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Summary: The occurrence of eight cases of adrenal deficit in children hospitalized for acute lymphoblastic leukemia (ALL) led us to conduct a prospective study from May 2006 to May 2007 to better characterize this corticoid-induced adrenal deficit. Forty of the 48 patients hospitalized for ALL were given a low-dose Synacthen test (1μg), a mean 7 days after the induction phase. An adrenal deficit was diagnosed in 27 patients (67.5%). No significant clinical or hematological difference was identified between the “with deficit” (n =27) and “without deficit” (n =13) groups. The diagnosis of adrenal deficit was not more common for children who had received dexamethasone (13/19) or prednisone (14/21), or for those who had (19/29) or had not (8/11) experienced corticoid toxicity during induction. The clinical signs suggesting adrenal deficit were identical in the two groups and none of the children presented an acute episode. In biological terms, only hypoprotidemia was significantly more common in patients with adrenal deficit (p =0.0004). Of 13 patients with a deficit at the end of the induction who had received a 2nd low-dose Synacthène® test before intensification no. 1, 3 weeks on average after the end of corticotherapy, only two still had a deficit. Thus, corticoid-induced adrenal deficit is a common complication in children treated for ALL, although it is not highly symptomatic. Most of these children recover normal adrenal function before intensification no. 1, but it does not eliminate the risk of a secondary deficit after other courses of corticotherapy. Systematic repeated Synacthène® tests in common practice among children treated for ALL does not seem justified. However, the results of this study encouraged us to propose a hydrocortisone substitution to children treated for ALL in the event of stress. [Copyright &y& Elsevier]

Summary: Sickle cell anemia is the most common hemoglobinopathy worldwide; its musculoskeletal complications consist more often of medullary infarctions involving long bones. Orbital infarction is uncommon. We report on a case of orbital subperiosteal hematoma in a 9-year-old male with a medical history of sickle cell thalassemia. [ABSTRACT FROM AUTHOR]

Summary: Background: Health professionals who monitor the growth of children are also involved in the early detection of overweight. Appropriate tools are required for this purpose. Objective: The study sought to identify predictive markers of the development of subsequent overweight using a simple set of criteria. Methods: A consecutive cohort was composed of 1424 grade 4 children in Aquitaine, France, aged 8–9 years. Body mass index (BMI) was calculated during school health assessments at 8–9 years of age. Data from previous assessments at 3–4 and 5–6 years of age were also collected. Results: Of the 189/1424 children (13.9 %) who were overweight according to the French national cut off for children aged 8–9 years, 67 (33.8 %) were already overweight at 3–4 years and 107 (54.1 %) at 5–6 years. Of the 134 (9.4 %) who were overweight at 5–6 years, 43.3 % were already overweight at 3–4 years and 79.9 % were overweight at 8–9 years. On the other hand, 76 of these 134 children (56.7 %) were not overweight at 3–4 years, so they had become overweight between the two assessments. The combination of the criterion “overweight at 3–4 years or 5–6 years” and “increase in BMI>1kg/m2 between 3–4 years and 5–6 years” appears to be the best predictor of the risk of overweight at 8–9 years, with good sensitivity (75.3 %) and specificity (87.9 %). Conclusion: A predictive tool based on BMI changes between ages 3–4 years and 5–6 years could be used for the early detection of the risk of developing overweight and obesity. The tool is easy to use, especially for health care in schools. Furthermore, the present findings confirm the value of following up and managing children who are already overweight between the ages of 3 and 6 years. [Copyright &y& Elsevier]

Summary: An echogenic tumor (22×22mm) isolated from the anterior part of the left leg at 27 WA of pregnancy suggested an angiomatous structure. This mass appeared to be well vascularized on Doppler examination. Three-dimensional imaging showed connections with adjacent tissues. The limbs were mobile. Delivery of a 3990-g-boy occurred normally. On the anterior part of the left leg, there was a plate-shaped mass with a pink hole at the superior part. Excision under general anesthesia was performed at the first month because of the risk of rupture and bleeding. The dissection was easy with the deep plane. Healing was complete 10 days after the surgical procedure and the aesthetic aspect was good 1 year later. Histological findings of the suspect mass emphasize the vascular aspect of the tumor. A hemangioma capillary with venous structures in the dermal hypodermic area was found. [Copyright &y& Elsevier]

Summary: Granulocytic sarcoma (GS) is a rare extramedullary tumor frequently associated with acute myeloblastic leukemia (AML). We report 3 cases of pediatric granulocytic sarcomas with various locations: skin, orbit, and bowel. Cases 1 and 2 were associated with AML; case 3 was isolated. In all 3 cases, the diagnosis was delayed or initially missed. Pathology and immunohistochemistry data identified the disease. GS is treated with chemotherapy, like AML. The prognosis of GS seems better than that of isolated AML. [Copyright &y& Elsevier]

