Effects of an early postnatal treatment of hypogonadotropic hypogonadism with a continuous subcutaneous infusion of recombinant follicle-stimulating hormone and luteinizing hormone

BACKGROUND

The neonatal-midinfancy surge in pulsatile gonadotropin secretion is attributable to an increase in GnRH pulse amplitude and is associated with a rapid expansion of Leydig and Sertoli cell populations with concomitant surges in testosterone, inhibin, and anti-Mullerian hormone production as well as an increase in testicular volume. Boys with congenital hypogonadotropic hypogonadism (HH) do not activate these processes. A potential cause for azoospermia and infertility in adult life is deficient proliferation of immature Sertoli cells before and during puberty due to the absence of FSH.

OBJECTIVE

The objective of the study was to investigate whether early postnatal continuous sc infusion of gonadotropins could mimic the physiological growth of testes and to evaluate responses of the Leydig and Sertoli cells to early gonadotropin replacement.

DESIGN AND METHODS

Two neonates (P1 with hypotuitarism and P2 with HH) with micropenis and microorchidism were treated for 6 months with high doses of recombinant LH and FSH (a gift of Luveris and Gonal-F from Serono, Lyon, France) delivered sc with an insulin pump.

RESULTS

Gonadotropin continuous sc infusion increased mean serum LH and FSH to normal or supranormal levels. Mean testosterone increased from undetectable levels to 7.6 and 5.2 nmol/liter, respectively, in P1 and P2. Inhibin B and anti-Müllerian hormone increased to normal levels. Mean testicular volume increased from 0.45 to 0.57 ml at birth to 2.10 ml at 7 months. Stretched penile length increased from 8 to 30 mm (P1) and 12 to 48 mm (P2).

CONCLUSIONS

The present regimen induced physiological postnatal testes growth and high-normal activation of Leydig and Sertoli cells.

Sédation au pentobarbital par voie rectale pour enregistrement des PEA chez l'enfant

OBJECTIVES

The aim of our study was to determine if rectal sedation with pentobarbital sodium provides safe and effective sedation for children undergoing auditory brainstem response (ABR) testing.

MATERIAL AND METHODS

A prospective study was conducted in the ENT pediatric department of Robert Debre's hospital (APHP, Paris). 68 children under 8 years of age were given rectal pentobarbital for ABR testing at a dosage of about 5 mg/kg.

RESULTS

61 children of 68 (89.7%) were adequately sedated with rectal pentobarbital. The mean elapsed time from drug administration to full sedation was 36,1 minutes. No adverse event was reported in 84.1% of children.

CONCLUSION

Pentobarbital provides safe and effective sedation. Rectal administration is easy, painless and with brief duration of action. It's a good alternative to general anesthesia for young children undergoing ABR testing.

[Current management of acute pediatric rhinosinusitis in France]

Un groupe de médecins généralistes et multidisciplinaire de spécialistes contribue à définir les différentes formes de sinusites ou rhinosinusites aiguës de l'enfant à partir des principaux symptômes et signes cliniques. Le rôle des pathologies associées telles que l'allergie, les troubles immunitaires est envisagé. L'incidence, la présentation clinique et la prise en charge des complications sont présentées. Les indications des examens radiologiques et biologiques sont analysées. La prise en charge médicale en particulier, la place et le type des antibiotiques sont discutés. Des propositions de prise en charge selon des situations cliniques rencontrées en pratique sont présentées.

[Snoring in children]

Only snoring loud enough to be heard behind a closed door have to be investigated and treated. Snoring is severe when associated with sleep apneas. The 3 most frequent causes of snoring in children are enlarged adenoids, enlarged tonsils and blocked nose due to allergic rhinitis.

Ethmoïdites aiguës extériorisées de l'enfant : à propos d'une série de 125 cas

Acute ethmoiditis are bacterial infections of ethmoid sinuses, which may spread to the orbital or the endocranial spaces. It is essential to fit the antibiotherapy to the bacteria responsible for these infections.

POPULATION AND METHODS

The charts of children hospitalized from 1995 to 2003 for an acute ethmoiditis were reviewed, particularly the results of bacterial exams and the antibiotics delivered.

