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Gabriela Lesanu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

SINDROMUL MUNCHAUSEN PRIN TRANSFER – O PROBLEMA REALA PEDIATRICA?

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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SINDROMUL MUNCHAUSEN PRIN TRANSFER – O PROBLEMA REALA PEDIATRICA?

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REZUMAT

Sindromul Münchausen (SM) şi Münchausen prin transfer (SMPT) aparţin afecţiunilor numite „Factitious disorder şi reprezintă tulburări mentale severe care au ca „scop“ situaţia de a deveni pacient respectiv de a „fabrica“ o boală unei alte persoane, aflată în îngrijire, solicitând sau necesitând intervenţie medicală pentru aceasta. Sindromul Münchausen prin transfer nu este rar, dar este dificil de recunoscut şi de confirmat, este o formă de abuz, în special asupra copilului, potenţial letală, frecvent neînţeleasă şi nedepistată. Metodele folosite de adulţii falsificatori pentru a induce o afecţiune falsă copilului sunt variate: otrăvire, rănire, producerea de sângerări, infectare. Acuzele expuse de mamă ca aparţinând copilului nu au drept scop obţinerea de avantaje personale, ci sunt alimentate de dorinţa mamelor de a le fi acordat rolul de „erou“ şi de a fi recunoscute ca fiind persoanele ce acordă cea mai mare grijă copilului lor. Diagnosticul trebuie să includă evaluarea copilului, a părinţilor şi a familiei, unele elemente fiind sugestive: copil cu multiple probleme de sănătate, care nu răspunde la tratament sau reapar sub terapie adecvată, cu investigaţii paraclinice discrepante şi semne şi simptome ce dispar în absenţa părintelui. Afecţiunea falsă a copilului, descrisă intenţionat denaturat de către adult, nu-l afectează negativ pe acesta, dar procesul medical de diagnostic şi tratament poate produce durere şi disconfort. Aspectele etice şi legale asociate SMPT implică şi personalul medical, prin consecinţele actului medical asupra copilului, ca urmare a falsificării realităţii de către părinte. Educaţia pacientului, familiei şi personalului medical reprezintă o etapă foarte importantă în recunoaşterea, pre venirea şi tratamentul SMPT.

Cuvinte cheie: Münchausen prin transfer, copil

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MUNCHAUSEN SYNDROME BY PROXY – A REAL PEDIATRIC PROBLEM?

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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MUNCHAUSEN SYNDROME BY PROXY – A REAL PEDIATRIC PROBLEM?

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ABSTRACT

Munchausen syndrome and Munchausen by proxy syndrome belong belong to a group of disease called “factitious disorder” and are severe mental disorders having the “end” position for a healthy person to become patient, respectevely to “create” a disease to another person, asking or requiring medical intervention for him/her. Munchausen syndrome by proxy is rare, but it is difficult to be recognized and confirmed, is a form of abuse, particularly against children, potentially lethal, often misunderstood. Many methods are used by adults counterfeiters to induce a false child’s condition: poisoning, injury, producing bleeding, infection. Complaints exposed by the mothers as belonging to the child are not for a personal benefit, but are justified by a desire to be a “hero” mothers and to play the role of the people most attached and thoughtful of their child. Diagnosis should include evaluation of the child, parents and family and is based on suggestive elements: child with multiple health problems that do not respond to treatment or recur under proper therapy, laboratory investigations discrepancies, child’s signs and symptoms disappear in the absence of the parent. The false disease of the child, intentionally distorted described by adult, do not realy affect him/her, but the diagnostic process and medical treatment can cause pain and discomfort. Ethical and legal issues associated with MSBP involves healthcare professionals by the medical consequences on the child as a result of false complains described by the parent. Education of patient, family and medical personnel is a very important step in the recognition, prevention and treatment of MSBP.

