Youssef Teklali

Peripheral osteoarticular tuberculosis in children: 106 case-reports.

INTRODUCTION We retrospectively reviewed 106 pediatric cases of peripheral osteoarticular tuberculosis (OAT) seen over a 21-year period in Morocco. Patients with vertebral tuberculosis were excluded from the study. PATIENTS AND RESULTS The 55 boys and 51 girls had a mean age of 8 years. The hip and knee together contributed 63% of the osteoarticular foci. Organ involvement was documented in 32 cases. Mean time from symptom onset to evaluation was 10 months. This resulted in diagnostic delay, which contributed to the 22% rate of residual abnormalities consisting of joint ankylosis and leg length inequality. CONCLUSION OAT is a source of functional disability that should be recognized and treated early, particularly in children, given that appropriate management can lead to a full recovery (14 patients in our series).

Polyorchidie chez l’enfant (à propos d’un cas avec revue de la littérature)

Resume La polyorchidie est une anomalie genito urinaire definie par la presence de plus de deux testicules confirmee histologiquement. Cette anomalie est extremement rare, une centaine de cas mondiaux ont ete decrits dans la litterature. Bien qu’elle puisse rester asymptomatique, la polyorchidie est souvent associee a la pathologie du canal peritoneo vaginal chez l’enfant (hernie, hydrocele) et a des troubles de la migration testiculaire. La revue de la litterature retrouve des cas de polyorchidie reveles par une torsion testiculaire et un risque accru de greffe tumorale et d’infertilite chez ces patients. Nous rapportons l’observation d’un adolescent de 14 ans, chez qui une masse testiculaire gauche douloureuse a conduit a une exploration chirurgicale et a permis de porter le diagnostic histologique de polyorchidie. A travers cette observation, les auteurs decrivent brievement les differents aspects pathologiques et therapeutiques de la polyorchidie, avec revue de la litterature.

Mixed epithelial and stromal renal tumour in a 12-year-old boy

Mixed epithelial and stromal tumour of the kidney (MESTK) is a rare kidney neoplasm that occurs almost exclusively in perimenopausal women. Long-term oestrogen replacement appears to play a major role in its pathogenesis. Around 70 cases have been described in the international literature, none of which involve male children. Herein, we describe an atypical case of MESTK diagnosed in a 12-year-old prepubertal boy who presented with hematuria. Pathology and immunohistochemistry revealed a typical MESTK. The child was free of disease at 2-year follow up after a partial nephrectomy and tumour excision.

Early elimination dysfunction associated with cephalic anomalies: Is there a link?

UNLABELLED Elimination dysfunction in children can be related to three main aetiologies: 1) spinal cord anomalies, 2) social and environmental disorders, and 3) syndromic elimination disorders. From this last group, we report cases of a previously undescribed combination of elimination disorders and cephalic anomalies symptoms which may constitute a proper entity for which conventional treatments may fail. A comprehensive review of congenital elimination disorders is given. PATIENTS AND METHODS Six patients (four boys, two girls) presenting with early elimination dysfunction associated with cephalic anomalies were assessed and treated between 1994 and 2005. None presented with identified lower urinary tract obstruction or spinal cord anomalies. Follow up ranged between 5.5 and 11.5 (mean 6.7) years. RESULTS All six had early elimination disorders, represented by urine retention, urinary tract infections, constipation and soiling. All had facial dysmorphy and cerebral anomalies with developmental delay of varying severity. All had a dilated urinary tract, with severe vesicoureteral reflux in five and one megaureter without reflux. All had abnormal renal isotope scans, two associated with chronic renal failure. The family medical history was significant in some cases. Treatment included early urinary diversion, and there was a high failure rate for ureteral reimplantation. CONCLUSION The combination of congenital elimination dysfunction with facial anomalies, developmental retardation, cephalic anomalies, abnormal urinary tracts, without identified spinal cord disorders or lower urinary tract obstruction, may represent a defined population of children. Identification may lead to early elimination support measures including temporary bladder diversion, Mitrofanoff diversion, alpha blockers and bowel transit medications.

