Aberrant course and anatomical variants of the branches of the aortic arch

The aortic arch is the segment of the thoracic aorta located between its ascending and descending portions at the level of the 4th thoracic vertebra. Its main collateral branches constitute the supra aortic trunks (SAT). We reported 4 cases of variations of these trunks. The first two cases show 2 supra aortic trunks with a right bicarotido-subclavian trunk; the third, 4 supra aortic trunks with a right vertebral-subclavian trunk and the fourth, an origin’s variant and an aberrant course of the supra aortic trunks. These variants find their explanation in the embryology and are important to be known by the neurologist, the neurosurgeon, the vascular surgeon, the otolaryngologist and the radiologist for an adequate diagnosis and therapy. Keywords: Aortic arch, SAT, Aberrant path

Long term results of Intramedullary Nailing in childhood femur fractures

Objective: To evaluate the impact on bone growth of intramedullary nailing of femur using Küntscher technique in childhood.  Methods: 18 patients who had undergone Küntscher  intramedullary nailing were analyzed as they have grown to adulthood. Growth of each lower limb was compared using predefined clinical and radiological parameters. Results: Patient ages at the time of evaluation, ranged from 21 to 30 years and the follow up length 12 to 16 years. Clinical examination noted 10 normal patients and 8 patients with anomalies, among them 6 were less than 12 years old at the time of intervention. Six patients had lengthening; 4 had atrophy of the thigh and 7 patients had coxa valga of operated limb. All patients with coxa valga had undergone the intervention before the age of 12 years. Conclusion: intramedullary nailing using Küntschter nails to treat femoral fractures in children  may have some long terms sequelae. Therefore it is advisable not to use this technique in children less than 12 years old. Key words: intramedullary nailing, children, growth plate, femur

Perforation gastrique médicamenteuse chez l’enfant : une complication rare, à propos d’un cas

La perforation gastrique est une complication redoutable après ingestion médicamenteuse. Elle constitue une urgence rare mais potentiellement mortelle chez l’enfant. Nous rapportons un cas exceptionnel chez une fillette de 03 ans, sans antécédents particuliers, reçue en urgence pour des douleurs abdominales généralisées, apparues de façon brutale, après usage de tisanes et d’anti inflammatoire, associées à des vomissements verdâtres et à un arrêt des matières et des gaz. L’examen physique avait noté un syndrome infectieux et un syndrome d’irritation péritonéale permettant d’évoquer une péritonite aigue généralisée. En per opératoire, l’exploration avait permis de confirmer le diagnostic préopératoire et de retrouver une perforation antrale. La fillette avait été l’objet d’une excision – suture des berges de la perforation. L’examen anatomopathologique de la pièce opératoire avait objectivé des lésions de gastrite périulcéreuse sans métaplasie. Les suites opératoires étaient simples. Une thérapie relative à l’éradication de l’Hélicobacter pylori avait été institué. L’examen clinique était normal avec un recul de 1 an.Mots clés: perforation, gastrique, anti-inflammatoire, enfantEnglish AbstractGastric perforation is a dreadful complication of drug ingestion.It is a rare,but potentially fatal emergency in children.We report the case of the a 3-year-old girl with no relevant past history received as an emergency for genetalised abdominal pain. The pain was of sudden onset,following the intake of infusions and anti-inflammatory drugs for a fever. It became associated with a greenish vomitus and cessation of stool and flatus passage. The physical examination revealed an infectious syndrome and features of peritoneal irritation, leading to the diagnosis of acute generalised peritonitis. Intraoperatively,exploration confirmed the diagnosis and sited an antral perforation. She benefitted from an excision and suturing of the borders of the perforation.The histopathological examination of the borders concluded to lesions consistent with a periulcerative gastritis with no metaplasia. The postoperative period was uneventful. She received a Helicobacter Pylori éradication therapy.A year later the clinical examination was normal.Keywords: Perforation, gastric, anti-inflammatory, childre