[Osteosarcoma of the radius after intramedullary osteosynthesis]. / Ostéosarcome du radius après une ostéosynthèse par embrochage centromédullaire.

Osteosarcoma is a malignant neoplasm characterized by local lytic or plastic processes. We observed a case of radius osteosarcoma in a 10-year-old boy 3 months after intramedullary osteosynthesis in the ipsilateral distal radius. Treatment consisted of amputation of the distal humerus and adjuvant chemotherapy; no complications were observed.

[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Neonatal occlusion due to a lumbar hernia]. / Occlusion néonatale due à une hernie lombaire.

A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair.

[Unusual discovery of omphalomesenteric fistula. A case report]. / Un cas de découverte inhabituelle de fistule omphalo-mésentérique.

Omphalomesenteric fistula is a complete persistence of the omphalomesenteric duct communicating between the umbilicus and the intestine. The presence of intestinal contents suggests the diagnosis in its typical form. We report a case of omphalomesenteric fistula in a 3-year-old boy to show that intestinal parasitic infection associated with ascariasis expulsion through the umbilicus can be the incidental finding of the omphalomesenteric fistula. This case needs no paraclinical investigation and treatment consists in partial transumbilical resection followed by umbilicus restitution.

[Nosocomial cavernous sinus thrombophlebitis due to multidrug-resistant Staphylococcus aureus. A pediatric case report]. / Thrombophlébite du sinus caverneux nosocomiale àStaphylococcus aureus multirésistant. À propos d'un cas.

Cavernous sinus thrombophlebitis is a serious disease. We report herein a case seen in a 9-year-old boy hospitalized for an acute pneumopathy. Clinical signs were made of a diffuse edema of the upper two-thirds of the face, eyelid edema, chemosis, exophthalmia, meningeal syndrome, and infections syndromes associated with alteration of consciousness. A CT scan revealed a heterogenous enhancement and enlargement of the left cavernous sinus and homogenous opacity of the sphenoidal sinuses. Therapeutic management was complicated due to allergy to ß-lactams and the multidrug resistance of Staphylococcus aureus.

La mortalité néonatale au service des urgences du CHUA-JRA Antananarivo Madagascar

Objectif: Determiner les facteurs de mortalite post-chirurgicale en periode neonatale au service des Urgences et de faire ressortir les difficultes de prise en charge. Methodes: C'est une etude retrospective et analytique allant du mois d'Aout 2008 au mois d'Aout 2009 sur tous les nouveaux-nes recus au service des urgences du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona Antananarivo Madagascar. Resultats: Soixante quinze nouveaux nes ont ete releves. L'occlusion intestinale et la malformation ano-rectale etaient le motif de reference dans presque la moitie des cas; avec une predominance masculine. Douze nouveaux-nes etaient decedes en post-operatoire immediat. L'absence de diagnostic prenatal; la prematurite; l'absence de transport medicalise; le retard de consultation; le manque de moyen de reanimation et les associations malformatives graves ont ete les principaux facteurs de mortalite dans notre serie. Conclusion: Des consultations prenatales regulieres; l'accouchement dans un hopital disposant d'une ambulance medicalisee et l'equipement en materiaux et en personnels de l'Unite de Soin Intensif Neo-natal devrait ameliorer le resultat

Rhabdomyosarcome vulvaire de l'enfant. A propos d'un cas

Le rhabdomyosarcome genitale de l'enfant est rare. Il est l'apanage des enfants de moins de six ans et se voit rarement en periode neonatale. Nous rapportons un cas de tumefaction vulvaire; decouvert vers l'age de cinq mois. Le diagnostic histologique de rhabdomyosarcome n'etait pose que vers l'age d'un an. Apres exerese chirurgicale; trois cures de chimiotherapie etaient prescrites. Une recidive survenait apres cette troisieme cure et l'enfant etait par la suite perdu de vue. Malgre les avancees therapeutiques de ces dernieres annees; le pronostic des rhabdomyosarcomes vulvaires reste sombre; particulierement dans un pays en developpement. En effet; le diagnostic y est souvent tardif et le cout du traitement inaccessible pour la majorite de la population

