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Biomedical subjects

J L Alain

Publications and source records attributed to J L Alain.

At least 19 recordsLinked to original sources

Anterior urethral valves and diverticula.

Obstructive lesions of the anterior urethra (valves, diverticula) are rare and can be difficult to diagnose. One recent case led us to review existing international reports; there are case histories for 260 patients over a 20-year period. The anatomical interpretation of these lesions is far from being unequivocal but many authors clearly distinguish between valves and diverticula, the basic difference being in the contiguity between the anomaly and the corpus spongiosum. Where the clinical presentation depends on age, the diagnosis depends essentially on voiding cysto-urethrography, which must image the whole urethra. Generally, the treatment for valves is simple, consisting of endoscopic resection. For diverticula it is not always necessary or desirable to remove the diverticulum; if there is a well-formed distal obstructing lip, removing it may be enough to cure the obstruction.

Child↗

Extramucosal pyloromyotomy by laparoscopy.

Since 1990, we have performed extramucosal pyloromyotomies by laparoscopy in 70 infants presenting with congenital hypertrophic pyloric stenosis. Ever since the first cases, the technique and the instruments have been adapted. The surgical technique and the precautionary measures are here explained again. This technique is beneficial for infants with a better postoperative course and avoidance of any skin scar.

Anesthesia↗

Laparoscopic fundoplication in children: our first 30 cases.

We report our experience performing 30 laparoscopic fundoplications in children (24 using the Nissen Rossetti technique and 6 using the Toupet fundoplication). Special instruments adapted to the young children are used: first, a miniature parietal suspender to decrease the intra-abdominal pressure and to provide more space; second, a retractable losenge-shaped liver retractor; and third, a Babcock forceps articulated at 60 degrees. In the Nissen Rossetti procedure, the wrap is fixed to the anterior face of the esophagus, the anterior wall of the fundus, and the upper right crus. In the Toupet procedure, the wrap is a retroesophageal partial fundoplication: the first suture attaches the wrap to the right crus, the second attaches the wrap to the esophagus, and the third recreates the oesogastric angle. We do not use gastrostomy. Patients have no gastric tube after the intervention. Thirty children from 2 to 15 years have undergone laparoscopic fundoplications. One conversion to open procedure was necessary. An average follow-up of 12 months was observed for 18 children with 3 complications: dysphagia for a psychotic girl, intrathoracic valve without any trouble, and recurrent episodes of digestive bleedings during 6 months. Laparoscopic fundoplication is a feasible extension of minimally invasive surgery in the hands of experienced surgeons; however limitations must be recognized to do a safe operation.

Adolescent↗

[Priapism. Apropos of a case in a 10-year old child].

We report a case of post-trauma priapism observed in a 10-year old boy. Arterial blood flow was high with normal venous backflow, an exceptional situation in the child. Locoregional caudal anaesthesia was successful.

Accidents, Traffic↗

[Pyloric stenosis in infants. Contribution of ultrasonography and video-surgery].

Hypertrophic pyloric stenosis is the commonest condition requiring abdominal surgery in infancy. The Fredet-Ramstedt pyloromyotomy gives a very rare morbidity rate as shown by a review of 300 personal cases. The diagnostic value of sonography is gaining significance over contrast roentgenography, a pyloric diameter of more than 14 mm and a muscular thickness of more than 4 mm being required for the diagnosis. Over the last 18 months, we performed extramucosal pyloromyotomies using laparoscopy in 19 infants. This new surgical technique using laparoscopy with precautionary measures for the pneumoperitoneum appears to be very promising and should become a widespread technique in the future.

Gastroesophageal Reflux↗

Extramucosal pyloromyotomy by laparoscopy.

We performed extramucosal pyloromyotomies by laparoscopy in 20 infants presenting with congenital hypertrophic pyloric stenosis. The surgical technique and precautionary measures, the outcome, and the advantages of this original approach are discussed. In the near future, laparoscopic pyloromyotomy is likely to become a widely used technique.

Humans↗

Extramucosal pylorotomy by laparoscopy.

Extramucosal pylorotomies were performed by laparoscopy in infants with congenital hypertrophic pyloric stenosis. The surgical technique and precautionary measures taken for the pneumoperitoneum are described in these initial 10 cases. The advantages of this original technique are discussed.

Female↗

[Pyloric stenosis in infants. New surgical approaches].

Pyloromyotomy as described by Fredet and Ramstedt is still widely used for the treatment of infantile hypertrophic pyloric stenosis, with a very low mortality rate. Three hundred case-records of patients treated using this technique were reviewed. Pyloromyotomy can benefit from the use of videosurgical methods. The creation of a pneumoperitoneum requires special precautions in infants. Nineteen infants were treated using laparoscopic Fredet-Ramstedt pyloromyotomy, a technique which can be expected to gain widespread acceptance during the next few years.

Female↗

[Contribution of continuous peridural analgesia to neo-natal surgery].

UNLABELLED: Continuous epidural analgesia is an common technique in neo-natal surgery. It will be possible with a fitting material. Principal indications are: omphalocele, gastroschisis, oesophagol atresia an diagphragmatic hernia. TECHNIQUE: our protocol has been approved by the Regional Ethical Committee and informed written consent has been obtained from parents. General anaesthesia was induced and children were placed in lateral position. After skin preparation, the interspace L 3-L 4 has been punctured to identify the epidural space by loss of resistance. An epidural catheter (19 to 27 G) has been placed. 0.5 ml.kg-1 of 0.25% bupivacaine have been immediately injected, followed by a continuous injection of 0.3 ml.kg-1h-1 of the same bupivacaine. Epidural has been kept for four to five days. ADVANTAGES: very good analgesia; abdominal and vascular pressures decreased; to wean from respirator very quickly. No accident was founded.

Analgesia, Epidural↗

[Extra-mucosa pylorotomy by laparoscopy].

An extramucosal pylorotomy was performed in infants with hypertrophic pyloric stenosis made possible by laparoscopic progress. After performing six cases by laparoscopy, the authors describe what precautionary measures must be taken for the pneumoperitoneum, the instruments utilized, and the advantages of this technique. It appears very likely that laparoscopic pyloromyotomies will become a widespread practice in the future.

Humans↗

[An unusual germ causing a limp: Eikenella corrodens].

A case of retroperitoneal appendicular abscess due to Eikenella corrodens is reported. This facultative anaerobe is normally found on the respiratory and intestinal mucosa and may be responsible for opportunistic infections. Culture is difficult and growth is slow. There have been few previous reports of the localization reported herein. A limp was the first manifestation of the infection. The differential diagnosis and pathophysiology of this symptom are discussed.

Abscess↗

[Single preoperative intravenous dose of metronidazole for appendectomy in children].

One hundred children were prophylactically treated with 15 mg/kg-1 of metronidazole immediately before appendicectomy and retrospectively compared with 100 other patients without any antibioprophylaxis. No statistically significant difference was found between the two groups as regards age, weight, sex and macroscopic appearance of the appendix. The overall incidence of complications was 1% in the antibioprophylactic group and 9% in the control group. Furthermore, a single pre-operative intravenous dose of metronidazole was as effective as conventional antibioprophylaxis.

Appendectomy↗

[Colonic atresia. Apropos of 2 type I cases treated by surgical enlargement].

Colonic atresia it's a rare congenital pathology. Urgent intestinal derivation it's a safety surgical procedure that could defer definitive surgical intervention with all security. In type I Colonic Atresia, plastic enlargement with diaphragm's resection can be an alternative surgical procedure. Authors report the treatment and the evolution in two newborns that underwent this intervention with two and seven years follow-up.

Cecum↗