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Biomedical subjects

G Levard

Publications and source records attributed to G Levard.

At least 19 recordsLinked to original sources
PubMed1998

t(3;17)(q21;q25) in Epstein-Barr virus associated peripheral T-cell lymphoma: a paediatric case.

We describe an immunocompetent 8-year-old boy with a serological profile indicating chronic infection by Epstein-Barr virus (EBV) who developed subcutaneous and pulmonary lesions related to a peripheral T-cell proliferation. No clonal rearrangement of T-cell receptor or immunoglobulin genes was seen. However, the finding of a t(3;17)(q21;q25) in 44 metaphases from one skin lesion demonstrated a clonal origin. We also showed that the proliferative T cells contained EBV genome leading to the diagnosis of EBV-associated peripheral T-cell lymphoma. Further cytogenetic and molecular studies are needed to identify genes implicated in the pathogenesis of this haematological malignancy.

Child↗
PubMed1997

[Post-natal diagnostic strategy of urinary tract malformations detected by prenatal screening].

BACKGROUND: The increasing experience with prenatal ultrasonographic diagnosis allows detection of more and more mild urinary tract anomalies. Thus, the clinical significance of many pyelectasis detected before birth is not known. PATIENTS AND METHODS: From a retrospective study of 78 patients, we determined the positive predictive value (PPV) of prenatal ultrasound findings for urinary tract malformations. RESULTS: This PPV was 27.3% when the prenatal pelvic dilatation was isolated, but grew up to 100% if a caliceal dilatation was associated. Renal pelvic diameter in the third trimester of pregnancy could predict the degree of post-natal renal impairment, as pelvic size was 6.7 +/- 2.15 mm for the post-natal pyelectasis group, significatively smaller than 13.4 +/- 3 mm in the ureteropelvic junction obstruction group (grade 1) and than 17 +/- 9 mm in other pathological renal units. On the other hand, antenatal ultrasound had a bad sensibility for vesico-ureteral reflux detection, four primary reflux among 14 being detected without homolateral antenatal ultrasound anomaly. CONCLUSION: According these results, we propose a post-natal diagnostic strategy. Urological explorations are performed when the prenatal renal pelvic diameter is larger than 10 mm. If the postnatal ultrasound shows an isolated pyelectasis below this level, a clinical follow-up is advised, the parents being informed of the possibility of vesico-ureteral reflux and of the necessity to perform a cytobacteriological exam of urines in case of unexplained fever.

Dilatation, Pathologic↗
PubMed1997

The fate of undescended testes in patients with gastroschisis.

Cryptorchidism is frequently associated with gastroschisis, yet little is published on its management in such circumstances. In a review of 10 consecutive boys with gastroschisis since 1980, 4 had undescended testes. Gestational age and birth weight did not differ from the 6 boys with normally descended testes. The first two patients had associated arthrogryposis multiplex congenita. The first underwent bilateral orchidopexy at 9 years of age for inguinal testes. In the second patient, the left testis was intraabdominal at the level of the sigmoid colon at birth; at 3 months of age, when a left inguinal hernia repair was required, left groin exploration revealed the testis at the internal ring and orchidopexy was performed successfully. In the third patient the left spermatic vessels were divided at the time of gastroschisis repair and the testis anchored in the prebubic area. The second-stage orchidopexy was performed at 16 months. In the last patient the intraabdominal testis could be placed in a scrotal pouch without mobilisation or division of the vessels. From our experience and a review of the literature we conclude that: 1) undescended testes are frequently associated with gastroschisis; 2) mechanical factors rather than prematurity are likely responsible for this association; 3) if the testis easily reaches the scrotum, orchidopexy can be done safely at the time of gastroschisis repair; 4) if the testis does not reach easily and appears to have a gubernaculum, it may be preferable to leave it in place since spontaneous descent can occur.

Abdominal Muscles↗
PubMed1995

[Choledochal cysts. A rare prenatal diagnosis].

Forty to sixty percent of main bile duct cysts are diagnosed before the age of 10 years, often at the time of a complication. Current progress in echography now makes it possible to diagnose such cysts antenatally. Wze report a case discovered at 33 gestation and focus on the difficulty of formal antenatal diagnosis and the unpredictable, sometimes rapid, course of the disease. The main prognosis factor is the development of complications, especially liver fibrosis. Antenatal suspicion of main bile duct cyst is important as they can then be managed early after echographic confirmation during the first days of life with the potential reduction in severe complications.

Adult↗
PubMed1994

Torsion of the gallbladder in children.

