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Summary: The decision procedure behind acute appendicitis (AA) is sometimes difficult and relies on a combination of clinical, biological and radiological signs. Aim: To evaluate the contribution of abdominal ultrasound in the diagnosis of AA in children. Patients and methods: This is a prospective study of 266 patients hospitalized in the Department of Pediatric Surgery “B” at the Children''s Hospital of Tunis for suspected acute appendicitis, from 1st January to 31st December 2010. These patients were divided in two groups: group I: 131 children who had an abdominal ultrasound; and group II: 135 children who have not had this examination. The selection criterion is the availability or unavailability of a radiologist. In Group I, an ultrasound diagnosis of appendicitis was made in 74 cases, if there is a swollen appendix or indirect signs of acute appendicitis. One hundred and ninety-one patients (86 in group I and 105 in group II) were operated in emergency or after monitoring of 24 to 48hours. In 75 cases, there are no sufficient radioclinical arguments of appendicitis even after monitoring for 24 to 48hours. The study of the correlation between the clinical examination, ultrasound and the histologic finding in the diagnosis of acute appendicitis shows a sensitivity of 79.6% vs 83% and a specificity of 93.7% vs 88.6% for the clinic vs ultrasound. Conclusion: Because its sensitivity is higher than clinical examination, abdominal ultrasound is a valuable aid in the diagnosis of acute appendicitis. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the estimation of fetal weight by external abdominal measurements, alone or associated with fundal height measurement and/or ultrasonographic exams near 32 weeks, to detect intra-uterine growth retardation (IUGR) near term. Patients and methods: A retrospective cohort study included all women who delivered a small-for-gestational-age infant less than 37 weeks gestation during 2008–2009. We analyzed the sensitivity of estimation of fetal weight by external abdominal measurements and the others different routine exams during third trimester, and compared them to detect IUGR near term. Results: The estimation of fetal weight by external abdominal measurements was used in 263 pregnant patients. External abdominal measurements and fundal height measurement were not statistically different and were better tests than ultrasonographic exams at 32 weeks to detect IUGR near term (sensitivity: 41.4%, 42.2% and 22.8%, respectively; P <0.05). External abdominal measurements associated with regular ultrasonographic examination at 32 weeks of gestation significantly increased the sensitivity to detect IUGR near term (42.9% vs 22.8%; P <0.05). But, the association of external abdominal measurements and fundal height measurement did not increase the rate of detection (47.9% vs 42.2%; P =0.22). Discussion and conclusion: The present findings confirm that the use of the estimation of fetal weight by external abdominal measurements to detect intra-uterine growth retardation is effective. Measures to improve the learning of this technique and its reproducibility are recommended. [Copyright &y& Elsevier]

Abstract: Solid pseudopapillary tumor (SPT) of the pancreas is a rare exocrine pancreatic tumor behaving in a low-grade fashion, with limited local invasion risk and a rare metastatic evolution. We report SPT in two young females, revealed by abdominal pain and an epigastric mass. The diagnosis of a cystic tumor was based on abdominal ultrasound and CT data in the first case and on MRI in the second. A distal pancreatectomy and splenectomy were successfully performed in the first case and a central pancreatectomy in the second. Histological study confirmed the diagnosis of SPT of the pancreas. [Copyright &y& Elsevier]

Abstract: Gallblader tuberculosis is uncommon and may mimic a neoplasia. We report a 55-year-old man who presented with fever and abdominal pain compatible with cholecystitis. Abdominal ultrasound and computed tomographic scan showed a tumoral aspect of the bottom of the gallbladder and invasion of adjacent liver. Diagnosis of pseudo-tumoral gallbladder tuberculosis was obtained with the histologic examination of surgical sampling. Disease course was uneventful with appropriate antituberculous therapy. [Copyright &y& Elsevier]

Summary: The adult form of Niemann-Pick type C disease displays specific phenotypic, biochemical and genetic features that differentiate it from the infantile and juvenile ones. This form is often linked to the variant biochemical phenotype with mild abnormalities of the filipin test that can make the diagnosis difficult. Visceral signs usually consist in an asymptomatic hepato splenomegaly which can be present since early childhood, remains poorly progressive, and may not be detected unless abdominal ultrasonography is performed. Psychiatric signs and cognitive troubles constitute the most frequent revealing symptoms in adults and can sometimes appear after 50 years. During the clinical course, main clinical features include vertical supranuclear gaze palsy, cerebellar ataxia, dysarthria, cognitive troubles and movement disorders. Because of these poorly specific signs at onset, the diagnosis is often delayed. Clinicians must know how to recognize mild vertical supranuclear gaze palsy, which is an almost constant and very specific feature. An early diagnosis is mandatory since the treatment seems more efficient when started early. [Copyright &y& Elsevier]