[Inhaled corticosteroids and statural growth in asthmatic children]

By its anti-inflammatory effect on the bronchial mucous membrane, the use of inhaled corticoids [IC] had significantly improved medicosocial care of asthmatic patients. In paediatrics, the most important problem is about growth. The aim of this study is to evaluate the effect of prolonged IC on asthmatic's growth. This study was conducted in the Unit 2 of Casablanca Children Hospital. One hundred children followed for moderate or severe asthma and treated by high doses of IC [500 to 1500 micro/day] for a minimum of 1 year were enrolled in the study. Height of patients has been regularly monitored, in order to establish their growth velocity. Height has been measured in standard deviation [SD] and compared to the reference curves of Sempe and Pedron. Prescribed corticoid molecules were Budesonide, Fluticasone Monopropionate and Beclometasone Dipropionate. Average duration of treatment was 3.3 years [from 12 months to 9 years]. In 84% of children, the initial height varied between -1 and +1 SD. Growth velocity after one year of IC was reduced in 51% of cases. In 78 patients, growth velocity was normal. Height referred to age and gender was normal in 99% at the last checking. One case of height growth retardation [-45D] was reported in a child who had initial height at -2SD. this study shows that the impact of IC on height remains exceptional. Even if the growth velocity has been slowed down during the first year of treatment, most often it recovered afterwards without consequence on final height. These results seem in line with other studies. The benefits of IC among children far out weight the incurred risks

rare cause of children's vascular cerebral ischemic strije: sickle cell disease

Ischemic cerebral infarctions are uncommun in childhood. Aetiologies are numerous. The etiologic diagnosis is difficult and this case further proves it. Amina, 9 years old, is admitted in Pediatrics 2 of Children's Hospital in Casablanca, for polyarthralgia evolving for one year, with right hemiplegia. Right hemiconvulsions had preceded the neurologic motor deficency. Cerebral scanner shows ischemic lesions confirming the ischemic stroke. Etiologic screening allowed elimination of systemic diseases, high blood pressure, congenital heart diseases and rythm disorders. Haemoglobin electrophoresis confirmed the homozygote sickle cell disease showing a high 84% rate of S haemoglobinemia. Split in four groups: cardiac, vascular, hematologic and metabolic diseases. But a large number stays idiopathic. The ischemic stroke is confirmed at once by cerebral scanner. Then in case of no evident aetiology, the first step involves monitoring of blood pressure and cardiac check-up, followed by hemoglobin electrophoresis. Appropriate questionning and well examination after stroke in children are very important. In our case, semiologic features of pain which were acute, none inflammatory and none mechanical, along with mongoloid facies, were suffisant to lead to the real diagnosis. The particularity of our patient is that she was not known for suffering from sickle cell disease, and it was the stroke that revealed it. It's difficult to suggest a plan for diagnosis evaluation for children who undergo an acute cerebral ischemic stroke, but a thorough questionning and examination can be helpful to make the etiologic diagnosis. However a first strategie is proposed

[Diagnostic difficulties of the atypical onset of Kawasaki disease: a 8 cases report]

Kawasaki's disease is a multisystemic vasculitis that most often affects young children. It is known for inducing adverse cardiac effects, especially the development of coronary aneurysms that could lead to death. The diagnosis is based only on clinical criteria, and needs the presence of typical fever and 4 out of the 5 other clinical criteria. The aim of this study is to highlight the occurrence of atypical onset of the disease that should in no way delay the diagnosis and the start of treatment. We reviewed 13 cases of Kawasaki disease treated at Pediatrics 3 in Children Hospital of Casablanca from 1996 to 2002: 8 had atypical Kawasaki disease with particular clinical onset or biological parameters and/or evolution, that initially led to other diagnosis. The clinical onset manifestations included one case of uveitis with blindness, another case of febrile purpura, the third case with pyretic hepatomegaly and liver cytolysis. A diffuse cervical lymph node enlargement was described in one case and led to the diagnosis of haemopathy. Two patients had neurological involvement, in one case with ataxia in the other with headache and strabismus. A 12 year-old child had polyarthritis and the diagnosis was made retrospectively and the evolution was sub acute. The last patient had respiratory manifestations with coughing, fever and radiological atelectasia. The risk of coronary aneurysms directs to suspect early Kawasaki disease in very young children with persistent fever and inflammatory patterns, even in the absence of all typical manifestations

atypical presentation of juvenile dermatomyositis: about one case

Juvenile dermatomyositis is a multisystem immune-mediated disease that affects the skin, muscles and gastro-intestinal tract. Elevation of serum muscle enzymes, electromyogram findings and muscle biopsy are helpful to confirm the diagnosis of dermatomyositis. The goal of this article is to describe an unusual presentation of juvenile dermatomyositis, associated to celiac disease, with atypical exploration and unexpected evolution to extensive calcinosis. Nora, 14 years old, is followed since the age of 10 for celiac disease successfully treated with a gluten-free diet. At 11 years she is hospitalized because of arthralgia and myalgia. The physical examination shows erythematous facial rash, Gottron papules in metacarpo-phalangian articulations, and desquamatives lesions of elbows. She presents ankles, knees and wrists arthritis with lumbalgia. The diagnosis of dermatomyositis is suspected. Laboratory findings show a moderate inflammation, non auto-immune signs, increased level of muscular enzymes, without any abnormalities neither in the electromyogram nor in the biopsy. The diagnosis of dermatomyositis is confirmed. The patient is treated with high doses of oral corticotherapy, articular kinesi-therapy and gluten-free diet. The outcome was satisfactory, but an extensive calcinosis appeared after 3 years. Dermatomyositis and celiac disease is a rare association; only a few cases have been reported. They have common auto-immune condition that can explain this association. Regarding the nonspecific results of the electromyogram and the muscular biopsy, it can be due to the choice of an area which is not involved. The calcinosis is unusual in this type of monocyclic and stabilized involvement. It can appear due to the poor efficacy of oral corticoids prescribed in the context of malabsorption