[ acute liver failure [ALF] in children - about 55 cases]

The acute liver failure [ALF] in children has multiple etiological factors.. In our context, the infectious, especially viruses, are in the first rank. In this study, the authors report 35 cases of ALF, diagnosed and treated in our unit, between January the 1st 2003 to february 28[th], 2006 for analyzing the clinical, biochemical characteristics, the evolution as well as the treatment. The age of the patients varies between 2 months to 14 years old. Clinically, the jaundice was noted at 57% of the patients, are bleeding 28%, a hepatomegaly 41% with cirrhotic once at 17% and a generalized edema at 34%. A hepatic encephalopathy was noted in 11% of the patients. On the biological parameters: the rate of prothrombin [RP] was lower than 50% in 82% of cases, the hepatic cytolysis was noted in 88% of cases, the hypoalbuminemia in 40% and low blood glucose in 43% of the patients. Concerning etiologies, the infectious origin accounts for 45%, followed by Wilson disease with a rate of 19%. The treatment is in all cases symptomatic; it was etiologie each time that a cause was identified. The death of 3 patients is deplored. The infectious origin remains the dominant cause in our department, represented primarily by hepatitis A and the leishmaniosis, followed by the Wilson's disease. The high mortality must encourage rapid evaluation and selection of the patients candidates to liver transplant

[Peritoneal tuberculosis in children about a 42 cases]

Peritoneal tuberculosis is a common affection in the developing countries. Its frequency in the industrial countries is substantially increasing mainly due to AIDS pandemiy. In Morocco it occupies the third position after pulmonary tuberculosis and gangional tuberculosis. It represents 75%of abdominal localisations. In this study, we report 42 cases that were hospitalized at the pediatrics department at the Hassan II University Hospital of Fez, Morocco, Our patients, 22 boys and 20 girls, were aged between 1.5 and 14 years old with an average age of 7.7 years. They were vaccinated with BCG in 97%of cases. Twelve cases were due to contagion. The clinical profile was dominated by ascitis, abdominal pain sometimes with resemblance to surgical pathologies and acute fever. Association with other tuberculosis affections, mainly pleural tuberculosis, was observed in 17 cases. In 26 kids diagnosis was confirmed with histology. The scheme and the duration of anti-bacilli treatment varied depending on cases and the coarse was good in general. Based on these observations we can con that the incidence of peritoneal tuberculosis is still very high in Morocco, since the frequency of contagion is very important the screening remains obligatory, the delay of diagnosis is due to the clinical polymorphism and to the lack of bacteriological evidence

[Ecthyma gangrenosum in the infant about 3 cases]

Ecthyma gangrenosum [EG] is one of the most dangerous bacterial cutaneous infections in the infant. The Pseudomonas Aeruginosa is frequently responsible. The skin localization is often associated with a bacteriemia, rares cases of primitive cutaneous localisation were described. The evolution is often fatal in case of immunodeficiency situation. The authors report 3 observations of ecthyma gangrenosum 2 months, 7 months and 18 months old. They all presented localised cutaneous erythema followed one week later by oedematous plates. These lesions evolved to necrosis and ulceration. The fever was absent in all patients and only one had a deteriorated general state. A high lymphocyte count was found in all patients. The inflammatory syndrome was inconstant. There were not any other localizations of the infection. The 3 patients were treated with cephalosporin of 3rd generation, associated in 2 cases with the gentamycin. The evolution was favourable. The early recognition of the lesions of EG and the institution of an adequate treatment often allows a favourable result in this affection