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Biomedical subjects

J Valayer

Publications and source records attributed to J Valayer.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Choleperitoneum due to rupture of the intrahepatic bile ducts caused by a closed injury of the abdomen. Apropos of 2 pediatric cases].

Two cases of biliary peritonitis due to intra hepatic bile duct rupture are reported. The first occurred in a seven year old girl with a right lateral hepatic duct. Outcome was favorable spontaneously after simple surgical drainage. The second was observed in a seven year old boy with rupture of the origin of the left hepatic duct under the falciformis. The recovery was complete after left lobectomy. Diagnosis is difficult. Sonography and CT scan were not diagnostic in the second case. Precise diagnosis and treatment require a laparotomy. These lesions resemble extrahepatic bile duct lesions which are, only exceptionally observed in children.

Abdominal Injuries↗
PubMed1987

[Peritonitis encapsulans in children. Report of a case].

Sclerosing encapsulating peritonitis is rare in children. The clinical features are discussed and the etiology must be searched for tuberculosis. Occurrence in prepubertal girls leads to a discussion of the pathogenesis in this age group. Surgery must be conservative.

Adolescent↗
PubMed1987

[Congenital dilatation of the common bile duct].

During a period of 18 years, 41 cases of congenital dilatation of the common bile duct in young patients (11 of them were less than 12 months of age) were treated at Bicetre Hospital. A retrospective analysis of these cases underline the following points. A close etiopathogenic relation exists between the presence of a common hepatico-pancreatic duct and a congenital dilatation of the common bile duct (in this study, 16 cases demonstrated the anomaly out of 20 cases for which the common bile duct could be analysed). Early surgical treatment must be undertaken before occurrence of liver complications (6 patients have cirrhosis when first treated, 4 of them were children less than 12 months of age). Abdominal echotomography (100% of preoperative diagnosis) and transparietal cholangiogram are the best investigations for providing pictures of hepatico-pancreatic abnormalities and collecting bile samples for bacteriological and chemical study. The treatment of congenital dilatation of common bile duct by cyst excision and Roux en Y hepaticojejunostomy has good long term results. After 20 cases of complete cyst excision, 6 of them were children under 12 months, and 17 cases or partial cyst excision respecting the cyst fundus when they were intraduodenal and retropancreatic in position (4 were children under 2 months) we have noted that 83% of these children had a good outcome with a mean follow up of 7 years. Complications include hepatico-jejunal stenosis at the anastomosis site in 2 patients, for which they were reoperated and cholangitis with hepatico-jejunal anastomosis in 6 cases. There were 3 deaths in children under 12 months who already developed hepatic cirrhosis and episodes of severe cholangitis when preoperative diagnosis was first proved. In conclusion, the future life of the majority of these children is expected to be uneventful inasmuch that bile stasis has been corrected, with resolution of inflammatory lesions which are known to expose to secondary malignancies of the biliary tract.

Adolescent↗
PubMed1986

Spleno-gonadal fusion: anatomic and angiographic study of a case.

The authors report a case of spleno-gonadal fusion in which the advantage of an angiographic study permitted, for the first time, an analysis of the vascularization of this malformation. The embryologic study explains the malformations associated with the continuous type of spleno-gonadal fusion.

Child, Preschool↗
PubMed1986

Benign tumors of the liver in children: analysis of a series of 20 cases.

Twenty children were treated for a benign hepatic tumor during a 17-year period. One child was not operated upon but followed since birth for 2 years by ultrasonogram. Mesenchymal hamartoma was found in 8 cases, a solitary cyst in 4, and 3 other cases of hamartomas were without cystic components. Two girls had lesions corresponding to focal nodular hyperplasia; two children had a solitary adenoma. Radical surgical treatment was possible in all 19 operated cases, except one case of focal nodular hyperplasia where a right lobectomy would have been necessary. Ultrasonography and angiography are the main explorations to be undertaken before treatment; preoperative embolization of the main arteries to the tumor was done in five cases, with unquestionable advantage in four of them. No mortality was recorded and results were good with a mean follow-up of 19 months.

Adenoma↗
PubMed1986

Hepatoblastoma and hepatocarcinoma in children: analysis of a series of 29 cases.

Twenty-nine cases of liver malignancies, 26 hepatoblastomas (HB) and 3 hepatocarcinomas (HC), were treated in a 13-year period. All children were submitted to operation but four had nonresectable tumors, even after chemotherapy. Surgery in the 25 cases consisted of right lobectomy in 14, a left lobectomy in 9, and a tumorectomy in 2; a secondary operation had to be performed in 5 cases, either because of histologic doubt on the cut section of the presumed normal parenchyma, or for local recurrence. Preoperative chemotherapy, instituted on a routine basis since 1982, did appear to facilitate surgery in otherwise inoperable tumors. The benefits of preoperative embolization, done for three children, were minimal. Ten children died, one in the immediate postoperative period, eight others from the disease, and one from a complication of chemotherapy. Follow-up for the 18 surviving children, all recurrence and metastasis-free, with normal alphafetoprotein (AFP) is less than 2 years for four and from 2 to 11 years for 14. One teen-age girl, with a fibrolamellar carcinoma has just recently been reoperated because of recurrence three years later. In spite of the fact that 6 out of 7 children operated without adjunctive treatment are cured, a systematic course of preoperative chemotherapy has been prescribed in the more recent cases. Follow-up for these is yet too short.

