Late-presenting congenital diaphragmatic hernia in pediatric emergency room: two case reports

A congenital diaphragmatic hernia is a serious, complex condition with high mortality. It is actually mostly diagnosed prenatally. In most cases, it presents in the neonatal period, but can rarely present later in life when it becomes symptomatic. The clinical presentation and prognosis depend on the time of visceral herniation. We report two cases of left Bochdalek hernia with delayed presentation. The two cases shared some important characteristics. In both patients, the asymptomatic period ended with an acute attack of disease. To initiate appropriate therapy, emergency doctors need to be aware of the various presentations of a delayed left-sided diaphragmatic hernia.     

Neurologic signs revealing a Beh?et's disease: two pediatric case reports]

Beh?et's disease can be revealed by neurologic signs. CASE REPORTS: We report two pediatric cases of Beh?et's disease which initially presented with cerebral venous thrombosis. Glucocortico?ds, associated with anticoagulant treatment allowed a rapid recovery. One of the children presented three years later a thrombotic recurrence. CONCLUSION: A cerebral venous thrombosis may reveal Beh?et's disease.     

Congenital hemangiopericytoma: two case reports

Congenital hemangiopericytoma is a rare tumor consisting of capillaries surrounded by pericytes. Only histologically can the tumor be distinguished from other vascular hamartomas. For a long time the congenital type was considered benign; however, metastases have recently been described. A histologic diagnosis of all soft-tissue sarcomas should be made. We describe two patients with congenital hemangiopericytomas in whom the diagnosis was not suspected until after histologic examination. Long-term follow-up is indicated. Accepted: 4 February 1997     

The Currarino syndrome: two case reports

The association of congenital anal stenosis, or other anal and rectal malformation, sacral defect and a presacral mass is known as the Currarino syndrome described for the first time in 1981. Currarino et al. proposed that abnormal endoectodermal adhesions and notochordal defects in early fetal life may result in a fistula between the gut and the spinal canal with enteric elements ventrally and neural elements dorsally. This abnormality appears to be a variant of the split notochord syndrome. The occurrence of Currarino's triad of anomalies is familial in more than 50% of cases. The most important suggested hypothesis of transmission is an X-linked dominant pattern, but most of the other reports are consistent with an autosomal dominant mode of inheritance. The medical therapy is poorly successful and, therefore, the surgical treatment is recommended for Currarino's syndrome.     

Intractable psychogenic sneezing: two case reports

Sneezing is usually the physiologic response to nasal irritation but intractable paroxysmal sneezing is very uncommon. Majority of cases of intractable sneezing are reported among adolescents and are psychogenic in origin. We report two adolescent girls with intractable paroxysmal sneezing in whom the removal of psychogenic stressors resulted incomplete remission.     

Gram-negative neonatal osteomyelitis: two case reports

Neonatal osteomyelitis is a rare and challenging diagnosis, particularly in the early onset period. Neonatal osteomyelitis is predominantly caused by Staphylococcus aureus with single bone involvement. Here, we report two cases of neonatal osteomyelitis in premature infants caused by Klebsiella pneumoniae with multiple bone lesions. Both cases presented with sepsis and meningitis and were initially diagnosed by incidental findings on plain films, with follow-up bone scan imaging. In both cases, diagnosis was timely and treatment was successful. These cases highlight the need to include neonatal osteomyelitis in the differential diagnosis when late-onset or prolonged neonatal sepsis is present, particularly because long-term outcome is dependent on rapid diagnosis and initiation of treatment.     

Neonatal salmonella meningitis: two case reports

Two cases of neonatal salmonella meningitis are reported. Both infants were seriously ill: one died 6 days after admittance to the hospital; the other required artificial ventilation for 4 days and recovered without sequelae. In both cases close relatives had shown signs of gastrointestinal infection just prior to the reported cases. The symptoms, the outcome and antibiotic treatment are discussed. In view of the increasing incidence of salmonella infections in Denmark and the serious prognosis of neonatal meningitis, it is important to consider the diagnosis in all cases of bacterial meningitis in infancy.     

Hypokalemic periodic paralysis: two case reports

We report two cases of hypokalemic periodic paralysis in children presenting to the emergency department with diffuse weakness and no antecedent history of neurologic disease. The literature is briefly reviewed. Any child with acute weakness and normal mental status should undergo serum potassium determination to allow prompt diagnosis and therapy.     

Paraesophageal bronchogenic cyst: first case reports in pediatric

We described for the first time a paraesophageal intra-abdominal bronchogenic cyst, first considered as hepatic tumor, in a young boy. Resection was successfully realized by laparoscopy. Abdominal bronchogenic cyst and differential diagnosis are discussed.     

