[Psychogenic pain in children]. / Durerea psihogena la copil.

Children present many relations between psychic and somatic processes. The most important clinical aspect is the pain that cannot be attributed to any medical condition and occurs in at least one organ. Psychogenic pain is frequent in the pediatric population and its incidence is increasing. The authors present some of the most debated theories on the mechanisms of psychosomatic pain and some types of such pain, underlining the importance of full investigations. The pain is diagnosed as psychogenic after the exclusion of a potentially lethal disease.

[Arterial stiffness in pediatric hypertension]. / Complianta vasculara în hipertensiunea arteriala la copil.

Non invasive assessment of large arteries structure and function is a valuable tool for early detection of athero/arteriosclerosis and the cardiovascular risk. The vascular injury is mainly represented by increased arterial stiffness (increased pulse wave velocity--PWV), increased peripheral arteries reflectivity (Aix) and the occurrence of significant atheromatosis (increased clMT). Although well described in adult, there are few data in children regarding the impact of uremia on vascular structure and function. This paper is an overview of the main determinants of arterial compliance in children, focusing on recent data describing the repercussions of hypertension and renal failure in this age group. To date, our group has performed the only case control study in children in order to describe the arterial stiffness, the reflective properties of peripheral arteries as well as the carotid intima-media thickness on 18 children under chronic dialysis treatment (hemodialysis and peritoneal dialysis). Comparing with control cases the dialysed children had a significantly higher PWV and Aix, which reinforce that uremia is associated with arterial stiffness even in children. There were no significant differences on IMT and PWV between hemodialysed and peritoneal dialysed children. In contrast with adult patient data, there was no favourable impact of hemodialysis session over PWv and Aix.

[Remission of primary vesicoureteral reflux in children with medical management]. / Remisiunea refluxului vezico-ureteral primar sub tratament medical la copil.

We studied the spontaneous resolution rate in children with primary vesicoureteral reflux (VUR) and the interference of some specific factors. We reviewed the records of 110 children (14 days - 16 years) admitted in the 4th Pediatric Clinic Iasi with primary VUR, between 1994 - 2003, which had exclusive medical management and minimum one follow-up cystogram. We used Kaplan-Meier curves to analyze the resolution rate of VUR during the follow-up in relation with initial grade, age at diagnosis, gender, recurrent urinary tract infections (UTIs) and the presence of renal scarring. The remission rate for all the cases was 70%, with differences based on the reflux grade: 100% for grade I and 45% for grade IV. The cases diagnosed during infancy recovered faster than those diagnosed after this period. The presence of renal scarring and breakthrough UTIs increased the remission time. In conclusion the majority of patients with VUR resolved during medical management, the remission rate being influenced by the reflux grade, presence of renal scarring and breakthrough UTIs.

[Treatment outcome using prednisone in corticosteroid-responsive primary nephrotic syndrome in children]. / Rezultatele tratamentului cu prednison in sindromul nefrotic primitiv cortico-sensibil la copil.

In children, the nephrotic syndrome is usually corticoid-responsive; approximately 70% of patients experience relapses, frequently triggered by infections. Our paper presents the results obtained using a 4 month prednisone regimen. This retrospective study included 83 children afflicted with nephrotic syndrome over a 10 year span. We analyzed: age at diagnosis, boys/girls ratio, response to corticoid treatment - after one month of prednisone and at the completion of the treatment course, number of relapses and their frequency, complications of prednisone treatment. The median age at diagnosis was 4.8 years, males predominating M:F = 1.5:1. Complete response after 4 weeks of prednisone therapy was noted in 98.79% of cases. We had 116 episodes of relapses during the first year of follow-up, occurring in 67.4% of children (27.9% were frequent relapsers, 11.62% subsequently became corticoid-dependent). Late relapses, after the first year, occurred in 32.55% of cases. We noted mostly mild adverse effects of the prednisone treatment: occurrence of infections during therapy (16.27%), cushingoid facies (37.2%), hirsutism (4.6%), high blood pressure (4.65%), stretch marks (2.32%). In conclusion, the 4 month prednisone treatment regimen is efficient in inducing and maintaining a remission. The incidence of relapses is 32.55%, comparable to the figure cited in larger studies. Serious adverse effects are significantly lower with this regimen compared to other corticoid treatment schemes. Key wo

[Acute renal failure in children. Study of 35 patients]. / Insuficienta renala acuta la copil. Studiu pe 35 de cazuri.

