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Inferior vena cava (IVC) agenesis is an extremely rare malformation, most times diagnosed randomly, representing an important risk factor in the development of spontaneous deep venous thrombosis (DVT) in children and young adults. We present the case of an 8-year-old male child admitted in our clinic for the following complains: right lumbar pain with paravertebral irradiation. The personal pathological history revealed a recent appendectomy. At the time of admission, an abdominal ultrasound was performed which revealed right nephromegaly, and also raised the suspicion of IVC agenesis. We performed a thoraco-abdominal angio-CT exam with contrast enhancement which confirmed the diagnosis of IVC agenesis and right common iliac vein, venous thrombosis of the right external iliac vein, right common femoral vein and right superficial femoral vein. We excluded a potential antiphospholipid syndrome or a thrombophilia, and the genetic tests ruled out the possibility of a family predisposition. We initiated anticoagulant therapy with close monitoring of the coagulation parameters, the evolution being favorable. Despite the very low frequency of this malformation, the early and correct diagnosis is essential for these patients' management and prognosis. [ABSTRACT FROM AUTHOR]

Objectives. Approaching acute diarrheal disease (ADD) in pediatric patient, we have set as a primary objective a throughout evaluation of etiology and risk factors and, on the other hand the risk/benefit assessment regarding the justification of antibiotic therapy in the treatment of ADD in pediatric patient. Material and method. We performed an analytic, descriptive study, in which we included 125 patients admitted in the 1st Pediatrics Clinic of Tg. Mureș during 2016 (January to December), diagnosed with ADD. Results. The study group comprised 125 patients, out of which a bacterial etiology was noticed in 23 cases (18.4%). On the other hand, it was observed that 84 patients received antibiotics (67.2%), 110 patients (88%) received symptomatic treatment, and in 60% of the cases (75 patients), a probiotic was associated. The medium hospitalization length was of 5 days, depending on the presence/absence of risk factors such as fever, inflammatory syndrome, hydro-electrolytical imbalances or acute dehydration syndrome, risk factors that increased the medium hospitalization length with up to 2 days (p < 0.05). Conclusions. Antibiotics must be used rationally and justified in the treatment of ADD, analyzing carefully the risk/benefit ratio. Taking into account the self-limiting character and the favorable prognosis of this disorder, we conclude that we face an abuse of antibiotics in case of pediatric patients diagnosed with ADD. [ABSTRACT FROM AUTHOR]

Enteropatia exudativă (EE) reprezintă o pierdere proteică anormală la nivelul mucosei tractului digestiv, fiind în majoritatea cazurilor secundară altor patologii gastro-intestinale sau extraintestinale. Cu toate acestea, există, de asemenea, cauze primare, genetice asociate cu EE. Prezentăm cazul unui copil mic, de sex feminin, în vârstă de 1 an şi 1 lună, cu un episod de enterocolită infecţioasă cauzată de Escherichia coli enteropatogen în antecedente, care s-a internat în clinica noastră cu edeme palpebrale matinale de aproximativ 1 săptămână. Analizele de laborator au evidenţiat hipoalbuminemie, hipogamaglobulinemie de tip A şi G, leucocitoză cu eozinofilie, şi anemie. Testul pentru detectarea hemoragiilor oculte din scaun a fost pozitiv, precum şi alfa-1 antitripsina şi calprotectina fecală. Am identificat, de asemenea alergie la proteinele laptelui de vacă, pe care am interpretat-o ca fiind secundară patologiei intestinale. Astfel, am stabilit diagnosticul de enteropatie exudativă după un episod de enterocolită acută cauzat de E. coli enteropatogen, şi am administrat tratament substitutiv cu albumină umană şi corticosteroizi, cu evoluţie favorabilă. Particularitatea cazului constă în diagnosticarea unui caz sever de enteropatie exudativă la un copil mic cu edeme palpebrale matinale, şi nivele scăzute ale albuminei serice, după un episod de enterocolită cauzat de E. coli enteropatogen, care s-a remis fără tratament etiologic. [ABSTRACT FROM AUTHOR]

