Search

Management of unresectable pediatric hepatoblastoma (HB) and hepatocellular carcinoma (HCC) remains challenging. The Society of Pediatric Liver Transplantation (SPLIT) database was used to study survival predictors in pediatric liver transplantation (LT) for HB and HCC. Event-free survival (EFS), associated risk factors, and postoperative complications were studied in children requiring LT for HB/HCC at 16 SPLIT centers. Three-year EFS was 81% for HB (n = 157) and 62% for HCC (n = 18) transplants. Of HB transplants, 6.9% were PRETEXT II and 15.3% were POST-TEXT I/II. Tumor extent did not impact survival (p = NS). Salvage (n = 13) and primary HB transplants had similar 3-year EFS (62% versus 78%, p = NS). Among HCC transplants, 3-year EFS was poorer in older patients (38% in ≥8-year-olds vs 86%8-year-olds) and those with larger tumors (48% for those beyond versus 83% within Milan criteria, p = NS). Risk of infection (HR 1.5, 95% CI 1.1-2.2, p = .02) and renal injury (HR 2.4, 95% CI 1.7-3.3, p .001) were higher in malignant versus nonmalignant LT. Survival is favorable for pediatric HB and HCC LT, including outcomes after salvage transplant. Unexpected numbers of LTs occurred in PRE/POST-TEXT I/II tumors. Judicious patient selection is critical to distinguish tumors that are potentially resectable; simultaneously, we must advocate for patients with unresectable malignancies to receive organs.

Resume Introduction La tuberculose neuromeningee est une forme rare de tuberculose, mais reste une des presentations de plus mauvais pronostic. La survenue d'infarctus cerebraux dans ce contexte est un facteur aggravant. Observation Un homme asiatique de 48 ans se presentait aux urgences pour une dysarthrie accompagnee de troubles de la deglutition, d'installation rapidement progressive. Le scanner cerebral objectivait une lacune ischemique recente de la capsule interne droite. La ponction lombaire montrait une meningite a liquide clair hypoglycorachique. Des images thoraciques micronodulaires faisaient evoquer le diagnostic de tuberculose, qui etait confirme par le lavage broncho-alveolaire. Une quadritherapie antituberculeuse et une corticotherapie permettaient d'obtenir une amelioration clinique en quelques semaines. Conclusion Les infarctus cerebraux lors des tuberculoses neuromeningees sont des evenements dont il ne faut sous-estimer ni la frequence ni la gravite. Leur mauvais pronostic est du en partie a une prise en charge mal definie, qui associe traitement antituberculeux et corticotherapie precoce.

Resume Introduction L’hyperkaliemie necessite une prise en charge rapide, notamment symptomatique a visee cardio-protectrice. A cote des causes facilement evoquees telles l’insuffisance renale, l’insuffisance surrenalienne, la lyse cellulaire ou les causes iatrogenes, celle d’une fausse ou pseudo-hyperkaliemie l’est moins et ne doit pas etre oubliee. Observations Trois patients (1 homme, 2 femmes, âges de 78, 84, 88 ans) pris en charge pour thrombocytose (entre 1306 et 2404 G/L) et hyperkaliemie non symptomatique (entre 6,1 et 7,7 mmol/L) sont rapportes. La kaliemie de controle sur tube heparine etait normale (entre 4,4 et 4,6 mmol/L). Il n’a donc pas ete necessaire d’instaurer de traitement specifique a cette pseudo-hyperkaliemie. Conclusion L’association thrombocytose et hyperkaliemie non symptomatique doit faire evoquer le diagnostic de pseudo-hyperkaliemie et faire imperativement realiser un controle de la kaliemie sur tube heparine. La reconnaissance de ce diagnostic est importante afin de ne pas instaurer un traitement non necessaire et potentiellement deletere.

Hyperkalemia is common in medicine and requires rapid management. Besides the easily evoked causes such as renal failure, adrenal insufficiency, cell lysis or iatrogenic causes, false or pseudo-hyperkalemia should not be forgotten.Three patients (1 man, 2 women, aged 78, 84, 88) were managed for thrombocytosis (between 1306 and 2404 G/L) and non-symptomatic hyperkalemia (between 6.1 and 7.7mmol/L) are reported. Kalemia on blood collected in heparin tube was normal (4.4-4.6mmol/L). Therefore, no specific treatment for this pseudohyperkalemia was required.The combination of thrombocytosis and non-symptomatic hyperkalemia should suggest the diagnosis of pseudohyperkalemia and should prompt for a control of kalemia on blood collected in heparin tube. The recognition of this diagnosis is important in order to avoid unnecessary and potentially deleterious treatment of hyperkalemia.

