S. Boukthir

Corticothérapie à forte dose dans le traitement des œsophagites caustiques sévères chez l’enfant

UNLABELLED Esophageal burns are frequent in some countries. Esophageal stricture is a severe complication after caustic ingestion. Its frequency is estimated to 5% and reaches 47% in severe esophagitis. AIM OF THE STUDY To study the influence of management of severe esophageal burns with high doses of steroids in the occurrence of esophageal stricture through the experience of an endoscopic unit. PATIENTS AND METHODS Twenty-six children with a mean age of 3.5 years (15 months-8 years) with a second b- (N =22) or a third-degree (N =4) esophageal burns due to accidental ingestion of a caustic substance were included between 1993 and 1999. Corrosive substances ingested were sodium hydroxide (N =17), bleach (N =4), alkali (N =3), others (N =2). Upper GI endoscopy was performed in 17 children within the 24 hours of caustic ingestion and within the first 48 hours in all cases. All patients received methylprednisolone (1 g/1.73 m2/day) plus cimetidine and ampicillin plus early oral feeding resumption. RESULTS Three children (2 grade II et one grade I) were not controlled on day 30 of the protocol and have then been excluded. The remaining 23 children were divided in two groups depending on the upper GI endoscopic results: group I of 12 patients completely or partially healed and group II of 11 patients who developed an esophageal stricture. No difference was observed between the two groups with regard to the delay between caustic ingestion and the start of treatment and the number of shots of methylprednisolone. Second b- degree esophagitis complicated with an esophageal stricture underwent a median of five esophageal dilations (1-12). After a median follow-up of three years, four of them have a normal esophagus. All children with a third-degree esophagitis developed an esophageal stricture. One had a surgical replacement of the esophagus with a segment of colon with good outcome. The three others underwent a median of seven esophageal dilations (5-10). One of them has a normal esophagus after a follow-up of five years while the two others were lost to follow-up. CONCLUSION High dose of corticosteroids seems to improve second b-degree esophagitis prognosis and may prevent from esophageal stricture.

Hétérotopies de la substance grise. À propos de quatre observations pédiatriques

Resume L’epilepsie severe de l’enfant pose un probleme de diagnostic etiologique. Les heterotopies de la substance grise constituent une cause rare. Les auteurs rapportent quatre observations concernant des filles âgees de trois ans, six ans, sept ans et neuf ans sans antecedents particuliers. Il n’a pas ete retrouve de consanguinite. L’âge de debut de l’epilepsie est situe entre neuf mois et quatre ans. Le retard psychomoteur a ete retrouve chez trois patientes et la regression psychomotrice chez une patiente. Trois malades avaient presente un etat de mal convulsif. L’IRM a visualise une forme sous ependymaire dans un cas et une forme corticale diffuse dans trois cas associee a une agenesie partielle du corps calleux dans un cas et une pachygyrie dans deux cas.

Serum leptin concentration in Tunisian non overweight non obese children

Leptin, an adipocyte-derived peptide hormone, is thought to play a key role in the regulation of body fat mass. Beyond this function, it appears to be an integral component of various hypothalamo-pituitary-endocrine feedback loops. Because childhood and puberty are periods of major metabolic and endocrine changes, we investigated leptin levels in 348 non overweight, non obese children (147 boys, 201 girls, age: 6-12 years) and then correlated these levels with age, anthropometric data, pubertal stage and insulin. A blood sample was collected from each subject to measure leptin and insulin levels by radioimmunoassay. Pubertal stage was assigned by physical examination, according to Tanner criteria for breast development in females and genital development in males. The results showed an increase in leptin levels in an age related way (r = 0.32, p < 0.0001 in girls; r = 0.21, p = 0.011 in boys) following a pattern that paralleled body weight (r = 0.6 in girls; r = 0.56 in boys; p < 0.0001) and BMI (r = 0.59 in girls; r = 0.6 in boys, p < 0.0001), suggesting that body fatness is a regulator of leptin levels in both girls and boys. A significant gender difference (3.39 +/- 2.79 ng/mL in girls vs 1.99 +/- 2.08 ng/mL in boys, p < 0.0001) with an increase during pubertal development in girls was also showed, while the levels remained constant in boys from Tanner stages T1 to T3. A correlation between leptin and insulinemia was noted in girls (r = 0.38, p < 0.0001) but not in boys, suggesting that insulinemia could be a stimulator of leptin synthesis in girls.

Foetus-in-fetu an Unusual Cause of Abdominal Mass in the Newborn

Abstract Foetus-in-fetu (FIF) is a rare congenital condition in which a vertebrate foetus is incorporated within its twin. The authors report the case of a newborn girl with prenatal ultrasonographic diagnosis of an intra-abdominal mass. Abdominal ultrasonography and computed tomography of the abdomen showed a heterogeneous cystic mass containing multiple calcifications. The patient had a laparotomy at 18 days of age with excision of a well-encapsulated 6 χ 5 cm retroperitoneal mass, containing many organs. Anatomicopathologic examination showed a relatively well-differentiated FIF attached to an amniotic sac by a rudimentary umbilical cord. Encephalon, coroidal plexus, vertebral bodies, rudimentary limbs, thyroid gland and teeth were identified. The postoperative period was uneventful.

Reversible posterior leukoencephalopathy syndrome: A rare complication of hypertensive encephalopathy in children

Reversible posterior leukoencephalopathy syndrome is a recently defined cliniconeuroradiologic entity, rarely reported in children. Hypertensive encephalopathy is the most common cause. A 4-year-old boy presented with reversible posterior leukoencephalopathy syndrome manifested by headache, seizures, coma, papilledema and facial paralysis complicating severe arterial hypertension. Computed tomography scan of the brain showed bilateral low-density areas corresponding to the frontal, parietooccipital white matter and to the internal capsula. Blood pressure was controlled within 4 days and clinical recovery was obtained within 5 days. Magnetic resonance imaging, performed 2 months later, was normal. The arterial hypertension was caused by renal scars of bilateral vesico-renal reflux. The clinical course, pathophysiology and neuroimaging features of reversible posterior leukoencephalopathy syndrome in children are discussed.