Chirurgie pédiatrique

Publications in this journal

• Article: [Indications and results of the MAGPI intervention in the treatment of minor hypospadias].

  T Felfela, P Mouriquand, A Pouyau, P Mollard
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  ABSTRACT: In order to clarify the indications of MAGPI procedure (Meatal Advancement and Glanuloplasty Incorporated), 18 patients operated upon have been reassessed after a long follow-up (mean: 30 months). The cosmetic and functional results are good in 16 cases, 2 non-satisfactory results are noticed with a wrong meatal position. The initial position of the meatus (glanular or coronal), the absence of chordee and the initial aspect of the glans (broad and flat) are the three main conditions to obtain a good result.
  Chirurgie pédiatrique 02/1990; 31(3):167-8.
• Article: [Growth acceleration in orthopedically treated diaphyseal fractures of the femur in children].

  R Jawish, J Saikaly, M Ponet
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  ABSTRACT: Authors reported 126 fractures of the femur in children having had orthopaedic treatment. Between them, 40 cases are reviewed at an average of 4 years 3 months of follow up. Radiographic measurement of limbs discrepancy revealed that the mean value of overgrowth is more important in boy (11.36 mm) than girl (6.38 mm), especially between 3 and 7 years of age, and it is related to the initial overlap value and the type of fracture.
  Chirurgie pédiatrique 02/1990; 31(4-5):235-9.
• Article: [Anatomic study of 2 sternopagus. Is the separation possible?].

  J Guitard, J Moscovici, B Deslaugiers, P Vaysse, S Juskiewenski
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  ABSTRACT: Trough two cases of Sternopagus, study of classification of conjoined twins with precise definition of anatomic characteristic of Sternopagus. Description of our own subject and review of literature. At the end of this study, it is evident that the heart and vascular fusion is always complicated. So, the true Sternopagus are inseparable and no likely to live, in opposition with Xiphopagus and Thoracopagus.
  Chirurgie pédiatrique 02/1990; 31(4-5):265-71.
• Article: [Hereditary angioneurotic edema. Management in pediatric surgery].

  C C Arvieux, J P Alibeu, N Drouet
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  ABSTRACT: Hereditary angioneurotic oedema is an autosomal dominant disorder associated with serum deficiency of functionally active C1 inhibitor protein (type 1) or normal serum level of functionally deficient C1-inhibitor (type 2). These biochemical abnormalities induce a complement activation which leads to episodic swelling of interstitial tissues usually of the abdominal viscera and of the upper airway with resultant asphyxia. Vasoactive peptides from the degradation of component C2 of the complement along with an activation of basophils by chemotactic substances from the degradation of C3 and C5 are the main mechanisms involved in vasodilatation and swelling. Attacks of angioneurotic oedema, sometimes fatal when involving the upper airway, can occur during any but usually during ear-throat-nose, dental or facial surgery. This article describes the pathophysiology and the main features of the disease in children. It reviews the different treatments used to avoid attacks or to cure an attack of angio-oedema once it has begun, both during planed surgery and during emergency surgery.
  Chirurgie pédiatrique 02/1990; 31(1):52-6.
• Article: [Congenital cutaneous aplasia of the scalp. Apropos of 4 cases].

  F Laumonier, F Varlet, T Favier, J Berthelot, F Pouplard
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  ABSTRACT: Report of four cases of congenital defects of the scalp. In two of these cases, the skin defect was associated with a skull defect and in one, there were other cranial deformities. In each case, the lesion seemed isolated in otherwise normal children. This study contains a review of congenital scalp defects. The different aspects of this rare disease are presented and the treatment is discussed with reference to natural evolution. The authors differentiate between cases with isolated lesion and cases with associated malformations or abnormalities, malformation syndromes, as has been previously defined. In the case of skull defects, it is thought that immediate reparatory surgery must be performed, to prevent infection and hemorrhage of sagittal venous sinus, as it was the case in one of the four children. The covering of the defect can be realized with rotated skin flaps, which seem preferable to any form of plastic surgery, for cosmetic reasons, and for the secondary treatment of the skull defect, if this is necessary. When spontaneous closure of the bone defect, is not noted, which occurs generally in the case of large defects, it seems reasonable to close the latter by cranio-plasty, to protect the brain. In one of the four cases reported, this technical approach of the lesion was used, with a good result being reported, four years later.
  Chirurgie pédiatrique 02/1990; 31(2):106-12.
• Article: [Sacrococcygeal teratoma. Apropos of 15 cases].

