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Biomedical subjects

F Sorge

Publications and source records attributed to F Sorge.

At least 19 recordsLinked to original sources

[Vaccinations for traveler child].

Each year, half a million of children leave France to travel towards countries south or east of the European Union, sometimes in poor sanitary conditions. In order to propose essential or useful immunizations for these trips, the current synthesis will allow the practitioner to insure that the routine French immunization schedule has been followed, and to complete it if needed, to protect the child according to the epidemiological situation in the visited area, to try to reduce the limitations of the immunization of the traveler child. In case of emergency, or close departure, it may be useful to follow an accelerated schedule of the last minute, and, sometimes, to immunize traveler children with a chronic disease. Informations on Internet sites useful for the knowledge of current infectious risks in the destination country are also provided.

France↗

[Acute uncomplicated malaria treatment in children in France in 2002].

CONTEXT AND OBJECTIVES: Imported P. falciparum malaria cases are rising in France reaching 1300 estimated children in 2000. Three years after the publication of therapeutic guidelines, the Groupe de Pédiatrie Tropicale conducted an observational survey in order to describe the practice of acute uncomplicated malaria treatments in children, to identify their limits and to make proposals to improve them. METHODS: A self administrated questionnaire has been proposed to 29 pediatric wards declaring over 10 malaria cases in 2000. Questions were focused on treatment practices and monitoring of children diagnosed with acute uncomplicated malaria in 2002. RESULTS: Twenty-six services, who treated more than 700 children, responded. Twenty-two on 26 services hospitalized systematically malaria cases. Mean duration of hospitalization was 2.2 days (S.D. +/- 0.9). First line treatment was halofantrine in 22 on 26 services and mefloquine in four services. A second halofantrine dose was given systematically at day 7 in three services. No clinical cardiac effects happened. Quinine was used in perfusion only in cases of gastric intolerance. Treatment failure has never been experienced in the 22 services using halofantrine and has been experienced at least once in two on four wards using mefloquine. Relapse occurred at least once in 19 on 22 wards treating with halofantrine. DISCUSSION: Halofantrine with hospitalization is still the leading treatment of acute uncomplicated malaria in children in France. In spite of the absence of clinical cardiac incident, a second cure of halofantrine was not often used, exposing to a high rate of relapse. Mefloquine is three time more used than in 1997, in spite of its digestives side effects that can explain failures of treatment. When done, the systematic clinical and parasitological control confirms failures after mefloquine and the high incidence of relapse after one cure of halofantrine. Only used in case of severity or digestive disorders, quinine is a little less prescribed in acute uncomplicated malaria in 2001 than in 1997. CONCLUSIONS: The limitations of antimalarial drugs used in France in case of acute malaria argue for an improvement of protocols (systematic second reduced dose of halofantrine after day 7, mefloquine associated with antiemetic drug) and a systematic clinical and parasitological monitoring. As alternative, efficient combinations of antimalarial as first line treatment are needed in France.

Adolescent↗

What happens to eating disorder outpatients who withdrew from therapy?

OBJECTIVE: Dropouts are frequent among eating disorder (ED) patients, but less is known about their natural history. This paper assesses the outcome of outpatients who dropped out from a therapy programme and its possible causes. MATERIAL AND METHODS: From 1992 to 1994, we assessed 222 ED subjects. Psychiatrists expert in EDs evaluated these subjects by defining baseline parameters and diagnosis was made according to the 3rd revisioned edition of the Diagnostic and Statistical Manual of Mental Disorders. One hundred and twenty-eight subjects (57%) dropped out during the treatment. In 1997, we contacted them, reassessed the same baseline parameters and asked for a self-judgment about their social and clinical condition during the previous 2-5 years. Patients were classified as "improved" and "not improved" (stationary or worse) according to their social, physical and psychological condition. The relation between baseline condition and outcome was determined statistically. RESULTS: Seventy-one percent of subjects were "improved" and no deaths were recorded. A significant correlation was found between "duration of illness" and no treatment following a dropout. DISCUSSION: The high percentage of improvement among dropouts was unexpected. Shorter duration of illness and lack of specific therapy in the improved patients suggest the existence of a subset of ED patients with acute onset and a spontaneous tendency to improve. This point obviously requires further investigation.

