Short Stature: Think About the Pituitary Stalk Interruption Syndrome

Pituitary stalk interruption syndrome (PSIS) is an uncommon congenital defect of the pituitary gland. It is considered one of the rare endocrinal causes of abnormally short stature. Herein, we present a case of a four-year-old girl who consulted for short stature and delayed growth. The patient's history did not include any past medical or surgical pathology. Birth history revealed a full-term delivery with a breech presentation. Clinically, the patient had a small stature, beneath the third percentile. Magnetic resonance imaging findings, through a typical triad, were consistent with PSIS. We describe through this report, what we believe is a rare typical case of PSIS. This case was discovered in a young patient with pituitary dwarfism. We hope that the concise and synthesized structure of this case report will help physicians acquire the necessary reflexes to notice and diagnose the already underdiagnosed PSIS.

Bilobed testicle diagnosed by ultrasound in a 9-year-old boy

Bilobed testis is an extremely rare congenital malformation, and even rarer on the right side. Only 7 cases have been reported in the literature. We describe the case of a 9-year-old boy with a right bilobed testicle confirmed on ultrasound and discovered incidentally as a mass on physical examination. The aim of our work is to consider the bilobed testicle as a differential diagnosis of a testicular mass despite its rarity and to show the importance of ultrasound and MRI for its definitive diagnosis to avoid unnecessary surgery.

Cystic lymphangioma of the upper limb: Clinical case and literature review

We report an observation of a macro- and microcystic lymphatic malformation located in the right upper limb. This was a 5-year-old girl with no previous pathological history, followed since the age of 11 months for a congenital subcutaneous, painless and soft swelling of the right upper limb.

Ultrasound of the soft tissue and magnetic resonance imaging (MRI) allowed the diagnosis of macro- and microcystic lymphatic malformation of the right upper limb.

There is little epidemiological data on cystic lymphatic malformations (CLM). Superficial MLKs are more numerous than deep MLKs; of the superficial MLKs, nearly 75% are located in the head and neck, with an estimated incidence of 1.2 to 2.8 per 1000 births, and in the axillary hollows in 20% of cases. They affect equally males and females and different ethnic backgrounds. Involvement of the upper limb and particularly the arm is very rare.

MRI plays an important role in the diagnosis and assessment of the tumor’s boundaries.

Treatment can be difficult because of the location of the tumor and its extension into the surrounding tissue.

Lead poisoning with encephalic and neuropathic involvement in a child: case report

Lead is a toxic substance in our environment that affects adults and children of all socioeconomic backgrounds, lead poisoning is one of the most common exposures that can cause inter alia significant neurological and functional damage in humans. Children are particularly vulnerable because of the effects of the toxicity on their developing nervous systems with potentially irreversible consequences. We report a case of severe lead poisoning encephalo-neuropathy in a 3-year-old girl, admitted for progressive paraplegia, swallowing disorders, and aphasia. A multitude of investigations undertaken could not explain her atypic symptoms, so anamnesis was redone in the sense of a toxic origin, we found a notion of pica, and a traditional herbalist father, so probably consumption of medications based on traditional medicine products. A venous blood lead level (BLL) was extremely elevated at 176.4 μg/l. The child was treated with an oral chelator succimer (SUCCICAPTAL). During the two following months in the intensive care unit, the child showed progressive respiratory distress and worsening signs of the nervous system. Despite treatment and the use of lead chelators, the patient died due to septic shock. Lead is highly toxic even at very low exposure levels, at high levels of exposure, it can damage the reproductive organs, immune system, liver and kidneys. in children, it can affect neurocognitive and behavioral development that could be irreversible. Peripheral and central nervous system damage should be considered as a possible manifestation of lead poisoning.

