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F Varlet

Publications and source records attributed to F Varlet.

At least 19 recordsLinked to original sources
PubMed2004

[Management of blunt abdominal trauma in children].

UNLABELLED: The aim of this study was to evaluate the radiological and therapeutic management of blunt abdominal trauma (BAT) in children, with retrospective data. POPULATION AND METHODS: During 6 years (Nov 1995-Oct 2001), 92 children were hospitalised for BAT (mean age 9.5 years; 61.9% boys). Falls (45.6%) and motor vehicle accidents (43.5%) were the most frequent causes. The initial management included abdominal plain film X-ray and ultrasonography, and sometimes computed tomography (CT). The non-operative treatment was used, unless the patient was hemodynamically unstable or had hollow visceral injury, diaphragmatic rupture or renal artery rupture. RESULTS: Among 92 BAT, 52 were minor traumas and 40 were associated with one or several abdominal injuries. The sensitivity of ultrasonography to find hemoperitoneum and/or abdominal injuries was 80.3%, but the initial diagnosis of such lesions was accurate in 21 cases (52.5%) and delayed in 19 cases (47.5%), ranging from 1 to 7 days. In the delayed cases, the diagnosis was possible in nine cases with ultrasonography, in five cases with CT, but also with transaminase, amylase or lipase assays in two cases, and surgery in three cases. Twenty-nine children had a non-operative treatment and stayed in hospital about 12 days on average. Three children had surgery in emergency (two bowel perforations and one splenic rupture) and eight with delay (four renal ruptures, one associated splenic nodes, one pancreatic pseudocyst and one duodenal perforation). Only seven children (17.5%) required blood transfusion and no death occurred. CONCLUSION: In a trauma centre, the management of abdominal injuries is possible with ultrasonography and its sensitivity is correct without increasing of morbidity and mortality. But, if in doubt, a CT must be performed because its sensitivity is better. Most of the time, the children can benefit from non-operative treatment.

Abdominal Injuries↗
PubMed2003

Role of laparoscopy in vaginal malformation.

BACKGROUND: The aim of this study was to assess the role of laparoscopy in the management of vaginal malformations in children, a subject not often discussed in the literature. METHODS: Between 1980 and 2002, we treated 22 children for vaginal malformations. Two main patient populations were distinguished: younger children with asymptomatic hymenal imperforation and hydrocolpos, and adolescents with hematocolpos. A third of the malformations were identified on systematic clinic examination, a third on the basis of abdominal pain, and a third due to various other symptoms. Nine of the girls had associated malformations of the uterus, external genital organs, or urinary tract. Eight patients underwent laparoscopy, either to look for endometriosis in cases of hematocolpos, to make an accurate determination of malformations in cases where clinical and paraclinical methods failed, or to manage an abnormality. RESULTS: Eleven laparoscopic procedures were performed in eight patients. Three diagnostic laparoscopies enabled us to determine the exact nature of the malformations. One newborn underwent two laparoscopic procedures to treat peritoneal fibrous bands that had caused repeated episodes of obstruction. Six patients underwent exploratory laparoscopy to look for endometriosis, but none was found. CONCLUSION: Laparoscopy is not applied systematically in the management of any malformation, but it can be useful when complementary exams fail to make an accurate diagnosis of the anomaly or for the management of the rare complication of adhesions and bands. When used to search for endometriosis, MRI detects ~50% of lesions, but laparoscopy is certainly still appropriate for that purpose. However, the optimal timing of the procedure still needs to be established.

Abnormalities, Multiple↗
PubMed2002

[Varicella complicated with necrotizing fasciitis caused by group A hemolytic Streptococcus].

UNLABELLED: Chickenpox has a high risk of invasive group A streptococcal disease and necroziting fasciitis. CASE REPORT: A five-year-old girl, during chickenpox treated with ibuprofen, developed sepsis and edematous and necrotic lesions of the pelvis and the abdominal wall. The child improved with surgical treatment and adjunction of clindamycin to the antibiotic therapy. CONCLUSION: We review the optimal medical and surgical treatment of necrotizing fasciitis and discuss the role of chickenpox and non steroidal antiinflammatory agents in this disease.

Chickenpox↗
PubMed2001

[Intestinal volvulus in extremely premature infants].

