Presternal giant epidermal cyst: about 2 cases

Epidermal cysts are a common benign lesion, occurring often above the shoulder and within the face and the scalp. Presternal site and huge volume are quite rare, especially in children. The authors report on two paediatric cases, discuss etiopathogenesis and diagnostic difficulties. A 2,5 and 3-year-old boys were admitted for voluminous subcutaneous tumour of the chest. The lesions had appeared since neonatal period with rapid growth after a minimal trauma for the last year. The physical examination found a great presternal cystic mass of 70 mm in diameter which is painless round and mobile. Ultrasonography and magnetic resonance imaging, showed a subcutaneous cystic mass with no mediastinal involvement or other localization in both. Complete surgical excision including the overlying skin with direct cutaneous closure was performed in both cases. The histological examinations confirmed the diagnosis of epidermal cyst. Postoperative courses were uneventful with no recurrence during respectively 18 months and 5 years follow-up periods. Giant presternal epidermal cyst is uncommon and can raise diagnostic problems. Imaging investigations facilitate accurate diagnosis. Because of malignant degeneration, surgical excision should be mandatory

Xanthogranulomatous pyelonephritis in childhood: diagnosis difficulties and success of conservative treatment

Xanthogranulomatous pyelonephritis is an uncommon form of chronic pyelonephritis rarely seen in children. Preoperative diagnosis is difficult and management is still obscure. The authors report on a focal pseudotumoral case and discuss therapeutic modalities. A 2-year-old boy was admitted for a 2-weeks history of fever and right flank pain. Physical examination revealed a right lumbar mass. White blood cell count was 12.800/mm3 and C reactive protein elevated [50 mg/1]. The urine culture was negative. Ultrasonography and computerized tomography demonstrated a focal multilocular cystic mass of the lower polar of right kidney, measuring 80 millimeters, with peripheral enhancement and perirenal involvement. At surgical exploration, a huge abscess of the lower polar of the kidney with dense adhesions to adjacent structures were noted. Excision of the collection and local drainage were performed. Pathologic examination of biopsy specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. Intraoperative culture was positive for Escherichia coli. Successful treatment of the lesion was achieved with adjunctive antibiotic therapy. The postoperative course was uneventful over a follow-up period of 2 years. Xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass. A first-line conservative treatment must be strongly recommended in pediatric focal cases

[Pyelonephritis xanthogranulomatous in childhood: case report and litterature review]

Xanthogranulomatous pyelonephritis [XGP] is a specific form of chronic inflammatory kidney disease rarely seen in children. The Symptoms are often vague and non-specific the aim of this paper is to return the particularities of imaging features in xanthogranulomatous pyelonephritis. insisting on differential diagnosis with renal tumors, especially in case of no renal stone or tract obstruction evidence, We report a case of xanthogranulomatous pyelonephritis in a 2-year-old boy involving the lower renal pole which demonstrates the diagnostic difficulties encountered in this disease Xanthogranulomatous pyelonephritis is a rare condition in children and should be included in the differential diagnosis of a child presenting a renal mass

traitement laparoscopique de la lithiase choledocienne

In a period of five years we operated 52 patients affected by choledocolithiasis. 38 patients had a laparoscopic approach, 10 patients had directly a laparotomy and 4 patients benefit of a sequential treatment, The conversion rote was 39% because we don't select candidates to laparoscopy, including even patients with acute cholangitis. Main causes of conversion were wedged calculi in the papilla, multiple stones and high inflammation of the common bile duct. Mortality and morbidity were nil. Duration of laparoscopic operation was in a mean of 165 minutes with 8,8 days of hospital stay. Two residual stones were successfully removed by endoscopic sphincterotomy. Lapnroscopic treatment of choledocolithiasis is an effective, safe method; it seems to be the best therapeutic alternative. This technique needs an additional and costly instrumentation and good laparoscopic skills. in order to reduce the conversion rate it is recommended to avoid the laparoscopic approach for patients with acute chotangitis and multiple common bile duct stones