Hematocolpos on late-onset hymenal imperforation: A case report

We report the case of a patient with hematocolpos on hymenal imperforation, revealed following cyclic pelvic pain with primary amenorrhea associated with pelvic heaviness for one year. MRI showed significant distension of the vagina forming a pseudo mass, well limited, in T1 high signal, in moderate T2 high signal, with the presence of declining deposits in hyposignal related to hemosiderin. A hymenotomy was performed under general anaesthesia, the postoperative course was favourable. This case illustrates the particularity of suspecting a hematocolpos in the presence of a pelvic mass in a young girl with amenorrhea.

Evaluation of estimated glomerular function (eGFR) versus creatinine clearance (CrCl) to predict acute kidney injury when using zoledronate for the treatment of osteoporosis

Zoledronate could be contributing to the development of acute kidney injury in a small number of patients. Since estimated glomerular function (eGFR) is simpler to obtain and at least as good a predictor as creatinine clearance (CrCl), it should be used in everyday practice.

INTRODUCTION

Zoledronate is widely used for the treatment of osteoporosis. A potential side effect is acute kidney injury (AKI). Advice from the UK Medicines and Healthcare products Regulatory Agency (MHRA) in 2019 stated that CrCl and not estimated glomerular filtration rate (eGFR) should be used and that treatment should not be given if CrCl < 35 ml/min. The objective of this study was to compare our current method of assessing renal function (eGFR) with the method proposed by the MHRA (CrCl) for predicting AKI after zoledronate infusions.

METHODS

The evaluation was performed at the Metabolic Bone Centre in Sheffield Teaching Hospitals, UK. Data on all the patients who had zoledronate from 1/09/2015 to 1/10/2020 were included.

RESULTS

Data on 4405 patients were retrieved (total number of infusions 7660). Creatinine in the 14 days post-infusion was available for a total of 969 infusions and AKI was observed within 14 days following 45 infusions (4.6%). One patient died due to pneumonia. One patient needed continued haemodialysis. Severe AKI (threefold in creatinine and/or eGFR < 15 ml/min/173 m²) was observed within 1 year following 24 infusions. If the MHRA recommendations had been followed, 996 infusions with baseline CrCl < 35 ml/min would not have been given. Of these, follow-up data on serum creatinine within 14 days were available for 142 infusions, showing AKI in only four (2.8%). Logistic regression showed that both CrCl and eGFR were significant factors in predicting AKI within 14 days, but that the current recommended cut-off of CrCl 35 ml/min had poor sensitivity.

CONCLUSION

Since eGFR is at least as good a predictor of AKI as CrCl, and permits the treatment of more patients at high fracture risk, we recommend that eGFR is used to determine renal function for zoledronate treatment. We suggest that the infusion is given over 30 min in patients with eGFR < 50 ml/min/1.73 m².

Dysplasie septo optique plus: à propos d´un cas

La dysplasie septo optique plus est une pathologie rare qui se voit chez l´enfant. Son diagnostic est radiologique, reposant sur l'imagerie par résonnance magnétique (IRM) cérébrale. Nous rapportons le cas d´un enfant âgé de 2 ans et 4 mois, sans antécédents pathologiques particuliers, qui a consulté pour un retard psycho moteur, un strabisme et des comportements de malvoyance. Un bilan biologique endocrinien explorant la fonction hypothalomo-hypophysaire a été réalisé, ne révélant pas d´anomalie. Le diagnostic de dysplasie septo-optique plus a été retenu sur les données de l´IRM encéphalique, devant l´agénésie du septum pellucidum et du splénium du corps calleux, l´hypoplasie des voies optiques et de la tige pituitaire ainsi que devant l´agénésie de la post hypophyse. Il s´y associait une schizencéphalie fermée. La dysplasie septo-optique est une malformation congénitale rare. Notre objectif est de rappeler sa sémiologie en imagerie et de souligner l´importance de l´IRM pour établir le diagnostic. La dysplasie septo-optique est une entité clinique rare associant classiquement des anomalies encéphaliques de la ligne médiane, une hypoplasie des nerfs optiques et une insuffisance hypophysaire. L´association à des malformations corticales comme la schizencéphalie et la polymicrogyrie désigne le terme dysplasie septo-optique plus. Les progrès de l´imagerie permettent actuellement un diagnostic précoce, ce qui est primordial pour une prise en charge adéquate. L´échographie anténatale peut suspecter la dysplasie, et l´IRM encéphalique confirme le diagnostic.