Pneumonia represents an inflammation of the pulmonary parenchyma that despite the multiple antibiotic classes available and despite the medical progresses, still leads to an increased mortality rate, especially in children. Deltfia acidovorans and Stenotrophomonas maltophilia are Gram-negative bacilli that can lead to respiratory infections. We present the case of a 2 years and 3-month old male patient, admitted in our clinic for the following reasons: productive cough, fever and loss of appetite. Based on the clinical exam, laboratory and paraclinical investigations, we established the diagnosis of right pneumonia associated with pleural effusion and we administered wide spectrum antibiotics. Nevertheless, the evolution was unfavorable, needing pleurotomy and drainage. From the pleural fluid, there were isolated two strains of bacteria, Delftia acidovorans and Stenotrophomonas maltophilia. We adjusted the antibiotic regimen according to antibiogram, with afterwards slowly favorable evolution. The particularity of the case consists in diagnosing a pneumonia with pleural effusion in a 2 years and 3-month-old child, without risk factors, who needed pleurotomy with thoracic drainage, in whom the pleural fluid revealed 2 germs usually encountered in immunocompromised individuals, with favorable evolution after the initiation of antibiotics regimen according to the antibiogram. [ABSTRACT FROM AUTHOR]

Boala urinilor cu miros de sirop de arţar face parte dintr-un grup heterogen de afecţiuni, respectiv erorile înnăscute de metabolism. Scopul lucrării. Ne propunem să prezentăm 2 cazuri diagnosticate în clinica noastră, urmărirea evoluţiei şi a răspunsului la tratament. Material şi metodă. Diagnosticul s-a documentat prin determinarea amino-acizilor serici şi urinari. Fiecare caz a fost analizat, urmărindu-se în dinamică datele anamnestice, examenul clinic, examinări paraclinice şi de laborator, scheme terapeutice, evoluţie. Rezultate. Vârsta la debutul tipic în primul caz, adică în zilele 5-6 de viaţă, şi la 3 săptămâni de viaţă la al doilea caz (deşi în ambele cazuri alimentaţia era naturală). Manifestările clinice la debut. Tabloul neurologic: letargie, apatie, adinamie (primul caz), somnolenţă, plafonarea privirii, hipotonie (cazul 2); apetitcapricios/tulburări de alimentaţie (acumularea AAşi a metaboliţilor acestora), în ambele cazuri; simptomatologia intercurenţei (tuse, rinoree la cazul 2; probabil ITU/ urosepsis în primul caz). Evoluţie. Primul caz, prezentând o formă severă asociază somnolenţă, hipotonie generalizată, uneori alternând cu crize de contractură tonică/rigiditate, trismus, cu necesitatea ventilaţiei mecanice şi în final deces; al doilea caz, cu o formă mai uşoară, a avut evoluţie favorabilă dependentă de tratament igieno- dietetic şi medicamentos. Concluzii. Deoarece postnatal nou-născuţii sunt aparent sănătoşi din punct de vedere clinic, neexistând o corelaţie fenotip-genotip, în multe ţări a fost adăugată în screening-ul neonatal al afecţiunilor metabolice. Diagnosticul precoce, alături de regimul specific, poate preveni complicaţiile, permiţând astfel o dezvoltare intelectuală normală a copiilor purtători ai acestor defecte. [ABSTRACT FROM AUTHOR]

Elastcgrafia este o nouă metodă imagistică bazată pe ultrasunete, care permite evaluarea structurii ţesuturilor în ceea ce priveşte rigiditatea lor, fiind utilă în explorarea diferitelor organe şi sisteme şi cu tot mai multe aplicaţii clinice. Dezvoltarea substanţelor de contrast de generaţia a doua a dus la amplificarea semnalului ecografic cu ajutorul microbulelor, care nu pot străbate peretele vascular şi care se elimină prin exhalare în 15 minute. Material şi metode. Prezentăm rezultatele unui studiu prospectiv derulat în clinica noastră, evaluând performanţele metodei ARFI (impulsul de difuzie a forţei acustice) în evaluarea elasticităţii ficatului la copii; prezentăm şi câteva cazuri pediatrice în care ecografia cu contrast a adus reale beneficii, uşurând diagnosticul şi facilitând luarea deciziilor terapeutice optime. [ABSTRACT FROM AUTHOR]

