[Diagnostic ultrasonographique d'une hernie inguino-labiale a contenu utero-ovarien. a propos d'une observation chez un nourrisson]. / Diagnostic ultrasonographique d'une hernie inguino-labiale a contenu utero-ovarien. a propos d'une observation chez un nourrisson.

Although indirect sliding inguinal hernias containing the ipsilateral ovary and fallopian tube are not uncommon in infant girls, those containing the uterus, ovary and fallopian tube are. We present the case of a 1-month-old girl with a palpable barely movable mass over the left labium major. Preoperative sonography was performed and revealed a hernia containing the uterus, ovary and fallopian tube. This diagnosis was confirmed during surgical correction. We suggest sonography be used for all diagnostic workup in female infants with an inguinal mass.

Bien que les hernies inguinales contenant l'ovaire homolatéral et la trompe soient relativement fréquentes chez la petite fille, celles contenant l'utérus, un ovaire et la trompe sont rares. Nous rapportons un cas chez une petite fille de 1 mois, né à terme présentant une masse peu mobile de la grande lèvre gauche. Une échographie réalisée a mis en évidence un sac herniaire contenant l'utérus, un ovaire et vraisemblablement la trompe ipsilatérale. Ce diagnostic a été confirmé durant l'opération. Nous suggérons que l'échographique soit mis à profit dans le diagnostic de toute formation inguinale de la petite fille.

The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa.

BACKGROUND: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. PATIENTS AND METHODS: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons' directory was used to identify paediatric surgeons in the Francophone's countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. RESULTS: A total of 41 paediatric surgeons (68.33%) responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%), scholarship from a non-governmental organisations in 14 (34.15%) and self-sponsorships in 20 (48.78%). The average salary was 450 Euros (€) (range: 120-1 400 Euros). Most of the paediatric surgeons (68.29%) had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80%) had no subscription to specialised scientific journals. CONCLUSION: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.

Aplasia cutis congenita associated with Goltz syndrome in a male neonate.

Here we report the association of giant aplasia cutis congenita in a newborn black male with Goltz syndrome. The cutis aplasia defect is extensive and circonscript at the vertex. The cerebral structures are visible through the lesions. In addition, the patient has a low birth weight, syndactyly, adactyly, cutaneous atrophy, and areas of hyperpigmentation on the legs and hypoplastic maxillary. We think that these signs are probably due to mosaic mutations in PORCN. We reviewed 18 cases of Goltz syndrome in 18 male neonates but none has aplasia cutis congenita. Such a combination of severe aplasia cutis congenita was not reported previously in Goltz syndrome.

[Typhoid intestinal perforation in children: renewed interest in the Veillard technique in tropical zones]. / Les perforations typhiques du grêle chez l'enfant: un regain d'intérêt de la technique de Veillard en milieu tropical.

GOAL: to value the results of the ileo colic intubation of Veillard in relation to the resection anastomosis and the ileostomy. PATIENT AND METHOD: It is about a randomised survey on 12 months (January 1st to December 31st, 2006). This study took place in the St. Jean de Dieu hospital of Afagnan. It was about children aged of less than 15 years having presented more a perforation of bowel. The diagnostic methods of the spindly shackle perforation were clinics and radiographic. It is about an observational randomized study in simple insu for the choice of the technique (resection anastomosis or ileostomy and ileo colic intubation). It was about a choice with two arms: ileo colic intubation versus resection anastomosis and ileostomy. The realization of the resection anastomosis or the ileostomy was left to the choice of the surgeon. Forty patients have been drawn by lot and have been distributed in tow groups: Group A (ileo colic intubation), group B (resection - anastomosis and ileostomy). The patients were distributed in 28 boys (70%) with 20 boys in the group A and 8 in group B and 12 girls (30%) with 8 girls in group A and 4 in group B whose middle age was of 8 years and 5 months (ranges: 4 to 14 years). The middle age were 8 years 10 months (ranges: 4 to 14 years) in group A and 8 years (ranges: 5 to 13 years) in group B. In operative meadow, a standard antibiotherapy was instituted in all patients: Ciprofloxacin and Metronidazole in 24 patients (60%), and Ceftriaxone and Metronidazole in 16 patients (40%). We have used the statistic test of KHI2 with a threshold 5% for statistical analysis. RESULTS: The ileo colic intubation technique has been practiced 22 times (55%), the resection - anastomosis technique has been practiced 15 times (37.5%) and the ileostomy technique has been practiced three times (7.5%). The middle length of hospitalization of the patients was of 15 days (ranges: 10 to 45 days) with 13 days (ranges: 10 to 25 days) in group A and 19 days (ranges: 15 to 45 days in group B. The post operative complications were significantly more frequent with the resection anastomosis (53.3%) than with ileo colic intubation (4.5%). CONCLUSION: The ileo colic intubation still rivets an interest in the intestinal typhoid perforation in tropical environment.

