Biomedical subjects
Publications and source records attributed to M Gruner.
A lipoma of the preputium clitoridis was found in a newborn girl. Ambiguous genitalia was first suspected. Surgery was successfully performed at 5 months.
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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.
BACKGROUND: This study describes a novel method of intraoperative localization of neuroblastoma with a gamma-detecting probe, to detect in situ tumor binding of radiolabeled 123I- or 125I-metaiodobenzylguanidine (MIBG) and improve the quality of tumor resection. METHODS: Fifty-eight children underwent 66 surgical procedures with intraoperative detection of radiolabeled MIBG. All patients with positive MIBG scintiscans at diagnosis were included in the study. A tumor/background ratio exceeding 2:1 at the time of operation was considered positive, indicating a significant uptake of MIBG, compatible with the presence of malignant cells. The surgeons were requested to evaluate the contribution of the method to the surgical procedure. Sensitivity and specificity of the method with either 123I-labeled MIBG or 125I-labeled MIBG, on the basis of correlations between probe findings and pathologic analysis of 288 resected specimens, were determined. RESULTS: Intraoperative detection was helpful in 65% of surgical procedures, allowing a better definition of tumor limits and extension to locoregional nodes or detection of small and nonpalpable tumors in sites with difficult surgical access, especially during operation for relapse. The detection was not contributory in 35% of the procedures (well-localized tumors, thoracic neuroblastoma for technical reasons, highly differentiated tumors as ganglioneuroma, and tumors with mainly necrosis or fibrosis). The sensitivity of 123I and 125I was the same (91% and 92%), but the specificity of 125I (85%) was significantly higher than that of 123I (55%) (p < 0.005). CONCLUSIONS: First, this study demonstrates the feasibility of intraoperative detection, with radiolabeled MIBG, of neuroblastoma in children. We advocate the use of 125I rather than 123I. Second, the method is useful to improve the quality of macroscopic resection in widespread neuroblastoma with nodal involvement, in sites with difficult access, and in operations for relapse.
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.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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.
We report a case of traumatic duodenal hematoma. The patient's age (2.5 y.) and the absence of evidence of trauma when the symptoms began led to perform plain films of the abdomen, upper GI series, US, CT, and MR. This excess of imaging modalities emphasize the diagnostic value of plain X Rays of the abdomen and opacification of the duodenum.
This case of mesenchymatous hamartoma in a nine-year-old boy, was an incidental finding on a chest X ray. CT and MRI suggested the diagnosis showing a large (9 x 11 x 14 cm) mass developed in the right lower lung with sharp margins, without any sign of pulmonary or mediastinal compression. This lesion contained fatty areas on both CT and MRI. It showed no calcification. It enhanced slightly after IV contrast. On T2 WI, it appeared lobulated with low signal intensity septa. Presence of fatty tissues and lobulated margins were suggestive of the diagnosis of mesenchymatous hamartoma. A 1.2 kg mass was surgically removed. The tumor was attached to the right lower lobe by a small pedicle. Pathological examination disclosed fatty and connective tissues. This rare observation shows a good correlation between CT, MR, surgery and pathological examination.
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.
Despite increasingly rigorous preventive measures which have limited the number of cases in France, the number of children undergoing surgery for tuberculosis has remained unchanged. Over the last ten years we operated on 40 children in our pediatric unit. In 10 cases, surgery was indicated for diagnosis, in 19 cases surgery was required in an emergency situation during treatment and in 11 the operation was performed at the stage of sequellae. The type of surgery depended on the clinical situation. Thoracoscopy was used for surgical diagnosis and to empty caseous nodes in the lateral tracheal chain but was generally impossible at the sequellae stage.
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.
Intestinal duplications are rare and are usually diagnosed in the first two years of infancy. They can occur at any level of the alimentary tract from the oral cavity to the anus. Duodenal duplication accounts for approximately 7% of all intestinal duplications. A previously healthy 4-year 6-month old boy was admitted with progressive increasing vomiting. Physical examination was normal, the serum amylase level was moderately increased. Upper gastrointestinal series showed an extrinsic compression defect of the proximal duodenum. Ultrasonography showed a 3 cm diameter cyst in the head of the pancreas. A duplication was suggested. Helical CT cholangiography showed a communication between duplication and the biliopancreatic common channel. The biliary tree was normal. Surgical resection of the intrapancreatic lesion was performed. Microscopic examination of the specimen revealed a duodenal duplication.
As low as 5 micromol/l of cis-linoleic acid proves to be cytotoxic for bovine lens epithelial cells in culture. Albumin eliminates the linoleic acid cytotoxicity completely, presumably by binding the fatty acid. However, the damaging effect appears again when the molar ratio of linoleic acid to albumin exceeds 1:1. The assumption that the linoleic acid-caused cell damage would be mediated by peroxidation products could not be confirmed. The results obtained rather favor the idea that linoleic acid molecules themselves injure lens epithelial cells. Obviously, cell damage even occurs in the presence of albumin if one molecule of albumin binds more than one molecule of linoleic acid. Micromolar concentrations of linoleic acid produce reversible bleb formation as well as cell retraction within 30 min. In primary culture 10 micromol/l linoleic acid damage lens epithelial cells irreversibly within some hours. Trans-linoleic acid, linolenic acid and oleic acid are also harmful to lens cells but to a lesser degree, while saturated fatty acids are without any effect. Bleb formation as a leading early sign hints at the plasma membrane as the primary target for linoleic acid induced cytotoxicity.