Prezentăm cazul unui băiat de 9 ani cu epilepsie refractară la tratamentul anterior, diagnosticat cu sindrom Stevens Johnson apărut după introducerea în tratament a Lamictalului. Băiatul a prezentat febră, exantem polimorf maculo-papulo-eritematos, cu elemente veziculo buloase generalizate şi denudare tegumentară, conjunctivită, leziuni bucale. Pneumonia asociata am interpretat-o ca afectare a mucoasei tractului respirator inferior din cadrul sindromului Stevens Johnson. Evoluţia bolii a fost favorabilă după doze mari de imunoglobuline intravenos. În concluzie, deşi incidenţa sindromului Steven Johnson este mică la copil, pediatrii trebuie să fie conştienţi de posibilitatea apariţiei ei (chiar după antiepileptice -- Lamictal), iar utilizarea imunoglobulinelor IV, deşi con troversată, administrată în doze mari pare că duce la vindecarea bolii. [ABSTRACT FROM AUTHOR]

Introduction: The increased frequency of functional constipation (FC) in pediatric ages makes it one of the most frequent reasons for pediatrician referral. The management of this pathology involves multiple therapeutic options. Material and method: Multiple studies focused on identifying the optimal therapeutic option in children's FC. Results: In case of children, FC reaches a prevalence of 14%, with a peak of incidence at the time of acquiring the toilet defecation reflex. There are no differences between genders regarding FC. Nevertheless, it seems that fecal incontinence is most frequent in males comparatively to females. Constipation leads to the accumulation of stools into the rectum resulting in fecal incontinence by overfilling. In time, the child loses the rectal sensation and the normal need of defecation. All these will lead to the decrease of bowel motility, anorexia, abdominal distension and pain, thus creating a vicious circle. In case of every child that presents constipation, the presence of alarming signs may indicate an organic pathology. The brain-gut tract own a major role in the development of functional abdominal pathologies. The management of FC consists in education, diet, the elimination of stressful factors and pharmacological therapy. The studies proved that education has the same importance and pharmacological therapy. The prognosis is burdened by uncertainty because only 50% of the children present long-term favorable outcome and can cease the laxative therapy. Conclusions: FC presents both medical and psychological implications. The proper management leads to a long-term favorable outcome only in a half of patients with FC. [ABSTRACT FROM AUTHOR]

Introduction: One of the most important contemporary challenges for the pediatrician is to fight against the high number of parental refusal to vaccinate their children. The controversies related to the composition of vaccines and their supposed side-effects misled the parents to doubt about their benefits. This information is based most frequently on uncertain data from the Internet, medias, celebrities and even misinterpreted studies. Material and method: The pediatrician must be aware that the only efficacious method to convince the parents regarding the benefits of vaccination is communication. Results: Recent studies proved the reappearance of certain diseases considered to be eradicated due to vaccinations, such as whooping cough or measles, most of the cases due to parental refusal to vaccinate their children. Thus, the development of the most efficacious communication skills might be the only method to decrease this trend. The first step is represented by active listening in order to prove the parents that their fears are understood and to provide them clear and accurate explanations, using an appropriate language, without letting the believe that their concerns are minimalized. Every argument that the pediatrician rises against the wrong parental conceptions must be based on clear evidences from the literature in order to gain their trust. Thus, the wrong ideas must be broke using a dialogue based on empathy and respect, overpassing the potential barriers that can appear. Conclusions: The only efficacious weapon of the pediatrician to fight against parental refusal to vaccinate their children is communication. [ABSTRACT FROM AUTHOR]

