Multifocal tuberculosis revealed by spinal tuberculosis in an eleven-year-old Guianese child.

Multifocal tuberculosis in a child is rare event. Here we report a case of multifocal tuberculosis revealed by spinal tuberculosis in an eleven-year-old French Guianese girl. This observation underlines the difficulties, the consequences of delay, and the necessity of an early diagnosis of this disease for children.

[Spinal tuberculosis in children: contribution of imaging to diagnostic and therapeutic management]. / Tuberculose vertébrale de l'enfant: place de l'imagerie dans la démarche diagnostique et thérapeutique.

BACKGROUND: Spinal tuberculosis is an increasingly common condition, particularly in children. CASE REPORT: A 2-year-old boy presented with spinal tuberculosis with psoas abscesses. Radiological imaging played a major role in the diagnostic process. DISCUSSION: In children, spinal tuberculosis is a serious condition due to its rapid spread. Clinical symptoms are often insidious and histological and bacteriological studies may fail to disclose the diagnosis. Radiological investigations are essential in the diagnostic approach.

[Tibia vara in adolescents. Apropos of 19 cases]. / Le tibia vara de l'adolescent. A propos de 19 cas.

PURPOSE OF THE STUDY: Clinical, and radiological aspects and treatment of adolescent tibia have been studied in a review of 19 children native of the Caribbean. MATERIAL: 23 cases of adolescent tibia vara in 19 children have been collected (14 males and 5 females, aged from 9 to 14). METHODS: Clinical aspects (weight, lower limb axis), radiological signs (aspect of the physis, mechanical axis, epiphyseal slope) were studied pre and post-operatively. RESULTS: All the boys presented an important overweight. Pain was the first symptom, characterized by a progressive varus deformity on a leg which was previously straight. Radiological findings consisted in metaphyseal varus and widening of the medial part of the physis. Mechanical femoro-tibial axis varied from 10 degrees to 55 degrees varus, medial epiphyseal slope from 12 degrees to 30 degrees. Average mechanical femoral angle was 92 degrees and accounted for a mean femoral varus deformity of 4 degrees. 23 knees were operated, 4 after fusion of the whole physis. 10 lateral hemi-epiphysiodesis were performed with a mean correction of 4 degrees every year until fusion. In 3 cases a tibial osteotomy was made in a second time, at the end of growth. In 6 cases of late treated patients, an isolated tibial osteotomy of valgisation was performed. In 7 cases of important deformity before closure of the physis, tibial osteotomy was associated with lateral epiphysiodesis. In one case, a lateral closing wedge osteotomy was performed, associated to an elevation of the medial tibial plateau and a lateral hemi-epiphysiodesis. DISCUSSION: Histopathological examination of the physis showed similarities between adolescent tibia vara, infantile tibia vara and Slipped capital femoral epiphysis: the entire physeal plate was involved. Concerning pathogenesis of adolescent tibia vara, mechanical factors are predominant, with abnormal pressures across the medial part of the physis. CONCLUSION: Adolescent tibia vara occur in obese black children and can be considered as an epiphysiolysis of the upper end of the tibia.

Congenital fibrous hamartoma of the hand: a case report.

A patient with a rare localization of a congenital fibrous hamartoma of the hand is described, and the differential diagnosis is discussed. A review of the literature shows the rare frequency of localization of this lesion on the limb extremities.

[Pubic osteitis caused by Salmonella indiana. Apropos of a case]. / Ostéomyélite pubienne à Salmonella Indiana. A propos d'un cas.

INTRODUCTION: The authors report the case of a pubic osteomyelitis caused by a salmonella indiana bacterium in a 12 year old child. CLINICAL CASE: A post traumatic left side pubic pain in a 12 year old child was associated to feverish and inflammatory syndrome, without any predisposing factor. Salmonella Indiana bacterium was found in fecal samples. Radiographs showed an asymetry of the iliopubic branches and an irregularity of the upper left border of the pubic branch. Bone scan showed a public hyperfixation and CT revealed a left-sided pubic osteolysis. The bacteriological examination of the osseous biopsy confirmed the presence of Salmonella Indiana bacterium. Recovery was obtained within 5 months with intravenous antibiotherapy. DISCUSSION: Since 1987, an increase of minor salmonella infections and particularly of Salmonella Indiana bacterium can be observed in metropolitan France (250 isolated in 1991). This increase is not experienced in Martinique. The contamination mode is yet unknown and the osseous localization is secondary to bacteriema. The patient had no predisposition excepted a chronic digestive carrier. This localization is unfrequent in children. The diagnostic has been achieved by bacteriological samples and osseous biopsy. The treatment based was on third generation cephalosporins and on quinolones.

[Duckett's+ simple surface or double surface? Comparison of 2 urethroplasty procedures. Report of 91 hypospadias]. / Duckett "simple face" ou "double face"? Comparaison des 2 procédés d'uréthroplastie. A propos de 91 hypospadias.

The results and complications of the treatment of hypospadias were studied in relation to the two pedicle foreskin mucosal flap techniques described successively by Duckett, "single surface" and "double surface". 91 urethroplasties were performed: 58 "single surface" and 33 "double surface" Duckett urethroplasties. The children were operated between the ages of 18 months and 16 years with a mean age of 4 years. 75% of children had a good result on long-term follow-up. In the case of major complications, essentially fistula, distal necrosis àf the urethra or stricture, a single reoperation increased the percentage of good results to almost 98% for the entire series. However, when the two procedures were compared, a good result was obtained immediately in 81% of cases for the "single surface" operation versus 66% for the "double surface" operation. The fistula rate was 27.2% with the "double surface" flap versus 13.7% with the "single surface" flap and the distal stricture rate was 15.1% with the "double surface" flap versus 3.4% with the "single surface" flap. In the light of these results, Duckett's "double surface" procedure has been abandoned in favour of the "single surface" flap.

[Apple-peel jejunal atresia. Nutritional management]. / Atrésie du grêle avec intestin en colimaçon. Prise en charge nutritionnelle.

Apple-peel jejunal atresia is a rare digestive tract congenital defect often accompanied with a short gut. Two cases managed by a three-stage medical and surgical approach are reported. A protein hydrolysate-jejunal secretion mixture was drip-fed through the distal ileostomy to stimulate trophicity of the distal gut.

[Multicystic renal dysplasia with ectopic implantation of the ureter in boys. Apropos of 6 cases]. / La dysplasie rénale multikystique avec abouchement ectopique de l'uretère chez le garçon. A propos de six observations.

The prevalence of multicystic dysplastic kidney has increased since the development of antenatal ultrasound diagnosis. Even though, the rarity of symptomatic forms and case reports of spontaneous regressions antenatally or after postnatal ultrasound follow-up have reduced indications of nephrectomy which is less and less appropriate. However, discovery of ectopic ureteric implantation in boys makes certain additional investigations as intravenous pyelography, cystography and ultrasound, essential before making any therapeutic decision. Nevertheless, some cases remain undescriptible. In these cases, operative opacification of any patent ureter can provide more precise information about ureteric implantation. Lastly, only a dissection and resection as complete as possible of any patent ureter and pelvic cystic dilatation can prevent subsequent complications.