Adolescent↗
PubMed1986

[Common channel for bile and pancreatic ducts. Presentation of 12 cases and discussion].

Between 1978 and 1985, 11 girls and one boy underwent an elective operation for a congenital choledochal dilatation associated with an anomalous biliopancreatic junction. In 10 out of these 12 cases the children suffered several episodes of abdominal pain, and the diagnosis was missed since a jaundice appeared. The ultrasonographic examination demonstrated in all cases a dilatation of both extra- and intrahepatic bile ducts. The preoperative diagnosis was always established by the mean of a transhepatic cholangiography (8 cases) or a percutaneous cholecystography (4 cases), which showed in every case a dilated choledochus, and a common biliopancreatic channel, 15 to 35 mm long. A high amylase level was found in the bile in 10/10 cases when it was measured. A cholecystokinin test was performed in 4 cases, resulting in each case in a considerable increase of amylase and lipase levels in bile. All children were treated by excision of the dilated choledochus and gallbladder, followed by an hepaticojejunostomy with a Roux en Y loop. The follow-up is 6 months to 5 years for 9 children: 8 are cured, and on girl, who had a major dilatation of the left intrahepatic bile ducts, suffered from episodic abdominal pain and an episode od cholangitis 6 years after the operation. The role of such a common channel in the pathogeny of congenital choledochal cysts, acute pancreatitis in children, and biliary carcinomas in young adults is discussed according to the literatures of the last 10 years.

Adolescent↗
PubMed1986

[Case of splenogonadal fusion with genital malformation].

A case of splenogonadal fusion associated with a posterior hypospadias is presented. The testis was ectopic, leading to realize an arteriography. The vascularization of the splenogonadal fusion was on the dependance of the renal artery. The testis and splenic tissues were separated, with anastomosis between the spermatic vessels and the epigastric one; this anastomosis was unsuccessful. Eighty nine examples of splenogonadal fusion have been reported. They are divided into two forms: the continuous type is often associated with other malformations (limb, micrognathia). These associations are explained by the embryology. The treatment must be conservative.

Child, Preschool↗
PubMed1986

[Portal hypertension in children. Therapeutic approach in cases of failure of a portosystemic shunt].

88 porto systemic shunts were performed between 1977-1985; 14 failures were observed. These failures occurred in ten children with extra-hepatic portal obstruction and in four with intra-hepatic obstruction. The treatment of these failures was different in these two groups: 7 reoperations in the extra-hepatic obstruction, none in the intra-hepatic. That reoperation is often not suitable in the intrahepatic obstruction because of the hepatic failure. The use of sclerotherapy or the beta receptor blocking agents is discussed in this group.

Adolescent↗
PubMed1985

[Urinary lithiasis in children. Apropos of 92 cases].

The charts of 92 children with urinary calculi were reviewed. There were 69 boys (75%) and 23 girls (25%), 20 (22%) were infants. Calculi were in kidney (74 times but were often multifocal. Fourteen children (15%) presented with a lithogenic metabolic disorder, 28 (30%) had a malformation of the urinary tract, in 4 (4.3%) a permanent urinary derivation had been performed for the treatment of a malformation or a neurologic bladder. The other children presented with apparently idiopathic lithiasis. However, urinary tract infection was found in 70%. Predisposing factors, whether stasis, urinary tract infection or some urinary malformations, were often intricate. The spontaneous elimination of calculi was rare. Even when difficult, the extraction of calculi had generally moderate functional consequences. There was one secondary renal atrophy. Relapse occurred in 11 patients. Etiologic inquiry, bacteriologic monitoring of urines and ultrasonography supervision over years are the essential means to a better evaluation of the risk of relapse.

Child↗
PubMed1985

[Surgical pulmonary biopsy in children].

During the last 2 years an open lung biopsy was performed in 16 children aged from 2 to 14 years. Fourteen of these had a chemotherapeutic induced immunodeficiency and a radiological picture of diffuse pulmonary infiltrate. A definite diagnosis was established in 11 cases: 5 pneumocystis carinii pneumonitis, 2 CMV infections, 2 pneumocalcinosis, 1 neoplastic pulmonary lymphangitis and 1 staphylococcal infection. Three had a non-specific interstitial pneumonitis. In this series there was no post-operative death and the single complication was a wound infection. The tracheal tube could be removed within the hours following the intervention in 14 of the 16 children. The review of the recent literature suggests that the open lung biopsy is a safe and accurate way for the diagnosis of pulmonary infiltrates in pediatric immunocompromised patients. It is however a very invasive procedure and it is expectable that in the next year the bronchoalveolar lavage with a fiberoptic flexible bronchoscope will be systematically attempted prior to the open biopsy.

