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Biomedical subjects

A Liard

Publications and source records attributed to A Liard.

At least 19 recordsLinked to original sources
PubMed2006

Secondary localisation of an intra-thoracic benign mesenchymoma in the fossa poplitea: a rare paediatric case.

Thymomas are tumours that rarely occur in children, are almost invariably benign, and are usually discovered incidentally in the anterior mediastinum on chest X-rays. Whereas in adults these tumours are often associated with myasthenia gravis and other autoimmune diseases, this occurrence is very rare in the paediatric population. Multiple localisation and/or extra-thoracic recurrence of thymomas in children also appears to be exceptional with no reported cases in the English literature. We report one rare paediatric case.

Adolescent↗
PubMed2003

[Management of meconium peritonitis: a remarkable case of idiopathic meconium peritonitis diagnosed antenatally].

Meconium peritonitis is an inflammatory peritonitis induced by meconium extruding into the peritoneal cavity through a perforation of the fetal intestine. Antenatal diagnosis is possible. Prognosis depends on the pathology having caused perforation. This is often unknown. The objectives of this article are to analyze the contribution of antenatal investigations to estimating neonatal prognosis of meconium peritonitis, and to define optimal management. We describe a case of meconium peritonitis diagnosed in utero with particularly severe ultrasound presentation suggesting a potentially lethal course for the neonate. An eutrophic infant was delivered vaginally after preliminary aspiration of the meconium ascites. The neonate presented with a very distended abdomen and responded well to neonatal resuscitation. Laparotomy exploration confirmed the diagnosis of meconium peritonitis. No cause was identified. No obvious perforation was found. The postsurgery period was uneventful. At later follow-up the infant was doing well, free of further problems notably of any digestive disorder. Antenatal ultrasound features suggestive of severe meconium peritonitis are distended fetal bowel loops, huge cystic masses, major meconium ascites, and polyhydramnios. These neonates have a high risk of obstruction and intestinal perforation. Intestinal resection is frequently required. Cardiopulmonary resuscitation is necessary more often in these neonates with a higher risk of fatal outcome due to respiratory distress syndrome or surgery complications. Prognosis remains good after antenatal diagnosis for neonates free of cystic fibrosis, providing delivery takes place in a center with adequate technical facilities.

Adult↗
PubMed2002

[Prenatally detected multicystic renal dysplasia and associated anomalies of the genito-urinary tract].

PURPOSE: To analyze the prevalence of genitourinary malformations associated with multicystic dysplastic kidney (MCDK). PATIENTS: and method: A retrospective analysis of medical and imaging records of 54 neonates who had the prenatal diagnosis of MCDK was carried out. All infants had the following examinations during their first month of life: ultrasound, voiding cystourethrography and intravenous urography. Genital and urinary abnormalities were recorded. RESULTS: Vesicoureteric reflux was present ipsilaterally in 17% cases, on the opposite side in 31% cases. Ureteropelvic junction obstruction was found on the opposite side in 7% cases. Four cases of megaureters, one child with ureteric duplication, 3 boys with posterior urethral valves, 1 with reflux into the ejaculatory duct, one case of megacystis with reflux and one child with ureterocele were identified. Genital anomalies were: 2 cases of seminal vesicle cysts, one case of absent testis, 5 children with inguinal hernia, one boy with incomplete foreskin and one with hypospadias. CONCLUSION: Embryology may explain the highest prevalence of genito-urinary abnormalities on both sides in neonates with MCDK. Hence, a prompt clinical and uroradiological evaluation in these patients with a single functional kidney should be performed.

Abnormalities, Multiple↗
PubMed2002

[Vesicoureteric reflux and functional voiding dysfunction in children].

PURPOSE: To analyze the efficacy of the different treatments of vesicoureteric reflux (VUR) associated with reflex bladder sphincter dyssynergia (RBSD). PATIENTS AND METHODS: The medical records of 33 children (28 girls) aged 4 to 12 years presenting reflex bladder sphincter dyssynergia and vesicoureteric reflux have been reviewed. The most common clinical symptom was urinary tract infection. Voiding dysfunction included: dysuria, urinary leak, enuresia, urgency, constipation. In most cases, vesicoureteric reflux was low grade (grade 1, n=9; grade 2, n=18; grade 3, n=6) and bilateral (n=18). Three types of treatments have been utilized: reimplantation, reeducation, medical treatment (diet, antibio-prophylaxis, anti-cholinergics). RESULTS: Eleven children (2 with a solitary kidney) underwent early reimplantation which was effective on vesicoureteric reflux but 6 of them had post-operative voiding dysfunction and 5 had a new episode of urinary infection. Six had reeducation first then they underwent reimplantation. Sixteen children had an exclusive medical treatment (13 with reeducation). In 9 children vesicoureteric reflux disappeared (one child still complains of voiding dysfunction). In 7, voiding dysfunction improved but vesicoureteric reflux is still present. CONCLUSION: The management of vesicoureteric reflux associated with reflex bladder sphincter dyssynergia is complex. Surgery should certainly not be the initial treatment. However, it can remain useful if one wishes to get complete resolution of reflux.

