Biomedical subjects
Publications and source records attributed to R Moog.
We report on the case of a 9-year-old girl who presented vaginal bleeding which led to the diagnosis of vaginal hemangioma. Such localisation is rare, and requires a clinical follow-up by vaginoscopy. A spontaneous regression can be expected but, at this time, the progress of puberty and future fertility are unknown.
BACKGROUND/PURPOSE: The aim of this study was to compare the results of 2 procedures of transanal pull-through for the management of rectosigmoid Hirschsprung's disease. METHODS: Twenty-one consecutive children with rectal or rectosigmoid Hirschsprung's disease were operated on between November 1999 and April 2003, in two pediatric surgical departments (Dijon and Strasbourg). Twelve children underwent a transanal perirectal pull-through procedure (TPR) and 9 had a transanal endorectal (Soave) pull-through procedure (TER). The collected data in each group included demographic data, length of aganglionosis, age and weight at operation, operating time, duration of hospital stay, incidence of postoperative complications (sepsis, enterocolitis, stricture) and quality of fecal continence on long-term follow-up. RESULTS: No significant differences were observed between the TPR and TER groups with respect to mean age at presentation, length of aganglionosis (rectosigmoid in 10/12 and 8/9 patients respectively), age at operation, with seventeen children operated on before one year of age (mean 3.8 and 3.3 months, respectively) and duration of hospital stay (5.2 vs. 5.3 days), frequency of bowel movements at 3 months postoperatively (1 - 3 per day). Mild differences were observed between TPR and TER groups for gender (ratio M : F 5 : 1 vs. 2 : 1), gestational age at term (39 vs. 37.5 weeks), birth weight (3240 g vs. 2520 g) and operating time (116 min vs. 138 min). No iatrogenic injury of the surrounding pelvic structures occurred during surgery and no blood transfusion was required in either of the groups. A retrorectal pelvic abscess was found in one child of the TPR group. It resolved after an enterostomy had been performed with parenteral antibiotics. Anal dilatation for postoperative anorectal stricture was required in 3 and 2 patients, respectively, for the TPR and TER groups. A mild postoperative enterocolitis developed in one case in the TER group. The average follow-up period was 35.3 months, but ten children still wear diapers, making a functional evaluation difficult. Constipation was noted in 4 and 3 patients, respectively, for the TPR and TER groups. No permanent soiling has been noted at long-term follow-up. CONCLUSION: As an objective assessment of fecal continence could not yet be done for this short series, further follow-up is required. Up to now, no significant difference was observed between these two transanal pull-through procedures.
Non-operative management of splenic trauma is one of the most notable advances in paediatric surgery. It should be systematically proposed except for cases of hemodynamic instability. Abdominal CT scan without and with contrast injection is essential with initial optimal management. Stay in paediatric surgical intensive care unit with monitoring can prevent rare but serious complications. The time of hospitalisation stay lies between two and three weeks and will be followed by three months without contact activity. The advantages of this treatment are obvious safeguarding of splenic function and absence of postoperative complications. Consequently only one of the 88 children admitted these ten last past years for splenic trauma in our unity was operated.