Introducere. Tumorile chistice la nou-născuţi şi sugari reprezintă un panel destul de larg de boli, de la forme benigne la forme maligne de boală, de la leziuni ce nu ridică probleme deosebite la altele ce impun terapie de urgenţă. Materiale şi metodă. Diagnosticul antenatal al tumorilor abdominale constituie punctul de plecare al evoluţiei şi supravegherii. O serie de 11 feţi cu tumori abdominale au fost monitorizaţi postnatal. Au fost notate caracterele ecografice, evoluţia şi corespondenţa cu diagnosticul copilului. Rezultate. Cele mai frecvente formaţiuni chistice la nou-născut şi sugar sunt hidronefroza congenitală, anomaliile chistice renale, chisturile de coledoc, duplicaţia intestinală, stenoza/atrezia duodenală, stenoza pilorică, duplicaţiile intestinale, chisturile ovariene, precum şi teratoamele. Schimbările de ecostructură intrauterine, dar mai ales cele din post-partum sunt frecvente, ceea ce face diagnosticul diferenţial dificil. Doar 8 din 11 tumori fetale au fost corect diagnosticate antenatal. Concluzie. Diagnosticul ecografic antenatal al formaţiunilor tumorale chistice este util la nou-născut, deoarece stabileşte precoce conduita terapeutică, măreşte şansele de supravieţuire şi previne apariţia complicaţiilor. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of neoplasia is very important to be established as soon as possible because the early diagnosis improves considerably the prognosis. The clinical and biological data are sometimes suggestive for the diagnosis, but other times are inconclusive. Material and method: Ultrasonography is the one that may often offer the key for the diagnosis, or requires complementary imagistic tools, being the first choice among the imagistic methods in child's malignancies. Results: Ultrasound allows: the classification of tumors into solid or cystic, establishing the benign or malignant character, organ origin, the presence/absence of Doppler flow with the assessment of neoformation vessels, the dynamic monitoring of this tumors under treatment. Among the most frequent tumors that can be diagnosed in child using ultrasonography, we mention hemangioendothelioma, hepatoblastoma, hepatic metastases, Hodgkin and non-Hodgkin lymphomas, neuroblastoma, nephroblastoma, but also more rare tumors such as teratoma, sarcoma or ovarian ones. Elastography and contrast-enhanced ultrasound may bring real benefits in differentiating benign tumors from the malignant ones. Contrast-enhanced ultrasound along with 2B ultrasound represent two useful methods in characterizing tumors. Conclusions:Ultrasonography has an essential role in the fast and accurate diagnosis, but also in what concerns the possibility of monitoring the evolution of child's cancer under treatment. [ABSTRACT FROM AUTHOR]

Introduction: Communication is one of the basic requirements of medical profession and most-likely the most important in achieving therapeutic success. Pediatrics is a particular area due to the fact that the doctor-patient relationship is in fact a triangle which involves also parents. The skills for successful communication must be owned by every physician even though lately the medical technology progress made less important this aspect. Material and method: Pediatrics pathology by its diversity and peculiarities imposes the acquirement of communication skills with both the small patient and adult. Results: A pediatrician must communicate the diagnosis to the family providing understanding and clarity in order to gain the parents' trust. He must be able to adjust to every difficult or unpredictable situation and to tailor communication to the family's needs. Every pediatrician must be aware that both verbal and non-verbal communication are important for establishing and maintaining the therapeutic alliance. The child must be involved in the communication act whenever possible. The diagnosis of any pediatric pathology involves complications without treatment, different therapeutic options, but also related risks and complications. All these must be explained to the child and family using an appropriate language, without medical terms, asking them to repeat what they understood in order to be sure of the proper therapeutic decision. The physical, psychological, cultural and social barriers must be overpassed in order to obtain the desired outcome. Empathy and respect are the main factors that may facilitate communication. Conclusions: Even though in pediatrics, communication is a trialogue, its success depends mostly on the pediatrician and it remains a daily challenge for him. [ABSTRACT FROM AUTHOR]

