Torsion testiculaire périnatale : à propos de dix cas

Perinatal testicular torsion (PTT) is a rare disease. Two entities have been described: prenatal or postnatal. The aim of this study is to recall the different etiopathogenic and histological features of this disease, to highlight the difficulties of diagnosis and discuss treatment modalities and finally to establish a treatment protocol of PTT.

Patients and methods

This is a retrospective study through which we studied 10 patients admitted in the pediatric surgery department of Monastir hospital between 1990 and 2009.

Results

Seven newborns had the antenatal testicular torsion form and three had the postnatal form. The main clinical symptom was the scrotal swelling. The controlateral vaginal hydrocele was found in 50% of cases. Doppler ultrasonography was performed in five cases and found a PTT with no blood flow in four of the five cases. The no surgical treatment was opted for a single patient and semi-urgent surgical treatment by scrotal incision has been practiced for the nine other cases. The PTT was extravaginal in all the cases. The surgical procedure consisted of an ipsilateral orchiectomy in 100% of cases and we have realized a contralateral orchiopexy in six of the nine cases operated. Pathological examination found a hemorrhagic infarction in seven cases and testicular necrosis in three cases. The postoperative and subsequent evolution was favorable in all cases.

Conclusion

The PTT is a rare disease occurring in utero and during the first month of life. Its pathogenesis is still poorly understood and the therapeutic approach is controversial.     

Apport de l’éducation sanitaire dans la poursuite de l’allaitement maternel : cohorte ici-ailleurs dans une population tunisienne

The promotion and support of breast-feeding is a global priority with benefits for maternal and infant health, particularly in developing countries. The objective was to test if a specified programme of health professional breast-feeding support affects the initiation and the duration of breast-feeding.

Population and methods

Two troops of children and their mothers were followed compared to the practice of the breast-feeding in two maternal and infantile protection centres in Tunis. The health professionals in the first centre received a strengthening of the formation on this practice with supervision and training, a calendar of follow-up of these children was applied. No additional formation was given to the health professionals in the second centre. The data were seized and analyzed by Epi Info software. The test of Log Rank was used in the analysis of the reliability's Kaplan Mayer survival curves.

Results

The reliability curves of the breast-feeding according to the age showed a statistically significant difference between the two centres. The intermediate duration of the continuation of the breast-feeding was 13 months for the first centre versus five months for the second (p < 10⁻³).The study in logistic regression showed that only the accompaniment of the health professionals was correlated with the continuation of the breast-feeding (RR: 5.16 CI 95%: [3.52–4.93], p < 10⁻³).

Conclusion

The accompaniment of the health professionals would intervene like a direct factor in the maintenance of the breast-feeding.     

La lithiase urinaire du nourrisson : étude de 14 cas

Background

Diagnosis of urolithiasis in infancy is uncommon. It imposes rational exploration resting on medical history, clinical features, radiologic assessment, metabolic investigation and stone analysis.

Aim

The aim of this study is to evaluate epidemiologic and etiologic features of the urolithiasis in infancy.

Methods

It's a retrospective study including 14 cases of urolithiasis in infants, enrolled in pediatric department of Charles-Nicolle Hospital during fourteen years (1995–2008).

Results

The median age was 13 months. Thirty five percent of the patients had a positive family history of urolithiasis. The main presenting symptoms were urinary tract infection (four cases) and macroscopic hematuria (three cases). Radio-opaque urolithiasis were diagnosed in nine patients (64%), multiple stones in four patients (28%). Six of patients were diagnosed as having metabolic urolithiasis, four anatomic, two infectious and two idiopathic.

Conclusion

In our study, metabolic causes remain the first cause of urolithiasis in infancy.     

Connaissances et pratiques de mères sénégalaises vivant en milieu rural ou suburbain sur l’alimentation de leurs enfants, de la naissance à l’âge de six mois

Breastfeeding practice is very common in Senegal. Indeed, it is the way nearly 100% of women feed their child. However, in 42% of cases, this practice is accompanied by early water administration (before sixth months). This is very often because of socio-cultural representations. Our work aimed to describe and analyze knowledge and practices of a sample of women on children feeding, from birth to six months of age.

Population and methods

It was a cross-sectional prospective study carried out from May 1st to June 30th, 2009. Qualitative data were recoded by face-to-face interviews with the mothers of six to 12 months old infants who frequented the two sites of the Institute of social and preventive paediatrics of the Cheikh Anta Diop university of Dakar (Senegal): the one being in the suburbs of Dakar (Pikine) and the other in a rural area (Khombole). Several topics were addressed: general knowledge on infants feeding, exclusive breastfeeding and the difficulties encountered in its practice, food introduced during exclusive breastfeeding and factors associated with their use.

Results

The study dealt with 44 mothers. The average time of first breastfeeding after birth was 6 ± 12 h (range: 1 to 72 h). The first food received by the newborn was the mother's milk for 64% of the mothers (n = 28). The 16 other mothers (36%) administered the “Tokental” (traditional drink for the newborn) before the first breastfeeding. Thirty-eight mothers held information about exclusive breastfeeding. Early breastfeeding was carried out by 22 mothers (50%). Exclusive breastfeeding up to six months was done by 29 mothers (66%). The reasons put forward by the 15 other mothers to choose another food are various. Among the factors influencing the practice of exclusive breastfeeding, the educational level of the mothers appeared, even if the difference were not statistically significant.