Resume Introduction Une consultation dediee aux professionnels de sante symptomatiques a ete ouverte au debut de l'epidemie de COVID-19, afin de repondre aux besoins specifiques de cette population. L'objectif de ce travail etait d'estimer la frequence du portage nasopharynge du SARS-Cov-2 chez les personnels de sante symptomatiques suspects de COVID-19, et de determiner les facteurs associes a ce portage. Methodes Etude descriptive des caracteristiques cliniques et epidemiologiques des consultants, conduite du 5 mars au 17 avril 2020. Le recueil des donnees cliniques et des resultats du test RT-PCR a ete conduit a l'aide de formulaires standardises. Resultats Des 522 consultants, 308 exercaient a l'Hopital et 214 a l'exterieur. Ils avaient des formes benignes de COVID-19 et des signes cliniques non specifiques a l'exception de l'agueusie/anosmie, significativement plus frequente chez ceux avec RT-PCR positive. Le taux de positivite de la RT-PCR etait globalement de 38 %, sans difference significative selon la profession, superieur chez les consultants exterieurs (47 % versus 31 %). A l'hopital, ce taux etait significativement moindre pour les personnels symptomatiques des secteurs de soins, compare aux personnels des plateaux techniques et laboratoires (24 %, versus 45 %, p = 0,006 et 54 %, p Conclusions Ces donnees confirment l'impact fort du COVID-19 sur les professionnels de sante. Les taux de positivite plus eleves chez les professionnels symptomatiques exercant en dehors de l'hopital, comparativement a ceux exercant a l'hopital, pourraient s'expliquer en partie par une penurie en equipements de protection et par des difficultes d'acces au diagnostic virologique, qui etaient plus importants en dehors de l'hopital quand l'epidemie a commence.

Résumé Introduction Une consultation dédiée aux professionnels de santé symptomatiques a été ouverte au début de l'épidémie de COVID-19, afin de répondre aux besoins spécifiques de cette population. L'objectif de ce travail était d'estimer la fréquence du portage nasopharyngé du SARS-Cov-2 chez les personnels de santé symptomatiques suspects de COVID-19, et de déterminer les facteurs associés à ce portage. Méthodes Étude descriptive des caractéristiques cliniques et épidémiologiques des consultants, conduite du 5 mars au 17 avril 2020. Le recueil des données cliniques et des résultats du test RT-PCR a été conduit à l'aide de formulaires standardisés. Résultats Des 522 consultants, 308 exerçaient à l'Hôpital et 214 à l'extérieur. Ils avaient des formes bénignes de COVID-19 et des signes cliniques non spécifiques à l'exception de l'agueusie/anosmie, significativement plus fréquente chez ceux avec RT-PCR positive. Le taux de positivité de la RT-PCR était globalement de 38 %, sans différence significative selon la profession, supérieur chez les consultants extérieurs (47 % versus 31 %). À l'hôpital, ce taux était significativement moindre pour les personnels symptomatiques des secteurs de soins, comparé aux personnels des plateaux techniques et laboratoires (24 %, versus 45 %, p = 0,006 et 54 %, p

