Mycoplasma hominis necrotizing pleuropneumonia in a previously healthy adolescent.

BACKGROUND: Mycoplasma hominis is a fastidious micro-organism causing systemic infections in the neonate and genital infections in the adult. It can also be the cause of serious extra-genital infections, mainly in immunosuppressed or predisposed subjects. CASE PRESENTATION: We describe a case of severe pneumonia and pericarditis due to Mycoplasma hominis in a previously healthy adolescent who did not respond to initial therapy. CONCLUSIONS: Mycoplasma hominis could be an underestimated cause of severe pneumonia in immunocompetent patients and should be particularly suspected in those not responding to standard therapy.

Feminist Perspectives on Motherhood and Reproduction

Motherhood and reproduction have been at the core of the feminist discourse about women's rights ever since its onset. For the first and second feminist movements, the right to abortion and the public recognition of motherhood have been main issues in the discourse on reproduction. Since the last two dec- ades of the 20th century, the potentials of assisted reproductive technologies (ART) have opened up new venues of feminist discourse.In this paper we sketch the main feminist lines of argumentation regarding motherhood and reproduction since the 1970s, and we identify specific shifts in their recurrent issues. We argue that an essential contribution of feminism to the understanding of motherhood as a structuring category has been its insis- tence on the distinction between biological and social motherhood. Feminist discourse shows how ART has further decomposed biological motherhood and has altered the meaning of motherhood and reproduction. Feminist analysis maintains that despite the rhetoric of choice surrounding ART, these technolo- gies have not increased women's reproductive freedom. The decomposition of biological motherhood, the medical, legal, and commercial development of re- production, and the change in the social perception of motherhood have rather established new forms of control over female reproduction.

La thérapie cognitivo-comportementale pour les troubles anxieux chez l'enfant et l'adolescent: efficacité et niveau de preuves

Cet article présente les résultats d'une revue systématique publiée par la Collaboration Cochrane dans la Cochrane Library (www.cochrane.org) : James A.C., James G., Cowdrey F.A., Soler A., Choke A., « Cognitive behavioural therapy for anxiety disorders in children and adolescents », Cochrane Database Syst. Rev., 2013 ; 6 : CD004690. Volontairement limité à un champ de recherche circonscrit, cet article reflète l'état actuel des connaissances de ce domaine. Il ne s'agit donc pas de recommandations pour guider la prise en charge d'une problématique clinique considérée dans sa globalité (guidelines).

Fisiologia de l'exercici en l'infant i l'adolescent. Algunes consideracions

En les edats infantil i peripuberal, les adaptacions a l'activitat física presenten particularitats específiques respecte a l'adult en els aspectes metabolics, resposta cardio-vascular i respiratoria, comportament neuro-endocrí, etc., amb diferéncies més evidents com més petit és el noi. Sembla evident que en alguns sentits el noi presenta unes respostes comparables a les de l'adult, mentte que en difereix substancialment en altres. Per aixo no és correcte considerar-lo en aquest sentit com un adult en miniatura (Borms, J., 1986). D'altra banda, cal saber en quina mesura la introducció de programes d'educació física escolar o, també en alguns casos, la participació en entrenaments intensius poden afectar les qualitats funcionals d'adaptació o alterar d'alguna forma el creixement pondo-estatural normal del noi. En aquest treball analitzem alguns aspectes essencials de tot aixo. Les consideracions que es puguin fer hauran de tenir en compte l'edat segons uns criteris biologics (grau de creixement sexual, estimació del nivell d'ossificació, dimensions corporals, etc.), més que no pas en un sentit cronologic. El fet de no atendre estrictament aquesta consideració pot ocasionar errors greus (Bar-Or, 1985).

Changes in leg spring behaviour, plantar loading and foot mobility magnitude induced by an exhaustive treadmill run in adolescent middle-distance runners.

OBJECTIVES: This study aimed to determine adjustments in spring-mass model characteristics, plantar loading and foot mobility induced by an exhaustive run. DESIGN: Within-participants repeated measures. METHODS: Eleven highly-trained adolescent middle-distance runners ran to exhaustion on a treadmill at a constant velocity corresponding to 95% of velocity associated with VO₂max (17.8 ± 1.4 kmh(-1), time to exhaustion=8.8 ± 3.4 min). Contact time obtained from plantar pressure sensors was used to estimate spring-mass model characteristics, which were recorded (during 30 s) 1 min after the start and prior to exhaustion using pressure insoles. Foot mobility magnitude (a composite measure of vertical and medial-lateral mobility of the midfoot) was measured before and after the run. RESULTS: Mean contact area (foot to ground), contact time, peak vertical ground reaction force, centre of mass vertical displacement and leg compression increased significantly with fatigue, while flight time, leg stiffness and mean pressure decreased. Leg stiffness decreased because leg compression increased to a larger extent than peak vertical ground reaction forces. Step length, step frequency and foot mobility magnitude did not change at exhaustion. CONCLUSIONS: The stride pattern of adolescents when running on a treadmill at high constant velocity deteriorates near exhaustion, as evidenced by impaired leg-spring behaviour (leg stiffness) and altered plantar loading.