Neutropenia may necessitate polymorphonuclear (PMN) transfusion, but among other reasons, PMN short shelf-life complicates realization of innovative transfusion strategies. In 18 donors, PMNs were mobilized using rHuG-CSF + dexamethasone. (8.3 +/- 1.6) x 10(10) PMNs were harvested in 203 +/- 8.7 mL. PMNs were stored undiluted (1, n = 18) and diluted 1-in-2, 1-in-4, 1-in-8 using T-Sol (2, n = 6), T-Sol + 1% HSA (3, n = 6), or autologous plasma (4, n = 6) for 72 h. Haemograms, pH values, phagocytosis, oxidative burst, and interleukin (IL)-1beta, IL-8 and tumour necrosis factor (TNF)-alpha levels were assessed every 24 h. PMN count decreased from (4.3 +/- 0.8) x 10(10) to (2.2 +/- 1.0) x 10(10), and pH value dropped from 6.4 +/- 0.3 to 5.4 +/- 0.2 within 72 h (1), whereas 1-in-4 and 1-in-8 dilutions exhibited consistent haemograms and pH values above 6.0. 1-in-8 dilution (4) stabilized pH at 7.1 +/- 0.4 after 72 h. Function deteriorated to about 50% within 24 h (1), but 1-in-8 (3), 1-in-4 and 1-in-8 diluted PMNs (4) kept it >90% for 72 h. In all collectives, cytokine levels increased during storage. After all, IL-1beta ranged between 31.0 +/- 16.3 (1-in-4, 4) and 100.0 +/- 21.4 (1-in-4, 2), IL-8 from 513 +/- 454 (1) to 3180 +/- 760 (1-in-8, 2), and TNF-alpha between 3.8 +/- 1.7 (1-in-2, 2) and 23.2 +/- 11.8 (1-in-8, 4) (pg mL(-1)). PMN function may be preserved for 72 h in vitro by dilution of PMN apheresates with, preferably, autologous plasma.
BACKGROUND: The aim of this study was evaluate a novel technique of laparoscopic hernia repair in children. METHODS: Eighty two consecutive patients aged >or=2 years old were operated on for hernia repair using a laparoscopic technique that reproduced every step of the conventional open procedure. Technical details and clinical results are reported. RESULTS: Ninety six sacs were divided in 82 patients (15 girls and 67 boys). Fourteen bilateral hernias that had been diagnosed before operation in nine cases and during laparoscopy in five cases were repaired. Nine controplateral dimples were left and not repaired. Mean operative time was 23 min in girls and 28 min in boys for unilateral hernias, and 30 min in girls and 40 min in boys for bilateral hernias. Sixty-seven of the children were followed up 6 months later. None of them suffered recurrences. No unsightly scars were observed at the port sites. Discomfort did not extend beyond 48 h after the operation, enabling a rapid return to normal activities. CONCLUSION: Dividing the sac and suturing the peritoneum is feasible and efficient by laparoscopy. Compared with the other techniques that have previously been reported, either without any dissection of the sac or any ligature, our technique seems to be advantageous. It is not time consuming and does not require any special laparoscopic skill.
The aim of the present study was to evaluate in vitro data on platelets collected by apheresis, processed on a preparation set followed by photochemical treatment (PCT). Fifteen single-donor platelet concentrates (PCs) were collected by apheresis (COM.TEC blood cell separator, Fresenius, Bad Homburg, Germany). The platelets were transferred to the preparation set and plasma was removed after centrifugation to resuspend the platelets in approximately 37% plasma and 63% platelet additive solution InterSol. PCT was done by exposing the platelets to amotosalen HCl followed by illumination with ultraviolet light. Blood cell counts and in vitro PLT function were measured up to 5 days. An average of 3.44 +/- 0.28 x 10(11) platelets were collected in a product volume of 351 +/- 21 mL. Plasma removal resulted in a mean platelet loss of 7.8%. After PCT, a progressive decrease in platelet function was observed. LDH level rose through storage (171 +/- 81 U/L) to levels approximating LDH levels observed post-collection (180 +/- 103 U/L). There was a gradual decrease of the platelets to respond to hypotonic shock response from 90 +/- 9 % post-plasma reduction to 48 +/- 16% at day 5. All PLT units met the European requirements for leukoreduction and the pH limit of 6.8 up to day 5 post-collection. The new preparation set was capable of producing platelet units meeting the requirements for PCT. Despite differences observed in in vitro platelet function parameters, PLTs at storage day 5 fit the German and European guidelines.
