Grigore Alexandrescu Clinical Emergency Hospital For Children

Bucharest, Romania

Grigore Alexandrescu Clinical Emergency Hospital For Children

Bucharest, Romania
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Balanescu R.N.,Grigore Alexandrescu Clinical Emergency Hospital For Children | Balanescu L.,Grigore Alexandrescu Clinical Emergency Hospital For Children | Moga A.A.,Grigore Alexandrescu Clinical Emergency Hospital For Children | Dragan G.C.,Grigore Alexandrescu Clinical Emergency Hospital For Children | Djendov F.B.,Grigore Alexandrescu Clinical Emergency Hospital For Children
Romanian Journal of Morphology and Embryology | Year: 2015

Segmental aganglionosis Hirschsprung’s is an extremely rare condition. Described as a segment of normally ganglionated bowel surrounded proximally and distally by aganglionosis, zonal aganglionosis is of interest because it may cause confusion in interpreting surgical margins. Diagnosis of segmental lesions in Hirschsprung’s disease may be missed as it is rarely suspected at initial surgery. We report the case of a 2-week-old baby girl admitted to our clinic for abdominal distension and vomiting. Considering the family history (near total colonic aganglionosis in a 2-month-old sister with unfavorable outcome), the suspicion of Hirschsprung’s is raised and serial large intestine biopsies are taken. Intraoperatively, a transverse colon stenosis caused by an incomplete web is noticed and segmental colectomy with anastomosis is performed at this level. Histopathological and immunohistochemical results established the diagnosis of segmental transverse colon aganglionosis, with the presence of ganglia cells in the ascending and descending colon. Subtotal colectomy with ascending colon pullthrough was performed with favorable postop evolution. In our patient, the association with a transverse colon stenosis raised suspicion concerning the diagnosis of Hirschsprung’s disease, but considering the family history, extended biopsies were taken and the correct diagnosis of zonal aganglionosis was established. Although zonal aganglionosis lesions are extremely rare, this case illustrates the point that the presence of ganglia cells at the resection line is not sufficient to guarantee postoperative function. Extended intestinal biopsies should be included in the algorithm for management of long segment Hirschsprung’s disease and will enable the surgeon to correctly detect zonal aganglionosis. © 2015, Editura Academiei Romane. All rights reserved.


Diaconeasa A.,Grigore Alexandrescu Clinical Emergency Hospital for Children | Boda D.,Carol Davila University of Medicine and Pharmacy | Solovan C.,Victor Babes University of Medicine and Pharmacy Timisoara | Enescu D.M.,Carol Davila University of Medicine and Pharmacy | And 2 more authors.
Romanian Journal of Morphology and Embryology | Year: 2013

Spitz nevus is one of the most difficult melanocytic lesions to diagnose in regard of malignancy, even for experienced dermatopathologists. We analyzed 28 tumors with Spitzoid morphology from 15 children (three little children 2-4-year-old, 12 peripubertary children 9-17-yearold) and 13 adults; there were 21 Spitz nevi, five atypical Spitz tumors and two Spitzoid melanomas in order to establish the diagnostic value of several morphologic parameters in different age groups. No significant differences in respect of age and/or tumor type occurred for gender, location, dimension, symmetry, sharp lateral demarcation, junctional nests orientation, adipose tissue extension, side-to-side cytologic symmetry, uniform melanin deposits, nuclear pleomorphism, presence of mitoses, inflammation and epidermal alterations. Pagetoid growth and/or melanin deposits in the keratin layer were significantly higher in little children. In adults, presence of isolated cells within the lateral margins allows differentiating Spitz nevus from atypical Spitz tumor and Spitzoid melanoma. Deep located mitoses were statistically associated with Spitzoid melanoma in adults. Ulceration was statistically more frequent in peripubertary patients than in adults, probably due to trauma. In conclusion, presence of worrisome morphologic features (pagetoid growth, isolated cells within the lateral margins or ulceration) is correlated to patient's age and less to tumor type; there is no unique morphologic feature to relay on when evaluating a Spitzoid tumor, the final diagnosis being the results of interpretation of multiple clinical, morphologic, immunohistochemical and molecular data and not least dermatopathologist's personal experience.