CL134 - Traitement endoscopique du méga uretère chez le jeune nourrisson

En presence d’une indication operatoire, la chirurgie du mega-uretere primitif chez l’enfant fait appel aux techniques de reimplantation ureterale avec ou sans modelage. Cette chirurgie trigonale est preferentiellement differee au dela de l’âge de un an. Dans le cas particulier des jeunes nourrissons porteurs de mega uretere obstructif symptomatique, les techniques classiques de derivation urinaires sont proposees (nephrostomies, ureterostomies et vesicostomies) en attendant la chirurgie radicale. Nous presentons notre experience preliminaire chez 3 nourrissons ayant beneficie d’un traitement endoscopique pour un mega-uretere avant l’âge de 1 an. Il s’agit de 2 garcons et 1 fille âges de 4 a 9 mois presentant un mega-uretere congenital primitif obstructif tres symptomatique, qui ont beneficie d’une procedure endoscopique (cystoscopie – dilatation – montee de sonde ureterale). Le recul apres l’ablation du drainage ureteral est d’au moins 10 mois et aucun de ces 3 enfants n’a necessite a ce jour une chirurgie radicale pour le mega-uretere. Le traitement endoscopique du mega-uretere offre une alternative interessante dans des situations urologiques bien precises. Il peut permettre en effet de differer, voir d’eviter, la chirurgie trigonale classique chez le jeune nourrisson.

Stiffness after neglected elbow trauma in children: a report of 57 cases

Neglected trauma of the elbow in the child is not rare, especially in countries where traditional treatment is still practiced. The authors report a study of 57 neglected elbow trauma in children and the complication of stiffness managed in the pediatric orthopedics department in Rabat, Morocco, between 1996 and 2002. Average patient age was 11 years, location predominated at the right elbow, and the average delay of consultation was 7 months after the trauma. Clinical examination found 36% of stiffness in bending, 29% in extension, and 35% mixed. Of these, 43% were judged very serious, 20% serious, and 37% moderate. Radiological finding showed 35 neglected elbow dislocations (61%), ten supracondylar humeral fractures (17%), and 12 posterior lesions difficult to determine. Abstention from surgery was recommended for 12 patients; 45 were operated on. The end result was 53% with minimal and moderate stiffness. The authors analyzed clinical and therapeutic aspects of all lesions, insisting on abstention from surgery according to the variable and unforeseen character of surgery results.RésuméLes traumatismes du coude négligés chez l’enfant sont loin d’être rares, surtout dans les pays où le traitement traditionnel est encore pratiqué. Les auteurs rapportent une série de 57 cas de traumatismes du coude négligés et compliqués de raideurs, colligée au service d’orthopédie pédiatrique de Rabat au Maroc entre 1996 et 2002. L’âge moyen des patients est de 11 ans, l’atteinte prédomine au niveau du coude droit, et le délai moyen de consultation est de 7 mois après le traumatisme. Le bilan clinique a objectivé 36% de raideurs en flexion, 29% de raideurs en extension et 35% de raideurs mixtes. 43% de ces raideurs sont jugées très graves, 20% graves et 37% jugées modérées. Le bilan radiologique a montré 35 luxations négligées du coude (61%), 10 fractures de la palette humérale (17%), et 12 lésions impossibles à déterminer a posteriori. Sur le plan thérapeutique, l’abstention thérapeutique a été préconisée chez 12 patients et 45 ont été opérés, le résultat global obtenu est de 53% de raideurs minimes et modérées. A travers cette série les auteurs analysent divers aspects cliniques et thérapeutiques de ces lésions, tout en insistant sur l’intérêt de l’abstention thérapeutique devant le caractère variable et imprévisible des résultats de la chirurgie.

Case: Eosinophilic cystitis presenting as a bladder mass in an 11-year-old girl

We report the case of an 11-year-old girl who presented with acute urinary retention and microscopic hematuria. Pelvic imaging revealed a bladder mass for which sarcoma was initially suspected. Surgical biopsies revealed a massive eosinophilic infiltration of the submucosa confirming a diagnosis of eosinophilic cystitis. Clinical evolution was favourable without treatment. Eosinophilic cystitis prognosis is usually benign, but rare severe complications, such as complete bladder fibrosis requiring bladder augmentation or cystectomy, may occur.

