Ibuprofen Lyell's Syndrome In An Eight-Year-Old Child.

Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare but serious drug-like toxiderma. Treated as a recent extensive burn in intensive care, its management must be urgent, and adapted in order to improve the vital prognosis of patients and reduce their mortality. We report a severe case of Lyell's syndrome occurring 24 hours after oral administration of an anti-inflammatory drug (ibuprofen) as a self-medication in an eight-year-old child.

Le syndrome de Lyell (nécrolyse épidermique toxique - NET) est une toxidermie médicamenteuse rare mais grave. Son prise en charge, urgente, doit être réalisée en CTB car elle s'approche de celle d'un brûlé. Nous rapportons le cas d'une NET survenue 24h après la prise orale, en automédication, d'ibuprophène.

[Anesthesic practice for gynecological and obstetric emergency in the Cocody CHU]. / Pratique anesthesique pour urgences gynecologiques et obstetricales au CHU de Cocody.

OBJECTIVE: To evaluate the anesthetic practice in the operating theater of gynecological and obstetric emergencies. MATERIAL AND METHOD: Prospective, descriptive and analytical study on patients admitted to the operating room for a gynecological and or obstetric emergency over a period of six months. RESULTS: We collected 3,486 patients out of 7,574 admissions, or 46.02%. The average age was 27.3 years with extremes of 15 and 45. SFA was the first operative indication for obstetric emergencies while gynecological emergencies were dominated by first trimester bleeding. 99.39% of the patients benefited from a CPA and 45.40% of them, were classified ASA I u. LAR by spinal anesthesia was the most commonly performed anesthetic regimen. Maternal lethality was 0.005. For the mother, the age group [30-45 years], the provenance, the hemorrhagic syndromes, the ASA III and IV classes, the long delays in transfusion and block management were factors of poor prognosis. (P≤0.05) For the fetus, hemorrhagic syndromes and general anesthesia were factors of poor prognosis. (P ≤ 0.05). CONCLUSION: Spinal anesthesia was the most widely used anesthetic regimen.

OBJECTIF: Evaluer la pratique anesthésique au bloc opératoire des urgences gynécologiques et obstétriques. MATÉRIEL ET MÉTHODE: Etude prospective, descriptive et analytique portant sur les patientes admises au bloc opératoire pour une urgence gynécologique ou obstétrique sur une période de six mois. RÉSULTATS: Nous avons colligé 3486 patientes sur 7574 admissions soit 46,02%. La moyenne d'âge était de 27,3 ans avec des extrêmes de 15 et 45 ans. La SFA était la première indication opératoire pour les urgences obstétricales tandis que les urgences gynécologiques étaient dominées parles métrorragies du premier trimestre. La majorité de nos patientes ont eu une consultation pré-anesthésique. L'ALR par rachianesthésie était le schéma anesthésique le plus réalisé. La létalité maternelle était de 0,005. Pour la mère, la tranche d'âge [30-45 ans], la provenance, les syndromes hémorragiques, les classes ASA III et IV, les longs délais de transfusion et de prise en charge au bloc ont constitué des facteurs de mauvais pronostics. (P≤0,05)Pour le fœtus, les syndromes hémorragiques et l'anesthésie générale constituaient les facteurs de mauvais pronostics. (P≤0,05). CONCLUSION: La rachianesthésie était le schéma anesthésique le plus utilisé.

Tetanus after application of traditional topical treatment to a severe burn.

A 2-year-old child was accompanied by his parents to the pediatric emergency room for refusal to eat, trismus and generalized contractures four days after the application of a traditional topical treatment (Cassava leaves) on lesions of a severe thermal burn. A temperature of 38̊C, a heart rate of 114 beats/min, and a blood pressure of 90/60 mm Hg were recorded. The tetanus vaccination was not up to date. The diagnosis of tetanus was immediately suggested. Antitetanus serum (immunoglobulin), an antibiotic (amoxicillin and clavulanic acid), and a myorelaxant (benzodiazepine) were administered. Local treatments were also performed. The child died within 24 hours.

[Acute respiratory distress syndrome secondary to a viper envenomation in children]. / Syndrome de détresse respiratoire aiguë secondaire à une envenimation vipérine chez l'enfant.

Viper envenomation is responsible for inflammatory disorders, hemorrhagic complications, and local or extended necrosis. The occurrence of respiratory complications such as Acute Respiratory Distress Syndrome (ARDS) is exceptional. We report on the case of a 15-year-old with no particular history who had, 24h after a viper bite, swelling of the right lower limb associated with blood dyscrasia. Despite the administration of antivenom treatment, the progression was marked by the onset of ARDS and the patient's death within 48h.

