Il se définit par l'absence de signes de puberté au-delà de l'âge de 13-14 ans chez la fille, de 15-16 ans chez le garçon. Il est dit « simple » lorsqu'un développement pubertaire spontané complet se produit ensuite. Chez la fille, le retard est souvent lié à une anomalie de développement des ovaires dans le cadre d'un syndrome de Turner. Chez le garçon, il est en général « simple » et n'entraîne qu'une gêne pour l'adolescent en raison de sa taille inférieure pour son âge. Ce n'est qu'en l'absence de développement des testicules qu'une consultation en milieu spécialisé s'impose ; elle permettra d'éliminer une éventuelle cause endocrinienne (insuffisance testiculaire). Le cas échéant, un traitement par testostérone peut être mis en œuvre pour accélérer la puberté.
Voir : adolescence.
pubis
Pièce osseuse composée de deux os et constituant la partie antérieure et inférieure de l'os iliaque (os large et plat qui forme le bassin).
L'articulation sur la ligne médiane des deux os pubiens s'appelle la symphyse pubienne. Elle est constituée par un cartilage, un ligament et un manchon fibreux. Cette articulation est fixe. Cependant, elle peut s'élargir un peu chez la femme au moment de l'accouchement.
Le pubis est recouvert d'un amas de cellules graisseuses appelé « mont du pubis », ou « mont de Vénus » chez la femme. Cette zone se couvre de poils (pilosité pubienne) à la puberté.
PATHOLOGIE
Le pubis est le lieu d'insertion de nombreux muscles de l'abdomen et de la cuisse. Il peut être le siège d'infections bactériennes (ostéoarthrites) ou d'une pubalgie. Un traumatisme violent peut fracturer le pubis. Très souvent, des lésions viscérales, notamment de la vessie, s'y trouvent associées.
Voir : bassin.
puériculture
Ensemble de mesures mises en œuvre pour assurer à l'enfant un développement physique et psychique normal.
La puériculture est fondée sur la connaissance de la physiologie, du développement psychomoteur et intellectuel de l'enfant. Elle comporte des prescriptions d'hygiène et d'ordre diététique et elle s'appuie sur la psychologie, la pédagogie et la pédiatrie.
L'enseignement de la puériculture est assuré dans les services de médecine infantile des hôpitaux et dans des écoles spécialisées qui donnent aux sages-femmes, aux infirmières, aux professionnels de la petite enfance, voire aux étudiants en médecine, les connaissances nécessaires dans ce domaine.
puerpéral
Relatif à la période qui suit l'accouchement (suites de couches).
Une fièvre puerpérale est le signe d'une maladie infectieuse qui peut se déclarer à la suite d'un accouchement.
pulmonaire (artère, veine)
Vaisseau reliant le cœur et le poumon.
Artère pulmonaire
Ce volumineux tronc artériel conduit le sang du cœur au poumon. L'artère pulmonaire mesure environ 2 centimètres de diamètre. Elle est issue du ventricule droit, dont elle est séparée par la valvule pulmonaire. Elle se dirige vers le haut puis se sépare sous la crosse de l'aorte en 2 branches : l'artère pulmonaire droite, la plus longue et la plus grosse, et l'artère pulmonaire gauche.
Chacune de ces deux artères se dirige vers le poumon correspondant afin que le sang qu'elle véhicule y soit oxygéné avant d'être ramené au cœur par les veines pulmonaires et de regagner la circulation générale.
PATHOLOGIE
L'artère pulmonaire peut se dilater lorsqu'il existe une hypertension artérielle pulmonaire. Dans certaines malformations congénitales, il peut exister un défaut de développement de cette artère, une atrésie (absence de développement) d'une de ses branches ou, exceptionnellement, une artère pulmonaire gauche en position anormale.
Veine pulmonaire
Au nombre de 4 (2 de chaque côté), les veines pulmonaires se jettent dans l'oreillette gauche, où elles ramènent le sang préalablement oxygéné dans le poumon ; le sang gagne ensuite le ventricule gauche pour être propulsé dans tout le corps (grande circulation).
En cas de rétrécissement mitral, l'hyperpression sanguine se propage aux veines pulmonaires puis aux poumons, entraînant un risque d'œdème pulmonaire aigu.
pulpe dentaire
Tissu conjonctif richement vascularisé et innervé, situé dans la cavité centrale de la dent, l'endodonte.
La pulpe dentaire, improprement appelée nerf dentaire, assure la formation de la dentine ainsi que la nutrition, la sensibilité et la défense de la dent. Tout au long de la vie, une calcification lente et progressive réduit son volume. On distingue la pulpe camérale, située au centre de la couronne, de la pulpe radiculaire, localisée au centre de chaque racine.
PATHOLOGIE
Une carie dentaire ainsi que certains traumatismes peuvent déclencher une inflammation plus ou moins marquée de la pulpe.
— Une inflammation réversible, appelée hyperhémie, provoque une hypersensibilité brève de la dent au contact d'aliments froids. À ce stade, la dent peut être soignée et conservée vivante.
— Une inflammation irréversible, appelée pulpite, fait suite à la précédente en l'absence de traitement. La dent doit alors être dévitalisée.
— Une inflammation persistante, qu'il s'agisse ou non d'une pulpite, s'accompagne d'une nécrose progressive de la pulpe, le plus souvent indolore. Peu à peu, les toxines provenant de la pulpe morte envahissent l'os environnant, provoquant la formation d'une lésion (kyste, granulome, abcès) qui devient brutalement douloureuse. Son traitement consiste à nettoyer le canal de la racine de la dent de façon à retirer le nerf abîmé ou mort et les microbes qu'il contient.
Voir : dent, pulpite, pulpotomie.
pulpectomie
Ablation de la pulpe dentaire.
Synonyme : dévitalisation.
Voir : dévitalisation.
pulpite
Inflammation aiguë et irréversible de la pulpe dentaire.
Une pulpite est due à une carie profonde ou à un traumatisme dentaire. Elle se traduit par des douleurs parfois provoquées par le contact avec des aliments chauds, mais souvent spontanées. Celles-ci peuvent être accentuées par l'accélération du rythme cardiaque à l'effort et irradier vers les oreilles et les pommettes. Lorsque la pulpe est inflammatoire, elle se trouve comprimée dans la cavité dentaire du fait de l'augmentation de son volume. Il faut alors dévitaliser la dent.
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