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New trends in epidemiology of hypospadias. RB. Galifer, N. Kalfa, C. Sultan. Department of pediatric surgery, La Peyronie hospital. Montpellier, France Hypospadias is the most frequent genital malformation in the male newborn and results from an abnormal penile and urethral development. This process requires a correct genetic program, timeand space-adapted cellular differentiation, complex tissue interactions, and hormonal mediation through enzymatic activities and hormonal transduction signals. Any disturbance of these regulations may induce a defect of virilization of the external genitalia and hypospadias. This malformation thus appears to be at the crossroads of various mechanisms implicat ing genetic, endocrine and environmental factors. Genes of the penile development (HOX, FGF, Shh), genes of the testicular determination (WT1, SRY) and genes regulating the synthesis (LH receptor) and action of androgen (5 α reducatse, androgen receptor) can be responsible of hypospadias if altered. Several chromosomal abnormalities and malformative syndromes include hypospadias, from anterior to penoscrotal forms. More recently, CXorf6 and ATF3 have been reported to be involved in the occurrence of this malformation. Beside this genomic and hormonal factors, multiple substances found in the environment can also potentially interfere with male genital development because of their similarity with hormones. The proportion of hypospadias cases for which an etiology is detected varies according to the authors but it remains nevertheless low, especially for less severe cases. An interaction between genetic background and environment is likely.

Our experience with extravesical ureterocystoneostomies suggests that there is always enough ureter for continent stoma and ureterocystoneostomy. The method enables the formation of a continent stoma with no intraperitoneal dissection. During the period from 1993 to 2007. In 5 patients the leakage was solved with sting procedure. are excluded. Serbia Background: A technique of using the distal ureter to construct a continent catheterizable stoma is described. which sometimes involves risking the good kidney with a complicated transuretero-ureterostomy.Continent urinary diversion variations on the ureteric Mitrofanoff conduit Krstic ZD. Follow up is for 4 months to 14 years. ureterocystoneostomy (with or without a psoas hitch). In all patients catheterization was easy and painless. Previous reimplantation is not a contraindication to the usage of the distal ureter. Conclusions: Compared with other techniques for continent stomas this method is quicker. Belgrade. and the aesthetic results were excellent. which is the reason why this vesicostomy is most frequently used in our hospital. the method was applied in 29 patients with neurogenic bladder. in one patient. Vukadinovic V. posterior urethral valve. Methods: Mitrofanoff described the use of a nonrefluxing ureter. Smoljanic Z. Depending on the condition of the ipsilateral urinary tract nephrectomy. . Avoidance of intraperitoneal dissection is one of its main advantage (especially in patients with ventriculo-peritoneal shunt). with or without tapering of the distal ureter. All consequences that results from urine contacting nonurinary epithelium which occurs in other continent stomas. Also. uretrocutaneostomy and in one patient bladder augmentation using the ureter on the proximal circulation. We formed a continent stoma by using the distal part of the refluxing or obstructive ureter/megaureter on the functioning or nonfunctioning kidney. In patients with reflux the continent mechanism was formed by using the Lich-Gregoire technique or Barry’s tunneling method. University Children’s Hospital. were carried out concurrently. we performed bilateral ureterocystoneostomy and continentna stoma using the distal ureter from the right side. simultaneously with bladder augmentation. 24 patients had no leakage. bladder extrophy or intraspinal neuroblastoma. requires less skill and causes few complications. Results: Patients had no stenosis of the ureterocutaneous junction.

1: Continence grading performed by anorectal manometry of the perirectal muscle layers. endoanal ultrasound (fig. pelvic traumas. Partial incontinence necessitates a long term period of active muscle training using similar tampons.5 million and in Europe approximately 18. In the group of complete incontinent patients (1998-2008 n=125) the tampon occluded the bowel for 5 hours and longer in 58%.5 million children and adults have continence problems.1). Meier3. G. 2: Voluntary contraction of the perirectal muscle layers can be observed by anorectal endoscopy and can be classified in 4 different continence stages. Saxena2. restoring continence. Fig. The surface of the tampon fits to the anatomical structure of the anal canal. The tampon has a spongy structure. Cohesive and adhesive forces between the surface of the tampon and the bowel develop similar adhesive forces comparable to the resting pressure inside the anal canal in healthy patients. pelvic tumors and overflow incontinence. Conclusions: Anorectal incontinence could be brought under control by continence tampons. Overflow incontinence caused by anal stenosis or by sphincter achalasia could be treated by anal dilatation using smaller tampons. a high elasticity and consists of polyvinyl foam. using tip-catheters: functional diagnosis of sphincter muscles. A. Overflow incontinence caused by anal stenosis or sphincter achalasia could be treated in 43 cases by anal dilatation using anal tampons. No side effects were observed. sacral anomalies. Fig. 4: Occlusion of the bowel by continence tampons and safety for involuntary soiling Fig 1 Fig. 3: Determination of perirectal muscle layers/scars by endoanal ultrasound: morphological/anatomical diagnosis of sphincter muscles. J. Standard size and individually shaped tampons are available (fig. C. The shape of the tampons is determined by endoscopic impressions. endoscopy (fig. Willital1. Tsokas4 1 2 Pediatric Surgical Research Institute. 4 to 5 hours in 20% and 2 to 4 hours in 12%. In 10% tampon application was not possible. Münster-Greven (Germany) Pediatric Surgical University Clinic.Franziskus-Hospital Münster (Germany) Introduction: In Germany approximately 3. M. Fig.H.2).Incontinence is still a taboo topic. 2 Fig. 3 Fig. Aims and methods: Supported by the VW-foundation continence tampons have been developed for partial and complete incontinence to occlude the bowel from inside. K.3) and electromyography. anorectal anomalies.4 . Fig. Perirectal muscle insufficiency can be determined by anorectal manometry (fig.4). A new device to treat anal and urinary incontinence by continence tampons. Results: One has to differ between patients who are completely incontinent and those with partial in-continence. Graz (Austria) 3 Pediatric Surgical University Clinic. Homburg/Saar (Germany) 4 Pediatric Surgical Outpatients Department . In the group of partial incontinence the tampon was used for active muscle training: in 425 children and youth the anal resting pressure increased within 15 months from 10 mm Hg to 125 mm Hg. Main reasons for incontinence are congenital abnormalities of the spine. Treatment of urinary incontinence in males and females by external compression of the urethra using special tampons is developed currently.

New perspectives in the treatment of disorders of sexual differentiation (DSD) Zoran D. Children leaved to grow in gender limbo will encounter numerous restraints in our highly sexually dysmorphic society. Krstić University children's hospital. Many parents find it hard to accept an intersexed child and so will opt for early surgery. Personal author’s experience is that vaginal reinterventions were not big surgical interventions and were methodized on introitoplastics. It is nonsense to think that normal and harmonic sexual development is only possible by clitoral preservation. multicentre studies that explore the potentially varied effect of timing and technique of clitoral surgery on psychological. Still. have claimed that such surgery is damaging and/or mutilating and while it is essentially cosmetic. Is there indeed consensus? Gender development is multifactorial and impossible to predict. It is believed that feminizing surgery is more successful both in cosmetic and functional manner. However. should not be performed until the fully informed consent of the patient could be obtained. Belgrade. It is much easier to make a vagina as a passive organ. Detailed. backed by patient support groups. unsatisfied sexual life could be consequence of inadequate surgery due to “poorly skilled surgeon” and not due to operative technique and clitoral surgery. rather than an erectile phallus of sufficient dimensions 3. Full and open communication with affected families is mandatory with the families encouraged to participate in the decision-making. There are few long term data to confirm or refuse the benefit of “normalizing” the genital appearance. This is in correlation with articles pointing out that more frequent orgasm achievement can be attained by self-stimulation technique. sexual and quality of life outcomes are needed. Bladder tissue engineering in pediatric urology: . Recently some authors. Avoid instantaneous gender assignment before expert evaluation 2. Surgical correction must be made as soon as possible. They will be teased and bullied and may grow into adolescence feeling frustrated and sexually inadequate. so as not to prolong the confusion in regard to the sex of the child 4. The effects on female children of having severely virilized genitalia throughout childhood are unknown. Some patients with urogenital sinus complicated by urine stasis and/or infection may demand early surgical intervention. clitoral surgery should be avoided in mild to moderately virilized children. but rather to form the external genital organs of the appropriate appearance that will allow functional sexuality 2. In 2006 a consensus statement was published summarizing key principles for management of DSD: 1. Recent "philosophy" of surgical treatment of DSD can be summarized with 4 basic principles: 1. Serbia The treatment of children born with disorders of sexual differentiation (DSD) has always been difficult. There are articles pointing out that clitoral surgery interfere sexual function especially when it comes to ability to achieve orgasm. The basis of surgical treatment is not to coordinate the phenotype and the genotype. We are suggesting that sexual “difficulties” may appear independently of surgical intervention that has aim to normalize cosmetic genital appearance. Assessment and longer-term management must be performed in a centre with an experienced multidisciplinary team 3. Sexual function can be compromised by involvement of other factors such as “shame” due to unsatisfied genital appearance. Feminizing genitoplasty does not always achieve this goal and in some patients it is completely successful. subject to evolving attitudes and technique and at times controversial.

without mucous. of Anesthesia – “Bambino Gesù” Children’s Hospital. 2 months aged. Rome. stones or diverticula. Italy Gastro-intestinal tracts for bladder augmentation/substitution presents significant morbidity (up to 30%). Gianfranco Bottazzo*** Dept of Nephrology and Urology (Head Prof. In the results. of Pathology (Head Prof.18%. Sandra Battaglia. underwent partial cystectomy (40 to 60% of native bladder) under general anesthesia. Regenerated bladder capacity was moderately reduced at T1 (. macroscopical and histological examination were evaluated and compared with the native bladder status. THE CLINICAL EXPERIENCE .05).5%. At T2. Animals were sacrified at 5 weeks (T1) and 3 months (T2) from surgery. Bottazzo) – “Bambino Gesù” Children’s Hospital. were reimplanted at the SIS/native bladder suture line (T0). was left in place for a 8 days postoperative period. emerging from the pig black. Renata Boldrini**. Chi-square test was adopted for statistical analysis (p < 0. but the engineered bladder wall was almost regular and not retracted.) and 56% vs 44% in the native bladder (p < 0. Italy **Dept. Gabriele Palombaro*. – “Bambino Gesù” Children’s Hospital. p < 0. At dead-line. and long term risk for malignancy. recognised only at the central portion. The collagen/muscle ratio was 72% vs 28% in the Group A. Italy ***Research Laboratory of Scientific Direction (Head Prof. 2).s. p = n. previously isolated from bone marrow and in vitro expanded. regenerated bladder capacity.05) and almost normal at T2 (+ 2. lined by a normally looking urotelium. M.Facts or artifacts? Paolo Caione. Bladder regeneration by tissue engineering techniques have been proposed. F. using a acellular membrane as bioscaffolds to stimulate. Bladder wall was replaced by 4 x 5 cm small intestinal submucosa (SIS) graft in 6 of them (Group A). In the remaining 4 pigs (Group B). THE EXPERIMENTAL STUDIES Methods and Materials: Ten pigs. Rivosecchi). Rome. Div. 71% vs 29% in the Group B (p = n. Div.Caione). Callea).). P. A suprapubic drain. autologous mesenchymal cells. centripetal fibroblasts and muscle cells ingrowth within the SIS membrane. the scaffold was not more evident and the newly developed bladder wall was well organized in 3 layers: inner urotelium central fibroblasts and smooth muscle fibres. of Pediatric Urology – “Bambino Gesù” Children’s Hospital. In vitro or in vivo bladder regeneration could represent an effective answer to the specific need (1. Italy *Dept of Pediatric Surgery (Head Prof.05 = significant). with thin blood vessels and neurofibrillac. Histology at T1 showed transitional epitelium fully covering the inner surface. utilizing biodegradable acellular scaffolds. seeded with cultured stem cells and biomolecules. both in animal models and in a pilot study on children and review critically the obtained results. a soft and well vascularized newly regenerated bladder wall was macroscopically observed. 3 pigs died and 7 completed the study. At T2. G. The muscular component was imperfect. Rome. Rome. We experienced in vivo new bladder wall development. Several papers recently appeared in literature during the last few years with discordant results. No significant difference was observed between Group A and Group B histology findings. outer well vascularized connective tissue (fig 1 A and B).s.

but it is still experimental in humans. Mean follow-up was 2.029 p=0. mucous or diverticula were observed. but dry intervals didn’t changed significantly (p > 0. At T1 bladder biopsy. cystoscopy with cystogram and bladder wall biopsy for histology. Results: Mean patients age at surgery was 10. Five exstrophic patients (3 males and 2 females) presenting poor bladder capacity and incontinence after complete repair. small nerve trunks and vessels were found with abundant collagen and fibroblasts. Table Age (years) Bladder Capacity at T0 Dry Intervals at T0 Bladder Capacity at T1 Dry Intervals at T1 8 80 cc 45 mins 85 cc (+ 6%) 45 ( . and normal transitional epitelial mucosa. Postoperative periods were uneventful.4 years (8 to17 years). Bladder wall regeneration starts from inner transitional epithelium and continues through smooth muscle bundles and fibroblasts with newly developed blood vessels . The SIS graft was 5x4 wide. SIS membrane was not evident.3 years). Bladder capacity and dry intervals at T0 and T1 are reported in table.The tissue engineering technique was extended in a pilot clinical study. Pre-op and post-op results were compared. bladder volume/compliance.5 years (6 months to 4. smooth muscle fascicles. Methods: “Bambino Gesù” Hospital Ethical Committee approval were obtained. adopting Wilcoxon test for statistical analysis.069 DISCUSSION AND CONCLUSIONS Bladder regeneration by bio-engineered techniques is nowadays feasible in animal models. encouraged by our animal moder results. Bladder capacity resulted significantly increased (p < 0.05).05). underwent bladder wall regeneration using a SIS graft as scaffold and omental wrap (figure). Patients were investigated before (T0) and at 7 months (T1) and 18 months (T2) from surgery by ultrasonography. No bladder stones. uroflowmetry. No long term complications occurred.) 8 90 cc 90 mins 115 cc (+26%) 100 (+15%) 8 90 cc 45 mins 110 cc (+22%) 50 (+11%) 11 120 cc 90 mins 140 cc (+18%) 100 (+15%) 17 130 cc 60 mins 155 cc (+20%) 75 (+25%) _____________________________________________________________________ p=0.

Zavaglia. 2007 (23): 837-839. D. Zavaglia D. Bottazzo. pg 556 (Abstract) . Functional results were partial satisfying. Zavaglia and G. M. D. P. N. Brugge (Belgio). Fierabracci. because the increased volume was not fully adequate and the regenerated wall histology was imperfect. In our limited experience. in our experience.and peripheral nerves ingrowth. Pediatr Surg Int. # S10-3. Atala A. Capozza. opening a new chapter to the Reconstructive Urology. Palombaro G. REFERENCES 1. Boldrini. Caione P. no complications occurred at 2 to 3 years follow-up. A. Lais. Prevel CD et Al. 151: 401-503. Identification and characterization of adult stem/progenitor cells in the human bladder (bladder spheroids): perspectives of application in pediatric surgery. offering an option to increase bladder capacity. Bladder regeneration using small intestinal submucosa as scaffold: experience in five children. grow-factors (TGFbeta). Caione. Di Giovine. P. J Urol 1994. Muscular/connective ratio was found significantly lower than normal. Am J Transplant 2004. 3. Anyway. stem cells. Kropp BP. 25-28 aprile 2007 – Journal of Pediatric Urology. Atti del XVIII Annual Congress of the ESPU. The pilot experience in children demonstrates that bladder wall regeneration is feasible in humans. 2007. Eppley BL.22(7):593-599 5. but it could increase with longer follow-up. Tissue engineering for replacement of organ function in the genitor-urinary system. R. DOI: 10.1007/s00383-007-1096-x 4. Experimental assessment of small intestinal submucosa as a bladder substitute. vol 3. Caione. Boldrini R. with high collagen and fibroblast components.6(suppl):58-73. A. myoblasts within newly selected acellular scaffolds could enhance and modulate the autologous regenerative process. Capozza N. F. In vivo bladder regeneration using small intestinal submucosa: experimental study . Pediat Surg Int 2006. 2.

hepatic steatosis. FRCSC. FAAP King Saud University. thus increasing their risks of developing serious and often life-threatening conditions. and orthopedic complications. The greatest concern and potential public health effects are that obesity during the pediatric age is a strong predictor of obesity in adulthood. hyperlipemia. The physical and social effects of severe obesity in young people are Obesity prevalence is rapidly increasing among children and adolescents worldwide. This presentation will discuss the bariatric surgery in children and adolescent . sleep apnea. The adult experience has demonstrated that surgery is the only effective means of achieving persistent weight loss in obese patients. Saudi Arabia qahtani@yahoo. hypertension. Riyadh .Obesity in children and adolescent and bariatric surgery. Although believed in the past to be less frequently associated with increased morbidity than in adults. obesity in children is now recognized to be associated with insulin resistance. However. The risk increases to 80% if one of the parents is also obese. It is considered one of the most alarming public health issues facing the world today. Aayed Alqahtani. Studies show that 50% to 77% of children and adolescents who are obese carry their obesity into adulthood. FACS. little is known about bariatric surgery in children and adolescents.

Nantes. The paediatric robotic surgery program has started in November of 2007 with at least one paediatric procedure per month. cost and effectiveness must be strongly assessed in order to select the best indications and develop a new strategy for minimal invasive surgery. Centre de pédiatrie Gatien de Clocheville CHRU Tours. Lyon. size of instrumentation and duration of procedures. Robotic surgery in children must be based on specific guidelines regarding team mobility. thoracoscopy or retroperitoneoscopy. Département de chirurgie pédiatrique. and Nice). Seventeen French hospitals are provided with a Da Vinci® robotic system (Intuitive Surgical® ). Most current procedures are pyelo-ureteric junction repair (Anderson Hynes pyeloplasty or polar vessels transposition). positioning of patient. France Video-assisted surgery for children is strongly developed and consists either in laparoscopy. and fundoplications for primitive gastrooesophageal reflux Four paediatric surgical teams will be able to start robotic surgery in the next few months (Limoges.Robot-assisted paediatric surgery: our experience in Tours Hubert LARDY. Robotic surgery is a way to improve minimal invasive surgery in children. Karim BRAÏK. Indications for robotic surgery will be extended to thoracic surgery and visceral malformative surgery such as choledocal cysts and anorectal malformations. However. nephrectomies. Michel ROBERT. A new therapeutic challenge for minimal invasive surgery in children is emerging with robotassisted procedures. The Universitary Hospital Center of Tours was equipped last year. splenectomies. .

excision of choledochal cyst. FACS. FRCSC. ladd's procedure and reduction of intussusceptions . both in neonates with TEF. The mean age was 93 days (range 1 day to 12 months). The weight ranged from 1.There were two conversions. Two neonates had Postoperative hypothermia (<35 C) and one neonate had high Pco2 postoperatively. repair of tracheo-esophageal fistula (TEF). lobectomy. in addition to the required anesthetic and surgical skills have made it difficult to perform these types of procedures in many international centers. MD. Saudi Arabia E-mail: qahtani@yahoo. King Saud University.Minimal Access Surgery in neonates and infants Aayed Al-Qahtani. pediatric surgery. Most of the operations were performed with 3-mm instruments and scopes and mean insufflation pressure of 10 mm Hg (range. operative time. 4-15mm Hg). FAAP Associate Professor. The present article will review our experience with MAS in neonates and infants in the first year of life. Procedures performed included. Intraoperative monitoring of end-tidal Co2 and core temperature are essential in avoiding unwanted effects of performing these procedures especially in neonates.2 kg (mean 4. procedures. Results: 70 infants were included in this study. Kasai's procedure.3 to 8.3 kg). Background: Minimal access surgery (MAS) in small infants caries an important consideration. 24 of these infants were neonates (34%). Riyadh. repair of diaphragmatic or hiatus hernias. All patients tolerated the procedure very well with lesser degrees in neonates undergoing thoracoscopic procedures. . The follow-up ranged from 1 month to 3 years (mean 19 months). The tolerance of these small babies and the assumed physiological effect of MAS. Methods: The medical records of all infants who underwent minimal access surgery over a period of three years were retrospectively reviewed for demographic information. outcomes and follow-up. There was one mortality and no morbidities. Conclusion: MAS in neonates and infants are safe and well tolerated. complications. 19 girls and 51 boys. pull-through for imperforated anus and Hirschsprung's disease plication of the diaphragm.

Acquired gastric outlet obstruction. It has been hypothesized by us that there is some sudden. episodic and sometimes intractable. normal regional anatomy in ultrasound and endoscopic examination. marasmus or even the growth retardation in long standing instances. congenital and the acquired both. dilated stomach with delayed gastric emptying time in upper GI series. non-specific and functional disorder of the pylorus without any extrinsic and intrinsic abnormality. We present here the further eight new cases of this new disease entity which has been called as “JODHPUR DISEASE”. dyselectrolytemia. It is an acquired. All these patients showed visible gastric peristalsis. . Sharma. hugely dilated stomach with normal pylorus and surroundings morphologically on exploration and no abnormality histopathologically including the ganglion cells. seen after 1996 onwards at our center and present our new “Sharma’s Classification of Gastric Outlet Obstruction in Children with the review of recent work published on this topic from now almost all over the globe stretching from Japan to Mexico including the western countries. We had devised the same in 1997 and presented the new disease entity called –“the acquired gastric outlet obstruction during infancy and childhood” which is recently being seen in many more parts of the world now. This has led to an absence of a cohesive thinking on the issue as a whole and thereby there is a need to develop a complete. This unusual condition was reported by the author for the first time in 1997 as a series of five unusual cases of gastric outlet obstruction in infancy and children. elaborate and comprehensive classification of the gastric outlet obstruction so that even the rarest entities could be accommodated and discussed as a compact topic. non-bilious projectile vomiting in wide ranging age group (one month to 17 years) causing dehydration. localized neuromuscular in –coordination in the pylorus due to some unspecified agent causing permanent changes in the functioning of this anatomic region making the drainage operation a necessity. New Sharma's classification. India The gastric outlet obstruction in text books of pediatric surgery is overwhelmingly the description of infantile hypertrophic pyloric stenosis with a small account of other causes. presenting as recurrent. K.

he has normal male external genitalia. uterus and tubes. keeping intact the vas deference on both side and bilateral orchidopexy. Laparoscpoic division of the persistent mullerian structures was performed. the right testis was retractile and the left one was nonpalpable. Otherwise. King Saud University. The video will demonstrate the intra-operative findings and the minimally invasive technique of dealing with this rare entity. Saudi Arabia E-mail: qahtani@yahoo. compatible with persistent Mullerian duct syndrome (PMS).com A 2-years-old boy presented with a nonpalpable left testis. pediatric surgery. . FACS. FRCSC. FAAP Associate Professor. MD. Riyadh. Laparoscopic exploration revealed two testes.Laparoscopic management of persistent müllerian duct syndrome Aayed Al-Qahtani. On examination.

FAAP Associate Professor. Riyadh. FACS.Robotic Pull through for imperforate anus Aayed Al-Qahtani. . It will elaborate on the advantages and disadvantages of such This video will present the first video of its kind describing the technique of robotic pull through for imperforate anus. FRCSC. Saudi Arabia E-mail: qahtani@yahoo. King Saud University. MD. pediatric surgery.

5. Habib Thameur Hospital. Multiple echinococcosis in childhood .Tunisia 4. introduced by our team in 1982.Tunis-Tunisia 7. 6.Radiology Department. Najet Ben Amor.8. La Rabta Hospital .Parasitology Department. Classic prevention modalities are still used.Radiology Department. using the different imaging modalities available to day.Gastro-Enterology Department. surgery was the only efficient treatment modality.Tunis-Tunisia 10.2.Tunis-Tunisia 2.Abdominal Surgery Department. However. Injection of scolicid in the cyst and Reaspiration of the cyst contents). Mohamed H. or by PAIR procedure (Puncture. sheep. diagnosis and US guided treatment . new promising modalities are found. 8. Tunis-Tunisia 6.Clinique CNSS . CT and MRI.Imaging in the hydatid diseases. Najia MoussaHaddad. such as bilharziosis. thoracic and small parts location. This technique is well appreciated by the population and adopted by WHO for the epidemiologic studies in other tropical diseases. in 1981. Fethi Ladeb. goats and definitive host such as dogs.Gastro-enterology Department Ibn Zohr 1003-Tunis-TunisiaHydatid disease (HD) is a worldwide calamity.. 7.Radiology Department. More than 3000 cases are published as successful treatment for the abdominal. mainly US is a wonderful tool for the screening of the asymptomatic population in rural epidemic areas.Radiology Department. Kassab Institute . Azza Hammou. Our US classification described for the US imaging.3 . Zoubeir Ben Safta. Ibn Zohr. Our multidisciplinary team played an important role in this field with a close collaboration and help from French.Tunis-Tunisia 3. Ibtissem Bellagha 2. Aspiration.1003. during endoscopy. we proved that medical imaging may play an important role for the eradication of this calamity around the world. interventional procedure.Cardiology Department.Tunis-Tunisia 5. Veterinary School Sidi Thabet –Tunisia 11.10.9Tunis –Tunisia 1. Habib Thameur Hospital. Formerly.1. is used all over the world to day. 23- 4- We will present the strategy we suggest for the exploration of HD. Italian and Europeans Institutions. based on the vaccination of intermediary host. Children Hospital-1007.National Center of Radiation protection Tunis 1007. During the last 35 years.Tunis-Tunisia. What is new in 2008 Wiem Douira. Abdejabbar. During these non surgical techniques medical treatment is still used as complementary method. 1Medical imaging. 1001. Sémia Lahmar. Daghfous.Rachid Mechmèche. Moncef Gargouri. cows. is worldwide used today for all the others modern imaging modalities. Today.Epidemiology.11. Férid Ben Chéhida.Radiology Department. 11. This PAIR technique.Ghorbal. La Rabta Hospital Tunis-Tunisia 9.4.

No productive biliary fistula was observed. Treatment outcome was defined as cure. Albendazole was given as 10 mg/kg daily continuously. MEKKI. A. KSIA. Tunisia Purpose: Multiple echinococcosis (ME) is a severe disease in childhood inaccessible to an initial radical surgical treatment. NOURI. The total treatment duration ranged between 1 and 5 years. stabilization or deterioration. The aim of this study was to evaluate the efficacy of Albendazole in ME and to discuss the role of surgery in this pathology. BEN BRAHIM. Two patients were operated laparoscpically. Methods: Thirteen patients were included in a prospective study between 1996 and 2006. This rate was only 31. M. Parasitologic examination of operated cysts showed that 30% of them were viable even after 3 years of treatment. improvement. A. A complementary surgical treatment is often necessary in hepatic localizations and it is facilitated with previous Albenazole therapy. .M.4% of hepatic cysts were cured. Monastir. After surgical therapy.7% pulmonary cysts and 96% peritoneal cysts were considered as cured. Results: Our patients totalized 331 cysts located essentially on the liver (215 cysts) and the lungs (81 cysts). Surgery was discussed after 1 year of treatment. ME was defined by the presence of 10 or more cysts in the same organ. Conclusion: Albendazole has proven a strong efficacy in pulmonary and peritoneal localizations.5% in hepatic localization. Combination of ABZ and surgery seems to have encouraging results and must be applied for those patients. BELGHITH. Department of pediatric surgery. 57. The high rate of viable cysts after medical therapy is problematic and must incite to develop new antihelminthic agents. EL EZZI. O. M. 60. With exclusive Albendazole therapy.

A. Masmoudi. S. Department of pediatric surgery. hydatid serology and preoperative biological analysis (blood grouping.Laparoscopic treatment of hydatid cyst of the liver in children. Results: 17 boys and 17 girls were treated by laparoscopic surgery for hydatid disease of the liver. Ben Brahim. and one year before and six months after surgery for the second case. M. I. Materials and Methods: This is a prospective study carried. Maazoun. M. L. Laparoscopic access of the abdominal cavity is achieved under direct vision after vertical incision directly through the umbilicus by a 10 mm trocar. Ages ranged from 3 to 14 years (Average: 7 years 7 months). Laparoscopic treatment of hydatid cyst of the liver remains controversial because of the small number of patients and lack of hindsight series published. sterilisation of its content by infusion of hypertonic saline solution during 10 min then reaspiration. The puncture-aspiration is done with a 1. Monastir. The cyst is opened and the proligerous membrane is removed and put in a sack. Tunisia. J. Sahnoun. Tunisia Introduction: Hydatid cyst is a parasitic disease caused by the tape Worm Echinococcus Granulosus or Echinococcus alveolaris. Mekki. The pads and resected pericyst are put in the same sack then exteriorised by the umbilical orifice to prevent the risk of intraperitoneal soiling and contamination. The CO2 pneumoperitoneum pressure is maintained between 10 and 12 mm/Hg depending on the patient’s weight. It includes 34 children who underwent laparoscopic surgery for hydatid disease of the liver at the pediatric surgical center of Monastir. A 0 or 30 degrees telescope is then used depending on the cyst localisation. Chahed. The third patient had a hydatid cyst of the left lung sized 20 mm and undertook Albendazole treatment one year after surgery in the hope of cyst regression. Operative technique: After the induction of general anesthesia. Nouri. hemostatic analysis). Krichene. Three patients had Albendazole therapy before intervention: two cases for disseminated hydatidose with treatment of five years before and six months after surgery for the first case. After that. Belghith. The disease is endemic in Tunisia and many other areas of the world. to avoid the surgery. M. The aim of this work is to study the specificities of this approach in the treatment of hydatid cyst of the liver in children. abdominal sonography. Laamari. a third trocar was necessary to retract the liver. M. All the patients had a chest-X-ray. . The abdominal tomography and the hepatic analysis weren’t done for all the patients. all patients received prophylactic antibiotics. The residual cavity draining is not systematic.out between September 2001 to July 2004. Two other 5 mm trocars are introduced in the right and left hypochondrium.6mm diametre needle through one of the trocars or transparietal Veres. Hidouri. The cyst is protected by sterile clean pads introduced through the umbilical trocar and filled with hypertonic saline solution. blood count. The parents were previously informed and they agreed to participate in this study. K. R. we proceed to a puncture aspiration of the cyst. In four cases. The last step is the resection of the dome and the search of biliary fistula.

3 patients had post operative Albendazole treatment. Complex cysts were not found to be a contraindication to this operation. However. 7 of type II. Also. The second case had 20 cysts. The advantages of the laparoscopic approach compared with open surgery are good cosmetic results. The laparoscopic approach can be advantageous because the endoscope can be introducted into the cyst cavity for inspection and to make sure that no daughter cysts or laminated membranes were overlooked [5. two for fissurated cysts of the liver. The patient. the number of cysts treated with surgery ranged from 1 to 7 (58 cysts:1. No patient needed a blood transfusion before nor after intervention. Discussion: Many reports of laparoscopic surgery for liver hydatidosis exist in the adult literature [2-3]. the indication of cyst cavity drainage is the no declivous residual cavities. We think that the number and size of the cysts are not contraindications to this operation. abdominal mass in three and in the check up of on hydatid disease of the lung in 21 cases. especially under high abdominal pressures induced by pneumoperitoneum [3. One case had an associated mesenteric hydatid cyst and an other a splenic hydatid cyst. 3 of type III and 2 of type IV from the Gharbi’s classification [1]. this approach helps to detect small bile openings [5. with the help of the magnification by telescope. No peroperative complications were observed and no conversion to an open operation was done. . Operative time ranged from 30 to 210 min (average 90 min). had the same 20 mm sized cyst after one year of medical treatment. In addition. less time duration and rapid recovery. cysts with biliary communication. that offers an advantage compared to classic surgery. The average hospital stay was 5 days (ranging from 4 to 14 days). the 10 remaining others were treated by laparoscopic surgery. this technique is safe in exploring the dome and cysts located posteriorly with a 30° telescope. No post operative complications were observed after a follow up ranged from 12 to 45 months (a mean of 23 months). This was the case of two of our patients who had a mesenteric and a splenic hydatid cyst associated to the cyst of the liver. who had a hydatid cyst of the left lung sized 20 mm and performed Albendazole treatment before and after surgery. Bicket and al [11] demonstrated that the increase in intracystic pressure was no greater than the increase in intraabdominal pressure and that the pneumoperitoneum was protective against spillage. These associated hydatid cysts were treated at the same time. 9].7 cyst/patient). The right liver was concerned in 35 cysts and the left one in 23 cysts. 12 involueted with medical treatment. It allows treatment of other abdominal cysts at the same time. 10]. The Eight remaining cysts were treated by laparoscopic surgery. 46 cysts were of type I. deepseated cyst of the 7th segment which was not found in peroperative. the location of the cyst also is not a contraindication as is reported by some authors [6]. Two cases of disseminated hydatidose were treated with Albendazole. We report one of the few pediatric series of hydatid disease of the liver treated by laparoscopic surgery [4]. In the other cases. 8].5 mm (ranging from 40 to 150 mm). The alimentation was introduced at the first post operative day. The cyst size was 65. Its evolution was favourable with medical treatment. As in the open surgery. This technique is controversial in adult studies. A major disadvantage of laparoscopy is the lack of precautionary measures concerning spillage. In fact. deeply located cysts and disseminated liver hydatidosis should be excluded [5-7]. The first one had 30 cysts treated medically with involution of 20 cysts. The residual cavity draining was done in 27 patients with no declivous cyst cavity. as we had a calcified cyst one year later.The circumstances of diagnosis were abdominal pain in 10 cases. one for a small. For many authors.

The recurrence in laparoscopic studies ranges from 0% to 9% [5. 13. The recurrence rate ranges from 0% to 30% following open surgery for hydatid cysts [18].2 % [23]). In our laparoscopic series with a mean follow-up of 23 months. including relatively short hospitalization. good cosmetic results. 16. Cyst puncture carries the risk of spillage. 14. remains the prophylaxy. This last situation was the case of the patient who had a small pulmonary cyst associated. the lack of accessibility to extra hepatic cysts. The procedure of needle aspiration. The conversion rate in our series with 34 patients was 0% while the average rate in other laparoscopic series has been 12 % (range 0 %. and possibility of performing the procedure using local anesthesia [19-21].27%) [8. 15]. however. 10]. . and limitations in treating cysts in proximity to major blood vessels [24-25]. and catheter drainage has advantages. small pulmonary associated cysts [6. Factors increasing the risk of conversion include posterior location and advanced stage of the cysts [12]. we have not seen any anaphylactic shock. In our laparoscopic series.The scolicidal agents are used pre and post operatively by some authors in these situations: disseminated liver hydatidose. results are similar to those obtained in open surgery. Some authors consider that this procedure is unsuccessful in 20 % of patients. infection and peri hepatic fluid collection [8. Another concern for the laparoscopic approach is the risk of anaphylaxis [8. spillage of the cyst content in the abdominal cavity. it is not without drawbacks. Post operative morbidity in laparoscopic studies ranges from 8% to 25% and includes biliary fistula.1 % to 0. 12. with better cosmetic results and a shorter hospital stay. we have not seen any recurrence. 12. which because of the procedure’s percutaneous nature can be uncontrolled. Percutaneous aspiration under radiologic guidance has been advocated as an alternative to surgical intervention. Conclusion: Laparoscopy represents an excellent approach for the treatment of hydatid cyst of the liver in children. 10]. 8. deeply located cysts of small size. the difficulty of eradicating complicated cysts (Gharbi type III and IV)[23. 10. 14]. Provided the exclusion criteria are observed and the surgeon has a perfect command of the operative technique. Post operative follow-up should be the same with the classic surgery. However. injection of scolicidal agent. Failures occurred more often with type III and IV cysts [26]. 17]. thus leading to dissemination of the disease or anaphylactic shock [22] (anaphylactic shock range from 0. 13.26]. The essential treatment. Also it may be indicated in the case of deep-seated cysts.