Brain lesions in eclampsia: A series of 39 cases admitted in an Intensive Care Unit.

The aim of this study was to identify the encephalic lesions in the eclampsia occurrences. Within a period of 18 months, computed tomography (CT) of the brain was performed in all patients admitted in intensive care for eclampsia. These CTs were analyzed and intracerebral lesions were identified. Thirty-nine patients were included. We noted 10 cases of ischemic stroke, 9 cases of cerebral edema, and 3 cases of hemorrhagic stroke and subarachnoid hemorrhage. The CT scan came back to normal in 20 eclamptic patients. Overall, delays in obstetric and intensive care and time of completion of the CT were long. CT has allowed highlighting in patients with eclampsia varied intracerebral lesions. The early performance of the CT is therefore essential for a better support of patients.

[Apparent malformations in an African area: factors influencing consultation delay in pediatric surgery]. / Malformations apparentes en milieu Africain: facteurs du retard à la consultation en chirurgie pédiatrique.

AIM: To analyze the attitudes of the Guinean and of the Ivory Coast communities leading to delayed consultation despite apparent malformations in children. PATIENTS AND METHODS: From January 1, 2000 to December 31, 2002, we carried out a prospective investigation in the paediatric surgery units of the Donka teaching hospital (Conakry) and Cocody, Treichville and Yopougon (Abidjan) teaching hospital. One hundred and two children affected with apparent malformations were included. The studied variables were: age, sex, ethnos group, religion, socio-economic level and the cultural designs of the families. RESULTS: Sex ratio male/female was 1,5 and the average age at first consultation was 17 months. Seventy-six per cent of the children carrying apparent malformations at birth were seen at an age ranging from 1 to 30 months. Orthopaedic malformations were prominent (44%) and led especially to negative reactions of the entourage of the patients. Some religious beliefs took a part of the delayed consultation and impaired relationships between the 2 parents. The low socio-economic level (54%) was determining in the delayed consultation. The birth of a child with malformation in the malinké, akan krou community could be understood like a parchment from a god or a witchcraft. CONCLUSION: The contributive factors of the delay to the consultation of the children carrying apparent malformations in the communities Guinean and of the Ivory Coast are poverty, ignorance and some religious beliefs. Education and well understanding of these reasons in developing country should improve the acceptance and taking care of these children as well as the development of medical insurance system.

[Rectal and colonic injuries induced by enemas: a 10-case series at the university hospital center in Bouake, Ivory Coast]. / Les rectocolites par les lavements à propos de 10 cas au CHU de Bouake (RCI).

The purpose of this study is to report our experience in the management of rectal and colonic injuries induced by enemas. A retrospective analysis was carried out in a series of 10 patients treated at the Bouake, Ivory Coast University Hospital Centre for rectal and colonic injuries induced by enemas between January 1, 1997 and December 31, 2001. There were 6 men and 4 women with a mean age of 26.2 +/- 5.6 years. Based on history taking five enemas involved criminal intent. The other five were carried out for abortion (n=3), therapy (n=1) or autolysis (n=1). The injurious product was known in 7 cases, i.e., sulphuric acid (n=4) and hot pepper (n=3). The mean quantity administered was 158 +/- 64 ml. The presenting picture involved diffuse acute peritonitis in 7 cases and abdominal pain with bloody mucoid rectal discharge in 3. One patient died at the time of admission. The remaining patients underwent either operative (n=6) or medical (n=3) treatment. Prognosis was unfavourable. Four patients died and one patient required colostomy that could not be removed due to sclerosis of the anal sphincter. Management of rectal and colonic injuries induced by enemas requires differential diagnosis to distinguish patients that require emergency laparotomy from patients that can be treated medically. For patients treated medically, close surveillance based on imaging and repeated clinical examination is of paramount importance to allow diagnosis of complications requiring surgical treatment.

[Honey bees massive poisoning in an infant]. / Envenimation massive par un essaim d'abeilles chez un nourrisson.

The authors report the case of an infant who survived a massive poisoning of honey bees (>350 bees stings) in 2002. The infant presented convulsions, anaemia, renal failure and haematuria. The main treatment consisted in administration of adrenaline. Systematic and early administration of this drug has limited the severe clinical picture despite massive attack.

[Postoperative hyponatremia in children: pathophysiology, diagnosis and treatment]. / Les hyponatrémies postopératoires de l'enfant: physiopathologie, diagnostic en traitement.

