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Résumé Objectifs L’objectif principal de cette étude était d’estimer la prévalence des conduites à risque et des symptômes dépressifs chez les adolescents consultant au service d’accueil des urgences (SAU) d’un hôpital général. L’objectif secondaire était de comparer cette prévalence en fonction des motifs d’admission. Méthode Étude observationnelle, monocentrique, menée de janvier à septembre 2013, à l’aide d’un questionnaire distribué à tous les adolescents de 12 à 18 ans se présentant au SAU pédiatrique. Les questions s’attachaient à décrire leur environnement, leur mode de vie, les conduites à risque et les symptômes évocateurs de dépression. Les patients ont été répartis entre trois groupes en fonction du motif initial d’admission : médical, traumatologique ou manifestation de souffrance psychique. Résultats Nous avons inclus 379 adolescents, de 15 ans d’âge médian. Ceux du groupe souffrance psychique différaient de façon significative sur les points suivants : vie avec un seul parent ou en foyer, suivi par un professionnel de la santé mentale et/ou par un éducateur, consommation régulière d’alcool, consommation en binge drinking , consommation plus élevée de cannabis et de tabac, fréquence des symptômes tels que douleurs abdominales, céphalées, dorsalgies, vertiges, des difficultés d’endormissement et consommation plus fréquente de médicaments à visée hypnotique et/ou anxiolytique. Ils avaient plus souvent fugué, eu des idées suicidaires et/ou fait des tentatives de suicide et présentaient plus de symptômes évocateurs de dépression. Dans les deux autres groupes, la fréquence de ces symptômes de dépression et/ou de conduites à risque était également très élevée. Conclusion Les SAU sont un endroit privilégié pour le repérage de situations à risque ou de signes de dépression dans la population adolescente, quel que soit le motif d’admission. Summary Objectives The main objective of this study was to estimate the prevalence of social and psychological problems, risk behaviors, and depression symptoms in a population of adolescents consulting in a Pediatric Emergency Department of a general hospital, and compare these according to the reasons for consulting. Methods Observational monocentric study, in the Pediatric Emergency Department of a general hospital in Britany, France, between January and September 2013, using a questionnaire dispensed to 12- to 18-year-old adolescents. The questions covered habits, school, symptoms, risk behaviors, and depression symptoms. Patients were classified into three groups based of the initial aim of the consultation: medical, traumatologic, and acute psychiatric. Results A total of 379 adolescents, median age: 15 years, were included. Adolescents from the “psychiatric” group resided significantly more often with only one of their parents or in a residential home; they were more often followed by an youth worker and/or a mental health professional such as a psychologist or a psychiatrist; consumed alcohol, cannabis, and/or tobacco more often; they complained more often of headache or abdominal and lumbar pain, dizziness, and sleep disorders; they consumed anxiolytic and hypnotic drugs more often; they ran away more often; and had signs of depression and/or suicidal ideation and behaviors. The prevalence of all these psychosocial and behavioral risks was also high in the two other groups. Conclusion The Pediatric Emergency Department is a good place to detect adolescents with behavioral problems and/or depression symptoms, even if this is not the initial purpose of admission. [ABSTRACT FROM AUTHOR]

Résumé Le cancer du testicule est peu fréquent chez l’adolescent mais représente la première cause de cancer solide des sujets de 15–30 ans. Nous rapportons l’observation d’un adolescent de 16 ans qui s’était présenté au service des urgences pédiatriques avec une masse du testicule évoluant depuis plusieurs mois et dont le diagnostic s’est avéré être un cancer testiculaire multi-métastatique. Or la précocité du diagnostic conditionne en grande partie le pronostic de ce cancer. Une revue de la littérature permet de faire le point sur les facteurs pronostiques, les causes de retard diagnostique et les pratiques actuelles concernant le dépistage de la maladie. Il n’existe à l’heure actuelle en France aucune recommandation officielle. Summary Testicular cancer is a rare disease in adolescents but is the leading cause of solid cancer in 15- to 30-year-old men. We report a clinical case of a 16-year-old who presented to the pediatric emergency unit with a testicular mass that had been enlarging for several months and the diagnosis turned out to be multimetastatic testicular cancer. However, early diagnosis largely determines the prognosis of this disease. A literature review enabled us to update the prognostic factors, the reasons for diagnostic delay, and current screening practices for this disease. There are currently no formal guidelines in France. [ABSTRACT FROM AUTHOR]

