[Inhaled corticosteroids treatment in infants with asthma: report of 60 cases]

The aim of this report was to evaluate clinical course of asthma in infants with long term inhaled corticosteroid therapy. We reviewed retrospectively 60 infants with asthma requiring inhaled corticosteroid-therapy at Infantile Medecine A Department in Children's Hospital of Tunis, during six years [1998 -2003]. We evaluated asthma control and treatment side-effects. 60 infants [43 males and 17 females] with asthma were given inhaled corticosteroids. The mean age at diagnosis was 11.2 months [2.5 -30 months]. The mean age at the beginning of the treatment was 17 months [3 - 42 months]. All patients were given beclomethasone propionate during a period of 23.5 months in average [9 - 66 months] with a mean daily dose of 697micro g [400 - 750 microg] initially. Patients were followed up and reevaluated 44 +/- [16.3] months later [19-99 months]. Before treatment, 34 infants had moderate asthma [56.7 percent] and 26 infants had severe asthma [43.3 percent] [according to DeBlic classification]. After corticosteroid therapy, clinical course improved in 57 patients [95 per cent] who developed intermittent asthma, while three patients developed moderate to severe asthma [p < 0.001]. The mean weight of patients passed from + 0.22 SD to + 0.33 SD [p = 0.313]. The mean height of patients passed from + 0.04 SD to + 0.48 SD [p < 0,001]. 10 per cent of patients developed local side effects related to inhalation. inhaled corticosteroids allowed asthma control in infants without compromising growth at meaddle term

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

[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

[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

Cow's milk allergy: a study of 15 cases

Cows milk allergy [CMA] is a frequent disorder in infancy. The aim of this report is to describe the wide range of symptoms and underline particular aspects. We studied retrospectively 15 cases of CMA collected beetwen 1998 and 2003 in Medecine infantile A service. 15 infants had CMA. They were 10 boys and 5 girls, aged 15 days to 6 months. Sixpatients had a positive familial history of atopy. Patients were given cow milk by the mean age of 24 days [birth, 3 months]. Symptoms were: urticaria [n=3], rectal bleeding [n=5] associated to diarrhoea and to haematemesis [n=3], and chronic diarrhoea [n=7]. Ten patients have various symptoms atopic dermatitis [n=4], gastroesophageal reflux [n=3], two of them have esophagitis, gastritis [n=3], and recurrent wheeze [n=3]. 14 infants received extensively hydrolysed formula, and one patient requires amino acid based formula. Six patients required specific nutrition: continuious enteral nutrition [n=3], and parenteral nutrition [n=3]. All patients tolerated cow's milk protein by the mean delay of 17 months [11 to 32 months]

[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

[Intrathoracic extramedullary haematopoiesis: a study of 1 case]

Intrathoracic extramedullary haematopoiesis [IEH] is a rare entity accompanying some chronic haematologic diseases. The authors report the case of a 16 year old beta thalassemia girl with IEH, presenting in the form of asymptomatic posterior mediastinial mass. Computed tomography scanning and magnetic resonance imaging of the chest showed multiples polylobar paravertebral masses which have the characteristics of IEM. The radiological diagnosis is essential to avoid biopsy and surgery which can be very harmful because of the extreme vascularity of the haematopoietic tissue