Chirurgie pediatrique最新文献

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.

Ten children with recurrent tracheo-oesophageal fistula have been treated over 13 years (1976-1988). Five patients were referred from other centers. The original pathology was oesophageal atresia in eight and two patients had a tracheo-oesophageal fistula alone. Barium swallow demonstrated the recurrent fistula in only five of eight cases. In fact, the key examination is tracheoscopy providing that catheterisation of the fistula. The position of the catheter is verified radiologically. The difficulties of surgery in recurrent fistula are linked to the problem of locating the level of the fistula peroperatively. Without catheterisation of the fistula, there were one failure out of three cases (one dead). By contrast, in the seven cases where the fistula was catheterised, a successful outcome was always obtained. The failure of surgery for recurrent tracheo-oesophageal fistula is not linked to a technical problem of closure of the fistulous tract but to failure to localize the fistula adequately.

Three cases of sternal cleft are treated. In two cases direct approximation of the two sternal halves have been possible in neonatal period. The third case was seen later at 11 months: the cleft was 5 cm wide, we used autogenous periostal graft in two layers, the first in depth, the second above the sternal halves. This technique have given a good clinical and radiological result for two years. She must be reserved for the wide and "old" sternal cleft.

Percutaneous nephrostomy is a new and very efficient technique of the drainage of the obstructed kidney. It is better indicated to treat obstructive anuria in the child especially if the obstructive agent is a bilateral stone. Having performed such method successively in 3 patients suffering of calculus anuria, the author tries to point out its advantages and review literature data. Thus, this technique allows prompt drainage of urine and removes emergency in case of infected intra-renal retention. It takes an important part in diagnosis by permitting dye injection in the drained upper urinary system. It could also inform about residual value of the desobstructed kidney and predict changes of its potential recovery. It represents lastly, a first step for in-situ treatment of the stone.

Between 1977 and 1988, 20 patients underwent the Fontan operation. Their age ranged from 4 to 24 years (mean 11 years). The basic disease was tricuspid atresia with ventriculo arterial concordance and right ventricular hypoplasia. Pulmonary stenosis was present in 16 patients. Twenty-eight palliative procedures had been performed previously in the group of patients presenting some forms of pulmonary stenosis. In 2 cases a non-valved conduit has been used for correction, in a third case a valve conduit was utilised, and in a fourth case a right atrioventricular connection was carried out. In the remaining 16 patients, a wide posterior connection between the right atrium and the pulmonary arteries was performed. There were 2 early deaths (10%), and 2 late deaths (10%). After a follow-up ranging from 6 months to 11 years, all survivors are in a satisfying functional condition. We think that a wide unrestricting atriopulmonary anastomosis is mainly responsible for those good functional results. Age at operation has not influenced the results. Previous and long standing shunts may be responsible for immediate and late postoperate cardiac failure. Consequently, we now prefer an earlier corrective procedure, particularly when the patient has a patent systemic pulmonary shunt.

Current interpretation of pH-metering tracings takes into account several variables which indirectly reflect how many times and for how long time pH falls below a threshold value and how efficient is acid clearance. In this investigation we have tested the hypothesis that area under pH curve summarizes all the former values in one single figure. We have compared the four classical pH-metering variables (percentage of time under pH 4, number of GER episodes, number of those lasting more than 5 minutes and duration of the longer episode) and the area under curve between a group of refluxing children (n = 50) and a control group (n = 20). A value of 4% time under pH 4 was selected as "gold standard" for separation of both groups. We have figured out sensitivity, specificity and accuracy for all values of each parameter and, by means of ROC (Receiver Operating Characteristic) method, we have determined their performance and the optimum threshold value. Our results demonstrate that area under curve is at least as performant as percentage of time below pH 4, and probably better because it reflects, in addition, the depth of pH falls and the clearance. Taking into consideration that its measurement can be done automatically, we suggest that it should be included in the currently available software for computerized pH reading.

We present two patients with intractable constipation, in which investigation revealed a huge rectal ectasia without apparent other anomaly. Findings at operation are similar to those observed in the focal ectasia of the terminal bowel that we have already described in some cases of low anal deformities. As long as the physiopathology of this anomaly is not elucidated, complete amputation of the rectum seems to be the treatment of choice.