Nouri Abdellatif3. The analysis of corresponding profiles yielded an interesting immuno-reactive double band of 27-28 kDa.strasse. The serological follow.up of human cystic echinococcosis Ben Nouir Nadia1. calcareous corpuscles and the germinal layer. The protein is mostly abundant on protoscoleces' tegument. Hemphill Andrew2. strongly persisted till the end point follow up of patients who had still active cysts. was successfully prepared by cloning the appropriate segment of c DNA into the PET 151/D vector (Invitrogen) and expressed in E.up is necessary to prognostically determine the efficacy of treatment and to detect newly growing or relapsing primary cysts as early as possible. Institute of parasitology.specific component of Echinococcus granulosus. Sera of follow-up from CE patients who underwent surgery and/or chemotherapy were analyzed by immunoblotting using protoscoleces soluble protein extracts. 5000 Monastir Tunisia Human cystic echinococcosis (CE) is one of the world's major zoonoses that still poses diagnostic and follow up problems. These findings suggest the P-29 protein as new marker of cystic echinococcosis follow-up and further studies are required to investigate this protein in developing laboratory tests for serological monitoring of human cystic echinococcosis. Mûller Norbert2. Gianinazzi Christian2. On the other hand. coli as a fusion protein with His-Tag. The search for new antigen markers for post-treatment follow. Immunological localization of this antigen on metacesode components was investigated by immunohistochemistry and electron microscopy using polyclonal antiserum. Naguleswaran Arunasalam2. and which.up value of recombinant P-29 was tested by inmmunoblotting with sera of follow. which progressively disappeared in cured cases. however.rue Avicenne. The full length recombinant P-29 protein. Gottstein Bruno2 1 University of Monastir. 5000 Monastir Tunisia. Conversely to non cured patients (active cysts by imagery) who were still positive regards to recombinant protein in 80% of cases. laboratory of parasitologymycologie. Mass spectrometry analyses revealed that this doublet corresponds to the 14-3-3 isofrom 2 and the P-29 protein a metacestode. Nuñez Sandra2. Immunological reactivity of sera from cured patients to recombinant P-29 showed a progressive decrease of intensity starting from 6 months post-treatment and only 7% of cases were immunoreactive at 1 year post-operative. .up from surgically confirmed 28 CE patients. 99UR/08-05 1. Faculty of pharmacy. Switzerland CHU Fattouma Bourguiba. 122 CH-3001 Bern. 2 3 University of Bern. Babba Hamouda1. Längasse.Cloning and expression of a c DNA encoding the P29 protein with potential usefulness in serologic follow.

that proved to be useful to treat fetal giant cervical masses and for the retreat of the tracheal occlusion in the plugged cdh cases. 2 shunts for bladder drainage in lower urinary tract obstructions (luto) and one percutaneous valvuloplasty to treat a fetal aortic stenosis of the heart. To date. Refinement of this technique and technological advances will permit its utilization for other pathologies in the future. We have carried out exit procedure in 16 cases. Spain. solid ccam and myelomeningocele. An accurate prenatal diagnosis is mandatory to select the cases that can benefit of this prenatal therapy. fetoscopic laser release of umbilical and extremities amniotic bands were performed in 2 cases. This technique was used in 241 cases to treat twin-to-twin transfusion syndrom (ttts) in biamniotic monochorionic twin gestations by means laser coagulation of communicant placental vessels. Less invasive surgical techniques as fetoscopy reduce incidence of this problems. After the detection of a fetal anomaly emerges the possibility to carry out an intrauterine treatment to repair or to interfere in the natural evolution of the malformation during the fetal period. Main limitation of open fetal surgery is preterm labor because uterine dynamics stimulated by surgical aggression. spina bifida and constrictive amniotic bands. Jose l. to analyze the therapeutic possibilities of the intrauterine treatment for the different antenatally diagnosed surgical malformations. up to now. We present the experience of our center in fetal surgery with the cases treated from January 2002. Prenatal image techniques with ultrasounds and mri permit. we are working to develop new strategies for treat by means fetoscopy other malformations as cleft lip-palate. We have placed 14 thoraco-amniotic shunts to treat fetal hydrothorax or ccam. Barcelona. In the experimental field. to carry out precise diagnoses of several fetal congenital malformations. Hospital vall d’hebron. . at present. in 36 cases for the obliteration of the umbilical cord in cases of discordant monochorionic twins with serious or lethal anomaly in one of the fetuses and for treat the sequence of reversed arterial perfusion (trap). Open fetal surgery is reserved. to treat the sacroccygeal teratoma. nowadays. Fetal surgery is. We used fetoscopy in 16 cases for the prenatal treatment of severe congenital diaphragmatic hernia (cdh) by fetal tracheal occlusion with an endotracheal balloon. we have performed 304 fetoscopies. It is indispensable to have a multidisciplinary formed medical team very well coordinated to achieve acceptable results in fetal surgery.Fetal surgery: experience of barcelona (spain). Finally. At present we have open fetal surgery and less invasive techniques as fetoscopy and the placement of ultrasound-guided shunts to treat different fetal malformations. a reality that permits to treat or to improve the prognosis of different antenatally detected fetal malformations. Peiró md.

children with such deformities are viewed with curiosity by their classmates and they are often confronted by teasing remarks. It is important to note that although thoracic wall deformities do not arouse the sympathy generated by limb or cranial anomalies. Experience from the data collected from 160 minimal access surgeries with regards to complication in thoracoscopy has been presented. and the changing trends in the world of fashion which expose more of the chest to the public view. This technique involves bilateral transverse chest incisions. resection of parasternal deformed cartilages. Austria Thoracic wall deformities represent a spectrum of musculoskeletal disorders of the anterior chest wall. Minimal access surgery has gained popularity in the management of thorax wall deformities. insertion of an introducer into the chest cavity. bilateral rib osteotomy and sternal wedge osteotomy and stabilization of the deformity using metal struts. The role of minimal access surgery however has been limited to pectus excavatum. en-bloc preparation of the musculo-cutaneous flap. pectus carinatum and combined forms. As more experience was gained in the surgical reconstruction of the thorax over a 20-year period in 1262 corrections. MD Department of pediatric and adolescent surgery. however thoracoscopy is associated with many complications most importantly . which is the most common of the thorax wall deformities. SAXENA. Conventional open surgical techniques have been successfully employed for the management of all forms of thorax deformities: pectus excavatum. retrieval of the introducer tip on the contra-lateral chest wall. these procedures have undergone constant improvements to offer reduction in intraoperative and postoperative surgical complications. These techniques involve a midline chest skin incision.Pectus deformities: changing senario to evaluation and treatment AMULYA K. . Various open and minimal access surgical techniques have been developed for the reconstruction of the deformed thorax wall. placement of the pectus bar and stabilization of the bar on the chest wall. careful dissection of the retrosternal cardiac attachments. Most of these deformities are fortunately not life-threatening and do not manifest in severe functional pathophysiology of the thoracic organs. medical university of Graz.pneumothorax. The introduction and standardization of thoracoscopy in minimal access surgery of pectus deformities has helped to improve the safety during procedures. Since the introduction of the minimal access correction of pectus deformities improvements have been made in the surgical technique to reduce the risks of complications. The modifications in surgical techniques have also played an important role in achieving excellent long-term results. The management of these deformities has gained more importance in the past decade because of the increased participation in competitive school sports as well as athletics.

Visceral communications .

Materials and methods: Eighty-four patients with HSCR admitted to our Department of Pediatric Surgery between July 2006 and July 2007 underwent interview. Based on the common genetic background we designed a prospective study aimed at determining the prevalence of CAKUT in patients with HSCR and at identifying RET.4 1 3 Department of Pediatric Surgery.4. the reported incidence of HSCR+CAKUT seems somehow underestimated. . Genoa. Results: Twenty-one HSCR patients (25%) have CAKUT. Dialysis and Transplantation. HSCR predisposing T aplotype of RET proto-oncogene was found in 64% of HSCR patients. Giannina Gaslini Institute. 18-fold higher risk of developing a CAKUT if compared to the normal population. Musso Marco MD 2*. GNDF and GFRα1 seem not to represent causative genes. RET should act as a modifier gene with other genes involved. GDNF mutations in 3 whereas no GFRα1 mutations were found. Six further HSCR patients have other non-CAKUT anomalies of the urinary tract that increased renal involvement to up to 32%. it will be mandatory to develop new diagnostic workups for patients with HSCR including renal and urinary tract screening. RET mutations were found in 5 patients. Jasonni Vincenzo Prof 1. Laboratorio di Genetica Molecolare. Furthermore. 4University of Genoa. We could thus speculate that HSCR+CAKUT is a novel syndromic association with low HSCR penetrance (in literature the average incidence of HSCR in CAKUT series accounts for roughly 2%). ultrasound screening (further investigation according to the detected anomaly). Ceccherini Isabella MD 3. Hydronephrosis and hypoplasia represented the most frequent CAKUT detected in our series. RET. a patient with HSCR has a 3. Nonetheless. GDNF. The proportion of predisposing aplotype in HSCR+CAKUT patients resembles that of other syndromic HSCR. 2Division of Nephrology. Finally. Discussion and conclusions: The incidence of CAKUT in HSCR patients is 4 to 6 fold higher than expected. 27 consecutive patients with isolated CAKUT were included as control group. If thess results will be confirmed on larger series. 50% of HSCR+CAKUT patients.Hirschsprung disease and Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A novel syndromic association Pini-Prato Alessio MD1*. and GFRα1 mutations or haplotypes.4 . Mattioli Girolamo Prof 1. Giunta Camilla MD 1. and DNA extraction for molecular genetics. Moreover. Nonetheless. and 24% of CAKUT patients. particularly hydronephrosis or hypoplasia. Ghiggeri Gianmarco MD 2. Italy Introduction: Hirschsprung disease (HSCR) can occur in association with congenital abnormalities of the kidney and urinary tract (CAKUT).

Results: The bowel movement reestablished within 7-12 hours postoperatively. avoiding abdominal exploration. In all 27 patients transitional zone was suggested by contrast enema and by perioperative full thickness rectal biopsy at 3 cm above the dentate line. The paracolic redon suction drain was applied for 24 hours. Bowel preparation was done using Bisacodyl suppositories. The extent of colonic resection was specified by perioperative biopsy. Ceftazidine and Metronidasole were used as antibiotics treatment. Conclusions: Transanal one stage endorectal pull-through operation for rectosigmoid Hirschsprung’s disease can be successfully performed in all ages with good results. Methods: Between December 2006 and June 2008. Aganglionic segment of the colon was resected and normal colon was pulled down to an anastomose with the distal end of anorectal remnant. The length of intestinal resection was between 15 and 42 cm. All but one patient healed up without complications. Slovakia Email: vidiscakm@yahoo. The colorectal anastomosis was performed according to Swenson’s technique. Children’s Purpose: This study presents a technique and results of transanal one stage endorectal pull-through procedure in children with rectosigmoid Hirschsprung's disease. Bratislava. Oral intake began 24 hours after the operation. 27 patients underwent transanal one stage endorectal pull-through procedure.Transanal endorectal pull-through procedure in patient with Hirschsprung’s disease Marian Vidiscak. Lucia Hustavova Department of Neoanatal and Pediatric Surgery. The length of hospitalization ranged from 5 to 7 days. Slovak Medical University. . In one patient perirectal collection with increased inflammation parameters was treated conservatively by means of antibiotics.

Chimezie Uchime. Dublin. Methods: We reviewed the records of 41 patients over an eleven year period spanning 1995-2005 inclusive with surgically treated hepatobiliary pathology in Our Lady’s Children Hospital. Ireland Email: seemamenon@hotmail. 1 died on OLTx waiting list. 1 had choledochoduedenostomy. Patients in group I and III did well without sequelae.Hepatobiliary Surgery: A single centre experience Hanan Said. 2: Caroli’s disease. Group IV involved only 1 cystadenoma of the pancreas. Paediatric hepatobiliary surgery is complex and must be carried out in a tertiary centre with an experienced and skilled hepatobiliary surgeon. Katherine Lannigan. Onasegun Owonikoko. Seema Menon.6 years. .) and 2 patients with head of pancreas mass lesions (1 modified Whipple). Group I included 21 patients who had abnormal pancreatico-choledochal junctions (18 primary and 2 secondary Roux en Y excision and drainage) of the 19 choledochal cysts (17: type one. The majority of this group presented with abdominal pain. Results: Mean follow up for all patients is 3. jaundice and abdominal mass. Group IV: The patient with cystadenoma had moderate pancreatic insufficiency following partial pancreatectomy. Martin Corbally Department of Paediatric Surgery. Group II included 19 patients who had biliary atresia treated by Kasai (mean age 5. 1 died of cardiac disease. Group III consisted of two patients who had traumatic biliary injury (blunt abdominal trauma in one and traumatic ductal injury in the other). Ireland. Conclusion: Our results from the cohort of patients studied are good and are in line with international Aim: A retrospective eleven year study of surgical hepatobiliary outcomes in a national Paediatric Unit. . Alan Mortell. Group II: 11 are anicteric but 2 has severe portal HT. 6 have undergone OLTx. Our Lady’s Hospital for Sick Children Dublin. and 1 had CBD exploration.1 weeks).

one patient had a gross leakage at the gastrostomy site that cannot be managed conservatively. There were 11 males and 14 females. V Sehiralti S. complications. A Bas. A Stamm gastrostomy was then performed.5-44 months). Results: During a 44 month period. C Ulukaya-Durakbasa.Pediatric percutaneous endoscopic gastrostomy. 10 children died of underlying disorders on an average of 8 months after PEG insertion. Department of Pediatric Surgery. The median age was 76 months (range. 26 PEG applications were done in 25 children. All procedures were done under general anesthesia in the operating suit. Among these. He underwent a second PEG insertion with removal of the first one. In one patient. . The mean postoperative follow up is 13 months (range. The most frequent indication for PEG insertion was chronic neurological disease (n=18) followed by intracranial tumors (n=6) and cleft palate (n=1). AN Tosyali. In another one gastroesophageal reflux developed 5 months later and an open fundoplication with gastrostomy was done. The catheter was removed in 2 after a mean of 9 months as the oral feeding was re-established. The initially inserted catheters were replaced with balloon-type silicone replacement catheters at the 4th month. PEG should be the first-line method for providing long-term artificial enteral nutrition.B. Regarding its simplicity. Methods: A retrospective review of all children who underwent a PEG application was conducted. M Sert. outcome and follow up is presented. PEG offers the advantages of being a minimally invasive procedure. The remaining 11 children are alive and actively using the PEG catheters. Conclusions: Although not devoid of complications. 1. Istanbul Goztepe Training Hospital. being easy to care for and enabling a permanent access for enteral nutrition in handicapped children. Turkiye Email: cigdemulukaya@yahoo. An audit regarding PEG indications. Either No early complications were encountered. H Okur. effectiveness and Aims: The experience on pediatric percutaneous endoscopic gastrostomy (PEG) applications is relatively limited in children. 8 months-14 years). HM Mutus. a gastrocolic fistula was detected 4 months after PEG insertion.

Ever since the first cases. we have perfomed extra mucosal pylorotomy by ombilical way in 70 children presenting with congenital hypertrophic pyloric stenosis.Extra mucosal pylorotomy by ombilical way Ouslim Rachid. This Technique is beneficial for children with a better post operative course and avoidance of any skin scar. The surgical technique and the precautionary measures are here explained again. . Boukli H Since 1998. the technique and instruments have been adapted.

S. 1 case of failure due to early necrosis of the gastric tube witch had been replaced by a colonic interposition. Ghorbel. I. In 9 cases. All the children are eating well and thriving without swallowing or respiratory problems. Baryum swallow was performed 7 days after the procedure and oesogastric endoscopy nine months after. Tunis. Tunisia Email: awatef_charieg@yahoo. S. Charieg. M.Esogastroplasty: a prospective study about 16 cases Introduction: The aim of this study is to analyze the outcome in 16 children undergoing an esophageal replacement with a gastric tube. Materials and methods: During a 4-year period. associated to cervicotomy in 14 cases and thoracotomy in 2. Children’s hospital. Sarray. the outcome was considered good to excellent. Jlidi. Brini. failed repair of different varieties of esophageal atresia(4cases). Chaouachi Department of pediatric surgery "B". and peptic stricture (1case). Results: There were 5 girls and 11 boys undergoing the procedure at a medium age of 4 years (range. Ben Dhaou. The most common indications for esopageal replacement included caustic injury (11 cases). Boukthir. B. A. 9 months to 14 years). R. Nouira. S. 16 children underwent gastric tube esophagoplasty. Laparotomy was performed in 16 children. F. Khemakhem. Conclusion: The esophageal replacement by a gastric tube appears to fulfill all the requirement of a good esophageal substitute with less drawbacks and good long-term results. from 2002 to 2006. . Anastomotic strictures occured in 7 patients all responding to endoscopic dilation. Anastomotic leakage occurred in 6 patients witch closed spontaneously.

CA KARADAG. Turkey Email: cakaradag@yahoo. Reduction procedure was applied by a radiologist and pediatric surgeon via a Foley catheter put into rectum. material and reason for fail were not sufficiently investigated. a spontaneous intestinal reduction was observed in the beginning of exploration. Conclusion: Hydrostatic reduction of intestinal intussusceptions by saline solution under ultrasonography is widely accepted. Surgical procedures as resection and anastomosis or ostomy were needed in 5 cases in both groups. We divided our series into two groups. Patients and Methods: During the period from1995 to 2008. the same reduction procedure was performed by different radiologists and pediatric surgeons during the period 2001 to February 2008 and the results of procedures in this group were evaluated retrospectively. Clinical progress was accepted as an additional sign. Experience of the team was a factor of high success rate of the procedure. hydrostatic intestinal reduction under ultrasonography was performed for 152 intussusceptions cases. In Group II. M YALCIN. easily applicable and highly successful therapeutic procedure. D BASKIN. low cost. Transit of saline solution from caecum to terminal ileum under sonographic vision was accepted as an efficient intestinal reduction. an exploration was performed: manual reduction was required in 3 cases in GI while in 18 cases in GII. In the case of fail of the procedure. In 7 cases of GI. . Group I: this is an prospective study group (n: 51) performed during the years 1995 to 2001 via same radiologist and specialist pediatric surgeons. Istanbul. The cases with delayed intestinal obstruction. low hospital stay. easy and efficiency of the procedure. shock and presence of peritonitis were excluded from the Aim: Hydrostatic reduction of intestinal intussusceptions by saline solution under ultrasonography is widely accepted procedure in many centers because of non-ionizing therapy mode. But the technical details of procedure as applying mode and time. N SEVER. The most important advantage of the therapy is being non-ionizing one.Hydrostatic reduction of intestinal intussusceptions by saline solution under ultrasonography. the success rate is high. A CANMEMIS. AF AYDIN. Because of surgical and radiological collaboration for evaluation of patient’s signs. Results: The success rate of the procedure was 80 % in group I and 71% in group II. No complication was seen in our series. AI DOKUCU Sisli Etfal Education and Research Hospital Pediatric Surgery Department. Here we reviewed our experience in our intussusceptions cases treated by this procedure. short applying time.

N. 5 patients have an homozygous form of SCA and 22 have sickle-β-thalassemia. In many cases. with emphasis given to the indications of splenectomy.2 years (range. Report of 27 paediatric cases. Conclusion: Splenectomy encourage particularly the increase of erythrocyte lineage and haemoglobin rate. followed by hypersplenism in 3 patients (11. Hopital Habib 1 2 Service d’immuno-hematologie pediatrique. F. They are divided on 16 boys and 11 girls. We retrospectively reviewed our experience in the management of 27 children with SCA who had splenectomy as part of their management. N KAABAR2. sex. Hb electrophoresis. but 3 patients (8. DHOUIB1. spleen weight and postoperative complications. The mean Hb levels befaure splenectomy is 7. M. The medical records of all children with SCA who had splenectomy at our paediatric unit were retrospectively reviewed for the following: age at splenectomy. Centre National de Greffe de Moelle Osseuse Tunis Service de chirurgie pediatrique. TLILI1. The mean Hb post-splenectomy is 9. But. the complete splenectomy exposes to more infectious risks. It eliminates the risk of ASSC. indication for splenectomy. and it is a good indication of hypersplenism during sickle-cell anaemia. Ten of our patients (37%) had splenectomy and cholecystectomy at the same time. Recurrent acute splenic sequestration crisis (ASSC) was the commonest indication for splenectomy in 24 patients (88. Their mean age is 7. This complication may be prevented by a good perioperative management.69 g/dL.8 years).07 g/dl. splenectomy is recommended in the treatment of some evolutive complications of SCA.BEJAOUI1 Email: tlili_yemen@yahoo.5-9. . 80-2000 g). Tunis Introduction: Sickle cell anemia (SCA) is one of the commonest hereditary blood disorders in Tunisia.Splenectomy for children with sickle cell disease.8%). and seizures in one case). There was no mortality.5 g (range. The mean spleen weight was 772. Results: 27 patients with SCA had splenectomy. 4.1%) developed postoperative complications (pulmonary infection in 2 cases. Y. MELLOULI1. Patients and methods: Between January 1998 and December 2006. It’s characterized by the presence of abnormal form of hemoglobin (HbS). type of surgery.2%).

Conclusions: The presentation of OMDR can vary from mild umbilical abnormalities to complications necessitating extensive resections. Tosyalı SB Göztepe Training Hospital. V. umbilical abnormalities in 14 (26%) and rectal bleeding in three (6%). perforation in three.M. The reported series on symptomatic children are not diverse. The major complications were found to be GI obstruction and inflammation. necrotic MD in two. acute abdomen in 15 (28%). surgical findings and pathological evaluation. Okur. Methods: A retrospective search through the years 1992 and 2007 was done for symptomatic presentations. Özen. The postoperative course was uneventful in all. volvulus or intussusception in 17. The operation revealed inflamed Meckel’s diverticuli (MD) in 17 patients. The remaining 10 specimens were lined by normal mucosa. umbilical sinus in two and completely patent OMDR in 12 patients. M. A. There were 34 males and 10 females.A. . Turkiye Email: cigdemulukaya@yahoo. OMDR can be the underlying etiology in any child with acute abdominal findings and prompt surgical treatment is indicated in all symptomatic cases. Mutus. Istanbul. The median age was 48 months. Histopathology revealed ectopic gastric mucosa in 13 (24%) specimens. ectopic pancreatic and gastric tissue in one (2%). Results: A total of 54 operations were done for symptomatic OMDs. inflammation in 24 (44%) and necrosis in five (9%).Omphalomesenteric duct remnants Ulukaya Durakbasa. A. ectopic pancreatic tissue in one (2%). obstruction due to band compression. This report gathers experience on the subject with emphasis on modes of presentation. Åžehiraltı. Wedge resection was done in half and segmentary resection in the other half. thickening in the wall of MD in two. One fourth of cases had such ectopic gastric mucosa. The presenting signs were GI tract obstruction in 22 (41%) patients. H. Department of Pediatric Surgery. Bas. Rectal bleeding was not found to be a predominantly leading complaint for OMDRs in children.N. Background: Omphalomesenteric duct remnants (OMDR) are the most common congenital gastrointestinal (GI) anomalies. Symptomatic OMDRs were more frequent in males.

Maazoun. 1 to 4 days). A. Results: The diagnosis of gastric perforation was made at an average age of Introduction: Gastric perforation in the neonate is rare. Associated malformations were noted such as duodenal atresia (2 cases). M. Hidouri. Masmoudi. There were 5 girls and 3 boys. esophageal atresia with tracheoesophageal fistula (1 case) and malrotation (1 case). Conclusion: Gastric perforation in the newborn is a rare serious and life-threatening problem.4 days (range. Two others infants (full-term baby and premature) underwent brief bag-mask ventilation for respiratory difficulty. The perforation wase closed. S. X-ray examination showed massive pneumoperitoneum in all cases Surgery was performed urgently after a brief resuscitation. There were six deaths (3 premature and 3 full-term infants) in the early post-operative period (5 cases) and after five days of operation (1 case) as a result of multiorgan failure. Jouini. The initial clinical finding was abdominal distention in all cases. . Necrosis was localized to the lesser gastric curvature in 4 cases. Email: i_krichen@yahoo. They had had asphyxia and required mechanical ventilation at delivery after bag-mask ventilation. prompt resucitation and immediate surgical intervention. It is a well-known as a catastrophic abdominal event with high mortality. 1050 to 2950 g). The average weight was 2130 g (range. An eight case report. M. Sahnoun. R. pyloric atresia (1 case). Department of paediatric eurgery. Ben Brahim. in one case to the huge rent anterior antrum surface. No complication was seen between the survivors during 4 years of follow up. Methods: The authors reviewed retrospectively eight case of neonatal gastric perforation over a 22-year period. Nouri. to the greater curvature in 3 cases and. Four babies were premature and weighting 1050 to 2050 g. L. Tunisia. Four neonates had a gastrostomy. Succes in treatement depends on early diagnosis. Monastir. K. H. Tandia. Krichene.Gastric perforation in the neonate. I.

Chahed J. Six patients were operated for omphalocele. Amiri R. Department of paediatric surgery Monastir – Tunisia Email: kaismz@yahoo. Hidouri S. The SDI involved the ileum in all patients.Segmental dilatation of the intestine. Results: Our patients are 5 boys and 3 girls. Methods: Eight cases of pathologically proven SDI from 1987 to 2003 were reviewed and discussed. Ajroudi S. Krichene I. Ben Brahim M. In all cases. The postoperative course was uneventful in 6 cases with a mean follow-up of 5 years. the diagnosis was not suspected before surgery. Histological examination demonstrated the presence of ganglion cells in all cases. The muscular layer was hypertrophied in two cases and very thin in one case. . Belghith M. Conclusions: Segmental intestinal dilatation in an exceptional pathology with an unknown etiology and a misleading clinical presentation. No anomalies were observed in 5 cases. which was the most frequent associated malformation. Mekki M. There were 7 newborns and a 1-year-old boy. The clinical polymorphism and the lack of specifity of radiological investigations explain the difficulties to have a preoperative diagnosis. However.Two patients presented with a low neonatal bowel obstruction. A heterotopic gastric mucosa was observed in one case. Sahnoun L. The treatment consisted on a resection of the dilated segment with an end-toend anastomosis. Tandia H. Maazoun K. this difficulty is compensated by the favorable evolution after resection of the dilated segment. Nouri Purpose: The aim of this work is to discuss the pathogenesis of the segmental dilatation of the intestine (SDI) and to review its clinical presentation and the ways to confirm the diagnosis.

a 3 mm transparietal forceps is introduced without any trocar in the right sub costal area.lardy@chu-tours. . Discussion: Complications may be explained by surgeons inexperience (isolated fellow without a senior mentoring) for insufficient pyloromyotomies. Insufficient pyloromyotomies may be reoperated laparoscopically. 50 first cases have been operated on by the same surgeon in order to assess the original technique. H. M. Under direct vision. . Further cases have been done by seniors and fellows. Favorable outcome is related to surgeon’s experience.8 days (excluding redo cases). and analyse the complications in order to prevent further difficulties with this demanding procedure. 277 of them have been made laparoscopically (Original technique). Lardy Departement de chirurgie pediatrique.Laparoscopic pyloromyotomy. Results: .8 mucosal injuries (3%) closed during initial procedure (4 in 2006). A 3 mm trocar is introduced in front of the pylore for pyloromyotomy and atraumatic forceps.7 insufficient pyloromyotomies (laparoscopic redo with favourable outcome) . Technique: Under general anaesthesia. results. Centre de Pediatrie Gatien de Clocheville. Laparoscopy is a safe technique but remains challenging procedure. Conversion should be recommended in case of difficulty. Robert . Material and method: During 1995 and 2007. CHRU Tours. First trocar (2 mm) is introduced with open technique right the umbilicus for optic. 312 children have been operated on for hypertrophic pyloric stenosis. S.Mean hospitalization stay: 2. Difficulties must be avoided with better vision (4 mm optic should be recommended during training for better vision). . conversion cases or mucosal perforation but also exist with seniors. There was no mortality in this series. Mucosal perforations have always been treated during initial procedure except one case during redo procedure for insufficient Aim: To present our series of laparoscopic pyloromyotomy about technical point of view. France Email: h. A monocentric study about technical aspects.4 conversions for exposure difficulties. Maurin. we use a 5 mm/Hg insufflating pressure.

fr Purpose: The purpose of this study is to assess the role of emergent laparoscopy as a diagnostic and potentially therapeutic modality in pediatric trauma. Laparoscopic therapeutic interventions were performed in 6 patients who had intestinal perforation. reduction of non therapeutic laparotomy rates. . or technical complications occurred. One patient had jejunal haematoma. F. No injuries were missed. No patients who underwent laparoscopy died. Laparotomy was avoided in 4 patients of these patients. Results: There were 174 abdominal trauma who had abdominal explorations for blunt (88%) and penetrating (12%) trauma. and a reduction of morbidity.Diagnostic and therapeutic laparoscopy in paediatric abdominal trauma. Demographic variables.MOROCCO Email: ettayebif@yahoo. as a result of laparoscopic explorations. Methods: A 7-year (January 2008-December 2007) retrospective review of pediatric abdominal trauma was performed in the emergency unit of the children hospital of RABAT-MOROCCO. Conclusion: Laparoscopy in pediatric trauma is a safe method for the evaluation and treatment of selective blunt and penetrating abdominal injuries in hemodynamically stable patients. mechanism of injury.. 11 patients had laparoscopy performed. operative interventions. which reduces the morbidity of a negative laparotomy .ETTAYEBI Surgical emergency unit at children’s hospital of RABAT . and information regarding patients who had operations for abdominal trauma was abstracted. Laparoscopy provides important information for the treatment of children with abdominal trauma and is accompanied by improved diagnostic accuracy. Laparoscopy serves as a diagnostic tool in abdominal trauma. and patient outcomes were examined.

the reason was noted and open surgery was made. experienced staff and laparoscopy oriented surgical intention. 129 cases (86 Aim: Laparoscopic appendectomy is reported safe and efficient in children. Results: During this period. Between January 2006 and December 2008. intestinal adhesions in 2. Postoperative complication rate is not higher than open surgery's rates. Demographic data. There were 12 postoperative complications: intraabdominal abscess in 3. The major advantages of LA are not only good cosmetic but lesser postoperative pain and short hospital stay. 2 working). wound infection in 1 and pleural effusion in 1. N CEVIZCI. all patients with appendicitis were reviewed. unique laparoscopic set per day. During this time. If laparoscopic intervention could not be performed. etc). 3. D BASKIN. technical reasons. complaining time of symptoms. The mean age was 10. we intended to perform laparoscopic intervention in whole patients with acute abdomen. Mean operative time was 48 mn for acute and 71mn for perforated cases.Laparoscopic appendectomy in children: 2-year experience AI DOKUCU. 569 patients were operated on. N SEVER. postoperative oral intake time. But there are some problems of applying of this procedure to whole acute abdominal cases. the convert to open surgery was made. Acute appendicitis was 75% while perforated ones 25%. O KUZDAN. Oral intake was started meanly in 1. No peroperative complication was seen.1 days in acute cases while 1.7 days in perforated cases. LA was successfully performed in 123 patients while in 6 children. umblical infection in 5. Istanbul. 43 female) were operated laparoscopically via 3 ports (1 optic.5 days in perforated ones. Applying of procedure to whole acute abdominal cases needs enough laparoscopic equipment. total hospital stay and postoperative complication were investigated.1. . Here we aimed to present our experience on laparoscopic appendectomy with intention of applying the procedure to whole acute abdominal cases.5 days for acute. Mean hospital stay was 1. Turkey Email: cakaradag@yahoo. inexperienced surgeon. 440 of them were not operated laparoscopically because of different reasons (operation in non-working hours. Patients and method: After obtaining of pediatric laparoscopic equipment in January 2006. Conclusion: LA is a safe and efficient therapeutic option and an acceptable operative time in experienced hands. M YALCIN Sisli Etfal Education and Research Hospital Pediatric Surgery Department. CA KARADAG. Appendix was dissected and brought out via umblicus and the stump was ligated extraperitoneally.

Laparoscopic-assisted transanal endorectal pull-through was reported but its indications are still non consensual. Some surgeons are rather inclined to a routine laparoscopy even in rectosigmoid aganglionosis. Laparoscopy may be reserved for those children who are at high risk for longer segment disease . The transanal endorectal pull-through constituted a revolution in the surgical treatment of Hirschsprung’s disease. Results: All the patients with short aganglionosis were operated exclusively by a transanal approach. MEKKI Mongi. This relatively simple technique was adopted by the majority of the pediatric surgeons because it allows a radical surgery without an abdominal approach in rectosigmoid aganglionosis. The Swenson. We think that there is no benefit to routine laparoscopic visualization. Duhamel and Soave endorectal pull-through procedures have all been reported using minimally invasive approaches.Laparoscopic assisted transanal endorectal pull-through: is it necessary for all patients BEN BRAHIM Mohamed. 5000 Monastir. For the 9 other patients. The indications of a laparoscopy in TERPT are still non consensual. NOURI Abdellatif Department of pediatric surgery. The post operative course was uneventful for all patients. we used a primary laparoscopy in order to mobilize the descending colon and the splenic flexure. HIDOURI Saida. 70 TERPT were performed in infants and Introduction: Described in 1998. Is it necessary for all patients or must it be reserved for long aganglionic segments? Material and methods: Between 2002 and 2008. Fattouma Bourguiba Hospital. EL EZZI Oumama.benbrahim@voila. Discussion and conclusions: Recently. definitive surgery for Hirschsprung’s disease has been performed using minimally invasive techniques. Tunisia Email: mohamed. Nine patients had a long aganglionic segment above the rectosigmoid. Restosigmoid aganglionosis was noticed in 61 patients. The mean opertaive time was respectively 118 and 146 mn.

In this article. Nissen fundoplication. Paul Daher. one of which was converted to open surgery due to tumor size and consistency. Material and methods: Our study is a retrospective review of all laparoscopic procedures at our hospital between April 1999 and July 2008 from which we excluded well known surgical indications (Appendectomy. 3 of which followed appendectomy. 3Revision of peritoneal dialysis catheter with complete adhesiolysis with or without omentectomy: 8 cases. However some of its nontraditional indications are still controversial. Introduction: Laparoscopic surgery has become the preferred approach for many procedures in pediatric surgery. The procedures were as follows: 1Undescended testis: 15 patients. 5Ovarian transposition prior to abdominal radiotherapy: 2 cases. we relate unusual use of pediatric abdominal laparoscopy in our hospital for the past nine years. cholecystectomy. 10Sexual ambiguity: 2 cases. . 2Placement of peritoneal dialysis catheter: 2 cases. Results: We found 44 patients that underwent unusual laparoscopic surgery. 6 (40%) of which had testicular agenesia. splenectomy and Heller esophageal myotomy). 9Genitourinary malformation: 1 case. it can even be used safely on patients with a history of prior abdominal surgery. Conclusion: Laparoscopic abdominal surgery in pediatrics has found new indications and is increasingly replacing traditional laparotomy for diagnostic and therapeutic procedures. 2 were due to colonic perforation. and 1 to infectious colitis in a leucemic patient. Roy Eid. 8Abdominal trauma: 3 cases. 3 had intra abdominal testis and 6 inguinal testis. Jad El Hachem. 6Adrenalectomy for neuroblastoma: 2 cases. 7Peritonitis (primary or after abdominal surgery): 6 cases. 12 (27%) of which were emergency procedures and 32 (72%) were elective.Unusual indications of laparoscopy in pediatric surgery. 4Ovarian mass and ovarion torsion: 3 procedures.