Abstract: Dengue (Df) and Chikungunya fever (Cf) arbovirosis are booming in the world, because of the plasticity of their pathogens, mutant RNA viruses making the acquisition of sustainable herd immunity and vaccination difficult in humans, and the plasticity of their vectors, the female mosquitoes of the genus Aedes (Stegomya), capable of adapting to different environments. This review summarizes the viral life cycle and epidemiology of these arboviruses, pathogenesis and pediatric aspects of their clinical forms and the basic principles of their treatment and prevention. [Copyright &y& Elsevier]

Abstract: Tracheomalacia (TM) or bronchomalacia (BM) refers to softness or weakness of the trachea or the bronchi. Its management is not evidenced-based. Conservative therapy is preferred in milder cases, since the outcome is usually favourable within the first 2 years of life. The clinical utility of non-specific treatments (anti-inflammatory agents, bronchodilators, antibiotics, physiotherapy) has not been proven by clinical trials. Treatment of symptomatic cases should be discussed on an individual basis. Airway surgery should be avoided, and non-invasive ventilation may be proposed as a temporary measure. In case of very severe cases, aortopexy, trachostomy or stent placement are the preferred treatments. Regular respiratory monitoring until remission is mandatory. [Copyright &y& Elsevier]

Summary: Introduction: Hemangioma is the most common tumor of infancy. Ulceration and functional prognosis justify systemic treatment. Case report: We report the case of an 8-month-old girl with a voluminous ulcerated hemangioma of the left forearm with a large, painful, central ulceration. Conventional treatment with topical and/or systemic antibiotics was unsuccessful. Flashlamp-pumped pulsed-dye laser (FPDL) could not be used because of the thickness of the lesions. We decided to use beta-blocker therapy (propanolol) for 4 months with a noteworthy efficacy. Discussion: Systemic corticosteroids and FPDL are currently the reference treatment of the superficial hemangioma during infancy, but the head and neck location or complications such as ulceration or the need for surgical embolization require the use of alternative treatments such as the beta-blocker. We discuss this option. [Copyright &y& Elsevier]

Abstract: The prescription drug for hypertension in children remains difficult because of the lack of pharmacological data validated in this age of life. The food and drug administration (FDA) have recently proposed some antihypertensive regimens orally. The authors found useful to reproduce a table by adding all the necessary data for its use in France. Here is a list of French medicines and doses applied to children. Similarly, they made a second table for injectable antihypertensive treatment based on American recommendations – but not yet validated by FDA. [Copyright &y& Elsevier]

Abstract: Many reviews exist about the use of psychotropic in children with depression (American academy of child and adolescent psychiatry en 2007 [Aacap] 2007, Food and drug administration [FDA] 2004, Afssaps 2008). Antidepressants are the most important long-term treatment: only fluoxetine has been effective and is authorised in France since August 2006. The risk of suicidality and sexual maturation alteration need to be control. Psychotherapy is needed to involve efficacy and tolerability treatment. Other IRS and IRSNA are used, but another study must be conducted in currently practice condition. [Copyright &y& Elsevier]

Abstract: Used for more than 10 years in addition to physiotherapy, orthopaedic surgery and rehabilitation, biphosphonate therapy has transformed the management of children with severe or moderate form of osteogenesis imperfecta. The authors of this article report indications, administration''s way, duration and safety of biphosphonate therapy with uncertainties about persistence in skeleton for many years. [Copyright &y& Elsevier]

Summary: Purpose: The aim of this retrospective study was to describe the prevalence of metabolic abnormalities among obese children. Patients and methods: Two hundred and forty-four obese children were referred in our center between 2003 and 2007. The frequency of metabolic syndrome (MS) was assessed with the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. Insulin resistance was defined as a Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) greater than the 75th percentile. Results: Around 95.9% of the children had abdominal obesity, 38.1% had systolic hypertension, 19.3% diastolic hypertension, 12.3% hypertriglyceridemia, and 4.1% hypoHDLemia. Insulin resistance was present in 69.6% of children; 11.5% of children met the criteria for MS. Both the Z-score of the body mass index and the prevalence of metabolic abnormalities were higher in the group of the youngest children. Conclusion: The prevalence of metabolic abnormalities is high among overweight children, particularly in the youngest children. However, the management of obesity but not metabolic-specific intervention remains the priority. [Copyright &y& Elsevier]

