Validation of an Arabic version of the Oswestry index in Saudi Arabia.

OBJECTIVE: The aim of this study was to adapt and validate the Tunisian version of the Oswestry Disability Index (ODI) within a Saudi Arabian population. METHOD: The translation of items 8 and 10 taken out of the Tunisian version was conducted according to Beaton's method. Adaptations were made after a pilot study on 100 patients. The validation study included 100 patients suffering from chronic low back pain aged 18 to 65 years old. Intra-observer reliability was assessed using the intra-class coefficient (ICC). Spearman rank correlation coefficient, the Kruskall-Wallis test and factor analysis were used to evaluate construct validity (convergent and divergent validity). Internal consistency was assessed by Cronbach's alpha coefficient. RESULTS: One hundred Saudi patients were included in the study. Intra-observer reliability was excellent (ICC: 0.99). The correlations of the index with the VAS pain scale (r=0.708), the Roland-Morris Low Back Pain Disability (r=0.656), and the Quebec Back Pain Disability Scale (r=0.792) suggest good construct validity. Factor analysis unveiled two main factors explaining a cumulative percentage variance of 63.5%. The first factor represents static activities and the second factor represents dynamic activities. CONCLUSION: The Arabic version of the ODI adapted to the Saudi population has high metrological qualities. Further studies assessing its responsiveness to change should be conducted.

Combination of partial situs inversus, polysplenia and annular pancreas with duodenal obstruction and intestinal malrotation.

Situs inversus is a challenge to the physician, both for the diagnostic and for the therapeutic. A combination of partial situs inversus, annular pancreas and polysplenia with bowel malrotation has been reported in a newborn who presented as duodenal obstruction. Situs inversus is rare especially without heart malformation. All the abnormalities in this combination can be explained on the basis of multiple organ malrotation. It also demonstrates the necessity of meticulous investigation and precise description of the anomaly as far as the management of this case is concerned.

Translation in Arabic, adaptation and validation of the SF-36 Health Survey for use in Tunisia.

OBJECTIVE: To translate into Arabic and validate the SF-36 quality of life index in a Tunisian Arabic population. BACKGROUND: No validated Arabic quality of life index is published. DESIGN: Arabic translation of the SF-36 scale was obtained by the "forward/backward translation" method. Adaptations were made after a pilot study involving 22 subjects from general population. Inter-rater reliability was assessed by use of intraclass correlation coefficient (ICC) and Bland and Altman method. Construct validity was assessed by Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis with Varimax rotation. Internal consistency was assessed by Cronbach alpha coefficient. RESULTS: We note that 130 Tunisian subjects were included in the validation study. No items were excluded. Inter-rater reliability was excellent (ICC=0.98). Cronbach alpha coefficient was 0.94 conferring to translated index a good internal consistency. Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 62.3% of the cumulative variance: the first factor represented mental component, the second physical component. The Cronbach alpha coefficient was 0.88 and 0.91 respectively for factor 1 and factor 2. CONCLUSION: We translated into Arabic language and adapted the SF-36 scale for use in Tunisian population. The Arabic version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further studies are needed to confirm such a hypothesis.

Surgical management of recto-sigmoid Hirschsprung's disease.

INTRODUCTION: Over the years, the surgical management of recto-sigmoid Hirschsprung's disease (HD) has evolved radically and at present a single stage transanal pull-through can be done in suitable cases, which obviates the need for multiple surgeries. AIM: The aim of this paper was to evaluate the role of transanal pull-through in the management of recto-sigmoid HD in our institution. MATERIAL AND METHODS: A retrospective analysis (between January 2003 and December 2009) was carried out on all cases of Hirschsprung's reporting to unity of pediatric surgery of Tunis Children's Hospital that were managed by transanal pull-through as a definitive treatment. All selected patients including neonates had an aganglionic segment confined to the rectosigmoid area, confirmed by preoperative barium enema and postoperative histology. Twenty-six children (86%) had their operation done without construction of prior colostomy. RESULTS: Transanal pull-through was performed in 31 children. Mean operating time was 150 minutes (range 64 to 300 minutes). No patients required laparotomy because all patients including neonates had an aganglionic segment confined to the rectosigmoid area. Blood loss ranged between 20 to 56 ml without blood replacement. Since all children were given an epidural caudal block, the requirement of analgesia in these cases was minimal. Postoperative complications included perianal excoriation in 7 out of 31 patients lasting from 3 weeks to 6 months. Complete anorectal continence was noted in 21 of 31 (67%) children in follow up of 3-5 years. CONCLUSIONS: Transanal endorectal pull-through procedure for the management of rectosigmoid HD is now a well-established and preferred approach. Parental satisfaction is immense due to the lack of scars on the abdomen. As regards the continence, a long-term follow-up is necessary to appreciate better the functional results of this surgery.