Conclusion: Pulmonary sequestrations are a heterogenic group of congenital lung lesions with a favourable outcome. . and intrapulmonary which is embedded in the normal lung sharing with it a common pleural investment. Open resection remains a valuable option for IPS with a lung spearing strategy. The infant with IPS recieved a thoracotomy at 3 months of age. with atypical resection of segments 8. T. Results: All patients had an uneventful intraoperative and postoperative course. that showed an abnormal echogenic solid mass in the left lower lobe with an abnormal systemic arterial blood supply. Till Department of Paediatric Surgery. Two forms of sequestration are recognized. extrapulmonary which is separated from the lung tissue by a separate lining of pleura. Patients and Methods: This study presents three patients with prenatally diagnosed pulmonary sequestrations. The other two infants with EPS had videoassisted thoracoscopic resection with ligasure at 6 months of age. Thoracoscopic assisted resection using Ligasure of EPS seems simple and safe. University of Leipzig. H.The impact of thoracoscopy on pulmonary sequestration H. All patients diagnosed by color flow Doppler sonography and MRI. 9 and 10. Lehnert. 3 and 6 months revealed that all the three patients were in good clinical condition and had fully expanded lungs on X-ray. no associated hydrops fetalis or maternal polyhydramnios. Ahmed. Metzger. R. No associated other congenital lung lesions. The combination of an aberrant systemic blood supply (identified by color-flow Doppler sonography) and an echogenic lung mass is pathognomonic for the prenatal diagnosis of pulmonary sequestration. one patient with intrapulmonary sequestration (IPS) and two patients with extrapulmonary sequestration (EPS). Germany Introduction: Pulmonary sequestrations (PS) are congenital lung lesions defined as non functioning pulmonary tissue lacking normal communication with the tracheobronchial tree and supplied by a systemic arterial supply from an aberrant aortic branch and are drained by pulmonary veins of the azygous or hemiazygous system. Follow-up at 1.

this technique yielded diagnostic pathologic findings (hystiocytosis X after a brushing of pleura as a treatment of a recurrent pneumothorax. M. The second indication of thoraoscopy was exploration of lung and mediastinal mass in 5 cases (27%). Results: 12 boys and 6 girls were admitted during this period for thoracoscopy. B. Charieg. A resection of an esophageal duplication was first attended by thoracoscopy but a conversion was necessary after an esophageal breach. we propose by this study to analyze our experience and describe the main indications of thoracoscopy in our institution. S. F.year experience T. Conclusion: Thoracoscopy is a good. and produces better esthetic results. Jlidi. It reduces morbidity. pain and hospital stay. pseudo inflammatory tumors. A. Chouikh. R. with near 3 years of hindsight. 18 thoracoscopy were made in our Introduction: Thoracoscopy brought to the pediatric surgeons a safe and reproducible technique to treat several lesions with low risk of parietal wound and post operative pain. Material and method: From January 2002 to December 2007. thoracic neuroblastoma). The main indication of thoracoscopy in our study was thoracic debridement of empyema in 67% of cases(12 cases). Patients were discharged 4 days after drainage. efficient. Chaouachi Department of pediatric surgery “B”. M. Belaiba. .Thoracoscopy in infants and children: A 5. The follow up of the patients was simple and the mean duration of drainage after the surgery was 3 days. Bendhaou. the mean age of the patients was 5 years. Ghorbel. The good results of our study encourage us to promote this safe and easy technique. reproducible and well tolerated way for management of children loculated empyema and exploration of mediastinal and thoracic mass. S. (4 month-13 years). All patients had follow up by clinical exam and chest X-ray 2 weeks and a month after thoracscopy. that was loculated in 50% of cases and resistant to antibiotherapy in 50% of cases. Nouira. Tunisia Email: awatef_charieg@yahoo. Khemekhem. Children’s hospital of Tunis.

We could only identify one other report in the literature of the use of this incision to access thoracic inlet pathology in children. one mesenchymal hamartoma and a metastatic seminoma from a mature cystic teratoma). Method/Results: The charts of four patients were retrospectively reviewed and a literature review was conducted. The use of the anterior cervico-thoracic trapdoor incision has been reported to give good exposure to the anterior superior mediastinum in adults. Conclusion: Studies in adults have shown the trapdoor incision to provide excellent exposure to the superior mediastinal structures. The location and complexity of thoracic inlet pathology along with the added challenge of adjoining neurovascular structures often makes complete excision difficult due to poor access and exposure.. . this incision is particularly advantageous as the ribs are more flexible thus allowing for greater retraction of the trapdoor laterally. one cystic hygroma. good cosmetic healing and no morbidities in four individual cases (one neuroblastoma. Discussion: The Trapdoor incision was initially described in adults. Ireland Aim: Tumours at the thoracic inlet are difficult to access via a thoracic or cervical approach. The thoracic inlet in children is a difficult surgical field and we believe the use of the trapdoor incision facilitates complete excision of thoracic inlet pathology in children. We report our experience of four cases where a trapdoor incision was used to gain excellent access and exposure to thoracic inlet pathology in children. Department of Paediatric Surgery . Our Ladys Hospital for Sick Children. Corbally MTC. Menon S. Yeap B. Dublin. for access to subclavian vessel injury and gives excellent exposure from the C-4 to T-3 vertebral levels.The use of the Trapdoor incision for access to thoracic inlet pathology in children. We successfully used this incision to gain excellent exposure.. In children.

) with early thoracoscopic cleaning and drainage of the pleural cavity . Very good results were obtained for all the patients. and clinical results similar to those achieved by open surgery. .Video Assisted Thoracic Surgery (VATS) and pleural empyema in children: Early management does make a difference: 2 centers experience Mohammed Youssef Alexandria Hospital for Sick Children Email: edini99@yahoo. VATS has been proven to be associated with a lower morbidity.17 years with non tuberculosis acute empyema were treated in 2 centers (TIBA Hospital . 64 children aged 1 .and Helios Center for Pediatric The treatment of empyema with pleural drainage is a widely accepted surgical procedure. shorter hospital stay. Egypt.VATS (Video assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema.Berlin. lower costs. Currently.Alexandria.

Discussion and Conclusion: LEMB is a safe technique which is easy to perform. After entering the abdominal cavity it takes an average of 2 . The procedure involves identification of pathological colonic segments. Germany *Pediatric Surgical Clinic of Graz. . Austria Email: cvantuil@gmail.3 min to take a biopsy. Elaborate diagnosis of such patients is only possible after inspection of thecolon and obtaining multiple biopsies for histopathological investigations. a colon mucosal injury/ perforation was encountered. In case of bleeding that may obscure vision at the site of biopsy. LEMB in our practice is a minimal invasive technique to obtain serial colon biopsies without morbidity for extensive histopathological examinations in severe motility disorders of the colon. dysmotility disorders of the colon are extremely difficult to diagnose in a vast majority of patients. Cornelia van Tuil MD and Amulya K. saline washings are utilized. Saxena MD* Pediatric Surgical Department of Heidelberg.Lapaoscopic extra mucosal colon biopsies in dysmotility disorders. incision of the taenia libera using metzenbaum scissors without opening the colonic mucosa. In such cases it was traditionally opted against taking serial colon biopsies due to the invasiveness of the open technique.5 mm or 5 mm instruments depending on the age of the child. Results: In none of the cases performed at our former Pediatric Surgical Center of Mü Introduction: Although Hirschsprungs disease is ruled out in most patients with motility disorders using standard rectal biopsy techniques. This technique requires no or little colon preparation and can be performed as a day care procedure. elevation of the biopsy edge and further preparation between the mucosa and serosa using metzenbaum scissors until the desired length of the biopsy has been obtained. LEMB is performed using an umbilical optic port along with two work ports using 3. Germany. Material and Methods: The laparoscopic extra mucosal colon biopsy (LEMB) technique has been found suitable for such patient groups.

The patients were discharged the next day and were followed up after six weeks. ETTAYEBI Department of Paediatric Surgery. one in the left upper quadrant and one in the right iliac fossa.Laparoscopic rectopexy in rectal prolaps. Our technique is simple and had excellent results. 3a & 3b). We recommend laparoscopic rectopexy in children with rectal prolapse resistant to conservative management. The peritoneum was incised in the area below the left internal inguinal ring (Fig. the laparoscopic approach has been appllied for rectal prolaps as a less invasive procedure in adults. F. In our unit we performed this procedure in patient who had failed transanal approaches. . as it is in adults Laparoscopic rectopexy can be easily performed in children.2). Children’s hospital of RABAT. The mobility of the rectum was checked. Several laparoscopic approaches have been reported in adults. Recently. Our results show that laparoscopic rectopexy is feasible and less invasive in children.MOROCCO Email: ettayebif@yahoo. Although transanal approaches such as sclerosing therapy and encircling-the-anus have been the preferred procedures of paediatric surgeons. Postoperatively feeding was commenced once the patients were Rectopexy is one of the accepted forms of treating rectal prolapse in children. and transabdominal approaches. 11 Patients with rectal prolapse (Fig 1) resistant to conservative treatment underwent laparoscopic rectopexy. Three 5mm ports were inserted: one in the umbilicus for a zero degree telescope. The rectum is fully stretched and sutured to the psoas muscle with 20 vicryl sutures (Fig. have been reported. A variety of techniques including transanal encircling-the-anus. these often fail in cases of full-thickness rectal prolaps. However. there have been few reports of these laparoscopic procedures in children. We report our experience of laparoscopic rectopexy in children.

Tunisia Email: j. The aim of our study is to stress on the role of coelioscopy associated to biopsy in the diagnostic confirmation of abdominal tuberculosis particularly in doubtful cases. Conclusion: Abdominal tuberculosis is still frequent in Tunisia. The final diagnosis was established by laparoscopy and histology. . JOUINI R.chahed@voila. Results: 11 cases of abdominal tuberculosis with mean age of 5. laparoscopy and biopsy should be practiced as first line investigations in case of doubtful abdominal tuberculosis. BELGUITH M. HIDOURI S. The diagnostic confirmation by histologic study was made on biopsies in 9 cases and on excision piece in other 2 cases. The evolution was favorable with antituberculosis treatment. It was peritoneal tuberculosis in all cases associated to an intestinal localization in one case. SAHNOUN L KRICHENE I.Abdominal tuberculosis CHAHED J. Nouri A. A conversion to laparotomy was practiced in three cases for appendicular plastron in one case. CHU Introduction: Abdominal tuberculosis is one of the most frequent extra-pulmonary localizations. The diagnosis is difficult to be established and may lead to a delayed prescription of antituberculosis treatment. Patients and methods: We conducted a retrospective study of 11 observations in the paediatric surgery department in Fattouma Bourguiba hospital in Monastir during a six year period (2001-2006). Department of pediatric surgery. BEN BRAHIM M.6 years diagnosed by laparoscopy and biopsy. The prognosis depends on the earliness of establishing the diagnosis and of beginning an adapted antituberculosis treatment. pseudo-tumor aspect of an intestinal loop which needed a resection-anastomosis in another case and appendicectomy and coecum biopsy because of its pathologic aspect. MEKKI M. Because of non specific clinical presentation and limited means of investigation. MAAZOUN K.

2 days. First dorsal lip of urethra was sutured to the glans tip. and then anterior lip of urethra was secured to glans. Circumcision was performed in all native cases. Urethral calibration was performed with 6-8 Fr catheters on the 15th post-operative day. One patient had undergone MAGPI. Age distribution was 6 months to 15 years with a mean of 2. Conclusion: The LUM technique. Follow-up period varied from 6 to 48 months with a mean of 35 months. Turkey Purpose: To assess outcomes in distal hypospadias repair with Limited Urethral Mobilization (LUM) technique. Slit-like urethral meatus with good functional results were obtained with the use LUM technique. glans wings were wrapped around urethra. Four patients had minimal chordee and 2 patients had glans tilt related to ventral skin. Glanular bed was prepared and then the mobilized urethra was placed in the deep bed. coronal in 5 and sub-coronal in 8 patients. Kocaeli. in distal hypospadias repair either with or without chordee is simple and effective. Neither retraction of the urethral meatus nor chordee was encountered. Following artificial erection test. This technique helps relieving chordee by mobilizing the urethral plate into the glans. 4 patients TIPU repair and subsequent circumcision. urethra proximal to the meatus was mobilized circumferentially for a distance sufficient to allow the urethra to reach the tip of the glans without tension.Limited Urethral Mobilization technique in distal hypospadias repair with satisfactory results Elemen L. Tugay M Kocaeli University. Urethral catheter was left in place. As no new urethral tube is constructed there is no risk of fistula. Department of Pediatric Surgery.5 years. If chordee was present it was released. Localization of urethral meatus was glanular in 22. . Five of the patients (1 of whom was the redo case) experienced meatal stenosis which responded to gentle dilatations. Results: Urethral catheters were removed in 3 to 5 days with a mean of 3. No fistula was observed. Patients and Methods: Thirty-five patients were operated for distal hypospadias in 4 years period with LUM technique.

the early complication rates was as follows: postoperative wound dehiscence rate was 6. In the 1st month postoperatively. urethral stricture and meatal stenosis rates were 3% for each (1 case for each). Purpose: To assess the success rate and postoperative complications of the tubularized incised-plate (Snodgrass) urethroplasty in recurrent distal hypospadias.7% (2 cases). A prospective study. wound infection and urinary retention rates was 3% for each (one case for each). 30 children (mean age = 81. Patients and methods: Between April 2002 and July 2007. the Late complication rates were as follows: repair disruption (whether partial or complete) rate was 50% (15 cases). oedema. the fistula formation rate (whither small or large) was 30% (9 cases). With 2-10 months of follow-up. Its rule in recurrent distal hypospadias repair is questionable. bleeding.Many causes are implicated for high failure rate of redo Background: Recurrent hypospadias is a major problem in paediatric surgery.4 months) underwent a redo Snodgrass repair in a prospective study. Conclusion: Although the Snodgrass tubularized incised-plate urethroplasty is one of the first choices in primary distal hypospadias repair.The tubularized incised plate urethroplasty (Snodgrass) in recurrent distal hypospadias. Good selection of repair type according to each patient criteria is mandatory. especially in cases with previous Snodgrass repair. epidermoid cyst rate was 6. penile torsion rate was 10% (3 cases). Snodgrass technique is one of the most common techniques used in distal hypospadias repair nowadays. .7% (2 cases). Ramy Waly Email: ramywaly@yahoo.

S.Modified Duplay technique in the treatment of hypospadias. France The surgical repair of anterior hypospadias depends on the surgeon’s custom and the anatomical variations of this anomaly. The procedure is described herein.Touabti1. . Aesthetic and functional results are reported and seem to be very satisfactory. Our procedure is based on the Duplay technique. We report on 150 hypospadias operated. Lyon. Dodat2 1 2 Service de chirurgie pédiatrique. in addition to personal modifications in order to correct the frequently associated penis anomalies. unité d’urologie pédiatrique Hôpital Edouar Herriot. Most publications agree nowadays on the one-stage surgery. unité d’urologie pédiatrique CHU de Sétif Algérie Service de chirurgie pédiatrique. H.

Preliminary results of two-stage preputial vascularized tube technique. Ebru Yeşildağ* . * Pediatric Surgery and Urology Center of İstanbul. We think thatwe benefited from the known advantages of flap applications in the hypospadias surgery in these patients. Tiny incisions were performed on the flap in order to provide the blood and fluid collection behind it. grafts are much more commonly applied in two-stage operations. Our experiencein a limited number of patients showed that the use of pediculated preputial mucosal flap to form the urethral platein two-stage operations increases the success rate of tubularization procedures in the second stage. was lied between the original urethra and glans tip. without being tubularized. The urethral catheter was removed with a mean of 6 days and 10 days after the operation in the first stage and in the second stage. it still is exacting to decide whether a single-stage or two-stage operation should be carried-on in cases with proximal hypospadias. Cem Kara*.5 years). In the second stage.N.5 months between two stages. In the first stage. A urethral catheter was placed in both stages and an elastic dressing was covered over the Mepithel or Bactigrass that was placed right over the wound. this flap. Cenk Büyükünal University of İstanbul. averaging 6 – 11 months) 3 patients are still waiting for the next step. Introduction: While the algorithms of the operative techniques in distal hypospadias are mostly standardized. Few fixation sutures were placed to ease the adhesion with tunica albuginea. Department of Pediatric Surgery. the flaps have the impression of healthy sources for future urethroplasties. in 10 children with primary proximal hypospadias with severe chordee. Following the correction of the ventral curvature. Cerrahpaşa Medical Faculty. Yunus Söylet. respectively. Discussion: Single-stage flap urethroplasties are preferred much than the graft urethroplasties in the correction of primary hypospadias. . Many of those who prefer two-stage approach in these patients use genital or buccal mucosa grafts to form the urethral plate.S. Division of Pediatric Urology. a rectangular flap was prepared from the preputial mucosa similar to pediculated preputial tube preparation of Duckett. Results: The mean age of the cases was found to be 3 years (1 – 3. On the other hand. While both stages were completed in 7 of the cases in this series (with an average of 7. Patients and method: Two-stage operation was performed between 2005 – 2008. In the other 3 cases that wait an average of 2 months for the next step. The minimum of 6 months is preferred to wait to proceed to the second stage. They all are urinating from the glans tip and the cosmetic results are satisfying. No complication is detected in the follow-up period ranging between 3 -18 months of the 5 cases in whom both stages were completed. The aim of the study is to evaluate the results of our experience in patients with primary proximal hypospadias in whom two-stage operation was indicated and pediculated rectangular preputial flap was used to form urethral plate in the first-stage. the urethroplasty was carried-on by tubularizing the flap prepared in the first stage.

We investigated retrospectively for both methods(MATHIEU group n:52 and spongioplasty group n: 37) the outcome regarding the complication. an adequate voiding and comparable outcome regarding the complication rate. the cosmetic satisfaction and the voiding and compared the results. A great diversity of procedures to correct hypospadias is suggested. Mohamed Jallouli. Tunisia Email: riadh.mhiri@rns. the MATHIEU technique and the spongioplasty. Riadh Mhiri Department of pediatric surgery. Mahdi Ben Dhaou.Results of the repair of distal hypospadia: Comparison between two techniques. In our department we use for the correction of the "distal" and "mid-shaft hypospadias defects mainly two different methods. Houda Kammoun. Hedi Chaker hypospadias is one of the most common deformities of the urogenital system. Nozha Kallel. Sfax . . We find a good cosmetic look.

Spongioplasty in treatment of hypospadias. applied in anterior hypospadia (90%) . – BOUKLI HACENE M. The result is good in short ant middle term.A & Coll Département of peadiatric surgery ORAN UNIVERSITY The authors describe SPONGIOPLASTY préservation of uréthral DUPLAY uretroplasty Glanduloplasty Spongious corpse dissection and plasty in middle line This approche vas perfomed in ORAN HOSPITAL since 1996 with 188 Cases. OUSLIM R.

Department of pediatric surgery. in our study. sex. Results: Of 565 children. Tunisia. there is no correlation between the apparition of contralateral hernia and age at surgery. Houssem YENGUI. Conclusion: The low incidence of contralateral hernia regardless of gender or age.8%). . Email: mohamed.jallouli@rns. Age. Riadh MHIRI. premature and the side of hernia. 3029 Sfax. Of the remaining 503. a metachronous contralateral hernia developed in 24 (4. does not justify routine contralateral exploration. Methods: This is a retrospective study of 565 patients during 9 years period at a single institution.Is contralateral exploration necessary in children with unilateral inguinal hernia? Mohamed JALLOULI. Hedi Chaker Hospital. Dalel TRIGUI. Hatem KALLEL*. 62 (11%) presented with synchronous bilateral hernias. and side of the hernia at presentation were recorded. The incidence of metachronous inguinal hernia and its risk factors were Purpose: This study was done to identify risk factors for metachronous manifestation of contralateral inguinal hernia in child with unilateral inguinal hernia. gender.

21 normal and 34 small sized testis). Data was collected from HIPE and patients charts from a single team at OLCSC Crumlin. a sac or vas like structure in 133 (66 %) and no groin structure (a sac or vas like structure ) in 13 patients (6. 2 of these 40 patients 1 %) needed re-exploration and subsequent orchidectomy. 36 (18 %) underwent single stage FS. 23 testes (11 %) were bilateral. 201 testes (25 %) were impalpable at presentation and included in this study. orchidopexy was performed in 50 (25 %). Menon S.5 %) . Conclusion: Meticulous EUA facilitates safe and accurate planning of the surgical approach to the patient with an impalpable testis and should remain part of the surgeon’s skill base. 69 (34 %) right sided.5%) cases had mild retraction at the upper half of the scrotum. 109 (55 %) left sided.5 %) underwent two stage FS and 40 (20 %) underwent excision of testicular (nubbin) or vas remnant. These 13 patients underwent laparoscopy and four had a blind ending vas. 38 underwent a standard orchidopexy (19 %) and 17 underwent single stage FS (8. Patients and methods: This retrospective study included all patients who underwent surgery for undescended testes from 1st of Jan 1990 to 31st of Dec 2005. Of 133 patients with a palpable sac or vas like structure. High testicular retraction was noted in 9 cases (4. Of these. 7 (3.5 %).5%) and 13 (6. Mean follow up was 18 months and mean age was 42 months. were treated by one team. a small sized testis in 34 cases(17 %). Results: 178 boys with 201 impalpable testes underwent EUA which revealed a normal sized testis in 21 (10. Corbally MTC Our Ladys Hospital for Sick Children. two underwent orchidectomy for an atrophic testis. Laparoscopy should be used for establishing or refuting the diagnosis of an absent testis when no structure is palpable.e. Of the 55 patients of a palpable testes (i. Crumlin Ireland Aims: We report our experience with boys with clinically impalpable undescended testes and determine the efficacy of examination under anaesthesia (EUA) in the management plan.Is inguinal exploration a still valid therapeutic option for the impalpable testis? Said H. .5 %). Of 716 boys with 792 undescended testes. Ghalab A. three had two stage Fowler Stephens (FS) and four had single stage FS.

On the basis of our experience. The operation consisted in sectioning the gubernaculums. Average age at presentation was 24 months.9%) were bilateral. Of the non palpable testes 10(47. Lebanon Multiple approaches exist for the management of the non palpable testis.Beyrouthy G.Is Fowler-Stephens procedure still indicated for the treatment of intra-abdominal testis? Daher.J.P. In all cases the testis was high in the intra abdominal position. The testis was then fixed to the scrotum even if there was traction on the spermatic vessels and upward retraction of the scrotal skin. Orchiopexy without division of the spermatic vessels should be the treatment of choice because it does not affect normal testicular vascularization and is minimally invasive. we treated 21 boys with non palpable testis.P. In all cases the testis was normal in size and found in the scrotum on follow-up. Between June 2003 and April 2008. All patients were discharged on the same day. Division of pediatric surgery. Beirut. we believe that the Fowler-Stephens procedure is not indicated anymore in the management of non palpable testes. In this study we report our experience with orchiopexy performed without dividing the spermatic vessels. 6(28. Nabbout.5%) were on the left side and 5(23. All cases were treated through a standard inguinal incision. with transperitoneal mobilization of the vas and vessels without transection.Feghali. Hotel Dieu de France.6%) were on the right side. It was identified by abdominal ultrasound or by laparoscopy. We had no intraoperative complications. .

Belguith. Tunisia Email: j. The most frequent urinary tract malformations were megaureter in 8. K. In fact urinary lithiasis and urinary tract malformation is not rare. Diagnostic modalities included the ultrasound. Post operative outcome was simple in all cases. Abdominal pain was the most frequent clinical symptom (38%). intravenous urography and retrograde urethrocystography. Jouini. Positif diagnosis relies particularly on kidney ultrasound. Sahnoun.8 years (ranging from 2 months to 14 years old). M. ureteropelvic junction obstruction in 7. .Urinary lithisasis and urinary tract malformation In conclusion urinary lithiasis and urinary tract malformation is a frequent eventuality. localization and size of the urinary lithiasis. Nouri. A.Chahed. CHU Fattouma Bourguiba. L. M. All of them have a urinary lithiasis with a urinary tract malformation. M. Krichene. We report 34 patients (19 males and 15 females) with a mean age of 4. indeed 30 to 39% of urinary lithiasis are associated to urinary tract malformation. R. The association of urinary lithiasis and urinary tract malformation is not rare and deserves to be considered because of its specific management. I. S. Its treatment is usually a surgical one. Ben Brahim. Treatment depends on the type of urinary tract malformation. Department of pediatric surgery. Maazoun. Monastir. intravenous urography and urethrocystography results. Hidouri. Mekki. Urinary infection was found in 10 patients (21%) and macroscopic hematurea was present in 10 patients (28%).chahed@voila. vesico-ureteric reflux was associated to urinary lithiasis in 8 cases but its malformative origine could not be precised. Treatment consisted of lithiasis extraction in 32 cases associated to a specific treatment of the uropathy in 27 cases.

The aim of this work is to specify the epidemilogic. Ben Brahim M. CCSK : 3. the metastasis were present in 4 cases. Masmoudi Renal tumors other than Wilms tumor are infrequent in childhood. clear cells sarcoma : 1. Prognosis depends of the histological diagnosis. MCN : 1.The follow up ranged from 2 to 10 years. lymphoma : 2.Non-Wilms renal tumors in children Ajroudi S. rhabdoid tumor of the kidney (RTK). Mekki M. Tandia H. Non-wilms renal tumors are a heterogeneous group that have distinct presentations. Maazoun K. renal cell carcinoma (RCC). RCC : 1. The most common non-wilms tumors are clear cell sarcoma of the kidney (CCSK). Krich̬ne I. Hidouri S. and multilocular cystic nephroma (MCN). the mortality is 23 %. Monastir РTunisia Email: kaismz@yahoo. congenital mesoblastic nephroma (CMN). . The most frequent clinical sign is the abdominal tumor. Sahnoun L. At the diagnosis. Department of paediatric surgery. Belghith M.The tumor corresponded to CMN : 4. Non-wilms renal tumors represented 13 % (13 cases/103) of the pediatric tumors of the kidney. Nouri A. RTK : 1. clinical and pathological characteristics of these tumors. Chahed J.

A special laparoscopic puncture needle (1. Sever N. Preoperative chest xray. Baskin D. Yalcin M. Here we present our experience with the minimal access surgical treatment of thoracal and abdominal hydatid disease. Patients continued to take albendazole postoperatively as well. A simplified approach. 4 thoracal) with large cyst either nonresponsive to medical treatment or has a risk of perforation. cyst was opened. Karadag CA. Conclusion: Use of a special laparoscopic puncture needle prevents spillage of the cyst content during the aspiration of the cystic fluid and instillation of the scolicidal agent. Results: Cysts were unilocular in all patients with a mean diameter of 100 mms. Kocaeli & Sisli Etfal Education and Research Hospital. Insertion of sterile pads into the abdomen for prevention of spillage was not required in our cases. Mean operative time was 165 minutes and none was converted to open surgery. Turkey Aim: Minimal access surgical treatment of hydatid disease is challenging for the pediatric surgeons because of the risk of the spillage of the cyst content. All patients had preoperative albendazole treatment. A haemovac drain was inserted into the cystic cavity in all cases. . and another had a cyst in the right lung. Istanbul. One patient with a huge cyst located on the dome of the liver needed 4 trochars. While concurrent kidney cyst was removed during laparoscopy in the same session. Ekingen G Depts. After the aspiration of the cyst fluid. Method: Between 2003 and 2007 minimal access surgical treatment of hydatid cysts were performed in 11 patients (7 abdominal. abdominal USG and abdominal CT were taken in all patients. Neither early complication nor (bronchial/biliary) fistula had occurred. Guvenc BH*. Drains were removed in postoperative mean 3. proligerous membrane was removed using an endobag and the dome of the pericyst was excised. There was no spillage into the (thoracal/abdominal) cavity. Minimal access surgical removal of large hydatid cysts is a safe and effective procedure. Median hospital stay was 5 days (2-13 days). lung cyst was removed with thoracoscopy in a separate session. Dokucu AI.Minimal access surgical treatment of hydatid disease. of Pediatric Surgery.6 mm) was used to aspirate the contents of the cyst and instillation of hypertonic saline during intervention.5 days. Anadolu Medical Center*. One patient had concurrent hydatid cyst in the left kidney. the rest was done with 3 trochar insertions.

We used three 5-mm ports: one in the fifth intercostal space on the posterior axillary line and the other two in the third and seventh intercostal space on the mid-axillary line. The histology of the resected tumour showed cystic neuroblastoma. Ancona. A 12-month-old girl was admitted to our hospital because of a sudden onset of dancing eye syndrome. afterwards in most cases the tumour arises in the in the adrenal gland. MRI and computed tomographic scan (CT) showed a left posterior mediastinal mass. Luciano Mastroianni Paediatric Surgery Unit. A 4 mm Hg pressure was used and the operative time was of 120 minutes. The child underwent a thoracoscopic resection of the mediastinal mass. In the first year of life frequent primary tumour sites are the thorax and the neck. but tumour size has to be between 20 60 mm. Thoracoscopy is the ideal technique for tumour biopsy and to determine tumour resectability for thoracic neuroblastoma. . it is a valuable and safe technique. Minimally invasive surgery (MIS) allows biopsy and primary tumour resection for thoracic neuroblastoma avoiding the cosmetic and functional disorders of the thoracotomy. The child was placed in supine position. Salesi. The level of the urinary catecholamine metabolites vanillylmandelic acid (VMA) and homovanillic acid (HVA) were elevated.Minimally invasive surgery (MIS) for children thoracic neuroblastoma. Mother and Child Hospital G. Italy Neuroblastoma is the most common extracranial malignant solid tumour in infancy and childhood.

The patient was discharged at day 2 postoperatively and no complaints then after. Mullerian anomalies may present in a wide spectrum with different symptomatology. an open appendectomy was performed because of acute abdomen. Here we present a teenager girl with an uteral anomaly Type IIb presenting abdominal pain and her laparoscopic treatment. Case report CA KARADAG.8%) anomalies of uterus. Severe uteral abnormalities as seen in our case should be treated in childhood period before possible occurrence of severe complications. a vaginoscopy was made and found normal. without any connection to vagina. Turkey Email: cakaradag@yahoo. beside to uterus. Laparoscopic therapy has several advantages on open surgery in surgical treatment of Mullerian anomalies. measuring 49x43mm. We performed a mass dissection via Ligasure while preserving right over and uturus itself and removed mass by enlarged umblical incision.Laparoscopic hemi-hysterectomy: Type II-b uteral anomaly. AI DOKUCU. thick-walled mass was situated between normal shaped uterus and normal shaped right over. Istanbul. This type of anomalies may stay without any symptomatology or present symptoms during menstruation or pregnancy. The mass was opened and a chochalate type liquide seen. 14 year-old girl presenting right lower abdominal pain during last 48 hours. . Laparoscopic treatments of this kind of anomalies may give more information on pathology and possibility to evaluate therapeutic options. M DEMIR. Laparoscopic procedure was performed by 3 ports (10mm at umblicus. First physical examination showed normal abdominal sings. Pathologic examination reported typical uteral structure. D BASKIN Sisli Etfal Education and Research Hospital Pediatric Surgery Department. But ultrasonographic and tomographic examinations showed a paraovarian mass.6%) or arcuat (32. 5 mm in both lower abdomen).com Disgenesis of Mullerian tract may result in different urogenital anomalies containing uteral malformations. The pain was occasionally seen and during one period 18 months ago. Endometriosis or uterus didelfis were suspected as diagnosis and an explorative laparoscopy was programmed. Before laparoscopy. Uteral anomalies exist about 4% of female population and the majority of them are septal (33. A solid.

We report the case of a neuroectodermal sarcoma of the rectum treated by neoadjuvant chemotherapy then by coloproctectomy followed by adjuvant radiotherapy and chemotherapy. With more than 2 years since the last chemotherapy. Pathology of the resection showed an 11 % remainder of the initial tumour with healthy safety therapeutic margins. Machet. . MRI post chemotherapy assessment showed an important tumor decline of the endoluminal part of the tumor but no effect on the wall of the rectum. Z. The coloscopy showed a polypoid. the rectal touch enabled a diagnosis with certainty. Dommange. Department of pediatric surgery. Chapet. Benchellal. Examination and rectal touch revealed an endoluminal mass infiltrating the right lateral wall of the rectum. Treatment of these tumors demands a multidisciplinary approach and the collaboration of adult surgeons who are used to these type of tumours. Rectal localization is rare and the difficulty lies in proper diagnosis. Restoration of the continuity of the gastrointestinal tract followed a surgical intervention 8 months after the first operation.lardy@chu-tours. Extension bilan was negative. S. Boscq. this patient seems to have a favorable outcome although more than 10 % of the tumour remained after neoadjuvant chemotherapy. Protective ileostomy is required and enables simple restoration of gastrointestinal tract continuity and a better tolerance of radiotherapy. France Email: h. the patient received a neoadjuvant chemotherapy and radiotherapy after bilateral laparoscopic ovariopexy. Clinical history begins by red blood rectal bleeding and constipation. Outcome of soft tissue sarcomas depend on initial localization and surgical resectability. In our case. the patient had a laparoscopic coloproctectomy with coloanal anastomosis and a protective temporary ileostomy. However. Centre de pediatrie Gatien de Clocheville. crumbly. The treatment demands a multidisciplinary approach.Laparoscopic resection of a sarcoma of the rectum H. Tumours of the rectum in children are rare and difficult to diagnose. The patient was treated according to the EURO EWING 99 protocol. Lardy. F. M. CHRU Tours. Robert. M. bleeding mass and the biopsy a neuroectodermal sarcoma of the rectum confirmed by molecular biology. After 6 courses of chemotherapy.

we studied 7 boys and 3 girls aged from 3 years to 11 years with intussusception due to lymphoma.Tandia. All were hospitalized for acute abdominal syndrom. Tunisia Introduction: Burkitt’s lymphomas are arely revealed by acute intestinal intussusception in children. Laparotomy was performed on emergency and found the primitive tumor in nine cases. I. Abdominall ultrasonography is the most efficient examination for the diagnosis. Maazoun. A. Laamira. J. Belghith. the procedure consisted in ileal resection. M. Mekki. Abdominal ultrasonography showed intestinal intussusception and primitive tumor in all cases.Burkitt’s lymphoma revealed by acute intussusception in children. . M. L. anatomopathogical and therapeutic aspects of intusssception due to lymphoma. R. M. Results: Between 2000 and 2007. Sahnoun. Chahed. The aim of this study is to report 10 cases of intussusception due to lymphoma and to determine the clinical. Patients and methods: we raport a retrospective study about 10 cases of burkitt’s lymphoma in children revealed by acute intussusception. S. One patient was not operated on and the diagnosis was performed through ultrasonography-guided-tumoral puncture. Krichene. Two deths due to chemotherapy complications were noted. Eight cases were succesfully treated with protocol chemotherapy wiyh 4 years follow-up. Nouri Departement of Paediatric Surgery Monastir. H. Conclusion: Burkitt’s lymphomas are rarely revealed by acute intestinal intussusception in children but the diagnosis must be suspect in case of an age older than 5 years. Masmoudi.The keys for the traitement rest the chemotherapy. Ben Brahim. Hidouri. M. K.