  R Besson, B Ducloux, H Giard, M Bonnevalle, V Martinot, P Debeugny
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  ABSTRACT: Fifteen cases of sacrococcygeals teratomas were treated at our hospital over the last ten years. There is no correlation between prematuration and tumor weight, as between tumor weight and low babys' weight. High tumoral weight didn't influence the prognosis. The treatment is always surgical. Chemotherapy was used only for recurrence in one case (the patient is dead). For all the cases, we performed a perineal procedure without abdominal procedure. No patient had an abdominal extension of the teratoma.
  Chirurgie pédiatrique 02/1990; 31(2):69-72.
• Article: [Extrahepatic biliary tract atresia and a common biliopancreatic canal. Review of the literature apropos of a case].

  P Vergnes, T Lamireau, J R Pontailler, J F Colombani, J M Bondonny
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  ABSTRACT: The authors report the case of an 3 months old caucasian boy which had an extrahepatic biliary atresia associate with a congenital biliary cyst and an anomalous pancreaticobiliary junction. The patency between gallbladder and duodenum permits the operative opacification of this long common pancreaticobiliary channel. The congenital biliary cyst was located on the upper part of the common bile duct and was obstructed by biliary concretions. Unfortunately, no patency between intrahepatic bile ducts and this cyst was found. Because this long common pancreaticobiliary channel may cause biliary dilatation or biliary cancer, we performed an hepatic portoenterostomy rather an hepatic portocholecystostomy. A few weeks later, the bile flow was restored and the jaundice decreased. With a follow up of 18 months, this boy is currently anicteric, despite the hepatic fibrosis found on the operative biopsy. The association extrahepatic biliary atresia-long common pancreaticobiliary channel is uncommon and only 20 cases were reported. In our case, the pancreatic juice reflux into the biliary tract might have caused the dilatation of the common bile duct and the biliary atresia by chronic obstructive cholangiopathy.
  Chirurgie pédiatrique 02/1990; 31(2):73-8.
• Article: [Neonatal pyloric obstruction. Diagnostic and therapeutic aspects. Apropos of 5 cases].

  P Debeugny, J P Farriaux, M Bonnevalle, D Turck, R Bensid, F Gottrand, P Faille
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  ABSTRACT: Five cases pyloric obstruction, revelated at the birth-period were summarized from 1964 to 1987; 1 pyloro-duodenal atresia, two cases of total pyloric obstruction by diaphragm, two cases of pyloric obstruction associated with several ileal and/or-colic atresia in the same family, and suspected at the antenatal echographic study. The treatment was either pyloro-duodenal anastomosis (1 case) or diaphragmatic resection with pyloroplasty (4 cases). In immediate results are obtained one immediate death, at the third day, and 4 initial good results; but two deaths came in a further period at 3 months and 8 months (the same family) with sepsis after ileus. A syndrome of immuno-deficiency was demonstrated in this two familial cases.
  Chirurgie pédiatrique 02/1990; 31(2):79-86.
• Article: [Laparoschisis. Indications for a teflon patch in wall repair].

