Case report: insulin-dependent diabetes mellitus in childhood associated with scleroderma

A 14-year-old boy presented with Type I diabetes mellitus and subsequently developed pancreatic exocrine insufficiency and systemic sclerosis (SSc). His diabetes had been diagnosed when he was about 5 years old, after the onset of ketoacidosis. Insulin treatment was provided from then until the time he was treated in our department. Exocrine pancreatic insufficiency, which occurred at age 9, was treated with pancreatic extracts. Cystic fibrosis was excluded after a chloride sweat test. The diagnosis of SSc was confirmed at age 14 on the basis of skin sclerosis, sclerodactyly and oesophageal and pulmonary involvement and then at age 18 by the occurrence of Raynaud's disease. Thus, this patient demonstrated a rare and previously unreported association of Type I diabetes mellitus and systemic scleroderma. Limited joint mobility and skin abnormalities are frequent in childhood diabetes mellitus but should not be misdiagnosed as systemic scleroderma.

[Epidemiology of infantile asthma in the Le Havre region]

BACKGROUND

Prevalence of asthma is influenced by environmental factors which may be different from area to area.

POPULATION AND METHODS

A cross-sectional epidemiological survey was carried out among 1,395 children attending primary schools in the city of Le Havre and the canton of Fécamp (Haute-Normandie). Questionnaires including data about the disease, family history, environmental and socio-economic factors were completed by the school physician in presence of the parents.

RESULTS

Prevalence rate of asthma calculated from 1,193 questionnaires was 7.8%. The logistic regression curves pointed out four risk factors: family history of asthma (odds ratio: 2.52) or hay fever (OR: 1.98), atopic dermatitis (OR: 3.96), and parental smoking (OR: 1.79). Sex, socioeconomic status of parents, type of housing, presence of pets in the house were not related to prevalence of asthma. Frequency of cough during the day was only significantly different between both areas.

CONCLUSIONS

The high level of school absence (21.1%) and frequency of hospitalizations for acute asthma (20.4%) should lead health professionals and educators to improve management of asthma in these areas.

[Isolated acute peripheral facial paralysis in children. Etiological and prognostic study]

BACKGROUND

As facial nerve palsy is usually of sudden onset and of obscure etiology, a survey of large series may provide new information.

PATIENTS AND METHODS

The files of 40 children suffering from acute facial nerve palsy seen in 3 pediatric and 1 otorhinolaryngologic (ORL) departments between 1980 and 1990 were analysed. Patients with congenital palsy and those with paralysis that appeared after injury or in the course of acute or chronic disease (otitis media, tumor) were excluded from the study. The children were 9 months-16 years old (mean: 7 year 1 month). There were 22 left and 18 right facial nerve palsies. The palsy was moderate in 17 children, severe in 15, and total in 5. Etiologic factors (viral serologic studies, CSF examination), ORL studies and electromyogram of the facial nerve were analyzed in the majority of cases. Corticosteroids were used in 30 patients.

RESULTS

A viral etiology was suspected and/or confirmed in 13 children; abnormalities were seen in 6 of the patients who underwent lumbar puncture. A familial facial nerve palsy was seen in 1 case and kidney disease in 2 cases. 23 cases appeared to be idiopathic. A moderate permanent residual weakness was seen in only 4 children. The mean time for recovery was 32 days (4-140 days). Corticosteroids did not influence the incidence of complete recovery, but decreased the time for recovery (26 versus 37 days) only in the patients who were treated before the 3rd day of the disease. Patients with idiopathic palsy recovered 23 days before those with viral etiology.

CONCLUSIONS

Idiopathic and post-viral facial nerve palsies seem to have an excellent prognosis. Corticosteroids seem to have no effect although there is some evidence of benefit when treatment is begun early.

