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Mariana Coman

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

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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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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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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DIAGNOSTICUL COMPUTER-TOMOGRAFIC IN URGENTA PEDIATRICA

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

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DIAGNOSTICUL COMPUTER-TOMOGRAFIC IN URGENTA PEDIATRICA

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REZUMAT

Introducere. Examinarea prin computer-tomograf (CT) deţine un rol important în orientarea diagnostică în Urgenţă.

Obiective. Ne-am propus să identificăm utilitatea examinării CT, în urgenţa pediatrică.

Material şi metode. Studiul are un design cross-secţional, referindu-se la anul 2010. Din cele 92.959 de vizite înregistrate la Unitatea de Primiri Urgenţe, a Spitalului Clinic de Urgenţă pentru Copii „M.S. Curie“, Bucureşti, un număr de 9.258 pacienţi reprezentau urgenţe (lotul A), iar 90 constituiau urgenţe majore (lotul B). S-au efectuat un număr de 102 examinări CT. Datele au fost exprimate procentual.

Rezultate. Procentul de vizite asociat cu examinare CT, a fost de 1% în lotul A şi 1‰, exprimat global. Toţi pacienţii lotului B au fost supuşi investigaţiei CT. Principalele indicaţii au fost: traumatismele cranio-cerebrale (TCC) – 50%, hipertensiune intracraniană (HIC) – 35%, politraumatisme – 12,7% şi suspiciunile de malformaţii – 5,9%. Rata de detecţie globală a unei leziuni a fost de 51%. Pentru TCC, rata a fost de 49%, identificându-se următoarele leziuni: edem cerebral difuz (19%), hemoragii intracraniene (15,6%), fracturi osoase (15,6%), leziuni de părţi moi (29%). Pentru HIC, rata de detecţie a fost de 43%, pentru politraumatisme 84,6%, iar pentru suspiciunile de malformaţii 100%. Ratele de detecţie lezională, pe diverse categorii de indicaţii (senzitivitatea metodei) nu diferă semnificativ statistic faţă de alte studii.

Concluzie. La pacienţii de vârstă pediatrică, indicaţiile de CT, în urgenţă, s-au efectuat după o atentă selecţie a cazurilor, iar examinarea s-a dovedit utilă în cazul traumatismelor şi a suspiciunilor de hipertensiune intracraniană.

Cuvinte cheie: CT, urgenţă, traumatism, hipertensiune intracraniană

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COMPUTED TOMOGRAPHY IMAGING IN THE PEDIATRIC EMERGENCY DEPARTMENT

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
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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COMPUTED TOMOGRAPHY IMAGING IN THE PEDIATRIC EMERGENCY DEPARTMENT

, , , and

ABSTRACT

Introduction. The Computerised Tomography (CT) plays a crucial role in the emergency diagnosis.

Objective. Our purpose was to identify CT-scan’s utility in Pediatric Emergency Department.

Materials and methods. We used a cross-sectional approach, for the year 2010. From a total of 92959 visits in the Emergency Room (ER) of the “Clinical Emergency Hospital for Children “M.S. Curie”, Bucharest, 9258 patients were considered emergencies (group A) and 90 patients were major emergencies (group B). We performed 102 CT scans. Results were given as percents.

Results. The global percent of ER visits associated with a CT scan was 1% within the group A and it scored 1‰ from all ER visits. All patients from group B underwent a CT scan. Main indications were: major head injuries - 50%, intracranial hypertension – 35%, polytrauma – 12.7%, suspicions of malformations – 5.9%. The global detection rate for any kind of lesion was 51%. For brain trauma the rate scored 49%, identifying the following lesions: diffuse cerebral edema (19%), intracranial hemorrhage (15.6%), skull fractures (15.6%) and other facial or visceral lesions (29%). For intracranial hypertension the method’s sensitivity was 43%, for multiple trauma 84.6% and for malformations’ suspicions 100%. The lesions’ detection rate, for different clinical conditions (or the method’s sensitivity) is similar with other medical studies.

Conclusion. In all pediatric patients, indication of a CT scan was made after a careful selection of cases. The method proved to be useful for managing all kind of trauma and intracranial hypertension situations.

