European journal of pediatrics
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Case Reports
Hypertension induced reversible posterior leukoencephalopathy syndrome: a report of two cases.
Reversible posterior leukoencephalopathy syndrome (RPLS) is a recently described disorder with typical radiological findings of bilateral grey and white matter abnormalities in the posterior regions of the cerebral hemispheres. The majority of patients with RPLS are adults and it is rare in children. In this report, two patients with RPLS are presented. In the first patient the primary diagnosis was acute post-streptococcal glomerulonephritis, a known cause of RPLS both in adults and in children. The second patient had Henoch Schönlein purpura. ⋯ These patients are presented to highlight the importance of reversible posterior leukoencephalopathy syndrome. As the spectrum of associated diseases is diverse, paediatricians must be aware of this syndrome in order to initiate appropriate management.
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Primary sternal osteomyelitis is a rare infectious disease in paediatric patients. It has not been previously reported as caused by community-associated methicillin-resistant Staphylococcus aureus. We describe a 9-year-old boy with a painful erythematous mid-sternal mass diagnosed as primary sternal osteomyelitis. The aetiological agent was community-associated methicillin-resistant Staphylococcus aureus, carrying a type IV staphylococcal cassette chromosome for mec. ⋯ Methicillin resistance should be taken into considered in patient with community-associated staphylococcal infections.
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The tourniquet syndrome describes severe strangulations of appendages by hair, cotton or similar material mainly observed in young infants. The painful swellings of digits or external genitals are surgical emergencies because the strangulation can cause ischaemia and tissue necrosis. More than 100 cases of the tourniquet syndrome have been reported in most of which the aetiology was unclear. We have treated five patients with a tourniquet syndrome. Four of them presented with strangulations of one or more toes by hair or threads and one girl was diagnosed with a clitoral tourniquet syndrome. In each case the strangulating material could be removed in time avoiding permanent damage. The lack of any reasonable explanation and the meticulous wrapping made a non-accidental course very likely. Due to the lack of convincing explanations in our cases as well as in most of those described in the literature, we suggest that the tourniquet syndrome is often the result of child abuse, an aetiology overlooked for decades. ⋯ the tourniquet syndrome in childhood should be included in the list of possible forms of child abuse and should be considered as a differential diagnosis until another aetiology can be convincingly proven.
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Non-steroidal anti-inflammatory drugs (NSAIDs) are known to have adverse effects on kidney function. Situations with a stimulated renin-angiotensin system such as volume depletion or pre-existing chronic renal failure predispose to acute renal failure (ARF) via inhibition of prostaglandin synthesis by NSAIDs. To date, NSAIDs are frequently used as antipyretic drugs even in situations predisposing to ARF. Within 20 months, seven children presenting with diarrhoea and/or vomiting and fever were treated with therapeutic doses (11.5-32 mg/kg per day) of ibuprofen for 1 to 3 days before developing ARF. Maximum plasma creatinine levels were 180-650 micromol/l. One patient required emergency dialysis for hyperkalaemia, uraemia, and hyperphosphataemia. After cessation of NSAID treatment and rehydration, all patients recovered completely with a normalised creatinine level after 3 to 9 days. Once the acute phase is controlled, long-term outcome is excellent. Interstitial nephritis, another possible adverse effect of NSAIDs, might require steroid treatment and is the major differential diagnosis. Only histological examination can confirm the exact pathomechanism of ARF after NSAID exposure. If immunological events are responsible for the ARF, the recovery period is usually longer. ⋯ non-steroidal anti-inflammatory drugs are potentially dangerous in situations with even moderate volume depletion.