Biomedical subjects
Publications and source records attributed to H Dodat.
Enterolithiasis in two neonates with oesophageal and anorectal atresia is reported. The features of the two cases and comparison with the literature, the particular appearance of these intracolonic calcifications and the importance of radiological examinations for associated digestive, urinary and pulmonary malformations are presented.
The authors report a very unusual case of urethral tumor in a child: fetal rhabdomyoma, after nephroblastoma treated by enlarged nephrectomy. Excellent result is observed four years after endoscopic treatment of this prostatic urethral tumor. Clinical and histological features of posterior urethral tumors and rhabdomyoma are recalled; the association nephroblastoma-tumor of urethra is discussed.
Twenty-three infants and children with primary or secondary vesico-ureteric reflux (representing a total of 38 reflux) were treated by endoscopic injection of Polytef paste with 86% complete corrections of the reflux after the first injection, and 92% after the two injections. These results are comparable to those published so far in the literature. There were no secondary stenosis. There is, however, a need for a more prolonged delay to correctly evaluate its long-term efficiency. This technique appears safe and efficient. Furthermore, it has an interesting economical aspect since it requires a maximum of two days of hospitalisation.
Epidermolysis bullosa associated with pyloric atresia is a rare autosomal recessive condition, usually fatal in the first few months of life. Since 1983 urinary tract disease is known to be another manifestation of this syndrome which becomes the main problem in children surviving beyond infancy. The case of a 2 1/2 year-old boy with mild cutaneous manifestations of junctional epidermolysis bullosa, corrected pyloric atresia and renal disease is reported. Hematuria, dysuria, obstruction of the uretero-vesical junction and worsening hydronephrosis led to bilateral ureterostomy (ureteral reimplantation was not attempted because the thickness of the bladder wall and the extensive ureteral fibrosis).
A congenital atresia of the bulbo-membranous urethra had been reported. The atresia extended for 1.5 cm. It presented early in the neonatal period with major dilatation of the upper urinary tracts. After a preliminary urinary diversion, the surgical repair through the perineum was done at the age of 18 months. Such cases are not seen frequently. This atresia must be differentiated from posterior urethral valves type III, and from other stenoses either iatrogenic, traumatic, or inflammatory. The partial atresia is the only type compatible with life. It may be presented in two forms: annular constriction or extended stenosis. The mechanism of evolution is not very clear: it is either due to a bad resorption of the urogenital membrane or a defect in the embryogenesis of the urethral tube. Treatment differs according to the site and extent of the lesion simple dilatation, internal urethrotomy, or urethroplasty in one or several stages can be done.
629 ureteric reimplantations were performed in 356 children. Indications for reimplantation were 315 uni or bilateral ureteral reflux, 248 primary reflux and 67 secondary to ureteric duplication, ureterocele, vesical diverticula, neurogenic bladder, bladder neck obstruction, or ureteral obstruction, and 52 megaureters, 38 primary and 14 secondary megaureters. 61 reimplantations (14 megaureters) by Leadbetter-Politano, and 568 reimplantations (58 megaureters) by Cohen procedure were performed. 3 psoas hitching and 15 ureteroplasties, 14 Hendren and 1 Kalicinski procedures, were necessary. Primary results in reflux were 98.5% of success with Cohen operation and 100% with Leadbetter-Politano operation. Results were not so good in megaureter, 70% of success with Leadbetter-Politano operation and 75% with Cohen. Results were better with psoas hitching and ureteroplasty (86.5% of success).
Midline cervical cleft and webbing is a rare congenital anomaly of the neck. A series of 4 cases is reported, among which 2 relapses. The neonatal diagnosis of the deformation leads to a surgical treatment for the first two years, associating excision of the cleft with its underlying fibrous cord, and closure with local plasty (wave-plasty, multiple Z-plasty). However, relapses are possible. They show evidence of a real regional hypoplasia that will require the contribution of tissue. Myo cutaneous flaps are used in 3 cases. The possibility of tissue-expansion is discussed. Mandibular surgery may be necessary at a later stage (genioplasty).
The authors have tried to evaluate the value of fibrin adhesive in 85 cases of urogenital surgery in children. The local hemostatic effect seems to be very useful in urethroplasty for hypospadias. Its application in vesical, ureteral or urethral sutures probably prevents fistulas.
23 cases of primary testicular tumors (TT) were observed in 6 different French divisions of Pediatric Surgery during a 10 year period. This series combined with a survey of the literature serve to stress the rarity of such tumors in boys under the age of 15 years. Yolk sac tumors are the most frequent ones (40%), followed by teratomas (32.5%) which, in children and in this localization, are almost always benign tumors of nongerminal origin, in particular rhabdomyosarcomas and tumors of sexual cords, represent 22% of an TT. They are different from what is observed in adults, in whom the most frequent tumors are seminomas, embryonal carcinomas and teratocarcinomas. Most testicular tumors reveal themselves as unilateral testicular masses. High serum alpha-foeto-protein is specific to yolk sac tumors and its post-operative surveillance is mandatory. Scrotal ultrasonography constitutes the main investigation in view of diagnosis and also serves to detect less evident tumors in case of precocious puberty, gynecomastia. Since lymphatic invasions are unusual in children, surgical exploration of the retro-peritoneal space is no longer considered necessary for the stagging and is replaced nowadays by ultrasonography and CT scan. In case of teratomas and others benign tumors, high inguinal orchiectomy is sufficient; in certain cases (well-delineated and superficial tumor in single-testis), tumorectomy alone is possible. As concerns Yolk sac tumors, the addition of chemotherapy from the age of 2, cures more than 90% of stage I tumors; radiotherapy is necessary when it comes to stage II or III. As for testicular rhabdomyosarcomas, in which prognosis is better than in others areas, the combination of surgery, chemotherapy and perhaps radiotherapy is able to cure from 80 to 90% of them.