Summary: Duodenal duplication is a rare congenital disorder of the gastrointestinal tract. The presentation is highly variable. We report a case of duodenal duplication presenting with hemorrhagic ascites in a 3-month-old girl. The diagnosis of duodenal duplication can be made preoperatively by resonance magnetic imaging. Surgical resection of the duplication was performed. Microscopic examination of the specimen confirmed the duodenal duplication. To our knowledge, this is the 1st reported case of hemorrhagic ascites caused by duodenal duplication and demonstrated by resonance magnetic imaging. [Copyright &y& Elsevier]

Abstract: Transverse maxillomandibular discrepancies are a major component of several malocclusions. They must be prematurely detected and treated. The causes are parafunctional, dysfunctional or kinetic. The different clinical forms encountered are alveolar (endoalveolia) or skeletal (endognathia), which may be associated with a kinetic anomaly. Orthopedic and orthodontic forces are used routinely to correct a maxillary transverse deficiency in a young patient to achieve harmonious growth. [Copyright &y& Elsevier]

Abstract: The functional mandibular prognathism belong to the class III malocclusion according to the terminology of Angle. Its origins are multiple, from the abnormality of eruption of deciduous or definitive incisors to lingual dysfunction (low position of the tongue). In spite of its weak prevalence, it must be prematurely detected and treated (mixed or temporary teeth) to prevent a functional anomaly to become a skeletal anomaly. It is important at this stage to proceed to the unique gesture which allows making the differential diagnosis: it is the De Névrezé procedure; it allows obtaining a more retrusive position of the mandible to minimize the dental relations. In case of true mandibular prognathism, the maneuver does not succeed; there is no modification of the dental reports. An interceptive therapeutic phase allows finding quickly a previous correct guide and to rehabilitate the growth of jaws. [Copyright &y& Elsevier]

Summary: Ingestion of foreign bodies is a common pediatric problem. The majority of ingested foreign bodies pass spontaneously. Management of foreign body ingestions varies based upon the object ingested, its location, and the patient''s age and past history. Esophageal foreign bodies should be urgently removed because of their potential to cause complications. Ingested batteries that lodge in the esophagus, sharp or pointed foreign bodies in the esophageal or gastric tract, and ingestion of multiple magnets all require urgent endoscopic removal. Flexible endoscopy is the therapeutic modality of choice for most patients. The use of devices such as a latex protector hood or an overtube may facilitate safer extraction of sharp objects. [Copyright &y& Elsevier]

Summary: Retroperitoneal fibrosis (RF) is a rare disease in children. We report the case of a 15-year-old boy who presented with a 2-month history of dorsal pain and a 2-week history of fever. The erythrocyte sedimentation rate and serum C-reactive protein value were high. Magnetic resonance imaging revealed a large heterogeneous retroperitoneal mass, suggestive of RF. Percutaneous biopsy of inguinal lymph node provided the diagnosis of anaplastic large cell lymphoma. This is the first report of RF revealing malignancy in childhood. It emphasizes that malignancy must be carefully searched for in children with unexplained RF. [Copyright &y& Elsevier]

Summary: In France, an annual seasonal influenza vaccination has been recommended since 2000 for patients suffering from chronic respiratory diseases, including asthma. Each year, a free influenza vaccination voucher is sent by the French Public Health Insurance authorities to patients with chronic respiratory disease, including severe asthma. In November 2006, this measure was extended to all asthmatic patients, irrespective of asthma severity. The present paper examines the 2006–2007 influenza vaccination coverage rate in 433 asthmatic children aged six to 17 years (mean age: 9.5 years; male: 61%) who consulted a pediatric pulmonologist between March and September 2007 in eight hospitals throughout France. The influenza vaccination coverage rate was 15.7% for the 2006–2007 season (13.9% for the 2005–2006 season and 10.9% for the 2004–2005 season). General practitioners vaccinated 72.1% of the children. Lack of information (42%) was the most frequently reported reason for non-vaccination. Free vouchers (received by 39.6% of the children) significantly increased the vaccination coverage rate (31% versus 5.9%; p <0.001). In France, in 2006–2007, the influenza vaccination coverage rate in asthmatic children was far below the national public health objective to achieve for the year 2008 (at least 75%). Concerted action is needed to improve the influenza vaccination coverage rate in asthmatic children. [Copyright &y& Elsevier]

Summary: According to the criteria of the International Headache Society, migraine occurs in approximately 5 to 10% of children. As many as 30% of young patients with migraine experience such frequent and disabling attacks, or have unsatisfactory results and/or experience adverse effects with pharmacologic treatment of acute migraine attack, that daily preventive medications are required. Many studies have investigated the use of antiepileptic drugs in this indication but there is a paucity of placebo-controlled studies. So far, in the setting of migraine with and without aura, only flunarizine and topiramate have proved their efficacy in more than one placebo-controlled study. Uncontrolled studies suggest the possible efficacy of valproic acid, gabapentin, levetiracetam, zonisamide, and magnesium in preventive therapy of childhood periodic syndromes. Most of antiepileptic drugs used in pediatric preventive therapy are well tolerated. The most common adverse events are asthenia and somnolence. [Copyright &y& Elsevier]

