Biomedical subjects
Publications and source records attributed to C Grapin.
Isolated levocardia is a rare condition in which intestinal malrotation may be encountered. The case herein reported is particularly uncommon and raises a number of questions about the development of abdominal symmetry.
PATIENTS AND METHODS: This method was used in 14 children, seven boys and seven girls, aged from 2.7 to 14 years, with acute appendicitis and peritonitis. RESULTS: Conversion to median laparotomy was necessary in order to perform adhesiolysis in two cases in which small bowel was observed. Postoperative complications occurred in four patients involving three wound infections and one mechanical intestinal obstruction. There was no intra-abdominal abscess. CONCLUSION: This procedure allows appendectomy by an open classical approach to be performed, and subsequently allows the treatment of the generalized peritonitis by video laparoscopy, usually without median laparotomy.
STUDY AIM: The aim of this prospective study was to evaluate the laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia. PATIENTS AND METHOD: Between November 1995 and February 1998, 91 consecutive children (78 boys, 13 girls) under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral hernia was diagnosed by a laparoscopy through the inguinal hernia sac before ligation. Results of this technique were correlated with those of herniography (79 cases) or with inguinal exploration (12 emergency). RESULTS: Laparoscopy was performed in 88 patients. Laparoscopy was impossible in three cases: one inguinal sac too thin, two cases of ectopic testis in the inguinal canal. Sensitivity was 73% and specificity 92%. The only complication arising from the procedure was wound infection in two patients. CONCLUSION: This method is a simple, safe and accurate procedure in order to select children for contralateral surgical exploration.
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A percutaneous nephrostomy (PCN) was inserted as part of the management in 17 newborns and infants with severe pelviureteric junction obstruction between 1981 and 1993. Nephrectomy was performed in eight cases and pyeloplasty in nine cases, successfully in six cases (mean follow-up: 7.7 years). PCN was useful for predicting that no non-functioning kidney on intravenous pyelography (IVP) in this series should have been preserved. Among the kidneys with a high excretion delay on IVP, PCN showed that only those that had a split creatinine clearance of more than 1 ml/min/1.73 m2, or theoretical clearance for age and weight of over 6%, should be preserved.
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A very unusual clinical case of histiocytosis X in a young girl with no unusual medical history, is presented. The patient presented with chronic suppuration of the groin and complex anal fistulae and multiple recurrent abscesses, despite surgical treatment (abscess drainage, terminal colostomy). Intestinal and immunologic evaluation were normal. Only histology made the diagnosis. Chemotherapy (vinblastine) resulted in healing and the colostomy was closed.
The authors report a case of laparoscopic nephroureterectomy in a four year old girl with a small kidney destroyed by vesicoureteric reflux.
Tumours of the testicle are rare in children (about one case in 100,000 male children). Their histological type usually leads to favourable outcome. We report here our series of 12 cases together with an analysis of the large published series in order to review the prognosis and therapeutic indications which depend on the histology. The most frequent intratesticular tumours in the child are nonseminoma malignant germ cell tumours. At birth the tumour is usually a mature or mixed teratoma. Between the ages of 1 and 3 years the most frequently observed tumour arises from the vitelline sac representing about 50% of all tumours of the testicle in the child. From 3 years to puberty, paratesticular rhabdomyocarsomas and Leydig cell tumours are the most frequently encountered. Finally, at puberty, tumours of the testicle are the same as those observed in the adult, notably seminomas which are not observed before puberty. Other tumours occur only exceptionally. Orchiectomy after ligature of the spermatic cord is the usual treatment. Complementary chemotherapy and node dissection are not required as first intention therapy when the tumour is well localized (complete exeresis, no lymph node invasion, no pulmonary metastasis), but are reserved for relapse or residual tumours revealed by a secondary rise in alpha foetoprotein levels or by extension from the initial site. A present, in 80% of the patients with localized tumours, outcome is favourable without lymph node dissection or chemotherapy. The three-year survival rate is approximately 90%.
The renal transplantation in children has some specificities: urologic anomalies (vesico ureteral reflux, posterior urethral valves) are frequently the cause of the renal failure, and necessitate a thorough surgical preparation before transplantation (nephrectomy, reconstitution of urinary tract). The child must have a sterile, compliant and continent urinary tract on the day of the operation. In small children (< 15 kg), it is often necessary to operate through a transperitoneal incision, especially if the donor is an adult: the anastomoses will then concern the aorta and vena cava. The results are good, even better than in adults, except for very young children (under six years of age). Transplantation with living related donor (LRD) give the best results. Currently, the graft survival is 87% to 90% after three years with LRD, versus 65 to 77% with cadaveric donors.
The authors report a series of 76 children with lung metastases followed from 1974 to 1989. Forty-four children were operated on with 64 thoracotomies (50 wedge resections, 5 segmentectomies, 2 pneumonectomies, 6 biopsies, 1 excision of an inflammatory granuloma): 23 of these children are alive, and 17 of them without any adjuvant radiotherapy. Thirty-two were not operated on; of the 13 that are alive, 7 had no adjuvant radiotherapy. The indications for surgery were: to treat a complication of the metastasis, to verify persistent images on CT-scan, but essentially to avoid more aggressive treatment (chemotherapy, radiotherapy) with its risk of sequelae in children.
Bladder exstrophy and epispadias with incontinence are associated with urinary tract and genital anomalies. The genital and sexual aspects were studied in 14 adolescent or adult males (12 exstrophies and 2 epispadias). The appearance of the penis was satisfactory in fifty percent of cases. Erections were always preserved but normal ejaculations were present in only one half of cases. Fertility potential was reduced. The improvement of surgical technique, and especially penile lengthening, has greatly improved sexual intercourse for these patients.
The authors report ten cases of women with previous exstrophy of the bladder or epispadias with incontinence followed up to child-bearing age. Six of the ten females had urinary diversion and four retained their bladder and were continent. Three key aspects are considered: physical appearance of the external genitalia which was satisfactory in all cases; preservation of sexual function, known in only four of the ten cases and which was reported by these patients to be satisfactory, and finally, the ability to bear children. Three patients became pregnant resulting in four normal births (one patient had twins). Cesarean sections were recommended in patients with pregnancies at term. Cesarean should be performed systematically in patients with bladder reconstruction.
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Ten children with a major parietal defect, abdominal or thoracic, were operated by using a resorbable polyglactine network, during these three last years. On six children, the parietal defect was only deep, according to the surgical ablation of a parietal malignant tumor; on four other children, the defect was total, interesting the muscular and aponeurotic plan, but also the skin (two gastroschisis, and two septic eviscerations). Neither reject nor suppuration were observed. In case of total defect, a parietal reflection may be necessary in the long term.
The authors report twenty two cases of obstructive anuria observed in children. Causes are diverse: 6 cases were observed during the course of tumors, 4 cases were secondary to bilateral renal stones (or unilateral in a single kidney), 3 cases were observed before surgical correction of latent or well tolerated congenital uropathy, and 9 cases in the immediate postoperative period (including 8 after antireflux surgery). In the emergency situation, treatment of obstructive anuria is based on urinary diversion ideally by percutaneous nephrostomy under ultrasonic control. But prevention is the best treatment of anuria: treatment of urinary tract infections resulting in renal stones, in case of tumor, ultrasonographic survey of chronic upper tract dilatation: rigorous atraumatic operative technique avoiding any oedema.
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