Operative versus conservative treatment for giant omphalocele: Study of French and Ivorian management.

INTRODUCTION: The giant omphalocele is currently a surgical challenge. The morbidity and mortality associated with its care is non-negligible. Nowadays, different studies have revived the debate between conservative and surgical management for giant omphalocele. The purpose of this study is to compare the conservative and surgical management of the giant omphalocele in terms of morbidity and mortality. METHODS: Retrospective study including all giant omphaloceles comparing surgical management (French University hospital centers) and tanning (Ivory Coast University hospital center). Epidemiology was studied as well as medical and surgical managements both intra and post operative. RESULTS: One hundred and forty-seven patients included (98 patients in the "tanning" group and 49 in the "surgery" group). Hospital length of stay is significantly shorter in the "tanning" group as they do not spend time in intensive care unit. Morbidity is higher in "surgery" group. The average duration for oral empowerment was acquired at 179 days in the "surgery" group, whereas in the "tanning" group 90% was immediately and exclusively breastfed. No significant differences in terms of epithelialization time. CONCLUSION: The tanning treatment has its own place in the therapeutic arsenal in the management of the giant omphalocele no matter where it takes place. However, its realization in surgical environments prevents certain complications related to the technique or the pathology.

Outcomes of conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: 15 years' experience.

BACKGROUND: The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. MATERIALS AND METHODS: In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. RESULTS: A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. CONCLUSION: Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay.

Epidemiologie des anomalies congenitales dans les centres hospitaliers et universitaires d'Abidjan

Les anomalies congenitales constituent l'une des principales causes de la mortalite infantile dans le monde et particulierement dans les pays en developpement. Objectif principal etait de repertorier toutes les malformations observees dans les trois centres Hospitaliers Universitaires d'Abidjan et a l'institut de cardiologie et les Objectifs secondaires de : - Repertorier leurs caracteristiques epidemiologiques ; - Hierarchiser les pathologies malformatives en fonction de leurs frequences ; - Etablir la mortalite globale de ces pathologies malformatives ; - Etablir la letalite de chacune de ces pathologies malformatives. Patients et methode. Il s'agissait d'une etude retrospective et descriptive sur 10 ans. Les donnees etudiees etaient celles epidemiologiques repertoriees a partir des dossiers medicaux et registres dans les 3 CHU d'Abidjan. Les nouveau-nes de 0 a 28 jours traites pour une anomalie congenitale pendant la periode d'etude etaient la population etudiee. Les donnees ont ete traitees et analysees par les logiciels epi info et Excel. Resultats. De 1996-2006; 1496 nouveaux nes presentant 1589 anomalies congenitales ont ete recenses dans les centres hospitaliers universitaires d'Abidjan. Il s'agissait de nouveau-nes; de meres agees de moins de 35 ans dans 33 des cas; multigestes dans 20 des cas; multipares dans 18 des cas. Les grossesses ont ete regulierement suivies dans 22 des cas et une echographie obstetricale a ete effectuee dans 1 cas sur 4. Le diagnostic prenatal des anomalies congenitales a ete effectue dans 1;5 des cas. Le diagnostic des anomalies congenitales a ete fait dans 79 ;5 des cas a la naissance. Les anomalies congenitales observees etaient : Orthopediques : 33; Neurologiques : 18; Digestives : 14; Faciales : 12;5; Parietales : 12; Urogenitales : 10; Cardiaques : 0;5. - La mortalite globale etait de 52. Les malformations digestives; parietales et neurologiques sont les plus letales Conclusion. les anomalies congenitales existent et sont relativement importantes dans nos structures hospitalieres. Leur diagnostic prenatal reste faible. Elles sont dominees par les anomalies orthopediques. Leur mortalite reste elevee. La mortalite est grevee par une letalite plus importante des pathologies congenitales viscerales

Infections osteo-articulaires (IOA) des nourrissons de moins de 3 ans: particularites cliniques; bacteriologiques; therapeutiques et pronostiques

