[Tuberculosis in childhood: clinical features and problems in diagnosis. report of 30 cases]

The clinical polymorphism and the low yield bacteriological tests make the diagnosis of tuberculosis [TBC] in children often difficult. The aim of this report is to specify hospital incidence of childhood TBC and to discuss problems in diagnosis. We reviewed retrospectively cases of TBC enrolled at Medicine A Department in Children's Hospital of Tunis during the last ten years [1998 - 2007]. Diagnosis of TB was supported according to bacteriological or histological confirmation or regarding the association of epidemiological data [TB contagium], clinical and radiological findings and favourable outcome with anti tuberculous drugs. Thirty children had TBC. They were 18 girls and 12 boys. The main age at diagnosis was 8. 6 years [3 months-14 years]. All children were vaccinated with BCG. Thirteen patients had definite familial history of TBC contact. Tuberculin-skin test was positive in 15 patients. The diagnosis was supported within a mean period of 44 days [8, 240 days]. Pulmonary TBC occurred in five patients and extra-pulmonary TBC in 25. Four patients had more than two TBC localizations. Miliary and TBC meningitis occurred in seven patients. The rate of diagnosis confirmation was 40%. Clinical outcome improved in 29 children with anti tuberculosis therapy while one infant died with miliary TBC. Five patients developed pleural, neurological or bone sequelaes and another patient presented autoimmune bicytopenia, diffuse bronchectasis and pulmonary aspergillosis. TBC occurs in 0, 91/ year/1000 hospitalized children in our institution. Low diagnosis confirmation rate was observed with infants and in pleural and primary TBC. Although all patients received BCG vaccine, 23. 3% of them developed a life-threatening form of TBC

Metaiodobenzylguanidine scintigraphy in neu-roblastoma

The aim of this study is to evaluate meta-iodo-benzyl-guanidine scintigraphy in the diagnosis and the management of neuroblas-toma. betwen September 1999 and jun 2004, 16 children aging from 4 months to 6 years, with neuroblastoma, underwent mlBG scintigraphy in military hospital nuclear medicine department. 23 mlBG scans were done. The exam was indicated for the initial staging in 7 cases, to evaluate chemotherapy or surgery in 12 cases and to seek for reccurences in 3 cases. The sensitivity of mlBG was 57% in the detection of the primary tumor, 100% for liver metastases and 67% for medullar involvement. mlBG scintigraphy should be a standard in the initial staging of neuroblastoma and in evaluating therapy response

[Colorectal polyps in children. A study of 34 patients]

Aim: To assess the frequency and the clinical features of polyps of the colon and rectum in children

Methods: A total of 34 patients [20 boys and 14 girls, mean age: 5.4 years] were enrolled in this 14-years retrospective study. Diagnosis was done for almost all patients by colonoscopy [n=8] or recto-sigmoidoscopy [n=19]. After endoscopic polypectomy, polyp's type is determined by histological examination

Results: Minimal and relapsing rectal bleeding was the most frequent finding of polyps of the colon and rectum [85.3%] followed by spontaneous emission of polyp [n=3], rectal prolapses [n=2], chronic constipation [n=1] and abdominal pain [n=1]. The polyp was unique in all cases and with a mean size of 12 mm. The majority of polyps were localized in the rectum or sigmoid [97%] and were pediculate [81.2%]. Endoscopic polypectomies concerned 26 polyps while two small polyps were left. Most of the polyps corresponded histologically to juvenile polyps [96.2%]. The immediate post-op course was uneventful for 26 children

Conclusion: Our study suggests that rectal bleeding is the most frequent finding of polyps of the colon and rectum in childhood. Outcome after endoscopic polypectomy is good