  P Debeugny, J P Canarelli, M Bonnevalle, R Besson, J Ricard, P Herlin, B Ducloux
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  ABSTRACT: In 14 newborns with gastroschisis, fascial closure was effected by muscular suture associated with teflon mesh prosthesis interposition. This was realized either in urgency during neonatal period (9), either secondly (5). Neonatal cases were treated between 0 h 30 and 5 h of age. Pulmonary hyper-pressure risk was very important when primary suture was early employed (card freq: 150 b. min-1. PA syst: 60 cm Hg; pulm pres: 20 cm Hg). When we used a teflon mesh prosthesis, we had 8 good results and only one initial death. 5 complications were represented by cutaneous ischemia which spontaneously disappeared (1), ischemia with infection and partial necrosis (2), important necrosis with teflon mesh prosthesis exteriorization (2). It has been definitely possible to achieve complete fascial in 7 newborns. Only one of them had a little ventral hernia. 5 newborns were early treated by simple skin coverage (Gross) as primary management. They have had teflon mesh prosthesis between 5 and 14 M of age and have undergone excision of the teflon mesh prosthesis and fascial repair without difficulty (5 good results). With teflon mesh prosthesis for treating congenital abdominal defects, abdominal hyper-pressure and pulmonary complications are exceptional. Local complications are very limited because of good vascular conditions. We did not have any adherences because of teflon mesh prosthesis good biological and histological tolerance. Digestive complications (statis, septicemia...) have been few and mild because physiological intra abdominal pressure has been early obtained.
  Chirurgie pédiatrique 02/1990; 31(1):18-25.
• Article: [Localized thoracic neuroblastoma: the role of surgery and therapeutic results. Apropos of 40 cases].

  H Rubie, O Hartmann, A Giron, G Lemoine, J Guitard, A Robert, J Lemerle
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  ABSTRACT: From 1982 to 1987, forty children with non-metastatic thoracic neuroblastoma were treated with a same therapeutic regimen. According to TNM staging, there were II CS I, 19 CS II and 10 CS III. All patients underwent surgery; thirty had primary surgical excision; in ten whose tumor were deemed uresectable, surgery was delayed until after a trial of chemotherapy. Operation was completed by several courses of chemotherapy in case of microscomic residual disease or lymph node involvement; radiotherapy was delivered in case of gross residual disease. Using this therapeutic approach. Event Free Survival is 92% with a median follow up of 40 months. Severe complications were rare and sequellae appear to be related to the disease i.e. neurologic consequence of cord compression.
  Chirurgie pédiatrique 02/1990; 31(3):146-51.
• Article: [The heterotopic pancreas in children. Apropos of 4 new cases].

  D Anagnostopoulos, E Lappas, V Kasselas, D Sfougaris
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  ABSTRACT: The authors report 4 new cases of heterotopic pancreas in children with prepyloric, jejunal, Meckel's diverticulum and mesenteric localization. Clinical manifestations were: hemorrhage in the prepyloric localization, abdominal pain in the mesenteric and Meckel's diverticulum and ileus in the jejunum localization. The authors emphasise the difficulties of preoperative diagnosis of the pancreatic heterotopias, owing to their usually small size and the necessity of surgical treatment.
  Chirurgie pédiatrique 02/1990; 31(3):164-6.
• Article: [Vascular traumatisms of the limbs in children. Report of 94 cases].

  P Debeugny, J P Canarelli, M Bonnevalle, L Lapasse, H Luck, P Huillet, L Boboyono
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  ABSTRACT: Ninety-four cases of limb vascular traumas were observed in children during a 25 year-period. Treatment was done less than 12 hours after the injury in 83 cases, later than 24 hours in 7 cases. Superior limbs were more often concerned than inferior limbs: 65 vs 29 cases. Bone lesions were found in 34% of cases, articular lesion in 12% and neurological lesions in 40%. Vascular repair was necessary in 63 cases, mostly by suture (41 cases) or venous graft (16 cases). Two patients died because of associated polytrauma. In 8 cases, anatomical and functional results are good, but follow-up is short. In 65 cases, results were initially satisfactory; 5 patients had later complications leading to sequelae in 3 cases. In 19 cases complications occurred and led to amputation in 5 cases; among the remaining 14 patients, results were finally satisfactory in 9 cases and sequelae were observed in 4 cases. Early diagnosis problems and treatment are discussed. Associated lesions have to be taken into account to assess the results.
  Chirurgie pédiatrique 02/1990; 31(4-5):207-16.
• Article: [True hermaphroditism. Late diagnosis. Surgical treatment and a 15-year follow-up].