Anti-Bacterial Agents↗
PubMed2001

The Mitrofanoff procedure: 20 years later.

PURPOSE: We review our initial cases of continent cystostomy to assess long-term functional results and complications after a minimum of 15 years of followup. MATERIALS AND METHODS: Between 1976 and 1984, 23 continent cystostomies were performed on 15 boys and 8 girls with neuropathic bladders. Mean patient age at surgery was 8 years and 4 months (range 3 to 16) and mean followup was 20 years (range 15 to 23). The neurological lesions were due to 21 myelomeningocele (2 associated with an imperforated anus in 21 cases), spinal neuroblastoma in 1 and complex genitourinary malformation associated with an imperforated anus in 1. Closure of the bladder neck was performed in 21 cases (16 during the same procedure, 5 secondarily) and 2 did not undergo this procedure. The appendix was used as the catheterizable conduit in 20 cases, 1 ureter in 2 and a bladder tube in 1. Bladder augmentation was performed during the same procedure in 2 cases and at a later stage in 8. Five patients presented with unilateral or bilateral secondary vesicoureteral reflux. RESULTS: One death occurred after conversion to cutaneous diversion due to a postoperative infection leading to a ventriculoperitoneal valve infection. The remaining 22 patients were followed every 6 to 12 months. No metabolic disorder, secondary malignancy or spontaneous bladder perforation was noted. Bilateral upper tract deterioration was found in 10 cases leading to secondary bladder augmentation by enterocystoplasty in 6 and creation of noncontinent diversion in 4. Leakage occurred after bladder neck closure in 5 patients. Bladder stones were found in 5 patients (2 had prior bladder augmentation). Complications related to the conduit included stomal stenosis or persistent leakage in 11 cases, which required surgical revision and/or repeated dilations and 1 noncontinent diversion after revision failure. Five patients presented with intestinal occlusion due to volvulus in 3 and adhesion in 2. We noted that after 10 years of followup complications were rare and concerned mostly the catheterizable conduit. Therefore, 16 patients had a good and stable result while 6 have noncontinent diversion. CONCLUSIONS: The rate of complications has a tendency to decrease with time. The results obtained in this series may appear less satisfactory than those of more recent series, which may be due to the fact that these oldest continent cystostomies correspond to acquisition of experience of this novel approach, and to a period when the concept of low pressure reservoir was not yet established and bladder augmentations were not routinely performed. Since 1984 no continent cystostomy performed at our institution was converted into a noncontinent diversion. This series with long followup demonstrates that continent cystostomy is a procedure with lasting efficiency.

Adolescent↗
PubMed2001

[Ultrasound for initial evaluation of post-traumatic renal lesions in children].

PURPOSE: To describe the findings and limitations of color doppler ultrasound (CDUS) compared to enhanced CT in the evaluation of pediatric renal trauma and to determine the indications for first line imaging work up. PATIENTS AND METHODS: 17 children (9 girls) aged 3 to 18 years were shown to have one or multiple post-traumatic renal lesions. All renal lesions were unilateral. All children presented with hematuria (microscopic (n=8), gross (n=7), not specified (n=2)). 16 had CDUS and enhanced CT (gold standard). A 13-year old girl had been imaged by both CDUS and IVU. RESULTS: No correlation between the degree of hematuria and the severity of renal lesion could be found. Final diagnosis was: fracture with uro-hematoma (n=6), contusion (n=5), pedicular lesion (n=2), clotted ureter (n=1), intra cystic hemorrhage (n=1), subcapsular hematoma (n=1), urinoma with no evidence of fracture (n=1), extra-urinary lesion (n=7). In four cases, CDUS was abnormal but the diagnosis of fracture had not been made. In 3 cases, a uro-hematoma was present and CDUS misdiagnosed a pedicular lesion. CONCLUSION: Imaging strategy should not rely on the type of hematuria. Presence of a urinoma alters the sensitivity of CDUS. When performed in ideal conditions, a comprehensive normal CDUS examination is probably sufficient to exclude a major renal injury.

Accidental Falls↗
PubMed2000

Enterocystoplasty complications in children. A study of 30 cases.

