Biomedical subjects
Publications and source records attributed to G Laguenie.
We report a case of Budd-Chiari syndrome following repair of a giant omphalocele. Thrombosis of hepatic veins and of retrohepatic inferior vena cava may result from direct pressure on the hepatic venous outlet after visceral reduction and final abdominal wall closure.
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Venous central oximetry (ScO2) in high-risk pediatric surgical patients (myopathies, congenital diaphragmatic hernia) is an useful guide to treatment. ScO2 was monitored in 15 patients (4 neonates) during and after thoracic interventions or interventions involving manipulation of the liver. Oximetrix ScO2 is not more invasive than a catheter of common stiffness, but the size 4F remains large for neonates. The physiological or pathological signification of its variation has to be deduced from clinical evaluation. Interpretation may be easier during anesthesia and in the absence of sepsis. ScO2 can be used either as a sensitive monitoring with usually an early response, to evaluate judicious treatment, or as an indirect way to evaluate cardiac output if the other factors of the Fick relation can be estimated or measured.
In an attempt to identify factors determining central venous catheter-related complications in newborns and infants, 587 cases have been retrospectively analyzed. Attention has been paid to the influence of the incidence of babies' body weight, site of insertion, and technique of placement of the catheter and the material used, ie, silicone (SI) or polyurethane (PU). Overall complications occurred in 28% of the catheters with 2 deaths due to cardiac tamponade. Mechanical complications happened in 22% of the catheters, including dislodgement (11.6%), extracorporeal perforation (5.3%), and obstruction (5%). Septic complications occurred in 4% catheters, including proven bacteriemia (2.5%), abscess at the entry site (1%), and isolated fever (0.8%). Clinically evident caval thrombosis occurred in 1% of the catheters. Overall complications were significantly higher when the body weight was lower than 2,500 g (P less than .01) due to a significantly higher incidence of septic complications (P less than .05). When a proximal site of placement of the catheter was used, both septic and mechanical complications were more frequent than in the distal approach (P less than .01). The incidence of complications was similar in surgically and in percutaneously placed catheters as in SI and PU catheters. Nevertheless, fatal complications occurred only in PU catheters, leading us to avoid the choice of such material in newborns and small infants.
Early postoperative use of iv immunoglobulins after septic surgery in infants is reported. As compared to the randomized control group of patients (n = 20), return of C reactive Protein to normal values first occurred in the group receiving IVI (n = 20) p 0.01.
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120 newborns with a congenital diaphragmatic hernia (CDH) were treated during the first day after birth in the Department of Pediatric Surgery at Saint Vincent de Paul's Hospital from 1980 to 1987. The overall survival rate was 40%. The influence of prenatal diagnosis, clinical and anatomical aspects is analysed. The side and the size of the defect, the intra-thoracic liver, the intestinal malrotation and the abdominal hypoplasia are significant prognosis factors. This preliminary study suggests that the natural history of CDH may be responsible of two different diseases: a disease with an early visceral intra-thoracic growth, and a severe lung hypoplasia; another one with a secondary herniation of the intra-abdominal mass, and a better prognosis.
Central microcatheters are important in neonatal intestinal surgery, as peripheral veins are quickly all used up in these patients; they are essential in maintaining a satisfactory nutritional status during the period of digestive exclusion. This retrospective study over an 18 month period concerned 105 catheters (82 central percutaneous catheters and 23 surgical catheters) put up in neonates operated on within the first few days of life. The advantages and disadvantages of both methods of catheterization were assessed by means of the infectious or mechanical complications, as well as the length of time the catheters were used. The frequency, timing and type of mechanical incidents requiring removal of the catheter were the same for both groups. There was only one septic accident, and this with a surgical catheter. An analysis of the patient files helped to decide on the best route for use in central catheterization, as well as technical improvements. Because of the absence of infectious accidents in the percutaneous series, this method was preferred, especially as it has a certain number of advantages over the surgical method. Percutaneous central microcatheterization would appear well suited to medium term parenteral feeding.
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The preliminary results of the use of high frequency positive pressure ventilation (HFPPV) in six newborn infants presenting a type III oesophageal atresia during the thoracic stage of surgical repair are reported. HFPPV allowed correct gas exchange during the surgical procedure. In the six cases, a significant decrease in PaCO2 (p less than 0.05) was observed, whereas the effects on PaO2 were variable. The technical problems, mechanism of gas transport during HFPPV and clinical interest of HFPPV in thoracic surgery are discussed.
Three recent cases of surgical closure of ductus arteriosus in very low birth weight infants (less than 1 000 g) are reported. The indications of both surgical and pharmacological closure in very low birth weight premature infants are discussed. The necessity of an early closure of a patent ductus arteriosus is now admitted in the very premature infant, but the use of indomethacin in the first days of life is often impossible because of its side-effects. The use of adapted non-invasive monitoring devices during surgery allows a better control of anaesthesia.
Following a recent case of adult-type respiratory distress syndrome in a four-year old child, the rare occurrence of this pathology in visceral paediatric surgery is recalled. The few published cases do not allow a comparison of the mortality in paediatric and adult patients. The treatment is discussed, as well as the results of pulmonary function tests performed some time after the acute pulmonary episode.
Method of artificial respirators desinfection by Formaldehyde is studied. Formaldehyde and ammoniac quantitative analysis are performed. Air samples are taken by dry process and by wet process. Two concentrations are in ceiling values for exposure of workers and exceed irritant concentrations during chronic exposition. Particular attention should be paid to perform measurement: air samples must be taken by wet process as artificial ventilation circumstances: indeed in this case air is humidified; potential toxicity is unappreciated in this use. Complementary studies are required.
The authors are describing a surgical technique to recognize the left recurrent laryngeal nerve during the oesophage atresia surgery. This technique uses for anatomical marks the superior line of the great azygos vein an the oeso-tracheal lateral junction. The dissection is very delicate, and the hight frequency ventilation during anesthesia gives a precious comfort to the surgeon.
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