Contexte. Dans les pays industrialises; les IoA sont prises en charge tres rapidement au debut des manifestations cliniques contrairement aux pays en developpement ou elles sont traitees tard au stade subaigu ou chronique. L'objectif de cette etude etait de decrire les IAo chez les enfants de moins de 3 ans afin de definir leurs particularites cliniques; d'identifier les bacteries en cause. Patients et methode. Sur une periode de 11 ans; de Decembre 2002 a Janvier 2013; nous avons collige des dossiers d'Infections osteo Articulaires (IoA) d'enfants au Centre Hospitalier Universitaire de Yopougon Abidjan Cote d'Ivoire. Les donnees cliniques concernaient; le delai de consultation; les portes d'entrees; la symptomatologie clinique (signes generaux; signes fonctionnels; signes physiques); Les parametres etudies etaient cliniques; biologiques; bacteriologiques; therapeutiques et evolutifs. Resultats. Au total; nous avons collige 105 dossiers d'Infections osteo Articulaires (IoA) d'enfants de 0 a 36 mois. Les resultats de l'hemoculture ont ete positifs dans 22%; ceux de la ponction articulaire ont ete positifs dans 51;5%; ceux de la ponction metaphysaire dans 22% et ceux du prelevement de la porte d'entree dans 60% . Les bacteries isolees etaient; le staphylococcus aureus dans 54%; Salmonella dans 23%; Klebsiella pneumoniae dans 19%; Pyocianique dans 4%. L'antibiogramme a montre une sensibilite des bacteries isolees dans 100% des cas aux Aminosides; aux Fluoroquinolones; a la Fosfomycine; aux Imipenemes et aux Glycopeptides. La sensibilite aux Betalactamines etait de 60%. Conclusion. Il faut eviter les betalactamines en mono antibiotherapie de premiere ligne au cours des IAo chez les nourrissons de moins de 3 ans. Nous suggerons l'utilisation d'une mono antibiotherapie avec amoxicilline acide clavulanique qui vise l'elimination du Kingella Kingae premiere bacterie en cause au cours des infections orL des nourrissons mais aussi a cause de l'acide clavulanique pour eliminer les staphylocoques dores producteurs de betalactamase

[Results of treatment of forearm fractures in the child]. / Resultats du traitement des fractures des deux os de l'avant bras de l'enfant.

OBJECTIVE: To describe epidemiology and to bring back the results of the treatment of the fractures of the forearm fracture. POPULATION AND METHOD: During 3 years and 3 months, we studied the forearm fractures of the children from 0 to 15 years. For each one of them, we studied, the age, the sex, the aetiology and the characteristics of the fracture, the treatment carried out and their evolution. RESULTS: Sixty-nine forearm fractures were listed, the frequency was 23 fractures per years. The sex ratio was 2,63 and the average age was 8 years and 2 months with 13 month and 15 years as extremes. The accidents of play accounted for 93% of the aetiologies. The cutaneous injuries were associated to the fracture in 30 cases (43%). The fractures with displacement was observed in 25 cases (36%), green steak fracture in 21 case (30%), fracture without displacement in 13 case (19%) and other displacements 10 cases (15%). The treatment was orthopaedic (reduction and immobilisation) in 97% of the cases. We observed 3 cases (4%) of secondary displacements under plaster and 6 cases (9%) of the vicious cal. CONCLUSION: The orthopaedic treatment is usually indicated for the Key words: fractures with anatomical restitution. The failures of the orthopaedic treatment need to be treated surgically.

[Experimental study of the influence of the segmental transverse colic reversion on the intestinal transit time]. / Etude experimentale de l'impact de l'inversion d'un segment colique transverse sur le transit intestinal.

