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Biomedical subjects

F Becmeur

Publications and source records attributed to F Becmeur.

At least 19 recordsLinked to original sources
PubMed1999

Retroperitoneoscopy versus laparoscopy in piglets: ventilatory and thermic repercussions.

BACKGROUND/PURPOSE: Endoscopic surgery of the retroperitoneal space in children is developing. During preliminary clinical experience, the authors were surprised by the differences observed in comparison with laparoscopic pneumpoeritoneum (PNOP); retropneumpoeritoneum (RPNOP) seemed to have less ventilatory repercussions. METHODS: The authors therefore undertook a study on animal models. Six suckling pigs, newly weaned, each weighing 10 kg successively underwent, at 8-day intervals and in random sequence, a right RPNOP with kidney and vena cava dissection, with insufflation of CO2 at 10 mm Hg of pressure and a PNOP with the same pressure of 10 mm Hg. RESULTS: P(ET)CO2 increased during PNOP, and it remained stable during during RPNOP (P = .035). The ventilatory peak airway pressures (PawP) increased during PNOP, but were not modified during RPNOP (P = .0001). Temperature decreased with time (P = .0001) without difference between the two procedures (P = .34). CONCLUSIONS: RPNOP was not associated with any adverse effects on the ventilation despite the insufflation pressure of 10 mm Hg, which allowed a satisfactory working area to be created. Operations by RPNOP could be developed in children with fewer respiratory repercussions than those observed during laparoscopy at an equivalent level of pressure.

Animals↗
PubMed1999

Tracheobronchial ruptures from blunt thoracic trauma in children.

BACKGROUND/PURPOSE: Tracheobronchial ruptures in blunt thoracic trauma in children are rare. The aim of this study was to suggest the means of an early diagnosis and a conservative management as often as possible. METHODS: Sixteen cases of tracheobronchial ruptures by blunt thoracic trauma were observed over 26 years in 9 regional pediatric centers. RESULTS: There were 12 boys and 4 girls, from ages 1 hour to 17 years. Nine children presented with associated lesions. Fibroscopy established the following diagnosis: 8 tracheal wounds and 8 bronchial wounds. Six children were operated on within 18 hours (on average) after installation of a thoracic drainage. Two lobectomies, 3 ideal tracheal sutures, and 1 bronchial suture were performed. Seven children were treated exclusively by thoracic drainage. Two of them were intubated through the lesion, leading to a transitory endoprothesis accompanied or not by an external thoracic drainage. One infant recovered spontaneously. There were no deaths in this series. Two recurrent postoperative nerve injuries were noted, one of which was a transitory spontaneously resolutive scar bud and one a granuloma treated by laser. Three times, a stenosis occurred after a conservative management. Two were operated on. CONCLUSIONS: Tracheobronchial ruptures in children are rare. An early fibroscopy holds an important place in the approach of this pathology. Treatment is variable, based on thoracic lesions, their tolerance by the child, and associated lesions. Surgery is not the only therapy because conservative treatment by simple thoracic drainage or lesion intubation has proved effective.

Adolescent↗
PubMed1999

[Should varicoceles be treated in the adolescent? How?].

Adolescents rarely consult for painful varicocele. The condition has to be confirmed by physical examination and a detailed Doppler exam. An ultrasound may be necessary to measure the size of the testis. About 15% of all adolescents have varicoceles. One out of three is graded II or III in the Dubin and Amelar classification. About 20% of varicoceles graded III occur in association with testicular hypotrophy. We do not know whether boys with a varicocele will fertility problems later on, but only 13% of adult men with varicocele are infertile. Surgery can be considered as necessary only after studying a large number of patients, comparing at random patients operated at a young age and followed for 15-20 years with patients not operated and with a group of healthy controls. The best treatment has to be selected because of the low risk of testicular atrophy and the disappearance of the varicocele in more than 90% of the cases. Inguinal root with microsurgery, and pre or intra-operative radiologic opacifications are the usual choice of most pediatric surgeons. Laparoscopy or retroperitoneoscopy have no major impact on the postoperative results. They are expensive and require great experience. Embolization and other radiological techniques induce a long period of radiation, are not always possible, expensive and demand an experienced radiologist. General anesthesia is required because of the time involved and finally the success rate is low. Microsurgical venous reanastomosis is still confidential probably because of technical difficulties. Scrotal anterograde sclerotherapy is the simplest and cheapest treatment and can be performed with a local anesthetic due to the short time required. But like other procedures, it can induce testicular ischemia.