[Multicenter study of sodium alginate in the treatment of regurgitation in infants]

An open multicenter study was performed to assess the efficacy and safety of alginic acid in two different dosages in 76 pediatric patients with gastroesophageal reflux confirmed by pH monitoring. Among the 69 patients in whom endoscopy was carried out before treatment, 18 had erythematous esophagitis and 5 had erosive esophagitis. Irrespective of the dosage used, the frequency of regurgitation and vomiting decreased significantly (p < 0.00001 and p = 0.01, respectively). Clinical and biochemical tolerance were outstanding and no adverse effects were recorded. On the basis of these data, the recommended dosage is 1 to 2 ml/kg/day in divided doses after meals.

[Esophageal pH monitoring in children. Methodological aspects and a review of the literature related to indications]

Because it offers high sensitivity and specificity, esophageal pH monitoring has become the reference method for the diagnosis of gastroesophageal reflux. This review was undertaken to evaluate methodologic problems raised by this method, involving selection of the electrode, selection of equipment, and criteria of normality according to the patient's symptoms. In some instances, multiple recordings are needed to detect correlations between clinical symptoms and esophageal pH, cardiac and respiratory tracings and esophageal pH, or oxygen saturation and esophageal pH. These studies allow improved qualitative interpretation of results. Emphasis is put on the value of esophageal pH recordings for the evaluation of medical or surgical therapies.

[Accelerated desensitization to Dermatophagoides pteronyssinus mites in children with asthma. Results of two years of immunotherapy]

16 children with chronic asthma were given a rush immunotherapy with standardized Dermatophagoides Pteronyssinus extracts. For two years, the dose of 10 IR was injected monthly. Before this rush, six children have received a typical immunotherapy ineffective on asthma. Examination of clinical, medication, immuno-allergologic and functional parameters were recorded before and at 6, 12 and 24 months of the follow-up. Rush immunotherapy was well tolerated. Substantial improvement of asthmatic syndrome was seen in 12 children. Skin sensitivity decreased significantly since 6 months (p less than 0.001). Laboratory results were not changed. At 24 months, improvement of CRF Helium was showed (p less than 0.01). This study with two years follow-up shows that specific immunotherapy is efficacy and possible in children with severe asthma. Symptom, medication, functional scores were substantial improvement.

[A prognostic study of cryptogenic infantile spasms]

The prognosis of infantile spasms is grim when a detectable brain lesion is present. In contrast, cryptogenic infantile spasms, in which there is no identifiable brain lesion, usually run a favorable course under treatment. Few studies have focused on the outcome in children with cryptogenic infantile spasms. Among 111 pediatric patients with a history of infantile spasms hospitalized over 18 consecutive years, 23 (21%) were given a diagnosis of cryptogenic infantile spasms. Follow-up ranged from 4 to 21 years. Outcome was as follows: the IQ was above 80 in 39% of cases and above 100 in 13% of cases; 42% of patients of school age were attending school but half of these had learning disabilities; 30% of patients had severe psychiatric disorders, and 22% had developmental delay and severe epilepsia. Early factors apparently associated with a good prognosis included the mild nature of psychomotor regression, persistence of spindles on EEGs recorded during NREM sleep, and prompt improvement of clinical status and EEG recordings under treatment. Conversely, severe regression, focalized EEG anomalies, failure of development to resume promptly after initiation of therapy, recurrence of spasms and hypsarrhythmia at discontinuation of treatment, and onset before 5 months or after 11 years of age were associated with a poor prognosis.

[Inflammatory joint disease as a manifestation of Toxocara canis larva migrans]

We report a case of migrating joint involvement occurring as the first manifestation of Toxocara canis larva migrans. We also reviewed the literature on joint disease caused by parasitic infections. Diagnostic criteria are described. We suggest that an immunoallergic mechanism is involved. Furthermore, the therapeutic trial with thiabendazole contributed usefully to the diagnosis in our patient.

[Neonatal cytomegalovirus infection with development of liver fibrosis]

Neonatal cytomegalovirus hepatitis usually recover completely. The authors report a case evolving toward fibrosis, mostly perisinusoidal and with mild biliary hypoplasia. Similar cases with portal hypertension previously published are reviewed.

