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Andreea Dinca

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

HEMIHIPERTROFIA IZOLATA LA SUGAR

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 4, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HEMIHIPERTROFIA IZOLATA LA SUGAR

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REZUMAT

Hemihipertrofia sau hemihiperplazia este o boală congenitală rară, a cărei incidenţă este dificil de estimat din cauza faptului că asimetria este foarte uşoară în multe cazuri, rămânând astfel nediagnosticate. Hemihiperplazia poate fi izolată sau asociată unor sindroame genetice. Prezentăm cazul unui sugar, de sex feminin, în vârstă de 6 luni, la care în perioada perinatală s-a ridicat suspiciunea unei hemihipertrofii congenitale, internându-se în clinica noastră din cauza prezenţei unei asimetrii faciale. Examenul obiectiv a scos în evidenţă, de asemenea, pe lângă hemihiperplasia hemifeţei drept, mai evidentă la nivelul frunţii, o hipertrofie a membrului superior şi inferior drepte. Analizele de laborator au identificat o uşoară anemie, nivele crescute ale transaminazelor, precum şi al alfa-fetoproteinei. Ecografia abdominală a decelat uşoară hepatomegalie, iar cea transfontanelară discretă ventriculomegalie şi atrofie frontală. Testul genetic a fost negativ, astfel că diagnosticul final a fost de hemihipertrofie izolată. Reevaluările ulterioare au arătat un nivel al alfa-fetoproteinei în scăderea, fără alte elemente patologice adiţionale. Particularitatea cazului constă în diagnosticarea unei hemihipertrofii izolate la un sugar de 6 luni, cu test genetic negativ, la care s-a observat o uşoară asimetrie facială în momentul naşterii, cu evoluţie ulterioară favorabilă, cu scădere progresivă a nivelului alfa-proteinei şi ecografie abdominală normală.

Cuvinte cheie: hemihipertrofie izolată, hemihiperplazie izolată, sugar, alfa-fetoproteina

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ISOLATED HEMIHYPERTROPHY IN CHILD

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 4, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ISOLATED HEMIHYPERTROPHY IN CHILD

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ABSTRACT

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-months-old female infant, in whom, during the neonatal period, was raised the suspicion of a congenital hemihypertrophy. She was 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 revealed 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.

Keywords: isolated hemihypertrophy, isolated hemihyperplasia, infant, alfa-fetoprotein

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„KISSING-ULCER“ – DEBUT CU COMPLICATII LA VARSTA MICA

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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„KISSING-ULCER“ – DEBUT CU COMPLICATII LA VARSTA MICA

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REZUMAT

Ulcerul este o patologie cu incidenţă scăzută la vârsta pediatrică, cu simptomatologie nespecifică sau chiar absentă, ducând astfel la apariţia complicaţiilor. Prezentăm cazul unui pacient în vârstă de 2 ani şi 10 luni, internat la spitalul de la nivel teritorial cu diagnosticul de gastroenterită acută febrilă, care în evoluţie (după 5 zile) a asociat hemoragie digestivă, impunând astfel transferul în Clinica de Pediatrie I, Târgu-Mureş. Endoscopia digestivă superioară, efectuată după reechilibrarea hemodinamică şi metabolică, a evidenţiat prezenţa a două ulcere la nivelul mucoasei duodenale, unul cu sângerare activă. Tratamentul cu inhibitori de pompă protonică şi dieta adecvată iniţiate au determinat evoluţia favorabilă a pacientului. Particularitatea cazului constă în apariţia a două ulcere duodenale la un copil de vârstă mică, fără antecedente personale patologice semnificative, cu condiţii de viaţă adecvate, fără factori de risc asociaţi şi fără infecţie cu Helicobacter pylori.

Cuvinte cheie: „kissing-ulcer“, copil, hemoragie digestivă superioară

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“KISSING-ULCER” – ONSET WITH COMPLICATIONS IN SMALL AGE

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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“KISSING-ULCER” – ONSET WITH COMPLICATIONS IN SMALL AGE

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ABSTRACT

Ulcer disease is a pathology with low incidence in pediatric population, with an unspecific symptomatology or even absent, thus leading to the development of complications. We present the case of 2 years and 10 monthold male patient, admitted in the regional hospital with the diagnosis of febrile acute gastroenteritis, who in evolution (after 5 days) associated digestive hemorrhage, thus being transferred in the Pediatrics Clinic I, Targu-Mures. The superior digestive endoscopy performed after the hemodynamic and metabolic re-equilibration, pointed out 2 ulcers in the duodenal mucosa, one with active bleeding. The treatment with proton pump inhibitors and the adequate diet initiated determined the patient’s favorable evolution. The particularity of the case consists in the appearance of 2 duodenal ulcers of the duodenal mucosa in a small child, without significant personal history, with adequate life conditions, without associated risk factors and without infection with Helicobacter pylori.

