Biomedical subjects
Publications and source records attributed to G Audry.
A lipoma of the preputium clitoridis was found in a newborn girl. Ambiguous genitalia was first suspected. Surgery was successfully performed at 5 months.
A total of 543 boys suffering from acute scrotal pain underwent emergency surgery between 1986 and 1996. Of these, 91 had a testicular torsion (TT) (16.8%) and 250 had an appendage torsion (AT) (46%). The cause varied with patient age, with most TTs in newborns and boys of 15 years and most ATs in 10-11-year-olds; 21.5% were operated upon within 6 h of the onset of pain and 69.2% within 24 h. Most stayed in hospital for less than 24 h. Pre-surgical examination identified no criterion for excluding TT. We therefore believe that all children complaining of acute scrotal pain should undergo surgery. As release of an inflamed AT reduces pain, three-fourths of the children benefited directly from surgery.
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.
PURPOSE: The effectiveness of laparoscopic diagnosis of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia was evaluated. METHODS: Ninety-three consecutive children under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral CPPV was diagnosed by laparoscopy via the inguinal hernia sac before ligation. The laparoscopy results of this technique were correlated with those of herniography or inguinal exploration. RESULTS: Laparoscopy was performed on 88 patients; sensitivity was 71% and specificity 89%. The only complication arising from the procedure was wound infection in two patients. CONCLUSION: This method is a simple, safe, and accurate procedure for selecting children for contralateral surgical exploration.
OBJECTIVE: To evaluate the morbidity of ambulatory repair of anterior hypospadias with a transurethral vesical catheter (TUVC) draining the urine between 2 diapers. MATERIAL AND METHODS: 34 children divided into two comparable groups were operated for anterior hypospadias. Group A comprised 17 children operated by ambulatory surgery, with catheter drainage of urine between 2 diapers. Group B consisted of 17 children operated by a conventional inpatient procedure, with the catheter connected to a urine collector. Postoperative complications and the results of a satisfaction questionnaire sent to the parents of children in group A are reported. RESULTS: In group A, one case of TUVC dysfunction was reported and 13 parents declared to be satisfied. One urethral fistula occurred in group B. CONCLUSION: Ambulatory repair of anterior hypospadias with TUVC draining urine between 2 diapers does not induce a higher complication rate than when repair is performed by conventional hospitalisation with the TUVC connected to a urine collector. Urine drainage by TUVC is not a contraindication to ambulatory surgical repair of anterior hypospadias in children.
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.
OBJECTIVES: Definition of prognostic factors for torsion of the testis in children. MATERIAL AND METHODS: From January 1986 to December 1996, 91 children were operated for torsion of the testis. Torsions were observed at all ages of childhood, but with two frequency peaks: during the neonatal period and in adolescence. Typical clinical features were observed in only three-quarters of cases. RESULTS: Thirty-nine testes were considered to be necrotic versus 52 with a chance of recovery. Factors of poor prognosis were: neonatal forms, delayed management or tight torsion with several turns. 28 of the necrotic testes were conserved: two were complicated by purulent necrosis, but 14% retained normal trophicity on long-term examination. CONCLUSION: The possibility of torsion at all ages of childhood and the frequently incomplete clinical features means that emergency surgical exploration must always be performed in the case of testicular pain. A conservative attitude is motivated by the possibility of recovery of testes considered to be necrotic at operation.
BACKGROUND: Intestinal stenosis following necrotizing enterocolitis (NE) occurred both in surgically-treated neonates after perforation, distal to an enterostomy and in medically-treated patients developing symptoms of obstruction. It has been proposed to detect stenosis by contrast enema before refeeding in those medically-treated patients. The aim of this study was to compare delay, clinical and pathological characteristics of surgical and medical patients, both after occlusion and prospective contrast studies. PATIENTS AND METHODS: Fifteen patients out of 50 with NE observed from 1984 to 1994 developed one or several intestinal stenosis. Diagnosis of NE was based on usual clinical signs, X-ray pneumatosis (43 to 50) and/or perforation in 16 cases. Among these 16 surgical patients, 12 survived the initial perforation. Among the 34 medical patients, 11 were seen before 1989 and did not have contrast studies before refeeding; 23 seen after 1989 had a contrast enema before. RESULTS: One or several stenosis occurred in four out of 12 surgical patients, four out of 11 medical patients without prospective contrast studies (one of them died from sepsis) and seven out of the 23 of the prospective group. On the whole, 26 stenosis occurred in 15 neonates: ten to the right colon, five to the transverse and 11 to the left colon. One ileal stenosis followed enterostomy. Delay of stenosis development was comparable in the three groups (between 3 weeks and 3 months). Pathologic examination showed similar lesions in the three groups (fibrosis 15, edema nine to 15 and chronic inflammation 12 to 15). CONCLUSION: Among 46 neonates who survived the initial period, 15 developed stenosis, a 30% proportion similar in patients operated on for perforation or in medically-treated patients whose diagnosis was made after occlusion or after contrast enema as well. These results suggest that systematic stenosis detection by contrast enema may avoid complications and permit programmed one-stage surgery.
