Asunto(s)
Cinésica , Relaciones Madre-Hijo , Comunicación no Verbal , Psicología Infantil , Humanos , Lactante , Recién Nacido , Fase OralRESUMEN
OBJECTIVE: To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study. RESEARCH DESIGN AND METHODS: We enrolled 2,579 patients aged 1-19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables. RESULTS: Mean HbA1c value for the whole population was 8.97 +/- 1.98% (normal 4.7 +/- 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables. CONCLUSIONS: Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.
Asunto(s)
Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Adolescente , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Niño , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/epidemiología , Cetoacidosis Diabética/etiología , Familia , Femenino , Francia/epidemiología , Hemoglobina Glucada/análisis , Humanos , Hiperglucemia/sangre , Hiperglucemia/etiología , Hipoglucemia/sangre , Hipoglucemia/etiología , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Prevalencia , Calidad de Vida , Análisis de Regresión , Factores de Riesgo , Apoyo Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it. CASE REPORT: A 4 1/2 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessary after 1 month of treatment followed by dacryocystorhinostomy. CONCLUSION: This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.
Asunto(s)
Dacriocistitis/etiología , Mycobacterium tuberculosis , Tuberculosis , Enfermedad Aguda , Preescolar , Dacriocistorrinostomía , Humanos , Isoniazida/uso terapéutico , Masculino , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis/tratamiento farmacológico , Tuberculosis/cirugíaRESUMEN
BACKGROUND--Exophthalmos or proptosis may be a result of several causes; when unilateral, it leads to search a variety of orbital tumors. CASE 1--A 2 month-old baby presented with a right exophthalmos which developed within a few days. Computed tomography showed infiltration of the orbit by a mass. Surgical biopsy showed capillary hemangioma. The patient was given prednisone 2 mg/kg/day for 2 months; exophthalmos disappeared within 10 days and the child was normal 7 years later. CASE 2--A 13 year-old boy was examined because he had developed left exophthalmos within 2-3 weeks. Ultrasonography and computed tomography showed an orbital tumor compressing the eye and the optic nerve. This tumor was excised and histological examination showed that it was a thrombotic arterial aneurysm. CONCLUSIONS--Vascular lesions can be responsible for a rapidly developing orbital tumor. Their diagnosis can be difficult and must be made in order to avoid aggressive surgery.
Asunto(s)
Aneurisma/complicaciones , Exoftalmia/etiología , Hemangioma/complicaciones , Neoplasias Orbitales/complicaciones , Trombosis/complicaciones , Adolescente , Aneurisma/diagnóstico , Femenino , Hemangioma/diagnóstico , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Neoplasias Orbitales/diagnóstico , Trombosis/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
A 21 month-old unvaccinated boy was admitted for an acute respiratory distress episode associated with major leukocytosis (maximum = 146 G/l). Transient heart failure and pneumomediastinum occurred but the outcome was favourable. Coughing attacks then occurred and the diagnosis of pertussis was serologically confirmed. This case report is reminiscent of the possible severity of pertussis pneumoniae, the mechanisms of haematologic abnormalities, and stresses to the benefit of pertussis vaccination.
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Leucocitosis/etiología , Tos Ferina/diagnóstico , Humanos , Lactante , Masculino , Tos Ferina/complicacionesRESUMEN
The two patients reported experienced initially typical Henoch Schönlein purpura, and Berger disease some years later. Same cases are described in the literature pleading for the relationship between the two entities; Berger disease may be considered as a symptomatic form of anaphylactoïd purpura.
Asunto(s)
Glomerulonefritis por IGA/etiología , Vasculitis por IgA/complicaciones , Niño , Humanos , MasculinoRESUMEN
Congenital megalo-urethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia or agenesia of spongy tissue. Two types are described, scaphoid and fusiform types, according to the presence or the absence of erectile tissue. Megalo-urethra is a rare condition, and 56 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.
