Tendinopathie d'Achille [Achilles tendinopathy].

Achilles tendinopathy (AT) is the most common cause of posterior heel pain. It is most often due to mechanical stress related to overload or overuse of muscle-tendon unit. It also may be associated in a minority of cases with inflammatory arthritis. Pain secondary to AT is generally located in the corporeal part of the tendon or its attachment to the bone and is worsened by exercise. Examination can reveal a painful swelling or thickening on palpation. Additional tests are not routinely recommended but may be useful. Treatment should be tailored to the stage of tendinopathy and to functional disability, and should include an assessment of predisposing factors, analgesia and physiotherapy. Other treatments (shock waves, ultrasound) are less well documented. The indications and effectiveness of infiltrations are controversial and are reserved for chronic AT. The risk benefit ratio should be well discussed with the patient.

Normal values for pancreatic stone protein in different age groups.

BACKGROUND: Pancreatic stone protein (PSP) has been identified as a promising sepsis marker in adults, children and neonates. However, data on population-based reference values are lacking. This study aimed to establish age-specific reference values for PSP. METHODS: PSP was determined using a specific ELISA. PSP serum concentrations were determined in 372 healthy subjects including 217 neonates, 94 infants and children up to 16 years, and 61 adults. The adjacent categories method was used to determine which age categories had significantly different PSP concentrations. RESULTS: PSP circulating levels were not gender-dependent and ranged from 1.0 to 99.4 ng/ml with a median of 9.2 ng/ml. PSP increased significantly between the age categories, from a median of 2.6 ng/ml in very preterm newborns, to 6.3 ng/ml in term newborns, to 16.1 ng/ml in older children (p < 0.001). PSP levels were higher on postnatal day three compared to levels measured immediately post delivery (p < 0.001). Paired umbilical artery and umbilical vein samples were strongly correlated (p < 0.001). Simultaneously obtained capillary heel-prick versus venous samples showed a good level of agreement for PSP (Rho 0.89, bias 19 %). CONCLUSIONS: This study provides age-specific normal values that may be used to define cut-offs for future trials on PSP. We demonstrate an age-dependent increase of PSP from birth to childhood.