Biomedical subjects
Publications and source records attributed to P Debeugny.
A method to reconstruct the perineum, after excision of a giant sacrococcygeal teratoma, using one anterior V and multiple posterior V incisions, is described. A baby weighing 2,400 g with a 1,000 g sacrococcygeal teratoma was operated using this technique.
UNLABELLED: Ninety-three cases of thoracic trauma (age ranging from 1.1/2 to 15 years) were observed over a 10 year-period (1980-1990): 86 cases of blunt trauma and 7 cases of perforating injuries. Road accidents were the most prevalent (63 cases) followed by home and sport injuries (9), falls (9), perforating trauma (9) and others. Associated lesions were frequent: skeletal (67), abdominal (19), and head injuries (5)--the latter influence the vital prognosis. Rib fractures were observed in 60% of cases of blunt trauma (86). Pulmonary lesions were as follows: pneumothorax (41), hemothorax (21), and lung contusions (29). In 48 cases, several of these pulmonary lesions were associated. Diagnosis and therapy problems were encountered in 21 cases. Results were as follows: 3 deaths, within 24 hours due to hemorrhage (1 case with aortic lesion). FOLLOW-UP: 85 good results, 5 sequelae, without any clinical consequence--either pleural (2), diaphragmatic (2), or lung (1). The treatment was as follows: none (27), pleural aspiration (2), thoraco-synthesis by drain in other cases for 2 to 9 days. Surgery was necessary in 10 cases, with 2 thoracotomies, 1 orthopedic traction, 1 embolization of iliac artery.
Hereditary multiple atresias involving the gastrointestinal tract from pylorus to rectum are the most unusual form of intestinal atresia; the type of inheritance was suggested to be autosomal recessive. The inheritance of the severe combined immunodeficiency syndrome can be autosomal recessive or X-linked. We report on 3 sibs with multiple-level intestinal atresias. One sib had severe combined immunodeficiency syndrome and clinical histories of the other 2 sibs strongly suggested a congenital immunodeficiency syndrome. The parents of those children were healthy and nonconsanguineous. To our knowledge, this is the first report of the association of multiple gastrointestinal atresias and immunodeficiency which appears to have an autosomal recessive pattern of transmission. Our family report suggests that, in the presence of multiple gastrointestinal atresias, attention should be given to possible associated immunological disorders.
A three year old boy presented a transanal evisceration of the rectum after sitting over a non covered drain site of a swimming pool. Peritonitis led to laparatomy 24 hours later. The high rectum was found to be necrotic and perforated. A protecting sigmoïd loop colostomy was performed with out any rectocolic resection. Five months later, resection of the fibrosed high rectum and end to end anastomosis between sigmoïd and low rectum was done. The colorectal function was quickly restored. Continence is now normal with a follow-up of 18 months. Pathogenesis of transanal suction may be as follows: relaxation of perineal muscles and anal sphincter during sitting position permit transanal evisceration by suction. Such lesions are rare (less than 10 cases reported). The therapeutic choice, between initial reparation and drainage associated, with protecting colostomy is discussed.
Ninety-four cases of limb vascular traumas were observed in children during a 25 year-period. Treatment was done less than 12 hours after the injury in 83 cases, later than 24 hours in 7 cases. Superior limbs were more often concerned than inferior limbs: 65 vs 29 cases. Bone lesions were found in 34% of cases, articular lesion in 12% and neurological lesions in 40%. Vascular repair was necessary in 63 cases, mostly by suture (41 cases) or venous graft (16 cases). Two patients died because of associated polytrauma. In 8 cases, anatomical and functional results are good, but follow-up is short. In 65 cases, results were initially satisfactory; 5 patients had later complications leading to sequelae in 3 cases. In 19 cases complications occurred and led to amputation in 5 cases; among the remaining 14 patients, results were finally satisfactory in 9 cases and sequelae were observed in 4 cases. Early diagnosis problems and treatment are discussed. Associated lesions have to be taken into account to assess the results.
The authors present a review of 34 clinodactylies. We observe 16 delta phalanx, 12 congenital angular inclination, 6 thumb abnormalities. The procedure is required when the angulation is superior to 40 degrees. In this study, 16 cases had surgical treatment (10 digits, 6 thumbs). Additional osteotomy or subtraction osteotomy were performed. The authors prefer this last one. The age of procedure is 4 years. The surgical treatment is difficult and the authors prefer abstention if there is no functional troubles with the growth.
In 14 newborns with gastroschisis, fascial closure was effected by muscular suture associated with teflon mesh prosthesis interposition. This was realized either in urgency during neonatal period (9), either secondly (5). Neonatal cases were treated between 0 h 30 and 5 h of age. Pulmonary hyper-pressure risk was very important when primary suture was early employed (card freq: 150 b. min-1. PA syst: 60 cm Hg; pulm pres: 20 cm Hg). When we used a teflon mesh prosthesis, we had 8 good results and only one initial death. 5 complications were represented by cutaneous ischemia which spontaneously disappeared (1), ischemia with infection and partial necrosis (2), important necrosis with teflon mesh prosthesis exteriorization (2). It has been definitely possible to achieve complete fascial in 7 newborns. Only one of them had a little ventral hernia. 5 newborns were early treated by simple skin coverage (Gross) as primary management. They have had teflon mesh prosthesis between 5 and 14 M of age and have undergone excision of the teflon mesh prosthesis and fascial repair without difficulty (5 good results). With teflon mesh prosthesis for treating congenital abdominal defects, abdominal hyper-pressure and pulmonary complications are exceptional. Local complications are very limited because of good vascular conditions. We did not have any adherences because of teflon mesh prosthesis good biological and histological tolerance. Digestive complications (statis, septicemia...) have been few and mild because physiological intra abdominal pressure has been early obtained.