Hepatoblastomul este o patologie rară la pacienţii pediatrici, afectând 5-10/un milion de copii anual. Prezentăm cazul unui pacient în vârsta de doi ani care a fost internat în Clinica noastră pentru investigarea unei formaţiuni tumorale abdominale. Ecografia şi tomografia computerizată (CT) au evidenţiat o tumoră hepatică solidă de dimensiuni mari, asociind tromboza venei porte drepte. Nivelul alfa-fetoproteinei serice (AFP) şi numărul de trombocite au fost mult crescute. Examinarea histopatologică a biopsiei hepatice a confirmat diagnosticul de hepatoblastom tip epitelial. Chimioterapia a fost iniţiată, urmată de o intervenţie chirurgicală în două etape: ligatura ramului portal drept şi rezecţia tumorală ulterioară. La şase luni după intervenţia chirurgicală o recidivă tumorală a fost suspectată, confirmată de examenul CT şi de nivelurile ridicate ale AFP. Pacientul a beneficiat de un transplant hepatic „de salvare”, cu evoluţie ulterioară favorabilă şi fără recădere de 3 ani. Nivelurile crescute ale alfa-fetoproteinei şi trombocitoza sugerează diagnosticul de hepatoblastom. Transplantul hepatic este opţiunea finală în cazul tumorilor inoperabile, de dimensiuni mari sau al recăderilor. [ABSTRACT FROM AUTHOR]

Acidul folic şi cobalamina sunt vitamine din grupul B, care joacă un rol esenţial în numeroase procese celulare. Deficienţa uneia sau a ambelor vitamine provoacă anemie megaloblastică, o anemie foarte rară la copii, caracterizată prin prezenţa megaloblaştilor. Deficienta de vitamina B12 poate fi determinată de un aport redus, scăderea absorbţiei sau afectarea utilizării. Prezentăm cinci cazuri de anemie megaloblastică care ilustrează apariţia anemiei la vârste diferite şi în patologii diferite. Concluzionăm astfel că anemia megaloblastică este o anemie rar diagnosticată la copii, cu multiple cauze, producându-se în contextul unei diete vegetariene sau asociată unei boli autoimune, dar şi prin malnutriţia protein-calorică a mamei în timpul sarcinii şi prezenţa anemiei megaloblastice la mamă, asociată cu lipsa de substituţie în timpul sarcinii şi în timpul alăptării. [ABSTRACT FROM AUTHOR]

Introduction: Idiosyncratic reactions represent rare, unpredictable adverse effects to drugs, which can lead to severe complications. The most often affected organ by these types of reactions is the skin, with the development of skin conditions which can vary from maculopapular rash to Stevens-Johnson syndrome or even toxic epidermal necrolysis. Material and method: We report the case of a 1 year and 10 month old female patient, diagnosed with an idiosyncratic reaction secondary to multiple antibiotic therapy, with the purpose of underlyning the clinical polymorphism and the therapeutic approach of this condition, while refering to the most recent literature data. Results: The patient, who had been previously hospitalised for otomastoiditis, for which she had received multiple antibiotic treatments in two other centres, was transferred to our clinic, presenting with fever, altered general status and polymorphous, generalised exanthema. Laboratory results revealed leukocytosis with neutrophilia, anemia, an elevated erytrocyte sedimentation rate and the presence of a hepatocytolisis syndrome, associated with cholestasis. Intravenous therapy with imunoglobulins and corticotherapy was started. Moreover, antibiotherapy was interrupted, while mantaining the symptomatic treatment. The patient's evolution was slowly favorable, her discharge taking place after approximately two weeks. Conclusions: Idiosyncratic reactions represent potential adverse effects to the administration of multiple antibiotic classes, which can evolve to Stevens Johnson syndrome, condition which presents a vital risk. Early onset therapy can lead to fast remission of the symptoms. [ABSTRACT FROM AUTHOR]