Keywords: CT, emergency, trauma, intracranial hypertension

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APORTUL IMAGISTICII IN DIAGNOSTICUL COMPLICATIILOR INTRACRANIENE SECUNDARE OTOMASTOIDITEI LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 2, An 2015
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

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

APORTUL IMAGISTICII IN DIAGNOSTICUL COMPLICATIILOR INTRACRANIENE SECUNDARE OTOMASTOIDITEI LA COPIL

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REZUMAT

Introducere. Otita medie (OM) acută este, una dintre cele mai comune infecţii diagnosticate în patologia copilului, cu evoluţie autolimitată cel mai frecvent (1,2). Ea poate duce în 2-6% dintre cazuri (2) spre complicaţii supurative intracraniene cu evoluţie nefavorabilă, fatală în 8-26,3% din ele (2,3). Apariţia semnelor neurologice în evoluţia unei otite supuraţive necesită investigaţii imagistice de urgenţă (2-8).

Material şi metodă. Se prezintă cazul unei fetiţe de 10 ani diagnosticată cu otită supurată complicată, transferată la Spitalul Clinic de Urgenţa pentru Copii „M.S. Curie“ Bucureşti în secţia ORL după o evoluţie a bolii de 2 săptămâni. Copilul se prezintă la internare cu: febră, otoree purulentă, semne neurologice reprezentate de cefalee, convulsii, redoare de ceafă. Se efectuează în urgenţă un examen computer tomografic (CT) cu substanţă de contrast intravenoasă (iv).

Rezultat. Examenul CT, extins şi la nivel cervical evidenţiază prezenţa unui proces litic la nivelul stancii temporale şi soluţie de continuitate între antrul mastoidian şi meninge, şi evidenţierea unui abces epidural perisigmoidian, tromboza de sinus sigmoid extinsă la nivelul jugularei şi sinusului lateral, semne de meningită, cerebrită cerebeloasă, abces cerebral şi empiem subdural.

Concluzii. Complicaţiile în infecţiile urechii medii sunt rare, însă apariţia semnelor neurologice la examenul fizic impune un examen imagistic care poate preciza arhitectura locală, prezenţa complicaţiilor locale sau la distanţa pentru instituirea unui tratament adecvat şi rapid.

Cuvinte cheie: copil, otită medie, complicaţii, computer tomograf (CT)

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CONTRIBUTION OF IMAGING EXAMINATIONS IN DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN CHILDREN OTOMASTOIDITIS

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 2, An 2015
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

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

CONTRIBUTION OF IMAGING EXAMINATIONS IN DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN CHILDREN OTOMASTOIDITIS

, , and

ABSTRACT

Introduction. Otitis media (OM) is one of the most common infections in child pathology, most often with selflimited evolution (1,2). In 2-6% of cases (2) developed, intracranial complications with unfavorable, fatal outcome in 8-26.3% of them (2,3). Presence of neurological signs in the evolution of suppurative otitis require early imaging examinations (2-8).

Material and methods. We presents the case of a 10 year old girl with suppurative otitis complicated, transferred to the Clinical Emergency Hospital for Children „M.S. Curie“, Bucharest to ENT department after 2 weeks of disease progression. The child presents at hospital: fever, purulent otorrhea, neurological signs represented by headache, seizures, stiff neck. Contrast-enhanced computed tomographic (CT) were performed in emergency.

Result. CT scanning, extended to the neck show the presence of a lytic process in the temporal bone, solution of continuity between mastoid antrum and meninges with epidural abscess form over sigmoid sinus, trombophlebitis and thrombus of sigmoid sinus, which is propagate to the lateral sinus and the jugular vein; signs of meningitis, cerebellar cerebritis, brain temporal abscess and subdural empyema.

Conclusions. Complications in middle ear infections are rare, but the appearance of neurological signs in clinical examination must be completed by CT of head with contrast, which can specify local architecture, presence of local or distant complications, help in the application to a fast and appropriate therapy.

Keywords: child, otitis media, complications, computer tomography (CT)

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