Two cases of torsion of the gallbladder in children (ages 5 and 7) are reported, and the relevant literature is reviewed. The condition is extremely rare in the pediatric population, and the correct diagnosis is rarely made preoperatively. However, the clinical presentation may be evocative of the diagnosis. Ultrasonography is helpful for the diagnosis, but ultrasonographic modifications of the gallbladder occur after the onset of the pain. The treatment of this condition is early cholecystectomy.

Child↗
PubMed1994

Motility of the transplanted small bowel: a manometric study in the piglet.

Complete transection of sympathic and parasympathic nerves is an inevitable consequence of intestinal transplantation. The aim of this experiment was to study if extrinsic denervation alters the motor function of the graft. Ten large-white piglets were used. In Group 1 control (5 animals), a segment of distal ileum was isolated on its intact neurovascular pedicle as a Thirty-Vella loop. In Group 2 study (5 animals), a Thiry-Vella loop of distal ileum was transplanted as a free autograft. The motility of intestinal loops was studied by intraluminal pressure recording at the 8th and 15th postoperative days, on conscious animals fasted for 24 hours. The measured patterns were period (P), duration (D), maximal amplitude (A) and speed of migration (S) of phases III of migratory myoelectric complexes (MMCs). One hundred and seven MMCs were recorded and compared between Group 1 and Group 2. The results were as follows: mean (+/- sem) of Group 1 vs mean (+/- sem) of Group 2. P (min) = 68.5 (+/- 8.1) vs 54.2 (+/- 3.2)(NS); D (min) = 5.9 (+/- 0.2) vs 5.9 (+/- 0.1) (NS); A (cmH2O) = 73.9 (+/- 4.1) vs 83.4 (+/- 3.2) (NS); S (cm/min) = 5 (+/- 1.1) vs 6.2 (+/- 1) (NS). The motor function of the loops was studied following intraluminal perfusion of a cholinergic compound (carbachol) at doses of 1, 2, 3, 4 and 5 mg. The mean and the maximal pressures were recorded during 3 minutes from the 2nd minute following injection of carbachol.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Sacral bone tuberculosis in a 6 year-old child].

BACKGROUND: Spinal tuberculosis is now rare in developed countries; its appearance in sacral vertebrae is exceptional. CASE REPORT: A 6 year-old boy was admitted because he had suffered from lumbar pain and rigidity for 24 hours, limiting anterior flexion. X-rays of the spine was normal, but a CT-scan showed lytic lesions of the sacrum. Bone scintigraphy showed no inflammatory lesions. Ewing sarcoma was diagnosed: surgical biopsy showed a cold abscess containing many bacilli that where resistant to decoloration with acid-alcohol. They were cultured for 12 days and identified as Mycobacterium tuberculosis. The boy had been given a BCG vaccination at the age of 2 years and was not immunodeficient. He was treated with isoniazid, rifampin and pyrazinamide for 2 months followed by isoniazid plus rifampin for 1 year. A cold abscess in the presacral area rupturing into the sacro-iliac articulation pointed above the left iliac wing during treatment and was treated by surgical debridement. Eighteen months later, the boy is well but still avoids bending. CONCLUSION: A sacrally located bone tuberculosis is difficult to diagnose. Careful therapy is necessary to avoid sequelae that may lead to spinal curvature.

Child↗
PubMed1994

[Sacral tuberculous osteitis].

The authors report a case of a 5 year old child suffering from isolated sacral tuberculosis which presented as sudden and total loss of function of the left leg. The rarity of this bony site, and the recurrence at nine months of a presacral abscess after 9 months of anti-tuberculous treatment in an HIV negative child, vaccinated with BCG, justify the presentation of this observation.

Child, Preschool↗
PubMed1994

[Volvulus of the superior mesenteric area and congenital variation of the colonic fixation. Human Ontogenesis and Physiopathology. Apropos of a case in an adolescent].

Volvulus of the superior mesenteric territory involving the left and transverse colon is rare. Congenital variations of intestinal fixation have been implicated. We report a case observed in an adolescent which illustrates this hypothesis. There was a fixation of pancreatosplenic region and the left colic angle. The duodenopancreas and the right, transverse and left colon were mobile. Human ontogenesis of the colon could provide a pathophysiologic explanation. During foetal development, the intestine results from unequal growth of the different segments which undergo pressure from the different intra-abdominal contents. The fixation of the different parts of the intestine are independent from each other. Specific circumstances are required for variations in congenital fixation of the colon to led to late events responsible for mechanical volvulus.

