Objectives. The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods.Methods. Smears were obtained from the clinically healthy buccal mucosa and floor of mouth of transplant patients (n = 21) and healthy volunteers (n = 27). Smears from each individual stained by the Papanicolaou method were analyzed using a stereologic method. Nuclear (NV) and cytoplasmic (CV) volumes were evaluated with Stereo Investigator software.Results. CV values were 123,012.71 +/- 15,840.96 fL in the floor of the mouth and 133,667.10 +/- 26,653.39 fL in the buccal mucosa of the kidney transplant patients. CV values were 133,746.93 +/- 14,210.67 fL in the floor of the mouth and 167,797.78 +/- 21,007.70 fL in the buccal mucosa of the control group. NV values were 945.68 +/- 65.85 fL in the floor of the mouth and 845.15 +/- 81.56 fL in the buccal mucosa of the kidney transplant patients and 485.17 +/- 18.03 fL in the floor of the mouth and 410.25 +/- 52.84 mu m(3) in the buccal mucosa of the control group. Significantly higher NV (P = .000) and NV/CV (P = .000) and lower CS (P = .000) values were found in the patient group compared with the control group.Conclusion. The findings suggest that there were alterations in oral epithelial cells, detectable by microscopy and cytomorphometry in kidney transplant patients.

Objective To investigate the value of three-dimensional contrast-enhanced power Doppler ultrasonography (3D-CE-PDU) in the diagnosis of prostate cancer and to compare 3D-CE-PDU with digital rectal examination (DRE), prostate-specific antigen (PSA) levels, grey-scale ultrasonography (GSU) and PDU.Patients and methods The study comprised 30 patients with localized prostate cancer scheduled to undergo radical prostatectomy and 29 with clinical BPH scheduled to undergo transurethral microwave thermotherapy. The 3D-CE-PDU examinations were carried out using 2.5 g of microbubble ultrasound contrast medium; the images were stored digitally to allow off-line analysis. All the reconstructed 3D images of the prostate were evaluated blindly in random order by two investigators tone expert and one novice, The images were scored according to asymmetry (0-2) and vessel distribution (0-3). Marked asymmetry (2) and/or a focal increase in vascularity (>2) were considered as suspicious for prostate malignancy. Diagnostic predictions using the DRE, PSA level, GSU, PDU, 3D-CE-PDU and their combinations were investigated using receiver operating characteristic (ROC) curves.Results True-positive and true-negative rates of the 3D-CE-PDU were 87% (26/30) and 79% (23/29), respectively, for the expert observer. The sensitivity of 3D-CE-PDU was higher than that of DRE, GSU and PDU, but not PSA level, and the specificity was lower, again except for PSA level. However, when compared with those of the other modalities in single-test evaluations, 3D-CE-PDU, and a combination of 3D-CE-PDU and PSA level, had the largest area under the ROC curve (0.830 and 0.933, respectively). The diagnostic agreement between the examiners was 76% (Cohen kappa statistic, 0.5).Conclusion in this selected group of patients, 3D-CE-PDU alone was a better diagnostic tool than the DRE, PSA level, GSU or PDU alone. The most suitable diagnostic predictor for prostate cancer was a combination of 3D-CE-PDU and PSA level.

Secondary early anemia of prematurity (SEAP) is the reason for a substantial proportion of blood transfusions. The mechanism is a decrease in erythrocyte life span and, above all, repeated blood sampling for diagnostic tests. Decreasing the amount of blood sampled significantly reduces the need for blood transfusions. In healthy premature infants, SEAP is well-tolerated and does not always require blood transfusion. In ill babies, no reliable biological criteria suitable for use in everyday practice are available, and the benefits of transfusion therapy are controversial; the indications for transfusion in this situation remain poorly standardized. Erythropoietin is effective on the blood cell precursors in SEAP and is produced in inadequate amounts in this condition. In randomized trials, erythropoietin therapy stimulated erythropoiesis and was associated with a significant but modest decrease in the number of blood transfusions. The subgroup composed of the smallest and most severely ill babies, which is typically characterized by the largest blood transfusion needs, showed the greatest reduction in the number of blood transfusions under erythropoietin therapy. The potential benefits of erythropoietin therapy are still under evaluation.

