[Evaluation of more than 1,000 surgical procedures under general anesthesia, performed in children less than 15 years of age at a day hospital].
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Biomedical subjects
Publications and source records attributed to M Lupold.
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During antibiotic treatment for E. coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abscess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.
The prognosis in fistulae of the small intestine in the infant and child is totally different according to whether they develop following a simple operation involving the healthy small intestine or multiple or complicated operations on pathological bowel. Under these latter conditions, constant medico-surgical cooperation, modern techniques of renutrition (total parenteral renutrition or constant flow enteral nutrition), together with restoration of water/electrolyte balance and the treatment of infections give increasingly satisfactory results. In a series of 19 children, with 26 enterocutaneous fistulas, deaths were reduced to 4. Independently of recourse to surgery determined by local abdominal conditions (peritonitis, obstruction) or persistence of the fistula, the choice between total parenteral renutrition and constant flow enteral nutrition (C.F.E.N.) depend essentially upon the site of the fistula. When the latter is proximal the digestive tract may not be used, while C.F.E.N. may be employed when it is distal, sometimes resulting in cure without further surgery.
The aim of this technical note is to show that ketamine hydrochloride anesthesia, owing to the preservation of muscle tone, enables one to safely and comfortably carry out gaseous encephalography on a simple radiological table in the toddler or child. However the authors very strictly select the indications for this investigation. Whenever the child's clinical condition leads one to suspect intracranial hypertension and/or a cerebral tumor, they think it more prudent, owing to the vasopressor effect of ketamine hydrochloride and a possible elevation in the cerebrospinal fluid pressure, to transfer the child to a specialized neuroradiological center, where the investigations would be carried out under the best technical conditions, and close to a neurosurgical unit which is capable of intervening rapidly in case of complications. The authors voluntarily limit their indications to children suffering from psychomotor retardation, epilepsy or neurological disorders which make one suspect a congenital malformation.
Hyperparathyroidism is able to determine suddenly after a very poor clinical history a deep coma : in such a condition, the diagnosis with the paraneoplastic hypercalcemia may be a difficult one : cervicotomy can be the heroïc way to lead to diagnosis and in the same time to perform treatment. To avoid such a dramatic situation, the authors propose cervicotomy for every patient suspected of P.T.H. adenoma, when calcemia is higher than 115 mg c/l, even if the symptoms are very slight or nil.