UNLABELLED: Volvulus with or without malrotation are infrequent in the extremely premature newborn. CASE REPORTS: Intestinal volvulus in seven premature newborns are reported with abdominal distention, bright and tense skin without visible bowel loops and spiraled bowel loops on the abdominal X-ray. Intestinal resection was avoided due to early diagnosis. We identified abdominal wall massages as a risk factor, because no new cases have occurred since interdiction of these practices. CONCLUSIONS: Symptoms and radiologic findings are relatively specific for excluding the diagnosis of necrotizing enterocolitis in premature newborns. Abdominal nursing could be the incriminating factor.

Abdomen↗
PubMed2001

Laparoscopic treatment of varicoceles in children. Multicentric prospective study of 90 cases.

PURPOSE: The aim of this study was to assess the results of the laparoscopic treatment of varicoceles. MATERIAL AND METHODS: 92 observations were received, however 5 patients underwent a simultaneous associated open surgery; 90 varicoceles were evaluated (3 bilateral varicoceles). The dilated spermatic veins were treated by clips and partial resection in 74.7 %, by coagulation and partial resection in 21 %, and by clips in 4.3 %. The spermatic artery was ligated in 60 varicoceles and preserved in 28; in 2 cases it was not specified. The results were studied with a mean follow-up of 11.1 months (2 to 36 months). RESULTS: The varicocele disappeared in 76 cases (84.4 %) and diminished significantly in 12 cases (13.2 %) where it was large before treatment. Two middle-sized varicoceles were not modified by the treatment. Therefore, the results must be considered good or excellent in 97.6 % of cases. The spermatic artery was preserved in 28 cases and the size of the varicocele was not good in 9 (32.1 %); it was ligated in 60 cases and the size of the varicocele was not good in 5 cases (8.4 %) -- p < 0.01. In 42 cases the testicular size was noted before and after treatment, and likewise the conservation or not of the spermatic artery; the 30 artery ligations produced no testicular atrophy; only 3 hypotrophic testes were noted with a loss of size of between 8.4 and 59 % with regard to the contralateral testis. In 27 cases, the testicular size remained normal or increased if it was hypotrophic before treatment; there was a good result in 90 % of cases with no atrophy. When the spermatic artery was preserved (12 cases), 1 hypotrophy occurred with a loss of size of 16.7 % -- NS. CONCLUSION: The laparoscopic treatment of varicoceles is an efficient technique and the complete ligation of the whole vascular spermatic pedicle above the vas deferens offers excellent success, without atrophy.

Adolescent↗
PubMed1999

Tracheobronchial ruptures from blunt thoracic trauma in children.

BACKGROUND/PURPOSE: Tracheobronchial ruptures in blunt thoracic trauma in children are rare. The aim of this study was to suggest the means of an early diagnosis and a conservative management as often as possible. METHODS: Sixteen cases of tracheobronchial ruptures by blunt thoracic trauma were observed over 26 years in 9 regional pediatric centers. RESULTS: There were 12 boys and 4 girls, from ages 1 hour to 17 years. Nine children presented with associated lesions. Fibroscopy established the following diagnosis: 8 tracheal wounds and 8 bronchial wounds. Six children were operated on within 18 hours (on average) after installation of a thoracic drainage. Two lobectomies, 3 ideal tracheal sutures, and 1 bronchial suture were performed. Seven children were treated exclusively by thoracic drainage. Two of them were intubated through the lesion, leading to a transitory endoprothesis accompanied or not by an external thoracic drainage. One infant recovered spontaneously. There were no deaths in this series. Two recurrent postoperative nerve injuries were noted, one of which was a transitory spontaneously resolutive scar bud and one a granuloma treated by laser. Three times, a stenosis occurred after a conservative management. Two were operated on. CONCLUSIONS: Tracheobronchial ruptures in children are rare. An early fibroscopy holds an important place in the approach of this pathology. Treatment is variable, based on thoracic lesions, their tolerance by the child, and associated lesions. Surgery is not the only therapy because conservative treatment by simple thoracic drainage or lesion intubation has proved effective.

Adolescent↗
PubMed1998

[Intra-thoracic costal sites of osteogenic exostoses in the child].

PURPOSE OF THE STUDY: The authors report 2 cases of internal costal exostosis in children. OBSERVATIONS: Case 1: A 15-year-old boy with hereditary multiple exostosis presented for chest pain. Radiograph and CT scan showed an internal rib exostosis. It was removed by thoracotomy. Eighteen months later, the child was painfree. Case 2: An-11-year old boy presented with fever and a headache. A chest radiograph showed an image of pulmonary opacity interpreted as a pneumonia. The child was admitted for antibiotic therapy. Two months later, X-ray lesion persisted and a CT-scan was obtained. It showed a solitary costal internal exostosis which was removed by thoracotomy. At 12 months follow-up, he was asymptomatic. DISCUSSION: Internal costal exostosis can induce some complications such as hemothorax, diaphragmatic or pericardic wounds. In case of symptomatic exostosis, the authors recommend a surgical removal to avoid severe complications. If the exostosis is asymptomatic, abstention can be recommend. As a matter of fact, hemothorax, for instance, can occur even due to a round and smooth exostosis without any history of trauma.