  M Amrani, P Renoirte
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  ABSTRACT: True hermaphroditism is an usual cause of ambiguous genitalia. In some social areas, the diagnosis is often late and raised as pubertair abnormally. We report a case of a 12 years old Sicilian child, seen in 1975, raised as a boy and whose the main complain was a gynaecomastia. Clinical and paraclinical investigations revealed a small testicle on the one side and on ovary with an uterus and an obturated tube on the opposite side. A small recurvated penis, partially adherent to the scrotum is noticed. A structure embryologycally close to a vagina is also found behind the bladder. Cytogenetic structures showed a mixte karyotype: mosaicim 46 XX/46 XY with a ratio of a 80/20. Hormonal assessment showed a normal level of estrogen while testosterone is below the inferior threshold. A surgical treatment is carried out in three steps: removal of the internal female organs and testicular prosthesis replacement in the one side after castration, reconstruction of the recurvated penis and replacement of the other testicular prosthesis, and finally construction of the anterior urethra. Since the very first step of the surgical management and adjuvant hormonotherapy (testosterone) is administrated in order to decrease the gynaecomastia but also to allow the normal growth of the male organs. We discuss the benefice of a such therapeutic option in the true hermaphroditism lately diagnosed recording to organic and psychological data. We also point out the difficulty in therapeutic choice, mainly when the patient has raised as a boy. The follow-up in this case in 15 years.
  Chirurgie pédiatrique 02/1990; 31(4-5):279-83.
• Article: [3 new cases of internal male pseudohermaphroditism].

  J P Giraud, J G Yao
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  ABSTRACT: The authors report 3 new cases of Male Internal Pseudohermaphrodism. It is a scarce entity. The discovery is fortuous during the cure of hernia or cryptorchidism. The family history has nothing particular. The main problem of this syndrome is its treatment. Our attitude consisted in conserving the mullerian derivatives and treating the hernia or the cryptorchidism. Hysterectomy is not justified for the following reasons; no case of cancerisation of the mullerian derivatives has not yet been reported. The vasa deferens and uterus are in intimate relationship; the dissection is therefore dangerous. We did not perform systematic castration in order to protect fertility. The removal of the testis is performed only when the gland is intraabdominal and undescendable considering the major risk of cancerisation.
  Chirurgie pédiatrique 02/1990; 31(2):100-2.
• Article: [Crohn's disease limited to the appendix. Apropos of a case].

  O Andze, C Matte, S Youssef, A L Bensoussan
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  ABSTRACT: A rare case of Crohn's disease limited to the appendix is reported in an 18 years old adolescent, hospitalised as having acute appendicitis. Appendectomy was performed. There were no postoperative complication and no recurrence after 3 years follow-up. Surgical indications are discussed and literature reviewed.
  Chirurgie pédiatrique 02/1990; 31(6):349-51.
• Article: [Contribution of continuous peridural analgesia to neo-natal surgery].

  G Terrier, A Lansade, M Ugazzi, J P Favereau, B Longis, J L Alain
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  ABSTRACT: Continuous epidural analgesia is an common technique in neo-natal surgery. It will be possible with a fitting material. Principal indications are: omphalocele, gastroschisis, oesophagol atresia an diagphragmatic hernia. Technique: our protocol has been approved by the Regional Ethical Committee and informed written consent has been obtained from parents. General anaesthesia was induced and children were placed in lateral position. After skin preparation, the interspace L 3-L 4 has been punctured to identify the epidural space by loss of resistance. An epidural catheter (19 to 27 G) has been placed. 0.5 ml.kg-1 of 0.25% bupivacaine have been immediately injected, followed by a continuous injection of 0.3 ml.kg-1h-1 of the same bupivacaine. Epidural has been kept for four to five days. Advantages: very good analgesia; abdominal and vascular pressures decreased; to wean from respirator very quickly. No accident was founded.
  Chirurgie pédiatrique 02/1990; 31(4-5):217-8.
• Article: [Hemorrhagic cyst of the kidney in the neonatal period. Apropos of 2 cases].

