Traitement orthopédique du coude flottant chez l’enfant : à propos d’un cas

The floating elbow in the child is rare and serious. The authors report a traumatic case of floating elbow without vascular and nervous lesions associated in a 6-year-old child. We treated these both fractures of the distal forearm and the supracondylar humeral by respectively cast plaster and a collar and cuff with an anatomical reduction. The radiological and clinical results were excellent with the 29 months follow-up.     

Les arthrites septiques streptococciques de l’adulte : 55 cas et revue de la littérature

Objectives. – To evaluate the rate of occurrence and characteristics of streptococcal septic arthritis.Methods . – Retrospective single-center study of patients with bacteriologically documented septic arthritis admitted to a rheumatology department over a 20-year period.Results. –Of 303 cases of septic arthritis, 55 (18%) were due to streptococci and 166 (55%) to S. aureus (55%). As compared to patients with S. aureus arthritis, patients with streptococcal arthritis were more likely to be female (56% vs. 36%, P < 0.006) and older than 60 years of age (71% vs. 58%), less likely to have comorbidities (36% vs. 56%), rheumatoid arthritis (5% vs. 19%, P < 0.01), or diabetes (2% vs. 15%, P < 0.01), and more likely to have cancer (13% vs. 7%). Involved joints and proportions of patients with arthritis in multiple joints were similar in the two groups. Mortality was lower in the group with streptococcal infection (3.6% vs. 7.8%). The streptococci were distributed as follows: Group A (n = 7), Group B (n = 12), Group C (n = 4), Group D (n = 7), Group F (n = 1), Group G (n = 2), nongroupable (n = 14), nontypable (n = 1), and S. pneumoniae (n = 7). Groups A and B and nongroupable strains mainly affected women; Group A selectively involved younger patients and Group B very elderly patients. Comorbidity, most notably cancer, was common in patients with S. pneumoniae or Group D streptococci. The portal of entry was often a skin lesion for Groups A and B and a medical procedure for Group D. Multiple joint involvement was common with Groups A and B and prosthetic joint infection with Groups B and C. Group A and S. pneumoniae were associated with severe systemic symptoms and extraarticular foci of infection, whereas a smoldering course was more common with Groups D and G and with nongroupable strains. Residual joint abnormalities were noted in half the patients, with no differences across groups.Conclusions . – The features of streptococcal septic arthritis vary according to the group of the causative organism and differ from those of S. aureus arthritis.     

Prise en charge médico-chirurgicale des abcès du cerveau à l’ère du scanner en Afrique sub-saharienne : à propos de 112 cas

Patients and methodThe authors report a retrospective study conducted on 112 cases of cerebral abscesses collected over a period of 12 years from the medical records of the department of neurosurgery at the Yalgado Ouedraogo university teaching hospital, Ouagadougou – Burkina Faso.ResultsThe analyses were conducted on the epidemiological, clinical and prognostic aspects of the cases. The mean age of the patients (73 men and 39 women) was 26 years. The primary mode of infection ranged from cranial injuries (25%) to meningitis (17.9%) and sinusitis (15.2%). Bacteria were isolated from 16.1% cases; staphylococci and streptococci were the most frequent bacteria identified. The main clinical symptoms were motor deficit (75.9%), fever (74.1%) and headache (66.1%). Diagnosis was performed by CT scan in all cases. Fifty-three patients were treated using antibiotics alone; this medical treatment was completed by surgery in 59 cases. The results showed that 37.5% of the patients in fact fully recovered while some sequelae were identified in 49.1%. The mortality rate was 13.4%.Discussion and conclusionConsciousness disorders were in most cases responsible for the patient's death. Moreover multiple and/or voluminous abscesses were factors of the poor functional prognosis. Due to the high mortality rate and the frequency of sequelae, the authors emphasize the need of prevention by using adequate and sufficient antibiotics during primary infections.     

L’ostéotomie de l’olécrâne dans le traitement des fractures de la palette humérale de l’adulte : évaluation anatomique et fonctionnelle du coude à propos de 14 cas

Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bicondylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bicondylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.     