Summary: Seizures are the most common pediatric neurologic disorder. This article describes the guidelines of the French Pediatric Neurology Society, highlighting the importance of a thorough history and examination. Paroxysmal nonepileptic events should be excluded. The role of biological and neuroradiological investigations is discussed. An electroencephalographic recording and advice from a pediatric neurologist are suggested. [Copyright &y& Elsevier]

Summary: Spontaneous pneumomediastinum is a rare entity in children, especially in young infants. We report the case of a 4-month-old infant with a massive spontaneous pneumomediastinum caused by acute viral bronchiolitis. Treatment including bed rest, codeine for its antitussive action, and nitrogen washout resolved the pneumomediastinum within 3days. In the literature, cases of pneumomediastinum in very young infants are exceptional. To our knowledge, codeine has never been used in this situation. Nitrogen washout is also rarely used because of poorly demonstrated efficacy. [Copyright &y& Elsevier]

Summary: Objective: This study reports the investigation of the patients of a private-practice pediatrician with smear-positive tuberculosis. Methods and patients: One thousand six hundred and fifty-six children were screened. Two screenings (T0 and 3 months later) were proposed, with a tuberculin skin testing (TST) and a chest radiograph. A T-cell-based assay was performed onchildren with intermediary values. Results: No active tuberculosis was identified. Skin tests on 1171 children (83.1%) were negative on screenings. Nearly all chest radiographs were normal (96.9% on the initial screening, 98.8% on the 2nd). T-cell-based assays were negative. Of the 803 children younger than 2 years of age, 583 (72.6%) were directed to prophylaxis, children older than 2 years of age were treated based on the 2nd screening as latent tuberculosis infection. Sixty nonserious side effects were reported 54 children, most of were digestive. Prophylaxis was stopped in 52 cases, in 22 cases a side effect. Compliance to the 2 visits was good (87.7%). Conclusion: This investigation concerning a large number of children confirms limited transmission of Mycobacterium tuberculosis from a pediatrician with smear-positive tuberculosis to pediatric outpatients. Coordination screening by the tuberculosis control section is essential. The T-cell-based assay could better correlate the contamination risk to the intensity and the length of exposure compared with TST and could avoid screening a large number of patients. [Copyright &y& Elsevier]

Summary: The quality of noninvasive ventilation in pediatrics is interface-dependent. Several types of interfaces are currently available: nasal and oral masks, nasal pillows and helmets. Despite material improvements in material design, shape, size and components, interfaces are still not adapted for most children. The ideal interface must fit the child’s characteristics and the disease requirements. For instance, a nasal canula is recommended for infants younger than 3 months of age. If necessary, nasal masks can be used as oronasal masks. Repeated and careful evaluations are indicated to ensure interface adequacy and to detect cutaneous injuries and facial deformities. Training is required for medical and paramedical personnel. Pediatrics studies, comparing interfaces, are needed to build evidence-based recommendations. [Copyright &y& Elsevier]

Summary: Pediatric arterial ischemic stroke (AIS) is little known by pediatricians, as it is rare and difficult to diagnose. Current therapeutic approaches include platelet aggregation inhibitors, anticoagulation using heparin or thrombolysis with rt-PA, and therapeutic abstention in the absence of consensus, in contrast with stroke in adults. We report the case of a 3-year-old child who benefited from intravenous thrombolysis with rt-PA 2h after a major AIS of the anterior and middle left arteries due to embolism from the heart. Neurological progression was marked by a persistent, severe functional deficiency, in spite of the early use of thrombolysis. No hemorrhagic complication occurred. This observation raises the problem of therapeutic indications in childhood AIS and more particularly the question of the use of intravenous thrombolysis. Currently, few studies exist on this subject and only a few case report of children and teenagers having received effective intravenous or intra-arterial thrombolysis further to an AIS are available in the literature. A single study describes 46cases of children with AIS having received thrombolysis but reports numerous complications. However, the absence of symptomatic hemorrhagic complications is noteworthy. There is currently insufficient evidence to recommend thrombolysis in pediatric AIS; nevertheless it can be proposed in certain rare cases, similar to the observation reported herein. [Copyright &y& Elsevier]

Summary: Pheochromocytoma is uncommon in children. We report herein a case in a 6-year-old boy whose pheochromocytoma was revealed by cerebral ischemia as a consequence of acute-cardiac failure. Twenty-four-hour urinary catecholamines were markedly increased. Abdominal ultrasonography and computed tomography located the tumor on the left adrenal gland. After surgical excision, hypertension disappeared. Diagnosis and treatment of pheochromocytoma in children are discussed. [Copyright &y& Elsevier]

