[Congenital lobar emphysema: report of 17 cases]

The aim of this report is to determine frequency and clinical characteristics of Congenital lobar emphysema [CLE] at Children's Hospital of Tunis Cases of CLE managed between January the 1st 1994 until December the 31 St 2004 were reviewed. Amongst 31 cases of cystic pulmonary malformations we report 17 CLE. They were 12 males and 5 females. The mean age at diagnosis was 41/2 months [20 days, 22 months] Symptoms were progressive respiratory distress [n=11]; recurrent attacks of dyspnea [n=5] pulmonary infection [n=1]. Chest X ray and CT scans showed hyper aeration of the affected lobes. Three patients had two affected lobes. CLE was associated to bronchogenic cyst [n=2] and to congenital cardiac anomalies [n=3]. All patients underwent lobectomy. Post operative course was uneventful in 16 children. CLE is an uncommon cause of respiratory distress in neonates and infants. CLE is the most common cystic pulmonary malformation in our institution

Clinical characteristics and outcome of cystic fibrosis: report of 16 cases

The aim of this report is to determine clinical characteristics and outcome of Cystic Fibrosis [CF]. Cases of CF managed at Infantile Medecine A Department in Children's Hospital of Tunis during 13 years [1994 -2006] were reviewed. 16 children had CF. They were 8 males and 8 females. 13 patients were consanguineous and four had similar familial cases. The mean age at diagnosis was 19 months [10 days, 13 years]. 3/4 of patients were symptomatic within the first trimester of life. Revealing symptoms were: obstructive bronchopathy associated to chronic diarrhea [n = 6], oedema-anemia-hypotrophy-hypoprotidemia syndrome [n = 3], meconium ileus [n = 4], bronchiectasis [n = 2] and chronic diarrhea [n = l]. The diagnosis was confirmed by sweat test and genotypic data. The F508 del was the most frequent mutation [54%]. Clinical outcome was characterized by the occurrence of respiratory and nutritional complications: acute respiratory failure [n = 6], chronic respiratory failure [n = 3], chronic pseudomonas aeruginosa infection [n = 6] at a medium age of 3.8 years, recurrent haemoptysis [n = 2], pleural effusion [n = 2], a malnutrition [n = 10] and diabetes associated to puberty delay in one patient. Seven patients died at mean age of 4.4 years [6 months, 17.3 years]. Among surviving patients, six had no compromised nutritional status or lung function. Prenatal diagnosis was performed in three families. CF is characterized by earliest onset and severity of symptoms. Therapeutic insufficiency is the main cause of precocious complications and poor prognosis in our series

[Infancy asthma: diagnostic and therapeutic approach]

Asthma in infants is characterized by recurrence of three episodes of dyspnea and wheezing within two first years of age. Asthma in infancy is a heterogeneous condition with different clinical phenotypes and outcome. So, the diagnostic and therapeutic approach are often difficult. The aim of this systematic review was to provide answers to the following questions in the management of recurrent wheeze in infants: is it asthma?, should we treat wheezy infants?, what are the modalities of prescriptions ? what is the long term outcome of wheezy infants? Electronic literature search was performed in Medline. Key-words used for the final search were "infant", "wheezing", "atopy", "asthma", "inhaled corticosteroids". We considered for analysis meta analysis, randomized controlled trials, systematic reviews, cohort studies and consensus statement reports. The diagnosis of asthma in infants is more difficult than in older children or adults since many causes of "wheezing" may simulate an asthma associated to difficulties to evaluate bronchial hyper responsiveness in this age. There are three groups of wheezy infants: transient early wheezers, persistent non atopic wheezers and persistent atopic wheezers or asthmatic .Since recent data have proved early bronchial inflammation in wheezy infants, inhaled corticosteroids have become the main treatment. However, management of asthmatic infants is more difficult according to anatomic and functional respiratory peculiarities. There is no reliable clinical or biological indicators of future asthma. The evidence of atopy in infants with recurrent wheezing seems to be the main risk factor of the development of persistent asthman

[Children helicobacter pylori infection: antibiogram results]

Helicobacter pylori infection is frequent in children. The eradication rate is variable, it is influenced by resistance of the bacteria to the antibiotics used The aim of this study was to determine the resistance rate of the most commonly used antibiotics among helicobacter pylori[Hp] strains isolated in infected children. 60 children [26 males, 34 females], with mean age of 8 years 8 months [3years and 2 month[2.5-13.5years] underwent an oesogastroscopy. Forty six of them had helicobacter infection assessed by the presence of Hp on the gastric biopsy and or positivity of urease test. The infected children were treated with three medications Omeprazole, Clarythromycin, and Amoxicillin. The eradication of Hp was confirmed in 13 patients by the absence of Hp on the gastric biopsy and/or negativation of the urease test. Culture was positive in 13 infected children susceptibility to anti microbial drugs was done in ten children,. Nine children had primary metronidazole resistance, three had both clarythromycin and Metronidazole resistance, three had Clarythromycin primary resistance. No case of Amoxicillin primary resistance was detected. Children eradication was achieved in four children among 13 children. This study shows the difficulty of Hp culture. it confirms the absence of Hp resistance to Amoxicilline. the high level of Hp resistance to Metronidazole and the mild level of Clarythromycin resistance. The authors stress the importance of Antibiotic susceptibility assay in helicobacter pylori infections