[Dysphagia, speech disorders and centrotemporal spikes-waves]

Repeated paroxysmal oropharyngeal fits consisting of sialorrhea and speech arrest are described in a 5 year-4-month old patient. Investigations were initially oriented towards a laryngeal or a gastrointestinal disease. Electroencephalographic tracings showed repeated bilateral centrotemporal spikes-waves discharges which sometimes were associated with bilateral facial clonic contractions synchronous with anarthria and sialorrhea. Consciousness was preserved. Attacks were related with a cluster of fits of a partial epilepsy. Transient pseudo-bulbar palsy (anterior opercular syndrome) resulted from seizures: loss of identifiable speech, drooling with difficulties in swallowing, absence of palatal movements and of the gag reflex. Intellectual functions remained normal. Other investigations were all normal (CT scan, MRI, cytologic and immunological CSF studies). With common anticonvulsant drugs (Valproate and Carbamazepine) seizures resolved within a few weeks. These findings suggest that this particular epilepsy is an unusual type of benign partial epilepsy with centrotemporal (or Rolandic) spikes.

[Pharmacologic efficacy of sodium alginate suspension on gastro-esophageal reflux in infants and children]

Eighty-three children presenting with symptomatic gastro-esophageal reflux (GER) (48 males, 35 females, aged 15 days to 57 months (mean = 7 months) were assessed by pH monitoring. All showed acid pathological GER on the 3 hours post-prandial esophageal pH measurement (% of time at pH less than 4 greater than 4.2) and all had a second pH measurement within the following 3 hours after intake of a single (5 ml) dose of sodium alginate (AGS). AGS administration was followed by a highly significant reduction (p less than 0.00001) of all pH measurement variables: a) Percentage of time spent at pH less than 4 returned to normal with a mean 11.7% to 4.8%; that is a 52.5% improvement (median); b) Total number of reflux reduced on average from 8.9 to 5.0: that is a 35% improvement (median); c) Mean duration of reflux reduced on average for 4 to 2 min; that is a 60% improvement (median). In 76 patients hourly monitoring of % of time spent at pH less than 4 shows that hourly improvement persists.

[Clinical value of the determination of serum IgE in allergy to cow's milk proteins in infants]

The serum IgE, that are associated to the process of the immediate allergy are studied in children presenting a clinical semiology suggestive of intolerance to the cow-milk proteins, in order to specify their contribution in the diagnosis and the follow-up of this disease. The serum IgE are determined by the PRIST method and the presence of the milk proteins specific IgE, by the RAST method. In infants (n = 80) fed with infant formula and less than 4 months old, if it obviously appeared an increase of the global IgE with the age, on the other hand, no one had specific IgE to the cow-milk proteins. The same methods were used in children presenting a clinical semiology of IPLV. It appeared these children could be separated in 2 groups according to the presence or the absence of extra-digestive symptoms (urticaria...). There is significant increase of the global IgE level and the first group, but not in the second one. The two main allergens more frequently implicated are the alpha-lactalbumin and the beta lactaglobulin. Meanwhile the RAST efficiency is better for the global allergen to the cow-milk. Meanwhile, the determination of the specific IgE to the milk PLV does not present a prognosis interest. In fact, the success of a milk proteins reintroduction is not necessarily correlated with a previous negativation of RAST.

Rectosigmoidoscopic findings during isolated rectal bleeding in the neonate

This study describes a group of 34 infants under 1 1/2 months of age presenting with isolated rectal bleeding not related to hemorrhagic disease of the newborn or to campylobacter infection and with spontaneously favorable evolution. Systematic rectosigmoidoscopy showed the presence of mucosal alterations in the form of either longitudinally stretched ecchymoses lying on a normal mucosa or diffuse ecchymotic patches dispersed on a congestive and friable mucosa, rarely associated to visible micro-ulcerations. Biopsies showed mucosal hemorrhage, capillary vessel congestion, and epithelial erosions, as well as various grades of inflammation. Clinical data indicate that this hemorrhagic colitis is a heterogeneous group where dietary protein intolerance may account for some cases.