Introducere. Obezitatea prezintă multiple complicaţii, consecinţa inflamaţiei cronice şi insulinorezistenţei, modificări induse de produşii secretaţi de adipocite. Scop. Determinarea nivelurilor serice a adipokinelor inflamatorii la copiii obezi şi evaluarea relaţiei cu indicii antropometrici şi parametrii biochimici. Material şi metodă. Studiu prospectiv incluzând 110 copii obezi, între 1 octombrie 2010-1 martie 2013. S-au determinat leptina, adiponectina, interleukinele (IL6-8), căutând corelaţiile acestora cu parametrii antropometrici şi de metabolism. Rezultate. Leptina a fost 16,79 ±1,39 ng/ml la obezi, mai mare decât la lotul martor (2,78 ± 0,43 ng/ml), iar adiponectina 14871,07 ± 713,17 ng/ml la martor şi 9.883,49 ± 562,54 ng/ml la obezi, cu diferenţe semnificative statistic (p < 0,0001 ambele). IL6 şi IL8 au fost, de asemenea, mai mari la lotul de obezi. Au fost corelaţii semnificative între adipokine şi indicii antropometrici. Dislipidemia s-a semnalat la 20% din obezi, 8,18% cu LDL-colesterol crescut, 26,36% hipertrigliceridemie şi 9,09% HDL-colesterol scăzut. Concluzii. Adipokinele inflamatorii sunt crescute la copiii obezi, corelate cu dislipidemia, iar adiponectina scade, sugerând că adipozitatea marcată poate avea şi la copil rol în patogeneza complicaţiilor. [ABSTRACT FROM AUTHOR]

Introduction. The intermaxillary segment consists of two medial nasal buds and two maxillary buds, having three components: the labial, the premaxillary with the dental arch of the incisives, the primary palate. Material and method. A cohort of 52 pregnant women, each fetus having three 3D ultrasound between 12-14 weeks, 16-17 weeks and 22-24 gestational weeks; through multiplanary-multi slice technique a cranial axial section was achieved, highlighting the alveolar ridge and measuring its area. Three spontaneously aborted fetuses at 12, 17 and 24 weeks were studied after cutting the head in transversal plan at the level of the mouth, highlighting the rough palate and the maxillary alveolar ridge, in order to compare the images obtained through ultrasound with those on anatomical preparations. Results. In all 156 fetal volumes, the processing through multiplanary technique obtained sections similar to the images of anatomical preparations. The measurement of the alveolar arch area was reported in biparietal diameter, forming a diagram. Discusions. In the presence of the upright dental maxillary alveolar ridge, the primary palate with the anterior portion of the maxillary bone and the four upper incisors will have a normal structure. The three-dimensional ultrasound can specify the anatomical structure of the primary palate. Conclusions. The maxillary dental alveolar ridge can be evaluated in fetuses through three-dimensional ultrasound, the images obtained being similar to those from anatomical preparations. The surface of this crest increases and can be related to the size of the biparietal diameter in normal fetuses. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a global health problem, with a difficult to manage pandemic extension. The incidence is increasing in pediatric ages, having multifactorial etiology. Non-alcoholic fatty liver disease (NAFLD) is nowadays recognized as the main form of chronic hepatitis in children, the most common cause of unexplainable, persistent elevated levels of transaminases. Aim To underline the importance of hepatic complications related to obesity in children. Material and method: We report the case of a 6-year-old male child, known with obesity, admitted in our clinic with hepatocytolysis in order to underline the potential hepatic complications of obesity that may occur. Results: The 6-year-old patient, known with obesity (W:32 Kg, H:115 cm, BMI:24.2), for which it was ruled out an endocrinologic cause, is admitted in our clinic with elevated liver transaminases, identified during an admission in another clinic. The laboratory tests performed in our clinic pointed out elevated liver transaminases (alanine aminotransferase: 338U/l, aspartate aminotransferase: 218U/l), thus we ruled out different infectious causes (negative serology), and also autoimmune ones. The abdominal ultrasound revealed hepatomegaly and hepatic steatosis in concordance with the values obtained at the hepatic elastography. The patient benefited of liver protectors during admission, with favorable evolution, thus he was discharged with the recommendations of diet, moderate physical effort and continuation of the liver protectors, but after approximately 2 weeks from the cessation of the liver protectors, the heptocytolysis syndrome reappeared. Therefore, we reinitiated the liver protectors, following to cease them at the time of patient's weight loss. Conclusions: NAFLD is a chronic pathology whose etiology is increasing in pediatric ages most likely due to the development of obesity in younger ages. The early diagnosis and intervention are vital for the prognosis of obese children. [ABSTRACT FROM AUTHOR]