The umbilical incision is a new approach for the curative procedure of hypertrophic pyloric stenosis in order to avoid the cosmetic impairment from the right upper quadrant incision. Our purpose was to evaluate the morbidity of the two approaches. One hundred and eighteen children operated on through an umbilical incision (UMB) from 1992 to 1994 were retrospectively compared with 121 children who underwent standard incision, in the right upper quadrant (RUQ), from 1989 to 1991. The two groups were homogeneous with regard to age, sex ratio, weight, and prematurity rate. Mean operating times were longer in the UMB group (52 [ +/- 14] minutes versus 38 [+/- 14] minutes, p < 0.001, t test). Morbidity was not significantly different with regard to mucosal perforations, vomiting during the first 24 postoperative hours, wound infections, stenosis relapses, and wound dehiscences. Postoperative hospital stays tend to be shorter in the UMB group as compared to the RUQ group. Thus, despite slightly increased mean operating times, the umbilical incision did not modify the morbidity of pyloromyotomy and left an almost undetectable scar.
Eight cases of rupture of the posterior urethra were observed in children and treated via a trans-symphyseal approach. Repair was easy in the cases seen rapidly (2 to 10 days), urethral suture was effective and the result was excellent. On the other hand, in cases seen later (6 cases), between 6 months and 5 years, marked fibrous callus had to be resected. Urethral repair was not always possible (only one failure out of 6 late cases). This approach preserves genital functions.
OBJECTIVES: This study evaluates the place of percutaneous nephrostomy (PCN) in neonates with posterior urethral valves (PUV). MATERIAL AND METHODS: 11 neonates with PUV, 10 of which were diagnosed antenatally, were treated. PCN drainage was performed in 9 cases, prior to endoscopic resection. Six PCN were bilateral and 3 were unilateral, for the following indications: renal failure in 5 cases, severe infection in 2 cases, evaluation of a dilated kidney in 2 cases. RESULTS: These PCN were left in place for an average of 18 days. Two cases of asymptomatic postoperative bacteriuria were observed. One nephrectomy and one cutaneous ureterostomy followed by reimplantation for megaureter were performed on the diverted kidneys. CONCLUSION: PCN has become the method of upper tract diversion in most cases of neonatal PUV. In addition to the classical indications (severe urinary tract infection, renal failure), it allows perfectly safe resection of valves in the case of upper tract dilatation and assessment of the kidneys.
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.
Collagen-coated Vicryl mesh (C.C.V.M.) was used in 28 children who needed repair of thoracic and abdominal wall defects. Herein the authors report the clinical experience, surgical technique, and outcome in these cases.
The congenital uro-enteral fistula are observed essentially in boy and quite exclusively with anorectal malformation. Cloacal anomaly in girl and cloacal exstrophy in both sexes are so exceptional than complex malformations.
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A two-year-old boy was referred for correction of an amputation of penis following ritual circumcision. The reconstruction involved mobilization of the profound part of corpora cavernosa and coverage by a vascularised flap taken from the hypogastric area through the use of a sub-cutaneous expandable prosthesis. After two years, appearance of the neo-penis is satisfactory considering the initial lesions.
To study the risk of wound infection in pediatric outpatients, two series of children operated on with an inguinal incision during a 5.2 year period in the same department, either in day-surgery or in standard hospitalization, are compared. It appears that the frequency of inguinal wound infection is lower for outpatients (1%; 18/1816) than for inpatients (4%; 17/427). This difference is due, on the one hand, to the way day-surgery hospitalization functions and, on the other hand, to the difference of population produced by the criteria for selection for admission in the Day-Surgery Unit.
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.