Schwannome du nerf oculomoteur chez l’enfant : cas clinique et revue de la littérature

An isolated schwannoma of the oculomotor nerve is rare in children without an associated neurofibromatosis. A 13-year-old girl, with a previous medical history of migraine, was admitted for disabling ophthalmic migraine with oblique diplopia. The clinical examination showed a right incomplete ophthalmoplegia with reduced ipsilateral visual acuity (8/10). There was no particular skin reaction. The MRI revealed a right (isosignal-T1 and isosignal-T2) nodular schwannoma located within the cisternal segment of the oculomotor nerve. The angio-CT performed later confirmed the absence of any vascular malformation. The treatment consisted of analgesics and corticotherapy, with complete regression of symptoms three weeks later and a normal MRI follow-up. Therefore, radiosurgery was not performed.     

De l’intégration à l’inclusion scolaire : implication des enseignants et importance du soutien social

Teachers are the main actors of inclusive schooling. Whereas many studies highlight the benefits of integration or inclusion for students, those that focus on teachers’ have shown that they hold mixed attitudes toward integrative/inclusive policies. In this article we explore, through a review of questions, the obstacles to integration/inclusion that are due to the uneasiness teachers may feel towards integrative/inclusive practices. Different aspects are treated with reference to a health psychology-based articulation between risk and protective factors. Our analysis is focused on teachers’ burnout as a risk factor in an inclusive context and on social support as a potential protective factor. Different modalities of social support are analyzed, in teachers’ education as well as in school contexts.     

Fistules du dorsum nasal de l’enfant : mise au point à propos d’une série de 6 cas

IntroductionNasal dermal sinus in children (NDSC) is a rare malformation (1/20,000 to 1/40,000). Apart from local infection, they present as median nasal lump or pit on the dorsum and their diagnosis and treatment are often delayed. Consequences of untreated NDSC are: local infection, meningitis, and empyema, due to their frequent intracranial extension.Patients and methodsSix cases of NDSC were retrospectively reviewed (5 boys and one girl), all treated between 2006 and 2012 in our institution (Nancy University Hospital). All patients underwent a brain and facial CT-scan and MR imaging to check any bony lesions, skull base extension by foramen cæcum, course of the sinus and the possible associated brain malformations. Evolution, treatment and follow-up (FU) were conducted by the same multidisciplinary team (neurosurgeon, ENT surgeon, and plastic surgeon). Children were operated on by a conjoined approach (cranial and facial) for removal of the sinus and its intracranial extension.ResultsMean age at diagnosis was 12 months (birth–36 months). Initial presentation consisted of three local infections, one dorsum nasal lump, one CSF leakage, and one asymptomatic child. Five children presented with a skull base extension. There were no associated brain malformations. We observed only one surgical complication (bleeding from the anterior part of the superior sagittal sinus during dissection) leading to blood transfusion. Pathology results confirmed three dermoid cysts, one epidermoid cyst, one cyst with granulation tissue, and negative in one case. Average FU was 30.8 months (4–84 months). Two recurrences (same child) occurred, leading to two re-operations. There were no recurrences or complications at the end of FU.ConclusionNDSC are rare malformations, mostly diagnosed before the age of three years, due to an infectious complication. The aim of the treatment is complete removal to avoid recurrence, and a multidisciplinary strategy is required.     

Kyste hydatique du rein chez l’enfant: à propos de 8 cas

ObjectiveThe aim of the study is to analyze the epidemiological, clinical, investigational features, the evolution, and the therapeutic procedures for the renal hydatid cyst in children.Patients and methodsThis is a retrospective study of 8 Children operated between 1995 and 2011, for renal hydatid cysts.ResultsThe age of the patients was between 3 and 14 years (mean 8.5 years). There were 3 boys and 5 girls with a sex ratio of 0,6. Abdominal pain was the presenting symptom in 4 cases. The diagnosis was confirmed on the basis of radiologic data and hydatid serology. Open surgery was performed in 4 cases, laparoscopy in 3 cases and retroperitoneoscopy in one. Follow-up was uneventful for all cases.ConclusionThe treatment of the renal hydatid cyst in children is essentially surgical and always conservative. It may be done through open surgery or video-assisted surgery which has the advantage of being minimally invasive.     

Méningite à Candida albicans chez l’adulte,apport des nouveaux moyens diagnostiques

Candida albicans or non-albicans are a frequent source of infection but seldom displayed in cerebrospinal fluid although responsible of an important number of nosocomial meningitis. Diagnosis is difficult which often delays treatment, which in turn hinders prognostic. This clinical case shows a patient afflicted with a deadly C. albicans meningitis and allows us to focus on new diagnostic tools and advice against this infection.