Abstract: France is the most important country out for imported malaria. Malaria epidemiological data managed by the malaria national reference center shows that the malaria of children concerns migrant who travel in Africa during summer to visit family. Preventing and treatment recommendations are formerly published by “Haut conseil de la santé publique”. Revision 2007 of the 1999 consensus conference about management and prevention of imported Plasmodium falciparum malaria were published in February 2008. This article presents the actuality of these recommendations for clinical pratice. [Copyright &y& Elsevier]

Summary: Health-related quality of life (HRQOL) is a multidimensional construct, without general agreement on the number of domains and the content of each domain. In children with epilepsy, the HRQOL evaluation includes both nonspecific aspects, such as behavioral, psychological and cognitive difficulties and the impact of a chronic pediatric illness on the child and its family and specific aspects, such as the perception of the severity of the seizures and of the undesirable effects of the antiepileptic treatments, as well as the social impact of a negative attitude toward epilepsy. The present article presents a review of the methods proposed for the assessment of HRQOL in children with epilepsy. Most methods rely on parental reports; however, there is an increasing effort to develop tools taking the child''s point of view into account. HRQOL tools have often been used in clinical trials and, especially, to evaluate the surgical treatments of epilepsy. For the clinician, HRQOL tools may be a preliminary approach to the patient''s problems to be interpreted in relation to the patient''s medical, psychological, cognitive, social and familial context. In France, few large-scale studies on HRQOL in children with epilepsy have been conducted. We present the preliminary results of a French study based on parental reports. [Copyright &y& Elsevier]

Summary: Central venous catheterizations are often used in pediatric intensive care units or for long-term intravenous treatment. It consists in positioning the catheter extremity in the venous cava–right atrium junction. Adapted material and techniques are necessary for young children because of particularities in anatomy and the size of the different venous trunks. The aim of this paper is to present the different material and techniques and to show the indications, complications and follow-up in central venous catheterization for young children. [Copyright &y& Elsevier]

Summary: We report a case of pygomelus, a malformation characterized by the presence of supernumerary limb. The patient was a 3-month-old girl born full term in the Zinder area of Niger. The mother had not attended prenatal visits. No drug had been administered during pregnancy and the family was not inbred. The malformation consisted of an almost fully developed third lower limb, attached to the lumbosacral spine, and of a small fleshy mass at the base of the limb resembling a penis. The appendage was removed surgically without complications and the child has been developing normally since the intervention. [Copyright &y& Elsevier]

Abstract: “Growing pains” are a frequent problem in paediatric practice. Over the last years, their diagnostic and therapeutic approaches have changed. Other syndromes than those well-known by paediatricians are to be taken in consideration. Current treatment consists in reassurance of children and their family reactivation of patients (which means to take up a normal physical activity) and treatment of painful crisis as well as complementary therapies. [Copyright &y& Elsevier]

Summary: Children, term and preterm newborn care require electrophysiologic investigations for seizure detection and therapeutic management or prognosis purposes. Amplitude-integrated electroencephalography (aEEG) offers an accessible by non expert, bedside continuous cerebral monitoring. A 2 year utilization of aEEG in a neonatal and paediatric intensive care unit is described as advantages and as pitfalls. Technical description and aEEG classifications for interpretation only available for term newborn are described. To obtain a performing utilization (technical and interpretation) it was necessary to have about 1 year of training including medical and paramedical formations. Our experience shows that this easy-to-use technique requires a careful management, a trained and vigilant staff notably electrophysiologist to avoid inappropriate conclusions. Finally, aEEG is very efficient but in complement of standard EEG. [Copyright &y& Elsevier]

Summary: GLUT-1 protein is the principal glucose transporter across the blood-brain barrier. GLUT-1 deficiciency results in a syndrome of infantile seizures refractory to anticonvulsive drugs, developmental delay, acquired microcephaly and neurologic manifestations including spasticity, hypotonia, and ataxia. A low cerebrospinal fluid glucose concentration in the absence of hypoglycaemia is pathognomonic of glucose transporter deficiency syndrome. Ketogenic diet is an effective treatment of epileptic manifestations but it has less effect on the cognitive symptoms. We report on a child who presented with paroxistical events often occurring prior to meals, developmental delay, microcephaly and spasticity. CSF and serum glucose levels measured simultaneously showed a CSF/serum glucose ratio of 0.39. Molecular analysis identified a heterozygous novel mutation. [Copyright &y& Elsevier]

