Management of loss of tissue substance in children's limbs. What are the salient peculiarities? A proposed algorithm

Loss of tissue substance in children's limbs has the same etiologies and in many cases, the same severity as in adults' limbs, and the means placed at the disposal of a surgeon are likewise comparable. It may nonetheless prove difficult to strategically position the different treatment methods in a decision-making tree. After all, a child presents numerous peculiarities: high quality of vascularization (both microcirculation and macrocirculation), better ability to achieve nerve regeneration and durable bone consolidation and, last but not least, a pronouncedly superior overall functional prognosis. Moreover, a child's future needs to be taken into account ; it is not only cicatrization per se, but also the quality of healing that should dictate therapeutic choices, which will consequently be determined in view of avoiding functional disorders during the growth process. On the basis of their experience and following a review of the literature, the authors have assessed the interest of each relevant technique and drawn up a decision-making tree.

[Brachytherapy for sarcomas]

The standard of care for local treatment for extremities soft tissue sarcomas relies on conservative surgery combined with external beam radiotherapy. Brachytherapy can be realized instead of external beam radiotherapy in selected cases, or more often used as a boost dose on a limited volume on the area at major risk of relapse, especially if a microscopic positive resection is expected. Close interaction and communication between radiation oncologists and surgeons are mandatory at the time of implantation to limit the risk of side effects. Long-term results are available for low-dose rate brachytherapy. Nowadays, pulsed dose rate or high-dose-rate brachytherapy are more often used. Brachytherapy for paediatric sarcomas is rare, and has to be managed in reference centres.

[Veinus thrombosis of the limbs in the cardiology service of the Gabriel Touré Teaching Hospital]

OBJECTIVE

Determine the frequency of thrombosis of the upper and lower limbs in the cardiology specialist unit. Describe the clinical and paraclinical signs observed. Identify etiological factors. Evaluate the response to treatment.

MATERIAL AND METHODS

This longitudinal prospective study was conducted from the 1st January 2007 to 31st May 2008 in the service of cardiology of the Gabriel Touré Teaching Hospital of Bamako. Included in the study were all the patients diagnosed with deep vein thrombosis confirmed by venous ultrasound imaging. The data was analyzed with the software Ear-information-6.04d.

RESULTS

12 cases of deep vein thrombosis confirmed for a total of 1171 hospitalizations, either of 1,88% with a high frequency between 30 and 44 years old (40,9%) without any preference of sex (sex ratio=1). 63,6% had no known cardiovascular antecedent. The clinical signs were evocative in 90 cases, 9%. Prolonged confinement was present in 59.09% of cases, and was associated with HIV infection in 18.1% of cases. The attack of the left lower limb was recorded the most (72.7%), only one case of the left upper limb (4.5%). The attack of the major network preferentially prevailed (86.3%) with preferably proximal seat (72.7%). The femoral vein was reached (50%). 86.3% of the patients received HBPM +AVK with 68.18% of cure without after-effect. The evolution was complicated by pulmonary embolism in 13.6% of cases and death in 4.5%.

CONCLUSION

Deep vein thrombosis of the limbs occupies a significant place among cardiovascular pathologies in Bamako and HIV seems to increase its frequency.