Keywords: Munchausen by proxy syndrome, child

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Overlap and other autoimmune phenomena in pediatric chronic hepatic disease

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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”

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ICMJE- Recommendations

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Overlap and other autoimmune phenomena in pediatric chronic hepatic disease

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ABSTRACT

Patients with chronic liver disease can present serological immune associations or a real overlap syndrome. The hepatic overlap syndrome includes biochemical and histological features either for two autoimmune hepatic diseases or for one autoimmune hepatitis and another chronic hepatic disease (chronic viral hepatitis B or C, Wilson’s disease, fatty liver disease). In the absence of appropriate treatment, the natural course of autoimmune hepatitis and overlap syndromes is towards cirrhosis and liver failure. The diagnostic criteria, prognostic scores and predictive factors for overlap syndromes are not yet established. The serological immune reactions are also found in liver disease other than autoimmune hepatitis. In chronic viral hepatitis C different types of immunological manifestations are oftenly associated. In non-alcoholic fatty liver disease the high prevalence of self-antibodies indicates the presence of an autoimmune response; on the other hand these antibodies can help predict the severity of the disease. The medical therapy of either the autoimmune reaction or the underlying hepatic disease should use an individualized algorithm regarding drug associations, dosing and duration of treatment.

Key words: hepatitis, overlap syndrome

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FENOMENE AUTOIMUNE DE OVERLAP IN HEPATITELE CRONICE ALE COPILULUI

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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”

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ICMJE- Recommendations

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Promoting Global Health

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FENOMENE AUTOIMUNE DE OVERLAP IN HEPATITELE CRONICE ALE COPILULUI

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REZUMAT

Pacienţii cu hepatopatii cronice pot prezenta fenomene imunologice serologice sau chiar un veritabil sindrom de overlap. Aceste sindroame prezintă caractere comune biochimice şi histopatologice pentru cel puţin două dintre afecţiunile autoimune hepatice sau pentru o afecţiune autoimună hepatică şi o altă afecţiune hepatică cronică nonimună (infecţie hepatică VHC, VHB, boala Wilson, steatoza hepatică non-alcoolică). Evoluţia hepatitelor autoimune sau sindroamelor de overlap este adesea către ciroză şi insuficienţă hepatică fără terapie adecvată. Criteriile de diagnostic, scorurile de prognostic sau factorii de predicţie pentru apariţia sindroamelor de overlap nu sunt încă pe deplin stabilite. Fenomene de overlap serologic sunt descrise, şi în alte afecţiuni hepatice în afara celor imune recunoscute. În infecţia cronică cu virus hepatitic C pot fi identificate mai multe tipuri de reacţii imunologice. În steatoza hepatică nonalcoolică prevalenţa crescută a autoanticorpilor sugerează prezenţa fenomenului imun precum şi posibilitatea folosirii acestora ca factori de predicţie pentru severitate. Tratamentul medical al fenomenelor autoimune, dar şi al bolii de bază conduce la o terapie personalizată ca asociere terapeutică, doze, durată.

Cuvinte cheie: hepatită, hepatopatii, sindrom overlap

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Overlap syndromes in pediatric hepathology

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, 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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Overlap syndromes in pediatric hepathology

, , , and

ABSTRACT

In hepathology, the term “overlap syndrome” describes different forms of hepatobiliary autoimmune disease: autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune cholangitis (AIC). Patients with hepatic overlap syndrome present with both biochemical and histological features of at least two of AIH, PBC, PSC. In the absence of appropriate treatment, the course of the disease in autoimmune hepatitis and overlap syndromes is towards cirrhosis and liver failure. It remains unclear whether these overlap syndromes are distinct entities or variants of the major autoimmune hepatopathies. Standardization and diagnostic criteria for overlap syndromes are not yet established and the term “overlap syndrome” is common in clinical practice, but not always used correctly. Empiric medical treatment of overlap syndromes includes anticholestatic therapy with ursodeoxycholic acid and immunosuppressive therapy with corticosteroids and azathioprine in a case to case based therapy schedule. In end-stage disease, liver transplantation is the treatment of choice.

Key words: hepatitis, child, overlap

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SINDROAME DE OVERLAP IN HEPATOLOGIA PEDIATRICA

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, 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”

