ACUTE ACALCULOUS CHOLECYSTITIS WITH GALLBLADDER PERFORATION IN CHILDREN – CASE REPOR

Although relatively common in adult pathology, acute acalculous cholecystitis with gallbladder perforation is a rather infrequent entity in pediatric practice. In many cases, its unspecifi c clinical symptoms and the often inconclusive medical imagining results lead to the diagnosis of acute acalculous cholecystitis being set intraoperatively. Nevertheless, this condition should be considered when setting the differential diagnosis of a peritonitis syndrome in children

TYPE 2 GAUCHER DISEASE: ONSET AND EVOLUTION – CASE REPORT

Gaucher disease is the most common lysosomal storage disorder, with autosomal recessive transmission. The disease is due to glucocerebrosidase enzyme defi ciency, resulting in accumulation of glucocerebroside in all organs. The diagnosis is established by measuring enzyme activity. Among the clinical forms, type 2 is the rarest and has the most dismal prognosis. We present the case of an infant found at 5 months of age with neurological symptoms and his subsequent evolution with massive hepatosplenomegaly, being diagnosed with type 2 Gaucher disease

HEMODYNAMIC AND STRUCTURAL MODIFICATIONS IN CONTINUOUS INFUSION WITH ANGIOTENSIN. II. AN EXPERIMENTAL STUDY

The renin-angiotensin-aldosterone system (RAAS) is a hormonal system which contributes to the regulation of both arterial pressure and extra cellular fluids volume. The increase of RAAS, especially at angiotensin II (Ang II) level, affects the target organs and increases the risk of cardio-vascular issues, by increasing arterial pressure and through the direct effect of Ang II upon the vascular endothelium and the renal and cardiac tissue. Ang II reduces the renal capacity of sodium excretion and initiates a set of events which increase arterial pressure. Increase of arterial pressure is necessary for re-establishing sodium excretion, being realized by the pressure-natriuresis relationship. Arterial hypertension affects the target organs (heart, kidneys) and leads to a vicious circle which contributes to maintaining a high arterial pressure. Materials and Method: Male Wistar rats subjected on a normal diet, received either a sham operation (n=9) or continuous angiotensin II (Ang II) infusion (300ng/kgc/ min) subcutaneously, via mini pumps. Water ingestion and systolic blood pressure were measured for 14 days, after which the animals were sacrificed under anesthesia with ketamin, and the xylasin body weight, water ingestion, heart mass, right and left ventricular mass, right and left kidney mass were measured. Results: After 14 days of Ang II infusion, bodily weight decreased, systolic blood pressure increased, heart and left ventricular mass indexed to body weight were significantly enhanced compared with the sham group, and kidneys mass indexed to body weight was similar in the two groups

Experimental models of acute pancreatitis -closed duodenal loop mode

Randomized controlled studies of severe human acute pancreatitis can be performed only with restriction, especially in children. Some pathophysiological or therapeutic aspects should be first verified through animal experiments. Animal test results can be transferred to clinical practice if the results are based on trials with established models, standardized methods and a study design imitating the clinical situation. This study aims to review the different experimental models proposed for acute pancreatitis, focusing on the experience of the researchers team with the closed duodenal loop model. A closed duodenal loop model was prepared in male Wistar rats. The duodenum was ligated 2cm distal and proximal to the junction of the hepatopancreatic duct. All rats developed severe acute pancreatitis. The histopathological alterations of the pancreas consisted in edema, parenchymal necrosis, thrombosis and hemorrhage. All animals died within 2-5 days from generalized sepsis. Animal experiments are of great value, especially in acute necrotizing pancreatitis because randomized controlled studies are problematic. The most common experimental models of acute pancreatitis are secretagogue hyperstimulation (cerulein pancreatitis), choline-deficient, ethionine-supplemented diet (CDE), duct obstruction/ligation, closed duodenal loop, duct perfusion. Closed duodenal loop model is easy enough from the technical point of view and presents histological characteristics that resemble those of human pancreatitis, but it has the drawback of early mortality