Adolescent↗
PubMed1998

[Treatment of blunt splenic trauma in children].

UNLABELLED: The conservative management of blunt splenic trauma in children has been generally accepted for about twenty years, in order to avoid serious post-splenectomy infectious complications. The objective of this study was to evaluate the results of conservative management. PATIENTS AND METHODS: 21 cases of blunt splenic trauma were treated between 1 January 1991 and 31 December 1995. Eleven cases were isolated and 10 were associated with other visceral, musculoskeletal or head injuries. The lesion consisted of subcapsular or intraparenchymal haematoma in 8 cases and ruptured spleen in 13 cases. All children were initially managed conservatively, except in the case of unstable haemodynamic parameters after resuscitation, perforated viscus or secondary complication. RESULTS: Emergency surgery for blunt splenic trauma was never required over this 5-year period. Four children required secondary surgery, 2 for left renal lesion, 1 for pancreatic pseudocyst and 1 for epidermoid cyst of the spleen discovered incidentally at the time of the trauma (partial splenectomy). No associated bowel perforations were observed. Four children were transfused, 3 for an associated visceral lesion and only once because of ruptured spleen. The mean length of hospital stay was 18.2 days in the case of isolated rupture and 28.7 days for a ruptured spleen associated with other lesions. No immediate or long-term complications were observed with a mean follow-up of 6 months. CONCLUSION: Conservative management of blunt splenic trauma is possible under good conditions of security and total splenectomy was never required. The blood transfusion rate was very low.

Adolescent↗
PubMed1997

Salmonella spondylitis.

We report a case of salmonella spondylitis in an adolescent without sickle cell disease or any history of salmonella gastroenteritis. The infecting organism (cultured from material aspirated from the bone lesion) was Salmonella enterica serovar Newport. With nonoperative treatment, evolution was favorable.

Adolescent↗
PubMed1994

Laparoscopic versus open appendectomy in children--comparative study of 403 cases.

Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure technique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal adhesion diseases (11%), those lesions were totally unknown with OA. Operative complications are more frequent with LA (5% versus 1%--p < 0.02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious complications that we had. On the other hand, the postoperative complications mostly occur after OAs (10.8% versus 1.5%--p < 0.001): 11 wound abscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The general anesthesia was significantly longer for LA (72 minutes vs 55 minutes--p < 0.001). Mean hospital stay was 4 days after LA and 6.4 days after OA. The postoperative complications involved 27 additional hospital days after LA and 162 days for OA. As a conclusion, OA is quicker and has few operative complications. But LA has many advantages: less traumatic, easy treatment of ectopic appendix, efficient lavage of the peritoneum, less frequent postoperative complications and better postoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.

Adolescent↗
PubMed1993

[Value of aortopexy in infants in the treatment of segmental tracheomalacia].

We report two cases of localized tracheomalacia, one associated with esophageal atresia, and one isolated. The pathophysiology explains that the symptoms are more important during or shortly after eating, the alimentary bowl crushing the trachea against the aorta, or the innominate artery. The exact cause of tracheomalacia is unknown. Esophageal atresia is frequently associated. The tracheal compression is more often due to the innominate artery, because its origin is located on the left side of the trachea in infants. The aorta or a vascular anomaly are rarely implicated. The symptoms of tracheomalacia are largely due to airway obstruction during expiration: stridor, baking cough, and the life-threatening "dying spell". For diagnosis, the endoscopy is the most important investigation. Among the many methods of treatment which have been proposed, the aortopexy appears to be the technique giving the best results. A single acute apneic attack is an absolute indication for surgery. It is also important to rule out severe gastroesophageal reflux, which can produce the same symptoms.

Aorta↗
PubMed1992

[Non traumatic acute suppurative mediastinitis].