Adolescent↗
PubMed1999

[Prenatal and neonatal management of digestive tract duplications. Diagnostic difficulties and therapeutic implications].

OBJECTIVE: To insist on the difficulty of the antenatal diagnosis of digestive duplications, to show the importance of a complete malformative screening, and the need for immediate management at birth. MATERIAL AND METHODS: A cystic duplication of the tongue, a duplication, abdomino-thoracic transdiaphragmatic, and a duplication of the small bowel are described and compared with cases previously reported in th literature. RESULTS: Antenatal evacuation puncture of a duplication of the tongue must be reserved for exceptional situations. Foregut duplications are often associated with other malformations. The duplication of the small intestine can exceptionally expose to a mechanical complication, mostly during the postnatal period, which may require emergency surgery. CONCLUSION: Duplications of the alimentary tract should be detectable on prenatal ultrasound examination. A complete antenatal malformative screening is required and in utero transfer is warranted because emergency surgery may be required.

Abnormalities, Multiple↗
PubMed1998

Pulmonary sequestrations: prenatal ultrasound diagnosis, treatment, and outcome.

BACKGROUND/PURPOSE: With the development of antenatal diagnosis of pulmonary sequestrations, the authors decided to define more accurate perinatal operative indications. METHODS/RESULTS: Antenatal ultrasound scanning (US) enabled the diagnosis of congenital pulmonary malformation in 10 cases between the twentieth and the thirty-third week of amenorrhea (WA; average, 26 WA). An absolute or relative regression of the thoracic mass size was observed in five patients. The systemic arterial blood supply was identified in four patients by Doppler US. Two fetuses required treatment. One of them suffered from a voluminous sequestration, larger than one hemithorax, with polyhydramnios. Three successive paracentesis of ascites and amniotic fluid allowed the pregnancy to continue until term. The second fetus had a sudden left hydrothorax at 30 WA and was treated by a pleuroamniotic shunt. Five spontaneous partial involutions of the mass during the antenatal period were observed. The 10 patients underwent surgery after birth. There was no mortality. Morbidity occurred in one case of antenatal treatment. Twenty-eight other cases of antenatal diagnosis of pulmonary sequestration have been described in the medical literature. Spontaneous involution of the mass has been reported in eight fetuses and its complete disappearance in two cases. Thirteen fetuses had polyhydramnios. Five of these progressed spontaneously without treatment; only two survived. Two other fetuses were drained or punctured, and one survived. Premature deliveries were undertaken for the six other fetus; there was one perinatal death. CONCLUSIONS: Sequestrations with polyhydramnios may be treated in an early prenatal period. Mortality and morbidity rates are still high. At birth, large-sized sequestrations (more than half a hemithorax) must be operated on, even in cases of no respiratory distress. Medium-sized sequestrations must be operated on to remove the mass. Small and asymptomatic sequestrations must be operated on in case of intralobar forms (often cystic), or with a big blood supply. The artery may be responsible for severe complications (hemoptysis, aneurysm).

Bronchopulmonary Sequestration↗
PubMed1998

Treatment of small-bowel obstruction by laparoscopy in children multicentric study. GECI. Groupe d'Etude en Coeliochirurgie Infantile.

In May 1996, the team working on infantile laparoscopy (GECI) carried out a retrospective study (using questionnaires) to analyse the use of laparoscopy in child postoperative obstructions (involving bands or adhesions). Of the 86 laparoscopic attempts, 66 could have been performed without conversion. Technical difficulties were responsible for the majority of the conversions performed on children aged 3 years younger than the average age in this study (10 years old). Digestive perforation accounts for a fifth of conversions, the perforations either occurring when the operational trocars were introduced (3 cases), or during viscerolysis (2 cases). For 5 children the treatment failed at an early stage (in the month following the operation). Relapses occurred in 3 children, usually at a later date (between 6 months and 3 years). Laparoscopic treatment of bowel obstruction should always be attempted, for as the results of the study show, morbidity is low and mortality is nil and the postoperative phase is quick and painless.