The medical care of children with acute renal failure and the necessity of the substituting the renal functions has dramatically modified over the past 15 years. The study has been conducted retrospectively on 35 children diagnosed with acute renal failure (ARF), for analyzing the etiological spectrum, the evolutionary patterns and the influence factors of the ARF evolution. The following parameters have been taken into consideration: ARF etiology, hTA/HTA, oliguria, level of serum creatinine, the type of treatment (renal substitution by hemodialysis, peritoneal dialysis, or conservative treatment). The ARF etiology is dominated by the sepsis (31.4%) and by the hemolytic and uremic syndrome (17.1%). The treatment applied was conservative in 48.5% of the cases; 51.50% of the patients were in critical state and required extrarenal substitution by hemodialysis--42.8%--and peritoneal dialysis--8.5%. Global mortality is reduced (22.8%), but in the dialysed patients it is of 44.44%. The main death causes were: severe hepatic failure, oncological diseases, severe neurological damage and hemodynamic damages. In conclusion, the ARF prognosis in children is influenced by the comorbidity states. Dialysis has improved the therapeutic results in the currently presented lot, the death causes being extrarenal.

[Management of primary vesicoureteral reflux in children]. / Tratamentul refluxului vezico-ureteral primar la copil.

The management of primary vesicoureteral reflux (VUR) in child suffered major changes by focusing on the medical treatment in order to prevent the urinary tract infections and the occurrence of postinfectious renal scars. Continuous antibiotic prophylaxis and the follow-up by serial cystography of the spontaneous resolution of the reflux are considered nowadays the best choice in most of the cases. Surgery is recommended only in selected cases. Sub-ureteral injection of bulking agents to correct the reflux holds promise as an alternative to open surgery, but presents the challenge of identifying the ideal bulking agent.

[Childhood toxoplasmosis today]. / Toxoplasmoza copilului în actualitate.

The comparative study of two groups of children suffering from acquired or congenital toxoplasmosis, being in hospital during two different decades (1979-1985--39 children and 1991-1997--117 children) proved: the fact that atypical or subclinical manifestations of the acquired toxoplasmosis (54%) draws our attention to the systematic research of the infection with Toxoplasma gondii, especially at the groups with increased risk now that the frequency of the diseases generating immunodeficiency; the increased frequency of congenital toxoplasmosis (5% in the first group, 8% in the second group) and especially of the invalidating of screening tests to the pregnant women; the therapeutic arsenal limited by the rate price/toxicity/medical resistance, must be individualized for each case, taking into account the increased number of other associated diseases (chronic hepatitis B 7%, TB 17%, HIV infection 5%); Rovamicine treatment at the second group had similar results to those obtained by administrating Pirimetamine--Trimetoprim to the children from the first group.

[Asthma and tuberculosis (considerations based on hospital case studies)]. / Astmul si tuberculoza (Consideratii pe baza unei cazuistici de spital).

The relationship between bronchic asthma and tuberculosis has stimulated the greatest interest and most controversy. The present paper refers to 55 cases, i.e. 29 males (52%) and 26 females (48%). Most of the men were over 50 and the women over the age of 40 years. In 50 cases (90%) bronchial asthma developed 6 to 25 years after the tb lesions had become stable. Only 5 cases (10%) presented bronchial asthma with evolutive pulmonary tb. Although tuberculin hyperergy was encountered in 26 cases (47%) in none of the cases could a diagnosis of tuberculin asthma be established. In the group studied, the patients' age, the clinical and evolutive aspect of the bronchial asthma lists in the group of late asthmas. Against the background of the postuberculosis syndrome, the evolution of asthma is as a rule severe. Similarly, asthma accompanied by evolutive pulmonary tb, is in general very severe, hypersecretory and suprainfected with common germs.

[Comparative serum and secretory IgA studies in recurrent bronchial infections (preliminary note)]. / Cercetarea comparativa a IgA serice si secretoare in infectiile bronsice recidivante

In a group of 84 patients with recidivating bronchial infections IgA were evaluated with the aid of radial immunodiffusion according to Mancini. In all the patients IgA were determined from expectoration extractions and in 50 of them serum IgA were also determined. In 38 cases the determinations were simultaneous. Concentration of S IgA was low in most of the cases (65%). These results are probably influenced by the technical difficulties raised by detaching the connections existing between S IgA and mucus fibrils from the bronchial secretion. The results obtained in the dosage of serum IgA are comparable with those mentioned in the current literature. No correlations were possible between S IgA and serum IgA and there proteins can be considered as independent.