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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]

Head and neck biopsies usually have a low diagnostic value in Wegener's granulomatosis (WG). On the basis of 49 biopsies obtained from 21 WG patients at diagnosis from various sites, i.e. nose (29), paranasal sinus (7), oral cavity (4), larynx (4), conjunctiva (3) and external ear (2), we described the suggestive histological features and studied the diagnostic potential of the biopsy size, anaesthesia method (general (GA) or local (LA)), anatomic region of the biopsy, number of sections, and presenting macroscopic manifestations. Associated granulomatous inflammation (scattered giant cells, 28.5% of biopsies; poorly-formed granulomas, 28.5%), necrosis (neutrophilic microabscesses, 16.3%; geographic necrosis, 18.3%), angiitis (leukocytoclastic, 10%; necrotizing, 12%; and granulomatous, 6%) which confirmed the diagnosis were only present in 18.3% of the biopsies (28.5% of the patients). We think it is possible to propose a "WG-compatible" diagnosis when at least one of these histological features is present (24.5% of biopsies, 26% of patients in our study). We found that it was always better to perform biopsies targeted on macroscopic lesions. When there was no lesion, samples from paranasal sinuses obtained under GA had the highest diagnostic value in the head and neck region, whereas 90% of nasal systematic biopsies performed under LA were nonspecific. Moreover, we demonstrated that performing two further sections increased the sensitivity of histological examination by 7%.

An aminoglycoside in association with beta-lactam antibiotic are usually the most efficient treatment for Pseudomonas aeruginosa infections in cystic fibrosis patients. Tobramycin has the lower MICs than the other aminoglycosides to Pseudomonas aeruginosa. The aim of the work was to compare pharmacokinetics of tobramycin after once daily (15 mg/kg/day; 11 patients) or thrice daily dose (5 mg/kg/day; 9 patients) in combination ceftazidime (CAZ 200 mg/day in 3 inj. IVD) in sputum and sera for two weeks. No statistical difference in the serum concentration obtained in each group of patients was observed between the first and the 14th day. Serum concentrations were three fold higher when tobramycin was administered in once daily dose. Low through concentrations were quickly obtained, but they were slightly higher after thrice daily doses. Bronchial concentrations were 2 to 2.5 superior and near the critical concentration of tobramycin. The clinical efficacy were comparable in the two regimens.

Background: Vertebral compression is rarely the first manifestation of acute leukemia (AL) in children., Case Report: Three children, 13, 4 and 13 years of age respectively, suffered from recent and persistent back pain. The first patient was considered as having psychosomatic problems despite thrombocytopenia at the first examination. The second patient was also pale with hematoma on his legs so that AL could be rapidly recognised. An initial diagnosis of Scheuermann disease was proposed for the third patient in whom hemogram was performed due to worsening of his general condition. The three patients had extended vertebral demineralisation on the first X-rays., Conclusion: Causes of back pain in children are often organic at this age of life. They must be searched by suitable examinations.

The interest of the treatment with a single daily dose of amikacin (AMK) in cystic fibrosis (CF) patients with P. aeruginosa infections has been much debated. The aim of work was to study the efficiency of this treatment on (CF) patients with chronic bronchopulmonary P. aeruginosa infections previously treated for two weeks with the combination ceftazidime (CAZ 200 mg/day in 3 inj. IVD) and AMK (35 mg/day in one IV perf. of 30 minutes). The bacteriological supervision of this treatment was performed 1: by the determination of MICs before and after treatment, 2: by the decrease of P. aeruginosa colonization immediately after this treatment and during 11 months, 3: by the identification of P. aeruginosa strains with phenotypic methods (serotyping and antibiotyping) and with genotypic method (pulsed field gel electrophoresis). The use of AMK in a single daily dose in order to treat chronic lung infections colonized with P. aeruginosa susceptible to this antibiotic shows encouraging results as far as bacteriology is concerned: this treatment has given means to reduce colonization for a month in 15 of 18 patients. For 9 of the 18 patients, no P. aeruginosa strains were isolated for nine months. The serotyping and antibiotyping systems do not enable us to study the P. aeruginosa epidemiology. Genome macrorestriction fingerprinting of P. aeruginosa in pulsed field gel electrophoresis confirms that patient with CF were colonized with one or several clones. In our study no variation of these clones was noticed for the first eleven months. Genome macrorestriction fingerprinting appears to be one of the most effective methods for delineate strains of P. aeruginosa colonizing CF patients.