CHAOUACHI2. A laparotomy was performed on emergency in eight patients. BORGI1. OUBICH1. 4. Introduction : Burkitt’s lymphoma is a lymphoblastic B-cell malignant tumor with very aggressive course. HAMZAOUI3.Hôpital Habib Thameur. Tunis. a complete remission was observed with a follow-up longer than one year after the complete remission (median follow-up: 19 months) in 7 cases. I. We retrospectively reviewed our series of patients with Burkitt’s lymphoma revealed by intestinal invagination to assess the role of surgery in the treatment of these patients. S. tow patients had died and they have Burkitt’s lymphoma stage IV. S.Service de chirurgie pédiatrique .Hôpital d’enfant de Tunis.Service de chirurgie pédiatrique « B » . B. there were 1 stage II. With LMB 2001 protocol chemotherapy. Surgery is required to confirm the diagnosis and the intestinal resection for ischaemia. Y. The diagnostic may be made by ultrasonography guided tumoral puncture. If the lymphoma is not visualized with ultrasonography. service de médecine infantile « A » . often. The procedure consisted in disinvagination and biopsy (n = 1). SAYED4. TLILI 1.Hôpital d’enfant de Tunis. Tunisie. Results: According to the Murphy classification. F. intestinal resection (n = 7). 2. It’s rarely revealed by acute intestinal invagination in children. nine children. Tunisie. M. primitive tumor (n = 5). A.Burkitt’s lymphoma revealed by intestinal invagination in children. seven boys and two girls (mean age: 5 years and 6 months) (4 . 3. One patient was not operated and the diagnosis was performed through ultrasonography guided tumoral puncture. BEL HADJ 1.Unité d’oncologie. Tunisie. KHEMIRI 1. long-term remission. At the end of the study. BARSAOUI1 1.Hôpital d’enfant de Tunis. Patients and methods: Between January 2001 and June 2008.Service de chirurgie pédiatrique « A » . M. 5 stage III and 3 stage IV patients. Tunisie.10 years) were hospitalized for an “acute abdominal syndrome”. Abdominal ultrasonography showed intestinal invagination (n =10). Conclusion: Burkitt’s lymphoma is extremely sensitive to chemotherapeutic agents that cause an initial rapid tumor dissolution and. mesenteric lymph nodes (n = 3). .

Çorapcıoğlu F2.5 Dept.4 Dept. germ cell tumor in 2 and timoma in 1 patient. . Discussion: Intrathoracic masses are the one of the most common presentations of childhood cancers. neuroblastic tumor in 4. Tugay M1. night sweating and weight loss were the most common accompanying symptoms with a rate of 64%. of Pathology. and radiologic interventions. The tumors in two patients were widespread with mediastinal involvement. Resection of the mass was accomplished in 10 patients while biopsies were taken in forty-one. Patients and Methods: Fifty-one patients who were treated and followed because of intrathoracic masses were reevaluated retrospectively from the pediatric oncology database. Akansel G4. Turkey Purpose: To asses the five years experience of a Pediatric Oncology Group in intrathoracic masses. The rest of the patients had anterior and middle mediastinal masses. Kocaeli. localization of the masses. Aksu G3. histopathologic diagnosis. of Pediatric Surgery. of Pediatric Oncology. Thirty patients were males.2 Dept. four patients had posterior primary mediastinal masses. Forty percent of the patients admitted with symptoms related to vena caval or bronchial compression. Histopathologic diagnosis was lymphoma in 42. multidisciplinary approach and treatment is crucial for successful results in childhood intrathoracic masses. Deveci M2. of Radiology. Mean follow-up period was 30 months. Fever. which are mostly lymphomas. medical therapy and current situation of the patients were recorded. Three patients are lost from follow-up and five patients were lost due to progressive disease.0 statistical evaluation software.5.3 Dept.1Dept. İnan N4. We think that. may require surgical intervention. surgical operations. Gürbüz Y5 Kocaeli University Medical Faculty. physical examination findings. complaints on admission. pleuro-pulmonary blastoma in 2. Anterior and posterior mediastinal masses.Intrathoracic masses in children: Five years of experience Elemen L1. Mutlu H2. sex. Three patients had anterior. Forty-three patients are still alive with thirty-nine disease free patients. Results: Mean age of the patients was 8. of Radiation Oncology. complications. symptoms. Age. Results were assessed with SPSS 11.

Surgical management of bilobar emphysema is controversial. Tunisia. L. Nouri. Ajroudi. H. J. S. Mekki. S.Congenital bilobar emphysema. cause of respiratory distress in the newborn. Maazoun. Sahnoun. Krichene. Laamiri. Tandia. I. Congenital lobar emphysema is an infrequent. Masmoudi. . M. Department of pediatric surgery. but important. M. R. We describe three cases of infantile bilobar emphysema. A. Belghuith. Fattouma Bourguiba Hospital Monastir. Hidouri. diagnosed preoperatively in one patient and during the follow-up period in the other two patients. . Chahed. K. M. Congenital emphysema affecting more than one lobe has been rarely reported. M Ben Brahim.

In prenatal diagnosis is possible to omit one of them. . Case Report 2: Neonate referred to our center for severe respiratory symptoms at birth and needed mechanical ventilation. Clinical course was asymptomatic but CT thorax six months later showed progression of the lesion until 6 cm. Corporació Parc Tauli. Introduction: The traditional classification of lung malformations could be difficult to apply antenatally. Prenatal ultrasound was normal in other center. Surgery performed 24 h later show the hybrid lesion CCAM type II and pulmonary sequestration confirmed by pathologist. and asymptomatic. Corporacio Parc Tauli. CT thorax confirmed macrocystic lesion 3 cm. Corporacio Parc Tauli (3) Pathology . CCAM type I and pulmonary sequestration was confirmed by pathologist. Rigol Sanmartin S (1). Surgery was performed at that time. Background/Purpose: We describe two patients with hybrid lesions combining congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration. because it is possible the postnatally confirmation of hybrid lesions.Hospital de Sabadell. Cabezuelo Hernandez MA (3).Hospital Sabadell . García-Gonzalez M (2). Combalia Soriano N (3). She was born at term. Discussion and Conclusions: the hybrid lesions could be explained by a common embryological alteration. Before birth it is better to use the term “lung malformations” in general. The hybrid lesion. Asensio De La Cruz O (2). CT thorax showed mediastinal shift and severe pleural effusion. Barcelone. Case Report 1: Prenatal diagnosis by ultrasound and MRI of CCAM right lung was made at 21 weeks of gestation. Surgery is the treatment of both between 3 month and 2 years in asymptomatic patients. (1) Paediatric Surgery . (2) Paediatric Pneumology .Hospital Sabadell. diagnosis of pulmonary sequestration. two cases Abad-Calvo P (1). Spain. Bardají Pascual C (1). The challenge could be prenatal diagnosis of hybrid lesions.Congenital lung malformations: hybrid lesions. Bosque-García M (2).

B Monastir Department of pediatric surgery.B Monastir 2 Objectives: The aims of our study are to remind the principal congenital bronchopulmonary malformations (CBPM) in childhood and to illustrate imaging features of each etiology. Nouri2. Ben Salem1. Conclusion: CBPM causes a lot of diagnosis and therapeutic problems. Jellali1. Materials and methods: We retrospectively reviewed data of 43 cases of CBPM diagnosed during 12 years. CT exam has a crucial role to examinate CBPM and to differenciate between each etiology. Hmida1. The age of our patients at diagnosis ranged from 5 days to 14 years. M. Clinical symptoms revealing the malformation were neonatal respiratory distress and repetitive infectious pneumopathies. A. Salem1. K. The diagnosis was first based on imaging finding: chest radiography was performed in all cases. CHU F. C. B. The final diagnosis must be confirmed by histopathological exam. CHU F. Imaging features are variable. Results: Our patient group consisted of 18 girls and 25 boys. MA. All patients underwent surgery.Imaging features of congenital bronchopulmonary malformations. Hafsa1. 6 cases of pulmonary sequestration and 2 cases of bronchogenic cyst. 11 cases of cystic adenomatoid malformation. Histopathological exam confirmed the radiologic diagnosis in 38 cases. A. Maazoun2. CT examen was performed in 39 cases and Doppler US for 7 cases. . R. M. Ben Brahim2. The malformations diagnosed are divided as follow: 24 cases of congenital lobar emphysema. Golli1 1 Department of Radiololgy.

L. J. Department of Paediatric Surgery. Krichene. Our study reports five cases of lipoblastoma carried in the department of Paediatric Surgery of Monastir between 1988 and 2008. El Ezzi. femoral. epiploique and sacro-coccygien. Chahed. M. O. A. M Mekki. Monastir Tunisia. The surgical treatment consisted of a complete resection in all cases. S. The purpose is to determine the epidemiological. Tandia. K. Hidouri. M. M Belguith. it has to be the most complete possible. I.Lipoblastoma in childhood. Report of 5 cases. The age varied from 7 months to 42 months. The tumor was dorsal. . clinical and therapeutic aspects of lipoblastoma. inguinal. H. It is about two girls and three boys. Maazoun. Masmoudi. Nouri. Ben Brahim. Evolution was favourable without recurrence after a follow-up of 12 months. The surgical resection is the only treatment of lipoblastoma. Sahnoun.

better cosmesis. Complications vary from bleeding to unsatisfactory cosmetic results. comfort of child and cosmesis.0 (SPSS Inc. Department of Pediatric Surgery. Results: Overall anesthesia time. ease of appliance. Patients and Methods: Ninety-six boys who underwent circumcision in 18 months period were randomized prospectively and grouped into two. Tyco. Kocaeli. The SPSS 10. circumcision is not free of complications. USA) sutures and in second group (n=45) 2-octyl-CA glue (Dermabond. . postoperative comfort and cosmesis were significantly better in 2-octyl-CA group. those should be evaluated by further studies. In first group (n=51) 6/0 polyglytone 6211 (Caprosyn. Tugay M Kocaeli University. bleeding status. A scoring system was constructed to evaluate duration of procedures. Quantitative differences between groups were assessed by Students t test and Mann Whitney U test. post-operative comfort and cosmesis. earlier recovery to daily activities without complications are advantages of 2-octyl-CA used for circumcision wound closure. P was significant at < 0. Chicago. UK) were used for wound closure. Turkey Purpose: Despite being the most frequent operation performed in boys. cost affectivity. Qualitative analyses were performed by χ2 test. Conclusion: Shorter duration of operation. Ethicon.05. IL. safety. per-operative and post-operative bleeding status. operation time. This study aims to compare the 2-octyl-cyanoacrylate (2-octyl-CA) glue with polyglytone 6211 sutures in circumcision wound closure on the basis of operative time.What are the advantages of Cyanoacrylate xound closure in circumcision? Elemen L. USA) was used for statistical analyses.

An experience of a private pediatrıc surgery institution E Yesildag. In the presented series. no significant difference is observed when compared with the naturally conceived ones but the higher incidence of inguinal. Turkey Purpose : To present the variation of congenital anomalies observed in children born with the aid of assisted reproductive technologies(IVF) between January 2003 – June 2008. 74 anomalies were detected in 92 cases. omphalocele. Results : Inguinal hernia and hydrocele were found to be the most frequently observed anomaly (29 patients: 37 units). 3 children. torticolis. Patients and Methods : The patient records between January 2003 – June 2008 were retrospectively evaluated and 86 children among 1584 patients admitted to a pediatric surgical centre were found to be born with the use of in vitro fertilization (IVF). Discussion : The assisted reproductive technologies are accused for increasing the risk for some anomalies in children. umbilical cord hernia.Surgical anomalies with assisted reproductive technologies. 11 of these 86 patient presented with more than 1 anomaly. coarctation of the aorta. were operated because of pyloric stenosis. 7 children were admitted with anorectal anomalies. undescended testicle was detected in 9 cases (11 units). . penile and urinary anomalies gives us a different vision in comparison with the previously published data in the English literature. triplets born with the help of IVF. Penile anomalies were detected in 18 children (hypospadias was the leading problem with 14 cases). İstanbul. Hemangioma. Urinary anomalies were observed in 9 children (hydronephrosis 2 cases and vesicoureteric reflux 2 cases). VSD and ASD were the other detected congenital anomalies. SNC Buyukunal Pediatric Surgery & Pediatric Urology Center of İstanbul. one with anal atresia and one with anterior ectopic anus.

F Hurtado. Cassinello F. prenatal tests. Torrejón R. In this setting we developed a special dedicated program in fetal therapy at a southern spanish university Center. Losada A. De Agustín JC. This program allowed the first intervention on a meningomyelocele for the first time in Europe. Objectives: The purpose of this work is to show the organization aspects of an emerging surgical area. This was a twin gestation with otherwise healthy brother. including preimplantatory diagnosis. . From all of them two were especially relevant to discuss. Open fetal surgery was done at 26th week and delivery done at 35 week. The second case is a fetus with an epignatus that occludes the airway. University Hospitals Virgen del Rocio. A new starting program in Spain. During this intervention extraoral tumor was removed and tracheostomy performed. type of surgery and results were analyzed. Demographic data. The other 3 cases were 1 massive pleural effusion and one materno-fetal transfusion. The second case represents also the first epignatus presented on twin gestation that was operated during EXIT procedure in the world. Conclusions: Fetal Therapy programs are completely necessary in selected countries. VP valve was necessary. A second intervention was required to remove completely the tumor 3 weeks later. Juan C L Lozano. Hydrocephalus was evident during gestation but unchanged during fetal life. EXIT surgery was done at 34 weeks of gestation. genetic therapy and fetal Introduction: Fetal surgery is a sophisticated area of Pediatric Surgery. Department of pediatric surgery. The first one was a 24th week female fetus that had a high lumbar meningomyelocele. Spain Email: juandeagustin@mac. Marquez J. After delivery the lumbar defect was covered by the interposed skin flaps and sphincter function and legs movements were normal.Fetal therapy. Seville. Antiñolo G. The patient follow up reveal no tumor recurrence. and to summarize our most interesting cases treated during 2007. Ontanilla A. Children Hospital. Jimenez J. A modern society is demanding the highest quality of medical care. Results: From a total number of 35 fetuses five were selected for fetal intervention. Three amniotic drainages interventions were necessary before the EXIT procedure. Six months after delivery the neuromuscular development is normal. Material and methods: All malformed fetuses diagnosed during prenatal period were evaluated. Carrillo R. Parents refused abortion and null intervention. The following day the intraoral tumor was excised and the trachea reconstructed. Ultrasonographic guided pigtail was used for the former and laser electrocoagulation for the other.

Antenatal ultrasonography showed: bilateral uretero-pyelic dilatation (8 cases). Postnatal sonography and voiding cystourethrography confirmed the diagnosis. . The main gestational age at diagnosis was 32 weeks (30-34 weeks). Three infants had already renal failure at birth. ultrasonographic appearance of renal parenchyma and amniotic fluid volume. Materials and methods: Between 2000 and 2007. Labassi Aymen. Charles Nicolle hospital. Department of pediatric néphrology-department of urology. resulting in renal failure in childhood. Renal failure developed in 5 of 8 patients. on endoscopic resection within a mean period of 46 days. 8 neonates with prenataly detcted posterior were treated in our department. Lakhoua Mohamed Rachid.The long-term outcome of prenatally detected posterior urethral valves Gargah Tahar. Tunis. Treatment was based on initial vesicostomy within a mean period of 2 days and secondary. The mean duration of follow-up was 4 years. Tunisia Email: tahar. Derwich Amine. Results: The diagnosis was suspected in the antenatal sonography and confirmed after birth in 8 of them. Chebil Mohamed. Conclusions: The outcome of posterior urethral valves is not yet significantly improved by prenatal diagnosis. Nowadays. Clinical outcome improved in two of them. The prenatal parameters analyzed were age of gestation at diagnosis. oligohydramniosis (4 cases). We reviewed the outcome of other neonates treated for posterior urethral valves which were not diagnosed prenatally during the same Introduction: Posterior urethral valves are the most common cause of congenital obstructive uropathy.gargah@rns. Two of the other five infants developed moderate renal failure. in most cases. diagnosis is suggested by antenatal ultrasound. including end stage renal disease in 1. hydronephrosis (1 case) and a megacystis in one foetus. Objective: To assess the impact of prenatal diagnosis and evaluation on the outcome of posterior urethral valves we studied all cases of valves detected prenatally.

The morbidity in this series was found to be 2. Turkey Purpose : To present our experience between February 2004 . in the superficial inguinal pouch/upper scrotum 47 units.4 years (9 months . In 6 patients with bilateral anomalies.June 2008. higher in the inguinal canal 4 units. No other complication was detected. İstanbul. Patients and Methods : 76 children with a mean age of 3. 11 left. 44 cases (70 units) had UT(the testis was. one side was operated with an inguinal approach as the testis was palpated higher in the inguinal canal in 5 and the nubbin was excised in 1).June 2008 in operating hydroceles and undescended testicles (UT) through a scrotal incision. An alternative for better cosmesis. 3 patients (6 units) had bilateral anomalies with hydroceles on the right side and UT on the left (the testis was. higher in the inguinal canal 1 unit).11 years) were operated through a scrotal incision between February 2004 .4 years). Discussion : The testis and hernial sac can sufficiently be prepared through the scrotal incision.6% (2/76)in a mean follow-up period of 2 years (2 months .Scrotal incision. Results : A hydrocele of cord and secondary undescended testis developed one year and 7 months after the operation. SNC Buyukunal. respectively in two patients operated for hydrocele and both of them was reoperated through an inguinal incision. Orchidopexy with high ligation was carried on in the UT cases and the testis was fixed with 4/0 Vicryl to the scrotal pouch. High ligation was performed in the hydrocele group. The incision was performed vertically on the lateral upper part of the affected hemiscrotum. 2 bilateral). E Yesildag Pediatric Surgery & Pediatric Urology Center of İstanbul. nubbin palpated 1). ascending 6 units. 29 patients (31 units) had communicating hydrocele (16 right. in the inguinal canal 12 units. in the superficial inguinal pouch/upper scrotum 2 units. This approach not only decreases the early postoperative pain problem observed commonly in inguinal incisions but also increases the cosmesis which is very much apreciated by the parents. .

and to measure serum urea. i/r. sham (s). in the s. left nephrectomies were performed to determine the levels of malondialdehyde (mda). glutathione reductase (gr). Results: The values of mda in the i/r group were higher than those in the s and i/r+gspe groups. and tubular necrosis in the i/r group were higher than those in the s and i/r+gspe groups. Müslim Yurtçu. Vascular dilatation-congestion and tubular vacuolisation were higher in the i/r+gspe group than the s group. biochemistry. Hatice Toy. tubular vacuolisation. Engin Gunel Selcuk university. mononuclear cell.The effect of grape seed Proanthocyanidin in renal ischemia/reperfusion injury. and i/r+gspe groups. alaninaminotransferase (ast). meram medical faculty. Serum urea. and this parameter of the i/r+gspe was lower than those in the s group. and histopathological changes in tissues.α (tnf-α) levels in blood. Discussion and conclusions: It was shown that prophylactic gspe treatment prevents renal i/r injury . ischemia/reperfusion (i/r). ast. but 15 mg/kg gspe was given with orogastric gavage to this group for 15 days before operation. The values of gr in the i/r group were lower than those in the s and i/r+gspe groups. and pathology. Vascular dilatation-congestion. konya-turkey Background/purpose: To determine the prophylactic effect of grape seed proanthocyanidin extract (gspe) in ischemia/reperfusion (i/r) injury-induced renal tissue damage. and ischemia/reperfusion plus gspe (i/r+gspe). departments of pediatric surgery. Mehmet Aköz. creatinine. Left rp exploration and right nephrectomy were performed in the s group. Same procedures were done in the i/r+gspe group. Both renal pedicles (rp) were explored in c group. and tumor necrotisan factor. Mustafa Yaşar özdamar. creatinine. and these parametres of i/r+gspe were significantly higher than those in the c and s groups. and tnf-α levels in the i/r group were higher than those in the other three groups. Occlusion (45 minutes) and reperfusion (60 minutes) of left rp were performed after right nephrectomy was carried out in i/r group. Material and methods: forty rats were divided into 4 groups each containing 10 rats: control (c).

2. Tunisia. Ben Rebeh I3. When achalasia is associated with alacrima in North African families the detection of IVS14+1GA mutation will be helpful for diagnosis and genetic counselling. the IVS14+1G-A mutation. Masmoudi S3. Email: hassen. this method allows easy detection of heterozygote individuals in a patient’s family. Alacrima is the most consistent feature of this syndrome and was observed in all patients. Sfax. Clinical and genetic analysis of six North African families Kamoun H1. Triple A syndrome is an autosomal recessive disorder characterized by the triad of adrenal insufficiency.kamoun@rns. Sfax. Sellami D5. Facult de Mdecine de Sfax . Fakhfakh F1 1 2 Medical genetic department. Other features. 3 Unite cibles diagnostiques et therapeutiques dans la pathologie humaine (CBS) 4 Service de Pediatrie . . such as achalasia or adrenal insufficiency. Aloulou H4.Achalasia in triple A syndrome. Belghith N1. Some other patients present with hyperkeratosis of palms and soles. 5 Service d’ophtalmologie.Hopital Habib Bourguiba. Laboratoire de Genetique Moleculaire Humaine. Some patients also present with progressive neurological degeneration presenting especially lower motor neuropathy.Hopital Hedi Chaker. We report twelve patients from four Tunisian and two Lybian families. achalasia and alacrima. The molecular analysis of AAAS showed a single homozygote mutation in all affected patients. The mutation was identified at first by sequencing then by enzymatic digestion of DNA. appeared in some cases before adulthood. Hedi Chaker hospital.

Hamdi Arbağ. Discussion and Conclusions: These experiments provide evidence for the potential and successful use of C in repair of the cervical oesophageal anastomosis leakages. A 1-cm smooth circular oesophageal segment was excised. and hydroxyprolin (HP) levels in both groups. . In the L group the animals were fed orally on postoperative day 2. and S anastomosis was performed using nonabsorbable suture material (6-0 polypropylene). Material and Methods: Twelve New Zealand rabbits were divided equally into two groups: smooth (S) and leakage (L). and cyanoacrylate (C) was installed to the fistula on postoperative day 10. The diameters of DOTOL in the L group were significantly greater than those in the S group. Otorhinolaryngology Head & Neck Surgery. Müslim Yurtçu. The cervical oesophageal tissues which were excised from the anastomosis and repaired fistula segment were taken to determine bursting pressure (BP). The animals were fed parenterally for 6 days and orally on postoperative day 6 on the condition that there was no oesophageal leakage after oesophagographic analysis. Adnan Abasıyanık Selcuk University. Meram Medical Faculty. Mehmet Öz. a 1-cm-long oesophageal segment was incised on the cervical oesophagus. diameters of the oesophageal lumen (DOTOL). Konya-Turkey Background/Purpose: This study aimed to investigate the effects of tissue glues in fistulas that occurred following oesophageal repairs (ORs). The cervical region was then closed using standard surgical technique and the catheter was extracted in both groups.The effect of Cyanoacrylate in fistulas following oesophageal anastomosis leakages. and Biochemistry. Results: The values of BP and HP in the S group were significantly higher than those in the L group. Departments of Pediatric Surgery. Osman Çağlayan. In the L group. a 1-cm-long fistula occurred at the cervical oesophagus in all rabbits 2 days later. and a single-layer oesophageal fixation to cervical skin tissue was performed using nonabsorbable suture material (6-0 polypropylene) to perform iatrogenic cervical oesophageal fistula. In the S group the oesophagus was dissected through a cervical midline incision from the trachea and other tissues.

Anastomosis group (AG): Ileal resection-anastomosis followed by food restriction for 1 week and excision of 2 cm ileal segment proximal to anastomosis. Kocaeli. of Pediatric Surgery. An In Vitro Study Tugay M1. Specimens were studied for their contractile (KCl. 3. Utkan T2 1 Dept. 3 Dept. Gocmez S2. The contractile response of carbachol was not significantly changed between the groups AG vs FG and AG vs SG. SNP. Acibadem Hospital. Erkus B1. Komsuoglu I2. Fibroblasts and plasma cells were decreased. of Pharmacology. Conclusion: Our study revealed alterations of receptor-dependent and receptor-independent ileal smooth muscle reactivity following re-feeding which emerges as a dynamic process entailing adaptation of smooth muscle and neuronal structures. Carbachol) and relaxant (EFS. Papaverine) response to receptor activation in the organ chambers set up. Material and Methods: Three groups of rats were used: 1-Sham Group (SG): Laparatomy and intestinal exploration followed by 1 week food restriction and excision of 2 cm of ileal segment. Kocaeli. Results: In AG. Kocaeli University. Composition and thickness of the smooth mucsle cells reduced. of Pediatrics. Elemen L1. 2 Dept. Turkey Purpose: To investigate the effect of feeding on smooth muscle reactivity in isolated rat ileum after resection and anastomosis.The effects of feeding on ileal smooth muscle reactivity after anastomosis. 4 Dept. ileal wall was thinned with atrophy of microvilli and intestinal epithelium. All the specimens were underwent histopathologic study. KCl induced (non receptor mediated) responses were significantly increased in FG vs SG. of Histology. 2.Anastomosis and feeding group (FG): Ileal resectionanastomosis followed by food restriction for 1 week. 1 week of re-feeding excision of 2 cm ileal segment proximal to anastomosis. Gacar N2. Yazir Y3. . Carbachol induced (receptor mediated) contractile response significantly increased in FG compared to SG.

Alger Ten patients have a large defect of the anterior palate. D.The repair was performed by a tongue flap with anterior pedicule.Cleft palate repair by a tongue flap. the pedicle was removed by section after verification of the flap viability. Hantala.The average age was 9 years. Beni Messous. We have rewiewed 7girls and 3 boys. Twenty one days later. .

Results: All the cysts were confirmed by neonatal ultrasound between the 2nd and 7th day of live. Ismail. the laparoscopic management of neonatal ovarian cyst is a good option but doesn’t prevent the loss of ovaries. adnexial torsion in 9 and simple cyst in 4 cases. We present a retrospective review of 14 cases of neonatal ovarian cyst treated surgically at the Hamad medical Hospital in Qatar from January 2003 to December 2007. Bassiouny Pediatric Surgery. A. The operative findings were an amputated ovary in one case. I. Surgery was performed in the neonatal period except for 3 patients after a follow-up varying from3 to 13 months. Errayes. A 5 year experience. T. Qatar. Ovarian cysts are the most frequent intra-abdominal cysts diagnosed antenatally. A simple cystectomy was performed in 4 cases and adnexcectomy in the remaining 10 cases due to necrotic ovary. No symptoms were found except in 2 cases. A. The post-operative course was uneventful in all cases In conclusion. 11 patients required laparoscopic assisted surgery and 3 open surgery. El kadhi. The developpement of antenatal management should prevent this issue. .E. Their management is still controversial. Doha.Surgical management of fetal ovarian cyst. Hamad Medical Corporation.

Hatice Toy. transmural necrosis. A significant weight increase was identified in the C group compared with the other groups. Results: The rate of mortality was significantly higher in the N. Material and Methods: Rats were divided randomly into five groups.The protective effects of oral pure immunoglobulin A and G in an experimental necrotizing enterocolitis model. Bahattin Aydoğdu. and S groups. transmural necrosis. IgG. Histopathologic findings such as villus injury. Departments of Pediatric Surgery. .1 ml/kg/day distilled water. and S groups compared with the TIgA and C groups. The NEC (N) group was fed with formula. and Biochemistry. Pathology. Müslim Yurtçu. and biochemical parameters such as interleukin-6 (IL–6). Meram Medical Faculty. IL-6. and apoptosis. There was no significant difference between the T-IgA and C groups according to histopathologic parameters. IgG. Mehmet Gürbilek. Engin Günel Selcuk University. Villus injury. Konya-Turkey Background/Purpose: This study aimed to compare the protective effects of oral pure immunoglobulin A (IgA) and G (IgG) in experimental necrotizing enterocolitis (NEC). The treatment IgG (T-IgG) group was fed with formula and 1200 mg/kg/day oral Ig G at 4-hour intervals. apoptosis. and TNF-α were lower in the TIgA group compared with the N. The rats in all groups were weighed and sacrificed on the fourth day. The control (C) group was breast fed. and tumor necrotizing factor-α (TNF-α) were evaluated in all segments of the intestine. The sham (S) group was fed with formula and 0. Discussion and Conclusions: Pure Ig A given orally decreased intestinal damage and prevented NEC in an experimental NEC model histopathologically. The treatment IgA (T-IgA) group was fed with formula and 600 mg/kg/day oral Ig A at 4-hour intervals.

Visceral posters .

Patient: A 4-year-old girl was admitted to our clinic with presumptive diagnosis of a ventriculo-peritoneal shunt catheter dislodged into the abdominal cavity. A non-absorbable anchor suture may prevent displacement of the proximal shunt apparatus. Tugay M1 1 2 Kocaeli University. Her mother complained of difficulty in applying clean intermittent catheterization very recently. Bladder was intact. She was taken to operation and the catheter was removed by means of cystoscopy. Elemen L1. No bladder repair was required. or more rarely to cortical irritation due to proximal migration of the shunt apparatus. from its first realization in 1908 by Kausch till our days. Department of Neuro Surgery. secondary craniosynostosis and etc. Kocaeli. Her pelvis X-ray and urinary ultrasound examination revealed that the ventriculo-peritoneal shunt catheter was coiled in the bladder. Another ventriculo-peritoneal shunt catheter was inserted to prevent hydrocephalus. Conclusion: Migration of ventriculo-peritoneal shunts is well described. infectious. . over drainage. Turkey Purpose: The cerebrospinal fluid shunt operation. Report of a case.). Kocaeli.Ventriculo-peritoneal shunt catheter migrated into bladder. Here we present the second pediatric case of ventriculo-peritoneal shunt catheter which dislocated into bladder. Turkey Kocaeli University. On the other hand patient might had bladder perforation during clean intermittent catheterization. Insufficient abdominal cavity resembling the presented case may enforce the shunt catheter to slowly dislodge into the bladder. But this hypothesis is only a speculation and the exact mechanism is not possibly known. Etuş V2. Department of Pediatric Surgery. Mechanical shunt failure must always be considered when there is a change in the physical aspects of a shunt. Result: She is doing well after the operation and clean intermittent catheterization continuous without difficulty. Well known are many complications connected with the use of the valve systems (malfunction. is still of a significant importance for the long-term treatment of the internal hydrocephalus. The subsequent symptoms relate to under-drainage and blockage.

He is still doing well without complications for a follow-up period of 2 years. The histopathologic examination was consistent with a bladder duplication. urethra and bladder was detected. Sevinç Tugay2. a cystic mass located infero-medial to the bladder was found. No communication with ureter. . Turkey 2 Acibadem Hospital. Kocaeli. Patient and Method: The patient was admitted to our clinic with right flank pain.Non communicating complete bladder duplication on the coronal plane. Each bladder receives its ipsilateral ureter and is drained by an individual urethra. Report of a Case Levent Elemen1. We present a 6-year-old boy with complete bladder duplication without a communication between duplicated bladder and urethra. Total excision of the mass and right ureteroneocystostomy was performed. Results: Post-operative course was uneventful and the patient was discharged on the 5th post-operative day. Abdominal ultrasonography and MR urography demonstrated right hydro-ureteronephrosis. The present case is the second case in the English language literature with complete bladder duplication without a communication with urinary system. The patient was taken to operation with the presumptive diagnosis of a right uretero-vesical junction stenosis. Discussion: Complete bladder duplication is associated with a duplicated urethra. ureter or primary bladder. Following mobilization of the ureter. Department of Pediatric Surgery. Further investigation with MAG3 scintigraphy revealed right uretero-vesical junction obstruction. Turkey Introduction: Duplication of the bladder is a very rare congenital anomaly classified as complete and incomplete forms with well described features. both of which drain into a common urethra. Incomplete duplication consists of two bladder halves separated by a thick muscular wall. Department of Pediatrics. Kocaeli. This rare anomaly should be kept in mind in differential diagnosis of pelvic cystic masses and during surgery of lower urinary system. Melih Tugay1 1 Kocaeli University.

Oran. We face in 30% of our cases the persisting expansion of urinary cavities after medical and surgical treatment and they are a site of urinary stasis.Residual dilatation after megaureter treatment in children DR AZZOUNI Samir. . Alger Our service has already acquired some experience in managing megaureters. This is aretrospective study over the late decade. infection and nephritis.

After a mean period of 6 years and 1 month. There were 4 girls and 1 boy. renal hypoplasia (2cases). Derwich Amine. The etiologies of chronic renal failure were: glomerular nephropathy (7cases). varies from 1% to 65%. Labassi Aymen. Tunisia. one child had undergone previous urological surgery. Results: There were 38 children. vascular pathology (4cases) and indeterminate (10cases). We report the experience of our center. Methods: We reviewed retrospectively cases of renal transplantation managed in our department from January 1993 to December 2007.Vesico-ureteral reflux after kidney transplantation in children. . Gargah Tahar. There were 4 living donor and one cadaveric graft. department of urolgy. Tunis. especially VUR. 13 girls and 15 boys. Lakhoua Mohamed Rachid Department of pediatric nephrology. Conclusion: Although rejection is the major cause of kidney graft failure. and has been claimed to be responsible for 2. 12 children (31. Charles Nicolle hospital. The main age at transplantation was 12 years.6%) developed late infections. Its prevalence and significance after kidney transplantation (Tx) in children varies widely. The incidence of VUR in transplanted patients. Email: tahar. congenital abnormality of the urinary tract (5cases).tn Introduction: Vesicoureteral reflux (VUR) is a risk factor for acute pyelonephritis (APN). Three of them had indeterminate nephropathy and 2 congenital abnormality of the urinary tract.5%) developed early urinary tract infection (first month) and 9 patients (23. Chebil Mohamed. inherited nephropathy (10cases). represent a significant source of morbidity. urologic complications. according to recent literature. Sonography and voiding cystourethrography revealed VUR in 5 patients. One graft was lost in patient with refractory chronic rejection.7% of end-stage renal disease in childhood. but its impact on graft survival is controversial. A report of 4 cases at a single center. All patients had Lisch-Gregoire implantation of the transplant ureter and insertion of double-J stent.gargah@rns.

Change in management of ureteropelvic junction obstruction S.from surgicalcorrection to observation of the hydronephrosis. Initial utrasonography and voiding cystourethrogram were available for all cases. Clinique mere Purpose: The aim of this study was to evaluate the change in ureterpelvic junctionmanagement. more significant were the hydronephrosis and impairment of renal function. CHU SETIF ALGERIA Email: touabtisl@yahoo. but renal function did not improve significantly. drainage improved. Intravenous urography and diuretic renogrphy were studied when avilable. Z. We checked whether or not is was deleterious for kidney Maretials and Methods: We retrospectively reviewed 100 cases. hydronephrosis decreased. surgery after observation. because surgery improves renal drainage but not renal function. Conclusion: Initial non operative management of hydronephrosis was not dangerous for renal function. Minimal follow-up of patients was one year. . It is advisable to detect at the earliest all signs of obstruction. Patients were divided into three groups: surgery right away.TOUABTI. and observation only. In group operated on right away.SOUALILI Chirurgie pediatrique. Results: Later was the diagnosis.

