Biomedical subjects

Arnaud Bonnard

Publications and source records attributed to Arnaud Bonnard.

8 recordsLinked to original sources

PubMed2006

Cytomegalovirus infection as a possible underlying factor in neonatal surgical conditions.

BACKGROUND: The seroprevalence of cytomegalovirus (CMV) in France is about 38%. Fetal contamination during pregnancy is 40%. We report a series of gastrointestinal conditions associated with CMV in neonates. PATIENTS AND METHOD: This is a retrospective study on neonates operated on for gastrointestinal conditions in our institution between January 1998 and December 2002. Only children with suspected CMV infection (characteristic nuclear inclusions) on pathologic examination were reviewed. We analyzed the age of onset, the clinical and radiologic presentation, and the serologic findings in mother and child. RESULTS: The study included 3 boys and 2 girls. The average gestational age was 34.4 weeks (range, 28-39 weeks) and the average birth weight was 2364 g (range, 790-3580 g). Two infants had necrotizing enterocolitis, 2 had pathologic condition related to Meckel's diverticulum (volvulus and perforation, respectively), and 1 had distal ileal atresia. All surgical specimens showed characteristic CMV nuclear inclusions. Maternal serologic studies were positive for CMV in only 1 case with CMV IgM detected in serum. Two babies had a positive serological finding for CMV with detection of CMV IgM, and 2 had CMV isolated on urinary viral culture (one had both). CONCLUSION: Cytomegalovirus is a viral agent that may be involved in surgical pathology in neonates. To confirm the causal relationship between CMV and these pathologic findings, a large-scale longitudinal prospective screening of CMV in neonates with intestinal conditions should be performed.

Cytomegalovirus Infections↗

PubMed2005

CARD15/NOD2 is not a predisposing factor for necrotizing enterocolitis.

Multiple factors are incriminated in the etiopathogeny of necrotizing enterocolitis (NEC) in premature infants, including oral feeding, vascular abnormalities, increase in pro-inflammatory cytokines, and inappropriate response of the intestinal barrier to bacterial microflora. CARD15/NOD2 is a gene recently recognized as important in the innate response to gut flora and is involved in Crohn's disease susceptibility. We thus tested its putative role in NEC. Ten children (seven boys and three girls) suffering from NEC who were admitted to Robert Debré hospital between 1999 and 2002 were retrospectively included in the study. Genetic screening of the 11 constant exons and the exon-intron junctions of CARD15/NOD2 by direct sequencing revealed no novel mutations of that gene in NEC patients. Furthermore, the three main mutations of CARD15/NOD2 (R702W, G908R, and 1007fs) associated with susceptibility to Crohn's disease were not found in these patients. Our results suggest that CARD15/NOD2 does not play a major role in genetic susceptibility to NEC.

Crohn Disease↗

PubMed2005

Video-assisted thoracoscopic surgery for pulmonary sequestration in children.

BACKGROUND: The purpose of this report is to describe our experience with video-assisted thoracoscopic surgery for pulmonary sequestration in children. METHODS: From May 2001 to June 2004, video-assisted thoracoscopic surgery was attempted for antenatally diagnosed pulmonary sequestration in 8 consecutive infants. Mean age at the time of surgery was 10 months (range, 4 to 44 months). Six lesions were located in the left lower lobe and two in the right lower lobe. Endovascular embolization was attempted before video-assisted thoracoscopic surgery in only 1 patient. All procedures were performed in the lateral decubitus position, and single-lung ventilation was used in all cases. RESULTS: Conversion to open surgery was necessary in two cases. Video-assisted thoracoscopic surgery was successful in 6 patients. After being identified and isolated, the aberrant artery was controlled by endoscopic ligation, and lobectomy, wedge resection, or sequestration was performed depending on the type of lesion. Mean operative time was 155 minutes. Average hospital stay was 3.5 days. There were no postoperative complications. Follow-up ranged from 4 to 50 months. CONCLUSIONS: Video-assisted thoracoscopic surgery is technically feasible for pulmonary sequestration. Early resection obviates the risk of infection. Elective ligation of the aberrant artery is a safe alternative to the use of stapling devices or clips. Cosmetic results are excellent.

Bronchopulmonary Sequestration↗

PubMed2005

Laparoscopic approach as primary treatment of common bile duct stones in children.

BACKGROUND: Preoperative endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy (ES) are an effective strategy for choledocholithiasis, but complications such as pancreatitis and outcome in children are unknown. The laparoscopic cholecystectomy became the new gold standard in children for cholelithiasis. For the choledocholithiasis in children, the attitude is more controversial. We analyzed our series of laparoscopic approach for the management of choledocholithiasis in children to determine if it is an effective procedure. PATIENTS AND METHOD: Between 1996 and 2001, 126 children were treated for cholelithiasis in our institution; 13 children (10.3%) were managed for a choledocholithiasis. We reviewed age at symptom onset results of paraclinical examinations, the type of laparoscopic management, and postoperative outcome. RESULTS: The mean age at clinical signs was 9.9 years (range, 3 months-15.5 years). One child was excluded because he had a preoperative ES. Twelve children had a laparoscopic cholecystectomy and cholangiogram at the same time. A choledocholithiasis was found in 10 cases. A flush of the common bile duct (CBD) was performed in all cases with a 3F or 5F ureteral catheter; the stone was pushed into the duodenum in 3 cases and successfully extracted in 3 with a 4F Dormia or Fogarty catheter. One child needed a conversion to open surgery. Three times, an ES was necessary in postoperative course in each case for clinical and biologic signs of CBD obstruction or pancreatitis (30%). All children are symptom-free with an average follow-up of 28 months. CONCLUSION: Laparoscopic CBD exploration for choledocholithiasis can be performed safely in children at the time of cholecystectomy and can clear all of the stones in the CBD in two thirds of cases. If there is residual obstruction, a postoperative ES can be performed. We suggest primary treatment of choledocholithiasis by laparoscopic approach in children.