Syntélencéphalie: variant inter hémisphérique médian de l'holoprosencéphalie

Holoprosencephaly (HPE) is a congenital malformation occurring very early in pregnancy and due to abnormal diverticulation of the prosencephalon. This defect in primary brain cleavage may be total or partial, which explains the anatomopathological variants of holoprosencephaly. The main forms of holoprosencephaly include alobar, semilobar and lobar HPE. Syntelencephaly also known as middle interhemispheric variant (MIHV) is a very rare type of HPE. While in the three most common variants, cleavage defect has antero-posterior gradient of severity, syntelencephaly does not follow this rule. The latter is characterised by abnormal communication between cerebral hemispheres in the posterior and parietal frontal regions, with normal inter-hemispheric separation of the anterior frontal lobes, of the occipital regions and central grey nuclei. The trunk of the corpus callosum is achieved at the level of the knee of the corpus callosum (allowing differentiation from lobar HPE) and of the splenium. An azygos cerebral artery is common, consisting of a fusion of the A1 segments of the anterior cerebral arteries to form a single arterial trunk. Other cerebral malformations may be associated with syntelencephaly, the most frequent being cortical dysplasia and grey matter heterotopia. Facial abnormalities are less common in syntelencephaly compared to classic forms of HPE. Prognosis depends mainly on these malformative associations in the brain and other organs, and even on chromosomal aberrations.

Posterior reversible encephalopathy syndrome revealing Takayasu's arteritis in a child

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare complication of Takayasu's Arteritis. We report the case of an 11-year-old girl who presented with a tonic-clonic seizure and loss of consciousness, without fever. Imaging revealed characteristic white matter edema of the occipital and parietal lobes, in keeping with PRES. Further imaging demonstrated right renal artery stenosis and wall thickening of the abdominal aorta. The combination of hypertension, the discrepancy of blood pressure recordings between upper limbs, and imaging abnormalities of the aorta and the left renal artery led to the diagnosis of PRES secondary to Takayasu's Arteritis. Treatment with oral corticosteroids, azathioprine, amlodipine, and propranolol resulted in the complete resolution of the patient's symptoms and imaging abnormalities.

[Gayet-Wernicke encephalopathy with normal thiamine level: a case report]

Gayet-Wernicke encephalopathy is a neuropsychiatric emergency due to thiamine deficiency (vitamin B1), secondary to several factors. We here report a case of Gayet-Wernicke encephalopathy in a 43-year-old woman who didn't consume alcoholic beverages, presenting with disorders of consciousness and diplopia with normal thiamine level. Classic triad of symptoms and Magnetic resonance imaging (MRI) played an important role, in particular, in the diagnosis of Gayet-Wernicke encephalopathy with normal thiamine levels in the absence of alcohol abuse.

[False aneurysm of the palmar arch in a child: a case report]

Le pseudo anévrysme de l'arcade palmaire superficielle est une entité rare et seuls quelques cas ont été décrits dans la littérature. La majorité se développe après une lésion de l'artère suite à un traumatisme pénétrant, à une intervention chirurgicale antérieure ou à une ponction artérielle. Le diagnostic repose sur une suspicion clinique élevée, notamment en présence d'une masse pulsatile. Ci-dessous, nous présentons le cas d'un faux anévrisme de l'arcade palmaire superficielle chez un enfant de 3 ans à la suite d'une blessure par du verre brisé.