Evaluation of the Management of Severe Trauma Kidney Injury and LongTerm Renal Function in Children

Objective: To evaluate the management and long term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury (STKI) grade IV (STKI IV) and V (STKI V) at the trauma center of Grenoble teaching hospital. Materials and methods: This is a single-center retrospective study between 2004 and 2014. All children under the age of 15 managed at the Grenoble teaching hospital for a STKI IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American association for surgery of trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury. Results: 21 children were managed at the Grenoble teaching hospital for a severe traumatic kidney injury (16 STKI IV and 5 STKI V). The diagnosis was initially made by an ultrasonography (8 cases) or a CT-scan (13 cases). A child with STKI IV underwent a nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (3 embolizations, 4 double J stents, 1 arterial stent, 1 peritoneal lavage for a splenic hemoperitoneum, 4 pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11/16 STKI IV with an average of 39.4%, and 17% for the 4/5 STKI V analyzed. Conclusion: Among the 21 children managed for a STKI IV (16 cases) or STKI V (5 cases), 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma, found an injured renal function at 39.4% for the 11/16 SKI IV analyzed, and 17% for the 4/5 SKI V analyzed. There is therefore a significant long term recovery of the renal function in children with STKI (especially STKI IV), confirming the currently conservative management.

SFCP CO-63 - Tumeurs carcinoïdes bronchiques chez l’enfant : à propos de 4 observations

Introduction Les tumeurs carcinoides bronchiques representent des tumeurs rares chez l’enfant. Leur description est rare dans la litterature pediatrique. Materiels et methodes Entre 2000 et 2013 les auteurs rapportent 4 observations concernant des garcons âges de 11 a 15 ans et presentant dans 3 cas des pneumopathies a repetition et dans un cas un tableau de toux chronique. Resultats Le diagnostic a ete pose grâce a l’imagerie et a l’endoscopie bronchique et le traitement a toujours ete chirurgical. Dans 2 cas une reimplantation bronchique a ete necessaire. Un seul enfant avait des noeuds lymphatiques peri-bronchiques envahis. Les 3 autres enfants etaient classes T1N0. Les suites ont ete favorables sans recidive. Conclusion les tumeurs carcinoides bronchiques de l’enfant doivent etre traitees par exercice pulmonaire carcinologique. Leur pronostic est excellent.

P226 - Traumatisme grave du pancreas céphalique chez l’enfant : intérêt d’une double approche combinée mini-invasive par endoscopie rétrograde de la papille et laparoscopie

Objectif Le traitement des traumatismes de la tete du pancreas (TTP) avec rupture canalaire pose des difficultes de prise en charge. Nous rapportons le cas d’une enfant traite par une double approche combinee : endoscopie et coelio-chirurgie. Observation Une fillette de 8 ans presente un traumatisme cranio-facial et une contusion abdominale sans lesion viscerale (TDM initiale). A J3 surviennent des douleurs abdominales, une ascension de la lipasemie, un important epanchement intra-peritoneal. Une TDM puis une wirsungo-IRM objectivent un TTP avec rupture complete du wirsung. On realise un double drainage interne et externe : catheterisme retrograde de la papille (CPRE) avec intubation de la plaie canalaire par une endoprothese, coelioscopie avec toilette peritoneale et drainage par lames placees au contact du duodeno-pancreas. L’evolution est, par la suite, satisfaisante avec guerison complete (recul de 24 mois). Commentaire En cas d’echec du traitement non operatoire des TTP avec rupture canalaire, le drainage interne des voies pancreatiques par CPRE avec pose d’endoprothese represente une alternative de choix. La coelioscopie peut s’y associer en realisant un drainage externe dirige. Le double drainage permet d’offrir a l’enfant le maximum de chances de guerison.