[Pancreatic pseudocyst in children: what is the best therapeutic approach?]. / Les pseudokystes du pancréas chez l'enfant : quelle approche thérapeutique ?

INTRODUCTION: Pancreatic pseudocyst is an uncommon disorder in children and the majority of reported cases are secondary to trauma. AIM: Treatment options range from medical management to different forms of drainage procedure. The aim of this study was to discuss therapeutic strategies. OBSERVATIONS: The authors report herein pancreatic pseudocyst in four children aged 7, 9, 12, and 13 years with non-resolving pancreatic pseudocyst over a 2-year period from January 2006 to July 2008. The etiology of pancreatic pseudocyst was abdominal trauma in two cases and acute pancreatitis in two cases. Ultrasound and computed tomography scans confirmed the diagnosis. Two patients had endoscopic drainage. There were no procedure-related complications, nor was there a recurrence of the cyst. In one case, the pancreatic pseudocyst resolved spontaneously. CONCLUSION: This report suggests that children with non-spontaneously resolving pancreatic pseudocyst can be treated successfully and safely with endoscopic drainage. Surgical treatment remains an important alternative in the therapeutic armamentarium of this affection.

Small bowel obstruction caused by congenital transmesenteric defect.

Transmesenteric hernias are extremely rare. A strangulated hernia through a mesenteric opening is a rare operative finding. Preoperative diagnosis still is difficult in spite of the imaging techniques currently available. The authors describe two cases of paediatric patients presenting with bowel obstruction resulting from a congenital mesenteric hernia. The first patient had a 3-cm wide congenital defect in the ileal mesentery through which the sigmoid colon had herniated. The second patient is a newborn infant who presented with symptoms and radiographic evidence of neonatal occlusion. At surgical exploration, a long segment of the small bowel had herniated in a defect in the ileal mesentery. A brief review of epidemiology and anatomy of transmesenteric hernias is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.

Primary pelvic hydatid cyst with sciatic compression.

Hydatid cysts are endemic in certain regions of the world and particulary in North Africa. They are usually located in the liver, lung, and spleen, though many uncommon locations have been reported. This is the first report of a child with primary pelvic hydatid disease causing a sciatic compression.

[Aerobic bacteria associated with acute appendicitis in children]. / Bactéries aérobies associées aux appendicites aiguës de l'enfant.

OBJECTIVE: The aim of the study was to determine the microbiological profile of acute appendicitis in children. STUDY DESIGN: Prospective descriptive study including children hospitalized for acute appendicitis. METHODS: A specimen of the appendice and the peritoneal exudates (if exists) was performed intraoperatively for aerobe bacteriological examination. Anaerobic incubation was not possible in our study. RESULTS: Eighty children were included. The specimen culture isolated aerobic bacteria in 56 patients (70%). Polymicrobial infection was found in 14 children. Gram-negative bacilli were the most frequently isolated microorganisms (64/70). Escherichia coli was found in 48 children. The resistance rate to amoxicilline-clavulanic acid and to cefazolin was 35%. Pseudomonas aeruginosa susceptible to ticarcillin was detected in seven patients. CONCLUSION: In our study, the specimen culture found aerobic bacteria in 70% of cases, especially Gram-negative bacilli. Empiric antibiotherapy in acute complicated appendicitis in children should be efficient against these microorganisms.

[Impetigo herpetiformis (two cases)]. / L'impétigo herpétiforme (deux cas).

UNLABELLED: The hepetiformis impetigo is a pustulosis dermatosis. It is rare and specific to pregnancy. It can menace the prognostic of the mother and the child. This entity is actually considered as a pustulor psoriasis. We report two cases. CASES REPORTS: Two patients, respectively, aged 24 and 21, presented erythematous, pustular and extensive plaques for which the diagnosis of hepetiformis impetigo was clinically and histologically posed. For the first patient, the lesions appeared in the two pregnancies and were more severe and foetal repercussions (oligoamnios and hypotrophy) during the second pregnancy. For the second patient, the pregnancy was complicated with premature interruption of the membrane, giving birth to a deed fetus and causing an aggravation of the cutaneous lesions. The treatment was oral steroid followed by acitretin for the first patient, however, for the second patient; the treatment was by local steroid associated with UVB during the pregnancy. Then, acitrétine was used and was efficient. CONCLUSION: Our two cases show the importance of gynaecological control in order to avoid complications which can be sometimes fatal. They also show the importance of local steroid associated with UVB which constitute another therapeutic alternative in the treatment of hepetiformis impetigo.

