[Lower-limb arterial thrombosis in a relapse of nephrotic syndrome]. / Thrombose artérielle d'un membre inférieur au cours d'une rechute de syndrome néphrotique.

INTRODUCTION: Venous thromboembolic complications are well-known in patients with nephrotic syndrome. Arterial thrombosis has rarely been reported and is mainly observed in adults. CASE REPORT: A 9-year-old patient with a history of steroid-dependent nephrotic syndrome was admitted after foot trauma. He presented with severe pain in his right foot, which was cold and mottled, with reduced sensation and motor activity. No pulse was palpable in his right foot. Doppler's ultrasonography confirmed the thrombosis of anterior and posterior tibial arteries in their distal portions. The patient received treatment with an arterial vasodilator and heparin, followed by antivitamin K therapy. CONCLUSION: Arterial thrombosis is a rare complication in children with nephrotic syndrome. It is presumably attributable to a hypercoagulable state and trauma.

[Eosinophilic granuloma revealed by torticollis: a case report]. / Granulome éosinophile révélé par un torticolis: à propos d'une observation.

UNLABELLED: Langerhans cell histiocytose is a rare condition in childhood. It presents in different ways ranging from a single bony disease to a multisystemic disease involving vital organs. CASE REPORT: We report a case of single bone involvement revealed by torticollis in an eight-year-old boy. The diagnosis was evocated on radiological findings and confirmed by histologic aspects. After a period of 2,5 years, this child is in total spontaneous remission. CONCLUSION: Torticollis must be explored and watched. Eosinophilic granuloma can be a rare aetiology in children. The outcome is often favorable.

[Hypernatremic dehydration in children: retrospective study of 105 cases]. / La déshydratation hypernatrémique chez l'enfant : étude rétrospective de 105 cas.

UNLABELLED: The hypernatremic dehydration defined by a serum sodium concentration> or = to 150 mmol/l, is a particular form of acute dehydration and constitutes a medical emergency requiring a prompt and adequate diagnosis and management. PURPOSE: To precise the epidemiological profile, course, causes and therapeutic particularities of hypernatremic dehydration in children. POPULATION AND METHODS: Retrospective review of 105 children admitted in the general Paediatrics department of the Fattouma Bourguiba university hospital in Monastir (Tunisia), for hypernatremic dehydration between January 1st 1990 and December 31 2002. RESULTS: Hypernatremic dehydration represented 11.51% of all kinds of dehydration. The mean age was 6.5 months with a small male predominance. The socio-economic level of the parents was good in 62.8% of cases. Half of the children were in shock. Severe dehydration was present in 87.6% of cases and neurological signs were observed in 77.14% of cases. The initial mean serum sodium concentration was 159 mmol/L. Acidosis and acute renal failure were associated respectively in 97.2% and 76.2% of cases. Prominent cause of hypernatremic dehydration was diarrhoea (94.3%). Intravenous rehydration with 5% glucose solution at the average of 147 ml/kg/day and containing a mean sodium level of 42 mmol/L was performed in 74% of cases. In most cases (84.1%) serum sodium was normalized within the first 72 hours. Complications were noted in 5.7% of cases and mortality rate was 11.4%. CONCLUSION: Hypernatremic dehydration was common in infant and the prominent cause is still dominated by diarrhoea in our country. The management of hypernatremic dehydration is based on oral or intravenous rehydration and plasma expanding fluids when shock is present or imminent. The serum sodium concentration should be gradually corrected and should not exceed 0.5 mmol/L/h. Prevention is based on the pursuit of breastfeeding and the use of oral rehydration solution in infantile diarrhoeas.

[Neuromeningeal enterovirus infections in Tunisia: epidemiology, clinical presentation, and outcome of 26 pediatric cases]. / Entéroviroses neuroméningées en Tunisie: profil épidémiologique, clinique et évolutif. A propos de 26 cas pédiatriques.

UNLABELLED: Non-polio enteroviruses are the most common identified cause of viral neuromeningeal infections following the introduction of the mumps and polio vaccines. OBJECTIVE: The aim of this study was to describe the epidemiology, clinical presentation, and the outcome of enteroviral infections of the CNS. METHOD AND PATIENTS: We performed a prospective study on 41 children admitted for viral neuromeningeal infections in the pediatric department of Monastir between December 2001 and November 2002. Enteroviruses were detected from cerebrospinal fluid by RT-PCR. RESULTS: This study showed that enteroviruses were responsible for 63.4% of the infections. The mean age of patients was 6.1 years. Aseptic meningitis was diagnosed in 14 cases and encephalitis in 10. The most frequent symptom was fever (61.5%), followed by seizures (42.3%), and confusion (23%). On follow-up, all patients with meningitis had recovered without sequels. Neurological complications in patients with encephalitis were epilepsy (3 cases), cerebral palsy (2 cases), and mental retardation (1 case). CONCLUSION: This study confirmed that enteroviruses were the most common cause of viral infections of the CNS. Common use of RT-PCR can have a significant impact on the outcome of patients with enterovirus infections.

[Prolonged fever in children. Retrospective study of 67 cases]. / Les fièvres prolongées de l'enfant. Etude rétrospective de 67 cas.

BACKGROUND: The first problem to face in prolonged fever is its etiologic diagnosis. Its incidence varies between 0,5 to 3% of all paediatric hospital-stay. Precise diagnosis need an extensive questionnary, complete physical examination and an algorithm of complementary exams. PURPOSE: To precise the epidemiologic profile and causes of prolonged fever in a children. POPULATION AND METHODS: Retrospective review of 67 children between two and 15 years old admitted in the general paediatrics department of the Fattouma Bourguiba university hospital in Monastir (Tunisia), for prolonged fever between 1(st) January 1988 and 31 December 1998. RESULTS: The incidence of prolonged fever was 1,02%. The mean age was seven years with female predominance. The mean fever duration was 30 days. Fever was isolated in 23,9% of cases. Fever was associated to rheumatic or respiratory signs in respectively 26,9% and 20,9% of cases. Hospital-stay was of 11 days in 50% of cases. Prominent causes were dominated by infectious diseases (56,7%) with predominance of localized infections, followed by inflammatory diseases (20,9%) with predominance of rheumatic fever and neoplasms (3%). Fever remained of unknown origin was seen in 19,4% of cases. CONCLUSION: Prolonged fever is still dominated by infectious and inflammatory diseases and depend on local epidemiological particularities. In fact we noted in this study the relative high-frequency of visceral leishmaniasis, complicated pulmonary hydatic cyst and rheumatic fever. The diagnosis approach should be based on complementary exams of first and second stage because of their high number and cost. Prognosis of fever of unknown origin is often favorable.

[Imerslund-Najman-Grasbeck anemia. Apropos of a case]. / L'anémie d'Imerslund-Najman-Grasbeck. A propos d'un cas.

Imerslund-Najman-Grasbeck disease is a rare inherited megaloblastic anaemia secondary to a selective malabsorption of vitamin B12 by ileal enterocytes. The authors report on a 4 year-old tunisian girl who presented as visceral infantile leishmaniasis because of huge splenomegaly and major anaemia. The diagnosis of Imerslund disease was performed on the basis of the association of typical megaloblastic cells in the marrow, permanent proteinuria and favourable outcome under parenteral B12 administration. In addition, ther were no folate deficiency, no anti-intrinsic factor antibodies and no intrinsic factor deficiency. The outcome of the disease is always favourable if parenteral administration of vitamin B12 maintained.