Adolescent↗
PubMed1992

[Primary hyperparathyroidism in children].

Primary hyperparathyroidism in children is an extremely rare condition. Slightly more than a hundred cases have been published in children or adolescents aged under 16. Forms with a neonatal presentation, the most rare, should be viewed apart since they rapidly become life-threatening. They involve hyperplasia of the chief cells of the parathyroid glands. Treatment is always surgical and should be rapid, consisting of total parathyroidectomy with autotransplantation. Primary hyperparathyroidism in older children more closely resembles that seen in adults. Sporadic forms are most often due to an adenoma and familial forms, which may occur alone or within the context of a polyendocrine syndrome, are most often due to hyperplasia. Treatment consists of parathyroidectomy, the extent of which depends upon the familial context, visual investigative findings and results of frozen section histology at the time of exploratory cervicotomy. Regardless of the age of the child, family investigation is always required to detect primary hyperparathyroidism occurring in the context of a hereditary disorder.

Adolescent↗
PubMed1990

[Colonic atresia. Which surgical treatment?].

We report seven cases of congenital colonic atresia over a 13 year period (1975-1988). The atresia was located in the ascending or transverse colon (4 cases), or in the descending or sigmoid colon (3 cases). According to Bland-Sutton classification, one patient was a type I, five were either a type II or III, and for the last patient the type was not precise. Three infants had associated malformations: jejunal atresia (case n. 6), intestinal malrotation (case n. 5), and gastroschisis and jejunal atresia. This last patient, in whom jejunal and colonic atresias were autopsy findings, died after a Schuster procedure for gastroschisis closure. The six other neonates survived. Five of them underwent emergency colostomy and delayed anastomosis when general conditions were stable (2 to 10 months after colostomy). The sixth neonate (case n. 2) was treated by colonic resection and primary ileocolic anastomosis. Two patients had postoperative complications, ie, anastomotic leak (case n. 4) or disfunction (case n. 2), which were successfully treated by another operation. The outcome, one year after the onset of the disease, was good for 5 out of the 6 survivors. All these five patients were normally passing stools, once or twice a day, with no abdominal distension. One patient (case n. 6) had a short bowel syndrome secondary to a jejunal atresia, with intermittent watery stools and abdominal distention. We reviewed the 161 cases of colonic atresia from English and French experience since 1960. The overall mortality rate is 25%. Associated malformations and infection are the main causes of death. The rate of anastomotic complications is high (15%).(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1989

Urinary bladder diverticula and the Ehlers-Danlos syndrome in children.

Two large bladder diverticula that induced severe micturition disturbances were surgically removed in a 5-year-old boy with Ehlers-Danlos syndrome (EDS). One year after surgery, a new, asymptomatic diverticulum developed. This case is discussed in the light of nine similar cases that have already been published. It is concluded that EDS diverticula form a distinct group characterized by postoperative recurrence. They are not due to vesicourethral obstruction but probably result from an anomaly of the vesical wall. They are responsible for micturition difficulties and urinary tract infections. Their unavoidable recurrence means that surgery should be restricted only to symptomatic patients.

Child↗
PubMed1989

[Neurocristopathy. The association of Hirschsprung's disease-ganglioneuroma with autonomic nervous system dysfunction in 2 children].

Two children with the coexistence of long segment Hirschsprung's disease, ganglioneuroblastoma with Ondine's curse in one case and autonomic nervous system impairment in the other are presented. All lesions may be related to aberrations of neural crest cell growth, their migration, or differentiation. A genetic etiology, and the link between Hirschsprung's disease and multiple endocrine adenomatosis is discussed. The combination of Hirschsprung's disease and a neurocristopathy strongly suggests that exploration of the autonomic nervous system and APUD system be carried out.

Autonomic Nervous System Diseases↗
PubMed1988

[Calcified thrombosis of the inferior vena cava in children].

A new case of calcified thrombus in the Inferior Vena Cava is described, and added to the 19 previously reported cases in literature. The etiology of these calcified thrombi is unknown, but a precise diagnostic an therapeutic approach is now well established. On plain X-ray of the abdomen, the right paravertebral bullet-shaped calcification is diagnostic. No further investigations are necessary, except in the neonatal period, when the thrombus is incompletely calcified, suggesting neuroblastoma or adrenal hemorrhage. Definitive diagnosis, in that case, can be made by abdominal ultrasonography. In the current state of our knowledge, the clinical tolerance of this anomaly is excellent. No specific treatment appears to be necessary.

Age Factors↗