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Jean-Martin Laberge

Publications and source records attributed to Jean-Martin Laberge.

22 records · Page 2Linked to original sources
PubMed2002

The changing face of surgical indications for necrotizing enterocolitis.

PURPOSE: The aim of this study was to compare the proportion of operations for acute necrotizing enterocolitis (NEC) and post NEC strictures. METHODS: The authors reviewed 195 charts of children referred to our institution for NEC or post-NEC strictures between 1990 and 1999. Seventy-one children were classified as Bell stage I and were excluded. The remaining 124 patients were classified as either Bell stage II or III and formed the basis of our study. These patients were subdivided into 2 groups: (1) group I (n = 69) comprised patients treated from 1990 until 1994 and (2) group II (n = 55) from 1995 until 1999. Statistical analysis consisted of X(2) and Student's t tests. Significance occurred when P less-than-or-equal 0.05. RESULTS: Both groups were similar with regard to sex, obstetrical history, indomethacin use, umbilical artery catheter use, and enteral feeding. The total operative rate for all patients with either acute NEC or post NEC strictures increased over time from 46% (32 of 69) in group I to 69% (38 of 55) in group II (P <.01). Specifically, post-NEC stricture was the initial operation in 16% (5 of 32) of group I patients versus 37% (14 of 38) of group II patients (P <.05). Subdividing each group by method of treatment of their NEC showed that medically treated patients had an increased incidence of stricture over time (group I, 15% v. group II, 48%; P <.01). Surgically treated children maintained a similar rate of stricture (group I, 36% v. group II, 33%). The mortality rate was comparable in both groups. CONCLUSIONS: At our institution, the total operative rate for necrotizing enterocolitis has increased over the last 10 years. This is because of 2 factors: (1) an increase in the percentage of stage III patients and (2) an increase in referrals for post--necrotizing enterocolitis strictures. No specific criteria could be identified to predict which patients were at risk for post--necrotizing enterocolitis strictures after medical treatment.

Acute Disease↗
PubMed2002

Ten years of experience with third and fourth branchial remnants.

BACKGROUND: Third and fourth branchial remnants may result in cysts and abscesses that are in close contact with the thyroid gland. These anomalies are rare and often present diagnostic and therapeutic challenges. METHODS: The charts of patients diagnosed with a branchial anomaly between July 1991 and July 2001 at the Montreal Children's Hospital were reviewed. All cases of third and fourth branchial remnants or pyriform sinus fistulae were identified. Clinical presentation, imaging, treatment, and outcome were recorded. RESULTS: Eight patients with a third or fourth branchial anomaly were identified and ranged in age from birth to 13 years. All anomalies were left sided. Presenting symptoms consisted of an asymptomatic cervical mass (n = 1), an infected mass (n = 5), neonatal respiratory distress (n = 1), and 1 incidental cyst found on magnetic resonance imaging. Ultrasonography was useful in suggesting the diagnosis in 7 cases. Barium swallow was performed in 3 patients with 2 positive results. Pharyngoscopy results showed the internal opening in 2 of 7 patients. A portion of the thyroid gland was resected in 6 patients. One patient has not yet undergone a definitive procedure. There was 1 recurrence in a patient whose pathology did not confirm a branchial remnant. CONCLUSIONS: The diagnosis and management of pyriform sinus anomalies are challenging. Ultrasound scan, computed tomography scan, barium swallow, and pharyngoscopy are all useful. The portion of thyroid involved in the fistula must be excised en bloc with the inflammatory mass, and the tract should be ligated at the level of the pharynx to minimize recurrence.

Adolescent↗