[ epidemiological data of children burns in Tunis. about 134 cases]

Burns injuries represented the most children common domestic accident which can be responsible of a dramatic consequences. To analyse the epidemiological data and preventive aspects of this victims, a retrospective study is reported between 1 January and 31 December 2006 concerning 134 children who were examined during this period in the emergency of the surgery department [B] of the children Hospital of Tunis. In 43 cases, a hospitalisation was necessary. The mean age of the patients was 36 months. The accident occurs in the house in 99 per cent of cases, especially in the kitchen in 93 per cent. The most common agents were scalding liquid in 89.5 per cent followed by flames in 8 percent. The mean total burns surface areas was 4 per cent for the non-hospitalised children and 14 per cent for those whose been hospitalised, 16 per cent of this children developed an infection of the burns injuries during their hospitalisation. In 3 cases an amputation was necessary due to a third degrees burn with carbonisation of the members. One patient died 48hrs after his admission by a respiratory distress. The children burn injuries can be considerably reduced by preventive measures and active public health programs to promote immediate cooling of burns with cool water which is at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children

Diabetic acido-ketosis revealing thiamine responsive megaloblastic anemia

Thiamine-responsive megaloblastic anemia [TRMA] is a rare autosomal recessive disorder including megaloblastic anemia, thrombocytopaenia, diabetes mellitus and progressive sensorineural deafness. We report cases of two infants, aged respectively four and five months, hospitalized for diabetic-acido-ketosis requiring insulin therapy. Laboratory tests revealed megaloblasic anemia, thrombocytopenia and normal thiamine-levels. Neurosensorial investigations showed bilateral deafness and ophthalmic involvements. Treatment with oral thiamine normalized hematological parameters and ameliorated diabetes

[Clinical and etiological features of primary adrenal insufficiencies in children]

The chronic primary adrenal insufficiency or Addison's disease is uncommon in children and belongs generally to a complex syndrome. Study of the clinical and aetiological features of primary adrenal insufficiencies in children. In a retrospective study, we reviewed clinical and diagnostic data of all cases of Addison's disease admitted within a period of 15 years [from January 1991 to December 2006], in a department of paediatrics. Cases due to congenital adrenal hyperplasia were excluded. 6 cases of Addison's disease were diagnosed. Five patients are the product of consanguineous marriage. The age at the diagnosis of adrenal insufficiency yarned from 15 months to 9 years 8 months. The adrenal insufficiency was associated to Allgrove syndrome in three cases, to autoimmune polyendocrinopathy type 1 in one patient and to probable peroxisomal disease in another one. The etiological disease was not determined in one patient. A substitutive hormonal therapy was conducted in all patients. During a mean follow-up of 26 months, two adrenal crises were noted. larger studies about Addison's disease are needed to confirm the preponderance of the Allgrove syndrome

[Brucellosis. report of a case]

The brucellosis is an infectious disease caused by brucella. We reported a case of brucellosis in a 14 year old boy admitted for a trailing fever and slimming. The diagnosis was confirmed by two blood cultures and the serodiagnosis of Wright. He was treated by rifampicin and doxycyclin. Two weeks later, he developed a brucella arthritis [spondylodiscitis]. The evolution after six months of treatment was good. This arthritis must be searched earlier with the radiologic explorations

[Acute poisoning in the pediatric service at the infant hospital of Tunis. report of 325 cases]

We reported a retrospective study concerning 325 cases of acute poisoning in the pediatric service at the infant hospital of Tunis during a period of one year from 1 January to 31 December. The aim of this report is to evaluated the epidemiologic, clinical and evolutive aspects. They were 194 boys and 131 girls. 60 per cent of the infants are aged under 3 years. The chemical products occupied the first place with 153 infants [49.7 per cent], the inhalation of petroleum represented 62 cases, the water of javel 58 cases. The medicines occupied the second place with 128 infants [39 per cent]. The evolution was favourable in 277 infants [85 per cent]. 12 patients [3.6 per cent] are presented a pneumonia after inhalation of petroleum. In 4 patients [1.2 per cent], we constated a caustic oesophagitis. One case of death was occurred in a patient with medicinal polypoisoning.The prevention stays the better way to fight this phenomenon

[Neurological diseases in the "triple a" syndrome]