OBJECTIVES: To review the current data on pathophysiology, causes and management of postoperative hyponatremia in children. DATA SOURCES AND EXTRACTION: The Pubmed database was searched for articles, combined with references analysis of major articles on the field. DATA SYNTHESIS: The incidence of postoperative hyponatremia has been evaluated at 0.34% and its mortality significant. Postoperative hyponatremia is triggered by the diminished renal ability to excrete free water, due to antidiuretic hormone release. Inappropriate secretion of antidiuretic hormone is frequently seen after spine, cardiac and neurosurgery but can occur even after minor surgery. In this context, the infusion of hypotonic fluids represents a strong risk factor for developing hyponatremia. Other causes of hyponatremia are represented by extrarenal fluid losses, cerebral salt wasting syndrome, desalination phenomenon, adrenal insufficiency or some medications. Preventive treatment is essential and based on prohibition of hypotonic fluids infusion and the use of isotonic fluids infusions, maintenance of a normal total blood volume, the observance of the good practice recommendations for fluid infusion in children, and frequent blood and urine sodium concentration determinations in patients at risk for developing hyponatremia. Hyponatremic encephalopathy requires an emergent management, consisting in respiratory care and hypertonic sodium chloride infusion. Chronic hyponatremia is most often asymptomatic and the main neurological risk factor is represented by a too rapid correction of plasma sodium, which may lead to centropontine myelinolysis.

The role of serum immunoglobulin E in the pathogenesis of Plasmodium falciparum malaria in Ivorian children.

The aim of the study was to determine the role of immunoglobulin E (IgE) in the pathogenesis of Plasmodium falciparum malaria in Ivorian children. The study comprised of 90 Ivorian children of both sexes, aged 6-72 months: 30 children suffering from severe malaria, 30 suffering from mild malaria and 30 in good heath (serving as the control population). The children underwent a total serum IgE test for the determination of haemoglobin and platelet level and parasite density. We noted a significant rise in IgE level in the children affected with malaria. The level was higher when the malaria was more severe, increasing from 84.61 kUI/l in the control children to 339.9 kUI/l in the children with mild malaria and 659.9 kUI/l in children with severe malaria. Among the comatose patients with severe malaria, the increase in IgE level was related to the level of deterioration of the consciousness. Moreover, we noted a negative correlation between IgE level and the level of haemoglobin and between the IgE level and platelet level. These results are in accordance with the results found in literature and confirm the use of IgE level as an indicator of P. falciparum malaria.

[Shaken baby syndrome: improvement of cerebral blood flow velocity after a subdural external derivation in a six-month old infant]. / Le syndrome du bébé secoué: amélioration de la circulation cérébrale après dérivation sous-durale externe chez un nourrisson de six mois.

The shaken baby syndrome is a severe form of child abuse. The intracranial injuries are associated with a high morbidity and mortality rates. A 6 month-old healthy infant presented at home a cardiorespiratory arrest. After a cardiopulmonary resuscitation, radiological survey showed sub-dural haematomas and retinal haemorrhages, without a history of trauma. The diagnosis of shaken baby syndrome was made. Despite medical management and a fontanelle tap, clinical signs of intracranial hypertension worsened. Transcranial Doppler examination found the cerebral blood flow velocities to be decreased while the pulsatility index was increased. A sub-dural-external drainage allowed the cerebral blood flow to increase and the pulsatility index to decrease. We conclude that transcranial Doppler examination can be helpful for the clinician caring children presenting a shaken baby syndrome.

[Severe malaria in expatriates in an intensive care unit in Abidjan (Ivory Coast)]. / Paludisme grave chez les expatriés en réanimation à Abidjan.

OBJECTIVE: To analyse clinical and prognosis aspects of severe malaria in expatriates hospitalized between 1990 and 1999 in the intensive care unit in Abidjan. STUDY DESIGN: Retrospective survey. METHODS: According to the World Health Organization's criteria, the retrospective study of severe cases of malaria who received treatment and care at the intensive care unit. Epidemiological, clinical manifestations and evolution were analysed on each patients. RESULTS: 66 upon 927 expatriates hospitalised in the period of the study, had severe malaria with falciparum Plasmodium (7.12%). The average age was 42 years. Eleven patients took prophylactic treatment (17%). The clinical aspects were neurological (83%) followed by renal failure (48%), haemoglobinuria (48%) and hyperparasitemia (59%). During the hospitalisation we recorded 12 deaths (18%). The criteria that were associated with mortality in pejorative order were: coma (RR = 8.04), respiratory distress (RR = 5.06), metabolic acidosis (RR = 5.06), shock (RR = 3.67) and convulsions (RR = 2.86). CONCLUSION: Severe malaria was frequent and associated with high mortality in expatriates who are living in Africa. This study reinsists the necessity of prophylactic treatment to be reinforced in informing the travellers. This study showed frequency and mortality rate of survey of malaria and the criteria associated with high mortality rate.