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Resume But de l’etude Le prolapsus rectal (PR) est une affection benigne du jeune enfant et represente un motif de consultation frequent en pediatrie. Le but du travail est de faire le point sur la prise en charge du PR recidivant chez l’enfant et d’etudier la place de la sclerotherapie sous-muqueuse dans le traitement de cette pathologie. Patients et methodes Etude retrospective concernant 15 enfants presentant un PR primitif et pris en charge pendant la periode allant de 2002 a 2009. Le traitement des patients de cette serie a consiste en une sclerotherapie perirectale sous-muqueuse, apres echec du traitement medical. Resultats Il s’agit de 15 patients d’un total de 25 n’ayant pas repondu au traitement medical. Les resultats a distance de la sclerotherapie ont ete evalues apres un recul de deux ans. La guerison a ete obtenue dans 100 % des cas apres une seule injection dans 14 cas et trois injections dans un seul cas. Aucune complication ni recidive n’ont ete constatees. Conclusion La sclerotherapie sous-muqueuse dans le traitement de PR primitif de l’enfant permet d’obtenir une guerison complete apres une seule injection dans la majorite des cas.

Resume Introduction Le pseudokyste du pancreas est une pathologie rare chez l’enfant, survenant dans les suites d’une pancreatite aigue, notamment apres un traumatisme pancreatique. Objectif L’approche therapeutique varie du traitement conservateur au drainage interne ou externe par voie chirurgicale ou endoscopique. Le but de cette etude est de proposer une strategie therapeutique devant les pseudokystes du pancreas. Les observations Nous rapportons 4 cas de pseudokystes du pancreas (PKP) âges de 7, 9, 12 et 13 ans pris en charge de janvier 2006 a juillet 2008. Un traumatisme abdominal etait en cause dans 2 cas et une pancreatite aigue dans les 2 autres cas. Le diagnostic a ete pose grâce a l’echographie couplee a la tomodensitometrie (TDM) abdominale. Dans 1 cas la resolution du kyste a ete spontanee. Deux enfants ont eu un drainage interne par voie endoscopique et 1 enfant a eu une kysto-jejunostomie par voie chirurgicale. Les suites ont ete simples dans tous les cas. Conclusion En cas d’echec du traitement conservateur de PKP, le traitement endoscopique parait le traitement de choix mais le traitement chirurgical reste une alternative importante.

Intestinal Atresia is generally caused by intrauterine vascular obstructions. Intrauterine intussusception is one of these disruptive events. Intestinal intussusception is a disease that affects children commonly between 3 months and 3 years old in 90% of cases. There are few clinical cases in literature that demonstrate relationship between antenatal intussusceptions and ileal atresia. We report the case of a newborn with neonatal occlusion, where the surgical exploration revealed a Type 3A ileal atresia owing to antenatal ileoileal intussusception.

Resume Objectif Determiner la nature et le profil de sensibilite des germes au cours des appendicites aigues chez l’enfant. Type d’etude Etude prospective, descriptive ayant inclus les enfants operes pour appendicite aigue non compliquee de peritonite. Methodes Un prelevement de l’appendice et de l’exsudat peritoneal (lorsqu’il existe) pour examen bacteriologique a ete realise en peroperatoire chez tous les enfants. La recherche des germes anaerobies n’a pas ete possible pour des problemes techniques. Resultats Quatre-vingt enfants ont ete inclus. Le prelevement etait positif chez 56 patients (70 %). Deux microorganismes differents ont ete isoles chez 14 enfants. Les bacilles Gram negatif ont ete de loin les germes les plus frequemment retrouves : 64 sur un total de 70 germes isoles. Escherichia coli a ete isole chez 48 enfants. Il etait resistant a l’association amoxicilline-acide clavulanique et a la cefazoline dans 35 % des cas. Pseudomonas aeruginosa sensible a la ticarcilline a ete isole chez sept enfants. Conclusion Dans notre etude, 70 % des patients avaient un prelevement positif a germe aerobie avec predominance de bacilles a Gram negatif (BGN), en particulier E. coli . Ce resultat pourrait nous orienter dans le choix des molecules lors de la prescription d’une antibiotherapie de premiere intention au cours des appendicites aigues compliquees chez l’enfant.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8 - p. 804-807