Primary peritonitis is rare condition in children. Twelve cases in previously healthy children is reported. The diagnosis was made at laparotomy in the absence of intra-abdominal findings, such as intestinal perforation. Organisms was isolated from peritoneal fluid in 7 cases, Staphylococcus aureus in 3, Streptococcus pneumoniae in 2, beta-hemolytic Streptococcus and E. coli in 1. Peritoneal fluid cultures were sterile in 5 cases, Streptococcus pneumoniae was otherwise incriminated in 2 cases. Recovery was rapid with broad-spectrum antibiotic therapy in 11 cases. One death in an infant was related to late intervention. Recent reports indicate an increase of primary peritonitis caused by gram-negative organisms. The prognosis has improved since the use of antibiotics, but its incidence appears unvarying.
From 1957 to 1985, 286 urethroplasties for hypospadias repair were performed. Anterior hypospadias (235 cases) have been corrected with good result in 88% of cases (94.3% since 1974). Glandular or coronal hypospadias have been repaired by MAGPI procedure (65 cases, 1 fistula, 1 meatal stricture), and distal penile hypospadias by Mathieu's urethroplasty (32 cases, 1 fistula), since 1981. For subcoronal hypospadias, MAGPI procedure has been attempted and deserted to Mathieu's technique (19 cases, 4 fistulas). Posterior hypospadias (51 cases) were performed by two- or more-stage procedure before 1982. Then, 25 cases have been corrected by Duckett's procedure and 1 case with bladder mucosa graft. Immediate good result was obtained in 10 patients and 4 more after meatostomy for meatal stricture. 10 patients developed fistulas. A lower rate of fistula has been obtained by Duckett's operation personal modification. Most of hypospadias (80%) have been corrected from 2 to 4 years old, since 1981.
Twenty-six cases of neonatal torsion of spermatic cord were studied and compared to 171 cases reported in the literature. In a few cases, the torsion was antenatal and this may explain some absent testes. Diagnosis is sometimes difficult to make; symptoms were comparable to those in other disorders: peritoneo-vaginal tunnel, testicular inflammation or testicular tumor. In these cases, surgery can make the exact diagnosis although it cannot save the testis even if it is performed early.
Study about 22 gastroschisis observed 17 years along allows to the authors to point out the elements of amelioration of prognostic and decrease of mortality. Antenatal diagnosis allows the hysterotomy at the end of gestation avoiding traumatic or infectious risks. Reanimation and transport are very important to bring the neonate in good conditions to the pediatric surgeon. The choice of surgical technics is only between primitive parietal closure or progressive reintegration (Schuster). Intestinal atresia must be cured in the same time, if possible. Finally, perisurgical nursing, antibiotherapy and recent parenteral nutrition method improved the prognosis. During the last 15 years, mortality has fallen from 80% to 10%.
The writers present a report of 2 observations of colo-rectal carcinoma, on a 19 month old infant with a mixed juvenile and adenomatous polyp situated at the recto-sigmoid junction and treated successfully by segmental colectomy, and on a 10 years old girl presenting a large colloid rectal carcinoma which occurred 6 years after resection of an atypical rectal juvenile polyp. After recalling the rarity and the gravity of colo-rectal carcinoma in childhood, the authors underline the importance of histological investigations in the juvenile polyposis which is usually benign; the possibility of histological aspects on separate polyps and sometimes on the same polyp explains the degeneration of some multiple juvenile polyps (several cases in the literature), or isolated polyp (first case described).
Interest of family study. The first boy deceased after some hours of life. Necropsy. The second boy was clinically normal with severe bilateral vesico-ureteric reflux detected by IVU only. Surgical treatment. This boy is actually in good health.
Calcified intraluminal meconium is rarely observed in newborn. Only 27 cases are related in litterature; the authors report 4 new cases and point out the role of intestinal obstruction (principaly anorectal malformations, but also atresia, meconium ileus or Hirschsprung disease). Pathogenesis is unknown, while intestinal urinary fistula is frequently described.
Seven cases of pyogenic arthritis of the sacro-iliac joint in children were observed between 1968 and 1981. Their analysis is discussed with the conclusions of the too much rare publications in the recent literature. Taking in to account the anatomic particularities the necessity of very precise roentgenographic technics in order to assess the sacro-iliac joint, especially in children because of incomplete ossification, the authors replace this pathology into the osteomyelitis in children. From the clinical aspects of the disease, with its typically localized pain, and its acute clinical and biological septicemic syndrome, the authors attempt to demonstrate that the classical idea of a delayed diagnosis, is not absolute. Even in this particular localization, an early "up to date" diagnosis is possible allowing rapid treatment with efficient antibiotherapy directed towards the responsible germ after their isolation (especially staphylococcus aureus). Indubitable progress has been gained with systematic radio-nuclide bone scanning in emergency.
The authors report a case of middle and superior gingival tumor in a newborn patient. Macroscopic and topographic aspects are a "congenital epulis". The surgical treatment is easy. Histologically finding shows a benign tumor with granulous cells called "Abrikossoff Tumor". The literature is reviewed to study histological aspect and pathogeny of this tumor. They try to distinguish the macroscopic aspect of the "congenital epulis" with the histologically finding. It is not systematically a granulous cells tumor.