Conclusion

The practice of exclusive breastfeeding and early breastfeeding do not seem to be limited by knowledge but by sociocultural representations. Among the factors limiting the early breastfeeding, the most important seems to be the “Tokental”. To improve the practices on infants feeding, it would be important to reinforce information by healthcare professionals about newborn babies.     

Évaluation des connaissances et des pratiques d’hygiène des mains au niveau de l’unité de néonatologie et soins intensifs du service de médecine infantile et néonatologie de l’hôpital Nord, Marseille

Background

The hygiene of hands stays the basic measure to reduce the incidence of the hospital-borne infections. Its importance is major in a service of neonatology. Our work aimed at estimating the knowledge and the practices on the hygiene of hands.

Method

The study was realized at the level of the unit of neonatology and the intensive care of the service of infant medicine and neonatology of the north hospital of Marseille and took place from 1st till 15 August 2008.

Results

We questioned 55 persons of the staff, seek attendants and observed 30 persons. Near the quarter of the staff (23.6%) think that the solutions hydro-alcoholic are less effective than the simple wash of hands and more half (the 51%) than they are less effective than the hygienic wash. In respectively 20% and 36% of the cases, the staff underestimates the duration of the procedure of wash of hands and the hydro-alcoholic friction. In 58.1% of the cases, the staff ignores that the hydro-alcoholic solutions can be used in all the situations where hands are not soiled. Attendants seems to have a good knowledge of the hydro-alcoholic solutions. They know the indication about it in 56.2% of the cases and think that they are effective in 50% of the cases. The staff seems to have a good theoretical knowledge (87.2 in 96.4%) measures of hygiene of hands to be before adopted and after the most current gestures in the unit. There is an inobservance of the hygiene of hands in 33.3% of the cases. None of the persons outside the service practised a measure of hygiene of hands. A bad quality of the wash of hands concerning the contagion at the end of procedure was found in 64.7% of the cases and it in all the observed categories.

Conclusion

There is a real lack of information of the staff about the hygiene of hands. For the improvement of the quality of the care, the evaluation of the practices and the training of the staff turn out indispensable.     

Clinique de la dyslexie

Dyslexia is characterized by a severe, persistent reading disorder occurring in an intelligent child. In the large field of learning disabilities, dyslexia is related to a cerebral dysfunction well described with Imagery and genetic studies. Nevertheless the diagnosis of dyslexia cannot be done by another way than clinical symptoms. Optimizing the management of children with dyslexia is a critical issue and is now possible, thanks to the improvement of neurosciences data and the mobilization of the key stakeholders. The knowledge of the precise symptoms is essential in order to lead the child's doctor able to improve coordination and harmonization of teaching and care and guidance of parents.     

À propos d’un cas de syndrome de Münchhausen par procuration à expression psychiatrique

The factitious disorder by proxy or syndrome of Münchhausen by proxy is the production of symptoms to a child by a mistreating adult who wishes to play the sick role through this child. This syndrome is a child abuse where the care system is instrumented. The medical profession becomes itself maltreating by scheduling more and more invasive additional examinations: the mortality would be 5 %. The symptoms most frequently presented to the paediatricians are sleep apneas and convulsions. The disease by proxy questions the clinicians in front of its unusual form and its absence of anatomoclinical parallelism. If all somatic symptoms were described, forms of artificial disorder by proxy with psychiatric expression are probably underestimated. After a review of the literature on the syndrome of Münchhausen by proxy on one hand and its psychiatric expression on the other hand, we shall explain a clinical case illustrating this atypical presentation. The psychotic symptoms adduced by the mother were able to be thwarted during an observation in protected environment which is ended the medical nomadism. The diagnostic of factitious disorder by proxy is very complex. The child can present an authentic psychiatric disorder establishing a differential or tangled diagnosis. On the other hand, the complications are numerous. The victim can develop psychological aftereffects of this child abuse like behavioural problems. The child can even secondly participate to the presentation of the symptoms in a morbid alliance with the simulated parent. We shall return on diagnostic and therapeutic measures of care to offer to the maltreated child but also to the parent too, whose psychopathological determiners will be useful to clarify.     

Les traumatismes des bourses chez l’enfant

Background

Scrotal trauma includes all injuries of the testicular parenchyma and scrotal envelopes. It is a surgical emergency, affecting mainly adolescent.

Objectives

To answer two questions, diagnostic value of ultrasound, and indication of surgical treatment in this type of trauma.

Methodology

Retrospective study of 16 patients with testicular trauma, treated between January 2004 and December 2009 in unit of surgical emergency in the Children's Hospital of Rabat.

Results

Attitude of service is the medical treatment and anti-inflammatory drugs when there is no clinical or ultrasonographic signs of severity, surgical exploration is indicated when serious testicular lesions are suspected. Among our 16 patients, 12 underwent surgery, five after open trauma and three after conducting an ultrasound. Four of our patients underwent a clinical and ultrasonographic observation. The average follow-up was 3 years, and the rate of testicular atrophy in our series is 6.25%.

Conclusion

Testicular trauma is an emergency requiring adequate and early care. Ultrasound should not delay surgical exploration of any traumatic haematocele in order to preserve the testicle.     

Les ateliers de l’atopie

Atopic dermatitis is a chronic disease, which is a burden with putative major repercussions. Its management could be complex. The workshops of atopy gather therapeutic education psychological help. Such interventions are not possible for all patients. They are very useful and efficient since clinical controlled trials have demonstrated that Scorad, a score of severity for atopic dermatitis, was decreased whereas topical steroids were globally less used.