Interest of direct radionuclide cystography in repeated urinary tract infection exploration in childhood.

108 children with repeated urinary tract infection were examined both with direct contrast cystography and radionuclide cystography. There was a good correlation between the two procedures in the majority of the cases (79), but in 21 cases, direct radionuclide cystography alone was positive and for 8 other children, direct contrast cystography showed a low-grade vesico-ureteric reflux even though radionuclide cystography was negative. When comparing the two procedures and taking into consideration the age of the patients we find that radionuclide cystography is more sensitive to detect vesico-ureteric reflux in the younger population (p < 0.02). This advantage is less clear for older children who more often present a low-grade reflux. Low radiation exposure is also a great advantage of radionuclide cystography, but anatomic definition is better with contrast cystography. It seems thus that the two procedures complement rather than rival each other. Their respective interest for evaluation of repeated urinary tract infection in children therefore depends on age, attain-ability of the procedure, and the possibility of a bladder or ureteral abnormality. Quite a few authors consider radionuclide cystography as at least as valid as contrast cystography, and even more sensitive. We have attempted to compare both procedures and to determine their respective role in repeated urinary tract infection exploration.

[Capsular shift for voluntary dislocation of the shoulder: results in children]. / Capsulorraphie dans les instabilités volontaires de l'épaule: résultats chez l'enfant et l'adolescent.

PURPOSE OF THE STUDY: Chronic shoulder instability is uncommon in patients with an immature skeleton. Some of these pediatric patients can produce their dislocation voluntarily raising the question of the traumatic or constitutional nature of the condition as well as its direction and tolerance. We report our experience with 29 patients. MATERIAL AND METHOD: Over a period of 28 years, 29 children aged 5 to 15 years were treated for voluntary shoulder dislocation. The dislocation was painful and poorly tolerated in 19, affecting daily life and sports activities. Posterior dislocation was observed in 15 patients and anterior dislocation in 4, but the direction was not always easy to establish, particularly in children with ligament laxity; multiple directions were not uncommon. Rehabilitation for at least eight months did not relieve pain in 11 patients who had a sensation of a blocked, unreliable shoulder which could not be controlled voluntarily. Posterior capsulorrhaphy was performed in 8 patients and anterior capsulorrhaphy in 3. RESULTS: Mean follow-up was 8 years. At last follow-up, all shoulders were stable and shoulder motion was normal with no loss of function. More than half of the children had resumed sports activities. Capsulorrhaphy was proposed when the pre-operative explorations did not reveal any bone or rim anomaly. The only preoperative finding in the operated patients was increased capsule volume, particularly in the inferior portion. Intraoperatively, ulceration of the humeral cartilage was found in two patients. Anatomic reconstruction of the capsuloligamentary structures enabled recovery of passive stability and active stability of the scapulohumeral joint, preventing further voluntary dislocation.