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Biomedical subjects

A Couture

Publications and source records attributed to A Couture.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of abdominal pain in Henoch-Schönlein syndrome by high frequency ultrasound.

The authors report the use of high frequency ultrasound (7.5-10 MHz probes) for the detection of intestinal complications in 14 children with Henoch-Schönlein purpura. Ultrasound gave information of 3 levels: (1) It explained the acute abdominal pain by showing in all cases the oedematous haemorrhagic infiltration of the intestinal wall, which appeared thickened (3-11 mm): lesions were diffuse (6 cases) or focal (duodenal in 5 cases, jejunal in 2 cases and ileal in one). (2) It followed the evolution of the disease: extension of lesions (5 cases) or resolution (progressive decrease of parietal thickening, reexpansion of small bowel lumen, reappearance of peristalsis). (3) It always detected surgical complication: ileo-ileal intussusception (3 cases), perforation (1 case).

Abdominal Pain↗
PubMed1992

[Neuroblastoma, factor of early decompensation of tetralogy of Fallot].

The authors report the case of a tetralogy of Fallot associated with a neuroblastoma secreting large quantities of noradrenaline. Anoxic decompensation of the tetralogy of Fallot occurred early at the age of 4 months with cyanotic crises associated with an impression of abdominal pain. A systemic-pulmonary anastomosis was performed and the cyanosis regressed but the crises persisted and investigations showed the presence of a neuroblastoma. The tumour was treated by surgery and chemotherapy and has not recurred after 2 years' follow-up. Complete repair of the tetralogy of Fallot was performed secondarily at the age of 2. In this case, the high concentration of circulating catecholamines was probably a factor of early decompensation of the tetralogy of Fallot by infundibular spasm. A review of the literature revealed 26 cases of cardiac disease with a peripheral neurogenic tumour. Two pathogenic mechanisms are suggested: an embryological abnormality of cardiac cell migration from the neural crest and chronic stimulation of neuroblastic cells by chronic hypoxia.

Humans↗
PubMed1990

Pericerebral fluid collections and ultrasound.

The authors have studied 142 cases of pericerebral fluid collection, by ultrasound. Three echographic patterns are individualized: anechogenic single compartment (109); thin linear echogenic membrane dividing the pericerebral fluid collection (25); the third group (8) presented with a peripheric echogenic collection. The use of high frequency probes permits the detection of pericerebral effusions, and provides new information about the high incidence. Ultrasound can define the anatomical position and show the complications which are mainly acute subdural hematoma.

Acute Disease↗
PubMed1989

[Solid tumors of the adrenal gland in children (excluding neuroblastomas). A study of a series of 18 cases].

This is a survey of the French South-East Group of Research in Pediatric Surgery (GRECPSE) concerning 18 Solid Adrenal Tumors, observed during a 20-years period (1969-1989) in 11 boys and 8 girls. 13 are tumors of the adrenal cortex (9 adenomas and 4 carcinomas). Clinical virilization is found in 7, cushing's syndrome in 3; while feminizing tumor, Conn's syndrome and non hormone-secreting form are quite exceptional (1 case each, respectively). 5 are adrenal pheochromocytomas (4 benign tumors and 1 malignant with local invasion). Ultrasonography, CT Scan and MIBG Scintigraphy are modern procedures which permit localization of the small and non palpable tumors with high accuracy. They make easier surgical management. Differentiation between benign and malignant tumors of the adrenal glands still remains the main problem. The course of the disease is surely the only distinguishing parameter. However weight tumor and selective histopathological characteristics are useful in predicting the prognosis and behavior of such tumors = Mitotic activity for adrenocortical tumors, extensive areas of necrosis and small cells for pheochromocytomas have the highest discriminating value.

Adolescent↗
PubMed1988

[Fibrous epithelial polyps of the pyelo-ureteral junction in children. Presentation of 3 cases and review of the literature (33 cases)].

Primary ureteral tumors are rare and benign ones constitute only a small portion. Of the benign neoplasms, fibro epithelial polyps are probably the most common and could be considered to be an exceedingly rare cause of Hydronephrosis in children. The exact etiology of benign ureteral polyps is not certain but it is likely that they have a congenital one. They are mesodermal in origin and consist of a thick fibrous stalk covered by a layer of normal transitional epithelium. They are more commonly found in boys (80.6%), who present usually with abdominal pains or renal colics. Fibro-epithelial polyps often rise in the proximal ureter and renal pelvis, especially at the left side (69.4%). Radiographic signs are those of a non typical uretero-pelvic Junction obstruction. IVP and retrograde ureterogram usually demonstrate a long, thin, filiform, lucent filling defect within the ureteral lumen with moderate hydronephrosis. Appropriate treatment of these benign tumors is local excision with or without segmental resection. Prognosis should be considered as excellent without a report of recurrence. A review of the literature revealed 33 cases of ureteral polyps in children. We report here 3 additional cases of obstructing fibro epithelial polyps, observed in boys aged respectively 4, 8 and 9 years.

Child↗
PubMed1987

[Role of cerebral echography in the diagnosis of aneurysms of the vein of Galen].