Resume Objectif Etudier le retentissement d’une pratique physique et sportive reguliere sur l’autonomie et la qualite de vie du paraplegique tunisien. Materiels et methodes L’etude porte sur 25 paraplegiques divises en deux groupes : dix paraplegiques sportifs et 15 paraplegiques sedentaires chez lesquels on a procede a une evaluation du degre d’autonomie par l’echelle de mesure de l’independance fonctionnelle et la qualite de vie par le questionnaire de qualite de vie SF36 dans sa version traduite en arabe. Resultats L’analyse des resultats montre une difference significative du score global de la mesure de l’independance fonctionnelle entre les deux groupes, les paraplegiques sportifs ayant developpe une meilleure autonomie aux activites de la vie quotidienne affichant un score total moyen de 115,10 contre 93,87 ( p p p p Conclusion Cette etude nous a permis de montrer que l’activite physique et sportive reguliere avait un effet positif aussi bien sur l’optimisation des capacites fonctionnelles du paraplegique que sur l’amelioration de sa qualite de vie, favorisant ainsi une meilleure reinsertion socioprofessionnelle.

Pyloric duplication cyst is a rare congenital anomaly. Few cases have been described in the literature. We report two cases of 2 and 5 year-old girl. The diagnosis was suspected on ultra sonography and upper gastrointestinal series and confirmed by surgery and histopathologic examination. Resection was total in one case and partial in the other. Pyloroplasty was associated. Post operative was unfaithful.

Resume Objectif. – Evaluer les resultats du traitement medical associe a la reeducation dans la prise en charge des ruptures transfixiantes de la coiffe des rotateurs. Methode. – L'etude est prospective ouverte, incluant des patients ayant une rupture transfixiante de la coiffe des rotateurs dont le diagnostic a ete confirme par l'echographie. L'evaluation de l'efficacite therapeutique a ete realisee avant traitement, a la fin du traitement, a un, trois et six mois. Elle a porte sur : la mesure de l'intensite de la douleur et du handicap par une echelle visuelle analogique, le score algofonctionnel de Constant, la mesure des mobilites articulaires globales et enfin la reprise des activites quotidiennes et/ou professionnelles. Nous avons conclu a un succes du traitement lorsque l'EVA handicap inferieure a 20, l'EVA de la douleur inferieure a 20 et le score de Constant superieur a 80. Resultats. – Vingt quatre patients ont ete inclus dans l'etude. L'âge moyen etait de 59 ± 10 ans. La rupture evoluait en moyenne depuis neuf mois. Les differents parametres d'evaluation a savoir la douleur, la fonction, les amplitudes articulaires et le handicap ont ete ameliores de facon significative des la fin du traitement. La moyenne du score de Constant est passee de 44,7 ± 15,4 a 71,8 ± 14,1 a la fin du traitement, et a 74,7 ± 15,2 a six mois. Soixante quinze pour cent des patients (18/24) ont ete nettement ameliores. Ces resultats semblent stables apres un recul de six mois. Conclusion. – Malgre le petit nombre de patients, notre etude semble confirmer que la reeducation doit toujours etre menee a son terme avant de decider une reparation chirurgicale.

L’atresie duodenale est la resultante d’une revacualisation incomplete de l’intestin primitif, alors que l’atresie grelique type apple peel est secondaire a un accident vasculaire au niveau de l’artere mesenterique superieure. On rapporte le cas d’un nouveau-ne qui presente une atresie de la portion distale du duodenum associee a une atresie grelique type apple peel. Il s’agit du quatrieme cas rapporte dans la litterature de cette association inhabituelle. On propose une revue de la litterature afin de determiner l’ethiopathogenie commune de cette association, les caracteristiques embryologiques et therapeutiques de cette association particuliere.

