[Invasive infections neisseria meningitidis in children in Tunis: about 79 cases]

We conducted a retrospective study of meningococcal invasive diseases [MID] contracted in children in Tunis between January 1997 and January 2006. The purpose of this study is to specify the clinical, epidemiological, therapeutic and evolutionary features of these infections and to determine antimicrobial susceptibility and the antigenic formula of N. meningitidis isolates. During the study period, we have collected 79 cases of MID arising in children aged 3 days to 11 years. The majority of children's were less than of 4 years [57.3%]. We note a frequency of the MID in winter and in spring. The most frequent clinical shape was meningitis [53%]. Twenty one patients [26.6%] had a fulminant meningococcal disease. In our series, the rate of lethality was equal to 17.7%. Among the 46 meningococcal isolates, the most frequent serogroup was the B [73%] followed by C and A. A high heterogeneousness of the antigenic formulae was observed. The most frequent phenotype was NT: NST for the group B isolates and 4:P1.13 for the group C ones. N. meningitidis with reduced susceptibility to penicillin and to amoxicillin account for 54% and 10% of all isolates respectively. The cefotaxim and the rifampin were uniformly active

[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

[Bronchogenic cyst: an uncommon cause of Congenital Lobar Emphysema]

We report a case of a one-month-old boy who developed respiratory distress. Chest-X- ray and CT scans showed over distension of the left upper lobe and mediastinal shift in favour of congenital lobar emphysema [CLE]. One month after uneventful lobectomy, he was admitted at hospital for another episode of respiratory distress. Chest radiograph revealed relapse of compressive emphysema in the remaining left lobe. Gastro esophageal transit and MRI were performed, showing mediastinal cystic mass. Thus, patient underwent thoracotomy. Surgical examination found a subcarinal bronchogenic cyst that compressed main left bronchus, causing the emphysema of upper and lower left lobes. Histological examination of removed cyst confirmed these data. Authors discuss causes of diagnosis delay

[Acute poisoning in the pediatric service at the infant hospital of Tunis. report of 325 cases]

We reported a retrospective study concerning 325 cases of acute poisoning in the pediatric service at the infant hospital of Tunis during a period of one year from 1 January to 31 December. The aim of this report is to evaluated the epidemiologic, clinical and evolutive aspects. They were 194 boys and 131 girls. 60 per cent of the infants are aged under 3 years. The chemical products occupied the first place with 153 infants [49.7 per cent], the inhalation of petroleum represented 62 cases, the water of javel 58 cases. The medicines occupied the second place with 128 infants [39 per cent]. The evolution was favourable in 277 infants [85 per cent]. 12 patients [3.6 per cent] are presented a pneumonia after inhalation of petroleum. In 4 patients [1.2 per cent], we constated a caustic oesophagitis. One case of death was occurred in a patient with medicinal polypoisoning.The prevention stays the better way to fight this phenomenon

[Bilateral wilms tumors: diagnosis and therapeutic management. about 12 cases]

Bilateral Wilms tumor [WT] is uncommon malignancy, the incidence is about 5% of all nephroblastoma. It shows association with some congenital anomalies. there is no scheduled regimen for bilateral WT and their management offers a great challenge. To evaluate the clinical characteristics and the treatment result. 12 patients with bilateral WT diagnosed between 1997 and 2005, were retrospectively reviewed. Data collected: patients characteristics, chemotherapy, modality of surgical resection, renal function and survival. 11 patients [pts] had synchronous tumor and one metachronous lesions. The median age at primary diagnosis was 17 months [range 6m - 72m]. Congenital malformation were present in 4 children. 1 pt had hemi-hypertrophy, genitourinary horse kidney, 3 had hypertension.. All pts received preoperative prolonged chemotherapy [CT] for 25 to175 days [median 45 days] 7 received double agent chemotherapy. [VCR + Actinomycine], 2 triple agents: one [VCR + Actino + Adriblastine], the others [Etoposide, Carboplatine, Cyclophosphamied] for tumor progression. Two pt died before surgery due to infection. Bilateral partial nephrectomy 1 case total unilateral nephrectomy with partial nephrectomy on the other side in 3 cases. 9 pts are alive without disease and normal renal function 87 months after. The 10th in course of treatment after unilateral nephrectomy.Prolonged preoperative chemotherapy permit conservative surgical treatement of favorable histology bilateral Wilm's tumor and may improve the preservation of renal masses and function without impairing patient survival