Globe rupture and nonaccidental trauma: two case reports

The association of globe rupture and nonaccidental trauma is not established in the literature. We present 2 cases involving a 9-month-old infant girl and a 14-month-old girl who experienced inflicted traumatic globe rupture. In the first case, the infant had isolated eye findings on physical examination, but extensive injuries were revealed on the skeletal survey and computed tomography of the head. In the second case, the toddler had a prior history of abuse, so our index of suspicion for nonaccidental trauma was heightened. Despite isolated eye findings on physical examination, this toddler also had evidence of additional injury on skeletal survey. These cases illustrate the importance of considering nonaccidental trauma in infants and toddlers who present with globe rupture and performing a complete evaluation for child abuse if no history is given or if the history is inconsistent with the injury.     

Chlamydia trachomatis pneumonia: two atypical case reports

We report on 2 recent and misleading cases of infants hospitalized for Chlamydia trachomatis pneumonia: the first one, 29 days old, had a clinically relevant presentation but was born by caesarean section; the second one, 43 days old, presented with acute respiratory distress. Microbiological diagnosis was achieved by the specific detection of C. trachomatis by molecular biology from a nasopharyngeal sample. These 2 clinical cases illustrate the need to systematically look for C. trachomatis during bacterial-like pneumonia in infants under 3 months of age.     

Congenital H-type anorectal fistula: two case reports

The congenital H-type fistula between the anorectum and the urogenital tract without anal atresia is an extremely rare entity in the spectrum of anorectal anomalies. We report about two young girls, who had a congenital fistula between the left labium/vulva and the anus (=H-type fistula). After the management of the local infection and the abscess, the two patients underwent an anterior sagittal anorectovaginoplasty (ASARVP). Up to now there was no relapse of the fistula or the abscess in both cases. Thus ASARVP can be used as a simple method for congenital H-type fistulas with excellent functional and anatomical results.     

Bartter's syndrome: two case reports in childhood

OBJECTIVE: To report a syndrome that is uncommon in childhood and call pediatrician?attention to the tubular diseases - just like Bartters syndrome - in differential diagnosis of failure to thrive and other diseases that can be usually found in children.METHODS: Two patients are presented. The first, a 3 years and 2 months old boy who was submitted for investigation of a failure to thrive detected when he was 9 months old. The second patient, a 3 months old girl, was admitted to the Intensive Care Unit due to severe electrolyte disturbances. She was supposed to have a pyloric hypertrophic stenosis.RESULTS: Both patients had failure to thrive, hypocloremic alkalosis, hypokalemia, and hypercalciuria. The first had a positive obstetric history for polihydramnios that is frequently found in the neonatal form of this syndrome. Treatment was done by blood potassium correction, together with indometacin and spironolactone administration. These drugs where well tolerated by the patients who have improved their growth rhythm only a short time after electrolytic disturbances had been corrected.CONCLUSIONS: The Bartter's syndrome is a tubular disease that is unusual in childhood. It must be considered as a possible cause of failure to thrive. The neonatal form is rare and can produce severe hydro-electrolytic disturbances, increasing the difficulties for diagnosis. The treatment is well tolerated, even by small children, and must begin early to reduce the troubles to thrive.     

Early recurrence of primary disease after pediatric renal transplantation: two case reports and a review of the literature

Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction after pediatric renal transplantation. We report the unusual occurrence of early graft dysfunction following kidney transplant in two pediatric cases. Both subjects had biopsy proven recurrence of CGN in less than a week after transplantation. We were able to sustain the renal function in one of them following aggressive treatment. Hence, early recurrence of CGN should be considered in the differential diagnosis of early graft dysfunction.     

Fetus in fetu: two case reports and review of literature

Fetus in fetu is a rare disorder. Its embryopathogensis and differentiation from teratoma has not been well established. It is a parasitic twin of a diamniotic monozygotic twin. Here we report, two cases of fetus in fetu with review of literature. In case report 1, a 2-year-old boy was referred for asymptomatic lump in abdomen since birth. X-ray showed the mass in the abdomen with some calcification and fluid inside. CT scan reported a heterogenous mass in the retroperitoneum with bony malformation. CT showed presence of three vertebrae in it. After surgically excising the mass and opening the sac it showed presence of trunk and two limbs with one of the limbs having a nail. Histopathology showed presence of GI tract. In case report 2, 4 month female was found to have lump in the abdomen by housemaid while bathing. X-ray showed a soft tissue shadow while ultrasonography revealed cystic mass arising from right kidney. CT suggested cystic mass with calcification not arising from kidney. During exploration whole mass was excised and there was frank fetus inside it. Histopathology confirmed presence of four vertebral bodies with germ layers. Although fetus in fetu is rare condition, correct diagnosis using imaging can be made before surgery. Complete excision is curative.     

Nemaline myopathy in the neonate: two case reports

Nemaline myopathy, one of the most benign myopathies in older children and adults, may be rarely associated with early death in the neonate. The authors report two cases, describing the ante-and postnatal clinical courses. Family history may help in establishing the diagnosis, but this was not the case in the two infants described. Above all, the diagnosis is based on the results of muscle biopsy.Conclusion Nemaline myopathy may lead to early death in the neonate.