Balanescu N.R.,Grigore Alexandrescu Clinical Emergency Hospital for Children
Journal of medicine and life | Year: 2013

We report the case of an 11-year-old female with acute pancreatitis, and review the literature highlighting the presenting symptoms and signs, laboratory tests, and investigational tools that helped in the establishment of a correct diagnosis. First, the patient presented to a regional hospital reporting abdominal pain, vomiting and liquid stool. She was admitted with the diagnosis of acute surgical abdomen and underwent surgery. Upon admission in our department, laboratory findings showed high values for total lipids = 2600 mg/dL and triglycerides 1200 mg/dL. Abdominal ultrasound revealed a pancreas with a small enlargement of the head (19 mm), and with a heterogeneous structure of the parenchyma. Abdominal computed tomography showed small left pleural collection and a high-dimensioned pancreas, particularly at the head, with heterogeneous structure, and peripancreatic collections. The patient was treated by fasting, gastric decompression by nasogastric tube, and intravenous antibiotherapy followed by antialgic and antispasticity treatment. Time of the patient's first feeding was after the 7th day of hospitalization. The patient was discharged in a very good condition after 22 days of hospitalization.


Frumuseanu B.,Grigore Alexandrescu Clinical Emergency Hospital for Children
Journal of medicine and life | Year: 2012

Glomus tumor (glomus cell tumor) is a rare, hamartomatous, usually benign neoplasm, whose cells resemble the modified smooth muscle cells of the normal glomus body. The diagnosis of a lower extremity is often delayed, due to the lack of awareness and low level of suspicion, by the treating physician. The glomus tumor (GT) often involves the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. There is a paucy of information about GT in general, especially among orthopedic surgeons. The aim of this article is to make the surgical community more aware of this disease.


Sterian A.,Grigore Alexandrescu Clinical Emergency Hospital for Children | Balanescu R.,Grigore Alexandrescu Clinical Emergency Hospital for Children | Barbilian A.,Carol Davila University of Medicine and Pharmacy | Ulici A.,Grigore Alexandrescu Clinical Emergency Hospital for Children
Journal of medicine and life | Year: 2015

The paper refers to a pediatric patient suffering from Osteogenesis Imperfecta that was diagnosed soon after birth, after suffering from an intrauterine fracture of the femur in the 7th month of pregnancy. The beginning of the presentation contains some general considerations regarding the illness and the treatment done up to the point when the first telescopic rod was used. Following the evolution of the child from birth to the age of 7 years, we could trace a line of evolution under several methods of treatment, surgical or conservative, and also on different surgical treatment variants and their outcome during growth. Together with the X-rays that documented each step of the treatment, we could affirm for sure that both clinically and radiologically, the best results were obtained after the last 4 interventions, when all 4 major bones of the lower limbs were operated on. Until the moment Fassier-Duval nails were used, the evolution of the illness and the complications that appeared after certain surgery procedures were not so good. Several procedures had to be revised because of nail or pin displacement and eventually the patient lost the walking capability. The main problem with non telescopic treatment was the lack of stability that the bone needed to have after an open surgery for deformity correction, and up to that moment, the methods used were not designed to work on the long term; even in the best circumstances, the patient had to go to the OR for nail replacement after the bone outgrew it.


Balanescu N.R.,Grigore Alexandrescu Clinical Emergency Hospital for Children
Journal of medicine and life | Year: 2013

Burkitt lymphoma has many forms of clinical presentations and, in children, it is usually discovered due to the presence of an abdominal mass. This rapidly growing tumor is highly malignant, aggressive, and may cause either indirect symptoms, due to pressure phenomena or direct involvement of the bowel lumen, leading to either intestinal obstruction or intussusception. We describe the case of a 4-year-old girl who exhibited an unusual presentation of ileocolic intussusception on a Burkitt lymphoma lesion of the ileum.