[A rare cause of mechanical occlusion in children: a case report]

Les bézoards correspondent à la concrétion de substances ingérées non digestibles dans le tractus gastro-intestinal. Le trichobézoard est la forme la plus fréquente des bézoards, et correspond à l'ingestion de cheveux, poils ou fibres de tapis ou moquette. Principalement de localisation intra-gastrique, il existe des formes rares d'extension duodénale ou à l'intestin grêle définies par le syndrome de Rapunzel. L'imagerie notamment scanographique est typique et joue un double rôle diagnostique et pronostique. Nous rapportons le cas d'une enfant âgée de 13 ans hospitalisée pour un syndrome occlusif sur un trichobézoard.

[Sturge-Weber syndrome: about a case]

Le syndrome de Sturge-Weber (SWS) ou angiomatose encéphalo-faciale, est un syndrome neuro-cutané et oculaire congénital rare. Il comporte deux types de malformations: capillaire faciale congénitale à type d’angiome plan et capillaro-veineux lepto-méningé de localisation le plus souvent pariéto-occipitale homolatérale. La Neuroimagerie, essentiellement l’imagerie par résonnance magnétique (IRM), joue un rôle important dans l'établissement du diagnostic, idéalement avant l'apparition de complications neuro-oculaires. Nous rapportons le cas d’un enfant chez qui le SWS est suspecté devant la présence d’un angiome facial et d’une épilepsie pharmaco-résistante.

Solid pseudopapillary tumor of the pancreas: a rare entity in children

Solid pseudopapillary tumors (SPTs) constitute 0.2 to 2.7% of non-endocrine primary tumors of the pancreas and comprise the majority (70%) of pediatric pancreatic neoplasms. These tumors are of unclear pathogenesis, low malignancy and favorable prognosis. Surgical resection offers an excellent chance for longterm survival, even in the presence of distant metastasis. The objective of this study is to review our experience in the management of SPT in a 12 years old girl at the pediatric hospital of the University hospital of Casablanca, in Morocco and provide an update on current management in pediatric population.

Forme rare du dysraphisme spinal fermé: la diastématomyélie

La diastématomyélie est une forme de dysraphisme spinal rare qui consiste en un dédoublement du canal vertébral et de son contenu. Deux types de diastématomyélie ont été décrits. Nous rapportons le cas d'un patient agé de 12 ans, de sexe masculin qui se présente pour une diminution de la force musculaire des membres inférieurs sans troubles sphinctériens associés. Le patient a bénéficié d'une imagerie par résonance magnétique (IRM) de la colonne vertébrale en séquence pondérée en T1 et T2, en coupe axiale, sagittale et coronale. L'IRM montre un aspect bifide de la moelle thoraco-lombaire en deux hémi-cordes sans éperon osseux séparant les deux hémi-moelles, compatible avec une diastématomyélie de type 1. Il s'y associe une moelle bas attachée avec cavité syringomyélique intéressant l'hémi moelle gauche et une lésion kystique biloculée au niveau de l'hémi moelle droite compatible avec un kyste neuro-enterique. L'IRM montre également la présence d'un défaut de fermeture de l'arc postérieur de D12 qui communique avec une poche sous cutanée en rapport avec un sinus dermique. La diastématomyélie est une anomalie rare de la colonne vertébrale qui peut être associée à d'autres malformations. La stratégie thérapeutique dépend essentiellement de la progression des signes cliniques (neurologiques) et des malformations associées.

