[Community acquired pneumonia in children]

Community acquired pneumonia is responsible for a high morbidity in children. The etiological diagnosis is not always easy and treatment remains probabilistic. To analysis clinical patterns and the outcome of community acquired pneumonia and to find arguments in favour of its origin. A prospective analysis of the files of 39 children [20 boys, 19 girls] hospitalized between [1 December 2004-30 June 2005] for community acquired pneumonia was performed. Included children whad between 6 months ad 15 years-old. The mean age was of 3 years and three months. Germ was identified in 41%of cases: Mycoplasma pneumoniae was the most important germ found in9 cases, pneumococcus was found in 4 cases and hemophilus in four cases. Coinfection pneumococcus and mycoplasma were found in two cases. None virus was identified. We have separated two groups: bacterial pneumonia and pneomoniae without definite etiology. Fat cough was associated to bacterial pneumonia mycoplasma pneomoniae was significantly associated with high fever and dry cough. We haven't found any others associations between clinical, biological or radiological patterns and the two groups of pneumonia. C-reactive protein more than 66 mg/I has sensitivity of 77%, specificity of 73.3%, positive predictive value of 46.7 99 of and negative predictive value of 91.7%. The outcome was favourable in all cases. Theses results showed the necessity to improve our microbiological methods to identify infectious agents of pneumonia. Mycoplasma pneumonia seems to be a frequent germ in preschool children

[Late post-operative adhesive small bowel occlusions. About 258 cases]

This retrospective study reports a series of 258 patients operated on for late developing post-operative adhesive occlusions. The impact of anterior interventions on these occlusions. The impact of anterior interventions on the occlusions as well as the clinical and paraclinical patterns are discussed before any approach to the different therapeutic aspects of this complication. Previous surgery had an impact not by number of the operations performed [80% of patient had undergone only one intervention on the pelvis or abdomen] but essentially by the nature of the operations since most of the adhesions occurred following surgery on the appendix. The diagnosis should be made urgently on basis of findings yielded by physical examination and plain abdominal x-rays [ct-scan of the abdomen is hardly indicated for the absence of hydroaeric levels on the plain abdominal film does not definitely exclude the strangulation]. Laparoscopic adhesiolysis an adequate treatment in case of a single adhesion. This laparoscopic is an adequate treatment in case of a single adhesion. This laparoscopic procedure practised on 11 patients had to be transformed in 3 cases into an open laparoctomy. Resection rate was 11.6%. Mortality and morbidity rates were 2% and 17% respectively

[Laparoscopic repair of a post-traumatic ruptured diaphragm: case report]

We report an observation of traumatic rupture of the diaphragm repaired laparoscopically. A 23-year-old man was admitted to our hospital two days after having undergone a traffic accident. The diagnosis was evoked by chest radiograph, then confirmed by Computed tomography scan, in front of an ascension of the left diaphragmatic cupola and an intra-thoracic digestive clarity. Seen the hemodynamic stability of the patient, a laparoscopic repair was indicated. The intra-abdominal pressure was fixed at 10 mm Hg. Despite the retraction of the diaphragmatic banks and the posterior seat of the breach, the intervention was held without any major incident. The postoperative course was marked by the formation of an encysted left pleural hematoma evacuated by a lung decortication. The evolution was normal thereafter

tumeurs mucosecretantes de l'appendice. A propos de 22 cas

The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome [73%]. The diagnosis was made pre or preoperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele [12 cases], a mucosal hyperplasia [8 cases] and a cystadenoma [2 caases]. For 5 patients, the diagnosis of peritoneal pseudomyxoma [4 cases] or extraperitoneal [1 case] was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later

Tumeurs carcinoides de l'appendice. A propos de 46 cas

Carcinoid tumors of the appendix are rare. The appendix constitutes the most frequent localization of these tumors. We studied of a retrospective way all cases that had an appendectomy in the service of general surgery of sfax on a period of 7 years going from 1995 to 2001. during this period 9584 patients had an appendectomy in our service. Among which, 46 cases [0.48%] of carcinoid tumor of the appendix have been diagnosed. In more than 95% of cases, patients were admitted due to acute appendicitis; but none of them had the signs of the carcinoid syndrome. The treatment was a simple appendectomy in 44 cases [95%]. The right hemicolectomy was necessary in two cases, because of an invasion of the appendicular base in a case and a tumor greater than 2 cm in the other case. There is no reported case of lymph node or systemic metastasis. The authors discuss data in the literature and analyse the features of the clinical picture, diagnosis, and try to define a convenient attitude of treatment of these tumors