Summary: Acute malnutrition or emaciation in childhood is defined by a low ratio weight/height. In Benin, 8% of the children are concerned. In the north of Benin, the situation is alarming. The aim of this survey is to specify: (1) the characteristics of infantile malnutrition in rural area in the north of Benin and (2) the management of the malnourished children. Subjects and methods: A descriptive survey was conducted in a paediatric dispensary. Anthropometric data of children from 0 to 60 months were collected. The children with severe malnutrition were admitted to a nutritional rehabilitation centre. The methods were those recommended by the World Health Organization and were adapted to the local resources. Results: The anthropometric data of 239 children were analyzed. The prevalence of emaciation was 33%. Thirty-eight children were admitted to the centre. Twenty-nine of the children recovered. Discussion: This survey confirms the precarious situation in the north of Benin, which may be explained by socio-economic and climatic factors. It can be prevented partly by better food availability, but also by an education on mothers. The strategies must be updated according to their effectiveness in terms of public health and their local acceptability. Conclusion: The prevalence of malnutrition in Fo-Bouré is beyond the value used by WHO to define the zones where the nutritional situation requires nutritional rehabilitation centres. [Copyright &y& Elsevier]

Summary: Aim: To determine the impact of rapid influenza test (RIT) on the prescription of additional tests, antibiotics and oseltamivir, and the influence of oseltamivir on clinical signs and parents’ day work stoppage. Methods: Prospective study in the pediatric emergency department of Nice University Hospital from 29th January 2007 to 3rd March 2007 including children from 1 month to 6 years old with fever greater or equal to 38.5°C for less than 48h. Virologic research on nasopharyngeal aspiration was: immunofluorescence, cell culture and RIT Quickvue®. Clinical informations, additional tests and treatments were registered for each child. An antiviral treatment (oseltamivir) was proposed to children older than 1 year with positive RIT. Evolution at 7 days was evaluated by phone contact. Results: One hundred and seventy-seven children were included (mean age 24 months, sex-ratio 1.88). The RIT was positive in 42.3% (n =75). Compared with cell culture, the sensibility, specificity, positive predictive value and negative predictive value of the RIT were, respectively, 95.6, 91.6, 88 and 97%. Clinical signs significantly correlated to influenza were: impairment, rhinitis and acute otitis media. In the RIT positive group, there were significantly less additional tests (13 versus 36) and particularly urinalysis (5 versus 19), and more spreading in the family (p =0.0002). There was not any significant difference concerning hospitalizations, antibiotic prescriptions, or parents’ day work stoppage. Conclusion: During influenza epidemic, in a pediatric emergency department, RIT allows a reduction of additional tests in febrile young children, particularly urinalysis. [Copyright &y& Elsevier]

Summary: Moyamoya syndrome has rarely been reported in association with Down syndrome. We report on 2 cases in 3-year-old and 6-year-old female children with Down syndrome, who presented with neurological deficit. Imaging (magnetic-resonance angiography and digital-subtraction angiography) revealed the classical Moyamoya pattern. The neurological deficits persisted in both cases. One patient has developed epilepsy. [Copyright &y& Elsevier]

Abstract: Objective: Fever without source (FWS) is a common cause of children visits to pediatric practices. Clinical evaluation does not always rule out efficiently an invasive bacterial infection. Among blood markers, several publications have suggested the value of C-reactive protein (CRP). This study was performed to assess, in private practices, the impact of rapid CRP test compared to usual technique at the laboratory for the management of children with FWO. Material and methods: The study was undertaken in 2006–2007, in 14 pediatric practices. Pediatricians had to enroll all children, older than three months, consulting for FWS, for whom CRP was prescribed. The pediatric practices were distributed in two groups: in the first one, pediatricians had rapid CRP tests (NycoCard® CRP test, Progen Biotechnique) and in the second one, they sent children to laboratory for the dosage of CRP as usually. Results: Between October 2006 and June 2007, 227 children were enrolled by 17 pediatricians: 159 in the group with rapid CRP test (group 1), 68 in the group without (group 2). The cost of routine biological tests (micro or macro CRP, blood cell count and urine cultures) was on average lower for group 1 compared to the group 2: respectively 7.7 versus 39.3€ (P <0.0001), a reduction from approximately 80% of cost. In group 1, more dipstick urine tests (22.6 versus 4.4, P =0.0009), less urine cultures (19.5% versus 67.6% P <0.0001) and blood prescriptions were prescribed (3.8% versus 100%, P <0.0001), pulmonary X-rays were not different (23.9% versus 19.1%, P =0.4). It was not observed difference in antibiotic prescription between the two groups (15.7% group 1 versus 19.1% group 2, p =0.5). The average time to obtain the results examinations in laboratory was approximately 11h (median 4.5h, extremes 45min to two days), for fivemin in group 1. In group 1, children management was different according to the CRP levels. During the follow-up, no difference was observed between the two groups except less hospitalizations in group 1 (2.9% versus 15.3%, P =0.0015). Conclusion: This study suggests the interest of rapid CRP test for febrile children in ambulatory pediatric practice by reducing number and cost of laboratory examinations and timesaving for patients and practitioners. [Copyright &y& Elsevier]

