[Screening of congenital dislocation of the hip in the newborn. A systematic and rigorous clinical examination. A restricted use of imaging]. / Dépistage de la luxation congénitale de hanche chez le nourrisson. Un examen clinique systématique rigoureux. Un recours sélectif à l'échographie.

(1) Clinical examination of the hips should be systematically performed in the newborn, in order to detect a possible congenital dislocation. This translates into hip joint instability, which can be evidenced by both Ortolani's and Barlow's signs, the latter being more sensitive. Special attention should be paid for abduction range, as limited abduction is a warning sign. (2) Use of imaging, especially sonography will be restricted to specific cases only. It's prescription, technical realization as well as interpretation have to be carefully done, so that it is actually relevant to uncertain or "at risk" situations. (3) Treatment if needed, should be ideally managed by a paediatric orthopaedic surgeon.

[Pigmented villonodular synovitis. Diffuse and localized forms in children]. / La synovite villonodulaire et pigmentée. Forme diffuse et forme localisée chez l'enfant.

UNLABELLED: Pigmented villonodular synovitis (PVS) is characterized by a locally aggressive synovial proliferation that engenders progressive destruction of cartilage and bone. Two cases, a diffuse and a localized form, are reported. CASE REPORT: 1) A 9.9-year-old boy followed up for a popliteal cyst presented with chronic arthritis of the left knee. Aspiration yielded a bloody synovial fluid. MRI showed a heterogeneous synovial process with decreased signal in both T1- and T2-weighted images. The diagnosis of PVS was made on histology of an excisional biopsy. A complete open synovectomy was then performed. 2) A 13.8-year-old boy had a palpable mass on the internal side of the right patellofemoral joint. MRI showed a heterogenous mass with areas of hypointensity on all spin echo sequences corresponding to hemosiderin deposits suggestive of PVS. Surgical excision of a reddish-brown circumscribed lesion was performed. Diagnosis of PVS was made at surgery and confirmed by histologic examination. CONCLUSION: PVS diagnosis is frequently delayed due to nonspecific symptoms. Bloody fluid aspiration and MRI are valuable tools for early diagnosis. Treatment is surgical: extensive synovectomy for the diffuse form, excision of the lesion for the localized form.

Vesicoureteral reflux after kidney transplantation in children.

BACKGROUND: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation in adults varies between authors and there have been few reports in children. METHODS: We conducted a retrospective study in a single-centre paediatric cohort. Fifty-five of the 84 children who underwent kidney transplantation over a 5-year period were checked with routine cystography after a median of 8 months post-transplantation. Graft function and urinary-tract infections were assessed during the first 6 years after transplantation. RESULTS: VUR into the graft was present in 58% of the patients. Graft function and incidence of urinary-tract infections were similar in the two groups, independent of VUR. After having excluded infections attributed to the presence of a catheter, actuarial survival rates without pyelonephritis and without pyelonephritis following a first lower urinary-tract infection were worse in patients with VUR (P:=0.017 and P:=0.0039 respectively). None of the eight patients with VUR treated with antibiotic prophylaxis after a first acute pyelonephritis (APN) episode presented subsequent APN after 4.4+/-3.3 years on therapy. CONCLUSIONS: VUR to the graft occurred in more than half paediatric renal transplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with VUR.

[Unusual presentation of nephroblastomatosis]. / Néphroblastomatose de présentation inhabituelle.

BACKGROUND: Nephrogenic rests generally constitute precursor lesions of Wilms' tumor. We report a case of right nephroblastomatosis with dysmorphic features. CASE REPORT: An enlargement of the right kidney was incidentally discovered in a 1-year-old girl with dysmorphic features but normal psychomotor development. Combined ultrasonography and computerized tomography (CT) scan showed right cortical nephroblastomatosis. Chemotherapy using actinomycin D and vincristin was successful; however, an hyperechogenic nodule was subsequently found, necessitating a right nephrectomy. CONCLUSION: The relationship between nephroblastomatosis and Wilms' tumor is discussed. This case report reminds us of the importance of a long-term follow-up including echography and CT scan in cases of nephroblastomatosis.

[Role of imaging in the management of abdominal trauma in children]. / Place de l'imagerie dans la prise en charge des traumatismes abdominaux chez l'enfant.

Blunt abdominal trauma is common in children and induces significant morbidity and mortality. Trends in management of solid viscera lesions have changed over the past 15 years and a conservative approach is now preferred whenever possible. Such management has become possible in selected cases due to advances in pediatric intensive care and medical imaging. The authors provide a review-based on international literature data-of the respective roles of medical imaging studies in the initial management of blunt abdominal trauma in children. The place of these investigations is discussed for each organ, with emphasis on the diagnostic value of sonography and computed tomography. Diagnostic pitfalls and limitations in prognostic accuracy are discussed.

[Analysis of the failure of endoscopic treatment of vesico-renal reflux in children using injections of teflon and collagen and the preliminary results of injections of Macroplastic]. / Analyse des échecs du traitement endoscopique du reflux vésico-rénal chez l'enfant par injections de téflon ou de collagène et résultats préliminaires des injections de Macroplastique.

This study of 785 cases of vesicorenal reflux in 494 children treated endoscopically over a 7-year period was designed to evaluate the results obtained with three products used successively: Teflon, collagen and Macroplastic. Following Teflon injection, despite a 90% short-term success rate, recurrent reflux was subsequently observed in 16.71% of the ureters reviewed. The failure rate was 52.63% after collagen injection and 11.77% after Macroplastic. After one or two injections, complete resolution of reflux was obtained in 48% of children treated with collagen, versus 85.72% with Teflon and 93.33% with Macroplastic. In one half of cases, failure was related to the quality of the product and its modifications after injection. The marked resorption of collagen accounts for the poor results despite the large doses injected. Apart from one case of partial resorption of Teflon paste, the failures with this product were due to lateralisation or secondary elimination of the product from the injection site due to its fluidity. Macroplastic, due to its higher viscosity and absence of retraction, currently provides the best results with doses of less than 0.20 ml in children.