The newborn immune system differs quantitatively and functionally from adults. At birth, the immune system is partially immature, resulting in deficiency in cell-mediated cytolysis, immunoglobulin synthesis and cytokine production. The most clearly defined deficit in neonatal phagocytosis defenses is diminished neutrophil storage. T cell function is diminished, including T cell-mediated cytotoxicity and T cell help for B cell differentiation. Selective decreases in cytokine production by T cells may contribute to all of these deficits. One of the fundamental differences between adults and newborns for T cell functions resides in whether or not the patient had prior exposure to antigens. Significant immune responses to antigens can be obtained in the neonatal period. These responses are qualitatively different from those induced in adults with a predominance of TH2 pattern.

Le paludisme d'importation est une réalité de la pratique pédiatrique dans les régions de passage et d'implantation des populations migrantes. La démocratisation du voyage aggrave ce phénomène.

Imported malaria is frequently observed in pediatric practices within geographical areas which have a migrant population.Material and methods. - All the pediatric malaria cases of a university children's hospital (Marseilles, southern France) had been studied retrospectively. The period of the study was from January 1987 to December 1997 Inclusion criteria were based on clinical diagnosis criteria established by WHO.Results. - Three hundred and fifteen clinical cases were observed. Ninety-nine percent were confirmed by blood smears. Eighty-six percent of the patients came from the archipelago of the Comoro Islands in the Indian Ocean. Twenty percent were not given chemoprophylaxis, and 77% of the patients with chemoprophylaxis were not compliant. Fever (92%), splenomegaly (61%), vomiting and/or diarrhea (50%) were frequently observed Neurological signs (23%), especially headaches (15%), were noted. The causative species was Plasmodium falciparum in 76%; coinfections with two species were observed in 98. Halofantrine was commonly used for therapy (64%), but relapses were noted with this drug. No death was observed during the study.Discussion. - Imported pediatric malaria is rare in France. Critical signs may lead to misdiagnosis when splenomegaly is not obvious, or when vomiting and/or diarrhea, cough or otitis occur Diagnosis relies on blood smears. Curative medications are chloroquine or halofantrine, with special attention to heart troubles. Mefloquine is rarely used in children. Quinine is reserved for serious attacks. Concerning chimioprophylaxy, medical prescriptions should be adapted to the stay abroad, and patient compliance to medications could be improved. (C) 1999 Elsevier; Paris.

UNLABELLED:Imported malaria is frequently observed in pediatric practices within geographical areas which have a migrant population.MATERIAL AND METHODS:All the pediatric malaria cases of a university children's hospital (Marseilles, southern France) had been studied retrospectively. The period of the study was from January 1987 to December 1997. Inclusion criteria were based on clinical diagnosis criteria established by WHO.RESULTS:Three hundred and fifteen clinical cases were observed. Ninety-nine percent were confirmed by blood smears. Eighty-six percent of the patients came from the archipelago of the Comoro Islands in the Indian Ocean. Twenty percent were not given chemoprophylaxis, and 77% of the patients with chemoprophylaxis were not compliant. Fever (92%), splenomegaly (61%), vomiting and/or diarrhea (50%) were frequently observed. Neurological signs (23%), especially headaches (15%), were noted. The causative species was Plasmodium falciparum in 76%; coinfections with two species were observed in 9%. Halofantrine was commonly used for therapy (64%), but relapses were noted with this drug. No death was observed during the study.DISCUSSION:Imported pediatric malaria is rare in France. Clinical signs may lead to misdiagnosis when splenomegaly is not obvious, or when vomiting and/or diarrhea, cough or otitis occur. Diagnosis relies on blood smears. Curative medications are chloroquine or halofantrine, with special attention to heart troubles. Mefloquine is rarely used in children. Quinine is reserved for serious attacks. Concerning chimioprophylaxy, medical prescriptions should be adapted to the stay abroad, and patient compliance to medications could be improved.

Le concept d'immuno-incompétence du nouveau-né a cédé la place à la nolion d'une competence immunitaire réelle mais différente de celle de l'adulte. Ces différences se retrouvent à tous les niveaux du système immunitaire.