Transfer of surgical competences in the treatment of intersex disorders in Togo.

BACKGROUND: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. MATERIALS AND METHODS: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. RESULTS: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French-speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. CONCLUSION: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.

[Acute scrotum in children]. / Les grosses bourses douloureuses de l'enfant.

AIMS: To evaluate the frequency, to identify the aetiologies of the acute scrotum and to describe their treatment in children. MATERIAL AND METHOD: Fifty seven children treated for acute scrotum in the paediatric surgery department of the Tokoin teaching hospital (Lomé) between January 2003 to December 2007 were studied. RESULTS: The frequency of acute scrotum was 5.80%. The average age was of 4.75 years (range: 7 days to 15 years). The aetiologies were: incarcerated inguino scrotal hernia (49.12%); spermatic cord torsion (29.83%); epididymo-orchitis (17.54%) and testicular trauma (3.51%). The delay of treatment was superior of 72 hours in 49.12%. The pain and the increase of the volume of the scrotum were present in all the patients. The emergency operation was performed in the spermatic cord torsion and the testicular trauma. The medical treatment was performed in the epididymo-orchitis cases. The patients presenting an incarcerated inguino-scrotal hernia benefited from a surgical cure in a delay of eight days after the acute episode. The operative continuations were in any cases simple. CONCLUSION: The diagnosis and the treatment must be precocious in the acute scrotum in order to avoid possible complications.

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management; which was held from December 4 th to 8 th ; 2006; in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of ""Saint Jean de Dieu"" Hospital of Afagnan; Togo. Results: There were 107 participants [five professors of paediatric surgery; 62 African paediatric surgeons (including 15 from African French- speaking countries); and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding; recognising; and treating the sexual ambiguities); and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis; two of female pseudohermaphroditism; and two of male pseudohermaphroditism); were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities"

Les grosses bourses douloureuses de l'enfant

But : Evaluer la frequence; identifier les causes et decrire la prise en charge des grosses bourses douloureuses de l'enfant. Materiel et methode: Il s'agit d'une etude transversale portant sur 57 dossiers d'enfants ages de 0 a 15 ans recus et traites pour grosses bourses douloureuses. Ces enfants ont ete admis dans le service de la chirurgie pediatrique du CHU-Tokoin entre janvier 2003 et decembre 2007. Resultats : Les grosses bourses douloureuses ont represente 5;80des cas de grosse bourse. L'age moyen etait de 4;75 ans (extremes : 7 jours et 15 ans). Les principales etiologies etaient : la hernie inguino-scrotale etranglee (49;12) ; la torsion du cordon spermatique (29;83) ; l'orchi-epididymite (17;54) et le traumatisme testiculaire (3;51). Le delai de prise en charge etait superieur 72 heures dans 49;12des cas. La douleur et l'augmentation du volume de la bourse etaient presentes dans tous les cas. Le traitement avait ete chirurgical d'emblee (torsion du cordon spermatique et traumatisme testiculaire) ou en differe huit jours apres l'episode aigu (hernie inguino-scrotale etranglee); et medical (orchi-epididymites). Les suites operatoires ont ete simples dans tous les cas. Conclusion : Le diagnostic et la prise en charge des grosses bourses douloureuses doivent etre precoces afin d'eviter d'eventuelles complications

[Rectal prolapse of intussusception in infants]. / Invagination intestinale avec boudin prolabé par l'anus chez le nourrisson.

