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Claudiu Mărginean

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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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National Awards “Science and Research”

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ICMJE- Recommendations

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ISOLATED HEMIHYPERTROPHY IN CHILD

, , , , and

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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VENTRICULOMEGALIA CEREBRALA FETALA „BORDERLINE“

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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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National Awards “Science and Research”

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ICMJE- Recommendations

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Promoting Global Health

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VENTRICULOMEGALIA CEREBRALA FETALA „BORDERLINE“

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REZUMAT

Ventriculomegalia reprezintă dilatarea ventriculilor cerebrali peste 10 mm, fiind clasificată în uşoară sau „borderline“ (10-12 mm), moderată (13-15 mm) şi severă (peste 15 mm). Incidenţa variază foarte mult în funcţie de tehnica utilizată şi de vârsta gestaţională. Locul de elecţie pentru măsurarea cea mai exactă a diametrului ventricular este la nivelul glomusului plexului coroid. RMN-ul este o altă metodă de evaluare a creierului fetal care permite, de asemenea, vizualizarea suprafeţei cerebrale. Ventriculomegalia unilaterală este cauzată de obstrucţia morfologică, fizică sau funcţională a orificiului Monro. Ventriculomegalia „borderline“ poate fi asociată cu anomalii cromozomiale, infecţii congenitale, accidente vasculare cerebrale sau hemoragie, precum şi cu alte anomalii extracerebrale. Factori care influenţează prognosticul copiilor diagnosticaţi cu ventriculomegalie uşoară sunt: sexul, vârsta gestaţională, dimensiunea ventriculilor, afectarea uni- sau bilaterală, ventriculomegalie bilaterală simetrică sau asimetrică, progresia ventriculomegaliei – probabil cel mai important factor al prognosticului, regresia ventriculomegaliei. Părinţii trebuie informaţi despre faptul că există limitări ultrasonografice în diferenţierea unei ventriculomegalii „borderline“ izolate şi ventriculomegalie asociată unor altor anomalii oculte, care nu pot fi identificate iniţial în vederea luării unei decizii adecvate. Ecografia fetală de control este de preferat a se efectuat după aproximativ 1-2 săptămâni de la diagnosticul iniţial de „ventriculomegalie“.

Cuvinte cheie: ventriculomegalie, creier fetal, ultrasunete fetale, RMN cerebral

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FETAL CEREBRAL “BORDERLINE” VENTRICULOMEGALY

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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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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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FETAL CEREBRAL “BORDERLINE” VENTRICULOMEGALY

, , , , , and

ABSTRACT

Ventriculomegaly represents the dilation of the cerebral ventricles above 10 mm, being classified as it follows: mild or “borderline” (10-12 mm), moderate (13-15 mm) and severe (over 15 mm). The incidence varies very much depending on the used technique and the gestational age. The level of choice in order to obtain the most exact measurement of the ventricular diameter is at the level of choroid plexus glomus. The MRI is another method to assess the fetal brain that allows also the evaluation of the cerebral surface. Unilateral ventriculomegaly is caused by the morphologic, physical or functional obstruction of foramen Monro. “Borderline” ventriculomegaly can be associated with chromosomal anomalies, congenital infections, cerebral vascular accidents or hemorrhage, but also other extra-cerebral anomalies. The factors that influence the prognosis of children diagnosed with mild ventriculomegaly are: gender, gestational age, ventricular size, uni- or bilateral impairment, symmetrical or asymmentrical bilateral ventriculomegaly, progression of ventriculomegaly – probably the most important factor of prognosis, regression of ventriculomegaly. The parents must be informed about the fact that there are certain ultrasonographic limitations regarding the differentiation of an isolated “borderline” ventriculomegaly of a ventriculomegaly associated to other occult anomalies that can not be identified initially, in order to take an adequate decision. The control fetal ultrasound is preferable to be performed after approximately 1-2 weeks from the moment of initial diagnosis of “ventriculomegaly”.

Keywords: ventriculomegaly, fetal brain, fetal ultrasound, cerebral MRI

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HEMORAGIA CEREBRALA FETALA DIAGNOSTICATA ANTEPARTUM

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 3, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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HEMORAGIA CEREBRALA FETALA DIAGNOSTICATA ANTEPARTUM

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REZUMAT

Diagnosticul antepartum al hemoragiei cerebrale fetale (HCF) este mai puţin raportat (0,9/1.000 naşteri) comparativ cu cel postpartum. Sunt prezentate două cazuri de hemoragie intraventriculară fetală, diagnosticate ecografic antepartum.
Cazul 1: HCF diagnosticată ecografic la vârsta gestaţională de 28 de săptamâni de gestaţie şi confirmată postnatal prin prezenţa în LCR a hematiilor (număr semnificativ, ratatinate) şi a modificărilor semnalate de ecografia transfontanelară (hidrocefalie internă severă, ţesut cerebral minim). Decesul a survenit la 24 de ore postpartum (ex. histopatologic: hemoragie cerebrală intraventriculară). Menţionăm absenţa aparentă a factorilor de risc materni, negativitatea testelor TORCH.
Cazul 2: hidrocefalie internă la vârsta de 37 de săptămâni de gestaţie şi confirmată la nou-născut (după cezariană) de modificările clinice caracteristice, suferinţa neurologică severă asociată cu modificări la ecografia transfontanelară şi aspectul hemoragic şi hipertensiv al LCR. Nu au fost depistaţi factori de risc materni. De asemenea, aparent nu au existat riscuri fetale: greutatea 2.820 g la 37 de săptămâni de gestaţie, teste TORCH negative, culturi şi CRP negative. Hidrocefalia a avut o evoluţie progresivă impunând ventriculotomii şi cisternotomii; plasarea unui şunt ventriculo-peritoneal în timpul celei de-a treia intervenţii neurochirurgicale a ameliorat prognosticul vital.
Concluzii. Prezenţa hidrocefaliei a fost un semn ecografic fidel pentru diagnosticul HCF. Evoluţia şi prognosticul sunt influenţate de severitatea hemoragiei şi de vârsta gestaţională. Supravieţuitorii beneficiază de tratamentul neurochirurgical. Etiopatogenia plurifactorială, incomplet descifrată a HCF conduce la dificultăţi în stabilirea unui grup ţintă de screening, în scopul identificării acestei leziuni.