BACKGROUND/PURPOSE: Bladder augmentation for small vesical capacity represents an important aid to these patients, but the appearance of complications is not rare. We analysed the complications of the enterocystoplasty techniques used in our Department. METHODS: From 1983 to 1997 sixteen girls and fourteen boys were treated. We performed 28 bladder augmentations (in 13 cases using small bowel, in one case using ileum and caecum and in 14 cases using sigmoid colon) and 2 bladder substitutions (in one case with ileum and sigmoid colon and in the second using a colonic segment). RESULTS: Twelve children present recurrent urinary infections. In five children bladder stones were formed (among them a case of familial cystinuria-lysinuria). Two children presented intestinal volvulus and another one a caecal volvulus. In two children a perforation of the augmented bladder was treated operatively. An 11-years-old child presented severe electrolyte disturbances. CONCLUSIONS: The complications presented in our patients confirm the view that they are associated with intestinal mucosa in the bladder and our study proves, once more, the current necessity to seek alternative tissues for bladder augmentation.

Adolescent↗
PubMed2000

Post-traumatic arterial priapism in the child: a study of four cases.

The authors report four cases of arterial priapism in the child, a rare condition since only 13 cases are described in the literature. High-flow priapism follows perineal or penile injury with damage to a cavernosal artery and formation of an arteriosinusoidal fistula. The onset may be immediate but more often occurs after a few days. Arterial priapism is painless, as the corpora cavernosa are less tumescent in the anterior third of the penis. The clinical appearance and circumstances of onset suggest the diagnosis. Doppler ultrasound is the complementary investigation of choice, confirming and localising the fistula. Various methods of treatment have been proposed. Injections of alphastimulant seem ineffective in most cases and are not without danger. Surgery, which is potentially damaging, has been used only in the adult. Most authors propose embolising with resorbable material the artery which feeds the fistula. However, priapism may resolve spontaneously in less than three weeks, as occurred in our cases, without recurrence or subsequent erectile dysfunction. We thus consider the condition may initially be managed by observation alone, with recourse to embolisation if priapism does not resolve after a period of time which however remains to be defined.

Arteries↗
PubMed2000

Epididymitis in children: is further investigation necessary after the first episode?

OBJECTIVE: The aim of this study was to evaluate the usefulness of investigating underlying urinary tract pathology after the first episode of acute epididymitis in children with no prior urological history, and also to assess the possible predictive factors of urological disease at the time of diagnosis. METHODS: Children with acute epididymitis were studied retrospectively over a period of 8 years. Diagnosis was made either using ultrasonography or surgical exploration. Renal ultrasonography and voiding cystourethrography were performed 1 month after epididymitis. RESULTS: These tests were carried out in 38 children who revealed 7 anomalies (18%). Only 1 patient received further surgery : endoscopic treatment of a ureterocele. We also studied 3 predictive factors: age <2 years; recurrence, and urine bacteria. None could be associated with the presence of urinary tract pathology. CONCLUSION: The authors suggest that, when there is no previous urological anomaly and absence of bacteriuria, routine screening for epididymitis should be carried out following the second episode.

Acute Disease↗
PubMed2000

Temporary high diversion for posterior urethral valves.

PURPOSE: Temporary high diversion for posterior urethral valves remains controversial. Even in the most severe cases some physicians deny the efficacy of this treatment. They assert that high diversion does not change the outcome of kidney function and has an iatrogenic, deleterious effect on the bladder. We believe that these 2 assertions may be inaccurate. MATERIALS AND METHODS: We evaluated 17 of 120 boys with posterior urethral valves who underwent temporary high diversion via Sober-en-T ureterostomy. This procedure immediately decompresses the upper urinary tract and leaves the bladder functional. Mean duration of diversion was 13 months. Bladder function results were good and diversion clearly had no deleterious effect. However, our series was too small to conclude with certainty that renal function improved due to diversion and not to valve resection only. Rapid improvement in creatinine was noted in all cases after diversion. RESULTS: In this study we reviewed opposing opinions. It appears clearly evident that physicians who believe that ureterostomy creates a valve bladder are considering only loop diversion, which temporarily defunctionalizes the bladder. On the contrary, Sober-en-T diversion preserves bladder cycling. In addition, those who report poor kidney function after high diversion fail to mention that this procedure is usually performed only in the most severe cases. CONCLUSIONS: For severe cases of posterior urethral valves one should not hesitate to create temporary high diversion, which may possibly improve renal function. Sober-en-T ureterostomy does not damage the bladder.

Child↗
PubMed2000

[Intestinal volvulus after enterocystoplasty: report of three cases in children].

Enterocystoplasty complications related to the presence of intestinal mucous presence in the bladder are well known and well reported in the literature. Mechanical problems in the intestinal tract due to using gut for bladder augmentation are not as well recognised. We analyzed three cases of children treated by ileocystoplasty who presented an intestinal volvulus in two cases and a cecal volvulus in one case around the vascular pedicle of the intestinal patch used for bladder augmentation.

Adolescent↗
PubMed1999

Results of the Gil Vernet procedure in preventing contralateral reflux in unilateral ureteric reflux.