Cerebral ultrasound imaging by a transfontanelle approach is now a common investigation during the first year of life. This exploratory procedure is non-invasive, non-irradiating, requires no sedation and can be carried out at the infant's bedside. In addition, the classical apparatus can be completed by deep Doppler allowing deep cerebral vessels to be studied. Three cases are reported of aneurysm of Galen's ampulla detected by ultrasound imaging during the neonatal period. Images demonstrated the presence of an abnormal fluid mass in the region of Galen's ampulla, confirmed as of vascular origin by Doppler, and allowed assessment of degree of subjacent ventricular dilatation and possible secondary ischemic lesions. In massive neonatal forms this exploration may be sufficient since prognosis is poor, but in lesions of moderate size CT scan and angiographic examinations and perhaps MR imaging are required. This technique allows detection of this malformation in the fetus and could therefore influence therapy.

Cerebral Veins↗
PubMed1987

[Intraventricular hemorrhage in the newborn infant at term: thalamic origin].

Four observations of intraventricular hemorrhage in full term neonates without perinatal asphyxia are reported. The clinical pictures were remarkably similar in the four infants: neurological symptoms developed several days after birth with sunsetting and eye deviation and symptoms of cranial hypertension. Ultrasonography and CT scan showed a thalamic hemorrhage.

Cerebral Hemorrhage↗
PubMed1987

[Acute intestinal invagination in infants and children, critical evaluation of the diagnostic and therapeutic strategy. Apropos of a series of 163 cases].

This study concerns a homogenous series of 163 cases of intussusceptions in children, seen in the Visceral Pediatric Surgical Unit of Montpellier from 1974 to 1985. The authors differentiate and compare two periods with regard to the year 1980: the first one (P1 = 64 cases) during which, surgery was always the rule;the current one (P2 = 99 cases) where non operative treatment is the modality of choice under precise conditions. Synthetic analysis and comparison of the different therapeutic groups which have been distinguished in every period lead to the following data. 14% of intussusceptions are directly operated whatever the period or the modality of management probably because this group represents the absolute contra-indications of a barium enema--It concerns children with a long duration of the disease, obstructive or peritonitis signs and late diagnosis--Laparotomy is mandatory and finds a high percentage of leading points and ileo-ileal forms. Intestinal resection was necessary in 59.5% of cases. Because of this and a poor general condition, morbidity was high and Hospital stay was long. 56.4% of intussusceptions are operated after failure of barium enema reduction. This hydrostatic irreducibility is probably explained by the prevalence of ileo-colic forms (53.3%) in this group. A shorter duration of the disease (less than 2 days in 43.1%) and a strong majority of idiopathic intussusception (90.5%) are surely responsible of a high percentage (80%) of successful manual reduction without the need of a resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1987

[Malignant leiomyoblastoma of the stomach (epithelioid leiomyosarcoma)].

Primary malignant tumors of the stomach are rare in children. They are chiefly sarcomas and lymphomas, carcinomas being quite exceptional. Leiomyoblastomas are mesenchymal tumors arising from smooth muscles. Histologic differentiation between benign and malignant leiomatous tumor is difficult. However, an histopathologic grade of malignancy can be assigned to each tumor according to the degree of hypercellularity, nuclear abnormality, mitotic rate, tumor size and invasion of adjacent organs. Moreover, some of these tumors are noted in conjunction with Carney's triad, associated with a pulmonary chondroma and an extra-adrenal para-ganglioma. Pre-operative correct diagnosis is seldom made, although the incidence of gastro-intestinal bleeding and anemia is much higher in smooth muscle tumors than in others. Wide surgical excision must be performed, whenever a chance to completely remove the tumor exists. Gastric resection is well tolerated in children and does not significantly alter the child's normal growth and development. The high risk of local or metastatic recurrence, the chance for a Carney's triad to appear imply a poor prognosis and neccesitate a long follow-up period. We here describe the case of a 15-year-old boy, whose gastric tumor was found on the fact of an important melena and anemia. Gastroscopy showed an ulcerative tumor of the lesser curvature and roentgenogram from a barium study described an important and irregular defect in gastric body with a central ulcer overlying the mass. At operation, the tumor appeared to be unlimited and total gastrectomy was performed. Histologic findings showed an epithelioid leiomyosarcoma with some unfavorable microscopic factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Total colonic form of Hirschsprung disease. Apropos of 6 cases].

6 patients with total colonic aganglionosis without small bowel involvement (HCT) have been observed during a 13-years period. From this material and a review of literature, the authors stress the diagnostic and therapeutic particularities of HCT, which justify a separate analysis and a comparative study with the more typical forms of Hirschsprung's diseases. The percent of HCT out of all types of Hirschsprung's disease is 7.9%. Male to female ratio is 2:1 and familial occurrence is much higher (15 to 20%) than that seen in the classical form of Hirschsprung's diseases. A diagnosis of HCT is more difficult because of lack of specificity in clinical picture, radiologic findings and manometric evaluation. However, age at time of revelation is the neonatal period in 83% and enterocolitis is present in 25% with a higher incidence than in shorter types of Hirschsprung's disease. Therefore in HCT, laparotomy with appendicectomy and open frozen biopsies is always required for correct diagnosis. Ileostomy is mandatory. It must be done early and adequate in situation and technic. This kind of diversion has its own morbidity and mortality with a higher rate than that observed after colostomy. Definitive operation must be ideally performed at age 2. The principal of preserving and utilizing a segment of colon in a side-to-side anastomosis to the ganglionated small-bowel, followed by a pull-through ileoproctostomy has been established as a reasonable treatment for HCT since Martin's first description. 5 cases underwent a Martin repair and 1 a total colectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Cecum↗