New advances in apheresis technology allow for the safe and efficient collection of peripheral progenitor cells (PPC). Two blood cell separators were compared with respect to separation results such as PPC yield and contamination of the products. A total of 11 patients (6 multiple myeloma, 4 non-Hodgkin lymphoma, and 1 medulloblastoma) underwent PPC collections with either the Amicus (Baxter) or AS. TEC (Fresenius) blood cell separator. PPC were mobilized by chemotherapy and granulocyte colony-stimulating factor (G-CSF) application. Blood counts were determined before and after apheresis as well as in the PPC product. CD34 antigen-expressing cells were measured in the peripheral blood and in the PPC product by flow cytometry. Median baseline CD34 antigen-expressing cells were higher in patients undergoing PPC collection with the Amicus device. More PPC/kg of body weight were collected with this machine (5.3 x 10(6)/kg body weight versus 1.7 x 10(6) in the AS. TEC). The median volume was 129 ml (range 80-156 ml) for Amicus products and 111 ml (range 66-202 ml) for the AS. TEC, respectively. The median platelet contamination of the products from the Amicus blood cell separator was significantly lower than in products from the AS. TEC machine (0.17 x 10(11) versus 0.65 x 10(11), p < 0.001). The data show that a higher yield of PPC was collected with the Amicus machine. The platelet contamination of the products obtained from the two blood cells separators was significantly different.
The present study analyses the number of concurrently collected red blood cell (RBC) units in plateletpheresis donors and the reasons why donors were deferred from multicomponent collection. Donors undergoing concurrent collection of RBCs and platelets (PLTs) were retrospectively evaluated for haemoglobin values and the reasons for deferral over a period of 1 year. A total of 404 RBC units were concurrently collected with PLTs. An average of 1.8 RBC units per year was collected from each donor. The baseline haemoglobin values were almost equal for the RBC donations. An RBC unit was not collected in 190 aphereses. Most frequent reasons for the noncollection of an RBC product were a donation interval of less than 3 months (20.5%), haematoma and blood flow problems (18.9%) and low pre-haemoglobin values (17.4%). Donor eligibility has to be taken into account to optimize concurrent RBC collection in plateletpheresis.
When harvesting peripheral progenitor cells (PPC) in children, the special situation of their circulatory system has to be taken into account. Therefore, extracorporeal blood volume and product volume should be small to avoid side effects. Nine children (age 2-14 years, weight 12.8-58.5 kg) with malignancies underwent 10 PPC collections with the MNC programme of the Amicus blood cell separator. The disposable kit was primed with red blood cells (RBCs) or human albumin to avoid circulatory side effects. The children were monitored for blood pressure and heart rate during the whole apheresis procedure. A median blood volume of 4,577 ml (range 3,536-8,596 ml) was processed in a separation time of 270 min (range 176-331 min). The median product weight was 81 g (range 53-107 g) and the yield of CD 34 antigen expressing cells was 12.5 x 10(6)/kg body weight (range 1.8-26 x 10(6)/kg body weight). Only one child had to undergo a second apheresis to collect the desired transplantation dose. The median platelet contamination of the product was 0.32 x 10(11) (0.13-0.85 x 10(11)). No circulatory side effects were observed. Blood flow alarms occurred in seven of ten aphereses and one collection had to be terminated due to insufficient flow. PPC can be efficiently collected in children with the MNC programme without circulatory side effects. The platelet contamination of the product was low due to the elutriation principle of the collection process, thereby avoiding thrombocytopenic bleeding episodes in the patients.