La syphilis est une maladie sexuellement transmissible liée à une infection par Treponema pallidum. Cette maladie, connue pour être une grande imitatrice, peut se révéler par des manifestations cliniques variées. L’ophtalmologiste doit évoquer le diagnostic chez un patient présentant une uvéite ou une neuropathie optique et une conduite sexuelle à risque et/ou une autre maladie sexuellement transmissible (comme le VIH). Par ailleurs, une choriorétinite postérieure en plaque ou une rétinite nécrosante doit faire rapidement rechercher cette étiologie. L’atteinte oculaire survient essentiellement pendant les phases secondaires et tertiaires de la maladie. La syphilis peut atteindre tous les tissus oculaires. L’uvéite est l’atteinte la plus fréquente (1 à 5 % des uvéites en centre tertiaire) sous la forme d’uvéite antérieure granulomateuse ou non, uvéite postérieure, panuvéite ou kérato-uvéite. L’atteinte du système nerveux central peut être asymptomatique mais est fréquente, ce qui justifie la réalisation systématique d’une ponction lombaire en cas d’uvéite et/ou de neuropathie optique. La confirmation diagnostique est essentiellement sérologique. Le traitement parentéral par pénicilline G est le traitement de première intention en cas de syphilis oculaire. Un traitement adjuvant par corticothérapie générale sera discuté en cas d’uvéite, de neuropathie optique ou de sclérite. Un suivi prolongé est nécessaire étant donné les possibilités de réinfections. Le pronostic anatomique et fonctionnel oculaire est souvent favorable après traitement antibiotique approprié.Syphilis is a sexually transmitted disease caused by Treponema pallidum. Previously known as the “great imitator”, this disease can have numerous and complex manifestations. The ophthalmologist should suspect the diagnosis in patients with uveitis or optic neuropathy and high-risk sexual behavior and/or another sexually transmitted disease (such as HIV) or those presenting with posterior placoid chorioretinitis or necrotising retinitis. Ocular involvement in acquired syphilis is rare, tending to occur during the secondary and tertiary stages of the disease. Syphilis may affect all the structures of the eye, but uveitis (accounting for 1–5% of the uveitis in a tertiary referral center) is the most common ocular finding. Granulomatous or non-granulomatous iridocyclitis (71%), panuveitis, posterior uveitis (8%) and keratouveitis (8%) are often described. In the secondary stage, the meninges and the central nervous system can be affected, sometimes with no symptoms, which justifies performing lumbar puncture in patients with uveitis and/or optic neuropathy. The diagnosis of ocular syphilis requires screening with a non-treponemal serology and confirmation with a treponemal-specific test. Parenterally administered penicillin G is considered first-line therapy for all stages of ocular syphilis. Systemic corticosteroids are an appropriate adjunct treatment for posterior uveitis, scleritis and optic neuritis if ocular inflammation is severe. Prolonged follow-up is necessary because of the possibility of relapse of the disease. With proper diagnosis and prompt antibiotic treatment, the majority of cases of ocular syphilis can be cured.

L'anemie secondaire precoce du premature est a l'origine de nombreuses transfusions. La diminution de la masse globulaire est due a la diminution de la duree de vie des hematies mais surtout a la spoliation sanguine liee aux prelevements a visee diagnostique. Diminuer la quantite de sang prelevee durant l'hospitalisation suffit a reduire de facon significative le nombre de transfusions. Chez le premature non malade cette anemie a peu ou pas de retentissement, les transfusions systematiques sont a proscrire. En cas de pathologie associee et en l'absence de criteres biologiques fiables, utilisables en pratique quotidienne, les indications de transfusions sont mal codifiees et les benefices restent controverses. Cette anemie n'entraine pas une augmentation adequate des taux d'erythropoietine circulante. L'utilisation d'erythropoietine exogene decoule des deux arguments suivants: les taux endogenes sont insuffisants et les precurseurs sont sensibles a l'erythropoietine. Il ressort des essais randomises que ce traitement stimule l'erythropoiese mais diminue de facon modeste, bien que significative, le nombre de transfusions, particulierement pour les enfants les plus petits et les plus malades qui sont les plus transfuses. Le benefice de cette therapeutique est encore en cours d'evaluation.

The newborn immune system differs quantitatively and functionally from adults. At birth, the immune system is partially immature, resulting in deficiency in cell-mediated cytolysis, immunoglobulin synthesis and cytokine production. The most clearly defined deficit in neonatal phagocytosis defenses is diminished neurophil storage. T cell function is diminished, including T cell-mediated cytotoxicity and T cell help, for B cell differentiation. Selective decreases in cytokine production by T cells may contribute to all of these deficits. One of the fundamental differences between adults and newborns for T cell functions resides in whether or not the patient had prior exposure to antigens. Significant immune responses to antigens can be obtained in the neonatal period. These response are qualitatively different from those induced in adults with a predominance of TH2 pattern. (C) 1999 Elsevier Paris.