DRUG INDUCED ACUTE TUBULAR NECROSIS – RARE CASE OF NEPHROTIC SYNDROME

We presented two cases of nephrotic syndrome (NS) drug-induced with tubular nephrotoxicity, with different evolution in the context of etiologic diseases. First is 5-month-old girl admitted with NS (clinically and biological proven) and acute renal failure after another hospitalization for pneumonia. The girl was treated with ceftriaxone and gentamicin 12 days. Congenital NS suspicion was eliminated by renal biopsy who revealed renal tubular necrosis highlighting recovery phase. The development was favorable in 7 days of peritoneal dialysis. The second case was 16 years old adolescents treated 3 years with carbimazol for Basedow disease. Was presented with nephrotic syndrome not influenced by corticosteroids. Histopathology revealed toxic tubular necrosis, interstitial fibrosis, absence of glomerular injury. Nephrotoxic treatment was stopped, and, after thyroidectomy, edema were reduced, but kidney function continued to depreciate, while nephrotoxic therapy given for 3 years. Conclusions. Renal tubular necrosis clinical and laboratory expressed by nephrotic syndrome, accompanied by renal insufficiency is a rare occurrence in children; gentamicin and carbimazol can be criminalized. The suffering or impairment may be improved by removing the causative drug. Treatment failure was associated with duration of drug aggression and evolution of comorbidities

POLYMORPHISM OF THE CLINICAL SIGNS OF CELIAC DISEASE IN CHILDREN

Celiac disease (CD) is an autoimmune systemic condition caused by sensitivity to gluten in genetically predisposed patients. The clinical signs of CD are extremely diverse, ranging from the typical intestinal malabsorption syndrome (characterized by chronic diarrhea, abdominal distension and malnutrition) to atypical symptoms that may involve any system or organ: chronic constipation, increased level of liver enzymes, iron deficiency anemia, recurrent abdominal pain, neurological conditions, tooth enamel erosion. The authors report four pediatric cases diagnosed with various atypical forms of celiac disease: the form associated with recurrent abdominal pain and increased level of liver enzymes, and the form associated with chronic constipation, all accompanied by failure to thrive and one case of type I diabetes mellitus associated with celiac disease. To conclude with, pediatricians, gastroenterologists and general practitioners should be familiar with all the clinical forms of coeliac disease in order to be able to diagnose this childhood disease and thus prevent long-term complications like osteoporosis, infertility and intestinal lymphoma

UPDATES ON THE DIAGNOSIS AND TREATMENT OF PEDIATRIC HEPATOBLASTOMA WITH PULMONARY METASTASES

Although the frequency of hepatoblastoma is low, it is the most common primary malignant liver tumor in children. The prognosis of the disease has improved considerably in the last decades due to oncological and surgical treatment advances. Nonetheless, tumors which are diagnosed at an advanced stage still have a poor prognosis. We present the case of a 33-month-old child, diagnosed with high-risk hepatoblastoma (pulmonary metastases) in February 2014. Surgery was performed and the tumor completely removed. Afterwards, chemotherapy treatment was initiated according to a modified SIOPEL-4 protocol – the chemotherapy blocks which should have been administered before surgery were received after the operation. After finishing the chemotherapy, the thoraco-abdominal CT scan indicated a complete response to treatment. The periodic evaluation of the patient revealed the absence of local tumor recurrence, the absence of metastases, and a Lansky performance status of 80 up to now. The administration of targeted molecular therapies, liver transplant, and new chemotherapy drugs could improve the prognosis for patients with high risk hepatoblastoma in the future. Also, modifying the chemotherapy protocols could be considered an option in the achievement of this goal

ABDOMINOPELVIC TUMOR MASS IN ADOLESCENT – A CASE REPORT

A palpable mass in the abdominopelvic region in a teenager has usually severe manifestation. If we deal with such a mass, it must be stated whether it is malignant and if it is associated with the compression of the neighboring organs. Such a mass is most often discovered when the volume of the abdomen is increased, appears poor general condition or digestive or urinary symptoms. The authors present the case of a 16-year-old adolescent who was admitted for the lumbar back pain, functional impotence of the right inferior limb and a tumor mass in the right iliac fossa 5 months prior. Physical examination, laboratory tests, imaging and pathology exams have revealed the diagnosis of rhabdomyosarcoma, embryonal type. The lack of communication between the teenager and the family delayed hospital presentation when the rhabdomyosarcoma was already at the terminal stage with pulmonary and bone metastases, with negative prognosis