[Laryngotracheobronchial foreign body in children: predictive factors of respiratory sequelae]

Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. Aim: identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. This retrospective study was conducted in the children hospital of Tunis during a period of nine years [2000 - 2008]. In all statistical tests, the significance level was set at 0.05. 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae [clinical, radiological and scintigraphic]. 10 children had respiratory sequelae [clinical and radiological and/or scintigraphic] at the last follow-up and four patients developed bronchial dilatation. Respiratory sequelae were correlated with the stay period of the foreign body exceeding 84H. Neither age, nor sex, nor the nature of foreign body or its location, nor the presence of radiological opacity at the initial radiograph, were predictive factors of respiratory sequelae. The inhalation of foreign body is a serious accident affecting essentially male infants. Clinical, radiological and scintigraphic follow up is mandatory

[Diabetic ketoacidosis and thyroid storm occurring while awaiting radical treatment, about 2 cases]

The association of uncontrolled type 1 diabetes and Grave's disease may induce metabolic decompensation leading to the simultaneous occurrence of diabetic ketoacidosis and thyroid storm. This double endocrine emergency, although rare, is known to be life-threatening. Diagnostic difficulties due to an atypical presentation of thyroid storm that can be masked by diabetic ketoacidosis result in delayed diagnosis and treatment and therefore in a fatal outcome. We report two cases in whom early recognition and intensive treatment have led to an improved outcome. Radical treatment of the Grave's disease immediately at the diagnosis of the associated type 1 diabetes may prevent this double complication