OBJECTIVE: to study the feasibility of the transverse segment colic reversion and to evaluate its impact on the intestinal transit time in the rat Wistar. METHOD: On a test group of the rats Wistar males anaesthetized, we isolated a segment from the transverse colon vascularized by a feeder pedicle. This segment colic was reversed and anastomosed into antiperistaltic out of termino-terminal on its site with polyglactine 6/0. Into post-operative, we studied, the weight, the volume of the ingestats, the intestinal transit time, the survival and the histological lesions of the reversed segment colic. On the group controls, we carried out the anastomosis of a segment of the transverse colon isolated and anastomosed into isoperisaltic. RESULTS: Thirty rats males of 231.5 +/- 8.3g had been operated, 15 for the test group and 15 for the control group. The average weight of the ingestats of the rats of the test group was of 21.87 +/- 3g and of 21.75 +/- 4.8g in the control group without significant difference. The intestinal transit occured at 3 +/- 1 post-operatives days in the test group and at 2 postoperative days in the control group. A mechanical obstruction of the bowels before the 15th post-operative day involved a mortality of 87% in the test group. Thirteen percent of the rats of the test group survived, with a regular catch of weight. The histological analysis showed inflammatory lesions on the proximal portion of the reversed segment and a normal wall without ischaemic injury on its distal portion. No death was observed in the group controls. CONCLUSION: The antiperistaltic anastomosis of a transverse segment colic within the colic in the rat Wistar, causes a stop of the intestinal transit time by mechanical occlusion without ischaemic lesion of the segment colic reversed.

[Therapeutic approaches for omphalocele in developing countries: experience of Central University Hospital of Yopougon, Abidjan, Côte d'Ivoire]. / Approches thérapeutiques des omphalocèles dans les pays en développement: l'expérience du CHU de Yopougon, Abidjan, Côte d'Ivoire.

A retrospective study about 80 cases of exomphalos treated in the digestive unit of the paediatric surgery department in Abidjan teaching hospital--Côte d'Ivoire had been performed to analyse the result of this malformation treatment during 8 years. Prenatal diagnosis was made in two cases on six antenatal ultrasounds. Prematurity involved 7% of newborn and their birth weight ranged from 2500 to 4000 grams in 70% of cases. Treatment began in 64% at birth, conservative treatment with merbromine tannage was systematic on the non disrupted exomphalos. Surgery was indicated in the disrupted exomphalos and in the complicated cases of conservative treatment. Intestinal occlusion was the main fatal complication observed in both treatments but most of the time it occurred with surgical closure. Total lethality reached 30%, influenced by exomphalos super infection and by neonatal resuscitation insufficient means. Authors think exomphalos lethality reduction implies antenatal ultrasonographic for early diagnosis which could indicate a possible caesarian section in case of the voluminous exomphalos in order to prevent disruption and neonatal resuscitation operation.

[Diagnostic, therapeutic and prognostic aspects of intestinal typhoid perforations in children of Abidjan, Côte d'Ivoire]. / Aspects diagnostiques, thérapeutiques et pronostiques des perforations typhiques du grêle de l'enfant à Abidjan, Côte d'Ivoire.

We conducted a retrospective study on 48 children (with a sex ratio of 22 males to 26 females) who had been operated over the preceding 10 years for typhoid perforation on the viscera ward within the paediatric surgery department of Yopougon teaching hospital in Abidjan, Côte d'Ivoire. The mean age was 9 years 3 months ranging from 3 to 16 years. Typhoid peritonitis was diagnosed on the basis of symptoms, intestinal injuries and only rarely by way of biological examinations. Medical treatment associated three antibiotics: aminosid, metronidazol and the third generation of cephalosporin. Hydroelectrolytical and haematological resuscitation was performed 3 to 6 hours before laparotomy. Excision-suture was made in 81% of cases. Exclusive parenteral nutrition began 48 hours after the laparotomy. Mortality occurred in 6% of patients and morbidity in 46%. Complications were parietal suppurations, digestive fistula, parietal hernia, early occlusive syndromes and necrosed cholecystisis. Rectorragy and leucocytosis were considered as pejorative signs when associated to the classic typhoid peritonitis.

[Bladder paraganglioma (pheochromocytoma): a rare tumor in children. Apropos of a case]. / Le paragangliome vésical (phéochromocytome): tumeur rare de l'enfant. A propos d'un cas.

The authors report the first case of bladder paraganglioma in a child admitted to their department successfully treated by partial cystectomy. The diagnosis was established histologically, after failure of clinical diagnosis. Retrospectively' the authors think that preoperative diagnosis should have been possible and emphasize the importance of a thorough clinical examination.