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The purpose of this study was to determine the clinical significance of children presenting with malrotation to develop treatment recommendations.Records of children undergoing a Ladd procedure were identified in the pediatric patient database from 1 June 1996 to 31 March 2007. Patients with intestinal obstruction caused by isolated intestinal malrotation were included. The exclusion criteria were the association of predisposing factors (omphalocele, gastroschisis, diaphragmatic hernia). Patient characteristics, imaging investigations, operations performed, and morbidity were evaluated.Eleven children (7 boys and 4 girls) underwent a Ladd procedure at the median age of 14 days. Seven patients presented bilious vomiting, alimentary vomiting associated with weight loss (2 cases), and melena (1 patient) at admission. The upper gastrointestinal radiological investigations established the diagnosis of intestinal malrotation in 6 cases confirmed by ultrasonography in 3 cases. Isolated Doppler ultrasound investigation was sufficient in 4 cases before abdominal surgery. In 1 case, preoperative diagnosis of intestinal malrotation was not made. Intraoperative anomalies were midgut volvulus in 7 cases, Ladd bands in 3 patients, and malrotation with intestinal ischemia in 2 cases with spontaneous resolution of midgut volvulus. Incomplete intestinal malrotation (180 degrees) was found in 10 cases and a mobile cecum in 1.These findings provide support for performing early diagnosis of intestinal malrotation to prevent the rare but potentially devastating complications of this anomaly.

We report two cases of fasciitis with necrotizing hypodermitis of the foot and arm which complicated varicella in immunocompetent children given nonsteroidal anti-inflammatory drugs. The skin barrier and immune function are weakened by the varicella zoster virus. Exposure to nonsteroidal anti-inflammatory drugs further favors necrotizing cutaneous infections caused by group A beta hemolytic streptococci. MRI can confirm the presence of superficial aponevrosis necrosis defining necrotizing fasciitis but should not retard surgical management which is always indicated for necrotizing fasciitis and sometimes for necrotizing dermo-hypodermitis.

This study was conducted in children treated surgically for spinal dysraphism between 1994 and 2000 to determine the value of electrophysiological parameters for followup in comparison with clinical, radiological and urodynamic findings.Electrophysiological examination was performed based on electromyographic detection of perineal muscle activity with evaluation of the sacral reflexes and measurement of lower limb and perineal evoked potentials. Clinical and radiological assessment consisted of physical examination, kidney ultrasonography and retrograde cystouretrography. Urodynamic assessment included determination of urethral pressure profile, bladder activity, compliance, voiding pressure and sphincter synergy. A total of 45 children were included in the study. In 28 cases electrophysiological assessment was performed routinely in 20 children (group 1) before and after (6 months and annually thereafter) surgical treatment (mean followup 30 months) and in 8 children (group 2) only after surgical treatment (mean followup 65 months). Electrophysiological findings were correlated with the urodynamic and clinical findings. Sensitivity, specificity and positive and negative predictive values were calculated. In 17 children (group 3) electrophysiological assessment was performed only once either before or after surgery.Electrophysiological assessment with combined electromyographic detection and perineal evoked potentials was highly sensitive in predicting urodynamic impairment, particularly vesico-sphincter dyssynergia (sensitivity 100%) or bladder dysmotility (sensitivity 86%). Specificity of perineal evoked potentials for detecting urodynamic dysfunction was 90%. Electromyographic detection and perineal evoked potentials also demonstrated satisfactory sensitivity in confirming urological impairment (sensitivity 79%, negative predictive value 90%).Electromyographic detection and perineal evoked potentials are valuable for assessment of patients after surgical treatment of spinal dysraphism. Because these techniques are minimally invasive and highly reproducible, they are suitable for baseline assessment in most cases (tethered cord, lipoma, syringomyelic cavities). Urodynamic assessment should be reserved for patients at high risk for secondary neurogenic bladder dysfunction such as myelomeningocele or sacral agenesis.