OBJECTIVE: To evaluate whether contralateral meatal advancement based on the technique described by Gil Vernet decreases the risk of postoperative contralateral reflux, which may occur after a unilateral reimplantation. PATIENTS AND METHODS: From January 1986 to 1997, 321 reimplantations were performed for unilateral vesico-ureteric reflux (VUR) using the Cohen procedure. In cases where the contralateral meatus was symmetrical or had a pathological appearance, preventive contralateral surgery with meatal advancement was performed. RESULTS: Ureteric reimplantation was exclusively performed unilaterally in 254 patients and in 67 a contralateral meatal advancement was performed. There were 29 cases of contralateral reflux at the 4-month follow-up. In nine patients contralateral reimplantation was necessary for persistent symptomatic VUR, the reflux resolved spontaneously in 14 and a radiological examination was necessary in six. Reflux also appeared on the Gil Vernet side in only 6% of patients; there were no clinical symptoms and the outcome was favourable. CONCLUSION: The advancement of the meatus using the Gil Vernet procedure is simple, with no surgical complications. We suggest that this technique constitutes a useful surgical alternative in the prevention of contralateral reflux.

Child↗
PubMed1999

[US-guided percutaneous drainage of an infected epidermoid cyst of the spleen in a child].

Epidermoid cyst of the spleen is a rare entity (2.5% of all splenic cysts) and rarely becomes complicated by hemorrhage, rupture or infection. Classically, management consisted of total or partial splenectomy. We report the case of an 8-year-old boy presenting with a splenic abscess complicating an epidermoid cyst. Percutaneous drainage of the abscess was performed under sonographic guidance and completed by intravenous antibiotic therapy. Six weeks later, laparoscopic surgery was performed and the splenic parenchyma could be preserved.

Abscess↗
PubMed1998

[Benign ureteral polyps in children: apropos of a case].

Ureteric polyp is a benign lesion, and an uncommon cause of hydronephrosis in children. It is associated with intermittent lumbar pain and haematuria. The diagnosis is usually based on intravenous urography or retrograde urography. Treatment must be conservative and consists of simple resection of the polyp, associated with varying degrees of ureteric resection depending on the size of the lesion. No case of recurrence after treatment has been reported to date. The authors report a case in a 7-year-old boy and present a review of the literature.

Child↗
PubMed1997

Surgical treatment of buried penis.

The buried penis is a rare congenital entity, whose treatment is surgical. There are few publications concerning this matter. The authors report on their experience in 10 cases (1990-1995). In this abnormality, the tip of the glans does not project from the pubic or scrotal skin. It is due to: 1) an excessive development of the penile fascia which retracts the penis; 2) insufficient attachment of the penile skin at the base of the penis; 3) often excessive prepubic fat worsens the appearance of the abnormality but does not by itself totally explain it; 4) a tight phimosis is often present. Surgical treatment is necessary because this aspect tends to persist even after puberty. One cannot indeed count on the development at the age of puberty, neither on the diminution of the fat, nor on the simple cure of the phimosis. One must above all ban circumcision which causes the risk of eliminating the skin necessary for reconstruction. The surgical procedure will comprise: 1) a longitudinal dorsal incision extended circumferentially; 2) resection of the thickened fascia penis; 3) anchoring of the deep face of the dermis to the proximal part of the fascia penis at the base of the penis. This surgical procedure has always brought a significant improvement to the appearance of the penis.

Child↗
PubMed1997

Idiopathic varicocele in children and adolescents--which therapeutic choice?

61 children were studied and treated between January 1986 and September 1993 for idiopathic varicocele. The aim of our study was to evaluate the advantages and disadvantages of the different techniques and to show the progression to a greater efficacy. The mean age at the time of therapy was 14 years, ranging from 7 to 16 years. All children presenting with pain or testicular asymmetry were treated. Four asymptomatic children were followed for 2 years before treatment. 36 children were treated by surgical ligature via the inguinal approach; 8 with a resection of the varicose veins as far as the tunica vaginalis. 14 children were treated by percutaneous sclerotherapy including 1 patient following unsuccessful classical surgical treatment. 12 children were treated by surgical inguinal ligature associated with peroperative phlebography and thrombosis. 56 children were reviewed postoperatively over a period which varied from 2 months to 4 years (5 lost to follow-up). For the 36 classical ligatures: 25 good results, but 9 hydroceles (5 out 8 varicose resections): 70% good results. 7 failures and 4 lost to follow-up. For the 14 percutaneous sclerotherapy: 4 technical failures (impossibility to catheterize the spermatic vein): 10 good results. For the 12 ligatures with peroperative phlebography and thrombosis: 11 good results and 1 lost to follow-up. All the above procedures were carried out at our out-patient clinic. The therapeutic choice will therefore have to take into consideration a procedure which produces the lowest morbidity rate and proves to be the most effective. The association of surgical ligature, phlebography and thrombosis meets these requirements.

Adolescent↗