Summary: Complications related to the ingestion of magnetic foreign bodies by children represents an affirmed health hazard in the United States. In France, an alert has been announced. We report the 1st case in France. Our aim is to alert pediatricians and emergency physicians and to draw attention to the particularities of this type of foreign body. Responsible for complications is the ingestion of at least 2 magnets, or 1 magnet and a metallic foreign body, with a time interval between ingestions. In these cases, it is strongly recommended to extract the foreign bodies with endoscopy if they have not yet passed the pylorus. For those further advanced in the intestinal tract, continuous observation is warranted and surgical extraction is indicated on apparition of 1st clinical symptoms. [Copyright &y& Elsevier]

Summary: Arteriovenous malformations are seldom in children but raise important therapeutic problems. Apart from intracranial arteriovenous malformations, few observations have been described in the literature. We report the case of a superficial perineal arteriovenous malformation in a 5-year-old child. Tailored embolization followed shortly by thorough surgery is the best attitude. Surgery must totally eradicate the lesion to allow hope for a cure. Surgery should be reserved for forms that are extensive or a source of complications. Even total resection does not ensure non-recurrence. [Copyright &y& Elsevier]

Abstract: Since the 1990''s, the widespread use of very sensitive and specific serological tests has completely changed the conditions of the diagnosis of celiac disease (CD). The active form of the disease is now only the tip of the iceberg representing it. Currently, CD is evoked either in front of mild digestive symptoms at the usual age or in the course of screening in siblings of an index case or in patients at risk (insulin dependent diabetes for example) at a later age using IgA anti-endomysium or anti-tissue transglutaminase antibodies, the sensitivities and specificities of which exceed 90%. In some cases, HLA typing is helpful in allowing to exclude a patient who is neither DQ2 nor DQ8. The intestinal biopsy remains the “gold standard” of the diagnosis showing villous atrophy; the latter, however, is less and less often severe as the disease is milder and milder. The diagnosis of CD then rests on the confrontation of the clinical, biological and histological data. Once CD has been diagnosed, it can be classified either as active or silent (positive serology with isolated villous atrophy), or latent (positive serology with a normal mucosa) and the appropriate therapeutic decision can be taken. [Copyright &y& Elsevier]

Summary: We report 10 paediatric cases of ventricular repolarisation disorders and long QT syndrome, which differed in their mode of revelation, from asymptomatic forms to syncope events or heart arrest. Diagnosis is based on electrophysiological explorations and exhaustive genetic investigation. It allows a well-codified preventive and therapeutic action according to the genotype. [Copyright &y& Elsevier]

Summary: The aim of this study was to look over the neurological disorders associated with Down syndrome. Material and method: We reviewed 12 patients with Down syndrome hospitalized from 1997 to 2003, suffering from various neurological complications. Results: Among the 5 patients with epilepsy, 3 presented with West syndrome and 2 with partial epilepsy; after treatment all were seizure-free. Four patients had ischemic lesions; 1 presented with Moya-Moya syndrome. Four patients presented with C1–C2 vertebral dislocation; all underwent surgery. One of the patients with epilepsy had neurological ischemic sequelae. Conclusion: West syndrome is the most frequent type of epilepsy encountered in Down syndrome. Outcome is favourable if appropriate treatment is initiated early. Any suspicion or sign of vascular lesion in patients with Down syndrome should be promptly investigated. The hyperlaxity associated with Down syndrome could lead to C1–C2 dislocation and a systematic screening is mandatory in order to avoid neurological complications. [Copyright &y& Elsevier]

Summary: Bacterial tracheitis is a severe cause of acute infectious upper-airway obstruction. Its characteristics include thick purulent secretions with or without plaques or pseudomembrane formation. Fatal complications are infrequent if an appropriate treatment is conducted. Case report: We report on 2 cases of bacterial tracheitis revealed by out-of-hospital cardiac arrest. At presentation in winter, both children first had the symptoms of viral croup. However, no response to the appropriate therapy for this disease was observed. A cardiac arrest occurred on the second day. Bronchoscopy allowed diagnosis. Findings on initial examination were erythema, edema and purulent secretions. Bacterial cultures of tracheal secretions were positive with Staphylococcus aureus. Serology with influenza A virus was also positive. Despite antibiotics and mechanical ventilation, both children died in the pediatric intensive care unit, consecutively to irreversible ischemic brain injury. Conclusion: Bacterial tracheitis remains a life-threatening upper-airway infection. Prompt recognition and accurate diagnosis could lead to decreased mortality. It is essential to reassess any croup whose outcome is not rapidly favourable. Such patients should be monitored in a pediatric intensive care unit. [Copyright &y& Elsevier]