Premiere description d'un lipoblastome a Madagascar; de localisation pre-vesicale anterieure

Nous rapportons un cas de lipoblastome chez une fillette de 3 ans qui avait consulte pour une tumefaction sus-pubienne gauche evoluant depuis neuf mois et une pollakiurie d'apparition recente. L'echographie suspectait une tumeur musculaire du muscle grand droit gauche. Une exerese chirurgicale complete etait pratiquee et l'examen anatomo-pathologique concluait en un lipoblastome a localisation inhabituelle; pre vesicale. Les suites operatoires etaient simples et l'evolution favorable apres un recul d'un an. Ce premier cas decrit a Madagascar est probablement le deuxieme cas africain. Les particularites diagnostiques et therapeutiques sont discutees a l'aide d'une revue de la litterature

Indications de la splenectomie dans une zone a forte endemicite palustre

Dans les zones d'endemie palustre; un fort pourcentage de la population; avoisinant 75; a une splenomegalie palustre hyperreactive et certaines d'entre elles necessitent une splenectomie. Objectif: Chez les patients ayant une splenomegalie enorme d'origine palustre; determiner les circonstances et les complications pour lesquelles la splenectomie est indiquee ou devient un acte indispensable; voire imperatif. Methodes: Parmi les 48 splenectomies realisees en deux ans (mars 1999 a mars 2001) dans le service de chirurgie du Centre Hospitalier de District de niveau II de Moramanga; nous avons etudie 31 dossiers de patients splenectomises pour splenomegalie enorme d'origine palustre. Resultats: Sur les 48 patients splenectomises; 64;58soit 31 patients ont une splenomegalie palustre stade III ou plus. La population active (15 - 55 ans) est la plus touchee. Par ordre de frequence decroissante; les indications d'ordre medical de la splenectomie etaient l'hypersplenisme; la rupture traumatique et la compression. Mais nous avons indique systematiquement la splenectomie pour toute splenomegalie stade IV et V meme en l'absence d'indication d'ordre medical pour des raisons bien analysees adaptees aux regions a forte endemicite palustre. La duree moyenne d'hospitalisation etait de 8 jours et les resultats a court et a moyen terme sont favorables. Conclusion: La splenectomie est indiquee systematiquement en cas de splenomegalie palustre enorme de stade IV et V meme sans les complications medicales ou chirurgicales realisant leurs indications habituelles

[Children's strangulated inguinal hernia]. / Les hernies inguinales étranglées chez l'enfant.

The inguinal hernia, malformations caused by persistence of peritonea-vaginal duct, is frequent in children. It is a benign affection as long as it is not strangled. During our five-year-retrospective study, we have found 32 cases (30 boys and 2 girls) of strangled inguinal hernia. There are 78,12% of cases under five years old. In 54%, the hernia was on the right side. Malnutrition and inguinoscrotal hernia are very exposed to strangulation. We observed obstruction syndrome in 81,25% of cases. We have to deplore one case of scrotal fistulae by intestinal necrosis and two cases of testicle necrosis. For all of our patients, the peritonea-vaginal duct was closed with ligature, associated with pre-funicular parietal refection. One case of recurrence is found in postoperative time.

[The voluminous primitive psoas abscess in children: report of three cases]. / Les volumineux abcès primitifs du psoas chez l'enfant: à propos de trois cas.

The primitive psoas abscess is a pathology extremely rare in the child. The diagnosis is difficult and often delayed. Their treatment requires a local and general sterilization of the infection. We report three observations of primary abscess of the psoas in the child. The clinic presentation is uncommon. Ultrasonography keeps an important place. The biology objective an infectious and inflammatory syndrome. Histology permits to put in evidence all shapes association of lesions. The bacteriological survey of the pus after drainage is only positive in one case. Surgical drainage with bactericidal antibiotherapy permit a definitive recovery.