Rectal prolapse is a rare complication of intussusception in infants. This complication is most often secondary to a side by side placing defect of the caecum and a long mesenter. Three cases of rectal prolapse of intussuception are reported herein and the pathologic and therapeutic aspects of the intussucseption complicated by rectal prolapse, as well as the particularities of intussusception diagnosis in an African country, are reviewed.

[Hip septic arthritis in young children with sickle-cell disease]. / L'arthrite septique de hanche chez l'enfant drépanocytaire.

PURPOSE OF THE STUDY: Sickle-cell anemia is an inherited disorder exposing patients to diverse complications, particularly bone and joint disease. Septic arthritis of the hip joint is a frequent infection in sickle-cell anemia. Without early management, there is an important risk of invalidating hip dysfunction. The purpose of this study was to analyze the epidemiological, clinical and therapeutic aspects of septic arthritis of the hip joint in order to focus on the need for early diagnosis, the best way to improve the prognosis of hip function. MATERIAL AND METHODS: This was a retrospective study over a 10 year period (1987-1996) which included nine children (seven boys and two girls), mean age six years who were managed in our hospital for septic arthritis of the hip joint. These children had at least one hemoglobin S: phenotypes SS (n=5), SC (n=2), AS (n=2). RESULTS: In these sickle-cell anemia children, the septic arthritis developed in a non traumatic context with osteonecrosis of the femoral head. One hip was involved in six children and both in three (12 hips). Mean time from symptom onset to consultation was eight days. Salmonella sp. were identified in nine hips (including all of the bilateral cases) and Staphylococcus sp. in three. The treatment included antibiotics for six weeks, puncture-drainage, and immobilization for three to four weeks. Outcome was excellent in nine hips and good in three. DISCUSSION: The diagnosis of septic arthritis of the hip joint must be made early, based on ultrasound or scintigraphic findings. Bacteriological samples of joint fluids are required to adjust the antibiotic regimen. Salmonella sp. were the most common agents in our patients, but other series have reported Klebsiella pneumoniae and Staphylococcus or Pneumococcus sp. Drainage is preferred, if possible by arthroscopy. Arthrotomy should be reserved for cases with a thick discharge which is difficult to evacuate via puncture drainage. Early diagnosis, careful evacuation of the joint collection, and adapted antibiotic therapy with hip immobilization are the keys to good functional outcome.

[Management of Lagrange and Rigault stage IV extension type supracondylar fracture of the humerus in children]. / Prise en charge des fractures supracondyliennes en extension stade IV de Lagrange et Rigault.

PURPOSE OF THE STUDY: Lagrange and Rigault stage IV extension type supracondylar fracture of the humerus (Gartland and Wilkins type III) involves major displacement, making treatment difficult. Several therapeutic methods have been described but indications vary considerably between teams. We conducted a retrospective analysis in order to evaluate the results of different methods, identify the most adapted technique, and detail the conditions necessary for good results with the collar and cuff immobilization method described by Blount. MATERIAL AND METHODS: Forty-four children (30 boys and 14 girls), mean age seven years six months, were treated between January 1990 and December 2001. The collar and cuff immobilization technique was used for sixteen children (including four who underwent open revision for early secondary displacement), percutaneous pinning for two, and open crossed pinning for thirty (including four who developed secondary displacement after collar and cuff immobilization). One out of two collar and cuff treatments was instituted within six hours of injury. The four secondary displacements after collar and cuff immobilization treatment occurred after fracture reduction more than six hours after injury. The proportion of open reductions increased with longer delay to reduction after injury. Mean immobilization was three and a half weeks. The Flynn criteria were used to assess outcome at mean seven years eight months follow-up. RESULTS: Outcome was satisfactory in all children treated with definitive collar and cuff immobilization and by percutaneous pinning; the rate was 97% after open procedures (persistent sequelae of radial palsy in one child). DISCUSSION: Early treatment before six hours increased the chances of success with the collar and cuff method which remains the technique of choice for Lagrange and Rigault stage IV extension type supracondylar fractures. In the event of failure or complications, other classical methods should be discussed, including percutaneous pinning or direct access for open osteosynthesis.