Acute mediastinitis is uncommon. When it occurs, it usually follows an esophageal perforation or thoracic surgery. We report on a case of a 2-year-old girl with non traumatic mediastinitis secondary to a pharyngitis, due to Staphylococcus aureus. The anatomic pathways that connect the cervical region with the mediastinum explains how the infection can spread within the cervicothoracic spaces. Knowledge of this anatomy is also important in evaluating the possible causes of symptoms and signs in this area, and the possible complications of infections in these regions. The treatment associates antibiotics and drainage of the abscess by either surgical procedure or computed tomography guided selective needle aspirations.

Acute Disease↗
PubMed1992

[Development of the operative and non-operative treatment of acute intestinal intussusception in children].

A review of 152 cases of acute intestinal intussusception shows a dramatic evolution in its management within the last 15 years. Ultrasound is the main procedure utilized, and in the hands of a trained-radiologist, it allows a safe non-surgical treatment via barium or pneumatic reduction. Surgery is now limited to the rare cases of failure of the above treatment, and to advanced or complicated cases.

Acute Disease↗
PubMed1992

[Congenital dilatation of the prostatic utricle. Embryologic review, diagnosis and treatment. Apropos of 2 pseudo-tumoral cases, without hypospadias].

The authors report two pediatric cases of congenitally dilated prostatic utricle. First a newborn with prenatal ultrasound diagnosis of abdomino-pelvic cystic mass and secondly a 4-year-old boy with urinary incontinence and lower abdominal mass. Unilateral renal hypoplasia was noted in both cases, but no hypospadias. The study of embryogenesis and pathogenesis shows that the anomaly happens before the 8th week of pregnancy. When hypospadias is associated, the anomaly develops later and has a hormonal cause. Prostatic utricle is not only an embryologic Müllerian remnant, but comes from the mesodermic and endodermic tissues. The first clinical signs are often urinary signs or an abdominopelvic mass. The prostatic implantation and the median localization of this cystic mass are both revealed by urethrography and ultrasonography. Computed tomography and especially Magnetic Resonance Imaging may be performed. MRI provides a detailed demonstration of the anatomy and a large field of view in all three planes. It helps to plan surgical therapy. The treatment of prostatic utricle may be percutaneous, endoscopic or surgical. The indications are based on the symptoms, but the risk of malignancy must be kept in mind. In our cases, the marked dilatation of the prostatic utricle led to surgical treatment and retrovesical excision was successful.

Child, Preschool↗
PubMed1991

Activity of intrapleural recombinant gamma-interferon in malignant mesothelioma.

Twenty-two consecutive patients with malignant diffuse pleural mesothelioma were treated with recombinant gamma-interferon by the intrapleural route. Diagnosis was made by thoracoscopic examination and all cases were confirmed by the French Mesothelioma Panel of Pathologist. Patients were staged based on thoracoscopic examination and computed tomography (CT) scan: 12 patients were classified as Stage I and 10 were Stage II. A solution of gamma-interferon (40 X 106 U) was infused twice a week over 2 months. Every patient experienced fever. One patient had a Grade 2 leukopenia and one patient suffered from pleural empyema. Response evaluation was based on the following: (1) CT scan performed 2 weeks after treatment ended, and (2) repeat thoracoscopic examination with histopathologic verification in nine patients who had demonstrated a stabilization or a regression of the disease on CT scan. From the original group, 19 patients could be evaluated. Four complete thoracoscopic histopathologic responses and one partial response were observed in Stage I patients (56%). One partial response was observed in Stage II patients.

Alkaline Phosphatase↗
PubMed1990

[Congenital cutaneous aplasia of the scalp. Apropos of 4 cases].

Report of four cases of congenital defects of the scalp. In two of these cases, the skin defect was associated with a skull defect and in one, there were other cranial deformities. In each case, the lesion seemed isolated in otherwise normal children. This study contains a review of congenital scalp defects. The different aspects of this rare disease are presented and the treatment is discussed with reference to natural evolution. The authors differentiate between cases with isolated lesion and cases with associated malformations or abnormalities, malformation syndromes, as has been previously defined. In the case of skull defects, it is thought that immediate reparatory surgery must be performed, to prevent infection and hemorrhage of sagittal venous sinus, as it was the case in one of the four children. The covering of the defect can be realized with rotated skin flaps, which seem preferable to any form of plastic surgery, for cosmetic reasons, and for the secondary treatment of the skull defect, if this is necessary. When spontaneous closure of the bone defect, is not noted, which occurs generally in the case of large defects, it seems reasonable to close the latter by cranio-plasty, to protect the brain. In one of the four cases reported, this technical approach of the lesion was used, with a good result being reported, four years later.

Calcinosis↗