Introduction: The 3A syndrome or Allgrove syndrome is an autosomic recessive disease characterized by the association of oesophagus achalasia, alacrymie and suprarenal insufficiency. Neurological disorders can appear at any time of the course's disease and would be due to a neuropathy affecting the central nervous system as well as the peripheral nervous system

Patient and methods: From1991 to 2005, we noticed 22 cases of Allgrove syndrome. The follow-up of these patients enabled us to notify the neurological abnormalities appear later in the evolution

Results: neurological symptoms appear at any time of the course's disease. All cases were backward pupil. 8 patients had a nasal voice due to palate paralysis. 7 patients had xerostomia wich is included in the dry syndrome due to the degeneration of salivary glands. One patient had a neurological motor disorder and 3 patients had a sensitive disorders with loss of cold feeling and vasomotor disorders in the hands and feet. These symptoms appear after 4 years on average after diagnosis. An orthostatics hypotension was noticed among three patients as a dysautonomic sign

Conclusion: All of these data approve that neurological disorders appear at a variable time of the course's disease. This polyneuropathy affects the oesophagus and always leads to the recurrence of the digestives signs

[Ambulatory pediatric morbidity. Evaluation of one year activity of consultation in department of Pediatrics, emergency and consultations of children's hospital of Tunis]

Pediatric morbidity has been the subject of many studies, nevertheless those concerning with ambulatory morbidity are rare. The subject of this study is to establish the epidemiologic profile of patients. Identify the encountered pathologies and their frequency, precise morbidity characteristics and raise difficulties in the diagnostic and therapeutic management. In this retrospective study we reviewed the data of 4387 children that have consult for the first time external consultation of the department of Pediatric External Consultations and Emergency [PUC] of the Children's Hospital of Tunis during the year 2003. The 4387 patients benefit from 7323 consultations which represent 44.3 per cent of the total of consultations of the year 2003 [16 507]. 59.4 percent of the studied population was male [sex ratio = 1.2] and two thirds were aged under 6 years old. The main motif of consultations was recurrent bronchopneumonia [15.2 percent], cutaneous disease [6.2 percent], vomiting [6.1 percent] and abdominal pain [5.6 percent]. 3.2 percent of the children were admitted. Ambulatory morbidity was dominated by four pathologies: digestive 16 percent, pulmonary 14.9 percent, neurologic 6.7 percent and hematologic pathothologies [6 percent]. Gastro-oesophageal reflux was the major digestive disease followed by acute diarrhea [10.6 percent]. The principal pulmonary disease were bronchopneumonia [60.5 percent], acute bronchitis [21.6 percent] and asthma [14.4 percent]. 59.9 percent of the neurologic pathology were represented by seizures. 28.4 percent of the seizures were feverous. Anemia is the most frequent hematologic pathology [55.1 percent]. It was caused by iron deficiency in 87 percent of cases. The endocrinologic pathology is essentially represented by the short stature. We suggest to informatize medical data so it would be more exploited for studies, to make more complementary explorations available in the Children's Hospital of Tunis and to decentralize the management of the simples diseases

[Severe acute liver failure. About 32 cases]

The current study was conducted to determinate clinical, biological and outcome characteristics of children hospitalized for severe acute liver failure [SALF] and to identify prognosis indicators in our patients. Patients hospitalized with SALF, between January 1995 and June 2005, were reviewed retrospectively. Thirty two patients, aged from 2 months to 13 years and 7 months were studied, 72 percent for them developed encephalopathy. The main causes of SALF were viral hepatitis in 31 percent of cases, toxic and drug induced liver disease in 28 percent of cases, inherited metabolic disorders in 31 percent of cases, auto-immune hepatitis in one cases and Budd Chiari syndrome in one case. The etiology of SALF remained undetermined in 16 percent of normal, serum bilirubin level above 300 micro mol/l and the grade of encephalopathy. In the absence of liver transplantation, a total of 11 patients died from sepsis or multiple organ failure. The spontaneous prognosis of severe acute liver failure is poor with an overall mortality. Preventive treatment of viral and toxic hepatitis is one of the most effective approaches

[Epidemiological characteristics of the traffic accidents at the child in big Tunis]

Purpose: to kick away epidemiological profile of traffic accidents at the child in the region of Tunis

Patient and methods: It is about a retrospective study of 1191 files concerning children aged between 0 to15 years, victims of public highway accident admitted to the emergency of the institution of the Paediatric Surgery [B] between 1st January and 31 December 2003

