Argumentaire pour une utilisation plus large de la photochimiothérapie extracorporelle chez l’enfant

International audienceThe management of immune diseases in children remains challenging , although significant advances have been made. In addition to pharmacological approaches, extracorporeal photochemotherapy (ECP) is distinctive in its ability to provide immunomodulation without immune suppression or toxicity. However, in practice, this therapy is not widely used because of logistical issues and the lack of robust clinical pediatric studies. Here, we discuss the potential clinical applications of ECP in children and emphasize the need for a rigorous and specifically pediatric clinical evaluation of ECP. ß 2010 Elsevier Masson SAS. All rights reserved. Résumé Malgré l'apport des biothérapies, le traitement des maladies dysim-munitaires sévères et des conflits allogéniques de l'enfant reste difficile et entaché de nombreuses complications. Dans ce contexte, la photo-chimiothérapie extracorporelle (PCE) (thérapie cellulaire qui repose sur l'effet immunomodulateur des cellules mononucléées du patient, prélevées par aphérèse et exposées ex vivo aux rayons ultraviolets A [UVA] en présence de psoralène) a l'avantage notable d'induire une tolérance immunitaire sans générer d'immunosuppression systémique ni de toxicité a ` court, moyen ou long terme. Cette immunomodulation fait intervenir notamment la génération de lymphocytes T régulateurs (T reg). Malgré cela, la PCE est peu utilisée en raison de ses contraintes logistiques et du manque de données cliniques. Nous proposons une revue des indications reconnues et potentielles de la PCE en pédiatrie. Nous insistons sur la nécessité d'une e ´valuation clinique spécifique a ` l'enfant qui ne peut se concevoir sans la participation active des cliniciens pédiatres en particulier dans le domaine de la transplanta-tion et des maladies auto-immunes et inflammatoires

Metabolic abnormalities in obese French children

Purpose: The aim of this retrospective study was to describe the prevalence of metabolic abnormalities among obese children. Patients and methods: Two hundred and forty-four obese children were referred in our center between 2003 and 2007. The frequency of metabolic syndrome (MS) was assessed with the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. Insulin resistance was defined as a Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) greater than the 75th percentile. Results: Around 95.9% of the children had abdominal obesity, 38.1% had systolic hypertension, 19.3% diastolic hypertension, 12.3% hypertriglyceridemia, and 4.1% hypoHDLemia. Insulin resistance was present in 69.6% of children; 11.5% of children met the criteria for MS. Both the Z-score of the body mass index and the prevalence of metabolic abnormalities were higher in the group of the youngest children. Conclusion: The prevalence of metabolic abnormalities is high among overweight children, particularly in the youngest children. However, the management of obesity but not metabolic-specific intervention remains the priority. © 2009 Elsevier Masson SAS. All rights reserved

Traitements médicamenteux (hors insuline) et variabilité glycémique dans une population de diabétiques de type 1 - Étude ancillaire de VARDIA

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