80% patients. Minor complications related to the urinary drainage were solved by irrigation of the catheter withthe sterile saline or pulling out the catheter. Material and methods: With the porpouse to reduce the immediate dysuria in patients with urethral stent wihout urinary diversion. Sarac D. we modified this technique by pulling a thinner catheter through the stent and indwelling it into the bladder. Novi Sad. The rate of the late complications was not significantly different among the groups. non invasive. Conclusion: Modified use of urethral stent and urinary drainage is a simple. This way we permitted urinary drainage for the first two postoperative days. Urethal stents may be used without additional urinary diversion. Institute for child and youth health care of Vojvodina. comfortable for patients and parents and related with few complications and short hospitalisation. without increasing of compilation rate. Results: Postoperative disuria was markly deminished in the group with the modified drainage comparing with stent only. and still permitting early discharge from the hospital. Minor complications related to the urinary drainage (obstructions of the thin catheter and its displacement) were seen in 11. . Lucic Prostran B. Serbia Introduction: Inherent to most hypospadias repairs is postoperative urinary drainage and use of urethral stents.20 days) was longer then in group with stent only (3. leaving patients to void through the stent.Modified use of uretral stent and urinary drainage in hypospadias repair.Zivkovic D. Some authors recommand stent-less procedures for distal hypospadias. Common forms of urinary diversion include: perineal urethrostomy. transurethral Folley catheter drainage and transurethral dripping stent. but much shorter in other two groups (8. After that the catheter is pulled out leaving the stent in place. transurethral folley catheter drainage and stent only. Varga J. suprapubic cystostomy. We compared postoperative comfort and the incidence of the complications in patients with this way of stenting and urinary drainage versus patients with suprapublic cystostomy. and later prevented by postoperative rehydration and diluting the urine. Discussion: This method permits initialy healing of the neourethra before contact with urine avoiding invasive procedures and long hospitalisation.10 days).20 days).Dobanovacki D. Starcevic Z. Duration of hospitalisation (4.

Report of two cases and review of the literature.sahnoun@rns. They are an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. Urinary tract infection was observed one month postoperatively for the 1st patient. M. S. Mekki. CH. . A. hematuria and urinary tract infection were the most common symptoms. Results: Dysuria. Conclusions: Fibroepithelial polyp of posterior urethra is a rare cause of urinary retention in childhood and should be considered in differential diagnosis of obstructive lesions. M. Email: lassaad.Fibroepithelial polyp of the posterior urethra. urinary retention. Transurethral resection of the polyp was carried out in both boys using a pediatric resectoscope. both boys were cured and urine analyses were normal. In the present study. extraction of the polyp was performed via transvesical Purpose: Fibroepithelial polyps of posterior urethra (FEP of PU) are rare benign tumors occurring in young boys. Nouri Department of pediatric surgery hospital of Monastir. L. For the 1st patient. Sahnoun. Krichene. urethrocystoscopy) suggested a polypoïd lesion originating from the veru montanum. Histology showed the lesion to be a fibroepithelial polyp. K. Tunisia. Belghith. we present our experience with two boys with FEP of PU along with a literature review. The diagnostic work-up (sonography. I. The two patients were discharged without complaints. Jamila. S. At follow-up. Materials and methods: We retrospectively identified two children with FEP of PU presented between 1983 and 2006 at age 21 and 17 months. Hidouri. Maazoun. Ben Brahim. M. Ajroudi. voiding cystourethrography.

Material and Methods: A retrospective study of 17 neonatal observations of antenatal isolated pyelectasis was conducted over a 24-month period. No chromosomal abnormalities were found. The degree of antenatal pyelectasis was measured in the anteroposterior renal pelvic diameter. . The purpose of this study was to evaluate the prognostic significance and the postnatal management of ultrasonographically detected isolated fetal pyelectasis. Postnatal surgery was assessed in 1 case of bilateral megauretere and spontaneous regression under a sequential treatment occurred in the other cases. Bilateral pyelectasis was found in 8 cases. Conclusion: Isolated fetal pyelectasis can have a pathologic significance. *Department of Neonatology – Charles Nicolle Hospital – Tunis **Department of paediatric surgery B – HET – Tunis *** Department of Obstetrics and Gynecology . Postnatal exploration revealed a transitional pyelectasis in 7 cases. echographic aspect. Fetuses with additional congenital anomalies and died fetuses were excluded. Finding interesting sex. Ben Hmida E*. Postnatal renal function hasn’t decreased in all cases.Charles Nicolle Hospital . Labidi K*. Chaouachi B**. Ben Hamouda S***. gestational age at diagnosis. postanatal management and medical follow up were assigned. Marrakchi Z*. an ureteropelvic junction obstruction in 6 cases. and vesicoureteric reflux (VUR) in only 1 case. Ayadi I*. Results: The majority of the cases were male. and no foetal urinary intervention was assessed in our study.Tunis Background: The ability to detect major malformations of the fetal urinary tract using diagnostic antenatal ultrasound is well-known. Prognosis was related to the degree of pelvic dilatation.Prognostic significance and postnatal management of antenatally isolated fetal pyelectasis. Bilateral pelvis dilation doesn’t carry a higher risk for uropathies in our study. An oligoamnios was noted in 4 cases. congenital megauretere in 3 cases.

Elmadi. In view of remote possibility of recurrence. Unlike cystic nephroma. A. K. Mahmoudi. Chemotherapy could be reserved for recurrent disease and tumor rupture. some studies show a male predominance. The prognosis of CPDN after surgical removal is excellent with 100 % survival rate. L.It is recommended to treat CPDN with surgery alone. Radiology is helpful in detecting the cystic character of the lesion. Usual age of presentation is between 4 and 24 months. CPDN constitutes 0. ultrasound showed a multiloculated mass. Morocco Email: chaterlamia@yahoo. About one case. Arroud. Twelve cases were reported in literature and only gadolinium-enhanced MRI showed these gross pathologic features previously. Concerning the gender of patients. Rami. The interior is entirely composed of cysts and septa in the conventional CPDN. . A. Absence of any solid area favors the diagnosis of CPDN or cystic nephoma. K. the septa contain blastemal cells. It is recognized as a tumour with low malignant potential. atarraf. Khalid.Fez. Ultrasound and CT scan clearly demonstrated the papillonodular projections. We report a second case of papillonodular type. Bouabdallah Department of pediatric surgery. MA. CHU Hassan II.Cystic partially differentiated nephroblastoma.5 % of all Wilms tumours. No case of metastasis is reported. Histopathological examination remains the mainstay of diagnosis. regular follow-up is needed. M. Cystic partially differentiated nephroblastoma (CPDN) is a rare clinico-pathologic entity occurring mainly in children. Primary resection of the tumor is the treatment of choice in such cases. We report a case of conventional type. Afifi. CPDN is distinguished from polycystic Wilms tumor only by the presence of macroscopic nodules of blastema. M. The tumor is a multiloculated and circumscribed lesion. chater. distinguishing it from other renal cystic tumors. The papillonodular type contains characteristic luminal papillonodules. Asymptomatic unilateral abdominal mass is the usual presentation.

S. Histopathological examinations confirmed diagnosis in all cases and rectified preoperative diagnosis in four cases. Khemiri. A. Radiological investigation with CxR/CTs led to diagnosis in CLE and CAM in the whole cases. pneumonectomy (n=2). One patient died after lobectomy with acute nosocomial pneumonia. Zouari. The aim of this report is to describe clinical pictures of CCLD and to discuss problems in diagnosis. Oubich. and contributed to the diagnosis of BC in 4/7 cases and only in ¼ of PS. S. recurrent attacks of respiratory embarrassment (n=6). Post operative course was uneventful in 28 children with a mean of follow up of 24 months (4 months. but contributed less in the diagnosis of BC and PS. Patients and methods: Cases of CCLD enrolled at Children’s Hospital of Tunis between January the 1st 1994 and December the 31st 2004 were reviewed. Symptoms were: respiratory distress (n=14). seven bronchogenic cysts (BC). CPM were: 17 congenital lobar emphysema (CLE). M. Khaldi. Problems in diagnosis are related specially to evolutive complications of CCLD. Hamzaoui. Barsaoui Background/Purpose: Congenital cystic lung diseases (CCLD) include several malformations with clinical and radiological similarities but distinct histological features. B. Y. Radiological investigation led to diagnosis in CLE and CAM in the whole cases. Tlili. F. M. Three patients had two associated CCLD. A. Hamzaoui. Conclusion: Dyspnea and infections are the main revealing symptoms of CCLD. US-doppler suspected the malformation origin of the cystic lesion in 6/11 of cases. F. five cystic adenomatoid malformations (CAM) and four pulmonary sequestrations (PS). Ben Becher. haemothorax (n=1) and fortuitously (n=1). Chaouachi. I. Results: 33 CCLD were diagnosed in 30 children (17 males and 13 females) aged 20 days to 16 years at diagnosis.7 years). The mean ages at diagnosis varied between two and 88 months. S. pulmonary infections (n=8) associated to haemoptysis in two cases. Bellagha. F. . Ben Mansour. and cystectomy (n=8).Congenital cystic disease of the lung. Experience with 30 cases at Children’s Hospital of Tunis. MRI led to diagnosis in 5/6 of cases 29 patients required chirurgical treatment with lobectomy (n=22). Borgi.

respiratory infections (5cases). Kammoun TH*. Hachicha M*. Tunisia **Paediatric surgery department. Resection was being a cystectomy in 1case. Aissa Kh*. Nouri A**. treatment. Surgical treatment was performed in 16 patients. 18 patients were diagnosed with congenital malformations of the lung which included bronchogenic cyst (1 case). and clinical outcome. and bronchoscopy (3cases). One patient had three simultaneous abnormalities (pulmonary sequestration. Analysis of clinical spectrum. bronchogenic cyst and cystic adenomatoid malformation). Krichen I**. Tunisia Background: Congenital malformations of the lung are rare and vary widely in their presentation and severity. nosocomial infection (1case) and chronic respiratory insufficiency (2cases). diagnosis tools. Results: During 21 years. Chabchoub I*. . *Paediatric department. and pulmonary hypoplasia (2cases). Purpose: Analysis of our experience and propositions on the diagnosis and treatment of congenital pulmonary malformations. Mekki M**. a segmentectomie in 2 cases and a lobectomy in 8 cases. None case was diagnosis in antenatal.Diagnosis and treatment of congenital pulmonary malformations. pulmonary sequestration (1case). Hedi Chaker hospital. Population and methods: Retrospective study of PM diagnosed between January 1987 and Mars 2008. Common clinical presentations were respiratory distress (2cases). MRI scan (1case). cystic adenomatoid malformation (3 cases). The evaluation of affected patients frequently requires multiple imaging modalities to diagnose the anomaly and plan surgical correction. Monastir. Bouraoui A*. Aloulou H*. During the follow-up (mean: 3 years). Fattouma Bourguiba hospital. Turki H*. Diagnostic modalities included chest radiography (18cases). we noted four deaths (23%) were due to pulmonary sequestration (1case). pulmonary agenesis (2cases). and dyspnea (11cases). congenital lobar emphysema (8cases). A review of 18 cases Maalej B*. CT scan (14cases). Sfaihi Ben mansour L*. Sfax. Conclusion: These data demonstrate that congenital pulmonary malformations usually can be diagnosed by plain chest x-ray films and computed tomography.

I. Krichene2. R. CT elucidates the fluid density within the cyst and demonstrates the relation to the other mediastinal structures. C. the cysts were discovered incidentally on chest radiography. Methods: We retrospectively reviewed data of five patients who have a mediastinal bronchogenic cyst. Histopathological examination confirmed the diagnosis of bronchogenic cyst in all patients. The mean size of cyst was 3. The evaluation of affected children requires multiples imaging modalities. Five case reports A. Ben Salem11. CT is the method of choice to study the cysts and should be used before more invasive procedures. A. The cysts were localised in middle mediastinum in three cases and in middle and posterior mediastinum in tow cases. CHU F.A. Hafsa1. Resutls: The age of children ranged between one week and five years. Chest radiography and CT were performed in all cases. All patients underwent surgery by thoracotomy in tow cases and videoassisted thoracoscopy for the others. Golli1 1 2 Department of Radiology. Salem1. In tow cases.B Monastir Department of pediatric surgery. Hmida1. they were revealed by infection or compression symptoms. CHU F. M. .5 cm.B Monastir Objectives: The aims of this study are to demonstrate the crucial role of computed Tomography to diagnose bronchogenic cyst and to illustrate the radiologic features of this pathology.Bronchogenic cysts of mediastinum in children. Conclusion: Bronchogenic cysts are lesions of congenital origin and are most common primary cysts of the mediastinium. M. Jellali1. and in the three others. Nouri2. B.

Bousseta . R. K. can grow to a large size. They often occur in children. requiring significant pulmonary resection. but have been described in various other sites. Chaouachi Email: annabisonia@yahoo. Inflammatory pseudotumors of the lung are rare and often present a dilemma for the surgeon at time of operation. They are found most commonly in the lung. S. Khemakhem . and are often locally invasive. The therapeutic choice was difficult. benign solid lesions so named because they mimic malignant tumors clinically and radiologically. is safe and leads to excellent survival. F. Jlidi and B.. Ghorbel.Inflammatory pseudotumors of the lung. Complete resection. . We reviewed our experience with one 9 year old patient who has this unusual pathology. S. He presents a parasternal mass one month after a thoracic traumatism. Nouira. Annabi S. Surgical biopsy confirms the diagnostic of inflammatory pseudotumors of the lung. when possible. Inflammatory pseudotumors are rare. The evolution is favorable after 10 months passing. A. The computed tomographic scan shows that a tumor invades the bronchus superior right and the lateral tracheal partition.

Khadhraoui MB*. The abdominal enhanced computed tomography showed a well defined abdominal mass including fatty areas. Axial skeleton is required for the diagnosis of fetus-in fetu. Kairouan E mail: Background/ purpose: Fetus-in-fetu is a rare entity complicating a monozygotic monochorionic biamniotic pregnancy. Amri F**. ultrasonography and enhanced computed tomography were performed. . **Paediatric department.Fetus-in-fetu imaging. The pathologic examination concluded to the fetus-in-fetu diagnosis. Néji H*. with hypoechoic. Plain abdominal radiography. In contrast. It is now distinguished from teratoma as they haven’t the same pathogenesis. tissular areas enhancing after contrast and some bony calcifications. hyperechoic areas and some macrocalcifications. A case report and a literature review. Material and methods: The new born girl G. Allani H*. teratoma was the most likely diagnosis and the mass was surgically removed. We report a case of fetus-in-fetu discovered in a new born girl and we discuss how imaging can help in diagnosis and in treatment. Alouini R* *Imaging department. Khattat N**. Based on these findings. teratomas arise from the uncontrolled growth of pluripotent stem cells. Ibn El Jazzar Hospital. Results: The abdominal plain radiography showed a water-like abdominal mass including some coarse calcifications. It occurs predominantly in the upper retroperitoneum and is revealed by an asymptomatic abdominal mass. Discussion and conclusions: Fetus-in-fetu is thought to be the result of a monozygotic monochorionic biamniotic pregnancy in which a twin is included in the other during the process of ventral folding of the trilaminar embryonic disc. Imaging can help in diagnosis but its confirmation is based on pathology examination. The abdominal ultrasonography found a well-limited heterogeneous abdominal mass.A was referred to paediatric department to explore an asymptomatic abdominal mass. Kahloul N**.

the first one being considered in complete remission 5 years after initial surgery. K. Centre de pediatrie Gatien de Clocheville. Functional respiratory assessment should be proposed.Reconstructive thoracoplasty after carcinologic chest wall resection in children H. For both our patients. A. Braik. De Treatment of chest wall sarcoma type tumours consists in neoadjuvant chemotherapy followed by a chest wall resection taking away the pathological and adjacent rib(s).lardy@chu-tours. Lardy. . M. The operation is technically easy but requires a few surgical tricks. We report 2 cases of chest wall tumours in 2 children aged 8 and 4 years who underwent surgery based on parietal carcinologic resection and chest wall reconstruction. B. the aesthetic and functional result is judged to be in line with expectations A proper follow up of the thoracic growth and in particular of the vertebral one has been set up with the orthopedic pediatric team. Robert Departement de Chirurgie pediatrique. France Email: h. Le Touze. Parietal prosthesis has the advantage to have a particular endothoracic face which prevents adherence to the lung. CHRU Tours. Rib reconstruction allows an almost normal cosmetic aspect and does not compromise the chest wall growth as the cement is located in the anterior and posterior arcs of the ribs using metallic pins.

Hospitales universitarios Virgen del Rocío. Conclusions: Suspicion of tracheobronchial injuries were confirmed by early fiberoptic bronchoscopy. Five days before admission he had had a previous right neumothorax drained elsewhere. After trachea decanulation he started with dyspnoea and hypoxia. All patients had an uneventful recovery. 105 abstract were found for a 7 year period. MEDLINE. Bronchial lesion healed spontaneously without mechanical ventilation. Objectives: During the last 5 years we treated 3 patients with injuries to the trachea and main stem bronchus. Bronchial rupture healed and emphysema spontaneously resolved by the 9th day after observation. De Agustín JC. Children’s Hospital. García-Hernández JA. Mochón A. endoscopical image and radiological records are reviewed and analysed. Seville. Prolonged intubation (15 days) bypassing the injury was enough for sealing the defect. These along one 1997 historical report (Chest) just identify 4 iatrogenic tracheal injury. . cervical and facial emphysema after foreign body removal from the right main bronchus. Results: The first patient is a 1 month old baby who was operated on Transposition of great arteries.Management of paediatric tracheobronchial injuries. The literature review only supports operative treatment for extended and complete airway ruptures and injuries of the tracheobronchial system diagnosed with delay. But the evidence in the scarcely literature recommends nonoperative management. Department of Paediatric Surgery. Methods: Demographic data. Early surgical intervention is frequently asked for by our paediatric colleagues. EMBASE and COCHRANE database were used for literature review (tracheal AND injury AND children: 2000-2008). We summarises our experience and review the literature. clinical. One month after diagnosis the trachea was completely healed. Only 13 showed reliable paediatric data. Maraví A. Spain. Fiberoptic bronchoscopy showed a posterior subglotic tracheal rupture. Blunt and sharp thoracic and cervical trauma accounts for the rest of them. Hosseinpour R. The last one was a 5 year old girl with iatrogenic rupture of the trachea after intubation for an amigdalectomy operation performed elsewhere. González-Valencia JP. Complete healing of the lesion took place 15 days later. Background: Rupture of the trachea or main stem bronchi are extremely rare in children. The second case was a 8 year old male who developed a massive mediastinal. Distal intubation to the tracheal injury allowed complete healing by air leaking prevention. The posterior tracheal dissection was evident for several centimetres. So conservative treatment can be undertaken. Neumothorax neumomediastinum and subcutaneous emphysema developed.

bilateral First and second branchial arch involvement during embriogenesis results in a wide spectrum of anomalies. We report a child with bilateral first and second branchial arch fistulas. . Albrerto Garcia Perla. Antonio Hernandez Orgaz Cirugia Pedipa¡trica. Clinical and tridimensional radiological findings are discussed.Bilateral First and Second Branchial cleft fistula Ana Maria Millön Lopez. Hospital NISA Sevilla Aljarafe. macrostomia. Spain Email: anamillanlopez@gmail. palpebral ptosis in association with congenital hypoparathyroidism.

Anastomosis was performed in both groups. Adnan Abasıyanık . This study aimed to compare the results of oblique and transvers anastomosis to prevent anastomotic stricture that occurred following oesophageal repairs (ORs). Oesophagographic analysis was carried out on postoperative day 7 and the animals were fed orally on the same day on the condition that there was no oesophageal leakage. Discussion and Conclusions: Our results suggested that oblique anastomosis is a better surgical procedure for preventing oesophageal stricture.End-to-end oblique anastomosis to prevent stricture in oesophageal anastomosis. Müslim Yurtçu. The rabbits were sacrificed to measure diameters of the oesophageal lumen (DOTOL) and bursting pressure (BP) in the anastomosis region 8 weeks later. Konya-Turkey of Pediatric Surgery. Hamdi Arbağ. A 1-cm-long tract of the cervical oesophagus was resected through a cervical incision in both groups. Mehmet Öz Selcuk University. Results: The diameters of the oesophageal anastomosis lines in the O group were significantly greater than those in the T group. Departments Otorhinolaryngology Head & Neck Surgery. . Meram Medical Faculty. Introduction: Oesophageal stricture continues to be a challenging pediatric surgical problem. The values of BP in the O group were also significantly higher than those in the T group. as shown by the increased diameters of oesophageal anastomosis lines and BP. Material and Methods: Twelve New Zealand rabbits were devided equally into 2 groups: oblique (O) and transvers (T).

A.the diagnosis was made this patient on ultrasound exam and CT-scan. BOUABDALLAH L. and therapeutic management of this rare localisation of hydatic disease.RAMI.MAHMOUDI. The surgical exploration found a peritoneal hydatid cyst . Introduction: Peritoneal hydatidosis is a rare localisation of hydatic disease.ARROUD . M. Case report: A 9 years boy was referred to our hospital for a clinical profile characterized by an abdominal mass in progressive developing. University Hospital Hassan II of Fez. Conclusion: In the light of this case report. About one case A. Its primitive form is considered due to haematogenous diffusion through arterial vessels. K. . We report a case of peritoneal hydatidosis.CHATER.ATARRAF. Y. radiological findings.KHATTALA.ELMADI. Morocco.Sterilisation and resection of the cyst were the surgical management. A. K. Pediatrics Surgery Department.Peritoneal hydatidosis in children. Surgical cure has been completed by pharmacologic treatment with the aim of avoiding a relapse. with no signs of inflammation .LECHQAR. AFIFI. M. we will discuss clinical aspects. in a 9 year-old boy. M. most often secondary to a hydatic cyst of the liver. There was no complication reported in the post operative with a follow of 2 years.

MSCT) and emergency surgery are something that we preferred. . Serbia E-mail : niboj@nadlanu. Good clinical presentation. Intraoperative findings were confirmed with PH results. MSCT revealed intrahepatic cyst with clear borders. Bojovic N Clinic of Pediatric Surgery and Orthopedics. Endemic area. but can be in other organs or cavities. ultrasound and RÖ examination did not indicate any specific sign of hydatid disease. but very serious complication of hydatid disease. Standard laboratory. Marjanovic Z. known liver cyst and intra-abdominal fluid in the patient history are some determining elements of hydatid cyst rupture. Abdominocenthesis was another step in making differential Background: The rupture of hydatid cyst in children is a rare. space occupation or rupture it presents with signs and symptoms. Krstic M. The common presenting symptom was abdominal pain. Two of them (~9%) were ruptured on reception. up-to-date radiology examination (MRI. time of surgery from the onset of symptoms. Clinical Centre Nis . Slavkovic A. Methods: Two patients were admitted to Pediatric surgery clinic in last six years with the diagnosis of acute abdomen after a simple abdominal trauma. gender. Otherwise. laboratory findings. The cyst may be ruptured after a trauma (usually in children) or spontaneously. Conclusion: Liver cysts in children are usually of parasite origin. One patient had symptoms and signs of anaphylactic reaction. any postponed or inadequate therapy faces us with numerous complications like secondary peritoneal hydatidosis. Hydatid cyst is usually asymptomatic until its size. post-surgical therapy and control examinations were evaluated retrospectively. The rupture is most often in the abdominal cavity. Zivanovic D. MRI examinations six months to six years after operation did not reveal disease recurrence.Acute abdomen in children as a result of liver hydatid cyst rupture. simple trauma. intraoperative and patho-histological findings.The signs and symptoms are heterogeneous. Age. diagnostic procedures. Results: In the last 15 years we had 21 cases of liver hydatid cyst disease in children. Kostic A. It requires immediate diagnostic procedures and surgical treatment. The cyst can be revealed accidentally by ultrasound or RÖ examination. surgical treatment modalities.

Aim is to determine the prevalence of the affection within the juvenile population of the wilaya of Setif. The hepatic hydatic polykystose ius met in 7.8 % of the cases. Boughaba A. Soualili Z.Algeria Email: soualili2001@yahoo. Faculty of medicine of Setif . Young populations amongst the most important in the world. Choutri H. Touabti S. Laouamri S. Smati The human hydatic cyst ha san impact not only in economy but also in public health. The pulmonary localization is meaningfully more frequent with boys. Results show that the prevalence is of 7. . Ait Yahia S.1 cases for 1000 and the major part of the children has an age understood between 4 and 12 years.The follow up of child with hydatic disease in the high plateau of Setif. The total eradication perspective remains the only hop and would allow the surgeons pediatricians to dedicate itself/themselves more efficiently to other pathologies malformatives .

The common presenting clinical features were abdominal mass in 4 children.H*. Mekki. and imaging have a major role in establishing the diagnosis. Nouri. Hachicha.M**.fr Introduction: Hepatic neoplasms are rare in children. and hepatomegaly in one case. Hedi Chaker Hospital Sfax. Fattouma Bourguiba Hospital Monastir. Turki. Tunisia Email: chabchoubimen@yahoo. 2/3 are malignant. Conclusion: We conclude that adequate surgical resection and adjuvant chemotherapy can improve disease free survival for children with hépatoblastoma. Kamoun. Results: The diagnosis was hepatoblastoma in 3 patients. one patient only is currently alive (after a decline of 3 years). The patients with haemangioendothelioma had surgical resection. the evolution was favourable. Computed tomographic scan and ultrasound were useful preoperative investigations for assessing site and resectability of tumour. Of them. Serum alpha-foetoprotein was useful to guide a diagnosis in hepatoblastoma and in monitoring disease activity.A*.6 years range from 15 days to 8 years. The sex-ratio was 0.A**.Hepatic neoplasms in children Bouraoui. biology. with histologically proven primary liver tumours. Clinical examination. Chabchoub. Tunisia.Th*.M* * Paediatric department. . The median age was 2.25 (1 boy and 4 girls). They constitute only 1-2 % of all paediatric tumours.I*. and haemangioendothelioma in 2 children. The patients with hepatoblastoma had adequate surgical resection and chemotherapy. between 19872007. ** Paediatric surgery department. Optimal treatment has yet to be devised for other malignant hepatic tumours. Material and methods: Five patients were admitted to a paediatric institution during a period of 21 years.

Unique case report and review of literature. Mohammed Youssef Alexandria Hospital for Sick Children Email: edini99@yahoo. a previous surgery was done to the baby and the parents were told that it was an inoperable liver tumor. orthopnea and recurrent chest infection. Conclusion: Infantile hepatic lymphangioma is an extremely rare condition and must be considered in the differential diagnosis of any hepatic Introduction: Hepatic lymphangioma is an extremely rare benign neoplasm that is usually associated with lymphangiomas of other viscera and when found in the pediatric population they are usually found in extra abdominal sites. Case report: We present a 10 month old female infant presented to our department with severe abdominal distension causing the baby dyspnea . Aim: Is to highlight a high suspicion index of such a condition in infants and children presented with hepatic masses. .Surgery was done to the baby after full laboratory and radiological work up and the mass was totally removed with complete preservation of the liver and a after a follow up period of 6 month till now the baby is doing well with no recurrence or relevant complaint.Solitary hepatic lymphangioma of a three and half month old infant.

During surgical exploration. Ahmed REKIK**. and review the embryology of this complex Hepatopulmonary fusion in neonate is very rare entity. Lilia TRIGUI**. 3029 Sfax. right hepatopulmonary fusion was encountered. Mohamed JALLOULI*. **Department of neonatology. Zeineb MNIF***. Abdellatif GARGOURI**.jallouli@rns. Hedi Chaker Hospital. Emna DOUAD***. only 8 cases are report in the literature. describe our surgical approach. Case report and review of the literature. TUNISIA Email: mohamed. Riadh MHIRI* * Department of pediatric surgery. Hatem BEN AMAR**. . We present the case of a female infant at a gestational age of 41 weeks who presented with a right congenital diaphragmatic hernia. ***Department of radiology.Hepatopulmonary fusion in a neonate. We review the existing literature on this problem.

Echography and the scanner are means paraclinic interesting for the diagnosis and the follow-up of the patients. heterogeneous containing zones anechogene. a normal hepatic assessment. flexible with a painful hepatomegaly to 2 cm of the edge costal. a thrombosis of the portal vein and an intestinal parasitosis. The most frequent causal agent is the staphilococcus aureus. The incidence varies from 5 to 20% of the hepatic abscesses. its abdomen was slightly slack. immunodeficiency such as granulomatosis. Laboratory tests on admission revealed an inflammatory syndrome with a sedimentation time of 89 mm/h and C-reactive protein level of 23. was admitted for feverish and painful hepatomegaly evolving since one week. An abdominal scanner showed an aspect evoking a cyst hydatic from the infected liver.Pyogenic Liver Abscess: a rare cause of feverish hepatomegaly in child. An abdominal ultrasonography objectified a round lesion limited well hypoechogene. A etiologic research was made and was negative (parasitic serologies. a deficit in IgE. its temperature was 39°C. Ben Ameur S. Ben Abdallah R. The child was put under oxacilline at 200mg / kg/ Introduction: The hepatic abscess is a rare pathology in the child. thrombosis of the portal vein). A predisposing ground is systematically required in particular a chronic septic granulomatosis. non vascularized to Doppler color. Trabelsi L. Service de Pediatrie. The remainder of the examination was without characteristics. The bacteriological study of the liquid of drainage insulated a sensitive staphilococcus aureus. The child had in urgency a surgical drainage which has objectivity an abscess of the Liver. Ben Halima N. Hemoculture. Observation: A 3 years old boy. CHU Hedi Chaker Sfax Email: lotfi_try@yahoo. On initial examination. Urgence et Reanimation pediatrique. Ben Salah M. the pyogenic liver abscess is an etiology to be evoked. coming from Ouled Haffouz. . Chabchoub I.82 Mg. Mahfoudh A. hydatic serology and amoebic serology was negative. in particular immunodeficient. Conclusion: In front of a feverish hepatomegaly in the child.

having a past medical history of hepatic colic since one year before the current presentation.8°. About one case A. a laparoscopic cholecystectomy was performed with uneventful postoperative course. M. Introduction: Pancreatitis is an inflammatory process of the pancreas with involvement of various close and distant tissues. University Hospital Hassan II of Fez . Y. MRI of biliairy ducts showed segmental dilatation of the proximal part of the principal biliairy duct (15 mm). containing micro-calculs. and through a literature review. CHATER. The patient presents in our department for acute abdominal pain. we will discuss the different epidemiologic. M. A. with normal intra-hepatic biliairy ducts. amylasemia à 1664 IU (12x). ELMADI. K. BOUABDALLAH Pediatrics Surgery Department. Conclusion: In the light of this presentation. good hemodynamic condition and sensibility of the right hypochondre. Abdominal ultrasonography pointed out a thickening of the gall bladder wall (4mm). K. with dilated principal biliairy duct (14 mm). with presence of collection around the vena cava. RAMI. . MAHMOUDI. AFIFI. Abdominal CT-scan endorsed the ultrasonography findings. It is a rare clinical entity in the childhood. associated with vomiting and fever. KHATTALA. Clinical examination pointed out fever of 37. normal renal function and normal blood formulae count. LDH 599 IU. After 3 weeks of follow up. pathogenic. diagnostic and therapeutic aspects. M. The patient sustained a close clinical and biological monitoring.Morocco. L. and was administered antibiotics (protected amoxicillin).ARROUD.Biliary pancreatitis in childhood. LECHQAR. aspect of the pancreas was homogenous. Nourishment was performed through a nasojejunal probe after relief of abdominal pain.TARRAF. having bleak prognosis and no straight forward treatment management. A. Case report: Our patient is a young child of 12 year-old. Workshop found the following values: lipasemia 1934 IU (10 x).

** Department of Radiology. Aloulou*. Sfax. Boukedi*. H. I. Habib Bourguiba Hospital. In other way. Idiopathic gallstones were found in 5 patients. I. L. Tunisia Email: chabchoubimen@yahoo. Hedi Chaker Hospital. Bouraoui*. None of the patients underwent therapeutic endoscopic retrograde cholangiopancreatography or medical therapy with ursodeoxycholic acid. and another with dehydration symptoms. Materials and methods: A retrospective study was performed in children with a diagnosis of cholelithiasis between 1987 and 2008 in the paediatric department of UHC Hedi Chaker (Sfax. A. Beyrouti***. All patients were diagnosed by abdominal ultrasound scan. Results: There were 8 boys and 7 girls. an increasing number of children with cholelithiasis has been identified. 7 had gallstones in association with a hemolytic disease. little is known about the epidemiology and the best therapeutic regimen for Cholelithiasis in children. Hedi Chaker Hospital. *** General Surgical Department. insist on the utility of abdominal ultrasound scan performed routinely and evaluate the management. Sfax. Hachicha* * Paediatric department. Tow patients had gallstones in association with biliary sludge (Byler disease and portal cavernoma). Aim: Remember etiology of cholelithiasis. Th. mnif**. Conclusion: Cholelithiasis in children is an unusual finding. Tunisia). . Surgery was performed in 13 patients: open cholecystectomy in nine and laparoscopic cholecystectomy in four. Z. but is not exceptional. A.Cholelithiasis in children. Tunisia. It was suspected in symptomatic children in 6 cases. Kamoun*. Background: Even though in the last years following the extensive use of ultrasound scanning. B. Lithiasis was discovered by chance in 2 cases and by systematic check in 7 cases. B. Maalej*. The median age at diagnosis was 8 years with extremes between 6 months and 15 years. Mansour*. 15 patients with gallstone were enrolled to the study. Sfax. M. Chabchoub*. The therapeutic strategies were extremely heterogeneous and guidelines for management are available for adults but not for children.

acro-osteolysis. No similar case was reported in the same family. oedema with pain. These difficulties restricted the girl activities. the finger clubbing were not improved. thickening of the facial feature. The dermatological manifestations (hyperhidrosis) and rheumatological symptoms (joint effusion. digital clubbing.kamoun@rns. Tunisia Email: hassen. Rheumatologiac symptoms are not always improved by nonsteroidal anti-inflammatory drugs while the dermatological symptoms. Radiological analysis showed subperiosteal new bone formation and acroosteolysis. Kamoun H Medical genetic department . Clinical examination showed pachydermia. arthritis. the dermatological manifestations and rheumatological symptoms associated would cause handicap. polyarthritis and hyperhidrosis. Belghith N. Pachydermoperiostosis is a rare hereditary disorder with no knows genetic defect. She had a normal caryotype (46 XX) but no other genetic analysis was done. periosteal ossification) led to difficulties in walking and using hands. .Pachydermoperiostosis in a young girl. seborrhea.Hopital Hedi Chaker – Sfax. We report here a sporadic case of fourteen year old girl with digital clubbing and Pachydermoperiostosis is a rare hereditary disorder inherited in an autosomal dominant pattern with variable penetrance that is often familial and occurs predominantly in men.

