Radiological and surgical management of bleeding pancreatic pseudocyst in a pediatric patient. / Manejo radiológico y quirúrgico del pseudoquiste pancreático hemorrágico en el paciente pediátrico.

INTRODUCTION: The pancreas is the fourth most frequently involved solid organ in pediatric abdominal trauma. We present the case of a giant pancreatic pseudocyst secondary to trauma and how it was radiologically and surgically managed. CLINICAL CASE: This is the case of a 13-year-old male patient admitted as a result of a grade IV pancreatic lesion, which turned into a 170x86x180 mm pancreatic pseudocyst. Intracystic bleeding required radiological embolization of the proximal gastroduodenal artery. Subsequent abdominal compartment syndrome, biliary leak, and chemical peritonitis required laparotomy and collection drainage. Pancreatitis and duct fistula had a slow but favorable progression. DISCUSSION: The presence of duct damage is a failure predictor in the conservative treatment of pancreatic trauma. Surgical management could be indicated in recurrent, multiple, or giant (> 200 mm) pseudocysts. Intracystic bleeding is rare but potentially fatal. Selective angiogram could be a useful tool for improved prognosis.

INTRODUCCION: El páncreas es el cuarto órgano sólido más afectado en el traumatismo abdominal infantil. Presentamos la complicación de un pseudoquiste pancreático gigante secundario a traumatismo y su manejo radiológico y quirúrgico. CASO CLINICO: Varón de 13 años que ingresa por lesión pancreática grado IV, que evoluciona desarrollando un pseudoquiste pancreático de 170x86x180 mm. Un sangrado intraquístico requirió embolización radiológica de la arteria gastroduodenal proximal. El posterior síndrome compartimental abdominal, fuga biliar y peritonitis química obligaron a realizar una laparotomía y drenaje de colecciones. La pancreatitis y fístula ductal tuvieron una progresión lenta pero favorable. COMENTARIOS: La presencia de daño ductal es un predictor de fracaso del tratamiento conservador en el traumatismo pancreático. El manejo quirúrgico podría indicarse en pseudoquistes recurrentes, múltiples o gigantes (> 200 mm). El sangrado intraquístico es raro pero potencialmente letal, pudiendo ser la angiografía selectiva una herramienta útil en la mejora del pronóstico.

Monitoring and evaluation of integrated disease surveillance and response in selected districts in Tanzania.

Integrated Disease Surveillance and Response (IDSR) is a strategy developed by the World Health Organization Regional Office for Africa in 1998. The Ministry of Health, Tanzania has adopted this strategy for strengthening communicable diseases surveillance in the country. In order to improve the effectiveness of the implementation of IDSR monitoring and evaluating the performance of the surveillance system, identifying areas that require strengthening and taking action is important. This paper presents the findings of baseline data collection for the period October-December 2003 in 12 districts representing eight regions of Tanzania. The districts involved were Mbulu, Babati, Dodoma Rural, Mpwapwa, Igunga, Tabora Urban, Mwanza Urban, Muleba, Nkasi, Sumbawanga Rural, Tunduru and Masasi. Results are grouped into three key areas: surveillance reporting, use of surveillance data and management of the IDSR system. In general, reporting systems are weak, both in terms of receiving all reports from all facilities in a timely manner, and in managing those reports at the district level. Routine analysis of surveillance data is not being done at facility or district levels, and districts do not monitor the performance of their surveillance system. There was also good communication and coordination with other sectors in terms of sharing information and resources. It is important that districts' capacity on IDSR is strengthened to enable them monitor and evaluate their own performance using established indicators.

