The 99 patients were given 16.27 +/- 14 ECT sessions. Among them 26 took antidepressant drugs and 34 were atopic. There was no difference, except for weight, between the 25 men and 74 women. The mean dose of propofol was 1.37 +/- 0.3 mg.kg-1. The dose decreased with increasing age. There was no statistical relationship between the amount of propofol and intensity of the electric shock required to set off a seizure. The use of antidepressant drugs, and atopy did not influence the required amount of propofol. Speed of injection seemed to be the determining factor for narcosis with low doses of propofol. Hyperoxia and hypocapnia induced by hyperventilating with pure oxygen seemed to facilitate occurrence and duration of seizures. Although propofol has been said to reduce the length of seizures, there is controversy concerning the ECT efficacy criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

[Propofol and etomidate: a comparative study in emergency anesthesia in ASA I and II patients]. / Propofol et étomidate: étude comparative en anesthésie d'urgence chez des patients ASA I et II.

The use of propofol and etomidate in emergency anaesthesia is studied in 39 patients ASA I and 11 patients ASA II. After premedication, the narcosis is induced and maintained either by iterative injections or by continued infusion. Concerning haemodynamic changes, the diastolic blood pressure decreases in propofol group without any deleterious effect for these patients. Recovering time is the same in the two groups. The time for recovering memorization is significantly shorter in the propofol group. The use of these two drugs is fully justified in an emergency situation with preference for propofol in case of preoperative haemodynamic stability.