[Inhaled corticosteroids treatment in infants with asthma: report of 60 cases]

The aim of this report was to evaluate clinical course of asthma in infants with long term inhaled corticosteroid therapy. We reviewed retrospectively 60 infants with asthma requiring inhaled corticosteroid-therapy at Infantile Medecine A Department in Children's Hospital of Tunis, during six years [1998 -2003]. We evaluated asthma control and treatment side-effects. 60 infants [43 males and 17 females] with asthma were given inhaled corticosteroids. The mean age at diagnosis was 11.2 months [2.5 -30 months]. The mean age at the beginning of the treatment was 17 months [3 - 42 months]. All patients were given beclomethasone propionate during a period of 23.5 months in average [9 - 66 months] with a mean daily dose of 697micro g [400 - 750 microg] initially. Patients were followed up and reevaluated 44 +/- [16.3] months later [19-99 months]. Before treatment, 34 infants had moderate asthma [56.7 percent] and 26 infants had severe asthma [43.3 percent] [according to DeBlic classification]. After corticosteroid therapy, clinical course improved in 57 patients [95 per cent] who developed intermittent asthma, while three patients developed moderate to severe asthma [p < 0.001]. The mean weight of patients passed from + 0.22 SD to + 0.33 SD [p = 0.313]. The mean height of patients passed from + 0.04 SD to + 0.48 SD [p < 0,001]. 10 per cent of patients developed local side effects related to inhalation. inhaled corticosteroids allowed asthma control in infants without compromising growth at meaddle term

[Bilateral wilms tumors: diagnosis and therapeutic management. about 12 cases]

Bilateral Wilms tumor [WT] is uncommon malignancy, the incidence is about 5% of all nephroblastoma. It shows association with some congenital anomalies. there is no scheduled regimen for bilateral WT and their management offers a great challenge. To evaluate the clinical characteristics and the treatment result. 12 patients with bilateral WT diagnosed between 1997 and 2005, were retrospectively reviewed. Data collected: patients characteristics, chemotherapy, modality of surgical resection, renal function and survival. 11 patients [pts] had synchronous tumor and one metachronous lesions. The median age at primary diagnosis was 17 months [range 6m - 72m]. Congenital malformation were present in 4 children. 1 pt had hemi-hypertrophy, genitourinary horse kidney, 3 had hypertension.. All pts received preoperative prolonged chemotherapy [CT] for 25 to175 days [median 45 days] 7 received double agent chemotherapy. [VCR + Actinomycine], 2 triple agents: one [VCR + Actino + Adriblastine], the others [Etoposide, Carboplatine, Cyclophosphamied] for tumor progression. Two pt died before surgery due to infection. Bilateral partial nephrectomy 1 case total unilateral nephrectomy with partial nephrectomy on the other side in 3 cases. 9 pts are alive without disease and normal renal function 87 months after. The 10th in course of treatment after unilateral nephrectomy.Prolonged preoperative chemotherapy permit conservative surgical treatement of favorable histology bilateral Wilm's tumor and may improve the preservation of renal masses and function without impairing patient survival

[Surgical aspects of intussusception due to lymphoma in children]

Introduction: Bowel's intussuception is a rare kind of child Burkitt lymphoma revelation mode. The management of this situation is full of traps. The retrospective study of 6 observations aims to analyse the clinical, evolutionary and therapeutic side of this revelation mode

Results: Four boys and two girls, aged from three to seven years with an average of 5 years, had Burkitt lymphoma revealed by a Bowel's intussusception. The abdominal ultrasound find the secondary cause in 3 cases .One patient had a full-column barium enema All the cases had a laparotomy. Three cases had a surgical resection. A biopsy of mesenteric lymph nodes was done in 3 cases. A chemotherapy was initiated as soon as we made the diagnosis .There was no after effects in all the cases. No recurrence was noted until two years and a half after the treatment

Conclusion: The diagnosis of lymphoma must be suspected when the bowel's intussuception occurs in more than 5 years old children. A biopsy must be done in the event of suspicion of lymphoma. The surgical procedure must be adapted to each case