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Helicobacter pylori (H. pylori) are one of the most common infections during childhood, and if left untreated it might persist lifelong resulting in severe complications such as gastric malignancies. The epidemiology of this infection has wide variations along the continents, countries and sub-regions being related mainly to the socio-economic status, hygiene and sanitary conditions. Nevertheless, a descending trend of H. pylori prevalence was noticed worldwide during the last decades, fact that might decrease in time the incidence of gastric cancer in adults. The diagnosis of this infection remains tricky in children and the selection of the most effective diagnostic tool is essential in order to early diagnose H. pylori associated gastropathies and extraintestinal manifestations. In spite of the lack of symptoms which occurs especially in pediatric subjects, H. pylori infection might result in severe damage to the gastric mucosa and further complications requiring close monitoring after the eradication regimen. Therefore, multiple non-invasive and invasive methods were designed to identify properly the presence of this bacterium within the individual’s stomach and for enabling the clinician to use to most adequate method based on its sensitivity and specificity, but also based on the specific clinical situations. Aside from the well-known standard triple therapy used for the eradication of this infection, multiple other regimens were lately proposed in order to prevent failure of eradication. Moreover, probiotics were recently proved to improve the eradication rate, and at the same time to decrease the side effects of the antibiotics therapy. The proper eradication of H. pylori infection during childhood remains the cornerstone in preventing gastric cancer during adulthood. [ABSTRACT FROM AUTHOR]

Aplastic Anaemia is a severe potentially fatal haematological syndrome, characterised by peripheral pancytopenia and bone marrow hypoplasia, with an occurrence rate of 2-6 cases per million per year. This case report is about a 9 year-old boy, with no pathological known antecedents, and a sudden onset, apparently without any pathological associated conditions, who was diagnosed with severe Idiopathic Aplastic Anaemia, and a fulminate evolution. The lack of compliance of the parents regarding the therapy, and also the lack of a protective Child's legislation, led to patient's death in a very short time. [ABSTRACT FROM AUTHOR]

Protein-losing enteropathy (PLE) represents an abnormal protein loss at the level of the digestive tract mucosa, being in most of the cases secondary to other gastrointestinal or extraintestinal pathologies. Nevertheless, there also are primary causes, genetic ones associated with PLE. We present the case of a small female child, 1 year and 1 month-old, with a history of infectious enterocolitis determined by Escherichia coli enteropathogenic, who presented palpebral edemas, especially in the morning for approximately 1 week. The laboratory tests revealed hypoalbuminemia, type A and G hypogammaglobulinemia, leukocytosis with eosinophilia, and anemia. The test for the detection of occult hemorrhages from feces was positive, likewise the fecal calprotectin and level of alpha-1 antitrypsin. We identified also allergy to cow's milk protein, which we interpreted as being secondary to the intestinal pathology. Thus, we established the diagnosis of protein-losing enteropathy after an episode of acute enterocolitis caused by E. coli enteropathogenic, and we administered substitutive treatment with human albumin and steroids, with favorable evolution. The particularity of the case consists in diagnosing a severe case of protein-losing enteropathy in a small child, with palpebral edema, predominantly during the morning, and decreased levels of serum albumin, after an episode of acute enterocolitis caused by E. coli enteropathogenic, which remitted without etiologic treatment. [ABSTRACT FROM AUTHOR]

Hemihypertrophy, or hemihyperplasia is a rare congenital condition, whose incidence is difficult to estimate due to the fact that asymmetry is very mild, therefore remaining undiagnosed. Hemihyperplasia can be isolated or associated to certain genetic syndromes. We present the case of a 6-monyh-old female infant, in whom during the neonatal period was raised the suspicion of a congenital hemihypertrophy, being admitted in our clinic due to the presence of a facial asymmetry. The clinical exam revealed also, besides the hemihyperplasia of the right hemiface, more obvious at the level of the forehead, a hypertrophy of the right superior and inferior limbs. The laboratory tests identified a mild anemia, increased levels of transaminases and alfa-fetoprotein. The abdominal ultrasound reveal a mild hepatomegaly, and the transfontanellar one discrete ventriculomegaly and frontal atrophy. The genetic test was negative, therefore the final diagnosis was of isolated hemihypertrophy. The further re-evaluations showed a decreasing level of alfa-fetoprotein, without other additional pathological elements. The particularity of the case consists in diagnosing an isolated hemohypertrophy in a 6-month-old female infant, with negative genetic test, in whom it was observed at the moment of birth a mild facial asymmetry, with afterwards favorable evolution, with progressive decrease of the alfa-fetoprotein level and normal abdominal ultrasound. [ABSTRACT FROM AUTHOR]

Burkitt lymphoma, a subtype of non-Hodgkin lymphomas, appears especially in small ages and it presents the most rapid tumor growth encountered in the human beings. We present the case of a 5 year-old child who presents diffuse, abdominal pain, abdominal distension and decreased consistency stools, and who is transferred in the Pediatrics Clinic 1 Targu-Mures, with the diagnosis of severe malnutrition and hypoproteinemia edema of unknown etiology. The laboratory investigations performed showed leukocytosis, mildly increased erythrocyte sedimentation rate, anemia, decreased level of serum proteins, and also an increased level of LDH. The abdominal ultrasound revealed intraperitoneal fluid, and the abdominal CT exam showed free fluid between the intestinal loops, 2 fistulas, one between the duodenum and the colon, and the other one between the jejunum and the colon, but also enlarged lymph nodes. The surprise during the surgery is the discovery of a tumor mass which involves the duodenum, the jejunum and the colon, and the pathological exam establishes the diagnosis of Burkitt lymphoma, extranodal type, with evolution after surgery burdened by multiple complications. After the third surgical intervention, the chemotherapy is initiated. Even though in some cases, the clinical picture is not suggestive for the severity of the pathology, the clinician's perseverance is the one that finally leads to the establishment of the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Spleen is the largest lymphoid organ in the body. Splenomegaly is the increase in spleen volume, in varying degrees of clinical detection by palpation of the abdomen or by various imaging investigations. Aim of the paper: The present paper aims to review the etiology of splenomegaly in children (hematological, oncological, digestive, infectious, metabolic diseases, etc.) and to point out the steps necessary to evaluate the pediatric patient with splenomegaly, starting from anamnesis, clinical examination, laboratory and imaging investigations, as well as the therapeutic options. Conclusion: Therapeutic management in the child with splenomegaly includes the treatment of the underlying disease. Splenectomy is required in symptomatic patients or in the presence of complications caused by enlarged spleen. [ABSTRACT FROM AUTHOR]