Annales de pediatrie最新文献

Idiopathic genu varum and genu valgum are common problems in pediatric orthopedic practice. Standardized evaluation is essential to compare the deformity with age specific normal ranges. Secondary deformities are infrequent, often unilateral, and progressive with growth. Epiphyseal stapling at adolescence is required only in severe deformities. Patient selection for this procedure is difficult because of uncertainties regarding accurate bone age determination and prediction of final poststapling outcome. Closely spaced evaluations between 10 and 13 years of age are helpful for determining the optimal time for stapling.

Rett syndrome is a degenerative neurological disorder with onset between 6 and 18 months of age. Severity of motor impairment is variable; some patients lose the ability to walk whereas others walk nearly normally. Orthopedic problems, which mainly involve the lower limbs and spine, can increase functional impairment and cause discomfort. Abnormal joint alignment in the lower limbs due to muscle contractures requires physiotherapy and orthopedic appliances. Surgery may be necessary, in particular to prevent dislocation of the hip or to correct talipes equinus. Scoliosis is common and unresponsive to conservative therapy and should be treated surgically if severe.

Epidemiological data on diarrhea due to Rotavirus are similar enough across different regions of the world to allow the pooling of clinical studies of Actapulgite for the treatment of acute diarrhea in infants and children in France and Africa. A total of 7,616 infants and children were entered into these open or placebo-controlled trials. Most patients were under two years of age, results of the analysis confirmed the antidiarrheal efficacy and safety of Actapulgite.

Analysis of the long-term outcome of slipped capital femoral epiphysis convincingly demonstrates that early diagnosis is essential. Chronic slipping with significant displacement are associated with a high rate of adverse outcomes including necrosis, chondrolysis, and early osteoarthritis. Orthopedic reduction increases the risk of complications. Inadequate reduction is associated with poor hip function and a high risk of early osteoarthritis. Improvements in overall long-term outcome could be achieved only by reducing the number of chronic forms with major displacement, since prognosis is generally favorable in acute forms and chronic forms with minor displacement.

There are several forms of pes cavus with specific anatomical features and different outcomes. Medial pes cavus is often due to a neurological disorder and causes severe symptoms. The causal disease is responsible for gradual deepening of the arch and deformities of the toes and hindfoot. Surgery is warranted in severe deformities with functional impairment. Procedures performed in younger patients involve the soft tissues; an example is plantar release with or without osteotomy of the calcaneus. In older children, osteotomy or fusion is required.

Flat feet are common in children. Loss of the medial arch may be due to intrinsic or extrinsic abnormalities of the foot. Physical evaluation usually suffices to identify the various growth stages which modify alignment and joint mobility, thus affecting foot function. Flat feet not caused by intrinsic structural abnormalities are right considered benign since they only exceptionally cause discomfort in adulthood. Shoe inserts provide only improved comfort during walking. Surgery is used in the extremely small proportion of patients with severe arch loss or deformities secondary to another condition.

The main causes of inequality of lower limb length are reviewed. In children, prediction of final inequality is difficult; accurate determination of bone ange and rigorous clinical and roentgenographic measurements should be repeated yearly. Surgical procedures are improving but remain less than ideal. Desepiphysiodesis, the only etiological treatment of growth plate sterilization, has a success rate of no more than 40%. Epiphysiodesis is reliable but the optimal bone age at which it should be performed is difficult to determine. Gradual lengthening techniques have changed considerably over the last five years; although the current slower, more rational methods provide higher healing rates within 40 days per centimeter gained, the complication rate remains at least 50% even in units with extensive experience. Such procedures should be used only in substantial inequalities after full information of the family about the significant rate of complications which often escape prediction.

This is an update on the surgical and orthopedic management of scoliosis in children. After a review of the biomechanical factors underlying the scoliotic deformity in the three dimensions, methods and indications of conservative treatment combining physiotherapy and full-time or part-time bracing are discussed. Development of new segmental spinal instrumentation devices has modified the surgical treatment of scoliosis by allowing three-dimensional correction of deformities and obviating the need for postoperative immobilization in a cast or corset. Results of conservative treatment are analyzed in an original series of 56 children with progressive scoliosis treated when the angulation was still under 30 degrees. Mean follow-up since the end of treatment is 14 years. Results show that proper conservative treatment arrests progression and modifies the natural history of scoliosis. Outcome after surgical treatment is analyzed in an original and recent series composed of the 50 first children who had posterior surgery with the new Cotrel-Dubousset instrumentation. Results of anterior surgery (V.D.S. instrumentation), which is still indicated in some cases, are analyzed in an older series of 18 cases. When the deformities are too severe to allow conservative treatment, short segment fusion effectively corrects the scoliosis and reliably provides good cosmetic and functional results.

Lipoma of the corpus callosum is a rare congenital intracranial tumor. Although only 153 cases had been reported as of March 1992, the incidence of this tumor is underestimated (some cases are unpublished and others are asymptomatic). Three cases of lipoma of the corpus callosum diagnosed in children are reported herein. These tumors may be either discovered fortuitously in an asymptomatic patient or responsible for manifestations of which the most common are seizures, headache, and mental disorders. Diagnosis rests on imaging techniques. The main investigation is computed tomography which discloses a mass composed of fat, with or without peripheral calcifications, and also identifies any other malformations such as dysgenesis of the corpus callosum.

A ten year old boy had six cutaneous angiomas and recurrent rectal bleeding responsible for iron deficiency anemia. Histological examination established the diagnosis of blue rubber bleb naevus syndrome. Endoscopy, arteriography, computed tomography, and angioscintigraphy disclosed additional angiomas in the stomach and rectum and along the blood vessels in the lower limbs. The value of angioscintigraphy for identifying angiomas escaping detection by other means was illustrated in this case. Embolization of the inferior mesenteric artery was successful in preventing further rectal bleeding. Treatment of this disorder remains controversial.