PURPOSE: Most pediatric surgical teams have adopted nonoperative treatment for a traumatic kidney lesion in children. In the emergency setting and at long-term followup dimercaptosuccinic acid (DMSA) scintigraphy enables us to identify the consequences on global renal function as well as on the function of each individual kidney. MATERIALS AND METHODS: Eight boys and 12 girls between 0.6 and 15.9 years old (average age 9.7) were evaluated after including renal trauma, minor and major injury in 10 each. Scintigraphy was performed 8 days and 6 months after injury. The tracer used was 2 MBq./kg. Tc-DMSA. Semiquantitative analysis of the images consisted of determining 2 parameters, namely relative renal function, corresponding to the fraction of activity of a single kidney compared to the activity of the 2 kidneys, and the calculated renal activity fraction, corresponding to the function of each kidney compared with the activity of a theoretical kidney in a child of the same age. The posttraumatic renal scintigraphy series was paired with a series of healthy children matched by age, weight, height, sex and affected side of function as a control group. Global renal function was also measured using a formula based on ethylenediaminetetraacetic acid scintigraphy with the height, weight and increased serum creatinine in each patient. RESULTS: For minor injuries the quantitative functional evaluation revealed a significant average loss of renal function +/- SD on the side of the lesion (12.8% +/- 3.1% versus 18.3% +/- 2%, p = 0.001). For major injuries on relative renal function evaluation we noted an average 36-point difference in the damaged and contralateral kidneys 8 days after the accident. Six months after trauma we noted a definitive loss of 48% in the calculated renal activity fraction on the side of the lesion. There was no compensatory hypertrophy on the noninjured side when the calculated renal activity fraction was compared with that of a normal kidney in a control patient (mean 19.1% +/- 4.2% versus 19.5% +/- 3.7%, not significant). Creatinine clearance was normal in each patient. DISCUSSION A renal contusion always induces parenchymal loss. Major kidney trauma has significant consequences on the opposite side. At 6 months the presumably uninjured contralateral kidney may be limited in its ability to compensate through hypertrophy, which worsens the global renal functional prognosis of a traumatic but initially unilateral lesion. CONCLUSIONS: Posttraumatic functional evaluation by DMSA scintigraphy, which measures the nephron capital of each kidney and the 2 together, seems essential to inform patients about the seriousness of the lesion and lead them to an eventual long-term nephrological followup with regular blood pressure assessment.
Data of 507 granulocyte donations from 183 donors were evaluated. No severe granulocyte colony-stimulating factor (G-CSF)-related side-effects were observed. Three donors complained of severe itching following infusion of hydroxyethyl starch (HES). A high proportion (85%) of the donors stated that they would donate granulocytes again. The mean granulocyte yield was 4.3 x 10(10). High-molecular-weight HES resulted in a significantly higher yield compared with low-molecular-weight HES. Mild, but no severe, adverse transfusion reactions were observed in 16% of the recipients. A leucocyte alloimmunization rate of 24% was found. G-CSF stimulation and transfusion of G-CSF-mobilized granulocytes were well tolerated by donors and recipients, respectively.
Multicomponent apheresis procedures offer the possibility to collect standardized blood components as compared to whole blood donations. A new program for the concurrent collection of platelets (PLTs) and red blood cells (RBCs) was evaluated in a prospective study. Apheresis donors ( n=18) underwent concurrent collection of PLTs and RBCs using the Haemonetics MCS+ blood cell separator. Aliquots of PLTs and RBCs were collected during five to six passes of the discontinuous flow procedure. The platelet product was in-line filtered during the last pass of the separation procedure. After collection, saline-adenine-glucose-mannitol (SAGM) preservative solution was automatically added to the RBCs. Thereafter, the RBCs were in-line leukodepleted by gravity filtration at room temperature. The PLTs and RBCs were subsequently stored at 22+/-2 degrees C for 5 days and 4+/-2 degrees C for 35 days, respectively. The following in vitro parameters were evaluated over the storage periods: blood cell counts, glucose, lactate, lactate dehydrogenase, pH, plasma hemoglobin, and potassium. Two ready-to-use blood components from one donor were collected in an average procedure time of 86+/-10 min; 2.47+/-0.74 x 10(11) PLTs were collected in a product volume of 232+/-43 ml. The RBC volume averaged 280+/-20 ml and the hemoglobin content was 56.8+/-2.4 g per unit. The leukocyte contamination of the platelet product was 0.44+/-0.56 x 10(5) and the residual leukocyte content of the RBC product was 0.28+/-0.02 x 10(5). Storage data showed no relevant drop in pH. Day 35 results of the RBC products showed that all of the units had less than 0.8% hemolysis. Standardized PLT and RBC products of good quality can be concurrently collected with the MCS+ blood cell separator. In vitro testing of the products collected and stored for 5 and 35 days, respectively, met the Council of Europe criteria for leukodepleted blood products.