[Impact of physical activity on the autonomy and the quality of life of patients with spinal cord injury]. / Impact de la pratique sportive sur l'autonomie et la qualité de vie du paraplégique.

OBJECTIVE: To assess the effect of regular physical activity on the autonomy and the quality of life of Tunisian patients with spinal cord injury. METHODS: The study relates to 25 paraplegic divided into two groups: 10 paraplegic sportsmen and 15 sedentary paraplegics among whom we assess the degree of the autonomy with the Functional Independence Measure and the quality of life with the quality of life questionnaire SF36 in its Arabic version. RESULTS: The result analysis shows a significant difference of the total score of the Functional Independence Measure between the two groups, the sporting paraplegic having developed a better autonomy on the daily activities than the nonsporting paraplegics with a total average score of 115.10 against 93.87 (p<0.001). A significant difference is noted, mainly in the headings "personal care" and ',"mobility". Concerning the shutter "quality of life", the scores of various dimensions of scale SF36 were higher in the sporting paraplegic with significant difference in the headings bodily pain (p<0.01), vitality (p<0.04) and global physical score (p<0.008). CONCLUSION: This study enabled us to show that the regular physical activity as well had a positive effect on optimization of the functional capacities of paraplegic as on the improvement of its quality of life, thus, supporting a better socioprofessional reintegration.

[Conservative management of full-thickness rotator cuff tears. A prospective study of 24 patients]. / Traitement conservateur des ruptures transfixiantes de la coiffe des rotateurs. Etude prospective ouverte. A propos de 24 patients.

OBJECTIVE: To evaluate the efficacy of conservative treatment of full-thickness rotator cuff tears. METHOD: A prospective open study of patients with full-thickness rotator cuff tears. The diagnosis was confirmed by ultrasonography examination. Therapeutic efficacy was evaluated before treatment, at the end of the treatment, and at 1, 3 and 6 months. Pain and handicap intensity were measured by a visual analogue scale, by the algo-functional Constant score, by articular mobility and, finally, by the resumption of daily and/or professional activities. Successful treatment was considered with a VAS pain scoreor=80. RESULTS: Twenty-four patients, mean age 59 years, with full-thickness rotator cuff tears for 9 months, on average, were included in the study. The parameters of pain function and handicap improved significantly since the end of treatment. The Constant score improved greatly, from 44.8 before treatment to 71.8 at the end of treatment and 74.2 at 6 months. This improvement continued until 3 months after treatment. The rate of success was 75% at 6 months. CONCLUSION: Despite the small sample size, our study confirm that rehabilitation should always be performed before a decision of surgical repair.

[Profile of basal cell carcinomas of the scalp after radiotherapy for tinea capitis (about 63 cases)]. / Profil des carcinomes basocellulaires du cuir chevelu secondaires a une radiothérapie pour teigne (a propos de 63 cas).

The induction of basal cell carcinoma (BCC) of the scalp by X-ray therapy for tinea capitis is well known. The aim of the study was to specify the epidemiological, clinical and histological characteristics of this disease. In a retrospective study, we collected data from the files of 63 patients, with a history of radiotherapy for tinea capitis, followed between January 1995 and December 2004. Fifty one men and 12 women with a total of 108 BCC of the scalp are reported (1.76 lesion per patient and 1.13 cm on average of diameter). The mean age at the occurrence of the BCC was 45.5 years. Thirty seven percent of BCC occurred on the occipital area; 28.7% were in the parietal site. The most frequent clinical aspect was the nodular BCC (51%) and the cicatricial BCC (35%). Histological study showed a nodular aspect in 74 % and pigmentation in 62% of cases. It is concluded that BCC of the scalp following X-ray therapy for tinea capitis have some clinical and histological particularities. It represents the most frequent tumour developing on irradiated scalp.

[Preparation and testing of Sardinella peptones: application to lipase production by Staphylococcus sp]. / Elaboration de peptones de Sardinelle: application à la production de lipase par la souche Staphylococcus sp.

Production of lipase by Staphylococcus sp. in media containing fish peptones from sardinelle (Sardinella aurita) prepared in the laboratory was studied. Lipase production is strongly affected by lipids present in fish flours. Fish peptones prepared from dIgresed whole flesh was an excellent substrate for lipase production. A comparison of lipase production in media containing fish peptones or high quality commercial peptones indicated that fish peptones enhanced enzyme formation.