Fear and anxiety at the basis of adolescent externalizing and internalizing behaviors: a case study.

Juvenile delinquency is rarely associated with success in psychotherapeutic treatment. Up until now, few data have been recorded regarding possible overlaps or common features of conduct disorders with anxiety disorders. This case report of a delinquent adolescent's presenting an obsessive-compulsive disorder discusses possible underlying common features of externalizing and internalizing disorders, mainly in terms of fear and anxiety regulation. The successful psychotherapy is discussed with regard to efficient psychological assessment and treatment of delinquent adolescents, and it underlies the importance of detailed analysis of psychopathology in cases of juvenile delinquency.

Problème de surcharge de l'articulation coxo-fémorale chez l'adolescent [Overuse injuries of the hip in adolescents].

Painful femoro-acetabular impingement symptoms localized in the groin in flexion, adduction and internal rotation can be explained either by a primary disease of the labrum often post-traumatic, and more frequently as part of femoro-acetabular primary or secondary dysmorphia. The kinematic of the normal hip joint depends of peri-acetabular structures, geometry of joints and possible pathologies that could contribute to modify either the geometry or the proprioceptive function. By combining and analyzing these parameters it is possible to describe a joint concept of centricity, an essential parameter for optimal functions of the joint. The concept of overload is explained as the inability of the hip to ensure its centricity during activities that could lead to the occurrence of any degenerative disorders.

A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers.

OBJECTIVE: To describe the determinants of self-initiated smoking cessation of duration of at least 6 months as identified in longitudinal population-based studies of adolescent and young adult smokers. METHODS: A systematic search of the PubMed and EMBASE databases using smoking, tobacco, cessation, quit and stop as keywords was performed. Limits included articles related to humans, in English, published between January 1984 and August 2010, and study population aged 10-29 years. A total of 4502 titles and 871 abstracts were reviewed independently by 2 and 3 reviewers, respectively. Nine articles were retained for data abstraction. Data on study location, timeframe, duration of follow-up, number of data collection points, sample size, age/grade of participants, number of quitters, smoking status at baseline, definition of cessation, covariates and analytic method were abstracted from each article. The number of studies that reported a statistically significant association between each determinant investigated and cessation were tabulated, from among all studies that assessed the determinant. RESULTS: Despite heterogeneity in methods across studies, five factors robustly predicted quitting across studies in which the factor was investigated: not having friends who smoke, not having intentions to smoke in the future, resisting peer pressure to smoke, being older at first use of cigarette and having negative beliefs about smoking. CONCLUSIONS: The literature on longitudinal predictors of cessation in adolescent and young adult smokers is not well developed. Cessation interventions for this population will remain less than optimally effective until there is a solid evidence base on which to develop interventions.

Médecine de l'adolescence : troubles des conduites alimentaires atypiques [Adolescent medicine : eating disorders not otherwise specified (EDNOS)]

Young people (mostly females) suffering from eating disorders not otherwise specified (EDNOS) are more and more numerous and their difficulties pose serious problems to health care providers as well as the society. These situations correspond to eating disorders which do not totally meet the DSM-IV criteria for either anorexia or bulimia nervosa. The duration of the symptoms, the extent of suffering as well as the impact on daily life should be taken into account to set-up the treatment. The therapeutic approach to these disorders should ideally include both cognitive/dietary and psychodynamic approaches. The Multidisciplinary Unit for Adolescent Health in Lausanne has set-up a group treatment for these patients.

Premature epiphyseal closure in an adolescent treated by retinoids for acne: An unusual cause of anterior knee pain

Introduction.- Retinoids are effective and widely used for the treatment of severe acne. Their use can be, however, associated with numerous side effects. For example, some rare cases of premature epiphyseal closure were reported.Observation.- A sixteen-year-old soccer player consulted for bilateral progressive anterior knee pain, since two months, evoking a femoro-patellar origin. After physiotherapy, the pain decreases on the right but remained on the left. The history taking brought out the use of isotretinoin for more than 6 months (0.5 mg/kg). Magnetic resonance imaging (MRI) findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more marked on the left. The diagnosis of retinoid induced premature ephysieal closure was retained. The treatment was stopped, with a resolution of symptoms within two months. The control MRI of the left knee present persisting small sequelar thumbprint-like growth plate lesion. Eighteen months later, neither limb-length discrepancy nor static disorder was noticed.Discussion.- Premature epiphyseal closure is a rare complication of retinoid treatment of acne. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. The knee seems the most involved joint. The clinical presentation is aspecific, sometimes lightly symptomatic. A careful pharmacological history and an appropriate imaging are necessary. MRI is now the gold standard. It shows an irregularity of the growth plate with an oedema on both sides. In chronic phase, a thumbprint-like image may persist. The symptoms resolution arises in few weeks after the treatment interruption. A single case of static disorder was reported until now. The small size of the growth plate interruptions, insufficient to lead to a growth disorder if the medicament is stopped early enough, explains probably it. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.