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SINDROAME DE OVERLAP IN HEPATOLOGIA PEDIATRICA

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REZUMAT

Termenul „sindrom de overlap“ descrie, în hepatologie, forme diferite de afecţiuni hepatobiliare autoimune: hepatită autoimună (HAI), ciroză biliară primitivă (CBP), colangită sclerozantă primitivă (CSP), colangită autoimună. Pacienţii cu sindrom hepatic de overlap prezintă caractere comune biochimice şi histopatologice pentru cel puţin două din afecţiunile autoimune hepatice. Evoluţia hepatitelor autoimune sau sindroamelor de overlap este adesea către ciroză şi insuficienţă hepatică fără terapie adecvată. Rămâne încă neclar dacă aceste „sindroame de overlap“ sunt entităţi distincte sau doar variante ale hepatopatiilor majore autoimune. Stadializarea şi criteriile de diagnostic, scorurile de prognostic sau de predicţie pentru apariţia sindroamelor de overlap nu sunt încă pe deplin stabilite, ceea ce face a termenul să fie folosit frecvent dar, nu totdeauna corect în practica medicală. Sindroamele de overlap sunt afecţiuni hepatice rare, dar cu prognostic sever. Tratamentul medical empiric al sindroamelor de overlap hepatic include: terapie imunosupresivă cu corticosteroizi şi azathioprină, terapie anticolestatică cu acid ursodeoxicholic, strict personalizată ca asociere terapeutică, doze, durată. Stadiile finale necesită transplant hepatic.

Cuvinte cheie: hepatită, copil, overlap

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Chronic pancreatitis in children

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Chronic pancreatitis in children

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ABSTRACT

Chronic pancreatitis (CP) is characterised by chronic inflammation, progressive fibrosis, pain and loss of endocrine and exocrine functions. In 1999 the hypothesis of sentinel acute pancreatitis event – SAPE was formulated. This suggests that the initial episode of acute pancreatitis generated by metabolic or oxidative stress is followed by recurrent or chronic inflammation which will finally lead to fibrosis. The pancreatic stellate cells have a key role in the progression of chronic pancreatitis and in the initiation of fibrinogenesis. CP is a heterogenous disese with a clinical picture that includes pain, endocrine and exocrine pancreatic dysfunction and various complications that might implicate adjacent organs. For the diagnosis of CP in adults histological, morphological criteria or a combination of clinical, functional and morphological arguments are needed. Recently the International Study Group Of Pediatric Pancreatitis proposed a set of diagnostic criteria for CP: (a) typical abdominal pain plus characteristic imagistic findings or (b) exocrine pancreatic failure plus imagistic findings or (c) endocrine pancreatic failure plus imagistic findings. The etiology of CP is different in children compared to adult patients. Lately remarkable progress was made in the knowledge of hereditary and autoimmune pancreatitis. Obstructive causes may be identified in CP in children. Chronic obstructive pancreatitis are determined by congenital or acquired mechanical factors. The therapy includes: conservative measures (analgesia, antiinflammatory medication, enzyme substitution), endoscopic interventions and surgical procedures. Endoscopic retrograde cholangiopancreatography is used as therapeutic procedure for biliopancreatic disease with recurrent or chronic pancreatitis. In patients with no response to any of this therapeutic measures total pancreatectomy and self transplantation of pancreatic islets may be tried.

Key words: pancreatitis, pancreatic stellate cells

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PANCREATITE CRONICE LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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PANCREATITE CRONICE LA COPIL

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REZUMAT

Pancreatita cronică (PC) se caracterizează prin inflamaţie cronică, fibroză progresivă, durere şi pierderea funcţiilor endocrină şi exocrină. În 1999 a fost formulată ipoteza episodului santinelă de pancreatită acută (sentinel acute pancreatitis event - SAPE), care sugerează că episodul iniţial de pancreatită generat de stres metabolic sau oxidativ este urmat de inflamaţie recurentă sau cronică care produce fibroză. Celulele stelate pancreatice au fost identificate ca având rol cheie în progresia pancreatitei cronice şi în dezvoltarea fibrinogenezei. PC este o afecţiune heterogenă cu un spectru clinic care include: durere, afectarea funcţiilor endocrine şi exocrine pancreatice şi variate complicaţii ce implică organele adiacente pancreasului. Pentru a stabili diagnosticul de PC la adult sunt necesare dovezi histologice, morfologice sau o combinaţie de argumente clinice, funcţionale şi morfologice. Recent, Grupul Internaţional de Studiu pentru Pancreatită la Copil (International Study Group Of Pediatric Pancreatitis) a propus următoarele criterii de diagnostic pentru PC: a) dureri abdominale tipice plus aspecte imagistice caracteristice sau (b) insuficienţă pancreatică exocrină plus aspecte imagistice sau (c) insuficienţă pancreatică endocrină plus aspecte imagistice. Etiologia PC este diferită la pacienţii pediatrici comparativ cu pacienţii adulţi. În ultimiii ani s-au realizat progrese remarcabile în cunoaşterea pancreatitei ereditare şi pancreatitei autoimune. În etiologia pancreatitelor cronice diagnosticate la copil pot fi identificate cauze obstructive. Pancreatitele cronice obstructive sunt determinate de factori mecanici congenitali sau dobîndiţi. Abordarea terapeutică include măsuri conservatoare (analgetice, antiinflamatorii, substituţie enzimatică), intervenţii endoscopice, precum şi proceduri chirurgicale. Colangiopancreatografia retrogradă endoscopică este utilizată ca procedură terapeutică pentru boala biliopancreatică ce generează pancreatita recurentă sau cronică. La cazurile de PC la care modalităţile terapeutice menţionate se dovedesc ineficiente se poate recurge la pancreatectomie totală cu autotransplant portal de insule pancreatice.