Summary: Bacterial tracheitis should be raised as a possible cause in cases of severe febrile dyspnea. It can be life-threatening due to airway obstruction or, less frequently, due to toxic shock syndrome. We report the observation of toxic shock syndrome-complicated bacterial tracheitis in a 14-year-old boy. We describe the signs and symptoms of these conditions as well as the principles of treatment. [ABSTRACT FROM AUTHOR]

Résumé Les troubles du sommeil chez l’adolescent peuvent avoir des conséquences à court et long terme (troubles de l’apprentissage, accidents, dépression, diabète de type 2…). Objectif Évaluer la prévalence des troubles du sommeil chez les lycéens du Finistère Sud. Rechercher les facteurs socio-familiaux et la consommation médicamenteuse associés à ces troubles. Méthode Étude observationnelle multicentrique, interrogeant les lycéens en mai 2015 par un questionnaire, complété anonymement sur le temps scolaire. Une variable : troubles du sommeil (TrS+) a été créée pour les adolescents répondant « souvent » ou « très souvent » à au moins un des six items relevant d’un problème de sommeil. Résultats La prévalence des TrS+ était de 73 % (4170/5556) ; 36 % avaient des difficultés d’endormissement, 33 % des réveils nocturnes, 10 % des cauchemars, 35 % se sentaient décalés, 49 % non reposés le lendemain et 9 % arrivaient de ce fait en retard au lycée. Les TrS+ étaient plus fréquents chez les adolescentes (fille odds ratio [OR] : 2,64 ; p < 0,0001), lorsque l’ambiance du lycée était mal vécue (OR : 2,64 ; p < 0,0001). Ils étaient corrélés à la consommation de tabac (> 10 cigarettes/jour ; OR : 2,39 ; p < 0,0001), d’alcool (> 1 fois/semaine ; OR : 1,4 ; p : 0,009) et de cannabis (< 1 fois/jour ; OR : 2,05 ; p : 0,009) et au temps quotidien passé devant un écran (> 8 h/jour ; OR : 2,7 ; p < 0,0001). Pour s’aider à s’endormir, 10 % parmi les TrS+ consommaient des médicaments et 9 % du cannabis. Conclusion Multimédia, drogues et bien-être scolaire ont un réel impact sur le sommeil des adolescents. Le dépistage de ces troubles et l’information des lycéens est à poursuivre par les professionnels de santé et de l’éducation. Summary Teenage sleeping disorders can have short- and long-term consequences such as learning disorders, accidents, depression, and type 2 diabetes. Objective To assess the prevalence of sleeping disorders in high school students in the southwest of Brittany (Finistère), France. To search for family and social factors causing these disorders and drug use. Method Observational multicenter study that took place in May, 2015, asking high school students to anonymously complete a questionnaire during school time. A variable was created: sleep disorders (TrS+) when teenagers responded “often” or “very often” to at least one of the six questions concerning sleeping disorders. Results The prevalence of TrS+ was 73 % (4170/5556). These teenagers had difficulty falling asleep (36 %), woke up during the night (33 %), or had nightmares (10 %). Their sleep routine was disrupted (35 %), they did not feel rested the following day (49 %): 9 % were late for class related to their sleeping disorders. TrS+ were more recurrent among females (OR: 2.64; P < 0.0001). A negative atmosphere in high school (OR: 2.64; P < 0.0001), tobacco use (> 10 cigarettes per a day) (OR: 2.39; P < 0.0001), alcohol (OR: 1.4, P = 0.009), marijuana (< 1 time per day; OR: 2.05; P = 0.009), and time spent using a computer or watching television (>8 h per a day; OR: 2.7; P < 0.0001) had an impact on their sleep quality. Ten percent of TrS+ individuals consume medications and 9 % cannabis to help them fall asleep. Conclusion Technology, drugs, and well-being at school have an impact on sleep quality. Screening of teenagers with sleeping disorders and information programs for teenagers must be provided by the teaching and medical staff. [ABSTRACT FROM AUTHOR]