Child↗
PubMed1998

[Color Doppler in the prenatal diagnosis of umbilical cord hernia].

Pathologies of the fetal ventral abdominal wall are easily diagnosed by antenatal ultrasonography. The most common anomalies are omphalocele, often associated with other malformations or chromosomal abnormalities, and gastroschisis. We describe an antenatal diagnosis of umbilical cord hernia which could be confirmed by color Doppler. This entity is important to know not to put the umbilical clamp on a bowel loop after delivery.

Adult↗
PubMed1998

[Hepatic trauma: pediatric features].

Conservative management of hepatic trauma has been demonstrated to be effective in children. However, surveillance of these patients in a specialized paediatric surgery unit is essential because of the possibility of rare, but unavoidable complications. The authors review the 20-year experience of conservative management of hepatic trauma reported in the literature.

Blood Transfusion↗
PubMed1997

The pregnant ewe: an animal model for fetoscopic surgery.

OBJECTIVE: To develop an animal model for fetal endoscopic surgery which could be feasible and reproducible. The aim of this work was to perform a fetoscopy without the need of a laparotomy. METHODS: Pregnant ewes underwent under general anesthesia laparoscopy with the creation of a maternal pneumoperitoneum. After localizing the placenta by transillumination, we carried out fetoscopy through a 5 mm trocar using a perfusion of Ringer's solution. RESULTS: Five video-assisted procedures have been performed. None of the cases has shown any bleeding from myometrial wounds and no suture was necessary. There was no leakage of amniotic fluid. Intrauterine space was large enough to manipulate instruments without producing any fetal damage. Sharp visualization and anatomical description of the fetus were precise without the use CO2. There were no miscarriages and postnatal examinations of the lambs were normal. CONCLUSION: Fetoscopic surgery can be performed in the pregnant sheep without any complications but preterm labor which is the main problem in human fetal surgery, is infrequent in the sheep. Our model is reproducible and simulates the surgical endoscopic procedures which will occur in a close future in the human species.

Animals↗
PubMed1996

Diversion of salivary flow to treat drooling in patients with cerebral palsy.

The authors performed six sialodochoplasties between 1991 and 1994 to treat drooling in six children who suffered from cerebral palsy. There were three boys and three girls, aged 13 to 22 years (mean, 16 years). All patients underwent parotid duct rerouting. The first four patients (group I) also underwent associated excision of submandibular ducts, and the last two patients (group II) benefited from rerouting of the submandibular ducts. In group I, results were considered good in two cases, fair in one case, and poor in one case. A fistula of the new Stenon duct appeared in one patient, which required excision and ligation followed by progressive involution of the parotid gland. Both group II patients had excellent and rapid results. The requirements leading to surgical decision are determined. The importance of physiotherapy is emphasized. Surgical techniques are described and discussed, as are objective criteria for the assessment of surgical results, namely salivary radioisotopic scanning.

Adolescent↗
PubMed1996

[Common mesentery: clinical and therapeutic aspects in children. Apropos of 58 cases].

Fifty-eight children with isolated malrotation of the midgut were treated in our service between 1970 and 1993. They presented with acute bilious vomiting in 75% of cases. The remaining 25% consulted for various digestive symptoms. Diagnoses were established by an upper gastrointestinal radiographic study. Prognoses were good whenever an emergency operation was performed.

Barium Sulfate↗
PubMed1996

Relationship between intraperitoneal hydrostatic pressure and dialysate volume in children on PD.

