Chirurgie pediatrique最新文献

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.

Operative and postoperative analgesia has become in a few years a major concern for pediatric anesthesiologists. The fact that pain can have dramatic metabolic and hemodynamic consequences has been well documented. This study shows the activity in our department in the field of analgesia during 1989. 82% of the 2,675 children having undergone surgery have received analgesia during the operative period either by the way of an i.v. narcotic or an regional block. No morbidity or mortality resulted from these techniques during the operative period. When a regional block was prolonged by the mean of a catheter, there were no major complication (2 seizures). The use of oral, rectal and i.v. analgesics follows the classic recommendations. Morphine by all routes of administration is used increasingly in our department. Two moderate respiratory depressions occurred in 1989 due to error in dosage with no consequence for the child. The authors underline the importance of well established protocols which have been discussed and approved by all, the importance of emergency procedures and treatment, which only can guaranteed the necessary safety.

Four cases of Carpal Tunnel syndrome during childhood are reported. Two of them are post traumatic cases; for one child, the syndrome was caused by hypertrophic cal six months after trauma. The other child has been operated because of a median and ulnar nerve deficit syndrome, which appeared one month after fracture. In the third observation, the authors have seen an abnormal muscle just in front of annular anterior ligament of the carpus during surgery. This muscle was assimilated to hypertrophic Palmaris Brevis muscle. In the last observation, the adolescent had a Poland syndrome with Sprengel malformation. In this paper, the authors point out clinical particularities due to musculo-tendinous malformation which can lead to Carpal Tunnel syndrome.

Obstructive lesions of the anterior urethra (valves, saccular diverticula) are rare, and can be difficult to diagnose. Three recent cases have led us to review the existing french and english literature and we have found case histories for 81 cases, encountered over a twenty year period. The anatomic interpretation of the lesions is far from being univocal; however many authors clearly distinguish between valves and diverticula, the basic difference residing in the contiguity between the anomaly and the corpus spongiosum. Where the clinical presentation depends on age, the diagnosis depends essentially on the voiding cysto urethrography, which must objectify the whole of the urethra. Generally speaking the treatment for the valves is simple, consisting in endoscopic resection. In the case of diverticula, it is not always necessary or desirable to remove the diverticulum itself; if there is a well-formed distal obstructing lip, removing it may be enough to cure the obstruction.

Carotid body tumors are encountered infrequently. We report a case of a fourteen year old boy presenting an inflammatory biologic syndrome with a right neck mass. The diagnosis was first an Hodgkin disease but the surgical approach and histological examination of the neck mass conclude to a benign carotid body tumor. A subadventitial excision allowed a complete recovery with one year follow up. The diagnosis of these tumors is essentially made by arteriography. They are benign in most of the cases but sometimes need for a vascular reconstructive surgery in very extended forms.

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.

A case is reported of a large left ureterocele in a duplicated system at the expense of the upper renal pelvis. This ureterocele caused acute pyelonephritis and dilatation of both left systems. It was treated by a classic endoscopic incision of its roof but 18 months later, infecting vesico-renal, grade 2, reflux was developed. This secondary reflux was treated successfully by submeatal polytetrafluoroethylene's (Teflon) paste injection. This new combination of endoscopic techniques proved to be available in this case.

Seventeen sacrococcygeal teratomas with prenatal diagnosis are studied. The diagnosis was made at 27 weeks. Three fetuses died in utero, two of them from the evolution of the tumor. Two died post-natally from hemorrhage and one post natally because of his prematurity. From the eleven long term survivors, one developed a recurrence and five sequelae. This study confirms the poor prognosis of fetal sacrococcygeal teratomas. The 2 major prognosis factors are the growth of the tumor and the occurrence of fetal congestive heart failure. That congestive heart failure is diagnosed by Doppler echocardiography before hydrops and placentomegaly who are of very poor prognosis. The extraction of the fetus is mandatory if these features appeared after 30 weeks. Before this term fetal surgery is the only effective treatment. At a long term, the risk of recurrence is low but implies a long term surveillance of the level of alfa foeto protein.

Ninety six distal tibial epiphyseal fractures were identified and treated in our institution from 1976 to 1988. The average age was twelve years and eight months (range two to seventeen years), but seventy-one were between eleven and fourteen years old. Using the Salter-Harris classification we have found twelve type 1 tibial fractures, fourty-two type 2, thirty type 3 and twelve type 4. Four were triplane fractures and seven were Tillaux fractures. Twenty-six had injuries in the medial corner of the ankle mortise (Mac-Farland). Fifty patients were treated non-operatively with closed reduction and plaster cast. Fourty-six fractures were treated surgically. Seventy patients were available for follow-up evaluation. The average follow-up was thirty-two months (range 6 months to eleven years). The tibial distal epiphyseal cartilage was closed in 48 patients. As short-term complications we have seen three post-operative displacements after closed reduction; all of them were treated surgically. Five incomplete closed reduction needed open reduction needed open reduction and bone fixation. Two infections occurred after a surgical approach. Among late complications we have seen eleven premature epiphyseal cartilage closure (rate 15%). Four were responsible of angular deformities. One child has a tibial osteotomy for varus deformity after a medial closure. Two ankle arthritis occurred: one of them was seen after a post-operative infection. In two cases of fracture of the medial mortise corner, a valgus deformity with hypertrophy of the medial malleolus occurred. Ankle arthritis is the most severe complication of the adolescent articular fractures (Tillaux and triplane fractures).(ABSTRACT TRUNCATED AT 250 WORDS)

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.