[Interest of imaging in tumors benign bone in children]

Benign bone tumors are more common than malignant tumors in pediatrics. The exostosis (ostéchondrome) is the most common. The different imaging techniques are pivotal in the study of tumors including its standard radiography. The aim of this work is to highlight the interest in imaging the diagnostic management of bone benign tumors in children through a retrospective study of 169 patients. All patients were investigated by plain radiography, scanner supplement with multiplanar reconstruction before and after injection of PDC and / or MRI 1. 5 Tesla was performed according to the indication. The average age is 6 years with a slight male predominance. Clinically, the swelling is present in 35% of cases. The pain in 29% of cases. The most common location is the metaphyseal long bone on: Femur: 25% of cases, humerus: 17% of cases, Tibia: 21% of cases. Main Benign tumors are found exostosis (20. 12%), bone cyst (31. 95%) and osteoblastoma (16, 57%). The imagery is used to specify the topography and extension of the lesion in the bone provide arguments in favor of benign and sometimes in favor of the cause of the injury. The only standard radiograph often provides a diagnosis of certainty in some cases.

A patient with pleuritic chest pain and abnormal blood clotting tests

We present the case of a 58 year old man who developed pleuritic chest while an in-patient; investigations revealed pulmonary embolism, despite a significantly raised Activated Partial Thromboplastin Time (APTT), which was subsequently attributed to Antiphospholipid syndrome (APS). The diagnosis and initial management of APS in the acute setting is discussed.

Comparative study of outcome of the endoscopic sinus surgery and conventional surgery for nasal polyposis

This is a cross-sectional study done in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College & Hospital (DMCH) & Bangladesh Institute of Research and Rehabilitation of Diabetic Endocrine and Metabolic Disorder (BIRDEM), Dhaka during the period of January 2009 to August 2010. This study included 60 cases of nasal polyposis, among them in 30 cases Functional Endoscopic Sinus Surgery (FESS) was done and in 30 cases conventional surgical procedure was done as treatment procedure. Here mean age of patient in FESS was 45.43 years and in conventional surgery was 45.13 years and male female ratio was 3.3:1. In this study postoperative complication of FESS were found in 07(23.33%) cases whereas in conventional surgery it were in 16 (53.33%) cases (p = <0.01, df = 1, Chi-squire = 7.65). In case of outcome, complete relief of symptoms occur in 22(73.33%) cases by FESS and 14(46.66%) cases by conventional procedure (p = <0.05 df = 2, Chi-squire = 9.29). In FESS 22(73.33%) cases and in conventional technique 14(46.67%) cases discharged within 24-48 hours (p = <0.05, df = 1, Chi-squire = 4.44). Recurrence after FESS was 6.67% cases and conventional surgery was 30% cases. The results of this series reveled that FESS had the combined advantages of precise removal of the disease with minimal complication.

A primary hypertrophic osteoarthropathy or pachydermoperiostosis

A young boy of 17 years presented with arthalgia and arthritis of multiple joints unresponsive to treatment, generalized clubbing and enlargement of distal part of the extremities for 5 years and hyperhidrosis for 3 years. On examination, thickening of the facial skin and seborrhoea were found associated with acne. The patient has a Marfanoid appearance with column like legs and spade like fingers. There was no evidence of cutis vertices gyrata. Mild anaemia was present and vital signs were within normal limits. Examination of the musculoskeletal system revealed pain and swelling of the knee, ankle, elbow, wrist and proximal & distal interphalangeal joints. The spine and gait were normal. Radiographs of the limbs revealed subperiosteal new bone formation. The patient was diagnosed as a case of the autosomal dominant disorder, Primary Hypertrophic Osteoarthropathy or Pachydermoperiostosis.

Acute paraplegia and pulmonary edema after benzathine penicillin injection

Accidental intra-arterial injection is a potentially devastating complication of the intragluteal injection of benzathine penicillin. A 35-year-old woman developed after intramuscular injection of benzathine penicillin G acute paraplegia and noncardiogenic pulmonary edema. Noninvasive positive pressure ventilation was initiated with furosemide and corticosteroids. A magnetic resonance imaging scan showed findings consistent with syringomyelia and spinal cord ischemia at T9 through T10. Vascular injury may be the result of microemboli of the injected crystals of the penicillin salts. The mechanism of noncardiogenic pulmonary edema is perhaps an immunogically mediated one. At 2-year follow-up, she had no improvement in neurologic status. The deficit is considered permanent.