Manejo radiológico y quirúrgico del pseudoquiste pancreático hemorrágico en el paciente pediátrico / Radiological and surgical management of bleeding pancreatic pseudocyst in a pediatric patient

Introducción: El páncreas es el cuarto órgano sólido más afectadoen el traumatismo abdominal infantil. Presentamos la complicación deun pseudoquiste pancreático gigante secundario a traumatismo y sumanejo radiológico y quirúrgico. Caso clínico: Varón de 13 años que ingresa por lesión pancreáticagrado IV, que evoluciona desarrollando un pseudoquiste pancreáticode 170x86x180 mm. Un sangrado intraquístico requirió embolizaciónradiológica de la arteria gastroduodenal proximal. El posterior síndromecompartimental abdominal, fuga biliar y peritonitis química obligarona realizar una laparotomía y drenaje de colecciones. La pancreatitis yfístula ductal tuvieron una progresión lenta pero favorable. Comentarios: La presencia de daño ductal es un predictor de fraca-so del tratamiento conservador en el traumatismo pancreático. El manejoquirúrgico podría indicarse en pseudoquistes recurrentes, múltiples ogigantes (> 200 mm). El sangrado intraquístico es raro pero potencial-mente letal, pudiendo ser la angiografía selectiva una herramienta útilen la mejora del pronóstico.(AU)

Introduction: The pancreas is the fourth most frequently in-volved solid organ in pediatric abdominal trauma. We present thecase of a giant pancreatic pseudocyst secondary to trauma and howit was radiologically and surgically managed. Clinical case: This is the case of a 13-year-old male patientadmitted as a result of a grade IV pancreatic lesion, which turned into a 170x86x180 mm pancreatic pseudocyst. Intracystic bleedingrequired radiological embolization of the proximal gastroduodenalartery. Subsequent abdominal compartment syndrome, biliary leak,and chemical peritonitis required laparotomy and collection drainage.Pancreatitis and duct fistula had a slow but favorable progression. Discussion: The presence of duct damage is a failure predictorin the conservative treatment of pancreatic trauma. Surgical mana-gement could be indicated in recurrent, multiple, or giant (> 200mm) pseudocysts. Intracystic bleeding is rare but potentially fatal.Selective angiogram could be a useful tool for improved prognosis.(AU)

[Inflammatory pseudo-tumor of the bladder expelled through the urethral meatus in a girl]. / Pseudo-tumeur inflammatoire vésicale expulsée par le méat urétral chez une fillette.

Inflammatory pseudo-tumors of the bladder are rare benign tumors that mostly arise in the differential diagnosis of sarcomas in children. The authors report an unusual case of pedunculated inflammatory pseudo-tumor of the bladder that externalized by the urethral meatus in a 13-year-old girl. The treatment consisted of a ligation-resection of the pedicle, followed by resection of the tumor. After regular follow-up for 18 months there was no tumor recurrence.

[Migration of an intrauterine device to the bladder]. / Migration de dispositif intra-utérin dans la vessie.

The authors report the case of a patient presenting with recurrent urinary tract infection and deterioration of the general status. Ultrasonography, plain x-rays and especially cystoscopy demonstrated the presence in the bladder of an intrauterine contraceptive device inserted 4 years previously. Endoscopic removal combined with antibiotics ensured cure of this patient.

The right skills for health systems development.

An in-service training programme has been developed for staff who operate health and family planning systems in Burkina Faso, in order to improve the services and strengthen the systems in difficult working conditions.

PIP: Health and family planning personnel at the provincial and district levels in Africa typically encounter very difficult conditions. For example, personnel in rural health centers may find that basic supplies are unavailable, staffing is inappropriate, and referral centers are too far away. Staff often have to work under conditions for which they are not prepared. Unhappy with having to cope with such conditions or accept additional tasks, staff may respond in a manner which compromises service efficiency. An in-service training program has been developed in Burkina Faso for staff who operate health and family planning systems with the goal of improving services and strengthening systems in difficult working conditions. Health and family planning personnel will be qualified to contribute to systems development from within. The program is intended mainly for staff who are in direct contact with the population and who have managerial responsibility for other personnel and access to higher levels of decision making. Action research is discussed.