Abstract: Hydrogels based on poly(ethylene glycol) (PEG) are of increasing interest for regenerative medicine applications and are ideal materials to direct cell function due to the ability to confer key functionalities of native extracellular matrix (ECM) on PEG''s otherwise inert backbone. Given extensive recent evidence that ECM compliance influences a variety of cell functions, PEG-based hydrogels are also attractive due to the ease with which their mechanical properties can be controlled. In these studies, we exploited the chemical and mechanical tunability of PEG-based gels to study the impact of ECM chemistry and mechanics on smooth muscle cells (SMCs) in both 2-D and 3-D model systems. First, by controlling the extent of crosslinking and therefore the mechanical properties of PEG-based hydrogels (tensile moduli from 13.7 to 423.9kPa), we report here that the assembly of F-actin stress fibers and focal adhesions, indicative of the state of actin contractility, were influenced by the compliance of 2-D PEG gels functionalized with either short adhesive peptides or full-length ECM proteins. Varying ECM ligand density and identity independent of gel compliance affected the physical properties of the focal adhesions, and also influenced SMC spreading in 2-D. Furthermore, SMCs proliferated to a greater extent as gel stiffness was increased. In contrast, the degree of SMC differentiation, which was qualitatively assessed by the extent of smooth muscle α-actin bundling and the association of calponin and caldesmon with the α-actin fibrils, was found to decrease with substrate stiffness in 2-D cultures. In 3-D, despite the fact that their viability and degree of spreading were greatly reduced, SMCs did express some contractile markers indicative of their differentiated phenotype when cultured within PEG–RGDS constructs. Combined, these data suggest that the mechanical and chemical properties of PEG hydrogels can be tuned to influence SMC phenotype in both 2-D and 3-D. [Copyright &y& Elsevier]

Summary: One of the numerous causes of abdominal pain, Fitz-Hugh-Curtis syndrome (FHC) can occur in the pediatrician population. Its rapid diagnosis and treatment can avoid long-term complications, such as extra-uterine pregnancy and infertility. We report a case of FHC in a 16-year-old female caused by Chlamydia trachomatis. We discuss the diagnosis, which can be easier with noninvasive methods including CT and laboratory tests. [Copyright &y& Elsevier]

Résumé La pyomyosite est une infection à pyogène d’un muscle strié. C’est une affection rare, survenant classiquement dans les pays tropicaux ou chez des sujets âgés immunodéprimés. Cependant, des cas récents de pyomyosite ont été recensés chez de jeunes enfants sains originaires de pays tempérés. Sa physiopathologie n’est pas encore bien comprise ; elle serait induite par une bactériémie transitoire provenant d’une source souvent indéterminée. De début insidieux, la pyomyosite nécessite un diagnostic rapide permettant à la fois d’instaurer précocement un traitement antibiotique, mais aussi de prévenir les complications septiques. Son expression clinique et biologique n’est pas spécifique. Il est donc important de garder en tête les diagnostics différentiels que sont l’ostéomyélite ou l’arthrite septique. L’imagerie par résonance magnétique est l’examen-clé qui permet le diagnostic. Nous présentons 2 cas de pyomyosite primaire chez un garçon de 8 ans et une fille de 11 ans. Summary Pyomyositis is a term used to denote primary pyogenic infection of a skeletal muscle. It is a rare disease that was first described in immunodeficient patients living in tropical climates. Lately, however, cases involving healthy children have been described in temperate climates. The origin of primary pyomyositis remains unclear, although it is thought to be caused by seeding from transient bacteremia. Onset of disease is insidious, therefore necessitating rapid diagnosis to successfully select appropriate antibiotic therapy and avoid complications. The signs and symptoms of pyomyositis are nonspecific, which highlights the importance of maintaining a broad differential diagnosis including disease entities such as osteomyelitis and septic arthritis. Magnetic resonance imaging is considered the best imaging modality for distinguishing pyomyositis from other potential etiologies. Here, we present two cases of primary pyomyositis of the lower limb muscles in an 8-year-old boy and in an 11-year-old girl. [ABSTRACT FROM AUTHOR]

