[Indications and outcomes of surgical treatment of gastroduodenal ulcer in child and adolescent. about 45 cases]

The goal of this study was to determine the indications and assess the results of surgery in the treatment of gastro-duodenal ulcers in children and adolescents. This is a retrospective study of 45 patients operated for duodenal ulcer in Sahloul Teaching Hospital [Susa, Tunisia] over period of 14 years [1988 - 2001]. The study is about 41 boys and 4 girls aged between 8 and 18 years [mean age 15 1/2 years]. Surgery was undertaken in cases of bleeding ulcer [9 cases], perforation [26 cases], stenosis [7 cases], resistance to medical treatment [3 cases]. The after-effects were mild in 40 cases with an average hospital stay of 6 days. Later after-effects comprised ulcerous relapse [2 cases], stricture of the pyloroplasty [2 cases], an diarrhea following vagotomy combined with pyloroplasty in one case. Indications of surgical treatment of gastro-duodenal ulcers in children and adolescents are, nowadays, nearly limited to complicated forms of the illness. Outcomes of surgical treatment are globally satisfactory

[Clinical feature and course of Kawasaki disease in central Tunisia: a study about 14 cases collected over a period of three years[2000-2002]]

To analyze the clinical features and course of Kawasaki disease in central Tunisia. We studied retrospectively 14 cases of children with Kawasaki disease collected in Tunisian center during three years [2000-2002]. The study is about II boys and 3 girls [sex - ratio: 3.6/I] aged from 6 months to 8 years [mean age: 4 years]. Twelve patients had at least 5 diagnostic criteria of the illness, the two others had an incomplete form. We noted cardiac complications in seven patients treated belatedly, beyond 10 days of progression, because of atypical clinical presentations. All patients had all a middle caliber coronary aneurysm that was complicated by a thrombus in three cases, associated with pericarditis and minimal mitral insufficiency in a case and with a cardiac rhythm disturbance [block of branch] in another cease. Besides the cardiac complications, several other visceral manifestation could be noted: joint symptoms in five cases, GI tract symptoms in three cases, neuro-meningeal in two cases and urinary tract symptoms in two other cases. Specific treatment [aspirin with anti-inflammatory dose and intravenous immune globulin [IVIG]] has been instituted in all patients. The course was favorable for 12 patients with fast regression of clinical manifestation and progressive normalisation of biologic values. Two patients did not respond to the initial IVIG treatment, and had to recense received an additional course of IGIV but without clinical nor biological improvement. These two patients were treated with corticosteroids. Cardiac lesions disappeared completely in all patients even for those with thrombosis and in patients with IVIG-resistant Kawasaki disease. Only one patient had kept neurologic sequellae: aphasia, bevavioral problem's and partial epilepsy. Kawasaki disease is not rare in our region. Incomplete or atypical presentations are frequent and are a source of diagnostic delay. Coronary aneurysm due to the delay of treatment often regresses even in patients with IVIG-resistant Kawasaki disease