Le xeroderma pigmentosum (XP) est une genodermatose caracterisee par l’apparition, a un â ge precoce, de tumeurs cutanees et oculaires posant souvent des difficultes therapeutiques. Le but de notre travail etait de decrire notre experience dans le traitement de ces tumeurs par radiotherapie (RT). Nos huit malades presentaient 24 tumeurs (un a sept par patient) qui siegeaient surtout au niveau des levres (sept cas), du nez (cinq cas) et des paupieres (cinq cas). La RT etait realisee dans un but curatif dans sept cas et dans un but palliatif, dans un cas. Le traitement etait base sur la contactherapie dans 16 cas (a la dose de 3,4 grays/seance, au rythme de trois seances/semaine, avec des doses totales allant de 30 a 62 grays), la RT transcutanee dans quatre cas (deux grays/seance, cinq seances/semaine) et la curietherapie dans quatre cas. Une regression clinique des tumeurs etait obtenue dans 18 cas sans aucune recidive, trois malades etaient perdus de vue et un malade etait decede. Les effets secondaires etaient a type de surinfections (quatre cas) et d’atrophie cutanee (deux cas). La RT parait satisfaisante (75 % de guerison), les effets secondaires etaient rares. L’exerese chirurgicale reste le traitement de premiere intention, la RT constitue une alternative therapeutique possible chaque fois que la tumeur est inoperable. La contactherapie permet de reduire la surface irradiee. Les effets secondaires a long terme sont mal connus notamment chez des enfants.

Background: To analyze the spectrum of testicular tumors in prepubertal children and the therapeutic resultants in an unselected population. Materials and Methods: Our hospital database was analyzed for testicular tumors from January 1995 to December 2010 concerning clinical presentation, treatment and therapeutic results. Results: Eight patients were operated on because of testicular tumors.In six cases (75%) the tumor was benign: benign teratoma (four cases), epidermoid cyst (one case) and immature teratoma (one case). Two patients (25%) had a malignant tumour: yolk-sac tumour (two cases). All this children underwent surgery. Radical inguinal orchidectomy was performed in six cases and conservative surgery was performed in two cases. One patient has received adjuvant chemotherapy. Followup was uneventfully three years after primary surgery.Conclusion: In prepubertal children, most testicular tumours are benign. If tumour markers were negative testis-preserving surgery can be proposed, complete excision of the tumour should be ascertained. In the case of testicular teratoma, the possibility of contralateral tumour should be considered in the follow-up.Key words: Children, Testis, Tumour, Teratoma,yolk-sac tumour

Introduction Over the years, the surgical management of recto-sigmoid Hirschsprung's disease (HD) has evolved radically and at present a single stage transanal pull-through can be done in suitable cases, which obviates the need for multiple surgeries. Aim The aim of this paper was to evaluate the role of transanal pull-through in the management of recto-sigmoid HD in our institution. Material and methods A retrospective analysis (between January 2003 and December 2009) was carried out on all cases of Hirschsprung's reporting to unity of pediatric surgery of Tunis Children's Hospital that were managed by transanal pull-through as a definitive treatment. All selected patients including neonates had an aganglionic segment confined to the rectosigmoid area, confirmed by preoperative barium enema and postoperative histology. Twenty-six children (86%) had their operation done without construction of prior colostomy. Results Transanal pull-through was performed in 31 children. Mean operating time was 150 minutes (range 64 to 300 minutes). No patients required laparotomy because all patients including neonates had an aganglionic segment confined to the rectosigmoid area. Blood loss ranged between 20 to 56 ml without blood replacement. Since all children were given an epidural caudal block, the requirement of analgesia in these cases was minimal. Postoperative complications included perianal excoriation in 7 out of 31 patients lasting from 3 weeks to 6 months. Complete anorectal continence was noted in 21 of 31 (67%) children in follow up of 3-5 years. Conclusions Transanal endorectal pull-through procedure for the management of rectosigmoid HD is now a well-established and preferred approach. Parental satisfaction is immense due to the lack of scars on the abdomen. As regards the continence, a long-term follow-up is necessary to appreciate better the functional results of this surgery.

Hydatid cysts are endemic in certain regions of the world and particulary in North Africa. They are usually located in the liver, lung, and spleen, though many uncommon locations have been reported. This is the first report of a child with primary pelvic hydatid disease causing a sciatic compression.