RESULTS

Over this 9-year period, 125 children (mean age 4.5 years) were hospitalized for acute ethmoiditis. Eighty were checked for blood cultures, which were sterile in 73 cases, and in the other cases, grew Staphylococcus, S. Pneumoniae or Streptococcus pyogenes. Seric soluble antigens were absent in the 5 cases where they were looked for. Ten children had a puncture of a subperiostal abscess: it was sterile in 5 cases, Staphylococcus was found in 4 cases, S. pneumoniae in the last case. Most children received an association of cefotaxim and fosfomycine for a mean duration of 5.6 days. Thirteen per cent of the children received 3 or 4 antibiotics.

DISCUSSION

It is always difficult to found the bacteria responsible for an acute ethmoiditis. In our serie as in others, the most frequent bacteria were Staphylococcus, S. pneumoniae and S. pyogenes.

CONCLUSION

In view of the bacteria responsible for these infections and their antibiotic resistance, we suggest the association of cefotaxim and fosfomycin for the first line of treatment of acute ethmoiditis.

[Tonsillectomy in 2005]

During the past years, the number of tonsillectomies (only palatine tonsils are taken off) has decreased, indications for surgery have changed. A multi-disciplinal group of paediatricians tried to elaborate the state of the art in the field. Tonsils are the first line defense of high respiratory tract. The immune functions of their lymphoid tissue are multiple: mucosal antigens capture, presentation to lymphocytes, antigens specific proliferation of lymphocytes T and B, differentiation of lymphocytes in effectors lymphocytes and immune lymphocytes. Epithelial cells on the tonsils' surface express non-specific defense. These facts explain partly tonsils' hypertrophy. Tonsillectomy has no general immune consequences. In 2002, in France, 75,000 tonsillectomies were realized, of which 90% were in children. Tonsil's hypertrophy is the major indication, mandatory when sleep apnoeas exist. The main historical tonsillectomy indication for recurrent tonsillitis should decrease due to a more precise diagnostic (rapid test at bed site), an efficient antibiotics therapy and better care for pain. Other indications are scarce. Surgery, feasible from 9 months of age, requires a brief general anaesthesia and has very few contra-indications. The technique, operator dependent, relies on his experience. The only potentially severe complication is an haemorrhage due to scab fall between the eighth and twelfth days. It requires explanation and a written note given to parents. The possibility of lack of feeding and voice modification, usually transitory, should be known. Multiple consequences of tonsillectomy especially allergy have been alleged. Since the years 1980, it is well established that pre-existing allergy or asthma are not a contraindication. More, its deleterious impact on allergic children has not been demonstrated. Last, a gain of weight post-tonsillectomy is possible and could become a risk if excessive.

Gestion en temps réel d'un réseau d'assainissement : vérification de l'optimalité et de l'applicabilité de la théorie des graphes par rapport à la programmation linéaire mixte

Dans le cas de la gestion en temps réel des réseaux d'assainissement, la première étape peut, par exemple, consister à vérifier qu'une manipulation des organes de contrôle tels que les vannes et pompes est capable de minimiser les déversements vers le milieu naturel. Cette gestion, que l'on appellera " gestion de référence ", permet de déterminer les stratégies de commande sur toute la durée de l'événement pluvieux connu à l'avance. Ce calcul se fait donc à la fin de l'événement pluvieux et permet de dire ce qui aurait pu être fait avec les organes de régulation en terme de minimisation des volumes déversés. La programmation linéaire par les graphes et la programmation linéaire mixte permettent de déterminer une solution optimale. Cet article s'intéresse à la vérification de l'optimalité et à l'applicabilité de la programmation linéaire par les graphes comparée à la programmation linéaire mixte dans le cas de la " gestion de référence " sur le réseau d'assainissement de Saverne (France). En comparant les volumes déversés par ces deux techniques d'optimisation sur 34 événements pluvieux, nous pouvons confirmer que l'approche par les graphes ne donne pas toujours le minimum global. Les résultats ont montré que la programmation linéaire mixte fournit des temps de calcul qui peuvent atteindre plus de 24 heures. Par contre, l'approche par les graphes permet un temps de calcul de l'ordre de 5 minutes en moyenne avec un minimum global en terme de volume déversé atteint qui n'excède pas 5% par rapport à la solution fournie par la programmation linéaire mixte.

[Treatment of tonsillitis]

Tonsillitis is a frequent infection. Most of cases are viral and require only symptomatic treatment. Tonsillitis due to Corynebacterium diphteriae, Neisseria gonorrhoeae and Fusospirochetosis require specific treatment. Antibiotic treatment of streptococcal tonsillitis is needed to avoid suppurative and non suppurative complications such as rhumatoid fever.

[Recurrent respiratory tract infections: how should we investigate and treat?]

Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful.

Determination of single-crystal elasticity constants in a cubic phase within a multiphase alloy: X-ray diffraction measurements and inverse-scale transition modelling

The scope of this work is the determination of single-crystal elastic properties from X-ray diffraction stress analysis performed on multiphase polycrystals. An explicit three-scale multiphase inverse self-consistent model is developed in order to express the single-crystal elasticity constants of a cubic phase as a function of its X-ray elasticity constants. The model is verified in the case of single-phase materials. Finally, it is applied to a two-phase (α+β) titanium-based alloy (Ti-17) and, as a result, the Ti-17 β-phase single-crystal elasticity tensor is estimated.

Peroxisome proliferator-activated receptor gamma and its ligands in controlling interleukin-1beta target gene expression: A confusing story

Antiinflammatory effects by peroxisome proliferator-activated receptor gamma (PPARgamma) agonists have been previously reported. However, PPARgamma dependency and the molecular mechanism involved in these effects require more investigation to clearly demonstrate whether PPARgamma is a key modulator of the antiinflammatory process. This would permit the design of more specific agonists or antagonists able to address the gamma subtype without cross reactions with other transcription factors, thus preventing undesirable side effects. However, several hurdles need to be taken into consideration, such as the coexpression of several PPAR isotypes in the same cell type. As PPARgamma and -alpha seem to play equal antiinflammatory roles, determining the subset of specific PPAR subtype target genes appears to be crucial. The work described here is our current understanding of the modulations of interleukin-1 target gene expression by PPARgamma and its ligands.

Mesoscopic residual stresses of plastic origin in zirconium: interpretation of X-ray diffraction results

Complementary methods have been used to analyse residual stresses in a heat-treated Zr702 sheet which had undergone uniaxial plastic deformation: X-ray diffraction and self-consistent models. The elastoplastic self-consistent model has been used to simulate the experiments and exhibits agreement with experimental data. X-ray diffraction analysis in the rolling direction shows opposite stress values for {10\bar{1}4} and {20\bar{2}2} planes, respectively. The measured strains were generated by an anisotropic plastic deformation. The comparison between ∊ϕψversussin2ψ and simulations confirms that prismatic slip is the main active deformation mode. Plastic incompatibility stress in X-ray measurements should be taken into account in order to make a correct interpretation of the experimental data.

Laryngotrachéoplastie avec quadrisection du cartilage cricoïde chez l’enfant

Four-quadrant cricoid division in laryngotracheal reconstruction is indicated in case of very tight laryngotracheal stenosis. The principle of this operation is to section the anterior, posterior and lateral walls of the cricoid and to increase the diameter of the laryngeal lumen by interposition of a cartilaginous graft in the anterior and/or posterior cricoid wall.

MATERIAL AND METHODS

From 1991 to 2001, 25 children underwent a laryngotracheoplasty with four-quadrant cricoid division. Two techniques were used: a single-stage procedure with a 10 days post-operative intubation (n=6), or a two-stage procedure with prolonged post-operative intraluminal stenting and tracheostomy (n=19).

RESULTS

In the two-stage procedure the decannulation rate was 89% (17/19) after the first operation, and 100% after revision surgery using the same technique. In the single-stage procedure the extubation rate was 83.3% (5/6).

CONCLUSIONS

Laryngotracheal reconstruction with four-quadrant cricoid division gives excellent airway patency especially in case of severe subglottic stenosis with altered laryngeal mobility. The single-stage procedure decreased the tracheostomy related morbidity. This technique is particularly adapted to children under three.

Adénites cervicales suppurées chez l’enfant

OBJECTIVE

To review the bacteriological features and treatment of suppurative cervical lymphadenitis in children in order to achieve optimal treatment.

PATIENTS AND METHODS

Forty-five children were hospitalized. Time of hospitalization was evenly distributed over Year and between Years. Age ranged from 2.5 Months to 13.5 Years (median 1 Year 10 Months). Twenty-nine patients had received prior antibiotic treatment. Bacteriological samples were sterile in 15 out of 45 children and were positive for Staphylococcus (all meti-S) in 20. Cefotoxim and fosfomycin were prescribed and was sufficient in 14 children (with needle aspiration). Surgical drainage was performed in the other cases.

CONCLUSION

Staphylococcus aureus is the predominant causal agent for acute suppurative lymphadenitis in children. Antibiotic therapy in the outpatient setting does not always prevent abscess formation and surgical drainage may be required.