Hexadactyly in two cases of defined syndromes: Patau syndrome and Bardet Biedl syndrome. Belghith N, Kamoun H Medical genetic department - Hopital Hedi Chaker - Sfax , Tunisia Email: Hexadactyly observed in child could be sporadic or familial; It could be also a single dysmorphic feature or a feature among others in defined syndromes. We report here two cases of syndromes including hexadactyly; the Patau syndrome for the first case and the Bardet Biedl Syndrome for the second. Patau syndrome (Trisomy 13) is a chromosomal anomaly caused by the presence of an extra chromosome 13. The first case had microphthalmia, cleft lip and cleft palate, hexadactyly and systemic anomalies. Cytogenetic analysis confirms the aneuploidy (karyotype : 47,XY,+13). Cardiac malformations and central nervous system anomalies explain the perinatal mortality for this case. Bardet-Biedl syndrome (BBS) syndrome is an autosomal recessively inherited disorder. This syndrome is characterized by genetic heterogeneity;12 causative genes have been identified (BBS 1 to 12). The second case is characterized by obesity, pigmentary retinopathy, hexadactyly, hypogenitalism and learning difficulties. Molecular analysis shows mutation in BBS 8 gene. would also develop renal disorders, diabetes and hypertension. Treatment is symptomatic only. Visual impairment is often severe and its management should be integrated into the global management of child and adult patients. Obesity requires management, with the prescription of a healthy lifestyle and, if necessary, specialised care. Hexadactyly could be due to different genetic defects ranging from chromosomal to molecular defects. Associated clinical features guide genetic analysis to do. The detection of the genetic defect allows genetic counselling.

Prenatal diagnosis of right upper quadrant cyst masses. Ana Maria Milôn Lopez, Juan Carlos de Agustin Asensio, Lourdes Gomez Izquierdo, Gema Calderon, Reyes vazquez Rubio, Guillermo Antiolo Gil Servicio de Cirugia Pediatrica, Servicio de AnatomÃa Patologica, Servicio de Anestesia, Servicio de Neonatologia, Unidad ClÃnica de genetica , reproduccion y medicina fetal Email: Duodenal duplications are rare malformations with several anatomical varieties. A case of large subhepatic cyst was identified sonographically in a 30-year old gravida at 20 weeks of gestation. In this fetus the differential diagnosis was foregut malformation, choledochal cyst or omentum cyst. Neonatal computed tomography scan was not definitive. He developed a neonatal gastric outlet obstruction and was operated on day 4. We discuss the accuracy of antenatal US in the right upper quadrant cystic masses and its correlation with the postnatal diagnosis.

New born tumours and pseudo tumours panorama N. BOUGHABA, S. TOUABTI; Z. SOUALILI Pediatric surgery department. CHU Setif. Algeria New born tumour pathology is acknowledged by its curiosity, its specificity, its taking care is most often late because the antenatal diagnostic tacks difficulty of distinction between tumour, pseudo tumour or organomegaly. The most part of these tumours are minor; some can have a clever progressive potential in the majority of cases, the treatment is surgical Across this work, we illustrate some observations of tumours and pseudo tumours met in our service with an analytical study of every type of tumour according to its clinical picture, its siege, its clever or minor type and it’s taken care.

and the passage by first surgery will be comfulsory. witch have caused a serious problem of diagnosis.increase the chance of cure and the survival rate on long time. We decide to operate this patient and we have find a voluminous abdominal strong masse. The biology balance-sheet and tumoural markers are normal.Abdominal tumour of child.huc of SETIF ALGERIA Email: lsmai2006@yahoo. their diagnosis will be easy cause contribution of the imagery (scanner and the biology. . In some case this couple dont give any information. We have releazed a carcinologic tumourectomy the result of anatomical pathology has revealed a malignant schwanome:neurofibromatose tumour. This Patient has white coffee marks means the recklinghausen illness. We repport a case traited in our care unit of pediatric surgery in HUC of SETIF(ALGERIA). The carcinologic surgery permet the recovery but the problem in this case is the risk to have another localizing of tumour again furthery witch the interest to supervise for all the life.witch permet their reimbursement on the diagnosis. but her origin has not be detected by scanner. pediatric surgery care. It's a girl's case of 14 years old whose have a voluminous abdominal masse revealed by compression sign and objectived by scanner. beginning in the mesenter The abdominal tumour of child remain frequent.

MERAD. The disease is often family. are seen and operated on average 3 times and let us lose sight of the fact we them towards 11-12 years. of the erythemateuses and pigmented lesions then spots of cutaneous atrophy with small telangiectasies and finally of the croûteuses and warted lesions. F. KAID SLIMANE Service of Plastic Surgery. Our series comprises 29 cases over one decade (1997-2007) The patients start to arrive in our consultation towards the 4 years age. F. L ZINAI-DJEBBAR. CHU ORAN * Anaesthesia-Reanimation Transformation into Epithélioma is of rule in Xeroderma Pigmentosum. only the minor forms arrive at the adulthood. 25 % with less than 10 years. MAHMOUDI.Experience of plastic surgery department of the CHU Oran in the treatment of xeroderma pigmentosum in the child. capable to delay the appearance of large tumours. BENRAHAL. in turn. The treatments summarize with the followed exerese directed cicatrisation. N. The authors plead for an early assumption of responsibility of the disease by explanations lit with the families often delivered to them same in a climate of distress and rejection (by the means of an association " domiciled " with the CHU) and especially of measurements of prevention on the various levels. the mutilations are the rule considering the advanced state of the lesions and the localizations of these tumours which are in 80 % of the cases of the épithéliomas spinocellulaires. a génodermatose which sees followin one another. A. R. . ABDERRAHIM *. Centre des Brûlés. it begins in the youth and it is sometimes associated in a particular state neuropsychic. consanguinity is found in 80% of the cases. GUECHAIRI. 6 cases in our series. F. This affection translates a particular sensitivity of the teguments to the light and leads to dead before the 15 years age in two thirds of the cases.

Normal values were considered: ΡΤ: (ΡΤpool±2sec).5) and 4) APTT with two reagents (activator:caolin. 2) FVIII activity at group B. G. 2. FV:70-120% και FVIII:60150%. APTT sensitivity is depended from the commercial reagents. Tsikopoulou*. K. Abnormal values of PT were observed when the activity of FV was less than 70% with all three commercial reagents. Technological Educational Institution of Thessaloniki **Pediatric Surgical Department. Aim: The aim of this in vitro study is to determine the sensitivity of PT and APTT in such deficiencies and its colleration with commercial reagents. . 1.15 in both. Vagdatli*. Hippokratio General Hospital. F. Thessaloniki Introduction: Many children with familial bleeding tendency need a preoperative laboratory study in order to detect an unknown deficiency of coagulation factors. Rupakias**. Tsikopoulos** *Department of Medical Laboratory Studies. from undiluted plasma to a 1 to 5 dilutions. Each of them was diluted with commercial deficient factor V (FV) plasma (A group) and deficient FVIII plasma (group B) in order to achieve progressively diminished concentration of those factors.85-1. S. Abnormal values of APTT were observed when the activity of FV was less than 60% (kaolin activator) and 30% (elastic acid). Differences between these values were not normalized with the use of Ratio.Effectiveness of determination of Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) preoperatively E. and elagic acid) at groups A and B. ΑΡΤΤ:(APTTpool±8sec) or Ratio:0. Results: 1. Conclusions: 1. 2. At a semiautomatic coagulation analyzer were measured: 1) FV activity at group A. So APTT is not suggested as a preoperative test for patients free of bleeding history as it can not reveal the carriers of coagulation factor deficiencies. 3) PT with three different reagents (ISI:1. Farmakis**. PT is sensitive at limited deficiencies of coagulation factors while APTT is not. Material and Methods: A plasma pool was created from normal donors and then this pool was separated in two parts.23 and 1. while FVII<36% (kaolin) and <24% (elastic acid).

Central Broviac catheter in neonates Report of 22 cases A Ben Thabet*, L Trigui*, M Jallouli**, H Ben Amar*, A Gargouri*, N Hmida*, A Ben Hmad*, R Regaieg*, M Kannou*, R Mhiri**, A Rekik* * Neonatology department- Hedi Chaker hospital ** Paediatric surgery unit- Hedi Chaker hospital Introduction: Broviac catheters are in common use for administration of parenteral nutrition, cancer chemotherapy, and antibiotic therapy within the paediatric population. They are less used in neonates especially when no other central venous access is possible. Patients and methods: This is a retrospective report of all tunnelled Broviac central venous catheters placed in neonates at neonatology department of Sfax over a nearly 4-year period (2005-2008). Single lumen Broviac catheters were used in all cases. They were surgically placed in the paediatric surgery unit of Hedi Chaker hospital. Results: Broviac catheter was placed in 22 patients. There were 10 at term neonates and 12 premature. The mean term of premature neonates was 30 weeks (extremes: 25 – 36 weeks). The mean weight at birth was 1650 g in the premature group and 2990 g in the at term group. All new-borns were hospitalised at birth because of: - respiratory distress in 15 cases - prenatal diagnosis of digestive malformation in 3 cases - hypoglycaemia in one case - very low weight at birth in one case - parietal abdominal malformation in 2 cases Broviac use was indicated at a mean age of 13,5 days (extremes: 2–34 days) for different circumstances: - post operative care of digestive surgery in 12 cases - premature babies with nutritional difficulties in 8 cases - persistent respiratory distress in one case - persistent hypoglycaemia in one case (hyperinsulinism) The catheter was maintained for a mean period of 12 days (extremes: 1-34 days). Venous thromboses were noted in 3 cases and infectious complications were confirmed in 5 cases. Ten neonates were dead. Their death wasn’t directly depending on Broviac catheters. Conclusion: Neonates in the neonatal intensive care unit often require central venous access for parenteral nutrition, antibiotics, repeated blood sampling, and transfusions. Whenever possible, peripherally introduced central venous catheters (PICC) are used preferentially. Tunnelled and surgically placed central venous catheters are used when long term access is indicated and placement of PICC has failed. Adherence to strict guidelines for insertion and handling can significantly reduce catheter-associated complications.

Unusual case of clitoromegaly Salih Cetinkurgun, Adnan Narci Önder Şahin, Evrim Özkaraca Afyonkarahisar Kocatepe Universitiy Faculty of Medicine Departments of pediatric Surgery and Pahology Email: Introduction: can be either congenital or acquired. The congenital forms are caused by hormonal disturbances, tumors or intersex states. Usually they are obvious at birth. Here in we present the unusual case of a 20 month years old with epidermoid cyst of the clitoris. Maternal and Methods: A 20 month year old caucasion girl was referred with clitoromegaly. She was investigated for an intersex disorder before surgical consultation. But hormon profile, chromosomal analysis and pelvic ultrasound were normal. Physical examination was normal with no signs of virilisation. Abdominal examination revealed the presence of approximately 3x3 cm rounded, cystic, mobil and nontender mass at the clitonal region. Tilting the enlarged clitoris upward revealed a normal female introitus. A cystic tunour of the cilitoris was diagnosed and surgical excision recommended. At operation, the cyst was easily dissected from the skin and corpona cavernosa and completely excised. Results: Histopathologic examination showed an epidermoid cyst lined by keratinised stratified squamous epithelium and filed with keratin flakes indicating origin from the epidermis postoperative course was unevenful. Discussion: Clitoral enlargement during childhood is a rare condition that requires careful history and physical examination. Endocrinological evaluations and imaging of the adrenal glands or ovaries can be necessary for diagnosis. If these investigations are negatives, biopsy and/or complete surgical excision of the tumor should be performed. Tumors of the clitoris are uncommon, but include a variety of categories such as fibroma, leiomyoma, angiokeratoma, hemangioma, epidermoid cysts and neurofibroma as clitoral involvement of neurofibromatosis. Conclusion: Although it is very rare, a cystic lesion should be considered in the evaluation of a neonate with an enlarged clitoris.

Inter labial masses in little girls Mohamed JALLOULI*, Lilia TRIGUI**, Abdellatif GARGOURI**, Houda KAMMOUN*, Nedia HMIDA**, Ahmed REKIK**, *, Riadh MHIRI* * Department of pediatric surgery; ** Department of neonatology. Hedi Chaker Hospital. 3029 Sfax. TUNISIA Email: When an interlabial mass is seen on physical examination in a little girl, there is often confusion about its etiology, its applications and what should be done. We present three uncommon interlabial masses; include a vaginal polyp, a urethral polyp and a vaginal prolapse. On the basis of our cases we believe that examination under general anesthesia can precise the exact location and allow a therapeutic approach when necessary. The histological exam is also necessary to establish the right diagnosis.

admitted in the paediatric department at CHU Hassan II The pheochromocytoma is a rare tumor in children that could be unilateral and isolated. L. Mahmoudi. It’s diagnosis depends upon a set of clinical arguments. The diagnosis confirmation calls for methods used in the molecular biology. or. M. Afifi. Bouabdallah Department of pediatric surgery. which is the case of our patient. Elmadi. Rami. K. A. especially the paroxystic high blood pressure. A. Von Hipel Lindau disease. Arroud.Bilateral pheochromacytoma. Morocco Email: chaterlamia@yahoo. most frequently. . she had an ischemic stroke syndrome. Elghassani hospital. and the prognosis relies on the speed and the quality of care. CHU Hassan II Fez. Y. MA. which is a particular way of revelation of the pheochromocytoma. in particular with the advent of the MIBG scintigraphy. The topographic diagnosis has become easier thanks to the development of the imaging procedures. that may leads the place to its complications. Atarraf. or Von Recklinghausen disease). bilateral and integrated as a hereditary disease (multiple endocrine neoplasia. along with the related localizations. The therapeutic care is multidisciplinary. Chater. About one case. K. M. Khalid.

it should be considered in the differential diagnosis of obstructive jaundice in children and a cystic mass within the common bile duct. Tunisie. M. between the second part of the duodenum and the head of the pancreas. On examination. and a Roux-en-Y hepaticojejunostomy was done. measuring 8 cm/4 cm/3 cm in diameter. Tunis. KHEMIRI1. TLILI1. BORGI1. 4 Service de radiologie. the child had hepatomegaly and icterus. A well-demarcated mass was found in the distal common bile duct. I. . Ultrasonography showed mild enlargement of the liver. BEN ROMDHANE3. A. During 3 year of follow up. Tunisie. 3 Service d’anatomie et de cytologie pathologiques. M. The patient underwent laparotomy with the diagnosis of hydatic cyst. The patient was given combined chemotherapy (vincristine. K. OUBICH1. abdominal distention. and mild dilatation of the main hepatic ducts and intrahepatic bile ducts. Hôpital d’enfant de Tunis. Y. service de médecine infantile « A ». and bilirubin (227µmol/dl) levels. Magnetic resonance imaging (MRI) study showed a cystic mass with heterogeneous intensity. and ifosfamide). Histopathologic examination of the specimen concluded in botryoid RMS. Tunisie. actinomycin-D. BELLAGHA4. it is important to know that this tumor can simulate hydatic cyst or congenital choledochal cyst. of 1-month duration. and the obstructive jaundice resolved. Case report: A 22-month-old male patient was admitted to the hospital with complaints of progressive jaundice. We report a new case of botryoid RMS. a dilated common bile duct (8cm in diameter).Rhabdomyosarcoma of the biliary tree: a rare cause of childhood cholestasis. F. Botryoid RMS is a rare type of mesenchymal neoplasm diagnosed at surgery or by preoperative liver biopsy. institut Salah Azaeiz. and weakness. Conclusion: Botryoid rhabdomyosarcoma of the common bile duct is a rare malignancy of childhood. there was no finding of recurrence. S. The mass was totally dissected from over the portal vein. Hôpital d’enfant de Tunis. HAMZAOUI2. 2Service de chirurgie pédiatrique « A ». BARSAOUI1 1 Unité d’oncologie. Introduction: Rhabdomyosarcoma (RMS) of the extrahepatic bile ducts is a rare cause of jaundice in children. Liver function tests revealed high alkaline phosphatase (2003IU/l).

Conclusion: It remains difficult to indicate time and type of surgery in treatment of ovarian masses. an abdominal mass or precocious puberty. evaluation and outcome of 30 patients with ovarian pathology surgically treated at our institution from January 1998 to April 2008. ovarian-preserving surgery should be performed whenever feasible. Of those presenting with acute abdominal pain. Fakhfekh. Charieg. Tunisia Email: awatef_charieg@yahoo. must be included in the differential diagnosis of all girls who present with abdominal pain. 20 (87%) had benign cysts. with biopsy in 2 cases. S. Because most of these lesions are benign.Surgery for ovarian masses in children and adolescents : 30 patients treated in a 10. M. 5 (25%) had ovarian cystectomiy and 2 had detorsion. Children’s hospital of Tunis. S. Of those who had urgent surgery. Jlidi. Ghorbel. and 2 had malignant tumors with one immature teratoma and one juvenile granulosa cell tumor. 19 patients had adnexectomy.year period M. Clinical presentation was acute abdominal pain in 27 cases. an abdominal mass in 2 cases and prenatal ultra sonography in 2 purpose: Ovarian pathology. 2 mature teratomas and only 1 malignant tumor. 3 had mature teratomas. Time and type of surgery remain difficult to indicate. F. although less frequent in children than adult. Khemekhem. Clinical presentation and ultra sonography help to diagnose adnexal torsion. Bendhaou. Chaouachi Department of pediatric surgery "B". Belaiba. 13 (65%) had salpingooophorectomy. B. R. . All patients are now desease free at 6 years mean follow-up. S. 20 (74%) underwent surgery urgently and 23(85%) had ovarian torsion. 14 of them had benign cysts. A. time and type of surgery of these lesions. Nouira. Results: Thirty girls with a mean age of 9 years (range 2 months to 14 years) underwent surgery for ovarian pathology. 28 of them had ultrasonography before surgery. we reviewed the presentation. Methods: To improve clinical appreciation. Of those who had ovarian torsion.

The purpose of this work is to define the imaging findings (ultrasonography and computed tomography) in this pathology. concluded to internal genital related masses. The mechanic obstruction is frequently due to a hymen imperforation. In all cases an ultrasonography and enhanced computed tomography exams of the abdomino-pelvic cavity were performed. When it extends to the uterus. Hydrocolpos is defined by a cystic dilatation of the vagina. Hydrometrocolpos was the most likely diagnosis. a cystic abdomino-pelvic mass with an echoic content and a proper wall. Kairouan. Tunisia Introduction: Hydrometrocolpos is defined by a cystic dilatation of the vagina and the uterus. Dilatation of urinary cavities was found in variable degrees. It represents the third etiology of the abdomino-pelvic masses in newborn. Allani H*. Material and methods: Retrospective study including 3 patients. 2 newborn and one 14 years old girl. . confirm the diagnosis. ** Departement of paediatrics. Amri F**. by itself. Ibn El Jazzar hospital. The clinical exam of external genital organs helped to confirm the diagnosis. CT exam is indicated in hard cases. This entity is caused by the obstruction of the vagina. Troudi M**. The CT exam. Khattat N**. admitted for the exploration of abdomino-pelvic mass. thanks to the MPR reconstructions. Alouini R* * Departement of radiology. it becomes called hydrometrocolpos.Hydrometrocolpos: imaging findings Aïssa A*. Results: The ultrasonography exam showed. in all cases. Discussion and conclusions: Hydrometrocolpos and cystic ovary are the most frequent pelvic cystic masses in girls. Ultrasonography exam can. Retrograde opacification of the bladder was realized in one case.

Perinatal prognosis of prenatal and postnatal congenital intestinal obstruction Ayadi I*. Guesmi M**. After birth. In the 2 other cases duodenal and an "apple peel" atresia were diagnosed. The other case was a jejunoileal atresia. Neonates with functional obstruction or additional congenital anomalies were excluded. Neonatal intestinal obstruction can have different variations in presentation depending on the level and extent of obstruction. Neonates with antenatal diagnosis have got immediately appropriate surgical treatment during at least 48 hours. Conclusion: Antenatal detection of surgically correctable congenital intestinal obstruction would ideally reduce perinatal morbidity and mortality by allowing a planned delivery with early resuscitation and prompt surgical intervention. *Department of Neonatology – Charles Nicolle Hospital . . Chaouachi B***. The diagnostic was detected by ultrasonography in 5 cases. 1 case of intestinal volvulus was found. Hamzaoui M**. Only one died with status of septic shock and neurological distress. The purpose of our study was to evaluate the morbidity and the mortality of congenital intestinal obstruction diagnosed antenatally or only diagnosed after birth. 2 cases of anorectal malformation were diagnosed at birth. Results: 10 cases of congenital intestinal obstruction were collected.Tunis ***Department of Paediatric surgery B – HET . when diagnostic wasn’t made during pregnancy. Labidi K*. clinical features such as vomiting. Chaouachi S*. Material and methods: A retrospective study of 10 neonatal observations of congenital intestinal obstruction was conducted over a 7-year period. with unrecognized antenatal intestinal obstruction deteriorate rapidly. Surgical advice is often sought when a prenatal diagnosis of gastrointestinal tract obstruction is made. Marrakchi Z*. show an increase of associated morbidity and mortality and appropriate surgical treatment becomes more hazardous. abdominal distension and delayed meconium passage were suggestive. and complicated by meconium peritonitis.Tunis Background: Presence of dilated bowel loops antenatally suggests fetal bowel obstruction.Tunis **Department of Paediatric surgery A – HET . Neonates. Duodenal atresia was the most common intestinal atresia diagnosed in the 5 fetus (4 cases).

Discussion: There is a variety of causes of chylous ascites in neonates such as congenital. Results: Repeated sonograms showed improvement and complete resolution of ascites was achieved after 15 days. lymphangioma. The neonate was extubated the first postoperative day. Radiographic control discovered a left sided diaphragmatic hernia. . Treatment with octreotide was administered for 10 days. The neonate was treated with total parenteral nutrition. Some cases will resolve spontaneously. medium chaine triglycerides while octreotide was applied at the second day. Ultrasonographic control at the second postoperative day showed an amount of free fluid into the peritoneal cavity. Patients and methods: A 3900g male neonate after 38weeks of gestation. There is no recommended dosage or duration of treatment with octreotide in neonates so we used similar to other cases. Conservative treatment is involving total parenteral nutrition. The neonate went under surgical repair the second day of life. Konstantinos Farmakis Taki ikonomidi 44. 3¼g/kg/d in three divided doses. Introduction: Chylous ascites is a rare complication after surgical repair of congenital diaphragmatic hernia. During the operation a great amount of lymph (70cc) was exteriorated. Treatment with octreotide. postoperative ascites is infrequent. subcutaneously. We present a case of a neonate with chylous ascites successfully treated with octreotide. Greece Email: kostafarmakis@yahoo. thessaloniki. conservative treatment will prolong hospitalization. lymphatic duct ligation and fibrin glue application. obstructive intestinal lesions. In persistent cases. At the 14th postoperative day the neonate went after a surgical repair of inguinal hernias at both sides.Chylous ascites in a neonate after repair of congenital diaphragmatic hernia. Surgical treatment is peritoneovenous shunt. delivered with caesarian section developed respiratory distress after birth. Normal nutrition started right after. liver disease etc. medium chaine triglycerides and octreotide. In these cases morbidity is increased. Conclusion Treatment of chylous ascites with octreotide is proved to be a safe option with no complications and short admission period.

University Hospital of Sétif. Case report and management principles. We discuss the various anesthetic and surgical problems faced in this syndrome. Algeria. the fascia defect was 8 centimeters in diameter. We conclude that despite the risk. E mail: s. After relieving the obstruction conservatively. Smain AIT YAHIA (*). University Hospital of Sétif. University Hospital of Sétif. Souham TOUABTI (*). (**) Department of Anaesthesia.Giant umbilical hernia in a patient with Hurler’s syndrome. Umbilical and inguinal hernias are common in this disorder and generally treated conservatively. (***)Department of Otolaryngology.aityahia@yahoo. it may be wise to perform elective hernia repair in selected cases of Hurler’s syndrome. Makhlouf BENZEMIT (***). . Zineddine SOUALILI (*). Karima BENDAOUD (*). The postoperative course was uneventful. The surgical and anesthetic management of patients with Hurler’s syndrome is a challenge because of many medical problems. Zouhir LEMTAI (**). Algeria. hernia repair was performed under general anesthesia using a prosthetic Hurler’s syndrome is an inherited lysosomal storage disorder resulting from a deficiency in alphaL-iduronidase. Algeria. (*) Department of Pediatric Surgery. We report a case of Hurler’s syndrome in 14 yearsold girl who presented with obstructed giant umbilical hernia of 18 centimeters in diameter with ischemic skin changes.

Tunis. Recognition of the typical appearance of various types of abdominal hernias and associated adverse features such as bowel obstruction. S. after a systematic examination. Department of paediatric surgery B. Conclusion: Spigelians and Grynfeltt hernia are rare but very important because they may mimic other serious conditions. A left Grynfeltt hernia interested a 2-month-old normally developed boy which was found after a systematic examination too. Chaouachi.Congenital rare parietal hernia: 4 case reports M. Ghorbel. Email: nouirafaouzi@yahoo. 3 and 4 month-old normally developed boys). Two patients had cryptorchydy. Only a 1-month-old boy presented with occlusif syndrom. strangulation. Nouira. Jlidi. and in the majority of patients. In all cases Hernia was reduced and the defect was closed. Ben Dhaou. Tunisia. Khemakhem. R. Introduction: A hernia is a protrusion of a tissue. The hernia was observed in the right lower abdominal quadrant in three cases. or part of an organ through the muscular tissue or the membrane by which it is normally contained. or volvulus formation can help in formulating an accurate diagnosis. varied symptomatology and possible etiology. . The treatment is surgical. Charieg. Purpose: 3 cases reports of Spigelians hernia and a case of Grynfeltt hernia are presented with a review of the pertinent anatomy. Cases reports: Spigelians hernia was found in three cases. structure. F. S. perforation. Postoperative outcome was uneventful after 6 months. it can be performed with a simple open technique. (new born. B. Children’s Hospital.

Small bowel obstruction caused by congenital mesocolic hernia. 3 case reports. M. Ben Dhaou, F. Nouira, H. Louati*, A. Charieg , R. Khemakhem, S. Ghorbel , S. Jlidi, I. Bellagha* B. Chaouachi. Department of paediatric surgery B, *Radiology department. Children’s hospital, Tunis. Tunisia Email: Introduction: Transmesocolic hernias are extremely rare. Their exact incidence is still unknown. A strangulated hernia through a mesocolic opening is a rare operative finding. Preoperative diagnosis is still difficult in spite of imaging techniques currently available. We report 3 cases of small bowel obstruction caused by congenital mesocolic hernia with literature review. Case reports: 2 new birth boy, a 12-year-old girl were admited in our departement with occlusif syndrome. On examination, they had an intestinal meteorism, a hard abdomen, painful on deep palpation. Through ultrasound and X-ray examination of the gastrointestinal tract they suspected an obstructed passage in the upper digestive tract. In all cases a laparotomy was performed. Almost all of the small bowels were incarcerated by an internal transmesocolic hernia, which was reduced surgically. The hernial peritoneal sac was excised before closure of the mesocolic defect. Postoperative outcome was uneventful after 6 months. Conclusion: Preoperative diagnosis of bowel obstruction caused by congenital mesocolic hernia remains difficult despite currently available techniques. Thus, the clinical situation requires an emergency procedure that will establish the final diagnosis and treat the patient.

Imaging of neonatal gastro intestinal obstruction A. Besbes; H.Ketata; L. Trigui; M. Jallouli*; S. Haddar; K.B. Mahfoudh; N. Hmida*; Z. Mnif Radio diagnosis department, neonatology department, *pediatric surgery department. Chaker Hospital, Sfax. Tunisia Email: Introduction: Neonatal intestinal obstruction occurs in 1/1500 live births. The radiological imaging plays a vital role in the evaluation of patients with neonatal gastro intestinal obstruction which requires the use of various imaging modalities for making the correct diagnosis and planning surgical correction. Materials and methods: We retrospectively report 13 cases of neonatal gastro intestinal obstruction between September 2006 and June 2008 in department of Radio diagnosis (Hedi Chaker hospital Sfax). Results: - Patients: 13 sex: 8 male, 5 female - Birth weight: 1400 to 4300 g The delivery: 8 cesarean, 5natural way Preterm delivery: 6 full term: 7 Mother age: 27 to 44years - Mode of presentation: vomiting (6cases); hydramnios (3 cases); delayed meconium (6 cases); bloated abdomen (6 cases). - Imaging modalities: o The plain abdominal X ray is a useful, simple and most inexpensive tool; performed in 8 cases; shows double bubble sign in all cases of duodenal obstruction, dilatation of the small bowel in jejunoileal atresia cases, air fluid levels in one case. o Upper gastro intestinal series is performed in 5 cases and reveal the obstacle level. o Contrast enema is performed in the ileal artesian cases (functional microcolon), meconium ileus and Hirshsprung disease (colonic dilatation, recto-sigmoid transition zone). o Pre and antenatal ultrasonography is performed in 7 cases, shows double bubble sign in one case (duodenal atresia), bowl dilatation (in atresia) with echgenic material (in meconium ileus), the whirlpool sign in a case of volvulus with malrotation. Final diagnosis: duodenal atresia (n=3), ladds band (n=1), duodenal diaphragm (n=1), annular pancreas (n=2), jejuno ileal atresia (n=3), jejunal duplication (n=2), meconium ileus (n=1), volvulus-malrotation (n=1), Hirshsprung disease (n=4). Conclusion: The goal of imaging is to provide an accurate diagnosis and other relevant information to the clinician to plan out the most suitable treatment efficaciously. Hedi


One stage PSARP for recto-vestibular fistula in children : Our initial experience in 5 cases. Mohammed Youssef Alexandria Hospital for Sick Children Email: Introduction: Rectovestibular fistula in neonates is one of the high anorectal anomalies which was treated in a staged approach starting with colostomy then PSARP at a latter stage and some surgeons do dilatation or cut back till a certain age and then do the definitive procedure. Aim: Aim of the study is to show that one stage approach for these children is safe in good hands. Patients: We present our experience in 5 patients with R.V fistula starting fro 1 month old to 4 years old to whom one stage PSARP was done. Conclusion: One stage PSARP is the best approach to these cases and it is safe in good experienced hands.

Algeria Since 2001 the posterior anorectoplasty of Pena became the treatement of anorectal malformations in male and female defects: . . Blida. this technic was required when the situation of the rectum is above or in the level that levator muscle.In male defects with high rectovaginal fistula or rectobulbar fistula or without fistula. Lacheheb. Boumelah. .In female defects with high rectovaginal fistula or without fistula In facts. M. We report in this poster a case of anorectal defect with rectobulbar fistula.Posterior sagittal ano-rectoplasty (Pena) L.

The anatomo-pathological study of fragment at the level of one of the mentioned perforations evokes an ischemic process probably linked to an intestinal infection caused by perfringens clostridium.Rare cause of multiple intestinal perforations concerning one case. complicated in four times by peritonitis secondary to perforations of the small intestine. Favorable evolution. M OUANANI .AIT ABDESSELAM A six year old hospitalized of acute intestinal obstruction with serious sepsis caused by ileum necrosis of ileum. . This observation shows its rarity. laparotomy and irrigation drainage system were done. Think about the perfringens colostridium when there are repetitive intestinal perforations. the super mancy of the parenteral reanimations. Transferred to the visceral surgery service of the professor HELARDOT (TROUSSEAU) where continuous parenteral nutrition.

Inflammatory Myofibroblastic Pseudotumor of Stomach: Report of a Case Elemen L1. Corapcioglu F2 1 2 Kocaeli University. we believe that it is possible to cure the tumour without extensive resection. MRI detected a solid mass with dimensions of 7x8x9 cm located behind the stomach. Histopathological examination of the specimen revealed an IMP. Results: The patient was discharged on the 4th post-operative day and still remains well without complications for a follow-up period of 36 months. Kocaeli. pre-operative diagnosis is difficult. often mimicking a malignant neoplasm. Kocaeli. Tugay M1. Conclusion: Although IMP is usually located in the lungs. Complete mass resection was possible without opening the gastric mucosa. It was originating from posterior aspect of gastric curvature major. Histopathological examination of the resected tissue following the excision is crucial for the prompt diagnosis. adherent to the spleen and transverse colon. Turkey Kocaeli University. We present a case of abdominal IMP which is rarely seen in children. Patient: A 9-year-old girl presented with a solid mass in the left upper abdomen. As imaging techniques generally have a limited role in differentiating the origin of the mass. review of the literature revealed 13 cases of being gastric origin. . Her medical history was significant for weight lost and weakness for a period of 4 months. Department of Pediatric Surgery. Turkey Purpose: Inflammatory Myofibroblastic Pseudotumor (IMP) is a rare solid tumor of unknown origin. Department of of Pediatric Oncology. Although abdominal IMP tend to recur locally prognosis is usually excellent if total excision is performed. Intra-operative assessment revealed that the mass was bigger than it had been assumed in the pre-operative radiologic intervention with dimensions of 12x10x8 cm. However.

05). sex. Results were analyzed by means of SPSS 13. of Pediatric Surgery. sex and age at operation. Face to face inquiries and physical examinations accompanied the evaluation. of Neurosurgery. Yasa N2. Elemen L1. Two groups were comparable according to their age. dosage of drugs and daily defecation frequency were significantly better in Group E3V (p < 0. Results: Group VPS contained 103 patients and Group E3V contained 50 patients. dosage of drugs used for constipation and duration for improvement of constipation. Etuş V2. This hypothesis is supported by the relatively decreased incidence of constipation in Group E3V. Patients and Methods: 153 patients who were operated for primary hydrocephalus between January 2002 and January 2008 were divided into two groups according to operation type: Ventriculoperitoneal shunt group (Group VPS) and endoscopic 3rd ventriculostomy group (Group E3V). Duration of constipation. 3 Dept. Turkey Aim: To asses the incidence of functional constipation in children who were treated for primary hydrocephalus. Acibadem Hospital. Kocaeli University Medical Faculty. Its incidence changes between 3%-%25. . Kocaeli. Discussion: Functional constipation is not an infrequent entity in children. of Pediatrics. Patients were evaluated prospectively according to their age. These results need verification by more detailed clinical and experimental studies. Tugay S3. duration of constipation. Tugay M1.The effect of two operation techniques on constipation of patients operated because of hydrocephalus. intractable constipation in children who were treated for primary hydrocephalus is a severe problem encountered in clinical practice. age at operation.0 statistical software system. Akay A1 1 Dept. Besides. 2Dept. Increased constipation incidence in Group VPS is thought to be due to continuous drainage of cerebrospinal fluid into peritoneal cavity or irritation effect of ventriculoperitoneal shunt catheter.