Purpose Appendicitis is the most common abdominal inflammatory process in children which were sometimes followed by complications including intra-abdominal abscess. This later needs classically a surgical drainage. We evaluated the efficacy of antibiotic treatment and surgical drainage. Methods Hospital records of children treated in our unit for intra-abdominal post appendectomy abscesses over a 6 years period were reviewed retrospectively. Results This study investigates a series of 14 children from 2 to 13 years of age with one or many abscesses after appendectomy, treated between 2002 and 2007. Seven underwent surgery and the others were treated with triple antibiotherapy. The two groups were comparable. For the 7 patients who receive medical treatment alone, it was considered efficient in 6 cases (85%) with clinical, biological and radiological recovery of the abscess. There was one failure (14%). The duration of hospitalization from the day of diagnosis of intra-abdominal abscess was approximately 10.28 days (range 7 to 14 days). In the other group, the efficacy of treatment was considered satisfactory in all cases. The duration of hospitalization was about 13 days (range: 9 to 20). Conclusion Compared to surgical drainage, antibiotic management of intra-abdominal abscesses was a no invasive treatment with shorter hospitalization.

In this paper, a new SVM (Support Vector Machines) synthesis method is presented. This method is based essentially on training criterion optimization of this machine by a set of hierarchical structures of learning automata. This methodology is adopted for the development of off-line isolated handwritten digits recognition system. A comparison is taken between this new approach and that of a standard approach for SVM synthesis. These two methodologies are also compared with a neural network based classification method. The obtained results show the performances of the new suggested method for SVM synthesis.

Situs inversus is a challenge to the physician, both for the diagnostic and for the therapeutic. A combination of partial situs inversus, annular pancreas and polysplenia with bowel malrotation has been reported in a newborn who presented as duodenal obstruction. Situs inversus is rare especially without heart malformation. All the abnor - malities in this combination can be explained on the basis of multiple organ malrotation. It also demonstrates the necessity of meticulous investigation and precise description of the anomaly as far as the management of this case is concerned.

In this study we will describe and compare different methods based on the Photothermal Deflection Technique (PTD) which permits the determination of thermal diffusivity for bulk semiconductors. The two first methods proposed here consist in drawing the experimental amplitude and phase variation of the photothermal signal versus square root modulation frequency. The sample placed in air is heated thanks to a modulated uniform light beam. The difference between these two methods is that in the second one the sample is covered by a thin graphite layer. We notice that the first method is only sensitive to the thermal diffusivity however the second method is sensitive for both thermal diffusivity and thermal conductivity. Finally the third method which is a spectroscopic one and where the sample is immersed in a CCl4 filled cell consists to draw the phase variation of the photothermal signal versus wavelength at a fixed modulation frequency. The phase difference between the two saturated zone (high and low absorption coefficient) is sensitive to the thermal diffusivity.

An experimental benchmark and its three-dimensional finite element (FE) simulation are presented for free vibration and effective electromechanical coupling of thick smart beams and plates bonded symmetrically on their upper/lower surfaces with a single pair of large piezoceramic patches. The so-called modal effective electromechanical coupling coefficient, which is post-processed from free-vibration analyses under short-circuit and open-circuit electrodes, is proposed as a unified free-vibration benchmarking comparator. For this purpose, the tests are numerically modeled, analyzed, and correlated using the commercial ANSYS® FE code. Realistic and desirable features were considered; they concern electrode equipotentiality, piezoceramic patches poling orientations (here opposite), and an FE model electromechanical updating. The original experimental benchmark and its refined modeling and simulation outcomes could be of major interest to smart materials and structures practitioners and researchers.

Objective The aim of this study was to adapt and validate the Tunisian version of the Oswestry Disability Index (ODI) within a Saudi Arabian population. Method The translation of items 8 and 10 taken out of the Tunisian version was conducted according to Beaton's method. Adaptations were made after a pilot study on 100 patients. The validation study included 100 patients suffering from chronic low back pain aged 18 to 65 years old. Intra-observer reliability was assessed using the intra-class coefficient (ICC). Spearman rank correlation coefficient, the Kruskall–Wallis test and factor analysis were used to evaluate construct validity (convergent and divergent validity). Internal consistency was assessed by Cronbach's alpha coefficient. Results One hundred Saudi patients were included in the study. Intra-observer reliability was excellent (ICC: 0.99). The correlations of the index with the VAS pain scale ( r = 0.708), the Roland–Morris Low Back Pain Disability ( r = 0.656), and the Quebec Back Pain Disability Scale ( r = 0.792) suggest good construct validity. Factor analysis unveiled two main factors explaining a cumulative percentage variance of 63.5%. The first factor represents static activities and the second factor represents dynamic activities. Conclusion The Arabic version of the ODI adapted to the Saudi population has high metrological qualities. Further studies assessing its responsiveness to change should be conducted.