  F Becmeur, R Dhaouri, L Marcellin, D Chistmann, J M Clavert, P Sauvage
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  ABSTRACT: Two cases of haemorrhagic renal cysts in neonate are reported. Both cases were premature newborns with obstetrical difficulties and delayed tumoral syndrome. The first case was considered a solitary renal cyst. The surgical procedure was a prominent domme resection. Four years later a contralateral Wilm's tumor appeared which became bilateral in 12 months, terminating in death 3 months later. The second case is clinically and radiologically similar in the neonate period. The surgical procedure was a nephrectomy. Compared histological reading of both resection materials, allowed us to establish diagnosis of congenital cystic nephroma. Cystic wall cells were normal elements of Bolande's tumor, of which microcystic forms have been soon reported. Hypothesis in our two cases would be mesoblastic nephroma in a pure cystic form, which would allow to widen morphologic spectrum of Bolande's tumor.
  Chirurgie pédiatrique 02/1990; 31(1):57-9.
• Article: [The possibilities of endoscopy in the treatment of various childhood ureteroceles. Apropos of a case].

  D Aubert, G Zoupanos, O Destuynder
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  ABSTRACT: A case is reported of a large left ureterocele in a duplicated system at the expense of the upper renal pelvis. This ureterocele caused acute pyelonephritis and dilatation of both left systems. It was treated by a classic endoscopic incision of its roof but 18 months later, infecting vesico-renal, grade 2, reflux was developed. This secondary reflux was treated successfully by submeatal polytetrafluoroethylene's (Teflon) paste injection. This new combination of endoscopic techniques proved to be available in this case.
  Chirurgie pédiatrique 02/1990; 31(1):63-4.
• Article: New approaches to the surgical management of rhabdomyosarcoma in childhood.

  D M Hays
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  ABSTRACT: Recent trends in the management of pediatric solid-tumors have resulted in reducing the scope of surgery. In the therapy of RMS of the orbit, genitourinary tract, head & neck and trunk & extremity sites, regimens of primary chemotherapy/radiotherapy have replaced, reduced or delayed excisional surgery. In some sites, these approaches have been successful. In others, a return to a more active surgical approach may be indicated, as observed in two studies noted below. Results of a primary chemotherapy approach for vesical RMS have been disappointing, as noted in the Intergroup Rhabdomyosarcoma Study (IRS) (U.S.) in which the mortality is greater than 25% and rate of bladder salvage among survivors less than 45%. Partial cystectomy for RMS was justifiably condemned prior to the development of effective chemotherapy, but deserves reevaluation. Partial cystectomy with adjunctive chemotherapy was performed in 33 children, 21% of the total pts with vesical RMS in the IRS. In 27 of these patients, it was carried out as the initial operation. Six additional patients had tumors which responded to chemotherapy, and a secondary partial cystectomy was performed. The mortality among these patients has been the same as in the overall group of patients with primary bladder tumors. The retention of functional bladders, however, has been greater than 95% among survivors with only 1/26 bladders lost to contracture. All patients (4) in this group who had postoperative functional vesical problems received more irradiation than is currently recommended. In this study, the use of partial cystectomy has been confined to cases in which it would obviously be successful.(ABSTRACT TRUNCATED AT 250 WORDS)
  Chirurgie pédiatrique 02/1990; 31(4-5):197-201.
• Article: [Mucosal impaction of a gastric foreign body (a coin)].

  A Dayoub, C Maurage, M A Bergeat, J Dubos, M J Ployet, J C Rolland
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  ABSTRACT: The follow up of a 4 1/2 years old boy ingesting a coin shows gastric stagnation of the foreign body. The coin does not pass through the pylorus and upper endoscopy is performed at 6 weeks. No foreign body is visualized but gastric retention is showed by X ray. The coin's extraction is performed after several "biopsy" because mucosal impaction. The patient is now no symptomatic. The anusual complication of coin's ingestion is reported to remember management of this problem.
  Chirurgie pédiatrique 02/1990; 31(3):189-90.