Cuvinte cheie: hemoragie cerebrală, diagnostic antepartum

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FETAL CEREBRAL HEMORRHAGE DIAGNOSED ANTEPARTUM

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Revista Romana de PEDIATRIE | Volumul LXV, Nr. 3, An 2016
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

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ICMJE- Recommendations

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Promoting Global Health

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FETAL CEREBRAL HEMORRHAGE DIAGNOSED ANTEPARTUM

, , , , , , , , , and

ABSTRACT

The diagnosis of fetal cerebral hemorrhage (HCF) is less reported (0,9/1000 births) in comparison to the postpartum one. We presented 2 cases of fetal intraventricular hemorrhages diagnosed.
Case 1: HCF diagnosed by ultrasound at the gestational age of 28 weeks and confirmed after birth by the presence of erythrocytes (significant number, pathological aspect) in the spinal fluid and by the modifications signaled by the transfontanellar ultrasound (severe internal hydrocephaly, minimum cerebral tissue). The death occurred after 24 hours postpartum (pathological exam: intraventricular cerebral hemorrhage). We mention the apparent lack of maternal risk factors, negative TORCH tests.
Case 2: internal hydrocephaly at the age of 37 gestational weeks and confirmed in newborn (after cesarean section) by the clinical characteristic modifications, severe neurological impairment with modification at the transfontanellar ultrasound and the hemorrhagic and hypertensive aspect of the spinal fluid. We did not encounter maternal risk factors. Also, apparently, there were not any fetal risks: weight 2,820 grams at 37 gestational weeks, negative TORCH tests, negative cultures and CRP. The hydrocephaly had a progressive evolution imposing ventriculotomies and cysternotomies; the placement of a ventriculoperitoneal shunt during the third neurosurgical intervention improved the vital prognosis.
Conclusions. The presence of hydrocephaly was a faithful ultrasound sign for the diagnosis of HCF. The evolution and the prognosis are influenced by the severity of hemorrhage and the gestational age. The survivors benefit from neurosurgical treatment. The multifactorial etiology, of the HCF incompletely elucidated leads to difficulties in establishing a target group of screening, in order to identify this lesion.

Keywords: cerebral hemorrhage, antepartum diagnosis

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Recent acquisitions in imaging diagnosis of digestive disorders in children

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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Recent acquisitions in imaging diagnosis of digestive disorders in children

, , , and

REZUMAT

Elastography is a new imaging method based on ultrasounds, which allows the assessment of the tissues structure in terms of their stiffness, being useful in the exploration of different organs and systems, having more and more clinical applications. The development of the contrast agents of second generation led to the amplification of the ultrasound signals using the microbubbles, which can not cross the vascular wall and are eliminated through exhalation within 15 minutes.

Material and methods. We present the results of a prospective study conducted in our Clinic, assessing the performance of the ARFI method (”Acustic Radiation Force Imaging”) in the assessment of the liver elasticity in children and we present some pediatric cases in which the ultrasound with contrast has brought real benefits, making it easier to diagnose and facilitate optimal therapeutic decisions.

Key words: imagistic diagnosis, elastography, contrast, digestive, child

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ACHIZITII RECENTE IN DIAGNOSTICUL IMAGISTIC AL BOLILOR DIGESTIVE LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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ACHIZITII RECENTE IN DIAGNOSTICUL IMAGISTIC AL BOLILOR DIGESTIVE LA COPIL

, , , and

REZUMAT

Elastografia 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.

Cuvinte cheie: diagnostic imagistic, elastografie, contrast, digestiv, copil

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A case of Stevens Johnson syndrome in child

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 2, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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A case of Stevens Johnson syndrome in child

, , , and

ABSTRACT

We present a 9-year-old boy with epilepsy refractory to previous treatment diagnosed with Stevens Johnson syndrome appeared after the introduction of Lamictal in treatment. The boy had fever, polymorphous exanthema, papulopustular erythematous, bullous generalized vesiculobullous elements and skin denudation, conjunctivitis, mouth lesions. We have interpreted the associated pneumonia as a damage of a lower respiratory tract mucous membranes within Stevens Johnson syndrome. The evolution of the disease was favourable after high doses of Ig IV (intravenous immunoglobulin). In conclusion, even if the Steven Johnson syndrome incidence is low in children, pediatricians should be aware of the possibility of its reggresion (even after antiepileptics - Lamictal), and even if the use of Ig IV is controversial, it leads to healing when is given in high doses.

Key words: Stevens Johnson syndrome, child, epilepsy, Lamotrigine (Lamictal)

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UN CAZ DE SINDROM STEVENS JOHNSON LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 2, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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UN CAZ DE SINDROM STEVENS JOHNSON LA COPIL

, , , and

REZUMAT

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 controversată, administrată în doze mari pare că duce la vindecarea bolii.

Cuvinte cheie: Sindrom Stevens Johnson, copil, epilepsie, Lamotrigin (Lamictal)

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