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Biomedical subjects

H Dodat

Publications and source records attributed to H Dodat.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Value of the use of a vicryl-collagen tape for the treatment of cleft palate. Experimental study in dogs].

The purpose of this study was to evaluate the bone forming capacity of a Vicryl/collagene tape, placed in a defect of the palatal bone. In order to decrease the rate of bucco-nasal fistulaes after primary closure of a cleft palate, the authors carried out an experiment on dogs. First of all, we had to demonstrate the good tolerance of the tape in the buccal cavity. The first group of 5 dogs redieved the tape between buccal mucosae and palatal bone. The tolerance was excellent concerning the 12 biopsies on the mucosae after 1 month; 10 were totally normal and 2 revealed signs of inflammation on the medial incision. Concerning the second group, we needed to know the delay of bone formation of a "neo-palatal" defect; for that reason a 2 cm2 bone resection and a histological observation after 1 month and 1,5 months, in the right palatal bone was performed. Then we performed the same resection in 5 other dogs, and let the vicryl tape in the defect before closing the mucosae. The histological results of the second group showed that the ossification began after 1 month, and after 1.5 months the defect was totally covered by bone. The good results we obtained led us to go on with this experiment even if the low number of dogs included in this series does not allow us to a statistical evaluation. Exact responsibility of both, vicryl and collagene, has to be determined by a longer experiment, before realising the device in child's cleft palate.

Animals↗
PubMed1990

[A rare case of bladder exstrophy with a completely malformed complex in a girl].

Report of the observation of a female newborn presenting a complex malformative set: distal anorectal malformation without fistula; bladder exstrophy without epispadias, with cutaneous bridge; congenital urethrovaginal fistula; malformative sexual ambiguity with bulky genital tubercle, whole urethra, urethral meatus on the apex of the genital tubercle, associated with a mid labial genital joint and a high genital orifice; unilateral multicystic kidney; vertebral abnormalities with supernumerary thoracolumbar vertebrae; no karyotype abnormalities and no familial pathological history; no endocrine abnormalities. The therapeutic multistage program permitted a good reconstruction of the different lesion, particularly with bladder functioning witch in hope a good continence with two years of follow-up. No similar case is reviewed in the literature.

Abnormalities, Multiple↗
PubMed1990

[Endoscopic treatment of vesicorenal reflux in children. Review of three years experience and prospects for the future].

Endoscopic injection of teflon paste, used since 1984, represents an alternative to the surgical treatment of vesico-renal reflux. The success rate varies from 75 to 89% after a single injection and from 85 to 95% after two injections, according to the teams. The results are less satisfactory for the high grades and for refluxes on duplicity (25 to 45% failure rate). This technique is particularly attractive in the case of a difficult surgical intervention, notably when a reimplantation has failed, in the case of reflux on neurological bladder, urethral valves or exstrophy. Various causes of failure or relapse are considered. The advantages of the technique are obvious (low morbidity, very short hospital stay) and surgery is always possible in the case of failure. After one or two years, the reflux reappears in 2 to 9% cases. Long term results cannot be assessed as the follow-up period is too brief at the present time. For this reason, and although the endoscopic and surgical findings are reassuring, tolerance to teflon both locally and at a distance requires confirmation and other products such as collagen are now being used.

Adolescent↗
PubMed1990

[Development of the diagnosis and treatment of pyelo-ureteral duplication in children. Reflections on 179 cases].

The method of diagnosis and therapeutic rules for pathological ureteral duplicity has been highly developed over the last few years. Recent advances in fetal ultrasonography sometimes allow an early diagnosis of renal or intravesical cystic structure to be appraised before complications (urinary tract infection or pyelonephritis, prolapsed ureterocele, recurrent orchitis, primary diurnal and nocturnal urinary incontinence with conserved micturation for a young girl). However, the basis of therapeutic rules remain unchanged, the superior pyelocaliceal system is not preserved in most cases of ureterocele with ureteral duplicity or ectopic ureter, because of major cystic dysplasia; although, in some cases when an earlier diagnosis is made, conservative treatment (primary endoscopy followed by a surgical intervention if necessary) can be proposed. Likewise, the endoscopic injection of Teflon causes the vesico-ureteral reflux to disappear in most cases (70%).

Child, Preschool↗
PubMed1990

Relapsing urinary ascites.

A 2-year-old boy was operated on for a left ureteral duplication with bilateral vesicoureteric reflux. Ten years later, he experienced two episodes of transient ascites following abdominal traumatism. A cystogram disclosed a peritoneal fistula. The fistulous orifice was localized by cystoscopy, and surgery was undertaken with success.