Resume Propos Les epidemies de grippe annuelles demeurent une cause majeure de maladie et mortalite specialement chez le sujet âge. La vaccination annuelle est le moyen le plus efficace pour prevenir la maladie, reduire les hospitalisations et les deces lies a la grippe dans la population âgee. Les objectifs de l’etude etaient d’evaluer la couverture vaccinale antigrippale et sa tracabilite chez des sujets âges hospitalises. Methodes Enquete « un jour donne », multicentrique incluant les patients âges de 75 ans et plus, hospitalises dans des services de medecine, maladies infectieuses et geriatrie aigue. Resultats D’avril a mai 2011, 903 patients ont ete inclus (63 services de 28 centres hospitaliers) d’âge moyen 85 ans : 82 % vivaient auparavant a domicile et 13 % en institution. Ils etaient majoritairement polypathologiques (77 %) et dans 21 % des cas admis pour une pathologie respiratoire, 58 % etaient vaccines contre la grippe. Il existait un support de tracabilite dans 53 % des cas. Le refus du patient serait un determinant frequent de non-vaccination, comme l’absence de proposition par le medecin traitant. Le taux de vaccination ne differait pas selon le lieu de vie habituel y compris dans les structures d’hebergement geriatrique. Conclusion La couverture vaccinale antigrippale est insuffisante chez les patients tres âges hospitalises. La tracabilite est mauvaise. Cette inobservance vaccinale en majorite liee au refus des patients, probleme preoccupant de sante publique, doit conduire a une sensibilisation des medecins traitants mais aussi des equipes hospitalieres, et institutionnelles, en vue d’une strategie pluriprofessionnelle preventive exemplaire face a l’exces de risque de morbidite infectieuse.

Introduction La fluticasone, glucocorticoide utilise sous forme inhalee et nasale pour le traitement de l’asthme et de la rhinite allergique, est metabolise au niveau hepatique par le cytochrome P450. Le ritonavir, inhibiteur de la protease du VIH, agit egalement comme inhibiteur de plusieurs isoenzymes du cytochrome P450. Cette propriete explique les nombreuses interactions medicamenteuses rapportees avec ce medicament. Observations Deux cas de syndrome de Cushing avec insuffisance surrenalienne associes a la prise concomitante de ritonavir oral a faible dose et de fluticasone inhalee a posologie moderee a forte sont rapportes. Conclusion Ces observations soulignent que l’association fluticasone et ritonavir doit etre evitee de meme que l’association de la fluticasone a d’autres medicaments inhibiteurs du cytochrome P450.

International audience; Background - Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. Methods - To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. Results - Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. Conclusions - Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. Clinical trials registration - CCTIRS 10.150 and CNIL DR-2010-379.

Herpes simplex encephalitis is rarely caused by herpes simplex virus type 2 (HSV-2) after the neonatal period. The pathogenesis of HSV-2 encephalitis is not known and its treatment has not been discussed. We report a case of mild meningoencephalitis secondary to HSV-2 primary infection after sexual risk behaviour in a healthy young man. The diagnosis was established upon clinical, biological and electroencephalographic criteria. Aciclovir treatment led to rapid clinical improvement. This case highlights HSV-2 as a rare cause of meningoencephalitis, and questions the management of this rare manifestation of HSV-2 infection.

WOS: 000340538700017, PubMed ID: 24789652, The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

Annual influenza epidemics is still a major cause of illness and mortality especially in the elderly. Annual vaccination is the most effective way to prevent disease and reduce hospitalizations and deaths related to influenza in the elderly population. In France, there are few data available about vaccination coverage of elderly at risk for influenza. The aim of the study was to measure the influenza vaccination coverage and assess traceability in the elderly (≥ 75 years old) admitted to hospital.In participating French hospitals, each patient aged 75 years or more, hospitalized in acute units of internal medicine, geriatric and infectious disease, was included in a multicentric point prevalence survey.Between April and May 2011, 63 departments of 28 hospitals participated and 903 patients were included (mean age of included patients: 85 years): 82% were previously living at home and 13% were institutionalized. Most of them had multiple diseases (77%) and 21% were admitted for a respiratory disease: 58% were vaccinated against influenza. A back-up for traceability was identified in 53% of cases. Patient refusal may be a common determinant of non-vaccination, as well as non-proposal by the attending physician. The vaccination rate did not differ according to usual living place including accommodation facilities in geriatric.Coverage for influenza vaccination is low in hospitalized elderly patients and traceability is insufficient. This vaccine, noncompliance mostly linked to the refusal of patients, is a worrisome public health problem, on which physicians and hospital staff in charge, as well as institutions, should turn attention toward a multi-professional preventive strategy against the morbidity risk of this infectious disease.