Relapsing urinary ascites.

A 2-year-old boy was operated on for a left ureteral duplication with bilateral vesicoureteric reflux. Ten years later, he experienced two episodes of transient ascites following abdominal traumatism. A cystogram disclosed a peritoneal fistula. The fistulous orifice was localized by cystoscopy, and surgery was undertaken with success.

[Multicystic renal dysplasia. Spontaneous remission of a hypertrophic form]. / Dysplasie rénale multikystique. Involution spontanée d'une forme hypertrophique.

A case of spontaneous regression of the tumor type of multicystic dysplastic kidney (MDK) is reported. This case is consistent with recent data on the natural history of MDK. The classical therapeutic approach which involves surgery is discussed in the context of this case and of others with a similar course.

[Idiopathic retroperitoneal hematoma. Apropos of a case]. / Hématome rétropéritonéal idiopathique. A propos d'une observation.

A 10 year-old girl presented with a progressive left ureteral colic with abdominal tenderness. Ultrasonography revealed pyelocalyceal dilatation and an intravenous pyelogram showed lateral deviation of the left ureter. Computed tomography confirmed retroperitoneal mass distinct from psoas. Laparotomy revealed an encapsulated retroperitoneal hematoma. No particular aetiology was found and the patient's health remained stable after treatment.

[Hydranencephaly and ingestion of estrogens during pregnancy. Fetal cerebral vascular complication?]. / Hydranencéphalie et prise d'oestrogènes pendant la grossesse. Accident vasculaire cérébral foetal?

The authors report a case of hydranencephaly which could result from a massive intake of oestrogens in a 18 week-gravid mother. After a brief clinical summary, the role of oestrogens in the triggering of a fetal circulatory disorder is discussed.

[Transient dilatation of the intra- and extra-hepatic bile ducts. A new aspect of bile duct involvement in scarlet fever]. / Dilatation transitoire des voies biliaires extra et intra-hépatiques. Nouvel aspect de l'atteinte des voies biliaires dans la scarlatine.

An extra- and intra-hepatic bile duct dilatation has been observed in a child in the course of scarlet fever. Manifestations of cholestasis, cytolysis and inflammation were present. Pruritus disappeared within 2 months, biological abnormalities within 3 months and ultrasonic bile duct abnormalities between 3 and 6 months, with a follow-up of 9 months. This case report suggests a relationship between a transitory obstruction, possibly toxic in origin, of the bile ducts and the scarlet fever.

[Cholestatic form of viral hepatitis and thickening of the walls of the intrahepatic bile ducts]. / Hépatite virale à forme cholestatique et épaississement des parois des voies biliaires intrahépatiques.

A biphasic acute hepatitis A is reported in a child. The cholestatic form of the second episode was associated with an ultrasonographic thickening of the gallbladder and intrahepatic bile duct walls. A possible relationship between the abnormal US appearance of intrahepatic bile ducts and cholestasis is discussed.

[Surgical results of uretero-vesical reimplantations in children. Apropos of 356 cases in 11 years (629 reimplanted ureters)]. / Résultats chirurgicaux des réimplantations urétéro-vésicales chez l'enfant. A propos de 356 cas en 11 ans (soit 629 uretères réimplantés).

629 ureteric reimplantations were performed in 356 children. Indications for reimplantation were 315 uni or bilateral ureteral reflux, 248 primary reflux and 67 secondary to ureteric duplication, ureterocele, vesical diverticula, neurogenic bladder, bladder neck obstruction, or ureteral obstruction, and 52 megaureters, 38 primary and 14 secondary megaureters. 61 reimplantations (14 megaureters) by Leadbetter-Politano, and 568 reimplantations (58 megaureters) by Cohen procedure were performed. 3 psoas hitching and 15 ureteroplasties, 14 Hendren and 1 Kalicinski procedures, were necessary. Primary results in reflux were 98.5% of success with Cohen operation and 100% with Leadbetter-Politano operation. Results were not so good in megaureter, 70% of success with Leadbetter-Politano operation and 75% with Cohen. Results were better with psoas hitching and ureteroplasty (86.5% of success).

Enterolithiasis in two neonates with oesophageal and anorectal atresia.

Enterolithiasis in two neonates with oesophageal and anorectal atresia is reported. The features of the two cases and comparison with the literature, the particular appearance of these intracolonic calcifications and the importance of radiological examinations for associated digestive, urinary and pulmonary malformations are presented.

[Extensive congenital stenosis of the bulbo-membranous urethra in a child. Apropos of a case discovered in a newborn infant]. / Sténose congénitale étendue de l'urètre bulbo-membraneux chez l'enfant. A propos d'un cas à révélation néonatale.

A congenital atresia of the bulbo-membranous urethra had been reported. The atresia extended for 1.5 cm. It presented early in the neonatal period with major dilatation of the upper urinary tracts. After a preliminary urinary diversion, the surgical repair through the perineum was done at the age of 18 months. Such cases are not seen frequently. This atresia must be differentiated from posterior urethral valves type III, and from other stenoses either iatrogenic, traumatic, or inflammatory. The partial atresia is the only type compatible with life. It may be presented in two forms: annular constriction or extended stenosis. The mechanism of evolution is not very clear: it is either due to a bad resorption of the urogenital membrane or a defect in the embryogenesis of the urethral tube. Treatment differs according to the site and extent of the lesion simple dilatation, internal urethrotomy, or urethroplasty in one or several stages can be done.