Adolescent↗
PubMed1984

Histological liver evaluation 5 years after surgery for extrahepatic biliary atresia: a study of 20 cases.

Clinical, biological, and histological data are described in 20 patients at least 5 years after surgery for extrahepatic biliary atresia. Seventeen had an " uncorrectable " type and underwent hepatoportoenterostomy or hepatoportocholecystostomy , 3 patients had a "correctable" type and underwent cystojejunostomy . Clearing of jaundice was observed in all patients. Portal hypertension developed in 16 out of the 20. Liver specimens were obtained by surgical biopsy in all patients. Definite biliary cirrhosis was seen in all but two. Particular patterns were observed in some cases: biliary structures without bile stasis were absent in 8, while 4 displayed marked cell infiltration in portal areas, and 7 had distended vascular channels. The appearance of liver cells was always normal. No relationship could be clearly established between the degree of fibrosis and the earlier presence of cholangitis.

Bile Ducts↗
PubMed1984

[Fetus in fetu: report of 2 cases and analysis of the literature].

Foetus in foetu is a very unusual cause of abdominal mass in the infancy. Twenty cases only have been quoted in the literature. Two others cases are added, concerning two girls: a three months infant, second born from a genuine twin pregnancy, and a four weeks newborn whose the mass was discovered before the birth, on routine ultrasonography. In together, the diagnosis was made in operating room, then confirmed by pathologic studies. Literature data are recorded, and the difference between teratomas and foetus in foetu is point. The pathogeny remains obscure. It could result from the inclusion of a parasite twin in his bearer, become during embryologic stage of the delimitation.

Diagnosis, Differential↗
PubMed1984

[Milk of calcium bile syndrome in children. 2 cases].

Milk of calcium cholecystitis is a rare entity in children. Two cases are reported here, each in a boy aged respectively 4 and 13. The symptoms were limited to abdominal pain with or without vomiting. Plain X-ray of the abdomen showed the usual milk of calcium picture, with calcified deposits within the gallbladder and an obstructing stone at the site of the gallbladder neck or the cystic duct. Surgery consisted simply of cholecystectomy with preoperative cholangiogram. Neither biochemical analysis of the gallbladder contents, nor the pathological examination of the gallbladder wall helped in determining the pathogenesis of the disease. Only four other cases of milk of calcium cholecystitis in children have been found by the authors in the literature, where a number of adult cases have been described.

Adolescent↗
PubMed1984

[Urethrorrhagia in boys].

Fourteen boys, aged 2 to 13, have been examined in the last six years for blood spotting from urethra between voidings, rarely associated with some degree of dysuria. No anomaly was seen on IVP, except in two cases which showed mild stenosis of the posterior urethra. Endoscopic evaluation was completely negative in 5 cases; moderate inflammation or hypervascularisation, some what a subjective aspect, was noticed in 4 cases; a definite "posterior urethritis" already described by others in the literature was demonstrated in 5 cases. The etiology of such a lesion remains unknown; no story of external or internal trauma was reported. Although these urethrorrhagia are of benign nature, we do not feel like others (1) that endoscopy should be considered as unnecessary, but on the contrary that it should help for correct evaluation and follow up of these patients, rather prone to be lost especially when no treatment has been prescribed.

Adolescent↗
PubMed1984

[Choleperitonitis after hepatoportocholecystostomy for atresia of the biliary tract].

The gallbladder, the cystic and the choledocal ducts are patent in one fifth of biliary atresia cases, and can be used for the corrective operation. The main interest of this hepatoportocholecystostomy (HPC) is to prevent the cholangitis episodes which are the most severe complication of successful hepatoportoenterostomies (HPE). However a singular complication of HPC has been noticed by previous authors: the choleperitonitis. We report a recent case in which this complication was diagnosed by a routine ultrasonography at the 3rd week of the uneventful postoperative course of a HPC performed in an 1 1/2 month old infant. An early reoperation (HPE) had a good result with restoration of a satisfactory bile flow. The child is anicteric with a follow-up of one year. In our experience with 208 corrective operations between 1969 and 1981, HPC was used in 38 cases, with restoration of bile flow in 17 cases. A choleperitonitis was noticed in 4 cases in this series, and in a 5th additional recent case. Three children were not suitable for reoperation because of very poor condition and died within 3 to 17 months after HPC. Two children were reoperated upon early with a good result. We advocate the HPC procedure despite the risk of choleperitonitis and emphasize the interest of early postoperative routine ultrasonography, especially when stools remain acholic at the 4th postoperative week.

Bile↗