Ascites↗
PubMed1989

[Correction of posterior hypospadias by a transverse vascular preputial graft, evolution of technics and results. Apropos of 42 cases].

During more than seven years 42 hypospadias were treated in on stage with different technics of urethroplasty by transverse preputial gauntlet grafts. With original Duckett's technic only 21,5% of patients had a good result. The authors reduced the risk of devascularisation first time by a personal modification then by using the double face flap described by Duckett himself; then the percentage of success after one operation overtake 75%. The different complications and their treatment are described and some operative details are pointed out to prevent complications.

Adolescent↗
PubMed1989

[Congenital mega-urethra. Comments apropos of a case report].

Congenital megalourethra is a malformation of the male urethra with a major dilatation of its penile part without obstruction downwards. It is either due to hypoplasia ore agenesia of spongy tissue. Two types are described, scaphoide and fusiform types, according to the presence or the absence of erectile tissue. Megalourethra is a rare condition, and 55 cases were previously reported until 1987. A new case of this severe anomaly is reported and management discussed.

Humans↗
PubMed1989

[Treatment of vesico-ureteral reflux in children by endoscopic injection of teflon. Evaluation of 2 years' experience].

Authors treated 131 children with vesicoureteric reflux by endoscopic injection of teflon (217 ureters). At one month follow-up, 88.04% of cases were treated successfully after the first injection, 93.22% of these good results were effective one year later. A complete correction was obtained in 89.3% after one or two injections. Most of recurrence was attributed to insufficient amounts of Teflon and to difficult anatomical conditions. Indications of this procedure and safety of the paste used are discussed.

Adolescent↗
PubMed1989

[Locoregional anesthesia in pediatrics].

Local anaesthesia may consist of a sensitive and a motor blockade. It is essentially used in human clinic for the sensitive blockade which is induced. All techniques or nearly are possible in regional anaesthesia for children if they are practised with discernment by a physician accustomed to the same techniques in adults. But caudal anaesthesia remains the most commonly performed and simple. The main advantages consist in abolition of intra- and postoperative pain, calm and comfort but also in a decrease of respiratory complications. There are two leading risks: infectious and especially toxic after an accidental injection of bupivacaine. These techniques should be systematically proposed but carefully carried out in all suffering children.

Anesthesia, Caudal↗
PubMed1989

[Management and treatment of uropathies detected in utero. Evaluation of 8 years' experience].

Over an 8 year period, the antenatal diagnosis of uropathy was made in 125 fetuses, but confirmed in only 22%; in the other cases, it was inadequate (50%) or wrong (28%). It was only in a few cases that surgery was any use in the first days of life (sectioning urethral valves, and temporary nephrostomy); in most cases, surgery was carried out between 1 and 3 months of age: total or partial nephrectomy (mainly for multicystic dysplasia and ureteral duplication with a ureterocele or ectopia), and usually conservative surgery (resection of the pyelo-ureteral junction, uretero-vesical implantation because of reflux or mega-ureter). The long-term results depend upon the degree of renal dysplasia: the prognosis was good in all cases of hydronephrosis that were operated on, but it is often poor when uropathies are characterized by early obstructive phenomena in intra-uterine life as occurs with urethral valves. In those cases, renal insufficiency cannot always be prevented by neonatal surgery.

Female↗
PubMed1989

[Endoscopic treatment of vesico-ureteral reflux using a sub-mucous injection of Teflon paste in children. Apropos of 337 patients (491 ureters)].

We reviewed our experience with endoscopic sub-ureteral injection of polytetrafluoroethylene (PTFE) in 337 children (84% females, 16% males). Four hundred and ninety one refluxing ureters were injected (93% primary reflux, 7% secondary reflux after reimplantation, correction of exstrophy of the bladder or neurogenic bladder). Reflux was: - stage I: 7.8% - stage II: 32% - stage III: 38% - stage IV: 20% - stage V: 2.2% Follow-up cystograms were performed one 428 ureters, 6 to 30 months after injection. 80% of children are cured after one injection while 4% required two injections in order to attain the same result. Improvement in the grade of reflux (minimal residual disease) was noted in 10% of the patients and in 6% the procedure failed. In the latter group, 16 children were operated on without difficulty; lymphatic migration of PTFE was noted in two cases. In the 33 patients with secondary reflux, the endoscopic treatment was associated with an 80% cure rate, in the 26 patients presenting a reflux on duplex systems, cure rate was 65%. This is a simple procedure performed on an outpatient basis; in our experience with 491 injections there were no complications at the time of injection nor there any postoperative ureteric obstruction. Endoscopic PTFE injections are less efficient than surgical reimplantation in the treatment of vesico-ureteral reflux. Teflon paste may not be the ideal material, other substances are presently being investigated. This technic is limited by the caliber of the urethra in young boys (Charrière 14).