Adaptation, Psychological↗

The frontotemporal region plays a role in the genesis of migraine without aura.

We have compared the migraine-inducing effect of nitroglycerin ointment applied to the frontotemporal region of the head, which is innervated by the ophthalmic and maxillary divisions of the trigeminal nerve, with that of nitroglycerin applied to the chin (innervated by the mandibular division), the posterolateral region of the neck (innervated by the second and third cervical roots), the lateral surface of the proximal third of the forearm (innervated by the sixth cervical root), and the medial surface of the upper-arm region (second dorsal root). One hundred patients suffering from migraine without aura were randomly divided into five equal groups. Each group received an application of 5 mg nitroglycerin in 2% ointment on a preselected body area for 2 hours. Frontotemporal nitroglycerin induced a significantly greater number of early onset migraine attacks with respect to the arm and forearm regions. In all cases, nitroglycerin applied to the frontotemporal region resulted in subsequent migraine, whereas there was a significant number of negative trials with nitroglycerin applied to the neck, arm, and forearm vs the frontotemporal area. It, therefore, appears that the trigeminal nerve endings in the affected frontotemporal region are particularly sensitive to the migraine-inducing effect of the nitrate. This suggests a peripheral neurogenic hypothesis of migraine genesis.

Adolescent↗

Source of pain and primitive dysfunction in migraine: an identical site?

Twenty common migraine patients received a one sided frontotemporal application of nitroglycerin (10 patients) or placebo ointment (10 patients) in a double blind study. Early onset migraine attacks were induced by nitroglycerin in seven out of 10 patients versus no patient in the placebo group. Subsequently 20 migraine patients, who developed an early onset attack with frontotemporal nitroglycerin, received the drug in a second induction test at other body areas. No early onset migraine was observed. Thus the migraine-inducing effect of nitroglycerin seems to depend on direct stimulation of the habitual site of pain, suggesting that the frontotemporal region is of crucial importance in the development of a migraine crisis. This is not consistent with a CNS origin of migraine attack.

Administration, Cutaneous↗

Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study.

An 8-month, double-blind, placebo-controlled, crossover trial of flunarizine in the prophylaxis of migraine has been performed in 70 children. After 4 weeks of medication-free base-line observation, 35 children (group A) received flunarizine (5 mg/day) and 35 (group B) received placebo over a 12-week period. After a 4-week washout they crossed treatments for another 12 weeks. Sixty-three patients completed the trial. In both groups flunarizine significantly reduced the frequency and average duration of headache attacks. In group A efficacy was maintained after placebo crossover for the last 4 months of the study. Five subjects in group B stopped placebo because of ineffectiveness; two children in group A discontinued flunarizine treatment, one because of excessive daytime sedation and the other because therapy was ineffective. The main side effects were daytime sedation and weight gain. It is concluded that flunarizine is an effective drug for the treatment of childhood migraine. In a study of this length no serious side effects were discovered.

Child↗

A double-blind placebo-controlled trial of indobufen in the prophylaxis of migraine.

In a double-blind randomized trial of 42 patients with classic or common migraine, indobufen, an antiplatelet drug that inhibits platelet cyclo-oxygenase, was compared with placebo in the prevention of migraine. The duration of treatment was 3 months, and the efficacy was assessed on the basis of the following variables: frequency and duration of attacks, headache index (intensity x frequency); 35 completed the investigation. Indobufen at an oral dose of 200 mg b.i.d. reduced all the variables considered, where placebo did not. The drug was generally well tolerated. The findings of the preliminary trial suggest that indobufen might be an useful alternative in the prophylaxis of migraine.

Adult↗

Platelet function in childhood migraine.

Platelet function in vitro and in vivo (ADP-induced platelet aggregation, circulating platelet aggregates, beta-thromboglobulin plasma levels) has been studied in children with common migraine, in headache-free intervals. Migraine patients demonstrated increased circulating platelet aggregates when compared with controls. Moreover, two of ten patients had pathological beta-thromboglobulin levels. These data indicate that in some children with migraine there is an abnormality of platelet function during headache-free periods.

Adolescent↗