PURPOSE: The in vivo pharmacokinetics (PK), biodistribution and antitumor activity of a new liposomal formulation of gemcitabine (GemLip) were compared to the conventional (clinical) formulation of gemcitabine (GemConv). METHODS: Gemcitabine was entrapped in a vesicular phospholipid gel (VPG) consisting of densely packed liposomes. Redispersed VPG containing GemLip consisted of 33% liposomally entrapped and 67% free gemcitabine. The in vivo efficacies of GemLip and GemConv were compared using the subcutaneously growing human soft tissue sarcoma SXF 1301 and the orthotopically growing human bladder cancer BXF 1299T. PK and biodistribution were evaluated using radiolabeled drug and lipid in SXF 1301 tumor-bearing nude mice. RESULTS: GemLip was highly active in SXF 1301 at a gemcitabine dose of 6-9 mg/kg (days 1, 8 and 15; dose near the MTD). In the 6-mg/kg groups, complete tumor remissions were observed in seven of eight mice. Equimolar doses of GemConv resulted in only moderate tumor growth inhibition. Even at equitoxic doses (360 mg/kg given on days 1, 8 and 15, or 120 mg/kg on days 1, 5 and 8) GemConv was less active than GemLip. Furthermore, GemLip was active in the orthotopically growing BXF 1299T bladder cancer model at 6 mg/kg and prevented distant organ metastasis. In the PK study, GemLip achieved a 35-fold higher plasma AUC (1680 mg x h/ml) than GemConv (47.6 mg x h/ml). The serum half-lives were 0.15 h for free gemcitabine and 13.3 h for liposomal gemcitabine (6 mg/kg each i.v.). Moreover, gemcitabine levels in tumors were fourfold higher following injection of GemLip than following injection of GemConv. CONCLUSIONS: GemLip is a highly effective gemcitabine delivery system which results in superior gemcitabine pharmacodynamics and PK than GemConv. The enhanced in vivo efficacy might be explained by sustained release and passive tumor targeting.
White blood cell (WBC)-reduced single donor platelet concentrates (SDPs) can be collected by most cell separators. WBC reduction can be achieved directly during plateletpheresis or by filtration. Continuous filtration with low filtration rates provides SDPs of good purity. To compensate the platelet (PLT) loss due to filtration, the PLT yield in the unfiltered primary product should be optimal. Fifty donors underwent plateletpheresis with the MCS+ blood cell separator (Haemonetics) with the new Fuji surge technique and continuous WBC filtration. Twelve SDPs were analysed for PLT yield, red blood cells (RBC), WBC, and pH after collection (Day 0) and at the end of storage (Day 5). Thereafter, further 38 SDPs were measured for PLT and WBC content in routine production at Day 0. PLT were determined electronically, RBC and WBC were counted manually (Neubauer and Nageotte chamber, respectively). For pH measurement, a pH-meter was used. Mean blood volume processed was 2621 +/- 112 ml in a donation time of 76 +/- 10 min. An average PLT yield of 3.45 +/- 0.88 x 10(11) was collected in a product volume of 325 +/- 77 ml. The collection efficiency was 60.0 +/- 5.5%. WBC contamination of all units tested was 0.046 +/- 0.059 x 10(6) and the RBC content of the SDPs analysed at Day 0 was 0.014 +/- 0.003 x 10(9). The pH was well maintained over the storage period of 5 days. The data indicate that Fuji surge technique and continuous in-line leukocyte filtration allow for the collection of SDPs with high platelet yield and low leukocyte contamination, meeting the Council of Europe quality standards.