Adolescent↗
PubMed1989

[Caudal anesthesia in pediatric surgery. Pharmacokinetic study and clinical significance].

In 1987, 758 caudal anaesthesia allowed the execution of 41% of all our department's operations. Urological, genital, inguinal and lower limbs surgery were the most frequent. The injection into the extradural space through the hiatus sacralis always included the mixture of lidocaine with bupivacaine to speed up the beginning of the operation. The patients were split up into 2 equal groups and were given 1.25 ou 2.50 mg.kg-1 of bupivacaine (i.e. 0.50 ml.kg-1 of a 2.50 or 0.50% solution). Bupivacaine plasma levels were determined by high performance liquid chromatography in 40 patients from the first group and in 42 patients from the second. They reached their maximum about 500 or 1,000 ng.ml-1 respectively, 30 mn after the injection and always fell back 4 hours after the administration. These concentrations were compared with the levels obtained by infusion to the dog, which cause serious cardiac disorders with 6,000 to 8,000 ng.ml-1 levels, and elicit ventricular fibrillation with 8,000 to 10,000 ng.ml-1. So the safety margin appears greater when overdose and/or intravascular injection are avoided. Caudal anaesthesia is easy, fast acting and allows to relieve post-operative pain. It is suitable for all surgery below the umbilicus and can be used on an outpatient basis.

Anesthesia, Caudal↗
PubMed1988

[Renal tumors in children, excluding Wilms' tumor. Apropos of 29 cases].

The authors present a multisource study of 29 kidneys tumors (Wilms excepted) in children. The most common types (18 cases) are tumors from metanephrogen blastema (congenital mesoblastic nephroma, nephroblastomatosis and nodular renal blastema, multilocular cystic nephromas. Mature kidney tumors are much more rare in childhood (8 cases): they are epithelial tumors (adenoma or adenocarcinoma) or mesenchymal neoplasms. In one case, histological study don't permit to list a malignant tumor to one of previous categories. Finely, among secondary tumors, two localisations of hemopathy are reported. After a limited exposure of cases and review of the literatures the authors emphasize the anatomo-clinical aspects, the value of paraclinical exams and the treatment of each type of tumor.

Female↗
PubMed1988

[Benign vulvovaginal tumefactions in children. General review illustrated by a series of 57 personal cases].

There are numerous etiologies of benign vulvo-vaginal tumefactions in children. However, the etiological diagnosis can usually be based on clinical data after careful examination. Para-urethral cysts are the main cause of labial and vestibular tumefactions; they are generally cured by simple puncture. Solid vaginal tumors are uncommon, but they always require surgical resection in order to exclude the exceptional and severe malignant tumours. Neonatal hydrocolpos is frequent in our experience and must always be treated surgically; associated malformations are frequent and must be systematically searched for. Ectopic prolapsed ureterocele and circular prolapse of the urethral mucosa are easily recognizable and need surgical treatment.

Adolescent↗
PubMed1988

[Care and treatment of uropathies detected in utero. Evaluation of an 8-year experiment].

Over an 8 year period, the antenatal diagnosis of uropathy has been evoked for 125 fetuses, but confirmed only in 22%; in the other cases, it was insufficient (50%) or wrong (28%). Early surgery was useful only in few cases during the first days of life (section of urethral valves, temporary nephrostomy); in most cases, surgery was performed between 1 and 3 months of age; total or partial nephrectomy (mainly for multicystic dysplasia and ureteral duplication with ureterocele or ectopy), and generally conservative surgery (resection of pyelo-ureteral junction, vesico-ureteral reimplantation because of reflux or mega-ureter). The long-term results depend upon the degree of renal dysplasia: the prognosis is good in all the cases of operated hydronephrosis, but is often poor in uropathies characterized by early obstructive phenomena during intra-uterine life such as urethral valves. In those cases, the course of renal insufficiency cannot always be prevented by neonatal surgery.

Female↗
PubMed1988

[The posterior approach in the treatment of hydronephrosis in children. Apropos of 65 cases].

The Simon posterior surgical approach to the kidney is excellent for pyeloplasty in children. The technique is reviewed and the advantages and limitation are discussed. This procedure has advantages of direct anatomic approach and excellent exposure of ureteropelvic area. In the newborn, the oral intake can be performed on the evening of surgery because there is no operative peritoneal mobilization. The posterior approach is especially recommended in simultaneous bilateral pyeloplasty. With transverse skin incision, a very cosmetic scar is obtained.

Child, Preschool↗