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Uretra/anomalías , Humanos , Recién Nacido , Masculino , Uretra/diagnóstico por imagen , Uretra/cirugía , UrografíaRESUMEN
Congenital megalourethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia ore agenesia of spongy tissue. Two types are described, scaphoide and fusiform types, according to the presence or the absence of erectile tissue. Megalourethra is a rare condition, and 55 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.
Asunto(s)
Uretra/anomalías , Humanos , Recién Nacido , Masculino , Radiografía , Uretra/diagnóstico por imagen , Uretra/cirugíaRESUMEN
The authors report the case of two siblings with a MU.LI.BR.EY syndrome. This acronym standing for a singular type of recessive autosomal intra-uterine dwarfism, insufficiently points to the role of pericardial constriction. The main symptoms and the prognosis of the disease are related to pericardial damages. The relevance of the diagnosis lies in the possibilities offered by pericardectomy.
Asunto(s)
Enanismo/genética , Retardo del Crecimiento Fetal/genética , Pericarditis Constrictiva/complicaciones , Femenino , Retardo del Crecimiento Fetal/complicaciones , Humanos , Recién Nacido , Discapacidad Intelectual/genética , Masculino , Fenotipo , Embarazo , SíndromeRESUMEN
The etiology of urethrorragias in the boy is usually unknown. The authors report one case related to a foreign body introduced into the urethra. Considering the urethroscopic findings, several publications about that type of urethral bleeding in the boy show that such a traumatic lesion is often found.
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Cuerpos Extraños/complicaciones , Hemorragia/etiología , Uretra , Enfermedades Uretrales/etiología , Niño , Humanos , MasculinoRESUMEN
A 4 years old girl presents a typical case of patent form of cutaneous late porphyria with a reduced activity of the erythrocyte, uroporphyrinogen decarboxylase (UROD) genetically transmitted over 3 generations; a multifactor inheritance (HLA A3, a normal phenotype of alpha 1 antitrypsin, exogenous toxins, or viral infections) is discussed.
Asunto(s)
Carboxiliasas/deficiencia , Porfirias/genética , Enfermedades de la Piel/genética , Uroporfirinógeno Descarboxilasa/deficiencia , Niño , Femenino , Humanos , Linaje , Porfirias/diagnóstico , Porfirias/patología , Piel/patología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/patologíaRESUMEN
The authors report an eleven year old girl who manifested predominantly an acute cerebellar syndrome secondary to infection by Epstein Barr Virus. This complication is unusual and males are predominantly affected. The diagnostic and common physiopathological hypothesis are discussed.
Asunto(s)
Enfermedades Cerebelosas/diagnóstico , Infecciones por Herpesviridae/diagnóstico , Herpesvirus Humano 4 , Enfermedad Aguda , Enfermedades Cerebelosas/líquido cefalorraquídeo , Niño , Femenino , Infecciones por Herpesviridae/líquido cefalorraquídeo , Humanos , Pronóstico , Pruebas SerológicasRESUMEN
An hemorrhagic shock caused by spontaneous spleen rupture in a 14 year old child with a congenital afibrinogenemia is reported. A conservative treatment was carried out with perfusions of whole blood and fibrinogen and with regular echographic examinations and a splenectomy was avoided.
Asunto(s)
Afibrinogenemia/congénito , Hemoperitoneo/etiología , Rotura del Bazo/etiología , Adolescente , Afibrinogenemia/complicaciones , Transfusión Sanguínea , Fibrinógeno/administración & dosificación , Hemoperitoneo/terapia , Humanos , Lactante , Masculino , Rotura Espontánea , Bazo/patología , Rotura del Bazo/diagnóstico , Rotura del Bazo/terapia , UltrasonografíaRESUMEN
In children, nephroepithelioma represent less than 10% of the malignant tumors of the kidney. Reporting 3 cases, the authors emphasize that the clinical expression of nephroepithelioma, often made only of recurrent hematuria occuring over years, may mislead adequate diagnostic approach. Thus, a kidney arteriogram should be included in the investigations of nephroepithelioma. Earlier diagnosis may improve the rate of recovery from nephroepithelioma which, in children, is about 30%.