Biomedical subjects
Publications and source records attributed to F Becmeur.
The different stages in the medical use of Teflon are recalled. After animal experimentation which started in 1949, Teflon has been used in humans since 1962 in otorhinolaryngology, since 1973 in urology and, more recently, since 1984 in the treatment of vesicorenal reflux. The long-term future is still uncertain, especially with regard to children, for whom life expectancy is long.
We report our experience with the endoscopic treatment of vesicoureteral reflux by a submucosal injection of Teflon in children. During a period of 20 months, 291 refluxing ureters were injected by 4 members of our surgical team. A cystography was performed 3 months later. Because 53 children have a follow-up of less than 3 months, we only consider the remaining 201 ureters. The success rate is 92% which is similar to that of surgical treatment. We insist on some precautions and contraindications. Endoscopic treatment is an undeniable progress, but surgical treatment is still required in some cases.
This study, based on the analysis of four samples of terminal ureter obtained at surgical resection, intends to relate the macroscopic and histologic aspect of lesions induced by Teflon injection in the ureteral wall. 6 months after the first injection and 3 months after the second one, the free ureteral lumen is compressed by an intraparietal nodule containing a central area of Teflon spherules and a rim of macrophages and resorptive multi-nucleated giant cells surrounded by a line of connective tissue without a mutilating sclerohyaline reaction. This study, however, is unable to prejudge the long-term future of Teflon or the aspect of the ureteral wall when treatment is efficient.
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.
We report a case of umbilical cord angioma in a female newborn. Ultrasonographic antenatal diagnosis had suspected either an omphalocele or a tumor of the umbilical cord. A caesarean had been decided at term. Surgery was necessary to ligate the umbilical vessels. The cord was 37 cm long and 7 cm large in several places. It weighed 495 g. The interest of this case resides in its rarity. First description of this kind of tumor was made by Gerdes in 1864 and since, only 20 cases have been reported. Antenatal diagnosis difficulties in umbilical cord tumors are reviewed. Vitelin cyst, angioma, and teratoma represent the most common diagnosis which are histologically and clinically discussed. Associated malformations and complications of umbilical cord angioma are reviewed in the literature.
24 cases of disruption of the perineum from 8 Centres of Pediatric Surgery in France, were studied. The patients were aged between 4 months and 13 years, with an average age of 6.7 years, and 70% were boys. The cause of the injury was crushing in 13 cases. The associated were complex. Fractures of the pelvis (18) and associated multiple fractures (13), as were as profuse pelvi-peritoneal haemorrhages arising from fractures (3) or lower limb amputations (3) determined the care of associated soft-tissue injuries. Disruptions of the skin were almost constant and displayed a high rate of sepsis. There were noted lesions of the ureter (9), the vagina (5), the anus and rectum (17), the ano rectal sphincter (10) and the penis (1). The care of each of these lesions followed the usual practices of Reparative Surgery specific to each organ, but was also adapted to each case. In effect, disruptions of the perineum take place in a context of serious polytrauma, where the hierarchy of urgency determines the choice of therapeutic attitudes.
We report the case of a patient with limy bile located in both the gallbladder and common bile duct, and disappearing spontaneously. Since the first description of this syndrome in 1911, approximately 300 cases have been reported in the literature, including 20 cases with double localization. The male/female ratio was 1/3. All patients were more than 40 year old. Conventional radiogram was sufficient to establish diagnosis. Spontaneous disappearance of limy bile is rare. The etiopathogenesis remains unclear; cholecystectomy is appropriate.
The authors report a new case of splenic artery congenital aneurysm. With regards to the surgical procedure, they insist on the necessity of a massive resection and remind a particular surgical procedure which allows to restore the colonic continuity with fittest conditions.
A retrospective study was made from the records of 68 patients who had temporary loop colostomy with left colectomy between 1975 and 1985. Six fecal fistula occurred. Two of these patients died in spite of the colostomy. The colostomy closure was complicated by six leakages and four wound infections. The results are compared with those from literature. Finally loop colostomy for protecting an anastomosis keeps good indications with sub-obstructions and acute obstructions without large colectasia, infections without abscess, bowels no or bad prepared, and some low colo-rectal anastomosis. Large bowel obstruction with megacolon, and peritonitis avoid all kind of anastomosis. The colostomy closure is a high colonic surgery procedure. It must occur three months after its formation. A barium enema is necessary before loop colostomy closure.
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Can we decrease the risk of recurrence of Crohn's disease by wide resection on either side of the pathological zone? A retrospective study of 58 cases of operated Crohn's disease analysed on the basis of the histological appearance of the limits of resection revealed that this element had no influence on the outcome of the disease. The patients were divided into two groups according to the histology of the limits of resection: Group A: healthy tissue at the limits of resection Group B: pathological limits Out of the 18 cases of recurrence, 13 occurred in cases with healthy limits of resection and 5 occurred in cases with pathological limits of resection (N.S. X2 = 0.435). There was no significant difference in the interval between the initial operation and the recurrence in the 2 groups of patients. These results justify the limited resection for Crohn's disease, with the removal of a small border of healthy tissue, which is best evaluated by intraoperative macroscopic examination.
A scaphoid megalo-urethra was diagnosed in a premature, free of other associated malformations. Surgical correction by Nesbitt technic was performed at 2 500 g weight. The follow-up was uneventful and the cosmetic appearance of the penis is good. High rate of consanguinity is noted. The reported case is exceptional because 75% of the patients exhibited severe upper urinary tract anomalies. Prune belly and imperforate anus are also frequently associated.
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Cystic adrenal masses are unusual in the fetus. The most common diagnosis for adrenal cyst is hemorrhage. We report 2 cases of cystic neuroblastoma diagnosed prenatally by ultrasound. In each case, diagnosis was confirmed in the neonatal period first by scintigraphy, then by histology. Differential diagnosis and management after delivery are discussed.
We report the prenatal diagnosis of a hepatic hemangioma presenting as a heterogeneous mass (6 x 5 cm) of the fetal liver, thickly septated with calcifications. Pulsed Doppler confirmed the vascular pattern of the mass. Subsequent postnatal examinations and follow-up have documented the spontaneous regression of this benign tumor. Antenatal diagnosis of fetal liver masses and management after delivery are discussed.
A 4 years boy with fulminant hepatitis due to virus A, underwent a temporary auxiliary liver transplantation. The graft which consisted in an adult reduced-liver, was implanted orthotopically after a left hepatectomy was performed on the recipient own liver. A good liver function was immediately restituted and the remaining native liver, that was 90% necrotic at time of transplantation, regained normal histological structure within 3 months. The auxiliary graft was then removed and immunosuppressive therapy permanently stopped.