[Delayed congenital diaphragmatic hernia in children. [study of 8 cases]]

Congenital diaphragmatic hernia [CHD] is the result of a defect of the musculo-aponevrotic septui which separate the thoracic cavity from the abdominal cavity allowing migration of the abdominal viscera in thorE, Its global frequency is estimated at 1/300010 1/5000 living births. In the majority of cases, it appears in the fir 24 hours of life revealed by an acute respiratory distress. In 5 to 25% of cases, the CHD was lately reveale beyond 4 weeks of life to several months or sometimes several years

Patients and methods: We report retrospective study of 8 cases of CHD with delayed revelation enrolled in the department of pediatrics on a peric of 22 years between 1984 and 2005

Results: Six patients of our cases had postero lateral hernia by th Bochdalek foramen of divided on 5 in the left side and one case on the right side. Only 2 patients had retro-cost[xyphoidien hernia of Larrey. Epidemiologic data reported 3 girls and 5 boys with the mean age of one year an half [range from 47 days to 3 years and half]. On the clinical plan the mode of beginning was acute on 6 case or chronic on' one case. CHD was fortuity discovered in one case during exploration of axillary lymph node! Respiratory symptoms were predominant in 7 cases associated to gastrointestinal symptoms in 4 cases. patients benefited from chest radiography that revealed digestive clarities on the lung bases. TOGD has bee also achieved in all cases and permitted to confirm the diagnosis and to specify the herniated organs. Thorac[abdominal scan in 2 cases and IRM in only one case revealed a right HDC with ascension of the liver. Seve patients have been operated. One child died quickly some hours after his admission by refractory hypoxernii Post operative outcome are favourable in six cases. One child dead one day after surgery by refractor respiratory distress

Conclusion: The diagnosis of the delayed CHD must be evoked in presence of respirator or digestive symptoms associated to unusual radiological abnormalities of the lung bases. Early surgic; treatment is efficient in the majority of the cases

[Constitutional deficiency in factor vii: study of two observations with review of the litterature]

Introduction: constitutional deficit in factor VII is an hereditary haemorrhagic autosomal recessive disease due to the decrease or the absence of factor VII in coagulation. It is a rare pathology with a frequency estimated at 1/500.000. Clinical expression is very variable and the severity of the haemorrhagic syndrome does not correlate with the residual rates in factor VII

Observation number 1: Kamel, a 9 year-old boy, descending from cousin-german parents is hospitalized for an average abundance recurrent epistaxis since the age of 2 years. Medical exam in the admittance found only a cutaneous and mucous paleness. On the biologic level, we noted set apart, a microcytic hypochrome-plate anaemia at 8 g / dl, a low TP at 35 per cent while TCA was normal [24/30]. The dosage of factors of coagulation showed a low rate in factor VII, of 24 per cent thus confirming the diagnosis of a congenital innate deficit in factor VII. This child was put taking out under martial supplementation after spontaneous drying up of the bleeding

Observation number 2: Wassim who is a newborn male, 3-rd child of cousin-german parents, is admitted at the age of 2 days for an average abundance of hematemesis. He is born from a well followed pregnancy and a caesarean delivery. Vitamin K was received at birth. At the age of 2 days, he presented an average abundance hematemesis whence the admittance in our service. Exam at the admittance was normal and he did not present exteriorized bleeding. A biologic balance showed a low TP twice at 17 and 15 per cent with a normal TCA at 32/30. The dosage of factors of coagulation in particular the factor VII practised with the baby showed a low rate of 1,5 per cent thus confirming the diagnosis of a congenital deficit in factor VII

Conclusion: At its worst, deficit in factor VIlcan put at stake the vital functional prognostic or even the vital one. The prognostic of the disease remains bound to the risk of notably serious cerebral bleedings arising in neonatal period. It is necessary to make a genetic council for the consanguineous parents of a patient affected with this disease

[West syndrome study of 25 cases]

The West syndrome is a scarce epileptic syndrome in infant characterized by a symptomatic triad associating epileptic spasms, psychomotor regression and hypsarythmy. The goal of this work is to analyze the electroclinic and etiologic aspects of the West syndrome and to propose a therapeutic control