Cuvinte cheie: pancreatită, celule stelate pancreatice

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COLITA ULCERATIVA SI BOALA CROHN LA VARSTA PEDIATRICA – TENDINTE DE EVOLUTIE IN ROMANIA

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 2, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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COLITA ULCERATIVA SI BOALA CROHN LA VARSTA PEDIATRICA – TENDINTE DE EVOLUTIE IN ROMANIA

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REZUMAT

Obiective. În ultimii ani, s-a observat o creştere a numărului de pacienţi diagnosticaţi cu boală inflamatorie intestinală (BII). Ne-am propus să determinăm epidemiologia acestei patologii în rândul populaţiei pediatrice din sudul României, după o perioadă de 10 ani.

Material şi metodă. Studiul de faţă este unul retrospectiv, efectuat în cadrul Clinicilor de Gastroenterologie Pediatrică din Bucureşti şi are drept scop identificarea caracteristicilor epidemiologice ale pacienţilor pediatrici care suferă de BII. Am selectat toţi pacienţii aflaţi în evidenţa cu boală inflamatorie intestinală în anul 2011. Un studiu asemănător a fost realizat în urmă cu 10 ani, raportând cazurile aflate în evidenţă în anul 2001, ceea ce a permis o analiză comparativă a datelor obţinute.

Rezultate. Am identificat un număr de 74 de cazuri de boală inflamatorie intestinală, în timp ce în anul 2001 au fost menţionate 21 de cazuri. Dintre aceştia, 35 de cazuri au fost reprezentate de boala Crohn (47,29%) şi 39 de pacienţi au fost diagnosticaţi cu colită ulcerativă (52,7%). Studiul precedent a raportat 17 (81%), respectiv 4 (19%) cazuri. Vârsta medie de debut a simptomatologiei este de 10,2 ani în timp ce în 2001 a fost de 13,2 ani.

Concluzii. Numărul de cazuri de boală inflamatorie intestinală s-a triplat în ultimii 10 ani. Colita ulcerativă continuă să reprezinte cea mai frecventă formă, însă am observant o creştere a numărului de cazuri de boală Crohn. Deşi cele mai multe cazuri sunt reprezentate de pacienţi cu vârste de pe

Cuvinte cheie: boală inflamatorie intestinală, epidemiologie, vârsta la debut

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ULCERATIVE COLITIS AND CROHN DISEASE IN CHILDREN – AN EVOLVING PROBLEM IN ROMANIA

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 2, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ULCERATIVE COLITIS AND CROHN DISEASE IN CHILDREN – AN EVOLVING PROBLEM IN ROMANIA

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ABSTRACT

Objectives. In the past few years we observed an increase in the number of patients with inflammatory bowel disease. We aimed to determine the epidemiology of this pathology among children in Romania over a 10 years period.

Matherial and methods. The survey was conducted in Pediatric Gastroenterology Departments in Bucharest. We selected patients beeing carred for inflammatory bowel disease in 2011. A similar study, performed 10 years ago in 2001, reported the same epidemiologic characteristics and comparative data were available.

Results. In 2001 we report 74 cases of inflammatory bowel disease, while there were 21 cases mentioned in 2001. We identified 35 cases of Crohn disease (47.29%) and 39 patients with ulcerative colitis (52.7%). The previous study reported 17 (81%) and 4 (19%), respectively. The mean age of onset of symptoms is 10.2 while in 2001 this was 13.2 years.

Conclusions. Inflammatory bowel disease has tripled in the last 10 years. Ulcerative colitis is still the most frequent form but we report a growing number of cases with Crohn disease.

Keywords: inflammatory bowel disease, epidemiology, age at onset

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