A study was performed to evaluate a new programme for peripheral blood stem cell (PBSC) collection with the use of the Amicus (Baxter) blood cell separator. Healthy donors (n = 9) and oncology patients (n = 21) scheduled for PBSC transplant were studied. Ten PBSC harvests were performed in the donors and 30 in the patients. A median of 6.37 x 106 CD34+ cells per kg recipient body weight (range 3.08-11.06 x 106) were collected from the donors in a product weight of 169.5 g (118-186). From the patients, 6.26 x 106 CD34+ cells per kg body weight (range 0.2-53.6 x 106) were harvested in a product weighing 121.5 g (range 92-190). The median platelet contamination was 0.93 x 1011 (range 0.45-1.23 x 1011) per donor product and 0.2 x 1011 (range 0.05-0.86 x 1011) per patient product. No severe side effects were observed during or after the PBSC collection procedures.
BACKGROUND: Delayed presentations of congenital hernia occurring outside of the neonatal period have been reported for all ages. Classically, repair of the hernia defect involves a transverse subcostal laparotomy in the pediatric age group and usually a thoracotomy in the adult. The first report describing a laparoscopic repair of a congenital diaphragmatic hernia in a 6-month-old infant was published in 1995. During the past 25 years, 17 patients with delayed presentation of congenital diaphragmatic hernias have been managed by our pediatric surgery team. The last three patients underwent surgery thoracoscopically. PATIENTS AND METHODS: This study involved two boys (ages, 8.3 and 19 months, respectively) and one girl (age, 9 months) weighing 8 to 13 kg. All three infants underwent surgery using a thoracoscopic approach with general anesthesia. A thoracic epidural catheter was placed systematically for postoperative analgesia during the first 24 hours. Reduction of the hernia contents using one optical trocar and two operating trocars was difficult in the case without any hernia sac. In the cases with a hernia sac, reduction was easily and quickly obtained with a pleural insufflation of carbon dioxide (~8 mmHg). The hernia defect was repaired using interrupted sutures of 2/0 Ethibond. For two of the three patients, this repair was reinforced with staples in the one case and a nonresorbable mesh in the other case. RESULTS: The mean operative time was 78 min. The chest tube was removed on the first or second postoperative day and the patients were discharged on the fourth or fifth postoperative day. At the 19-month follow-up assessment in one case, the chest x-ray was perfectly normal and diaphragmatic motion also was confirmed to be normal by ultrasonography. CONCLUSIONS: The thoracoscopic approach for the repair of delayed-presentation congenital diaphragmatic hernia is feasible. Our results demonstrate the safety and efficiency of this surgery, as well as a remarkable functional and cosmetic result and a very quick recovery.
STUDY AIM: The treatment of Hirschsprung's disease was improved by the laparoscopic approach. The study aim was to report the results of a short series. PATIENTS AND METHOD: From December 1996 to January 2000, 13 children (7 boys and 6 girls) were operated for a Hirschsprung's disease with a laparoscopic approach. The mean age at the time of surgery was 6 months. A colostomy had been performed previously in 10 of them. The colostomy was closed and the colorectal anastomosis was performed with Duhamel's technique in 10 and Swenson's in 3. Location of aganglionnic bowel was rectum and sigmoid colon (n = 9) rectum (n = 2) left colon (n = 1), left colon and right transverse colon (n = 1). RESULTS: The mean duration of the procedure was 160 minutes. One conversion to laparotomy was necessary. One postoperative leak required a temporary colostomy. One intestinal occlusion due to an incarceration of an intestinal loop behind the pulled through colon, required a reoperation. The mean 26 month-follow-up was too short to draw conclusions about functional results. CONCLUSION: Laparoscopic approach was an important progress in the treatment of the Hirschsprung's disease but, more recently, the transanal approach that we used in the last five patients, seems to be another more important innovation.
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