Patients and methods: We report a retrospective study of 25 cases of West syndrome collected in the department of pediatric between 1991 and 2005. Several epidemiologic and evolutionary parameters were studied

Results: The middle age of our patients is 5 months and half with the extreme going from 45 days to 12 months. The spasms are in bending in 96% of cases; only one child had spasms in extension. A delay of psychomotor development was noted in all cases, it was previous to spasms in 48% of cases. The initial electroencephalogram objectified a typical hypsarythmy in 20 patients [80 %] and an atypical hypsarythmy in 5 cases [20%]. On the etiologic plan, it acts of 24 symptomatic forms. The cryptogenic form was noted in only one case. The treatment of first intension was variable and the evolution under treatment was marked by a disappearance of spasms in 22 cases with persistence of a significant psychomotor delay in 9 cases, 3 cases evolved toward a syndrome of Lennox Gastaut

Conclusion: The gravity of this pathology incited us to know better its different electroclinic and therapeutic aspects in order to improve the forecast in these children

progressive family intrahepatic cholestasis difficulty of diagnosis and taking charge in a developing country

The progressive family intrahepatic cholestasis or Byler syndrome is a group of recessive autosomic illness. It is responsible of an intra-hepatic cholestate which is secondary to an anomaly of the metabolism and the excretion of biliareses acid .In spite of progress achieved over the last few years in the understanding of the physio-pathological mechanisms and the genetics of this group of cholestasis, the hold in charge remains difficult in a developing country like Tunisia. Patient and methods: it is about a retrospective survey concerning 12 children treated in the paediatric service during a period of 18 years [1986-2003] for progressive family intrahepatic cholestate confirmed by clinical, biological and histological data. our set includes 12 children who have presented a cholestatic jaundice with dark urine and discoloured waste beginning between the ages of 3 days and 18 months with an average age of 4 months, the parental inbreeding has been noted in 10 patients, the domestic antecedents of jaundice of the infant were found in 5 cases the jaundice was in irregular all cases and partner to a prurits in 8 cases. The hyperbilirubinemy and the increase of the alkaline phosphatases were present with all patients. The rate of cholesterol was normal with all patients. The gamma GT was normal in 10 cases and increased in 2 cases, biliary acids have been measured in 10 patients, they were raised in all cases. The hepatic biopsy has been achieved in 10 cases; it showed signs of cholestase and fibrosis in all cases. Eight patients received a treatment associating acidic ursodesoxycolic [AUDC] and Rifampicin, whereas 4 patients have been treated with cholesteramin in the absence of hold social. The K vitamin by way parenterale has been prescribed for all children, whereas vitamins A and E, not available in Tunisia are taken only by 2 patients. The evolution has been made toward the death in a graph of decomposed cirrhosis in 3 patient [age ranging from 1 month to 4 years]. The other patients are treated again with thrusts of jaundice and pruritus but with no sign of serious hepato-cellular insufficiency. A lot of difficulties persist at the level the diagnosis of the PFIC in Tunisia [biliary acid dosage abroad] and especially at the therapeutic level: unavailability of fat-soluble vitamin and absence of a hepatic transplantation program

[Primitive lymphedema of children. About 4 observations]

In children, the lymphedema often results from a primitive abnormality of lymphatic vessels. Through four observations depicted in the pediatric department of Sfax, we try to show the clinical and etiological polymorphism of this disease and to underline the difficulties of the coverage especially at the child. 1: a girl hospitalized at birth for Bonnevie-Ullrich's syndrome associating an innate lymphedema and Turner's syndrome. A boy hospitalized at the age of 13 months for congenital unilateral lymphedema with penio-scrotal atteinte, associated to urinary malformation [not obstructive pyelo-ureteral connective syndrome]. A 7 years old boy hospitalized for familial primitive premature bilateral lymphedema type Meige. A 13 years old boy, hospitalized for recidivated erysipele. The diagnosis of sporadic primitive premature unilateral lymphedema associated to venous malformation was retained