Sahnoun L. Methods: Eight cases of pathologically proven SDI from 1987 to 2003 were reviewed and discussed.Segmental dilatation of the intestine Maazoun K. Histological examination demonstrated the presence of ganglion cells in all cases. There were 7 newborns and a 1-year-old boy. . Department of paediatric surgery Monastir – Tunisia Email: kaismz@yahoo. Conclusions: Segmental intestinal dilatation in an exceptional pathology with an unknown etiology and a misleading clinical presentation. The treatment consisted on a resection of the dilated segment with an end-to-end anastomosis. The postoperative course was uneventful in 6 cases with a mean follow-up of 5 years. Krichene I. Hidouri S. However. A heterotopic gastric mucosa was observed in one case. Belghith M. The clinical polymorphism and the lack of specifity of radiological investigations explain the difficulties to have a preoperative diagnosis. In all cases. No anomalies were observed in 5 cases. Chahed J. the diagnosis was not suspected before surgery. this difficulty is compensated by the favorable evolution after resection of the dilated segment. Mekki M. Six patients were operated for omphalocele. Results: Our patients are 5 boys and 3 girls. Tandia H. Amiri R. The SDI involved the ileum in all patients. which was the most frequent associated malformation. The muscular layer was hypertrophied in two cases and very thin in one case. Ajroudi S. Two patients presented with a low neonatal bowel obstruction. Nouri Purpose: the aim of this work is to discuss the pathogenesis of the segmental dilatation of the intestine (SDI) and to review its clinical presentation and the ways to confirm the diagnosis. Ben Brahim M.

TANDIA Hadya. HIDOURI Saida. This girl was the product of an uneventful pregnancy and no anomalies were seen at obstetrical ultrasonography. Surgical exploration noticed combined non communicating esophagogastric duplication. Biology showed a severe microcytic anemia (3g/dl). .. Case report: An eight month old girl presented with maelena noticed by the mother 3 days ago. KSIA Amine. Some cases may need a combined thoraco-abdominal approach. The esophageal part was difficult to enucleate through this abdominal approach. A case report BEN BRAHIM Mohamed. Post operative course was uneventful. NOURI Abdellatif . No heterotopic gastric mucosa was seen into the esophageal part of the Introduction: Digestive duplication are unfrequent congenital malformations that commonly become manifest within the first year of life and can present a substantial diagnostic and therapeutic challenge. Fattouma BOURGUIBA Hospital. A technetium scan did not show any gastric fixation. Department of paedatric surgery. 5000 Monastir. Discussion and conclusions: Combined oesophagogastric duplication are extremely rare. The cyst had a mediastinal extension and a well defined muscle wall. Awareness of the full extent of anomalies is necessary in planning the extensive surgical intervention required for correction. Histology findings confirmed the diagnosis. only 12 cases of combined oesophagogastric duplication were reported in the world litterature. To date. Upper Gastro-intstinal study did not reveal any communication with the cyst.benbrahim@voila. The baby underwent a complete cyst excision. Physical examination was normal except an abnormal paleness of the skin. Abdominal US and CT scan showed a retrogastric bilobar cystic mass.Combined oesophagogastric duplication. Oesogastroduodenoscopy was normal. Tunisia Email: mohamed.

M Masmoudi. H Tandia. Our study reports three cases of intestinal Malrotation with late presentation carried in the Department of Paediatric Surgery of Monastir between 2005 and 2008. R Laamiri. A standard Ladd’s procedure with appendectomy was performed in all cases. M Ben Brahim. M Belguith. All patients had resolution of their symptoms. K Maazoun.Monastir Tunisia. Department of Paediatric Introduction: Intestinal rotation disorders may be discovered during investigation for abdominal symptoms. . Results: Three patients have undergone laparoscopy. Symptoms were: abdominal pain and vomiting in all cases. A Nouri. There were no complications. Methods: The procedure was performed using 3 trocars of 5 mm diameter. Purpose: This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of intestinal rotation abnormalities in children. Age ranges between 6 months and 4 years. Conclusion: Laparoscopic Ladd’s procedure is a safe and effective technique for the management of children with intestinal rotation abnormalities offering potential advantages compared with open surgery. Diagnosis was established by radiologic exams in all cases. L Sahnoun. M Mekki. Ports were placed in the infra umbilical ring and the right and left mid to lower quadrants. I Krichène. S Ajroudi. J Chahed.Laparoscopic Ladd’s procedure in infants with late presentation of malrotation. S Hidouri. Email: medtun@yahoo.

Renal function was normal I didn’t found any others malformations. a bilateral undescended testis Radiological investigation showed a distension of the urinary tract at echography.The diagnosis is easy in front of this triad: big bell hypoplasia of abdominal muscles + cryptorchidism and urinary malformation. S.H. The baby was reviewed every month to control his weight and size as well as his renal function wich stays normal In literature the prune belly syndrome is rare. Clinical examination founded a big bell and hypoplasia of abdominal muscles. RAMDANE. HAOUARI. CANASTEL. in 75 per cent others anomalies are founded which was not in this case . N. HADJOU. UCR + UIV founded a massive right reflux level five (5) and a left bladder’s diverticulum + a bilateral megaureter. The diagnosis of prune belly syndrome was made in front of this triad: big bell + undescended testis and urinary malformation The treatment consisted on prevention of urinary infections by medical treatment and bilateral Orchydopexie at one year. MALAH. A case report. HAMIDOU. Service d’urologie E. N.ORAN ALGERIE It is a case report concerning a newborn of one day of age admitted in our department of paediatric urologic surgery (EHS Canastel Oran) for a prune belly or Eagle-Barrett syndrome. BENMOHAMED. N. F. The prognostic depend of the renal function in effect 30 percent of this babies develop chronic renal insuffiency.Prune Belly syndrome. . H.S.

Orthopedic programme Discussion of problematic cases .

R.Sousse -Tunisia.CHU Sahloul. Ben Ayach. Mtaoumi . Conclusion: The surface tumour-like lesion of bone poses frequently diagnostic lesion of bone: diagnostic problems M.month history of arm swelling. Observation: A 11 year-old girl presented with a 6. Boughammoura . R. Bouattour . Orthopedic Department . Ben Maitigue. It was deep to the fascia. Its identification isn’t usually easy. J. Introduction: The surface tumour-like lesion of bone is a rare pathology.Surface tumour. N. M. MRI showed a large soft-tissue mass with cortical erosion. The patient had an open biopsy. On examination there was a firm swelling 3x 2 cm in size on the lateral aspect of the right arm. Mseddi . Naouar . Frikha . ML. The diagnosis of aggressive process was suspected. K. Radiographs showed erosion of the lateral cortices of the proximal humerus. We report a case of surface tumour-like lesion of humerus. Ben Hamida . Dahmène . . The surgical biopsy is necessary. H. M.

Bouabdallah pediatric surgery. Pure metaphyseal localizations without epiphysis affection are very exceptional. The patient was operated. CHU Hassan II Fes Morocco Email: chaterlamia@yahoo. L. M. Rami. she benefited of curettage of the tumoral mass with osseous transplant. Elmadi. it represents less than 1 % of all bone tumors. A. Arroud. A. The clinical examination found a painless tumefaction of the inferior extremity of the thigh at palpation. Observation: We report a case of a 14 years old female patient presenting pains at the lower limb. Mahmoudi. Introduction: The chondroblastoma is a very rare benign cartilaginous tumor. it had well subscribed internal limits with a bowled over aspect of the cortical and without any periosteal reaction. However. M. Afifi. It is mostly localized at the level of the epiphysis of long bones and it might extend to the metaphysis. atarraf. The X-Rays showed a metaphyso-diaphyseal gap of 7cm in the main line direction. The evaluation was favorable with absence of recurrence in one year recession. this would also weight on the functional prognosis. which require a less conservative and more extensive surgery. This recurrence is often accessible for a new curettage-transplant treatment approach.Exceptional metaphyso-diaphyseal localization of chondroblastoma. chater. Khalid. no inflammatory signs were observed. Discussion and conclusions: The evolution of the chondroblastoma is mainly dominated by risk of local recurrence which varies between 5 and 38 %. Y. . K. The biopsy of the tumoral mass recognizes a benign chondroblastoma. K. sometimes it is associated to a tumoral extension in the joint or to adjacent morrow. elghassani hospital.

CHU Habib Bourguiba.Ewing Sarcoma of the fibula: difficulties of diagnosis and of surgical treatment. Department of orthopedic surgery and traumatology. The reconstruction of the external ligament of the ankle was done by a strip of the tibial Authors report a case of Ewing sarcoma of the distal fibular metaphysis in a 14 years boy. Moez Trigui. Mohamed Zribi. Slim Ben Jmaa. Kamel Ayadi. . Sfax. Tunisia Email: dr_moez_trigui@yahoo. Hassib Keskes. fixed by staples. This Ewing sarcoma was characterized by the difficulty of its diagnosis since it simulated an acute osteomyelitis as well on the clinical presentation as on biology and radiology. The resection of this tumour also posed a problem because we were obliged to remove the lateral side of the tibia without passing through the interosseous membrane to have a complete resection. Fakher Gdoura.

Mahfoudhi K. femoral and tibial locations which consults for a painful tumefaction of the right hollow poplity with a soft consistency. Email: moez. Vascular complications of exostosis are very rare. The authors report an exceptional case of a 13 year old girl followed for exostosis disease with humeral. Their seat paraarticular can expose to certain complications especially vascular. for embolisms even of arterial break of pejorative preview. . Dridi M.A case of tibial exostosis associeted with a vascular complication. Centre de traumatologie et des grands brules de Ben Arous. Mbarek M. it associats exostosectomy to a vascular gesture with type of venous angioplasty allowing the vascular restoring of the continuance. The patient was treated by resection of the exostosis associated to a stake with flat of the false aneurysm and repair vascular by venous patch. Investigation by ultrasonography showed vascular lesion for the tibial exostosis. Diagnosis. Microtraumatism by friction on the exostosis can be responsible for The exostosis is the most frequent tumors that evolution is often good-hearted. Ben Hassine H. 90 % of cases are false aneurysm. Trabelsi M. evoked on the cilinic apperence and the ultrasound is easily confirmed with the angio-scan and the artériography. It was confirmed with the arteriography which allows the diagnosis of a false aneurysm of the popliteal artery. Naanaa T. The treatment is surgical. Ben Zid M.dridi@voila.

Tunis .Surgical problems of skip lesions in long bone tumors. M. AMARA1 . We report here the case of a 14 year-old boy presenting a proximal metaphyseal Ewing sarcoma of the left tibia with longitudinal diaphyseal extension. LOUATI2 .Tunis Children’s Hospital. 70% of the tibia bone was resected and reconstruction was done with intercalary prosthesis and non vascularized cortical bone graft taken from the controlateral tibia. Tunis .Tunis Children’s Hospital. H. extraperiosteal in proximal and subperiosteal in distal.Tunisia. . In fact and in our knowledge.Tunisia Department of Pediatric Radiology . M. SMIDA1 .Salah Azaiz Institute. BEN ROMDHANE3 . this type of a mixed resection is not described. constitutes the originality of the case. K. Tunis . Considering safe margins. K. BELLAGHA2 . BEN GHACHEM1 1 2 Department of Pediatric Orthopaedics . EZZINE1 .Tunisia 3 Department of Pathology . I. MRI showed a distal metaphyseal skip lesion. H. IDRISS3 . Bone resection in this patient. M.

H. ibtissem. M. Tunis . mainly sarcoma. Smida**. Tunis . K. Ben Ghachem**. Careful consideration is required to ensure the correct diagnosis. . Douira*.Tunisia *** Department of Pathology . I. Conclusion: Myositis ossificans circumscripta is a benign pathology of soft tissue occurring in young patients often after localized trauma. An excision biopsy was performed. well-defined. Radiographs obtained at admission showed a large.A pediatric case report of an ossifying soft-tissue lesion: Myositis ossificans circumscripta W. with a thin area of decreased opacity separating the mass from the femoral shaft. Laboratory exams.bellagha@rns. Purpose: Illustrate one case of myositis ossificans circumscripta and describe the imaging features.Tunis Children’s Hospital. She has no remarkable past medical history. Clinical examination revealed a firm mass in the adductor muscles of the right thigh.Salah Azaiz Institute. and partially ossified soft-tissue mass. MRI did not contribute any further diagnostic information. Bellagha*. Periosteal reaction was seen in the adjacent femur. Calcification within the mass was denser peripherally than centrally. Tunis . The patient had no history of injury or specific symptoms. Ben Romdhane***. M.Tunis Children’s Hospital. * Department of Pediatric Radiology . Histological examination concluded to a myositis ossificans circumscripta. US showed a soft-tissue mass with calcification and increased vascularity. Louati*.Tunisia ** Department of Pediatric Orthopaedics . Results: Laboratory results revealed increased blood sedimentation rate. Ben Hassine*. Idriss***. L.Tunisia. plain-x ray. Materiel and methods: An 11-year-old girl was admitted with a history of a painful mass in the proximal right thigh. Histological and radiological appearances may mimic a malignant neoplasm. Ultrasound (US) and Magnetic Resonance Imaging (MRI) were done.

can be responsible for complications going from simple adeno phlegmon to often mortal generalized infections. He was hospitalized in the paediatrics department for dehydration with change of the general status. The bécégite of bones constitutes a frequent localization.BCG multifocal osteomyelitis. Bone scintigraphy had objectified one hyper premature and diffuse illegal uptake in bones. We bring back a case of generalized bécégite at an old infant of 6 months followed since the age of 4 months as recurrent pneumopathy. In spite of an improvement under antituberculeux. Hazem Ben Ghozlen. A reaction to the point of injection of BCG had been noted. usually harmless to most part of the children. Fawzi Abid. Hôpital TAHAR SFAR. immunoglobulins and a transplant of the marrow. Mahdia . A case report Louati Issam. Yadh Zitoun. The treatment of the osseous bécégite remains still badly codified and bases itself essentially on anti tuberculosis drugs. In the examination the infant was feverish in 39°C. The surgical exploration of the hurt site at the superior extremity of the right femur showed a geode containing pus and histological examination identified granulomatosis constituted by macrophages filled with numerous bacilli. Service d’Orthopédie – Traumatologie. The diagnosis of certainty bases itself on histological and bacteriological information. Biology had shown hyper leucocytosis and an increase of CRP. Noureddine Sassi. Mobilization of the limbs as well as the palpation of all the bones length was painful.Tunisia The anti tuberculosis vaccination by bacillus of Calmette and Guérin (BCG). . the evolution was fatal. The immunizing balance sheet had shown a severe combined immunizing deficit. X-rays revealed multiple metaphyseal osteolysis hurts well limited and surrounded by ostéocondensation. In spite of its rarity the osseous bécégite must be evoqued at every infant's presenting signs of generalized infection and has to make look for an immunizing deficit.

Bakhchali K. Centre de Traumatologie et des Grands brulés de Ben Arous Email: The stress fracture of the superior femoral epiphysis is a location at the same moment exceptional and little reported in the literature. Biology is normal.Stress fracture of the femoral epiphysis. Ben Hassine H.dridi@voila. the initial radiography showed no abnormality of the superior femoral epiphysis. Differential diagnosis settles essentially with an infectious or tumors diseases. without pathological history. bone scintigraphy and especially MRI allows to a not evident diagnosis. Trabelsi M. Hadj Salah M. Mbarek M. . An exceptional location. Dridi M. The scintigraphy shows a hyperfixation of the right femoral head. The stress fracture of the femoral neck is already an exceptional location. The epiphyseal location in child was never described according to our literature review. In this observation the premature functional treatment has allowed clinical and radiological cure strengthening so hypothesis diagnosis. Zaraa M. not sportswoman. It is about a 12 year old girl. The diagnosis of fracture of the superior femoral epiphysis was confirmed only with the MRI. Clinical history. who appears with a pain of the right hip without fever that happened after an intense physical effort during three week in a colony of vacancy. Annabi H.

Ladjadj Myositis ossificans progressiva in childhood is an extremely rare inherited disease transmitted as an autosomal dominant defect. It can lead to the stimulation of new sites. Merazi. R. . Benahmed-Kermani. We report a case of myositis ossificans progressive in a 4 years old boy. Premature death often results from respiratory failure. The diagnosis could be evoked by the association of progressive ossification of soft tissues with anomalies of the big toes (congenital hallux valgus. Excision of heterotopic bone is futile. Report of a case and literature review. The X-rays showed extensive ossification of muscles. microdactyly). Y.Myositis ossificans progressiva in childhood. N. with numerous swellings on the back with large bony masses restricted movement of the neck.

AMMAR. But serious cutaneous complications happened earlier… .Tunisia Tibial hemimelia (THM) is a rare congenital anomaly occurring approximately in one per 1. the arthrodeses was between talus and distal fibular epiphysis. By a postero-medial approach. SMIDA . A. At 5 years of age. CH. the girl was reviewed and clinical exam found lower limbs discrepancy and a severe club foot.000. KHELIFI . She had been examined at one year of age and surgery was indicated but her parents had refused the operation and neglected the deformity. BEN GHACHEM. By preserving the fibular distal growth plate. A case report. Case report: H. The widely used classification in the literature was proposed by Jones.Tunis Children’s Hospital. Below knee amputation and foot preservation were proposed in the medical staff but parents have preferred preservation. Tunis .Type II tibial hemimelia and surgical problems.H. It is typically characterized by an absent or hypoplasic tibia with a relatively intact fibula resulting in lower limbs discrepancy and severe club foot in some types. The aim of this paper is to present difficulties and problems of surgical treatment of type II TMH. N. Department of Pediatric Orthopaedics . M. M. is a 5-year-old girl presenting a right type II TMH. a tibialization of the fibula associated to ankle arthrodeses was done.000 live births. M. NESSIB. GAALICHE .

CHERIF Service d’Orthopédie – Traumatologie. A case report S. BOUMAIZA . Actually.R. BEN GHARS – M. Bizerte . The clinical exam poses complete sensitive and motor paraplegia on D 10 level. the patient was transferred to a special centre of re-education.W.O. The plain X-RAY and else computed tomography was normal. SAKKA .Dorsal spinal cord injury without radiographic abnormalities.C.W.M. after one year of traumatism he has partial motor and especially sensitive recuperation. After emergency treatment and stabilisation of general status. MRI showed also a medullar contusion in front of the 10th and 11th dorsal vertebra without bones and ligaments lesions. Hôpital Habib Nouri.A. The diagnosis of spinal cord injury without radiographic abnormalities (S. MRI of the spine revealed a cervical prevertebral haematoma with rupture of inter spinal ligament in front of 6th and 7th cervical vertebra without signal anomalies of the spinal cord.R. AMRI .) on the thoracic level was retained. .Tunisia The authors report the case of 13 years old’s child who was victim of a street accident witch causes crania-facial traumatism with a traumatism of cervical and dorsal spine.I.K.

ABID Abderrazak. MNIF Hichem. ZRIG Makram. an important fusiform periosteal reaction of humerus was seen. Introduction: Infantile cortical hyperostosis or Caffey’s disease is a rare familial disorder of unknown etiology that usually occurs in the first few months of life. JAWAHDOU Rafik. which showed similar changes of cortical thickening in the radius and ulna as well as the affected humerus. The diagnosis of Caffey’s disease was made following a skeletal survey. Echographia of shoulder showed denseness of soft tissue and absence of physeal injury. ALLAGUI Mohamed . . The baby was pyrexial. KOUBAA Mustapha. HAMMOUDA IMED. After 5 weeks. including leukocytosis with an elevated erythrocyte sedimentation rate. osteomyelitis and sickle cell crisis. Monastir. The radiographic examinations demonstrated bone periosteal reaction in proximal humeral metaphysic. Case report: A 1-year-old baby girl presented a 2-day history of acute pain and swelling in the right shoulder. Department of Orthopaedic and Traumatic Surgery. Monastir. Conclusions: Caffey’s disease is an unusual cause of bone pain in the infant. soft tissue swelling and fever in the infant. Symptoms and signs are subtle and the diagnosis is generally made with plain X-rays. * Department of Pediatric suregery. ALOUI Issam. Fattouma Bourguiba Hospital. Tunisia. Tunisia. NOURI Abdellatif*. Fattouma Bourguiba Hospital. Our chief differential diagnoses at this point were accidental injury. Laboratory analysis revealed signs of inflammation. bone pain. It is a rare cause of irritability.Infantile cortical hyperostosis. .

Orthopedic oral Communications .

8% in the upper extremity. Conclusion: The course in bone LCH was benign in case of SS.Hôpital d’enfants de Tunis. 48 patients (pts) were diagnosed and followed by standardised schedule. computed tomography scans or MRI of affected areas. Extent of disease was evaluated by laboratory studies. irradiation.Patterns and course of bone Langerhans cell histiocytosis.Institut Salah Azaiz. skin (21%). Ben Ghachem2. 15% in the spine. steroids. However. Some pts have been followed without treatment. Tunisie Service d’Orthopédie Infantile. The main age at diagnosis was 4 years and 4 months (range 6 months-17 years). S. 10% in the upper extremity and 6% in the thoracic bones. abdominal ultrasound and radiological survey of the skeleton. Oubich1. Tlili1. 8% in the pelvic.Hôpital d’enfants de Tunis. Tunis . Y. chest-x-ray. Tunisie Background: Langerhans Cell Histiocytosis (LCH) is a rare disorder with a heterogeneous clinical picture and course. M. 40 pts (83 %) with bone involvement. The distribution of the initial bone lesion: 42% were found in the skull. M. Ben Romdhan3. followed by multiple bone lesions (23%).Hôpital d’enfant Tunis. Initial complaints in pts with bone disease were mostly described as local pain and/or swelling. I. ear (23%). . Bone disease reactivation remained restrictive to skeleton and did not influence survival. Retrospective study at a single center. Treatment comprised surgery.Tunisie Service de Radiologie. Procedure: We reviewed retrospectively cases of LCH managed at Tunis Pediatric Oncology unit. M. K. Mostly bone is involved whether in SS or multi-system (MS) disease. These reactivations had impact in morbidity and sequelae correlated to the sites of the lesion. F. Smida2. Tunisie Service d’Anatomopathologie. Barsaoui1 1234Service de Médicine infantile A . 19% in the lower extremities. anti-inflammatory drugs. In specific cases. liver (23%). At median follow-up of 5 years (range 2 months-8 years) reactivation restricted to the skeleton occurred in 15%. the outcome and the sequelae presented by survivors. Protocol of treatment was LCH II and III. 01 patient of traffic accident. Orthopaedic problems related to lesional sites occurred in 3 patients. Single system (SS) disease is the most common presentation. lung (8%). Bellagha4. the prognosis in MS depend on others visceral lesions. Three patients had died of progression to multi-system disease. chemotherapy. Initial organ involvement included bone (80%). Khemiri1. diabetes insipidus (8%). Authors report clinical profile of children with bone involvement LCH. Results: Single bone lesions were most common (56%).

The mean score was 60%. Dubousset J. The mean age was 13. Saint Vincent de Paul Hospital Paris Email: nourihabib@yahoo. the femorosacral continuity should be reconstructed. Four patients developed metastases and 4 patients died within 7 months.3 years. a certain number of complications must be accepted. reconstruction was achieved by an ilio-femoral arthrodesis in 6 cases. Finally. Saddle prosthesis in 2 cases and allograft in 2 cases. Sixteen patients were alive and were reviewed with a mean follow up of 5.Malignant bone tumors of the pelvis in young patients. Wicart P. Nine patients had a type I+II resection. Functional result was assessed by MSTS Score. To achieve good functional outcome. Seringe R. ten a type II+III resection and one had hemipelvectomy. the hip was very instable and there was a loosening of the femoral component. Mascard E. In the case of CD reconstruction. Local recurrence was seen in 2 cases. . A deep infection and lymph oedema occurred in one case due to radiation therapy.5 years. Resections involving the ilium bone were reconstructed by an autologous bone graft between the sacrum and the remaining acetabulum in 5 cases. The mean functional score was 60%. Nouri H. When sparing the ilium bone. Saddle prosthesis was revised within 9 years and replaced by a composite prosthesis. Ilio-femoral arthrodesis gave the best functional score and the lower complication rate. The ideal method of reconstruction after acetabular resection remains a subject of controversy. endoprosthesis in 1 case and spine material with prosthesis in 1 case. an allograft in 3 cases. Four allografts were evaluated with a mean follow up of 2. A secondary transposition of the hip was done. In case of arthrodesis between the sacrum and the acetabulum. Facing the goal of limb Twenty patients with malignant bone tumor of the pelvis underwent a limb-sparing surgery. we observed a progressive cranialization of the femoral head. Hip transposition could be a good solution when the primary reconstruction fails. Missnard G.7 years.

Maric D. once to three times. Conclusion: The standard treatment is fenestration. Novi Sad. eosinophil granuloma. The average age of treated children was 8. The ratio boys/girls was 1. Petkovic L. Different orthopaedic and surgical procedures are used in the treatment: percutaneous punctions.8/1.6 years. In 12 patients (37%) the initial therapeutic procedure included the instillation of methylprednisolone acetate (MPA). the less invasive approaches were suggested such as percutaneous decompression and instillation of methylprednisolone acetate (MPA). fibrodysplasia and different bone tumours. and in 13 patients (37%) there were aneurismal bone cysts.The treatment of the bone cysts in the development age. Gajdobranski DJ. Clinic for Paediatric surgery. Djan Introduction: Cysts are usually clinically detected after the trauma and X-ray and CT findings are characteristic. X-ray and CT examinations as well as laboratory analysis. methods of internal fixation (Kirschner’s wires or elastic nails). In recent years the percutaneous punction methods as well as the instillation of Aetoxysclerol. Serbie Email: lazmir@neobee. arterial scleroembolisation etc. In 9 patients (28%) the therapeutic procedure that was conducted was the instillation of Aetoxysclerol sol 2% or 3%. Results and discussion: Solitary juvenile cysts were found in 19 patients (63%). curettage with the placing of bone graft but due to significant percentage of recurrence. Methodology: Diagnostics include clinical. fenestrations and curettage with or without osteoplastics. The surgical procedure of fenestration and internal fixation was conducted in 3 patients (9%) as the primary treatment and in 3 more patients (9%) where preliminary punction treatment was not successful in total in 6 patients (18%). are being used. In 8 patients (25%) the instillation of bone marrow was performed. . Petkovic M Institute for Children and Youth Health Care Vojvodina. nonossificating fibroma. especially of the autologous bone. It is important to distinguish solitary (juvenile) bone cyst from aneurismal cyst.

6 years. The purpose of this study is to report results of the treatment of malignant bone tumours around the knee by limb-salvage procedure in young patients in order to assess the safety of such procedures in both oncological and functional outcome. NOURI* . ZOUARI** – M. In the past. When the growth plate is still open. The diagnoses were osteogenic sarcoma in 18 cases and Ewing’s sarcoma in one case. Functional result was assessed according to the musculo skeletal score. Long term results showed a high rate of complications and a degradation of the functional result. OUERTATANI* MESTIRI* M.Limb salvage in malignant tumours of the knee for young patients. MANNOUBA. Patients were reviewed with a mean follow up of 6. There were 13 boys and 6 girls with a mean age of 16.21 years. ** Department of Paediatric Surgery. Limb sparing surgery is safe procedure in managing malignant bone tumours. Two patients developed metastases and one patient died within 3 years.A. Nineteen patients underwent lower limb-sparing surgery for long bone sarcoma around the knee. TUNISIA The knee is the most frequent location of malignant bone sarcomas. KASSAB ORTHOPAEDIC INSTITUTE. amputation was the definitive treatment of these tumours. It remains a solution when endoprosthesis fails. Local recurrence was seen in 4 cases. * Department of Adult Surgery.M. The tumour was located in the distal femur in 13 cases and in the proximal tibia in 6 cases. radiological imaging and reconstructive surgery have made limb-salvage a safe alternative for the majority of patients. problems related to growth have to be considered before deciding which indication should be done. KARDI * . JENZRI** . Reconstruction was achieved by endoprosthesis in 12 cases and by knee arthrodesis in 7 cases. advanced chemotherapy. Is it really the solution? H. Although a durable reconstruction is elusive especially in young patients. . However. Endoprosthesis is the method of choice in the reconstruction of the knee.M. Knee arthrodesis has the advantage to be a biological reconstruction with a definitive result although the loose of knee motion is usually unacceptable by patients.

Therapeutic procedure of punction and sclerosation with 2% or 3% Aetoxysklerol was performed in one act in 5 patients (5 cysts). not even unpleasant complications during these procedures. The complete normalization of the clinical and ultrasonographic examinations was observed in 23 patients (25 cysts). Gajdobranski Đ. Petković L. Clinic for Pediatric surgery Novi Sad . Conclusion: Ultrasonography is a first line diagnostic procedure for popliteal cysts in children and punction (tapping) and instillation of sclerotisin substance (Aetoxysklerol 2% or 3%) is the most convenient therapeutic procedure in the whole treatment . Dobanovački D. Methodology: It includes clinical and ultrasonographic diagnosis and follow-up of the effects of the punction therapy in the period of 3-6 weeks. Serbie E mail: lazmir@neobee. but in 4 cases (4 cysts) cystic formation still existed. Borišev V Institute for Children and Youth Health Care Vojvodina. in two acts in 10 patients (11 cysts) and in three acts in 19 patients (21 cysts) in the period of 3-6 weeks. Results and discussion: Comprehensive analysis of five-year period consists of 34 children (37 cysts) with clear clinical and ultrasonographic diagnosis.Ultrasonographic diagnosis and sclerosing therapy of popliteal cysts in children. hygroma fossae popliteae. There were no serious. clinical and ultrasonographic examination. Nowadays the most important procedures are punction (tapping) and sclerosation. or Baker’s cyst diagnosis is made by anamnestic. So far the common treatment was surgical Introduction: Popliteal cyst. For 7 patients (8 cysts) there were no further data about last check-up.

Materials and methods: Thirteen cases of proven lipomatous tumors (9 lipoblastomas. BELLAGHA2 .5 years median follow-up. KHELIFI1 .Tunis Children’s Hospital. Purpose: In children. 13 documented cases of lipomatous tumors are reviewed and the purpose was to evaluate their characteristics.Tunisia. BEN GHACHEM1 1 2 Department of Pediatric Orthopaedics . I.Tunisia 3 Department of Pathology . the tumor was diagnosed at birth. M. IDRISS3 . If resected completely. LOUATI2 . In only 4 cases. A.Lipomatous tumors of limbs in children. recurrence of lipoblastoma happened respectively one and 7 years after surgery and a second surgery was done. .Salah Azaiz Institute. Tunis . SMIDA1 . the tumor was painful. these tumors have an excellent prognosis despite their potential to local invasion. In this work. K. All the patients presented often a painless mass of soft tissue.Tunisia Department of Pediatric Radiology . lipomatous tumors are very rare and often benign. In 2 patients. In 6 children. M.Tunis Children’s Hospital. BEN ROMDHANE3 . Results: There were 11 boys and two girls ranging in age from 7 months to 14 years. Tunis . there was no recurrence. MRI (12 cases) and CT scan (one case) had suggested the diagnosis of lipomatous tumors by revealing characteristic imaging appearance of these rare tumors. resection was preceded by a biopsy. Tunis . M. M. H. In the other cases. GAALICHE1 . tumor resection was done directly. Eleven patients made an uneventful recovery and after 4. The lower limb was the most frequent localization. In some cases. 3 lipomas and one chondrolipoma) treated from 1990 were reviewed.

R. . Reconstruction interested 4 times the tibia. The most frequent major complication was the pseudarthrosis of the docking site functional and anatomical results were good and the consolidation was reached in 88 %. N. Sahloul Hospital. The index of external fixation was estimated 45 days / cm. These results strengthen our conviction on the place of this method in the bone reconstruction. M. since its description and the obtaining of first results. Orthopaedic Department. This method gives a good regeneration and getting closer to the normal bone on the biomechanical and anatomical Characteristic. Sousse – Tunisia Ilizarov's method. Ben Ayeche. J.Reconstruction of osteomyelitis bone defects with the Ilizarov method. We present through a retrospective study the results of 9 bone defect cases treated by bone transport using the Ilizarov technique and we suggest some recommendations allowing to improve the quality of the result and to decrease morbidity. M.16 years). Frikha. was gradually adopted in the therapeutic arsenal of reconstruction of bone defects. The causes of the bone defects were chronic osteomyelitis. 3 times the femur and twice the ulna. Naouer. The bone defect average was 8 cms (6 -10 cms). This method allowed a reconstruction of 8 cms on average (22 % of the segment length). A report of 9 cases. Mtoumi.L. M. Dahmene. The average age was 10 years (6 . Ben Maitig.

A).The modified Quad procedure for reconstruction of shoulder abduction and external rotation in late obstetrical brachial plexus palsy. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with obstetrical palsy. there was a significant improvement in abduction. Conclusions: Among many procedures described to improves the functional status of shoulder in late cases of obstetrical brachial plexus Palsy there’s the modified Quad procedure that describe by Nath. MA. T. The mean pre-operative active abduction was 80 degrees (70 degrees to 110 degrees). . This procedure involving release of the contracted internal rotators of the shoulder combined with decompression and neurolysis of the axillary nerve greatly improves active abduction in young patients with muscle imbalance secondary to obstetric brachial plexus palsy. El Alami. SZ. Twenty eight females and Seventeen males. Amrani. El Medhi. Miri. Gourinda. A. At a mean follow-up of 11 months (6 to 24 months). Dandane. forward flexion and external rotation as compared to preoperative values. The mean active abduction was 160 degrees (130 degrees to 180 degrees) while thirty three (73%) of the patients had active abduction of 160 degrees or more. Morocco Background: Children with obstetrical palsy have significant functional disability in shoulder. No decline in abduction was noted. statistically significant. Results: Forty five patients. Material and methods: Between June 2006 and January 2008. Rabat’s hospital for Children. Mallet class was recorded preoperatively and postoperatively. Right shoulder was affected in Twenty nine cases while left in sixteen cases.5 to 12 years). mainly related to residual muscle weakness with soft-tissue contractures which limit the functional range of movement and lead to progressive glenoid dysplasia and joint instability. Pediatric Orthopedic’s and reconstructive surgery unit. H. The surgical procedure was uniform in all cases. Forty five patients who had functional deficit of shoulder elevation and external rotation were operated by a senior surgeon (A. with average age of 36 months at operation were included in this series (range from 1. A.

33girls and 63 boys. Discussion and Conclusion: The management is variable were among our patients: * Improvment of an awkward spasticity making hygiene difficult to maintain or threatening orthopaedic balance (dislocation of the hip/recurvatum of the knees). Results: . A pre and post-therapeutic rehabilitation preceded by a meticulous clinical evaluation (muscular spasticity/force/walk). followed by a discussion of the best therapeutic procedure on a case-by-case basis. . Materials and Methods: It is a retrospective study. Ben Salah F Z. analytical and critical bearing on the children with cerebral palsy hospitalized in the service of physical therapy medical rehabilitation.The Middle Age was of 3 years and 7mois. Miri I. . * Improvement of the diagram or stability to walk. We review the hospitalized children over 2 years (January 2006 . among which neuro-orthopedic disorders and particularly feet spastic.January 2008). * * Recovery or improvement of the endurance to loading of the young patients. based on the realization of a complete clinical examination (orthopedic/neurological). . Dziri C Department of physical therapy medical rehabilitation of the Kassab Institute Introduction: The cerebral paralysis is a state responsible for several disabilities. Chrifi J. All the patients profited from an initial and final evaluation. descriptive. The aim of the study is to emphasize the importance of a premature coverage and to present the various necessary therapeutic means to protect the functional autonomy. like on an analytical and filmed study walk.Experience of the department of physical therapy and medical rehabilitation of Kassab institute in the management of the spastic foot in cerebral palsy. The essential report which emerges through our work it is the need for a discussion of the patients on a case-by-case basis within the framework of a multidisciplinary center in order to be able to make benefit the patients to the maximum of the benefits from each therapeutic technique.21 patients profited from the realization of successive plaster-casts . 43 patients of a toxin injection preceded by Motor nerve blocks and 32 patients had either a combination plasters/toxin. and whose methods of management were discussed out of multidisciplinary staff. are the bases essential and essential to the post-therapeutic profit and the maintenance of best orthopedic balance neuro and the best body diagram.96 patients were integrated in the study. or another therapeutic method (rehabilitation/postures/surgery…).