Résumé Les douleurs ostéo-articulaires sont des motifs de consultation fréquents chez l’enfant et de causes variées, le plus souvent traumatiques, infectieuses ou inflammatoires. Les leucémies aigües (LA) peuvent parfois débuter par des signes ostéo-articulaires et l’imagerie par résonance magnétique (IRM) peut mettre en évidence des anomalies en faveur d’une hémopathie. Nous rapportons deux cas pédiatriques de LA révélés par des signes ostéo-articulaires pour lesquels l’IRM a permis d’orienter le diagnostic. Chez ces deux enfants, les premiers signes étaient des douleurs récidivantes, sans anomalie des bilans hématologiques initiaux. Un délai est intervenu entre l’apparition des arthralgies et le diagnostic du fait de la présentation atypique et peu spécifique de la maladie. Les IRM ont orienté les investigations et permis de poser le diagnostic de LA. Ainsi, la persistance de douleurs de type inflammatoire doit faire envisager une IRM osseuse et recontrôler le bilan sanguin afin de ne pas méconnaître le diagnostic de cette hémopathie. Summary Bone and joint pain are common causes of pediatric consultation for a variety of etiologies. The causes are mostly traumatic or infectious or have an inflammatory origin. Acute leukemia (AL) can sometimes begin with osteoarticular signs and radiological investigations such as magnetic resonance imaging (MRI) can help guide the diagnosis. We report on two cases of pediatric AL revealed by osteoarticular signs, with MRI helpful in the diagnostic procedure. In these children, the first signs were recurrent joint pain, with no blood count anomalies. There was a delay between the onset of arthralgia and diagnosis due to atypical presentation of the disease. MRI guided the investigations to the diagnosis of AL. The persistence of pain or inflammation must lead to considering a bone MRI and a complete blood count must be repeated in case of persistent inflammatory bone pain to avoid a missed diagnosis of blood disease. [ABSTRACT FROM AUTHOR]

Burgel P-R, Fajac I, Hubert D, Grenet D, Stremler N, Roussey M, Siret D, Languepin J, Mely L, Fanton A, Labbé A, Domblides P, Vic P, Dagorne M, Reynaud-Gaubert M, Counil F, Varaigne F, Bienvenu T, Bellis G, Dusser D. Non-classic cystic fibrosis associated with D1152H CFTR mutation. Background: Limited knowledge exists on phenotypes associated with the D1152H cystic fibrosis transmembrane conductance regulator ( CFTR) mutation. Methods: Subjects with a D1152H allele in trans with another CFTR mutation were identified using the French Cystic Fibrosis Registry. Phenotypic characteristics were compared with those of pancreatic insufficient (PI) and pancreatic sufficient (PS) cystic fibrosis (CF) subjects in the Registry (CF cohort). Results: Forty-two subjects with D1152H alleles were identified. Features leading to diagnosis included chronic sinopulmonary disease ( n = 25), congenital absence of the vas deferens ( n = 11), systematic neonatal screening ( n = 4), and genetic counseling ( n = 2). Median age at diagnosis was 33 [interquartile range (IQR, 24–41)] years in D1152H subjects. Median sweat chloride concentrations were 43.5 (39–63) mmol/l in D1152H subjects and were markedly lower than in PI and PS CF subjects (p < 0.05). Bronchiectasis was present in 67% of D1152H subjects, but Pseudomonas aeruginosa colonization and pancreatic insufficiency were present in <30% of subjects. Estimated rates of decline in forced expiratory volume in 1 s (FEV1) were lower in D1152H subjects vs PI CF subjects (p < 0.05). None of the D1152H subjects identified since 1999 had died or required lung transplantation. Conclusions: When present in trans with a CF-causing mutation, D1152H causes significant pulmonary disease, but all subjects had prolonged survival. [ABSTRACT FROM AUTHOR]

Background: International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease (COPD). Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed.Methods: Endobronchial biopsy (EBB) specimens from patients with a clear clinical diagnosis of asthma and COPD (50 per group) were examined by three pathologists in a double blind manner. They were asked to propose a pathological diagnosis of either asthma or COPD and to analyse qualitatively the most frequent abnormalities reported in the literature.Results: The sensitivity and specificity of EBB ranged from 36% to 48% and from 56% to 79%, respectively. Eosinophils strongly biased the pathological diagnoses in favour of asthma, whereas their estimated prevalence was similar (11-37% in asthma and 13-41% in COPD). Metaplasia (11-39% in COPD, 1-18% in asthma) and epithelial inflammation (28-61% in COPD, 11-38% in asthma) tended to be specific to COPD, whereas epithelial desquamation (80-98% in asthma, 61-88% in COPD) and basement membrane thickening (71-94% in asthma, 53-88% in COPD) tended to be associated with asthma. There was acceptable intra- and inter-observer agreement only for metaplasia and epithelial eosinophils.Conclusions: Specific histopathological features of asthma and COPD probably exist, but current routine analysis procedures to assess EBB specimens are not sufficiently discriminatory. This might be rectified by improving pathological definitions. [ABSTRACT FROM AUTHOR]