ABDOMINAL HOLLOW VISCUS TRAUMA IN CHILDREN, INJURY MECHANISMS AND TREATMENT PRINCIPLES

Abdominal hollow viscus trauma represents an important cause of pediatric morbidity, following head, vertebral column, spinal cord and thoracic injuries, whose main mechanisms of production are road traffic accidents, falls with abdominal impact, sports injuries, physical aggression and explosions. If there is a penetrating abdominal trauma, most frequently it associates hollow organ injuries, while abdominal blunt trauma is associated more often with parenchymal injuries, with effects on the hemodynamic status. Imaging and paraclinical investigations used to evaluate an abdominal trauma consist of thoraco-abdominal radiography in orthostatic position, abdominal ultrasonography, diagnostic peritoneal lavage, abdominal computed tomography and exploratory laparoscopy. Unlike penetrating injuries, when surgical exploration is obvious, in the case of young children with abdominal contusions, the injuries involving hollow viscus can be overlooked at time of the initial assessment, because of a poor communication between doctor and patient, difficult interpretation of symptoms when there are other injuries associated, but also because of the intial lack of ultrasound signs of perforation. Delayed diagnosis and adequate treatment lead to extended duration of hospitalisation, to elevated costs and rates of morbidity. The incidence of mortality caused by abdominal trauma associated with hollow viscus penetration is approximately 10%, being more elevated as the digestive injuries are multiple or associated with other lesions

ATOPY, RISK FACTOR FOR OTITIS MEDIA WITH EFFUSION

Chronic otitis, one of the major causes of pediatric hypoacusia is frequent associated with some allergic diseases. The continuous rice of atopic diseases prevalence in childhood, involves a multidisciplinary approach of Eustachian tube dysfunction, adenoid inflammation or recurrent otitis, for a complex pathogenic management. The objective of this study was to determinate the association between otitis media and the allergic diseases with the implication in the treatment and evolution of this patients. Methods. Retrospective study on 92 children, between 6 month and 6 years, admitted in II Pediatric Clinic, Clinical Hospital of Children “Sf. Maria” Iasi with diagnosis of acute otitis media, for a period of 1 year. Results. Majority of cases (61patients) have been suppurate otitis, 31 cases have been otitis media with effusion out of which 23 have been recurrent. Association with allergic diseases has been more frequent in children with serous otitis media (26/31 cases). 4 cases with suppurate otitis media have developed adverse reaction to antibiotics with major implication in the cases evolution. Association with gastroesophageal reflux was relatively similar between cases with serous otitis and the suppurate ones (10/31 cases and 11/61 cases). From the atopic patients with gastroesophageal reflux, 10 presented cow’s milk protein allergy. In conclusion, the children with otitis media, especially those with recurrent none suppurate form should be investigated for atopy and, eventually, for gastroesophageal reflux, possibly with determination of the allergic markers or of pepsin in the otic exudates, in order to a targeted therapeutic management

ATOPIA, FACTOR DE RISC ÎN APARIŢIA OTITEI SEROASE LA COPIL

Otita medie seroasă cronică, cauză majoră a hipoacuziei în perioada copilăriei, este frecvent asociată cu sensibilizarea alergică. Prevalenţa în continuă creştere a atopiei la această vârstă implică o abordare multidisciplinară a copiilor cu adenoidite, otite recurente şi disfuncţii tubare, în vederea unui management patogenic complex. Obiectivul studiului a constat în determinarea asocierii otitelor medii cu bolile alergice, şi implicaţiile acestei asocieri în tratamentul şi evoluţia pacienţilor. Material şi metodă. S-a realizat un studiu retrospectiv care a inclus 92 de copii, cu vârste cuprinse între 6 luni şi 6 ani internaţi în Clinica II Pediatrie, Spitalul Clinic de Copii „Sf. Maria“, Iaşi, cu diagnosticul de otită medie, pe o perioadă de 1 an (ianuarie 2015 – ianuarie 2016). Rezultate. Majoritatea cazurilor au fost otite supurate (61 de pacienţi), 31 de cazuri au fost otite seroase, dintre care 23 au fost recurente. Asocierea cu bolile alergice a fost mai frecventă la copiii cu otită seroasă (26/31 cazuri). 4 pacienţi cu otită supurată au prezentat reacţii adverse la antibiotice, cu implicaţii majore în evoluţia cazurilor. Asocierea cu refluxul gastroesofagian a fost relativ asemănătoare între cele 2 loturi (11/61 de cazuri şi respectiv 10/31 de cazuri), la 10 pacienţi atopici, obiectivându-se alergia la proteinele laptelui de vacă. În concluzie, copiii cu otite medii, în special cei cu otite medii seroase recurente ar trebui investigaţi pentru determinarea coexistenţei atopiei şi a refluxului gastroesofagian, eventual cu dozarea markerilor de inflamaţie alergică sau a pepsinei în exsudatul otic, în vederea unui management terapeutic ţintit

OBESITY AND DYSLIPIDEMIA IN CHILDREN WITH CHRONIC HEPATITIS

Chronic hepatitis association with various types of dyslipidemia is a reality not only for the obese pediatric patient, in which we expect to find hypercholesterolemia and / or hypertriglyceridemias, but also for normal weight children with hepatitis. The causes of this association are multiple, but we need to consider first the innate predisposition and transmission of genetic forms of dyslipidemia. Meanwhile, some secondary dyslipidemia are chronic liver disease related. Those considerations are forming a vicious circle in which primary treatment of metabolic imbalances has a great importance for the success of antiviral therapy