[Surgical aspects of intussusception due to lymphoma in children]

Introduction: Bowel's intussuception is a rare kind of child Burkitt lymphoma revelation mode. The management of this situation is full of traps. The retrospective study of 6 observations aims to analyse the clinical, evolutionary and therapeutic side of this revelation mode

Results: Four boys and two girls, aged from three to seven years with an average of 5 years, had Burkitt lymphoma revealed by a Bowel's intussusception. The abdominal ultrasound find the secondary cause in 3 cases .One patient had a full-column barium enema All the cases had a laparotomy. Three cases had a surgical resection. A biopsy of mesenteric lymph nodes was done in 3 cases. A chemotherapy was initiated as soon as we made the diagnosis .There was no after effects in all the cases. No recurrence was noted until two years and a half after the treatment

Conclusion: The diagnosis of lymphoma must be suspected when the bowel's intussuception occurs in more than 5 years old children. A biopsy must be done in the event of suspicion of lymphoma. The surgical procedure must be adapted to each case

[Neurological diseases in the "triple a" syndrome]

Introduction: The 3A syndrome or Allgrove syndrome is an autosomic recessive disease characterized by the association of oesophagus achalasia, alacrymie and suprarenal insufficiency. Neurological disorders can appear at any time of the course's disease and would be due to a neuropathy affecting the central nervous system as well as the peripheral nervous system

Patient and methods: From1991 to 2005, we noticed 22 cases of Allgrove syndrome. The follow-up of these patients enabled us to notify the neurological abnormalities appear later in the evolution

Results: neurological symptoms appear at any time of the course's disease. All cases were backward pupil. 8 patients had a nasal voice due to palate paralysis. 7 patients had xerostomia wich is included in the dry syndrome due to the degeneration of salivary glands. One patient had a neurological motor disorder and 3 patients had a sensitive disorders with loss of cold feeling and vasomotor disorders in the hands and feet. These symptoms appear after 4 years on average after diagnosis. An orthostatics hypotension was noticed among three patients as a dysautonomic sign

Conclusion: All of these data approve that neurological disorders appear at a variable time of the course's disease. This polyneuropathy affects the oesophagus and always leads to the recurrence of the digestives signs

Severe corrosive oesophagitis: are high doses of methyl prednisolone efficient to prevent oesophageal caustic stricture in children?

Corrosive oesophagitis stricture is the long term complication of severe corrosive oesophagitis. The aim of our study was to evaluate the effect of a high doses of steroids on incidence and quality of oesophageal stricture. We reviewed the case histories of 28 children seen at children hospital from 31 December 1991 to 31 December 2001. These children has second and third degree oesophageal burns and they were treated by systemic Methylprednisolone [1000mg/l,73/m2 SC]. The frequency of stricture was 12/26 [46%]. Ten children required a mean of 6,7 [5,74] dilatation range [1 - 17].One patient required an oesocoloplasty. The frequency of stricture in the group treated early before the 24th hour and after the 24th hours was [9/21] [47,4%] versus [3/7] [42,9%]. This difference was not significant [P = 1]. The frequency of stricture in the group treated less than 21 days and more than 21 days was 6/17 [40%] versus 6/9 [66,7%]. This difference was not significant [P = 0,400]. High doses of methyl prednisolone seems to decrease the risk of oesophageal stricture. We found no difference between the children treated before the 24th hours and those treated after the 24 hours and those treated less than 21 days and those more than 21 days

[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

[Urinary infection in children in outpatient environment]

This study concerns 113 case of urinary infection confirmed by biological analysis [10[5] germs/ml]. We observed the must case of infection concerns girls, and 71.6% of children under 3 years. E. Coil represented the most of germs in analysis of girls [75%], and proteus in analysis of boys [65.6%]. 58 children were explored by two radiological methods after the urinary infection, 22.4% of children presents urological anomalies, cystouretheral reflux is the most frequen