Extensor type of fracture was verified in 143 patients (94. On the basis of clinical examination. Petkovic L. with certain modifications in the treatment of supracondylar elbow fractures with third grade Introduction: Elbow fractures represent 7-9% of all the fractures in childhood.08%). Results: We analyzed in this paper 151 (69.¹. Orthopedic reposition and percutaneous pin fixation under the control of the X-rays was performed in 216 patients (99. 218 patients were hospitalized due to a supracondylar fracture of the humerus with third grade fragment dislocation. Conclusions: Obtained results in the treatment.5 months. Average follow-up period was 4.² ¹Clinic of Pediatric Surgery. and our experience. 84% of all the supracondylar elbow fractures occur up to the age of 10 years (most often between the 5th and 8th year).36%). Serbia Email: drgajdobranski@gmail. and after completion of the rehabilitation. Discussion: Analysis of the literature points to the advantages of the orthopaedic reposition and percutaneous pin fixation. satisfactory result was obtained in 144 patients (95. ²Clinic of Pediatric Rehabilitation. all the advantages of this procedure.Osteosynthesis with Kirschner wires in the treatment of unstable supracondylar humeral fractures in children.¹. while supracondylar type of fractures is the most common of them (up to 70%). Maric D.¹ i Mikov A. Gajdobranski Dj.¹. make us conclude that orthopedic reposition and percutaneous pin fixation is a procedure of choice for the treatment of supracondylar elbow fractures with third grade dislocation in childhood.7%). Material and methods: At the Pediatric Surgery Clinic in Novi Sad over the period from 1996-2005. Tatic M. Male patients predominated over the female patients 113:38. The aim of this study was to present the technique and results of the treatment of supracondylar fractures with third grade fragment dislocation in pediatric population. Treatment was orthopedic reposition and percutaneous pin fixation.9%) patients who had full documentation. while in 7 patients the final outcome was unsatisfactory. . All the patients were aged 3-15 years. Novi Sad.

-p. A recurrence was seen in one patient with bilateral clubfeet (5 %). Abdellali.The Ponseti method for the treatment of congenital clubfeet.83 weeks (8-19 weeks). The mean duration of active treatment was 9.-talocalcaneal angle and the lateral talocalcaneal angle are evaluated. 98 % were corrected without other plaster cast. M. Azzouz EHS Boukhroufa AEK route de canastel 31000 ORAN ALGERIE Email: amel_dehou@yahoo. Rate of successful correction without open release surgery. Amel Dehou-Mahmoudi. . S. A total of 40 clubfeet in 35 patients were treated using the Ponseti method at our department. Results: The mean of the follow up was 15 months. . Allout. classification according to Dimeglio at the time of the last follow up. All the patients were corrected without open surgery. Conclusion: Open release surgery can be averted in most cases of idiopathic clubfoot using the Ponseti method. the mean a. Material and methods: It is a prospective study between October 2006 and December 2007. The aim of our study was to evaluate our early results and experiences with the Ponseti method. I. radiological findings. Beressa. The mean tibiocalcaneal angle 3-4 weeks after the percutaneous tenotomy of the Achilles tendon. recurrence rate and duration of treatment were defined as outcome measures for this prospective Introduction: The Ponseti method for the treatment of congenital clubfeet has been propagated due to the sometimes disappointing functional results after surgical treatment. Scarring of the soft tissue and especially of the joint capsule can thereby be avoided. N.

El Alami. Material and methods: Between June 2006 and December2007. Morocco Email: amraniabdel@menara. Paediatric Orthopaedic’s and Reconstructive Surgery Unit. MA. Conclusions: The surgical procedure called the triangle tilt surgery as described by Dr Nath improved shoulder function and corrected the glenohumeral axis in these patients. Scapular hypoplasia. Rabat.Shoulder medial rotation contracture in obstetric brachial plexus palsy managed by Nath procedure: triangle tilt surgery': A preliminary results A. Surgical levelling of the distal acromioclavicular triangle combined with anterior release of shoulder. Children’s Hospita. 14 children underwent a surgical procedure called the triangle tilt operation as described by Dr Nath to correct this bony shoulder deformity. .ma Background: The medial rotation contracture caused by weak external rotation secondary to obstetric brachial plexus injury leads to deformation of the bones of the shoulder. elevation and rotation deformity are accompanied by progressive dislocation of the humeral head. H. SZ. Dandane. Results: The posture of the arm at rest was improved and active external rotation increased by a mean of 53 degrees (45 degrees to 85 degrees ) in the 9 children who were followed up for more than one year. T. Amrani. El Medhi. There was a significant improvement of the Mallet shoulder function score after surgical correction of the bony deformity. Gourinda.

Azzouz Department of paediatric orthopaedic surgery EHS Canastel Oran. Algerie Email: ismahene_beressa@yahoo. c6. If recovery is incomplete by the end of the first month. The average birth weight was 4171g 07/21 have associated lesion. 21 new born with neonatal brachial plexus palsy were entered in into a prospective study in witch details of birth and serial clinical examinations were recorded. Except for the Claude Bernard Horner sign I found no sign witch can predict bad recovery. c5. The conventional non operative management is used by some authors. others prefer early microsurgical treatment if there is no biceps recovery at three month. I concluded that in this study prognostic of total recovery is not as good as it is found in some articles. Allout. total+Claude Bernard Horner two (02) cases.Neonatal brachial plexus palsy Beressa.c6 fourteen (14) cases. Result: The level of injury was :c5. Patients were grouped according to Narakas classification. In Algeria there is no study witch give this incidence. Abdelali. The purpose of this study is to report natural history and to determine the prognostic for bad recovery in patient who were identified at our service as having a neonatal brachial plexus palsy in our department of paediatric orthopaedic surgery (EHS Canastel Oran) Methods: Between (July 2007 to June 2008). . referral to a multidisciplinary team is necessary. Shoulders elbow and hand functions were graded according to Gilbert’s score. Only 03 /21 babies have present total recovery 05/19 has recovery biceps at three month. c7 four (04) cases. The incidence of obstetrical plexus palsy doesn’t decrease during the last century in the word. total (01).

Infantile Orthopedic Department – Kassab Institution – Tunis Email: jenzri. The appreciation of the result of the treatment was essentially based on the evaluation of the functional state after the treatment. 8 were able to get an autonomous walking back and 5 patients stayed in the same state in spite of the segments of armed members. Through a series of 21 patients treated in our institution. Jenzri M. The average age during the first consultation was 4 years. Arbi S. we describe the difficulties and the results of the coverage. We distinguished three categories of patients according to the age of the first arisen fracture: 5 grave forms. Discussion: We discuss in this work the difficulties of the orthopedic coverage of the children affected by the Lobstein disease as well as the interest of the medical treatment of the osseous fragility. About 21 Introduction: The Osteogenesis Imperfecta or Lobstein disease is characterized by an osseous fragility which results in numerous fractures arising spontaneously or in the regression of a minor traumatism. 3 minor forms and 13 intermediate forms. All the patients were surgically treated and we did the usual technique of internal fixation with an intramedullary rod according to the technique of SOFIELD. Daghfous MS. Zouari O.5 years. Each file was studied by clarifying the following elements: the age in the beginning of the coverage. The average age during the first surgical treatment was 7. We afterward studied the undertaken treatment and its inherent complications. the number of fractures and their locations.Osteogenesis imperfecta: therapeutic difficulties. Eight patients could walk and 13 patients could not during the first orthopedic coverage. Material and methods: This consists of a retrospective study of 21 patients affected by the Lobstein disease and treated in our department since 1990. The coverage must be multidisciplinary to improve the functional and vital prognosis of these patients. Conclusion: The Osteogenesis Imperfecta is characterized by an abnormality of the synthesis of the collagen getting to all the structures of the body conferring him a general character of the affection. the age during the first fracture. Yakoubi N. the sex. and which are responsible for deformations of the members involving the functional prognosis of the patient. the presence of deformation and the ability to walk. Results: The study concerned 7 boys and 14 girls. Hadidane R. We noted three infections and a death. . These elements allowed clarifying the gravity of the disease and the functional state before any coverage.. Our results were estimated as follows: Among the 13 patients who initially could not walk.

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The patient underwent surgical decompression of the nerve and resection of the osteochondroma. HAMDI Mohamed Faouzi. knees. Peroneal mononeuropathy in children is uncommon. The peroneal nerve was flattened by the exostosis. on admission. there was a complete recovery of the deficits. These benign tumors remain asymptomatic. MNIF Hichem. The diagnosis in our patients was not formally made until electro diagnosis studies identified the probable location of the lesions. and ankles bilaterally.Peroneal nerve compression resulting from fibular head osteochondroma. . This lesion may require surgical intervention. ALOUI Issam. sparing the superficial peroneal sensory responses. ZRIG Makram. After a follow-up of 20 months. No evidence of recurrence was seen. Case presentation: An 11-year-old boy presented with right peroneal neuropathy. Introduction: Osteochondroma of the proximal fibula is relatively common. The tinel sign could be elicited at that point. The electromyography and nerve-conduction studies are normal. Discussion: Osteochondroma is a benign tumor consisting of projecting bone (exostosis) capped by cartilage. but continued growth beyond that point should raise the suspicion of sarcomatous transformation. The electrodiagnosis findings supported an axonal loss deep peroneal mononeuropathy. Physical examination disclosed multiple bony exostosis overlying the ribs. The authors report a case of a child presented with peroneal nerve compression secondary to fibular head osteochondroma. a large exostosis was palpated at the right fibular head. paresthesia. Multiple tumors occur in the setting of multiple hereditary osteochondroma. These tumors may be solitary or multiple. but reports of this lesion in conjunction with peroneal nerve compression have been scarce. KOUBAA Mustapha. HAMMOUDA Imed. It may continue to enlarge throughout childhood. ABID Abderrazak. Monastir. Fattouma Bourguiba Hospital. ALLAGUI Mohamed. ABBADI Abdelmalek. In particular. The radiological examinations (standard and computed tomography) demonstrated an osteochondroma in the head of the right fibula. Department of Orthopaedic and Traumatic Surgery. although plain roentgenographs demonstrated the pathologic findings. although they can produce bony deformities or may also compromise joint motion by compression of the tendons. Tunisia. cause compressive mononeuropathy. Osteochondroma is an uncommon cause of peripheral nerve dysfunction.

the result was excellent. . Hassib Keskes. In our knowledge. Moez Trigui. Mechanism of this injury is probably a compression force on the radial head associated with a violent contraction of the biceps brachialis muscle. such as in Jeffery II type or very displaced Jeffery I type. Fakher Gdoura. Reduction was stabilized with a Kirchner wire and a splint during 1 month. Mohamed Zribi. This fracture involved an anterior displacement of the radius instead of a displacement of the radial epiphysis which preserved his normal connections with humeral condyle. Kamel Ayadi. CHU Habib Bourguiba. This fracture was successfully treated by closed reduction with manipulation of the proximal radial metaphysis. Authors report in this paper an exceptional displaced radial neck fracture in a 12 years old child. this type of radial neck fracture was not described previously. At 2years follow-up. Slim Ben Jmaa. Tunisia Open reduction is usually indicated in completely displaced radial neck fractures. Sfax. This fracture was not associated to any injury of the ulna or the elbow joint. Department of Orthopedic and Trauma Surgery. with a painless elbow and a complete range of motion.Closed reduction and stabilization of a completely displaced radial neck fracture.

Abid. F. Bone scintigraphy and CT scan of the left foot revealed an osteoid osteoma. Zitoun. The clinical examination was normal and the X-rays revealed the simple bone cyst of the talus which did not explain the night-and inflammatory pains. Hôpital Mohamed Tahar SFAR. A rare association I. Ben Ghozlen. At 3 years follow-up. Louati. We report the case an association of an osteoid osteoma of the talus and simple bone cyst of the calcaneus of the left foot in a 15-year-old teenager. The association of these tumours the year level of the same foot is unusual. the patient has been free of recurrence. Y. Sassi. Service d’Orthopédie – Traumatologie.Osteoid osteoma of the talus and simple bone cyst of the homolateral calcaneus.Tunisie Osteoid osteoma and simple bone cyst are readily observed in long bones but are much less common in the short bones of the foot. The patient complained of pain for 4 months which worsened at night. N. . H. Mahdia . Resection of the osteoid osteoma and curettage and filling with cancellous bone of the bone cyst was realized.

Infantile Orthopedic Department – Kassab Institution – Tunis Email : jenzri. The pain was a constant reason for consultation. The study of the files allowed retrieving the epidemiological. The treatment was always surgical by doing the posterior way in 15 cases and the anterior way in a case for the corporeal Osteoid Osteoma of T5. . The rachidian stiffness was noticed with all patients.mourad@voila.. the diagnosis of which is classically difficult. The scanning is the examination of choice to direct the diagnosis and locate the Osteoid Osteoma. A spine curve was found in six cases. Feki H. In the follow-up of 5 years 5 months on average. Results: The study concerned 11 men and 5 middle-aged women of 18. The standard radiography showed a located sclerosis with a one-eyed peduncle in 15 cases and was considered normal in 1 case. Three cases required stabilization with transplant: 2 for a resection considered very wide and one for a correction of a structural scoliosis. Ammar A.5 years with extremes from 8 to 50 years. Three patients presented a scoliotic attitude and three female patients presented a structural scoliosis with a hump. thoracic in 3 cases.Scoliosis and osteoid osteoma of the spine Jenzri M. Conclusion: The Osteoid Osteoma is a painful mild osseous tumor. The lesion was pedicular in 6 cases. Zouari O. S. laminar in 7 cases. It must be evoked in front of a stiff and painful rachis with sometimes a spine curve. The tumor sat in the cervical level in 3 cases. The scoliosis was particularly studied to determine these clinical and radiological characteristics and its evolution after the treatment of the Osteoid Osteoma. we study the particularities of the scoliosis associated to the Osteoid Osteoma. Material and methods: We studied the files of 16 patients presenting Osteoid Osteoma of the spine brought together over a period of 27 Introduction: The vertebral localization of the Osteoid Osteoma is rare (10 in 20 % of Osteoid Osteoma). all our patients are satisfied with disappearance of the pain. The resection of the Osteoid Osteoma allows generally a spontaneous correction of the scoliosis. and corporeal in only 1 case. Daghfous MS. The improvement of the disorders of the static vertebral with disappearance of the stiffness and the deformity was seen on average 7 months after surgery. Through a series of six scoliosis out of 16 vertebral Osteoid Osteoma. showed a hyperfixation. All our patients saw their pains disappearing 24 hours after the resection. Hadidane R. clinical and radiological particularities of the Osteoid Osteoma at the level of the rachis. lumbar vertebra in 8 cases and sacral in 2 cases. We noted a case of pseudoarthrosis of the transplant. The scintigraphy. practiced to 4 of our patients. articulair in 1 case. It comes along with a scoliosis in 53 in 85 % of the cases according to the series. The anatomopathologic examination confirmed the diagnosis in all cases.

BEN SLIMEN3. KHELIFI1. Tunis . The treatment consisted on restriction of sport activities and walking with crutches. M.Salah AZAIZ Institute.Tunisia Stress fracture of the femoral neck in skeletally immature children is a rare event and only few cases (< 15 cases) have been reported. M. One year late. This rare and particular clinical observation will be presented with a review of literature. BEN GHACHEM1.Stress fracture of the femoral neck in child with negative bone scintigraphy. Tunis . DOUIRA2. H. SMIDA1. F. M.Tunisia Department of Pediatric Radiology . M. . 1 2 Department of Pediatric Orthopaedics . We present in this paper. the case of 8-year-old boy who sustained a compression-sided femoral neck stress fracture.Tunis Children’s Hospital. EZZINE1. The technetium bone scan was negative.Tunis Children’s Hospital.Tunisia 3 Department of Nuclear Medicine . BEN HASSINE2. MRI was performed later and discovered a femoral neck stress fracture on the compression side. the patient was asymptomatic and had returned to full activities and there was radiographic evidence of healing of the fracture. Tunis . W. Initial plain radiographs showed an area of sclerosis along the inferior margin of the femoral neck.

Both surgical and non surgical management has been advocated for ABC. MN. Bellagha**. Initially the lesion involves the posterior arch with an extension to the pedicle and the vertebral body. to show bony walls and liquidliquid levels suggestive of ABC.Vertebral aneurysmal bone cyst. The treatment consists on complete tumor resection which offers the best chance for cure. Surgery is the treatment of choice when stability of the spine is compromised and neurological signs are present. . children Hospital. C. children Hospital. Nessib*. the clinical presentation consists on pain and spinal cord compression. M. Report of 4 cases. scoliosis or instability may occur. At lease four years later. neither recurrence nor sequels are noted. Other techniques could be used such as selective arterial embolization. C. Jalel*. Tow lesions are located in cervical spine (C2 and C7) and tow in the lumbar spine (L1 and L3). Patients and methods: The authors reports four cases of spine ABC. Discussion and conclusion: ABC is a benign but potentially devastating lesion account for 15% of primary tumors of the spine. MRI is the best exam to analyze the spinal cyst. for voluminous and very aggressive cysts or as preparation to surgery. nerve root irritation. W. Selective arterial embolization can be used in some localization. The potential for instability following surgical excision is high. Ammar*. Diagnostic imaging by CT and MRI revealed an expansive osteolysis. to evaluate the tumor extension and to search spinal cord compression or nerve root irritation. Smida*. Tunis **: Department of radiology. W. For all patients. decompression. Tunis Introduction: Aneurysmal bone cyst (ABC) is an aggressive fast-growing benign tumor. M. Safi*. ABC is mainly located in long bone and less frequently in the spine where spinal cord compression. I. The age of patients ranges between 6 to 12 years. radiotherapy or injection of ethibloc. so reconstruction and stabilization of the spine must be complete using bone graft with or without instrumentation. K. S. H. and posterior arthrodeses. Ben Ghachem* *: Department of orthopedic surgery. Neurological complications are frequent and urgent surgical removal is some times needed. Douira**. Saied*. Bouchoucha*. Amara*. All cases are treated successfully with curettage.

BEN HASSINE2 . Technique: Under radioscopic control.Extra-articular percutaneous excision of benign epiphyseal tumours in children K. W. all children were free of pain with normal joint function and radiographs documented complete healing with no recurrence. M. using a technique of percutaneous extraarticular curettage. M. The extra-articular approach for excision of epiphyseal benign tumors offers several advantages but it has also disadvantages. Tunis . LOUATI2 .13 years). L. 3 boys & 2 girls (8 .Tunisia 3 Department of Pathology . IDRISS3 . Results: At late follow-up. M.Tunisia. AMARA1 . Standard treatment of benign epiphyseal tumors consists of thorough curettage of the lesion. The residual cavity is then packed with bone graft. Excision of the tumors was done by extra-articular percutaneous approach to avoid difficulties of these particular epiphyseal sites and disadvantages of joint opening. a retrograde guide pin is drilled from the metaphyseal cortex into the tumor within the epiphysis (step 1). were presenting painful epiphyseal tumors with decreased joint function (four superior femoral epiphysis [3 chondroblastomas & 1 aneurysmal bone cyst] & one superior tibial epiphysis [chondroblastoma]). Patients: Five children. we believe that extra-articular percutaneous excision of benign epiphyseal tumors is safe.Tunis Children’s Hospital.Salah Azaiz Institute. In the case of superior femoral epiphysis chondroblastoma. SAIED1. Discussion: Chondroblastoma and aneurysmal bone do not undergo spontaneous resolution if left untreated.Tunisia Department of Pediatric Radiology . followed by optional bone grafting. M. BEN GHACHEM1 1 2 Department of Pediatric Orthopaedics . Objective: To report 5 cases of benign epiphyseal tumors excised. A tunnel with sufficient diameter is drilled over the pin using a cannulated drill (step 2). KHELIFI1 . Curettage-biopsy of the tumor is performed by curved curettes (step 3).Tunis Children’s Hospital. effective and curative technique. SASSI3 . In spite of our small experience. . S. precocious iatrogenic epiphysiodesis was happened. Tunis . Tunis . H. SMIDA1 .

M. CH. M. L. It interests particularly the insertion one of the adductors muscles and no cases of proximal lateral vastus avulsion have been found. DOUIRA2 . BEN HASSINE2 .Tunis Children’s Hospital. Tumoral aetiology remains the primary diagnosis to eliminate. The muscle avulsion interested. JALEL1. a surgical biopsy was done to eliminate tumoral lesion. . BEN GHACHEM1 1 2 Department of Pediatric Orthopaedics .Tunis Children’s Hospital. 10 and 13 years presenting lateral vastus in one case and adductor insertion avulsion in two cases. Diagnosis delay is due to a non specific clinical examination. A. Cases report: We are presenting three cases of muscle avulsion among three children aged respectively 4.Tunisia Department of Pediatric Radiology . Radiological images show a periosteal reaction without traumatic or septic context. The X-Rays has shown a periostal bone reaction below the great trochanter in the first case and in the medial side of femur in the other two cases. L. GAALICHE1 . Tunis . Report of three cases. DAMAK1 . In the first case.Tunisia The sport of high level is done at ages more and more young exposing children to accidents. Tunis . apophyseal inserts because of their low resistance. in the immense majority of cases. this injury has been rarely reported in children. Discussion: The avulsion muscles represent a specific entity of high level sports after a long period of solicitations. In literature. But metaphyso-diaphyseal avulsions inserts represents a rare and special entity. W.Children muscle avulsion. SMIDA1 .

L. LECHQAR. Conclusion: The sternoclavicular dislocation. Y.Post-traumatic sterno-clavicular dislocation in the childhood. Case report: A young child aged of 14 year-old having sternoclavicular dislocation since the age of 4 year-old. which would be of orthopaedic or surgical management. RAMI. pose problème de prise en charge avec des difficultés opératoires quand l’indication est posée. MAHMOUDI. M. physical examination pointed out an instable articulation. . Introduction: The sterno-clavicular dislocation is a rare disease in the childhood. may be challenging when the surgical management is decided.ARROUD . The patient had been operated by performing pinning of the sternoclavicular articulation. ATARRAF. Morocco. and is generally of good prognosis. K. ELMADI . K. M. BOUABDALLAH Pediatrics Surgery Department. La luxation sterno claviculaire. KHATTALA. who presented 2 months before hospitalization pain of the right sternoclavicular articulation associated with paresthesis of the upper right limb. rare disease in the child. CHATER. AFIFI. A. University Hospital Hassan II of Fez. M. Radiographic workshop found an articular diastasis. pathologie rarissime chez l’enfant. About one case A. A. the postoperative course was uneventful.

Traumatic hip dislocation in children. ZRIG Makram, MNIF Hichem, NEJI Nabil, HAMMOUDA Imed, ALOUI Issam, ALLAGUI Mohamed, HAMDI Mohamed Faouzi, KOUBAA Mustapha, ABID Abderrazak. Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia. Introduction: Traumatic hip dislocation in children is rare. It is a serious injury with potentially catastrophic consequences such as avascular necrosis. Appropriate evaluation and treatment are necessary to avoid such complications and to optimize patient outcomes. Material and methods: We treated 5 boys between 3 and 14-years-old during 1995 to 2005. The dislocations were unilateral and occurred from minimally traumatic event. All had Thompson and Epstein Type I posterior dislocation of hip without any associated fracture. Closed reduction was performed under general anaesthesia in all cases. Time to reduction was less than 6 hours in 4 cases. After reduction, traction was performed in all children, for 21 days on average. Results: At mean 7 years follow-up, all hips are considered normal clinically. Standard radiographs of all children were normal. Discussion: Traumatic dislocation of the hip differs from injury in adults because it requires less force to produce dislocation and has fewer associated injuries. The diagnosis of posterior dislocation of hip is made promptly by recognition of classical deformity of flexion, adduction, and internal rotation. It is not uncommon to see delayed or missed diagnosis. The vast majority of hip dislocations in children can be managed by closed manipulation and reduction under sedation or general anaesthesia followed. Avascular necrosis of the femoral head is the most serious complication that can occur after traumatic hip dislocation in childhood and accounts for the poor prognosis of this injury. Risk factors are prolonged interval before reduction, older age and the presence of fracturedislocations. Affected children should be followed regularly until skeletal maturity since abnormalities in the development of the hip may only manifest years later.

Mitkovic's external fixator (cd) in the treatment of humeral abbreviation Gajdobranski Dj1, Mitkovic M2, Petkovic L1, Tatic M1, Mikov A3, Marcikic A1. Clinic of Pediatric Surgery1; Clinic of Orthopedic and Traumatology Nis2; Clinic of Pediatric Rehabilitation3. Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia Limb length discrepancy in the childhood is caused for the two group of reason: abbreviation due to slowly growth and elongation due to growth stimulation. As length discrepancy of lower extremity has influence on gait mechanism and disturbed forces in spine and joints of lower extremity, surgical treatment is recommended. However, abbreviation of upper extremity has esthetic and forensic value so the surgical treatment is rare. The aim of this paper is to represent a method of distraction osteogenesis in treatment of upper arm using Mitkovic's CD distracter. In treatment of children with limb discrepancy, we use Mitkovic's CD distracter for transosseal distraction osteogenesis since 2000. Distracter application technique is the same as for external fixation and includes corticotomy in the metaphysis region. We represent a 17 years old boy with abbreviation of right upper arm in length of 9cm after surgical treatment of solitary bone cyst in proximal part of humerus. The functional and esthetic result of this method of treatment is excellent. Mitkovic's CD distracter provides limb elongation without limits and also offers a great possibility for correction. This surgical procedure is minimally invasive and is followed by shortness hospital stay, functional activity of the arm from second postoperative day and reduction of life and work ability with small rate of complication. Distraction process is very simply and it is easy to realize by patients or parents.

Soft tissue cartilaginous tumors in children. Report of 3 cases. A. GAALICHE1 ; M. SMIDA1 ; L. DAMAK1; N. NESSIB1; H. LOUATI2 ; M. IDRISS3 ; S. SASSI3; L. BEN HASSINE2 ; M. BEN GHACHEM1
1 2

Department of Pediatric Orthopaedics - Tunis Children’s Hospital. Tunis - Tunisia Department of Pediatric Radiology - Tunis Children’s Hospital. Tunis - Tunisia 3 Department of Pathology - Salah Azaiz Institute. Tunis - Tunisia. Soft tissue cartilaginous tumors are rare and often seen in adults. We report here three pediatric cases. The first is a soft tissue chondroma of the posterior aspect of the left axilla in a 3-year-old boy. CT scans showed a spherical fatty density soft tissue mass without evident calcifications, attaching the infraspinous muscle. The second patient is a 9-year-old girl presented with a right auricular finger soft tissue chondroma. Radiographs showed several punctuated calcifications with adjacent bone scalloping. MRI revealed a lobulated soft tissue mass attaching the flexor tendons. The tumours were entirely removed. At follow-up, the patients had good functions without evidence of recurrence. The third patient is a 12-year-old boy presented with a left shoulder region chondrolipoma. MRI suggested the diagnosis by showing double fatty and cartilaginous structures of the tumor. The tumours were entirely removed. At follow-up, the patients had good functions without evidence of recurrence.

M. SAIED. he had a severe volar angular deformity in the distal part of the forearm without any neurovascular deficit or cutaneous lesion. . M. In addition. Case report: An eleven-year-old boy fell from a height of about one meter and sustained an injury of the left forearm.Monteggia fracture dislocation associated with ipsilateral distal radial metaphyseal fracture. Roentgenograms showed an anterior dislocation of the head of the radius and a fracture of the middle third of the ulnar diaphysis with volar angulation. GAALICHE. there was a fracture through the radial metaphysis with posterior displacement but without dislocation of the distal radio-ulnar joint. AMARA . BEN GHACHEM Department of Pediatric Orthopaedics . A case report A.Tunis Children’s Hospital. Adequate reduction of both fractures was obtained under general anaesthesia and the extremity was immobilized in a plaster cast and bone union had occurred. Tunis . Combined Monteggia injury and isolated metaphyseal fracture of the radius in the same forearm had never been described. K. W. SMIDA.Tunisia The association of a Monteggia fracture dislocation and a lesion of the lower extremity of the radius is very rare and there are few reported cases in the literature. When the child was firstly seen.

In this work. KHLIFI1. IDF is seen in infants and young children but often appearing during the first 2 years of life. BEN GHACHEM1 1 2 Service d’Orthopédie de l‘Enfant et l’Adolescent. of 6 cases. The are approximately 100 case reports in literature. M. Occurring typically on fingers and toes. Laboratoire de Cytologie et d’Anatomopathologie. H. M. Infantile digital fibromatosis (IDF) is a rarely encountered benign fibrous tumor. Histopathology is pathognomonic. M. M. Institut Salah AZAIZ. . SASSI2. S. S. Hôpital d’Enfants de Tunis. the recurrence after removal is frequent.Infantile digital fibromatosis . the lesions may be solitary or multiple appearing together. Spontaneous regression is possible and surgery is needed when diagnosis is not certain or when the overgrowth of the digital mass is deranging esthetically or functionally. SMIDA1. BOUCHOUCHA1. the authors will report their experience on 6 cases of IDF collected in the Pediatric Orthopedic Department of Tunis Children Hospital from 1990. However. EZZINE1.

H. M.A soft tissue pseudotumor. a rare benign soft tissue pseudotumor. S. an uncommon disorder.Tunis Children’s Hospital. DAMAK. SMIDA. A case report of calcinosis cutis and review of the literature. metastatic or dystrophic. Here we describe a case of a neonate who developed a dystrophic calcinosis cutis of her left ankle few days after receiving calcium gluconate by an intravenous administration for neonatal hypocalcaemia. Tunis . M. Pathophysiological mechanisms. BOUCHOUCHA.Tunisia Calcinosis cutis. . The patient was addressed to our department with a suspected diagnosis of tumoral calcinosis. may be classified as idiopathic. BEN GHACHEM Department of Pediatric Orthopaedics . EZZINE. L. It has been often described in adults. prevention and differential diagnosis of this condition are discussed. the course.

SASSI3 . particularly in the rare location. The histological study highlights an acrochordon in its “lipomatous” variant. BEN HASSINE2 . LOUATI2 .Tunisia Department of Pediatric Radiology . Malignancy procession is an obsession. BEN GHACHEM1 1 2 Department of Pediatric Orthopaedics . affecting preferentially eyelids. size and age of occurrence of this tumor.Salah Azaiz Institute. S. AMARA1 . Tunis . Tunis . M. Discussion: The localization of this tumor at the lower limbs. Affecting particularly obese patients.Tunis Children’s Hospital. Case report: A child of 13 years comes with a skin tumour measuring 6/4 cm. The localization in lower limbs is exceptional. as well as its appearance in a child poses a diagnosis problem. M. The acrochordon is often associated with metabolic disorders or with diabetes mellitus that we should look for. Conclusion: This observation is exceptional as well by localization. H.Acrochordon of limbs. L. MRI finds a fatty tumor without deep plans invasion. DAMAK1 . . the size tumor doesn’t exceed 3cm. Acrochordon is a benign soft tissue tumor. Finally other skin lesions must be searched. armpits and regions under breast. A complete tumoral remove has been achieved.Tunisia 3 Department of Pathology . painless with a large base implementation. L.Tunisia.Tunis Children’s Hospital. M. SAFI1. SMIDA1 . Tunis . About a geant pediatric case K. A single case of acrochordon of lower members has been found in literature. neck. IDRISS3 . H.

Synovial hemangioma of the knee in an 8-year-old boy. ABID Abderrazak. KOUBAA Mustapha. it can also appear in other joints or tissues. Open complete resection of the circumscribed capillary hemangioma was performed. if the lesion is extended enough and communicating with the circulation. A delayed diagnosis is common and due to its unspecific clinical presentation. Tunisia. Magnetic resonance imaging (MRI) revealed an intra-articular circumscribed tumor. ZAKAMA Abdelfateh*. Case presentation: An 8-year-old boy presented with a 2-years history of recurrent pain and swelling in the right knee. Physical examination revealed a small painful point adjacent to the lateral side of the patella. ZAMMEL Nizar. After a follow-up of 24 months. ZRIG Makram. ALLAGUI Mohamed. Introduction: Synovial hemangioma is a rare intra-articular benign tumor that is difficult to diagnose because of its nonspecific symptoms. no evidence of recurrence was seen controlled by MRI and the physical examination of the knee showed normal results. Final diagnosis can only be obtained with histological examination. MOUSSA Adnene*. Monastir. are satisfactory. We report a case of a boy affected by an intra-articular synovial hemangioma of the knee. particularly in the localized form. Treatment is surgical and it consists in complete removal when possible of the hemangioma. The results. although MRI may be useful and arteriography clearly reveals it. The condition is very rare in children. Fattouma Bourguiba Hospital. While mainly affecting the knee. recurrence is infrequent and it is generally due to incomplete excision of the tumor. MNIF Hichem. ALOUI Issam. Discussion: Synovial hemangioma is a benign vascular tumor. The biopsy confirms the diagnostic of synovial hemangioma. Department of Orthopaedic and Traumatic Surgery. . SALLAMI David.

Essafi Y. . A case Report Bahri M. Gavrilov V Orthopaedic Department . which causes increasing severe deformities in patients. The osteoporosis is responsible for the osseous fragility. 3100 Kairouan-Tunisia. Bouferes R. Kahlaoui N. which accounts for the frequent fractures even following minor accidents (glass bone disease).Osteogenesis Imperfecta Tarda. We report a particular observation of 16 year old adolescent boy who presented with tardy form of osteogenesis imperfecta. It affects children and it regresses by puberty. Aguir Z. E-mail : bahrimhamed@yahoo. Kairouan Hospital. He was treated by intra -medullary nailing.Ibn El Jazzar. Bellassoued A. Ladhari M. A review of the literature was The osteogenesis imperfecta known also as "LOBSTEIN" disease is a genetic disease with dominant hereditary transmission. Osteogenesis imperfecta is characterized by the osseous fragility.

These histological aspects evoke the diagnosis of a fibrous dysplasia associated to an aneurismal cyst. we note the presence of small cystic with a haematic containing. We discuss in this work. Surgery: Resection in bloc of the tumor and preserving the internal clavicle epiphysis. The cortical is thin. Rx: Lytic image for the internal 1/3 of the left clavicle with geographic contours. Zouari O. TDM: Aspect in favor of a tumor benign with a vascular cartilaginous component. Ben Hmida MK. the histological type of the tumor and the undertaken therapeutic conduct. Daghfous MS. Abid A. Infantile Orthopedic Department – Kassab Institution – Tunis. The surgical consequences are favourable in 6 months with consolidation of the tibial graft. Hadidane R.. Jenzri M. without the notion of traumatism. . reconstruction by a tibial graft. Clinical exam: Absence of inflammatory signs facing the tumefaction and the mobility of the shoulder is complete and painless. Besides. The portion shows a white formation not well limited with a firm consistency.7 cm. who was hospitalized due to a tumefaction and pains at the level of the internal 1/3 of the left clavicle evolving since 5 months. Macroscopy: A clavicle segment which measures 3x2x1.Fibrous dysplasia at the level of the clavicle.Tunisia It is about a 12 years old girl.

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