PubMed | Grigore Alexandrescu Clinical Emergency Hospital for Children
Type: Journal Article | Journal: Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie | Year: 2016

The commonest cause of head and neck malignancy in pediatric patients is lymphoma. A particular case is the tonsillar lymphoma. Even though unilateral tonsillar enlargement represents an ominous sign for neoplasia, clinical manifestations vary and are non-specific. Therefore, a delayed diagnosis is performed which compromises optimal therapy and hinders the prognosis. We present the case of a 5-year-old boy who was initially diagnosed with obstructive sleep apnea, without reported systemic complaints. Asymmetric tonsillar hypertrophy created the premises for performing a tonsillectomy to rule out malignancy. The pathological evaluation of the resected tonsils revealed a malignant non-Hodgkins lymphoma, with immunophenotypic features consistent with sporadic type Burkitt lymphoma. The aim of this paper is to emphasize the importance of the histopathological examination and of the immunohistochemistry testing for the prompt and accurate diagnosis of all asymmetric tonsillar hypertrophy in children undergoing tonsillectomy. Furthermore, immunohistochemical diagnosis is vital for establishing a personalized multi-agent chemotherapy regimen, which dramatically improves the survival rate. We recommend histopathological evaluation in all children with asymmetric tonsillar hypertrophy undergoing tonsillectomy for various reasons. Needless to say, it is better to be cautious and exclude the presence of tonsillar lymphoma, than to confront with the severe consequences of misdiagnosis.


PubMed | Grigore Alexandrescu Clinical Emergency Hospital for Children
Type: Case Reports | Journal: Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie | Year: 2016

T-cell lymphoblastic lymphoma is an aggressive malignancy that represents 85% of all lymphoblastic lymphomas. It usually occurs in late childhood, adolescence and young adulthood with a 2:1 male preponderance and it presents with pleural effusion and respiratory symptoms and in rare cases vena cava syndrome can be encountered. We present the case of a 13-year-old patient who was referred to our clinic from a local hospital where he was diagnosed with a mediastinal tumor. The patient presented with thoracic pain, fever, coughing and fatigability for a month prior to admission, after having underwent surgery for abdominal pain (appendectomy). On admission to our hospital, a thoracic computed tomography (CT) scan was performed and showed the presence of an anterior mediastinal mass measuring 109/76/140 mm, well defined, which came in close contact with the superior vena cava, the ascending aorta and the pulmonary artery, right pleural effusion and a collapsed lung on the right side. The decision was taken to perform a tumor biopsy and a right pleural drain was placed. The patients post-operative evolution was favorable with the remission of the respiratory symptoms. The histopathological result showed the presence of T-cell lymphoblastic lymphoma and the patient was then transferred to the oncology ward where he underwent chemotherapeutic treatment, with a favorable outcome. T-cell lymphoblastic lymphoma is an aggressive type of lymphoma and it is usually hard to diagnose considering the fact that the symptoms are often vague. It is essential to establish the diagnosis without delay and start appropriate chemotherapeutic treatment.


PubMed | Grigore Alexandrescu Clinical Emergency Hospital for Children
Type: Case Reports | Journal: Journal of medicine and life | Year: 2013

We report the case of an 11-year-old female with acute pancreatitis, and review the literature highlighting the presenting symptoms and signs, laboratory tests, and investigational tools that helped in the establishment of a correct diagnosis. First, the patient presented to a regional hospital reporting abdominal pain, vomiting and liquid stool. She was admitted with the diagnosis of acute surgical abdomen and underwent surgery. Upon admission in our department, laboratory findings showed high values for total lipids = 2600 mg/dL and triglycerides 1200 mg/dL. Abdominal ultrasound revealed a pancreas with a small enlargement of the head (19 mm), and with a heterogeneous structure of the parenchyma. Abdominal computed tomography showed small left pleural collection and a high-dimensioned pancreas, particularly at the head, with heterogeneous structure, and peripancreatic collections. The patient was treated by fasting, gastric decompression by nasogastric tube, and intravenous antibiotherapy followed by antialgic and antispasticity treatment. Time of the patients first feeding was after the 7th day of hospitalization. The patient was discharged in a very good condition after 22 days of hospitalization.


PubMed | Grigore Alexandrescu Clinical Emergency Hospital for Children
Type: Case Reports | Journal: Journal of medicine and life | Year: 2013

Burkitt lymphoma has many forms of clinical presentations and, in children, it is usually discovered due to the presence of an abdominal mass. This rapidly growing tumor is highly malignant, aggressive, and may cause either indirect symptoms, due to pressure phenomena or direct involvement of the bowel lumen, leading to either intestinal obstruction or intussusception. We describe the case of a 4-year-old girl who exhibited an unusual presentation of ileocolic intussusception on a Burkitt lymphoma lesion of the ileum.

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