Adolescent↗

PubMed2005

Evaluation of intestinal absorption after longitudinal intestinal lengthening for short bowel syndrome.

PURPOSE: The aim of this study was to answer if the longitudinal intestinal lengthening and tailoring (LILT) by Bianchi, modified by Aigrain, can allow the child to be weaned from parenteral nutrition (PN) and if the length of the bowel after the procedure can influence the results of the absorption test such as Schilling or D-xylose test. PATIENTS AND METHODS: We reviewed the files of 7 children who have had LILT from 1980 to 2003. We performed to explore 2 intestinal function tests: the D-xylose and the Schilling tests. Both were performed early (during the first year after the procedure) and late (during the second year) after the LILT. We used the chi2 and Bartlett's correlation tests for statistical analysis. RESULTS: There were 6 boys and 1 girl. The surgical indication was short bowel syndrome with parenteral nutrition owing to multiple intestinal atresia (2 cases), severe necrotizing enterocolitis with volvulus (1 case), necrotizing enterocolitis (1 case), intestinal atresia with gastroschisis (2 cases), and volvulus owing to malrotation (1 case). The length of the bowel was significantly different before and after LILT (P < .0001). After LILT, the length of the bowel was significantly correlated with the percentage of PN on energy at 6 months (P = .02) and at 12 months (P = .001). Moreover, the length of the bowel after the procedure was significantly correlated with the results of the D-xylose test during the first year (P = .002) but not with the results after the second year. The length after lengthening influenced neither the results of the Schilling test during the first nor those of the second year after. Four patients were weaned from the PN 21 months in average after the LILT (57%); 1 was not because we had only a 2-month follow-up. The average follow-up was 111 (5 months; range, 4-206). CONCLUSION: Longitudinal intestinal lengthening and tailoring for short bowel syndrome is a good option to allow children to be weaned from the PN. The length of the bowel after the procedure can influence the absorption test such as D-xylose during the first postoperative year but not during the second and does not influence the Schilling test. We think it is not necessary to perform these tests during the follow-up of these patients.

Child, Preschool↗

PubMed2005

Retroperitoneal laparoscopic versus open pyeloplasty in children.

PURPOSE: The indications for laparoscopy in pediatric urology are expanding and yet the advantages over open surgery remain unclear. We compared the results of retroperitoneal laparoscopic vs open pyeloplasty for pyeloureteral junction obstruction in children. MATERIALS AND METHODS: A total of 22 children with a mean age of 88 months (range 25 to 192) underwent laparoscopic dismembered pyeloplasty via the retroperitoneal approach. An additional 17 children with a mean age of 103 months (range 37 to 206) underwent similar procedures via open surgery through a flank incision. We retrospectively analyzed and compared operative time, the use of analgesics (acetaminophen or morphine derivatives) and hospital stay. RESULTS: The 2 groups were similar in mean age and weight at surgery. Mean operative time was significantly shorter in the open surgery vs the laparoscopy group (96 minutes, range 50 to 150 vs 219, range 140 to 310, p <0.0001). Mean postoperative use of acetaminophen (1.9 vs 3.22 days, p = 0.03) and morphine derivatives (1.9 vs 3.06 days, p not significant) was less in the laparoscopy group. Mean hospital stay was shorter in the laparoscopy group than in the open surgery group (2.4 days, range 1 to 5 vs 5, range 3 to 7, p <0.0001). Mean followup was 21 (range 12 to 51) and 24 months (range 12 to 60) in the open and laparoscopy groups, respectively. CONCLUSIONS: The operative time of laparoscopic pyeloplasty remains significantly longer than that of the open procedure in children. The main advantage of the laparoscopic approach is that it significantly decreases hospital stay compared with that after an open procedure. Although in our study analgesic use was less after laparoscopy, our results should be confirmed by a prospective, randomized study.

Adolescent↗

PubMed2003

[Inguinal hernias in children].

The inguinal hernia repair account among surgical procedures the most frequently performed in children. Most inguinal hernias in infants and children are indirect due to patent processus vaginalis. Failure of closure of the processus vaginalis accounts for nearly all the inguino scrotal abnormalities seen in infancy and childhood. In little girls, the processus (canal de Nuck) may remain patent and may allow the ovary and fallopian tube to enter the inguinal region. Incarceration represents the most common complications associated (30 per-cent during the first year of life). Consequences concern in the first place the testicular blood supply before to interest the vitality of the incarcerated intestine. The surgically repair is recommended shortly after the diagnosis. The concurrence rate of recurrent inguinal hernia after uncomplicated inguinal hernia repairs is generally reported at 0.5-1 per cent, increasing for premature infant and complicated inguinal hernia.

Child↗

PubMed2002

Omphalocele: beyond the size issue.

A small omphalocele was diagnosed and followed up prenatally. Ultrasonography examinations and clinical examination at birth were all consistent with an isolated, small omphalocele. Immediate surgical exploration at birth found an associated type I intestinal atresia. This rare association and the need for immediate postnatal management of omphalocele are discussed, and the literature is reviewed.

Adult↗