Summary: Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient''s bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime–sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient''s general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime–sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime–sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime–sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations. [Copyright &y& Elsevier]

Summary: The review of the international literature presented here aimed to determine the measuring instruments of the coping of children chronic disease currently available. This research task was carried out starting from the numerical databases Psychinfo, Medline and Science Direct with various key words such as coping, child, chronic illness, assessment. It was related to the years 1985–2006. More than 200 articles were selected bearing on the adaptation of children with a chronic disease. Among these articles, only 6 measuring instruments of coping could be updated in the paediatric population. All these instruments aim to evaluate the way in which the children manage to overcome the negative effects of their disease. Two types of evaluation were, however, distinguished: (1) concise evaluations of the adaptive strategies to a whole of stresseurs related to the chronic disease (pains, hospitalization…); (2) detailed evaluations of the answers of coping to the painful procedures related to the chronic disease. The discussion of this analysis of the literature relates to the need for developing and for using in the clinical practices the measuring instruments of the coping to the chronic disease during the child. [Copyright &y& Elsevier]

Summary: Introduction: Actinic lichen planus (ALP) is a chronic and benign disease that affects young people of the Middle East and Maghreb countries. Purpose: To analyse clinical features and prognosis of ALP in children. Patients and methods: A retrospective, descriptive study of cases observed in the department of dermatology of Sfax hospital over a period of 11years (1995–2005). Results: Our patients were 5boys and 1girl. Mean age at diagnosis was 11years. Onset was during the summer in 5cases. The face was involved in 5cases and the upper limb in 3cases. The annular form was found in 5cases, the pigmented melasma-like form in 1. Cheilitis was associated in 3 cases. Treatment consisted in photoprotection in all the patients. Antimalaria drugs were used in 4patients and topical steroids in 2. Evolution was favourable in 5cases. Disease relapsed in one child after treatment interruption. Conclusion: ALP can be seen during childhood. Ultraviolet rays are involved in pathogenesis. The annular form is predominant. Treatment is based on sun protection associated with antimalarials or topical steroids. [Copyright &y& Elsevier]

Abstract: Constipation is a common pediatric problem. We propose guidelines based on an integration of expert opinion and a review of the medical literature. Physiopathology, symptoms, diagnosis for functional or organic constipation, clinical forms and treatment are considered. [Copyright &y& Elsevier]

Summary: Introduction: The Sickle Cell Disease (SCD) is a serious illness considering its complications. For the children seriously affected, three therapeutic options are currently validated: transfusion therapy, hydroxyurea and bone-marrow transplantation. Objectives: To see the contribution of hydroxyurea therapy on severe forms of SCD in affected Tunisian children. Material and methods: This investigative study lasted over 6 years and 9 months, (September 2000–May 2007), enrolling 47 patients including 27 homozygous SCD and 20 double heterozygote SCD-S/β thalassemia. The median age was 12 years and a half. The average dosage were 20mg/kg/d (14–30mg/kg/d). The average duration of treatment was 52 months (18–81 months). Results: The main indication for hydroxyurea treatment was prevention of recurrence of an acute chest syndrome in seven cases; episodic vaso-occlusive crises exceeding three events per year in 38 cases and prevention of deterioration of cerebral vascular accident in two cases. We observed a fast and sustained improvement of the clinical expression of the disease with a significant decrease of the number of days of hospitalization per patient and per annum from 29.3 d (10–84 d) to 3.2 d/(p <0.01). Treatment was well tolerated. We observed a significant increase of haemoglobin fetus (HbF) rates from 3 to 30% (p <0.01), hemoglobin from 7.8 to 9.6g/dl (p <0.05), average blood cells volume from 79.1 to 100.3fl (p <0.05) and a significant fall of the white blood cells rates from 14,914 to 8464 per millimetre cube (p <0.05), polynuclear neutrophils from 6799 to 3486 per millimetre cube (p <0.05) and platelets from 508,666 to 293,500 per millimetre cube (p <0.05). Conclusions: Hydroxyurea represents a privileged choice of treatment in the severe forms of SCD in children, for homozygous SCD-SS as well as for double heterozygote SCD-S/β thalassemia. Used carefully, with frequent monitoring, it appeared as a safe treatment in short and medium term, but studies of long-term tolerance should be undertaken. [Copyright &y& Elsevier]