La fièvre du petit enfant : que font les parents? (à propos d'une enquête réalisée aux urgences pédiatriques de Brest en décembre 2000)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Connaissances, attitudes et habiletés en matière d'asthme (étude transversale auprès de parents d'enfants asthmatiques hospitalisés dans le Finistère)

BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Suivi d'une cohorte d'enfants ayant présenté une première crise d'épilepsie entre 1994 et 1998 dans le district de Rennes

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pyélonéphrite aigue de l'enfant (évaluation d'un protocole de prise en charge ambulatoire)

BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Pyélonéphrites aigues de l'enfant (évaluation de la pertinence des critères d'hospitalisation dans le cadre de la mise en place d'une prise en charge ambulatoire)

En Février 2007, l'AFSSAPS a publié des recommandations sur le diagnostic et le traitement des pyélonéphrites de l'enfant. Dans ce contexte, un protocole de prise en charge ambulatoire des enfants présentant une pyélonéphrite a été mis en place aux Urgences Pédiatriques du CHU de Brest fin avril 2007. Il a été évalué sur un an et ses résultats étaient, dans l'ensemble, positifs. Cependant, seulement un tiers des enfant (88) a pu en bénéficier. Nous avons étudié les critères retenus pour l'hospitalisation des autres enfants (206) sur cette même période dans une démarche d'évaluation des pratiques professionnelles. Cette analyse met en évidence 12 hospitalisations discutables. Elle montre par ailleurs, l'absence de différence statistiquement significative ente la population prise en charge en ambulatoire et la population hospitalisée sur certains critères cliniques ou biologiques. Cette constatation fait apparaître la subjectivité importante de la décision du médecin d'hospitaliser ou non un enfant. Des axes d'amélioration sont apparus pour la définition des critères d'hospitalisation et pour certains aspects de l'étape diagnostique en particulier concernant le mode de recueil des urines et la possibilité d'obtenir des ECBU 24h sur 24. Une évaluation progressive vers une simplification de la prise en charge est possible en proposant dans de plus nombreux cas un traitement et un suivi ambulatoires. Reste en suspend la question du traitement per os d'emblée chez les enfants présentant une pyélonéphrite sans critère de gravité. Des études devront valider ce mode de prise en charge en prenant en compte l'écologie bactérienne particulière en France.BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

[Quantitative assessment of medical students' clinical practical learning in department of obstetrics and gynecology of Brest Hospital University].

International audienceOBJECTIVE: The main objective of this study was to describe how medical students got progressively trained to perform the most frequent medical procedures in obstetrics and gynecology. The secondary objective was to rationalize and plan the training. METHODS: The medical students in our University Hospital were contacted either directly or by e-mail. They were given an anonymous simple choice questionnaire relating to eight most important acts in the specialty. RESULTS: Three hundred and eighty-two medical students have been consulted. We got 173 answers which means a participation rate of 45.3%. The survey showed up that the considered procedures were progressively put into practice with the exception of two: the insertion of an intrauterine contraceptive device (coil) and of an implant. CONCLUSION: The study showed off some insufficiency in the training in two of the considered procedures. An amendment was proposed with simulated performances of the acts and the setting up of a training course booklet

Normal sonoanatomy of small joints in healthy children: changes in cartilage and vascularisation according to age and gender.

International audienceThe metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints may be involved in juvenile idiopathic arthritis. Our goal was to describe their normal sonoanatomy in healthy children, according to age and gender

Efficacy and safety of BH4 before the age of 4 years in patients with mild phenylketonuria.

International audienceBACKGROUND: Sapropterin dihydrochloride, an EMEA-approved synthetic formulation of BH4, has been available in Europe since 2009 for PKU patients older than 4 years, but its use with younger children is allowed in France based on an expert recommendation. We report the cases of 15 patients treated under the age of 4 years and demonstrate the safety and efficacy of this treatment for patients in this age group. PATIENTS AND METHOD: We report the use of BH4 in 15 PKU patients treated before the age of 4 years. RESULTS: Fifteen patients were enrolled in this retrospective study. Mean phenylalaninemia at diagnosis was 542±164 μM and all patients had mild PKU (maximal phenylalaninemia: 600-1200 μM). BH4 responsiveness was assessed using a 24-hour BH4 loading test (20 mg/kg), performed during the neonatal period (n = 11) or before 18 months of age (n = 4). During the test, these patients exhibited an 80±12% decrease in phenylalaninemia. Long-term BH4 therapy was initiated during the neonatal period (n = 7) or at the age of 13±12 months (n = 8). The median duration of treatment was 23 months [min 7; max 80]. BH4 therapy drastically improved dietary phenylalanine tolerance (456±181 vs 1683±627 mg/day, p < 0.0001) and allowed a phenylalanine-free amino acid mixture to be discontinued or not introduced in 14 patients. Additionally, in the eight patients treated after a few months of diet therapy, BH4 treatment significantly decreased mean phenylalaninemia (352±85 vs 254±64μM, p < 0.05), raised the percentage of phenylalaninemia tests within therapeutic targets [120-300 μM] (35±25 vs 64±16%, p < 0.05), and reduced phenylalaninemia variance (130±21 vs 93±27μM, p < 0.05). No side effects were reported. CONCLUSION: BH4-therapy is efficient and safe before the age of 4 years in mild PKU, BH4-responsive patients

Adult-onset eculizumab-resistant hemolytic uremic syndrome associated with cobalamin C deficiency.

International audienceA 20-year-old man was hospitalized for malignant hypertension, mechanical hemolysis, and kidney failure. Kidney biopsy confirmed glomerular and arteriolar thrombotic microangiopathy. Etiologic analyses, which included ADAMTS13 activity, stool culture, complement factor proteins (C3, C4, factor H, factor I, and MCP [membrane cofactor protein]), anti-factor H antibodies, HIV (human immunodeficiency virus) serology, and antinuclear and antiphospholipid antibodies, returned normal results. Malignant hypertension was diagnosed. Ten months later, we observed a relapse of acute kidney injury and mechanical hemolysis. Considering a diagnosis of complement dysregulation-related atypical hemolytic uremic syndrome (HUS), we began treatment with eculizumab. Despite the efficient complement blockade, the patient's kidney function continued to decline. We performed additional analyses and found that the patient's homocysteine levels were dramatically increased, with no vitamin B12 (cobalamin) or folate deficiencies. We observed very low plasma methionine levels associated with methylmalonic aciduria, which suggested cobalamin C disease. We stopped the eculizumab infusions and initiated specific treatment, which resulted in complete cessation of hemolysis. MMACHC (methylmalonic aciduria and homocystinuria type C protein) sequencing revealed compound heterozygosity for 2 causative mutations. To our knowledge, this is the first report of adult-onset cobalamin C-related HUS. Considering the wide availability and low cost of the homocysteine assay, we suggest that it be included in the diagnostic algorithm for adult patients who present with HUS