Keywords: “kissing-ulcer”, child, superior digestive hemorrhage

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GASTROENTERITA ACUTA CU CLOSTRIDIUM DIFFICILE LA UN COPIL MIC CU INTOLERANTA EREDITARA LA LACTOZA

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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GASTROENTERITA ACUTA CU CLOSTRIDIUM DIFFICILE LA UN COPIL MIC CU INTOLERANTA EREDITARA LA LACTOZA

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REZUMAT

Acute gastroenteritis with Clostridium difficile is insufficiently studied in the specialty literature due to its small incidence at this age, with increased rates of morbidity and mortality. We present the case of a 1 year and 10 month-old child, diagnosed with hereditary lactose intolerance in the neonatal period, admitted in the Pediatrics Clinic I, Targu-Mures, for vomiting, loss of appetite, decreased consistency stools, with a bed smell, with bacterial infection signs in the blood tests and slowly favorable evolution under treatment with cephalosporin. The patient is readmitted after 1 day from discharge with the reappearance of bad smell stools and loss of appetite, with unfavorable evolution after administering a 3rd generation cephalosporin, thus we raise the suspicion of infection with Clostridium difficile, confirmed by the identification of toxins in the stools, with favorable evolution under treatment for anaerobe germs (metronidazole). The particularity of the case consists in the development of a gastroenteritis with Clostridium difficile in a small child (1 year and 10 months), known with retardation in the neuro-psychomotor and language development, repeated episodes of hypoglycemia, with hereditary lactose intolerance which represented a challenge in establishing the diagnosis.

Cuvinte cheie: Clostridium difficile, child, gastroenteritis, hereditary lactose intolerance

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ACUTE GASTROENTERITIS WITH CLOSTRIDIUM DIFFICILE IN A SMALL CHILD WITH HEREDITARY LACTOSE INTOLERANCE

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 2, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ACUTE GASTROENTERITIS WITH CLOSTRIDIUM DIFFICILE IN A SMALL CHILD WITH HEREDITARY LACTOSE INTOLERANCE

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ABSTRACT

Acute gastroenteritis with Clostridium difficile is insufficiently studied in the specialty literature due to its small incidence at this age, with increased rates of morbidity and mortality. We present the case of a 1 year and 10 month-old child, diagnosed with hereditary lactose intolerance in the neonatal period, admitted in the Pediatrics Clinic I, Targu-Mures, for vomiting, loss of appetite, decreased consistency stools, with a bed smell, with bacterial infection signs in the blood tests and slowly favorable evolution under treatment with cephalosporin. The patient is readmitted after 1 day from discharge with the reappearance of bad smell stools and loss of appetite, with unfavorable evolution after administering a 3rd generation cephalosporin, thus we raise the suspicion of infection with Clostridium difficile, confirmed by the identification of toxins in the stools, with favorable evolution under treatment for anaerobe germs (metronidazole). The particularity of the case consists in the development of a gastroenteritis with Clostridium difficile in a small child (1 year and 10 months), known with retardation in the neuro-psychomotor and language development, repeated episodes of hypoglycemia, with hereditary lactose intolerance which represented a challenge in establishing the diagnosis.

Keywords: Clostridium difficile, child, gastroenteritis, hereditary lactose intolerance

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LIMFOMUL BURKITT – PERSEVERENTA CLINICIANULUI IN STABILIREA DIAGNOSTICULUI

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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LIMFOMUL BURKITT – PERSEVERENTA CLINICIANULUI IN STABILIREA DIAGNOSTICULUI

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REZUMAT

Limfomul Burkitt, subtip al limfoamelor non-Hodgkin, apare cu predilecţie la vârstele mici şi prezintă cea mai rapidă creştere tumorală întâlnită la oameni. Prezentăm cazul unui copil în vârstă de 5 ani, cu dureri abdominale difuze, distensie abdominală şi scaune semiconsistente, este transferat în Clinica Pediatrie I Târgu-Mureş, cu diagnosticul de malnutriţie severă şi edeme hipoproteice, de etiologie neprecizată. Investigaţiile de laborator efectuate arată leucocitoză, VSH uşor crescut, anemie, nivel scăzut al proteinelor plasmatice, precum şi nivel crescut al LDH-ului. Ecografia abdominală pune în evidenţă lichid intraabdominal, iar CT-ul abdominal arată lichid liber între ansele intestinale, 2 fistule, una duodeno-colică şi una jejuno-colică, precum şi andenopatii. Surpriza intraoperatorie este descoperirea unei mase tumorale care implică duodenul, jejunul şi colon, iar examenul histopatologic stabileşte diagnosticul de limfom Burkitt, formă extranodală, cu evoluţie post-operatorie grevată de multiple complicaţii. După a treia reintervenţie chirurgicală, se iniţiază chimioterpia. Deşi uneori tabloul clinic nu este sugestiv pentru severitatea patologiei, perseverenţa clinicianului este cea care duce în final la stabilirea diagnosticului.

Cuvinte cheie: limfom Burkitt, copil, diagnostic.

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BURKITT LYMPHOMA – CLINICIANS’S PERSEVERANCE IN ESTABLISHING THE DIAGNOSIS

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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BURKITT LYMPHOMA – CLINICIANS’S PERSEVERANCE IN ESTABLISHING THE DIAGNOSIS

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ABSTRACT

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.

Keywords: Burkitt lymphoma, child, diagnosis.

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