Bleeding after dental extractions in patients taking warfarin

OBJECTIVE

To assess the incidence of bleeding after dental extractions in subjects taking warfarin continuously before and after extractions whose International Normalised Ratio (INR) was below 4.0 at the time of extraction.

METHODS

This was a case series study of 150 patients without controls who required extraction of at least one tooth under local anaesthetic. All sockets were subsequently packed with absorbable oxycellulose and sutured.

RESULTS

A total of 58 women and 92 men were included (mean age 66 years); their ages were similar. The mean INR (S.D.) was 2.5 (0.56), although most patients had an INR less than 2.5 (n=101). Ten patients (7%) bled after extraction, enough to require a return to hospital. Five patients of 101 with an INR</=2.5, and 5 with an INR>2.5 out of 49 bled after extraction (p=0.29). Bleeding after extraction was not associated with operative antibiotics. All patients who bled were managed conservatively and none was admitted to hospital.

CONCLUSION

Patients taking warfarin whose INR is up to 4.0 and who have dental extractions in hospital do not have clinically significant bleeds post-operatively.

[Giant retroperitoneal liposarcoma]

The authors report a case of giant retroperitoneal liposarcoma. The diagnosis was suspected after scanography and magnetic resonance imaging and confirmed by the histological analysis of the extracted piece after surgical treatment. Postoperative evolution was favourable after one year without recurrence or distant metastasis. The authors discuss the pathologic and therapeutic aspects and the prognosis of retroperitoneal liposarcoma.

Inhibitor(S) of prostaglandin endoperoxide synthase and lipoxygenase activity in extracts of barley

Aqueous extract of barley was found to inhibit PG endoperoxide synthase and lipoxygenase enzymes responsible for arachidonic acid metabolism. Only 6% (v/v) of aqueous extract produced 50% inhibition of PG endoperoxide synthase while five times more extract was required to produce 50% inhibition of lipoxygenase. Boiling barley extract did not destroy the ability of the extract to inhibit the enzymes. Fractionation of barley with organic solvents, petroleum ether, chloroform, ethylacetate and acetone exhibited selectivity in its action in that foamy layer formed during petroleum ether and ethyl acetate extraction inhibited PG endoperoxide synthase completely whereas lipoxygenase activity was only partially inhibited. These results suggest the presence of inhibitor(s) of arachidonic acid metabolism in extracts of barley.

Rhabdomyosarcome para vertebral : cause rare de compression medullaire

Le rhabdomyosarcome est la tumeur maligne mésenchymateuse la plus fréquente chez l’enfant. Il se voit essentiellement au niveau des extrémités et la sphère ORL. La localisation paravertébrale avec compression médullaire est beaucoup plus rare. Les auteurs rapportent un cas de rhabdomyosarcome paravertébral avec extension endocanalaire et compression médullaire. Il s’agit d’une fille âgée de 6 ans admise pour un tableau de compression médullaire. L’examen clinique retrouve une patiente paraplégique avec niveau sensitif T8, des réflexes ostéo-tendineux abolis et une contracture des muscles paravertébraux. L’IRM médullaire montre un processus tissulaire à point de départ musculaire paravertébral droit, de signal hétérogène avec extension intra-canalaire et compression médullaire. La patiente a eu une laminectomie avec biopsie chirurgicale. L’étude histologique a posé le diagnostic d’un rhabdomyosarcome alvéolaire. La patiente a été traitée par chimiothérapie suivie d’une radiothérapie. L’IRM de contrôle a montré une régression totale du processus tumoral. Après un recul d’une année, la patiente a présenté une récidive locale avec métastases pulmonaires. Malgré cette localisation rare, le rhabdomyosarcome doit être évoqué devant un processus paravertébral avec extension épidurale et compression médullaire chez l’enfant.Mots clés : Rhabdomyosarcome, IRM, compression médullaire.