As a result of the theoretical risk of an excessive increase in intraperitoneal pressure (IPP) in association with peritoneal dialysis, reduction of instilled intraperitoneal dialysate volume (IPV) is often proposed in infants compared to adults; a further reduction is often noted in neonates compared to children. To better evaluate the significance of this risk, we have tested the relationship between the IPP (cm of water) and the IPV (mL/m2) in our population of children on peritoneal dialysis (n = 17) during the last three years. IPP was measured after a nocturnal dialysis session, during a morning study day, after sequential exchanges of ten minutes' dwell time each, with progressively increased instilled dialysate volumes from 600 to 1400 mL/m2. Mean IPP values were 8.2 +/- 3.8 cm for a mean IPV of 990 +/- 160 mL/m2 body surface area. These values are lower than the IPP values established for adults (13.4 +/- 3.1 cm), which were given for higher IPV values of 1585 +/- 235 mL/m2. The relationship between IPP and IPV was age-dependent. In neonates, stable IPP values (3.5 +/- 1.6 cm) were noted for IPV from 600 to 800 mL/m2; thereafter, increasing IPV led to an increase in IPP. In the range of 600 to 1200 mL/m2 IPV, no significant increment of mean IPP was noted in infants (4.8 +/- 2.6 cm) and in children (9.6 +/- 2.1 cm). However, increasing the dialysate volume over 1000 mL/m2 induced an overincrement of the individual IPP value in most cases, and the rise of IPP was substantial when IPV rose from 1200 to 1400 mL/m2.

Adolescent↗
PubMed1996

[Small bowel obstruction and laparoscopic treatment in children].

From 1992 to 1996, 15 children with an acute small bowel obstruction were treated by laparoscopy. There were 10 boys and 5 girls between 6 to 15 years. They had been formerly operated in the neonatal period (4 cases), for appendectomy (9 cases), or ureteronephrectomy for Wilm's tumor (1 case), and caudal pancreatectomy after a traumatism (1 case). Thirteen times it was the first obstruction and twice the second or more (but never treated by surgery). Conversion in laparotomy was necessary in 4 cases. There were no operative complication. We noted a quick recovery (12 hours), an early discharge (3.5 days), and a good postoperative comfort. Laparoscopic viscerolysis for acute small bowel obstructions seems to be a good treatment in children.

Adolescent↗
PubMed1995

Auxiliary liver transplantation for fulminant and subfulminant hepatic failure.

We report the first series of 9 auxiliary liver transplantations performed as a bridge to recovery in 8 patients with fulminant and subfulminant hepatic failure. Hepatic failure was due to hepatitis A virus (n = 3), hepatitis B virus (n = 1), hepatotoxic drugs (n = 2), autoimmune disease (n = 1), or it was of unknown origin (n = 1). The donor liver was reduced to a left lobe (n = 2), a left liver (n = 4), or a right liver (n = 3), and was implanted in an orthotopic position beside the native liver after it was resected by a left or a right hepatectomy. Conventional immunosuppression was used to prevent rejection. Six patients regained normal consciousness within 2 weeks, without any sequelae. Two patients had persisting encephalopathy due to graft initial dysfunction, one of whom showed portal vein thrombosis, which was successfully cleared. The other one showed hepatic vein stenosis and was retransplanted at day 15. Five of eight patients had to be reoperated because of a surgical complication. Five patients showed rapid regeneration of their native liver, but one died at day 45 from severe herpes virus broncholitis. The auxiliary grafts were removed (n = 3) or left to atrophy by tapering immunosuppression (n = 1). One patient developed cirrhosis of the native liver and died of infectious complications at day 42. The native livers of the two remaining patients are still atrophic, one at 4 months and one at 1 month posttransplant. Finally, 6 of 8 patients are alive with a follow-up of 1 to 17 months. Four of them have permanently stopped their immunosuppressive therapy. Our experience demonstrates that auxiliary orthotopic liver transplantation (1) is feasible in children and adults, using either a left or a right liver graft, (2) is efficient in providing adequate liver function, and (3) gives a real chance to the native liver to regenerate, offering these patients a future free of immunosuppression.

Adolescent↗
PubMed1995

Spontaneous regression of fetal pulmonary sequestration.

The prenatal diagnosis of pulmonary sequestration can usually be made by the third trimester of pregnancy, from the combination of an intrathoracic mass and indirect signs such as cardiac deviation, fetal hydrops, pleural effusion and polyhydramnios. We describe four cases in which pulmonary hyperechogenicity was detected before 26 weeks' gestation. In three cases the hyperechogenic mass was isolated. In all cases it had mostly regressed during the pregnancy. A review of the cases of isolated pulmonary sequestration that have been diagnosed during the antenatal period is presented. Antenatal evolution was found to be unpredictable regardless of the type or severity of the case at the first diagnosis. We propose a classification to define more clearly the optimal management of pulmonary sequestration.

Adult↗