[Chronic constipation in childhood. A report of 78 patients]. / La constipation chronique du nourrisson et de l'enfant. Etude de 78 cas.

AIM: To assess the aetiology and the clinical patterns of chronic constipation in children. METHODS: A total of 78 patients (62% boys, mean age: 4.6 years) were enrolled in this retrospective study. For each patient, we collected these data: clinical features, radiological data, rectal manometry and rectal biopsy results, treatment and follow up. RESULTS: Functional constipation was the most frequent cause of chronic constipation (49 cases, 62.8%) followed by Hirschsprung's disease (19 cases, 24.3%). Rectal manometry, performed in all suspected Hirschsprung's disease, concluded to the absence of inhibitory rectoanal reflex in 17 of them. Rectal biopsy concluded to segmental absence of parasympathetic ganglion cells in eleven of them. Therapeutic approach consists of treatment of functional constipation by laxatives, enemas and dietary fibers in respectively 22, 12 and 6 children. Two other patients had a biofeedback re-education. Treatment was successful in 9 patients and unsuccessful in 2 others. Seven children with Hirschsprung's disease underwent Soave's (n = 3), Swenson's (n = 3) and Duhamel's procedures (n = 1). Outcome was favourable in five of them and complicated by stenosis in 2 others. CONCLUSION: Our study suggests that functional constipation is the most frequent cause of chronic constipation in children and that Hirschsprung's disease is the first organic cause of chronic constipation indicating the need of rectal manometry for diagnostic confirmation.

[Treatment of upper gastrointestinal bleeding in portal hypertension in children]. / Traitement des hémorragies digestives dans l'hypertension portale de l'enfant.

Variceal bleeding is the most common cause of severe gastrointestinal bleeding in chilhood. Biliary atresia and portal venous obstruction are the most common causes. The patients with acute bleeding, pharmacotherapy with octreotide should be used immediately. All of these patients should undergo therapeutic endoscopy with band ligation. All children surviving variceal hemorrage should undergo secondary prophylaxis with band ligation. Transjugular intrahepatic portosystemic shunt creation in children is as safe in children than in adults. The primary prophylaxis in children with oesophageal varices is controversed.

[Metaiodobenzylguanidine scintigraphy in the diagnosis and followup of neuroblastoma. Apropos of 16 cases]. / La scintigraphie à la méta-iodo-benzyl-guanidine dans le diagnostic et le suivi des neuroblastomes. A propos de 16 cas.

AIMS: The aim of this study is to evaluate meta-iodo-benzyl-guanidine scintigraphy in the diagnosis and the management of neuroblastoma. PATIENTS AND METHODS: betwen september 1999 and jun 2004, 16 children aging from 4 months to 6 years, with neuroblastoma, underwent mIBG scintigraphy in military hospital nuclear medicine department. RESULTS: 23 mIBG scans were done. The exam was indicated for the initial staging in 7 cases, to evaluate chemotherapy or surgery in 12 cases and to seek for reccurences in 3 cases. The sensitivity of mIBG was 57% in the detection of the primary tumor, 100% for liver metastases and 67% for medullar involvement. CONCLUSION: mIBG scintigraphy should be a standard in the initial staging of neuroblastoma and in evaluating therapy response.

[Colorectal polyps in children. A study of 34 patients]. / Les polypes recto-coliques chez l'enfant. Etude de 34 cas.

AIM: To assess the frequency and the clinical features of polyps of the colon and rectum in children. METHODS: A total of 34 patients (20 boys and 14 girls, mean age: 5.4 years) were enrolled in this 14-years retrospective study. Diagnosis was done for almost all patients by colonoscopy (n=8) or recto-sigmoidoscopy (n= 19). After endoscopic polypectomy, polyp's type is determined by histological examination. RESULTS: Minimal and relapsing rectal bleeding was the most frequent finding of polyps of the colon and rectum (85.3%) followed by spontaneous emission of polyp (n=3), rectal prolapses (n=2), chronic constipation (n=1) and abdominal pain (n=1). The polyp was unique in all cases and with a mean size of 12 mm. The majority of polyps were localized in the rectum or sigmoid (97%) and were pediculate (81.2%). Endoscopic polypectomies concerned 26 polyps while two small polyps were left. Most of the polyps corresponded histologically to juvenile polyps (96.2%). The immediate post-op course was uneventful for 26 children. CONCLUSION: Our study suggests that rectal bleeding is the most frequent finding of polyps of the colon and rectum in childhood. Outcome after endoscopic polypectomy is good.

[Contribution of clinical, biological and radiological parameters in the diagnosis of urinary infection localization]. / Apport des parametres cliniques biologiques et radiologiques dans le diagnostic de localisation de l'infection urinaire.

Urinary infection was a problem in pediatrics. Currently the diagnosis is easy but it is hard to diagnosis the localisation of the infection. We have to go fast and precisely to treat correctly this infection and diminich the possibility of developing renal scars. Dimercaptosuccinic acid (DMSA) scintigraphy is a reference exam for detection acute renal lesions. We have realised a prospective study in 29 children presenting urinary tract infection. In whom a DMSA scintigraphy is realised between the one day and 30 days after the infection. We study the sensibility ans the specificity of clinical, biological and radiological parameter for the diagnosis of localisation of the infection. The better parameter of sensibility of upper urinary tract infection is of fever, and the better parameter of specificity is the association of fever, echo Doppler renal and VS.