Background. Abdominal pain in children receiving chemotherapy for cancer presents the clinician with unique problems due to the altered immunity of these patients or to the oncologic setting. The major clinical decisions regarding these patients are to determine if and when operative intervention is indicated. Methods. A retrospective study was done to examine the clinical, radiographic, and laboratory findings that indicate the need for surgical intervention. Sixty-eight of 1090 children who underwent treatment for cancer from October 1982 to December 1990 developed abdominal complaints requiring them to be hospitalized. Nineteen of these patients underwent exploratory laparotomy (operative), and the other 49 were observed (nonoperative). Results. No significant differences were observed in the phase of chemotherapy, treatment with vincristine or corticosteroids, or the hematologic indices between the operative and nonoperative groups. Eighteen of nineteen patients survived their surgeries. Seventeen (89%) of these laparotomies were positive based on the surgical pathology and the operative report. Peritoneal signs on physical examination (P < 0.001) or pneumatosis intestinalis on abdominal radiographs correlated with positive laparotomies (P = 0.001). Conclusions. Peritoneal signs on physical examination or pneumatosis intestinalis on abdominal X-rays were associated with and specific for the presence of

Multidrug-resistant tuberculosis (MDR-TB) management is based on specific WHO guidelines.The authors report MDR-TB management, in three French hospitals.The authors retrospectively included patients with positive sample for multidrug-resistant Mycobacterium tuberculosis (isoniazid+rifampicin) from January 1, 2000 to December 31, 2005. The management was compared to the French and international prevalent guidelines.Sixteen patients were initially managed for MDR-TB by eight different medical teams over 6 successive years: 12 (75%) presented with primary MDR-TB. Management advice from the national referee center (NRC) for tuberculosis was reported in seven out of 14 treated cases. The median length of the intensive treatment was 2 months (IQR: 1-3). Eight patients (58%) had an overall treatment length of 18 months. The median number of effective drugs prescribed was 4 (IQR: 4-5). Nine patients (64%) were also managed in a sanatorium. Only eight patients (57%) completed the prescribed treatment. Nine patients were clinically cured and still followed-up, six of whom were bacteriologically cured.TB-MDR management was not conform to WHO guidelines in our study. Management in a sanatorium, NRC involvement, ambulatory DOT were highly beneficial.

Fluticasone is a corticosteroid drug which is used in inhaled and nasal formulations for the treatment of asthma and allergic rhinitis. It is metabolized in the liver by the cytochrome P450. Ritonavir, an inhibitor of the HIV protease, also acts as an inhibitor of several isoenzymes of the P450 cytochrome. This property explains the many drug interactions observed with this agent.We report two cases of Cushing's syndrome with adrenal insufficiency associated with the combined administration of oral low dose ritonavir and moderate to high dose inhaled fluticasone.These observations highlight the fact that the combined administration of fluticasone and ritonavir must be avoided as well as the combined administration of fluticasone and other inhibitors of the cytochrome P450.

A case of intracranial mixed malignant germ cell tumor (GCT) in a patient with the Klinefelter syndrome (KS) is reported. Extragonadal GCTs, including those of intracranial origin, have previously been noted in KS patients. A review of the English literature suggests that although this phenomenon is rare, there appears to be more than a coincidental relationship between GCTs and a 47,XXY karyotype. This case represents the sixth reported case of intracranial GCT in KS but the first to be histologically confirmed to have mixed malignant germ cell elements. This occurrence of malignant cell types in a KS patient emphasizes the need for a histologic diagnosis prior to initiation of therapy.

Abdominal pain in children receiving chemotherapy for cancer presents the clinician with unique problems due to the altered immunity of these patients or to the oncologic setting. The major clinical decisions regarding these patients are to determine if and when operative intervention is indicated.A retrospective study was done to examine the clinical, radiographic, and laboratory findings that indicate the need for surgical intervention. Sixty-eight of 1090 children who underwent treatment for cancer from October 1982 to December 1990 developed abdominal complaints requiring them to be hospitalized. Nineteen of these patients underwent exploratory laparotomy (operative), and the other 49 were observed (nonoperative).No significant differences were observed in the phase of chemotherapy, treatment with vincristine or corticosteroids, or the hematologic indices between the operative and nonoperative groups. Eighteen of nineteen patients survived their surgeries. Seventeen (89%) of these laparotomies were positive based on the surgical pathology and the operative report. Peritoneal signs on physical examination (P0.001) or pneumatosis intestinalis on abdominal radiographs correlated with positive laparotomies (P = 0.001).Peritoneal signs on physical examination or pneumatosis intestinalis on abdominal X-rays were associated with and specific for the presence of acute surgical disease of the abdomen in immunocompromised pediatric oncology patients.