Results: The age bracket the most concerned was that of children aged between 4 and 8 years [53.5 per cent]. Twice on three, the victim was a male [63 per cent]. The accidents were more frequent in spring and graver during the weekend. Three peaks of frequency were noted during the day; at twelve o'clock, at 15 p.m and 18 p.m. The victims became especially from the most unfavourable cities of the the capital, 98.6 per cent were pedestrians. The light care was responsible for 77 per cent of accidents. In 84 percent of cases, the driver having caused accident alerted the helps. The transport was not medically in 70 per cent of cases. The cranio-cerebral region was the most concerned in this series [66 per cent], while the thoraco-abdominal region was interested in 28.7 percent and members in 21.2 percent of cases. 11.68 per cent were hospitalized. The rate of death represents 1.1 per cent of patients. Neurological after-effects represented 1/4 of observed after-effects

Conclusion: The analysis of results every year conclude at the decrease of the traffic accident generally, contrasting with an increase of grave accidents responsible for a more important number of death and this at the same time as the increase of the number of vehicles on the road in Tunisia. We conclude to the importance of the prevention and the amelioration of the quality of the coverage to be begun by, the improvement of the conditions of collection and the implementation of structures of reception multi-field

[Crossed renal ectora : a two cases report]

Crossed renal ectopia is a rare congenital anomaly, in which, the two kidneys are in the same side with one of the ureters which crosses the midline to be brought together in the bladder on the opposite side. Generally asymptomatic and of fortuitous discovery, this anomaly can appear by abdominal pains, urinary tract infection or a hematuria. The diagnosis rests on the radiological examinations in particular the ultrasonography, the intravenous urography and the CT scann. The treatment is surgical and is reserved for the complicated forms. We report two observations of children with a crossed renal ectopia The first observation is that of a 5 years old girl, presenting urinary tract infections at repetition whose etiologic assessment comprising a renal ultrasonography, a voiding cystourethrography as well as a three-dimensional tomodensitometry objectified a vesico-ureteral reflux grade HI, on left kidney in crossed ectopia. After sterilization of the urines, this patient profited from a surgical cure of her left vesicoureteral reflux with simple continuations.The second observation concerns a 10 years old boy, carrying a malformation anorectale, operated at birth, and at which the malformatif assessment [renal ultrasonography, vertebral radiography] objectified a left kidney in crossed ectopia with vesicoureteral ipsilateral reflux grade Ill associated with complex vertebral anomalies. This child was operated according to the same technique with simple operational continuations. From these two observations and after review of the literature, we recall the clinical, radiological and therapeutic characteristics of this malformation and discuss the pathogenic assumptions

[Idiopathic pulmonary hemosiderosis presenting with spontaneous pneumomediastinum]

The association between idiopathic pulmonary hemosiderosis [IPH] and pneumomediastinum is unusual. We report a case of a five year old girl admitted for intense pallor, dyspnea and cervical subcutaneous emphysema. In past record, the patient was treated for an iron deficiency anemia since two years old. Complete blood count showed a severe iron deficiency anemia. Chest radiograph revealed bilateral diffuse alveolar infiltrates and pneumomediastinum. Bronchoalveolar lavage fluid showed numerous siderophages. Control chest radiograph two months after, revealed an interstitial fibrosis. Pneumomediastinum may be secondary to pulmonary fibrosis that complicate an old IPH. The patient had a coexisting celiac disease

[Caustic ingestion in children: a review of 589 cases]

Accidental ingestion of caustic substances remains frequent in children. Esophageal stricture is a severe complication of caustic esophageal burns. To study the epidemiologic features of caustic ingestion in children and to assess the management of a caustic esophageal burns. Records for 589 children hospitalized for ingestion of a caustic agent, between l990-2000, were reviewed. Hospital prevalence was 2.25%. Children with ages ranging between one and three years were observed in 53.3% of cases. Domestic products were the most common corrosive substance ingested, especially bleach which was ingested in 80.5% of cases. Upper gastro-intestinal endoscopy was performed only in 435 children. 112 patients have corrosive burns on the upper gastro-intestinal tract [25.7%] including esophagitis in 71 cases, gastric burn in nine cases and both in 32 cases. Among the 20 children having a severe oesophageal burn, nine developed strictures. Four of these received high doses of steroids at acute phase. Four cases of stricture underwent esophagoplasty. An improvement of the management t of corrosive esophageal burns is required to decrease the risk of esophageal stricture