[Pathologic childhood aerophagia]. / L'enfant avaleur d'air: définition et prise en charge.

UNLABELLED: "Air swallowing" described as being part of functional gastrointestinal disorders in "Rome criteria" in 1999 is often misdiagnosed, particularly in non-mentally deficient children. AIMS: To recognize "air swallowing" child and to describe any progress according to the treatment. POPULATION AND METHODS: This retrospective study reports 13 cases of children without mental deficiency or neuromuscular disease. Clinical elements and precise histories are detailed and we have contacted consulting doctors or families for news. RESULTS: Ten boys and 3 girls, from 2,5 years to 10 years old, were referred for long lasting pain or abdominal distension. Numerous laboratory investigations were always normal. Diagnosis relied upon the observation of air swallowing and X-Rays views of gastric distension. Air swallowing was observed 7 times, 9 children had twitches and 3 language troubles. In 10 cases, X-rays showed gastric and colic distension. Three children have Chilaïditi syndrome. Favourable results followed in 12 cases after an average of 28 months of treatment. One case was lost for follow-up. Treatment was long, often disappointing and required the intervention of a psychiatrist, a paediatrician and (temporarily) a speech therapist. CONCLUSION: Pathological childhood aerophagia is often underdiagnosed and deserves to be better known by paediatricians, psychiatrists and surgeons. A late diagnosis leads to many negative results and causes anxiety. An early diagnosis should lead to a multidisciplinary care.

[Need for multidisciplinary care management in the treatment of type III laryngo-tracheo-esophageal cleft]. / La nécessité d'une prise en charge pluridisciplinaire dans le traitement des diastèmes laryngo-trachéo-cesophagiens de type III.

We report a case of type III laryngotracheoesophageal cletf. To our knowledge, this case represents the fourth case repaired. Survival was 22 months. The surgical repair we describe here is the first condition to survival. Close collaboration initially with anesthesiologists, then with the intensive careteam unit is required for post-operative management. Moreover, in addition to the surgical trauma, post-operative management is often long with tracheotomy and gastrostomy leading to a corporeal schema disorder in swallowing and respiration. Early psychologic assistance is indispensable to a good functioning of the aero-digestive region.

Early symptoms in autism from family home movies. Evaluation and comparison between 1st and 2nd year of life using I.B.S.E. scale.

The analysis of 11 home movies taken by parents before the recognition of autistic or atypical disorders of their own child has confirmed the major value of this method for describing early pathological signs. Symptomatology analysis has revealed anomalies of eye contact, a deficiency and variability of emotional expression, a defect of attention and initiation of communication, as well as motor abnormalities. The comparison of the frequency of abnormal behaviour, assessed with a rating scale among three groups of children (autistic, pervasive developmental disorders and normal) revealed behavioural differences as a function of early age and diagnosis, which concern not only social and communicative behaviours, but those of emotion and attention as well. The limits and interest of this methodological approach are discussed and the possibilities of subsequently using these documents in a more complete method, such as blind examination and scoring by uninformed investigators, are suggested.

Comparison of clinical diagnoses and Rimland E2 scores in severely disturbed children.

The Rimland E2 questionnaire was applied to three groups of children for whom clinical diagnoses of Infantile Autism, Autism with Associated Symptoms, and Mental Retardation had been made, as well as to normal controls. The results confirm that the Rimland scale is accurate in differentiating autistic from nonautistic children. But the scale does not appear to permit clear differentiation of infantile autism from autism with associated symptoms, and the more typical autistic children (diagnosed as Kanner's EIA) did not all yield high scores. Several possible explanations for this fact are put forward.

Dopamine-beta-hydroxylase (DBH) and homovanillic acid (HVA) in autistic children.

In the present study, plasma DBH activity and urinary HVA levels were measured in 19 autistic and 15 normal children. DBH activity was significantly elevated in the 8 less retarded autistic patients. In this subgroup, a negative correlation was found between plasma DBH and urinary HVA levels. These results support the hypothesis of a possible involvement of brain catecholamine dysfunction in the production of autistic symptoms.

Y chromosome length related to fetal loss.

The Y/20 ratio (length of Y chromosome/length of chromosome 20) was examined among 216 males, 108 of whose wives had a history of repeated abortions (study group), and 108 who were mentally retarded (controls). There was no significant difference in frequency of long Y (Y/20 equal to or greater than 1) between the study group and controls. Also, there was the expected male: female ratio among normal living children of couples in the study group, and the Y/20 ratio was not significantly increased among fathers with abnormal male offspring. However, wives of long Y males were more likely to have at least one abnormal male birth, compared with other wives (this approached statistical significance, p less than 0.08). In addition, a significantly higher frequency of long Y was found in a subset of affected males whose wives had 2 or more spontaneous abortions plus some other abnormal pregnancy outcome. Although the findings reported here do not strongly support a causal relationship, they at least suggest an association between long Y chromosome and abnormal fetal development.