Introduction et objectifs La fluticasone, glucocorticoide utilise sous forme inhalee dans le traitement de l’asthme est metabolise au niveau hepatique par le cytochrome P450, Le ritonavir (r) est un inhibiteur de la protease (IP) du VIH et du cytochrome P450 utilise a faible dose comme « booster » des autres IP. Nous rapportons 2 cas de syndrome de Cushing avec insuffisance surrenalienne (ISR) secondaire lie a l’association Fluticasone/ritonavir. Materiels et methodes MMe B, VIH+, traitee pour asthme par fluticasone et salbutamol debute un traitement anti retroviral (ARV) par r/lopinavir-tenofoviremtricitabine. Un mois apres, apparaissent des signes de syndrome de Cushing avec ISR associee. Le diagnostic de Cushing iatrogene est retenu. La fluticasone est arretee et un traitement par hydrocortisone debute. Dix huit mois plus tard, l’evolution clinique est favorable, la fonction surrenalienne normale. Mr F, VIH+ traite par r/atazanavir-tenofovir-emtricitabine, souffre d’une BPCO stade II et d’un asthme traitee par salbutamol. Lors d’une poussee aigue, la fluticasone est introduite. Deux mois plus tard, on retient le diagnostic de Cushing iatrogene avec une ISR. La flucitasone est arretee, l’hydrocortisone debute. Six mois apres, l’evolution est favorable et la fonction surrenalienne normale. Resultats Il s’agit de syndromes de Cushing avec ISR, lies l’utilisation concommitante fluticasone/ritonavir : concordance chronologique, absence d’autre cause retrouvee, evolution favorable a l’arret de la fluticasone. 25 cas similaires ont ete decrits. La lipodystrophie liee aux ARV et la voie d’administration du fluticasone peut rendre le diagnostic clinique difficile. L’ISR peut persister 6 a 12 mois apres l’arret d’un des 2 medicaments. Conclusion L’association fluticasone /ritonavir doit etre evitee de meme que l’association de la fluticasone a d’autres medicaments inhibiteurs du CYP450-3A4.

Protein C (PC) is a vitamin K-dependent protein which functions as both an anticoagulant and profibrinolytic. It is synthesized as a single chain protein (SC-PC) and post-translationally modified into a two chain form (2C-PC). Two chain PC consists of a light chain (LC) and a heavy chain (HC). The present study was undertaken to determine the composition of the molecular forms of PC in plasma. PC was immunoprecipitated, subjected to SDS-PAGE and Western blotting. The blots were scanned by densitometry to determine the distribution of the various forms. The percentage of SC-PC and 2C-PC was found to be 10% and 90% respectively. This is in agreement with previous work. SC-PC and the heavy chain of 2C-PC consisted of three molecular forms ("alpha", "beta", and "gamma"). The "alpha" form of HC is the standard 2C form with a MW of 40 Kd. The "beta" form of HC has also been described and has MW which is 4 Kd less than the "alpha" form. The "gamma" species of the SC and 2C-PC has not been previously described. However, its 3 Kd difference from the "beta" form could be due to modification of the "beta" species or to a separate modification of the alpha-HC. The LC of PC was shown to exist in two forms (termed form 1 and form 2). The difference between these two forms is unknown. The molecular forms of PC are most likely due to a post-translational modification (either loss of a carbohydrate or a peptide) rather than from plasma derived degradation.

6. Douglas WW. Histamine and antihistamines; 5-hydroxytryptamine and antagonists. In: Goodman LS, Gilman A, eds. The pharmacological basis of therapeutics, ed, 5. New York: Macmillan, 1975:608. 7. Krenzelock EP, Anderson GM, Mirick M, Massive diphenhydramine overdose resulting in death. Ann Emerg Med 1982;11:212. 8. Savchak VI. [Diphenylhydramine poisoning after topical administration] Vestn Dermatol Venerol 1982;1:62. 9. Shawn DH, McGuigan MA. Poisoning from dermal absorption of promethazine. Can Med Assoc J 1984;130:1460. 10. Schipior PG. An unusual case of antihistaminic intoxication. J PEDIATR 1967;71:589.