Fifteen cases of sacrococcygeals teratomas were treated at our hospital over the last ten years. There is no correlation between prematuration and tumor weight, as between tumor weight and low babys' weight. High tumoral weight didn't influence the prognosis. The treatment is always surgical. Chemotherapy was used only for recurrence in one case (the patient is dead). For all the cases, we performed a perineal procedure without abdominal procedure. No patient had an abdominal extension of the teratoma.
Five cases pyloric obstruction, revelated at the birth-period were summarized from 1964 to 1987; 1 pyloro-duodenal atresia, two cases of total pyloric obstruction by diaphragm, two cases of pyloric obstruction associated with several ileal and/or-colic atresia in the same family, and suspected at the antenatal echographic study. The treatment was either pyloro-duodenal anastomosis (1 case) or diaphragmatic resection with pyloroplasty (4 cases). In immediate results are obtained one immediate death, at the third day, and 4 initial good results; but two deaths came in a further period at 3 months and 8 months (the same family) with sepsis after ileus. A syndrome of immuno-deficiency was demonstrated in this two familial cases.
Explore the source record for details and available documents.
Two cases of isosexual precocity in relation to granulosa cell tumor in 2 girls aged 6 and 9 months respectively are described. In the two cases clinical and biological signs of hyperoestrogenemia were found but in one, acute signs of tumoral rupture were the first symptom. Histologically, the two classical subtypes were found: macrofollicular ("adult" type) and "juvenile". These two children are alive without any sign of recurrence with a follow up of 12 and 18 months. The occurrence of granulosa cell tumors in such young girls seems extremely rare.
Eighteen patients with ano-rectal malformation were studied by computered tomographie (1 low malformation, 9 intermediates, 6 high malformations and 2 cloacale malformations). There is no indication of this technic during neo-natal period. Computered tomographie is more important for analysis of the sequel because the appreciation of the pull through digestive segment is better. However, perineal muscles are more difficult to evalue, because there is not objective criterion.
Report of eight cases for a two-years period from a group of 16 ovarian cysts diagnosed at the antenatal period and treated by non-operative method. A puncture with ultrasonographic control was performed at 6 times: 4 good results were obtained (two perfect, two with little residual cyst), 1 good but with short follow-up, 1 poor result with recidive coming to later surgery, at last no puncture in the both last cases, either for a complication during the watching, or a mistake of diagnosis with intestinal cystic lymphangioma. After description of the technique by trans-urethro-vesical approach, the authors consider advantages and inconvenience of the non-operative method of treatment.
Explore the source record for details and available documents.
We report on a case of dumping syndrome 1 month after Nissen fundoplication in a 5 month-old infant presenting with symptoms of late hypoglycemia. Blood glucose levels in pre- and post-prandial periods, oral glucose tolerance test and isotopic gastric emptying study confirmed the diagnosis. All symptoms resolved with diet therapy which could be stopped 8 months later. Dumping syndrome is not a so rare complication of gastric surgery and should be considered in patients with non specific symptoms.
The observations of 79 patients with rectal or ano-rectal lesions were studied in 15 centers, on a 25 years period. The etiology of the lesions was: 23 patients which suffered from traffic road accident, 39 patients which suffered from impaling, 10 patients with lesions caused by foreign bodies, 6 patients which suffered sexual violence and 1 patient with other causes. The primary results were: 2 patients who died, and 27 patients who suffered from other complications. 19 of them were of infectious nature and the other 6 suffered from urethral-rectal or vaginal-rectal fistula. The secondary results showed that 28 patients developed early complications and 1 patient developed late complications. The majority of the complication were: 9 anal stenosis and 11 were anal sphincter incompetence. The analysis of the results showed the factors implicated in the appearance of these complications, which were: the initial unknown nature of the lesions in the polytraumatised patients, the nature of the lesions, the associated lesions of the sphincter or the perineum, the late diagnosis and the factors which increase the risk of an early infection.
Explore the source record for details and available documents.
16 cases of intestinal perforation following blunt abdominal trauma in children (14 boys and 2 girls from 3, 5 to 15 years old) are recorded in a 18 years period. We found 12 injuries of the small bowel, 2 of the colon and 2 of the duodenum. Except in the cases with hypovolemia or traumatic coma, the diagnosis is often made on abdominal physical findings and clinical evolution. Laboratory and radiological data were often useless. Then, surgical management was often delayed, principally in the most recent period with the non operative management of most pediatric blunt trauma. Simple closure (7 cases), resection and anastomosis (7 cases) or resection and double ostomy (2 cases) were performed. The result summarize 2 death and one complication (fistula). Complications do not increase with delay.