[Child proctology. Practical aspects].
This review analyses the clinical and therapeutic bases of the various affections of child proctology. The authors emphasizes the need for a careful clinical examination.
Biomedical subjects
Publications and source records attributed to J F Dyon.
This review analyses the clinical and therapeutic bases of the various affections of child proctology. The authors emphasizes the need for a careful clinical examination.
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The use of somatostatin in the treatment of a newborn infant with hyperinsulinism is reported. When administered alone, somatostatin was only able to prevent hypoglycemia for a short period of time, whereas the addition of a constant infusion of glucagon allowed successful control of the patient's hypoglycemia. As hyperinsulinism relapsed after a subtotal pancreatectomy, a trial was carried out with a somatostatin analog, which has an expected longer duration of action. It led to a significant rise in the blood glucose level but failed to prevent safely hypoglycemia even when 4 injections were performed daily.
The authors report a case of tumour of the right iliac region in a 14 years old girl, disclosed by a light traumatism, without appreciable antecedents, nor locomotor disfunction. Ultrasonography and computed tomography showed its cystic constitution. Surgically, there was a synovial cyst of the ilioinguinal area, cyst of the iliopsoas bursa, with a hip joint communication. It was resected and a partial recurrence occurred, corrected surgically three years later. A recent MRI showed the spontaneous development of a same cyst on the left side, asymptomatic at all. A non exhaustive survey of literature confirmed the iliopsoas synovial bursa is uncommonly pathologic, but a constant natural formation in man. Pathology occurs only in over sixty years old adults. This case seems to be the first pediatric case. The cyst of the psoas bursa is generally revealed by an inguinal swelling; abdominal growing is rare. Imaging with ultrasonography, computed tomography and RMI such as in this case, showed the cyst issued between the coxofemoral joint and the iliac psoas terminal tendon. It can grow in a retroperitoneal way. Pathogenic hypothesis are debated. In this bilateral case, etiology evoke an anatomic anomaly, in relation a joint communication.
Massive bilateral breast involvement in the course of a Burkitt's lymphoma is reported as an exceptional occurrence in a 13 year-old girl, in early puberty. It was an extensive form, stage IV, with massive organ involvement but without CNS involvement. Chemotherapy (LMB 84) induced total cure (18 months disease free survival).
23 cases of primary testicular tumors (TT) were observed in 6 different French divisions of Pediatric Surgery during a 10 year period. This series combined with a survey of the literature serve to stress the rarity of such tumors in boys under the age of 15 years. Yolk sac tumors are the most frequent ones (40%), followed by teratomas (32.5%) which, in children and in this localization, are almost always benign tumors of nongerminal origin, in particular rhabdomyosarcomas and tumors of sexual cords, represent 22% of an TT. They are different from what is observed in adults, in whom the most frequent tumors are seminomas, embryonal carcinomas and teratocarcinomas. Most testicular tumors reveal themselves as unilateral testicular masses. High serum alpha-foeto-protein is specific to yolk sac tumors and its post-operative surveillance is mandatory. Scrotal ultrasonography constitutes the main investigation in view of diagnosis and also serves to detect less evident tumors in case of precocious puberty, gynecomastia. Since lymphatic invasions are unusual in children, surgical exploration of the retro-peritoneal space is no longer considered necessary for the stagging and is replaced nowadays by ultrasonography and CT scan. In case of teratomas and others benign tumors, high inguinal orchiectomy is sufficient; in certain cases (well-delineated and superficial tumor in single-testis), tumorectomy alone is possible. As concerns Yolk sac tumors, the addition of chemotherapy from the age of 2, cures more than 90% of stage I tumors; radiotherapy is necessary when it comes to stage II or III. As for testicular rhabdomyosarcomas, in which prognosis is better than in others areas, the combination of surgery, chemotherapy and perhaps radiotherapy is able to cure from 80 to 90% of them.
Report of two cases of truncular dermoepidermal skin defect in newborn. The defect concerned the lateral thoracoabdominal area, on both sides of the umbilicus, jointed with a fine linear communication, and have the classical butterfly wind-like shape. Recovery was achieved by centripetal spontaneous cicatrization, only managed with protective vitamin dressing, in about 45 days. There was no clinical evidence of other anomaly. In this occasion, an exhaustive review of congenital skin defects is done. This disease is not frequent, 500 cases are published, principally in the scalp area (vertex). Thoracoabdominal localisation (10%) are symmetrical, spontaneously healing without surgery, in spite of a large defect. Skin defect of extremities (25% of cases) have also a good issue, except in case of associated congenital diseases; on the other hand scalp defects are sometimes complicated with sepsis or bleeding. Discussion emphasize the characteristics of skin defects, the possible pathological association (rare in case of thoracoabdominal defect) and pathogenic hypothesis, not yet definite at all.
Report of an observation of a small intestine diverticulum with colic and gastric heterotopy in a seven year old girl. Unrecognized for many years, the lesion was at the origin of a severe digestive hemorrhage for which an urgent operation was necessary. A propos of this new enough case (30 published cases), characteristics of diverticular gastric heterotopy are remembered from diagnostic, nosologic and therapeutic point of view. Their individualization with regard to Meckel's diverticulum and remainders of omphalo-mesenteric canal is emphasized.