INFANTILE LEISHMANIASIS: The protozoan parasites of the genus Leishmania are the causal agent of various diseases ranging from cutaneous lesions to fatal systemic diseases. In southern France, Leishmania infantum is an endemic species recognized as the causal agent of infantile leishmaniasis (Mediterranean visceral leishmaniasis). Little is known about the pathophysiology of the disease in humans, but models in mice may provide a new approach. INSECT VECTOR: Leishmania infantum are carried by sand flies. Antigenic modifications of the promastigote forms occur in these insects modifying lipophyosphoglycan (LPG) or glyocprotein gp63. Salivary gland lysates from the sand flies also enhance Leishmania infectivity. HUMAN INFESTATION: In humans, LPG and gp63 play a role in complement fixation, cell adhesion and resistance to complement-mediated lysis. Macrophage expression of class I and II major histocompatibility complex antigens is suppressed. T cells and interferon gamma are very important keys in the control of the parasite infection.

PURPOSE:The purposes of this study were to describe the characteristics of pediatric visceral leishmaniasis in southern France and to evaluate a new scheme of therapy. METHODS:Hospital records of 59 children with visceral leishmaniasis were retrospectively reviewed. The period of the study was from 1981 to 1997. RESULTS:All children but one lived or had previously dwelled in the south of France. None was coinfected with human immunodeficiency virus or known to be immunocompromised. The mean age was 31 months; 10 children were younger than 1 year when admitted to the hospital. The male:female ratio was 0.73. Fever and splenomegaly were present in 90 and 100%, respectively. Anemia, leukopenia and thrombocytopenia were commonly observed, especially in the youngest patients. Hypergammaglobulinemia was noted in 64%. A biopsy sample of the bone marrow was always performed, but direct microscopic examination failed to identify Leishmania in 13 (22%) cases. In these patients specific serology and genomic amplification with polymerase chain reaction were useful tools for the diagnosis. All patients were initially treated with meglumine antimonate (Glucantime). Twenty-six (44%) patients receiving the drug experienced at least one adverse event during treatment. Treatment failure occurred in six children (10%), who were subsequently cured with liposomal amphotericin B. Three additional children were treated with liposomal amphotericin B. All the children were finally cured and no death was observed. CONCLUSION:Our experience suggests that liposomal amphotericin B is effective therapy for visceral leishmaniasis in children.

La peau du nouveau-né à terme est très semblable à celle de l’adulte, cependant l’adaptation de la peau à la vie extra-utérine peut être responsable de dermatoses « physiologiques » et transitoires qu’il convient de connaître pour éviter les traitements et explorations inutiles. Les particularités de la peau du nouveau-né doivent également être connues pour éviter toute iatrogénicité due à une utilisation inappropriée de topiques. Ce chapitre abordera les principales affections dermatologiques dites « physiologiques » autorésolutives, puis les dermatoses les plus fréquemment rencontrées au cours du premier mois de vie, en privilégiant une approche par lésion élémentaire ou dont l’aspect clinique est facilement identifiable et doit entraîner une prise en charge spécifique.

L'élévation du taux plasmatique de l'élastase granulocytaire est l'un des marqueurs biologiques les plus sensibles de l'infection néonatale. L'objectif de ce travail est d'évaluer la valeur diagnostique d'un dosage très précoce pratiqué au sang du cordon, immédiatement après la naissance, chez des nouveau-nés présentant des facteurs de risque d'infection maternofœtale.

Purpose: To evaluate prospectively the prognostic significance of intermediate MRT performed at 3 to 6 months corrected chronological age in infants who suffered birth asphyxia.Methods: The study group was composed of 40 premature infants and 20 full-term infants evaluated with T-1- and T-2-weighted magnetic resonance (MR) imaging (I) at 1.0 Tesla between 3 and 6 months corrected chronological age for birth asphyxia, seizures, and/or abnormalities of muscle tone. Neurodevelopmental outcome was assessed after at least 2 years of follow up.Results: The MR examination was normal in 10 infants, of whom 9 developed normally. Isolated external hydrocephalus was found in 15 infants, of whom 13 developed normally. Focal or multifocal lesions were depicted in 6 infants, of whom 2 developed normally. MRI showed diffuse brain involvement in 29 cases including isolated atrophy in 18, leukomalacia in 5, basal ganglial lesions in 3, and delayed myelination in 3. Of these 29 infants, 25 showed neurologic impairment, whereas 4 developed normally.Conclusion: These results indicate that an intermediate MRI performed at 3 to 6 months (corrected) chronological age has prognostic significance in neonates suffering from mild-moderate neurologic insult.