Thoracoscopic treatment of pulmonary hydatid cyst in children: a report of 25 cases

Open surgery is the standard option for the treatment of hydatid pulmonary cysts. Surgeons are able to replicate the principles of conventional surgery using minimally invasive techniques ,in particular thoracoscopy. However, there are few reports about this subject in children. To our knowledge, this is one of the biggest pediatric series ever reported in the literature.The purpose of this study was to determine the best indications of the thoracospic surgery for the treatment of the pulmonary hydatid cysts in children. We report a series of 25 cases with pulmonary hydatid cysts treated using the thoracoscopic approach from 2005 to 2009. We retrospectively analyzed the patients' sex, age, symptoms, biological data, characteristics of hydatid cysts [location, number and size] and the medical treatments. Pulmonary hydatid cyst diagnosis was performed on Chest x-ray, abdominal ultrasound and biological data in all the cases. Tomography was not systematic. All patients underwent video-assisted surgery. A conversion to thoracotomy was conducteded in 2 cases. All the patients had a chest tube and received an antibio-prophylaxy, without Albendazol . A concurrent hydatid cyst at the opposite lung or in the peritoneal cavity was treated later

[Persistent hyperinsulinemic hypoglycemia [HHI] of infancy: about 3 cases]

Hyperinsulinaemic hypoglycaemia [HHI] is the most frequent aetiology of recurrent severe hypoglycaemia in newborn and infant. This pathology arises the problem of early medical and surgical management to prevent brain damage. The aim of this work is to stress on the treatment emergency, to underline difficulties to distinguish damage. The aim of this work is to stress on the treatment emergency, to underline difficulties to distinguish between focal forms and diffuse forms, and to discuss our results with literature data. Our work is a retrospective study of 3 observations of symptomatic newborn HHI. Due to failure of glucose supplementation and medical treatment based on diazoxide and hydrocortisone, the 3 patients were operated between 50 and 107 days of life. Surgical exploration did not find any macroscopic pancreatic abnormality and intervention consisted of subtotal pancreatectomy [90-95 percent]. Anatomopathological study showed diffuse form in 2 cases and focal form in one case. After a follow up of 3 months to 2 years and a half the 3 patients have a normal glycaemia with no need to medical treatment. Yet 2 patients present brain damages .HHI is an emergency which needs a rapid medical management. Medical treatment failure should lead quickly to surgery to prevent neurological complications

[Clinical and evolutive features of invasive pneumococcal infections in child abot 10 cases]

Currently, pneumococcal infections are an important public health problem in Tunisia and through the world. The aim of this study is to analyze clinical and evolutive profile of penicillin-resistant pneumococci in children in our region. We studied retrospectively 10 cases enrolled in the paediattics department of Sousse during an 11 years period [1993-2003]. There were eight boys and two girls [sex-ratio 4] aged from 5 to 42 months [mean age: 13 months]. Four children were carriers of purulent meningitis, three a pneumonia, two an osteo-articular infection and one an isolated septicemia. The pneumococcus was isolated in pathological products and the oxacillin disk screening test detected all penicillin-resistant isolated germs The survey of penicillin sensitivity was completed by determination of minimal inhibitory concentration [MIC] by E. Test [R] every time that the diameter of inhibition was lower to 26 mm. After antipneum000ceal antibiotics treatment adapted to infections sites, six patients presented severe complications and two among them died, Frequency gravity and resistance of pneumococcal infections give a renewal interest for antipneumococcal vaccination in patients with risk

[Clinical and evolutive features of invasive pneumococcal infections in child. About 10 cases]

Currently, pneumococcal infections are an important public health problem in Tunisia and through the world. In order to analyze the epidemiological, clinical and evolutive profile of penicillin-resistant pneumococci in children, we studied retrospectively 10 cases enrolled in the pediatrics department of Sousse during 11 years period [1993-2003]. There were eight boys and two girls [sex - ratio = 4] aged 5 to 42 months [mean age: 13 months]. Four children were carriers purulent meningitis, three a pneumonia, two an osteo-articular infection and one an isolated septicemia. The pneumococcus was isolated in pathological products and the oxacillin disk screening test detected all penicillin-resistant isolated germs. The survey of penicillin sensitivity was completed by determination of minimal inhibitory concentration [MIC] by E.Test[trademark] every time that the diameter of inhibition was lower to 26 mm. After antipneumococcal antibiotics treatment adapted to infections sites, six patients presented severe complications and two among them were died. Frequency, gravity and resistance of pneumococcal infections give a renewal interest for antipneumococcal vaccination in patients with risk

[Atypical haemolytic uremic syndrome associated with steroid-resistant idiopathic nephrotic syndrome]

The association of atypical hemolytic uremic syndrome [HUS] with idiopathic nephrotic syndrome has been exceptionally described and its physiopathology is not yet understood

Observation: We report the observation of a four year and two month old boy descended of consanguineous parents which have since the age of three years a steroid-resistant idiopathic nephrotic syndrome with minimal glomerular lesions treated favorably by cyclosporine A during 12 months but whose ulterior evolution was marked by relapse of the disease and after a few months by the installation of an atypical hemolytic uremic syndrome and afterwards a terminal renal insufficiency

Conclusion: Idiopathic nephrotic syndrome may constitute the terrain of an atypical HUS. Its physiopathology, complex and not yet clarified, does probably incriminate an infectious factor and/or a genetic predisposition that remains to confirm

[Out come of steroid resistant and steroid dependant nephrotic syndrome traeted by cyclosporine]

We study retrospectively 9 cases. We colliged 5 boys and 4 girls aged between 2 years 3 months and 13 years how have steroid resistant nephrotic syndrome in 6 cases and steroid dependant nephrotic syndrome in 3 cases.The renal biopsy show minimum lesion in 2 cases, segmental glomerular sclerosis in 6 cases, and proliferative glomerulonephritis in one. All this patients received cyclosporine.The out come is good in 5 cases: 4 enfants have complete remission, one have tow relapse steroide sensible. Two enfant were ciclodependant and need prolangation of the treatement and two were resistant