A simplified panorama of the different formation phases of the upper respiratory system (larynx, trachea, main bronchi) is presented. Chronologic evolution of organogenesis in embryologic phase and fetal phase is emphasized. Post-natal growing is also described. A classification of malformations of the upper respiratory system is done, based on topographic data. The mechanism of genesis of the malformations remains of hypothetical value.
Within the 1984 Symposium of the French Society of Pediatric Surgery, concerning tracheal and main bronchi malformations surgery, a synthesis is done from the observations of rare aerodigestive fistulae (esophageal atresia, H type tracheoesophageal fistula, esolaryngotracheal clefts excluded). The two types of aerodigestive fistulae reported in the literature are the communications with the esophagus and the biliary tract. 1) In the group of communications with the esophagus, the study concerned: fistulae associated with tracheal agenesia, with bad prognosis; fistulae associated with bronchopulmonary agenesia, with possible esophageal atresia; fistulae associated with bronchopulmonary foregut malformations. 2) The quite tracheobiliary fistulae, setting up the second group of aerodigestive fistulae, are reviewed. This report analyse the etiologic, anatomic, clinic and therapeutic data of every one malformations.
Three cases of asphyxia at the beginning of general anaesthesia for mediastinoscopy or biopsy of adenopathy are described in patients with malignant lymphoma. One of them died in spite of endobronchial intubation, artificial ventilation and steroids. The two others recovered when specific chemotherapy was added to the same symptomatic treatment. The risk of respiratory obstruction seems higher in non-Hodgkin than in Hodgkin lymphomas. This kind of obstruction is not relieved by an antiasthmatic therapy. Pulmonary lymphatic filtration may be hindered in case of mediastinal lymphoma, especially during anaesthetic induction, and pulmonary interstitial congestion may occur impeding gas propagation. Specific chemotherapy according to the histological type of the tumour may relieve the compression and respiratory obstruction in a few hours.
Between 1975 and 1980, 42 pancreatic injuries have been managed, they represented 9.5 per cent of abdominal injuries. Nine patients received penetrating trauma and thirty three patients sustained blunt trauma, the majority of them was a road accident. Associated and concomitant injuries of abdominal organs were present in 81 per cent of cases with the pancreatic trauma. More than 66 per cent have multiple brain, thoraco, abdominal, and bones injuries. Thirty two patients have been treated before the sixth hour. The emergency surgical treatment has been conservative in twenty six patients and a primary resection has been performed in twelve patients, (with eleven partial pancreatectomy and one pancreatoduodenectomy). But four patients died on the operating table because they have extensive injuries to several abdominal organs. Postoperative complications were present in 66 per cent of cases. They obliged the drainage of abscesses, three distal pancreatectomy and one pancreatoduodenectomy. The global mortality is 31 per cent, the secondary mortality is 21.4 per cent. The authors conclude thanks to the study of this series and of literature that the frequency of pancreatic trauma increased, and that its gravity is directly related to the number of other organs damages, missed or delayed diagnostic and to an inappropriate emergency treatment, which let necrosis and infection making their deadly evolution.
The authors emphasize the various possibilities of exploration of chest with the mediastinoscope, in a 11 patients series, aiming and reducing surgical parietal approach in infancy, while preserving the feasibility of the procedure. In the thoracic level: beyond the mediastinal approach by the transcervical pathway (mediastinoscopy), the principal application is the pleural cavity access (pleuroscopy) which was performed in seven 3 to 12 years old children. Pleuroscopy was realised through a small intercostal access permitting biopsy with a good visibility (pulmonary biopsy: 4 cases; lateral mediastinal tumor: 2 cases). A cloisonned pyopneumothorax drainage was performed once easily managed. Mediastinoscopy was used likewise in 3 cases of transcervical thymectomy (myasthenia gravis or thymic hyperplasia), permitting effective visual field to control quality of exeresis. This "surgical endoscopy" procedure offers so food indications in Pediatric Surgery, more especially as not any complication was observed.
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The authors present the report of their experience of 20 injections of the lymphatic system of the stomach during surgery by vital staining dye: 19 times by Pontamine sky blue 6 BX, 1 time by patent blue violet. The results of this study are analysed; the anatomical interest is specified. Nevertheless, this technique presents no surgical interest concerning the stomach, in spite of many authors' opinion.
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The case of a 5 month old female infant with respiratory problems since birth in the form of a recurrent right pneumonia, associated with slight pulmonary arterial hypertension. Persistence of a paramediastinal opacity suggestive of a right upper lobe atelectasis led to bronchography being performed which revealed a bronchus implanted into the right side of the trachea. At operation there were two abnormalities: --an azygos lobe represented by the apical segment of the right upper lobe; --a tracheal bronchus, apical segmental apical, ventilating this territory. Simple disenclavement of the parenchyla and pleuroplasty led to regression of the respiratory disturbances. The special feature of the case lay in the rarity of an azygos lobe ventilated by a tracheal bronchus. The azygos lobe results from an abnormality in the topography of the arch of the azygos vein which draws the parietal pleura with it, forming a mesoazygos. It is not a supernumary lobe. Abnormalities of bronchial implantation are located above all along the right side of the trachea (tracheal bronchi) and correspond in most instances to ectopic positioning of a segmental bronchus of the upper lobe, as in the present case.
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