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Biomedical subjects

N Genton

Publications and source records attributed to N Genton.

At least 19 recordsLinked to original sources
PubMed1998

Long-term followup of renal functional reserve capacity after unilateral nephrectomy in childhood.

PURPOSE: We establish renal function and renal reserve capacity in the long-term followup of unilateral nephrectomy in childhood. MATERIALS AND METHODS: We recalled 37 subjects who underwent unilateral nephrectomy during childhood (age less than 16 years) to determine glomerular filtration rate, renal plasma flow and functional renal reserve capacity after oral protein loading. Interval since nephrectomy was 0.5 to 10 years in 10 cases, 11 to 20 in 13 and more than 20 years in 14, during which regular repeated renal function tests were done at our hospital. None of the patients had hypertension or significant proteinuria and all developed normally into adults. A group of 7 healthy normal subjects with 2 kidneys served as controls. RESULTS: Creatinine clearance increased 34% immediately after surgery from a mean plus or minus standard error value of 78.6 +/- 6 to 105.4 +/- 7.2 ml. per minute per 1.73 m.2, peaked 2 to 6 months postoperatively and then plateaued (approximately 125 ml. per minute per 1.73 m.2). This level of renal function was sustained for more than 20 years. At the present testing glomerular filtration rate and renal plasma flow were not different from those of the controls. Renal reserve capacity was normal (stable) only during the first decade after unilateral nephrectomy (approximately 6% decrease), and it decreased by 50% at 10 to 20 and 66% at 20 to 30 years later. CONCLUSIONS: This long-term followup study demonstrates that a single remnant human kidney continues to function normally for more than 20 years. The prolonged increased workload does not interfere with normal development and maturation. The renal reserve capacity decreased significantly during the years may, however, indicate a vulnerability of the single kidney and raises the possibility of renal functional impairment with much longer followup.

Adolescent↗
PubMed1997

Esophageal replacement in children: evaluation of the one-stage procedure with colic transplants.

After having practiced two-stage esophagoplasties by retrosternal Iso-peristaltic colic transplant since 1966, we introduced the one-stage procedure in 1989, placing the transplant in the posterior mediastinum following a closed-chest esophagectomy. We have performed 121 such esophagoplasties in children until now. To evaluate the possible effects of the different techniques as accurately as possible, we recorded two uniform series of 32 and 41 esocoloplasties carried out under identical conditions by two operators respectively. All of the children, aged 1.2 to 13.9 years (mean age: 4.3 years and 4.8 years, limits 1.2-13.9 years), were operated upon for caustic burns of the esophagus. The general concept of both interventions is the same. Improvements such as optimizing the proximal and the colo-gastric anastomosis and the creation of an anterior anti-reflux hemi-valve were aimed for. The one-stage esophagoplasty has become a shorter procedure (mean 4.9 h) than the two-stage one (mean 5.7 h). The one-stage procedure has no higher rate of per-operative complications than those observed during the two-steps of the staged operation. One-stage esophagoplasty provides better morphological results. The redundancy of the transposed colon, the narrowing effect of the upper cervical passage and of the point of re-entry into the abdominal cavity are avoided. The mediastinal colon is straighter, which allows better emptying by gravity. The improvement of the lower anastomosis decreases the reflux rate in the transplant to 12%. Postoperative care demands a longer stay in the intensive care unit because of pharyngeal and left pulmonary respiratory complications. For these reasons we kept our patients intubated for a period of 2 to 5 days (mean period: 3.4 days). All patients survived the intervention.

Adolescent↗
PubMed1996

Hepatic trauma in children: long-term follow-up.

The purpose of this report is to assess the role of long-term clinical and hepatic ultrasound (US) follow-up in children who sustained blunt liver trauma. Forty-three children with blunt hepatic injury were prospectively studied between 1976 and 1994 in our institution. Four patients died (9%). Fourteen children (52%) were operated upon and 13 (48%) were treated conservatively. Twenty-seven patients were recalled for a long-term echography (US) with a mean time span of 6 years after trauma. The physical examination and the liver tests were normal in all patients. The US aspect of the liver was abnormal in 22% of our cases, showing hypoechogenic areas and anomalies of the biliary tract in four patients (11%). Cholelithiasis secondary to hemobilia was demonstrated in 2 patients. Cholecystectomy was performed in one patient because of posttraumatic strictures of the biliary tract. All patients with US anomalies of the liver and biliary tract were clinically asymptomatic and had normal liver tests. We recommend a follow-up US in children having sustained blunt hepatic injury about 6 months after the trauma. If no cholelithiasis or alteration of the biliary tract is present, no other follow-up procedure seems necessary.

Abdominal Injuries↗
PubMed1991

Infected teratoma of lower posterior mediastinum in a six-year-old boy.

A six-year old boy presented with prolonged unexplained fever caused by an infected teratoma of the lower posterior mediastinum. Modern imaging, combining ultrasonography with computed tomography, enabled the correct diagnosis of topography, extension and nature of this rare lesion to be made and explained the clinical features. Follow-up CT showed regression of the abscess after antibiotics thus permitting elective surgery.

Child↗
PubMed1991

[Dorso-lumbar spinal compression fractures in the child. Follow-up at the termination of development].

Between 1970 and 1985, we count 32 children with compressive fractures of the vertebral column. None of them undergo a surgical procedure. We examine 24 of these 32 children with a mean delay of 10.5 years. Most of the fractures were referring to sporting activities and home games. The main localization was dorsal (T6) and upper-lumbar (12). The mean reduced height of the ventral portion of the vertebra was 27%. Some 10 years later, two third of the patients have some persistent pains and half of them daily. Most of the aches concerned children of more than 12 years when trauma occurred and those who developed a scoliosis during evolution. Wonder the global static of the rachis is little concerned in most of these children. Therefore compressive vertebral fracture of the youngster should be reduced and fixed by a corset. But the immobilization shouldn't be longer than 2 months, accompanied by appropriate gymnastics and followed by a quick renewal of the sporting activities.

Adolescent↗
PubMed1990

[Possibilities for assessing unilateral functional disorders of the upper urinary tract in infants with urethral valves].

Upper urinary tract function was evaluated in 15 infants in whom urethral valves were diagnosed. One baby died at 16 days of age and was not completely investigated. In 4, the valves did not have untoward effect on the bladder and the upper urinary tract. In 10 others, function was evaluated using the Hodson index, creatinine, PAH, inuline clearance and renal I123-Hippuran scintigraphy with measurement of the accumulation indices. The various examination procedures were of value in providing precise evaluation of the renal performances at diagnosis as well as in prognosis and follow-up of the function of each kidney.

Creatinine↗
PubMed1990

[Characteristics of thoracic injuries in children].

Thoracic trauma is uncommon in children. It should not be managed any more as adult's trauma. We present our experience with 85 children form 1 to 16 years of age, presenting severe thoracic trauma treated in Lausanne, Switzerland, between 1976 and 1990. The specific features of diagnosis, treatment and outcome are presented. Most of them were involved in traffic accidents (62%), 55% had multisystemic injuries. The mortality rate was not a function of the Injury Seventy Score as in adults, but was only related to the Glasgow Score. Only 3 patients (3.5%) had hemodynamic instability on admission in relation with their thoracic injury. Patients with intrathoracic lesions showed dyspnoea (65%), cyanosis (25%), or clinical suspicion of a pleural effusion or a pneumothorax (47%). However 12 children had an asymptomatic severe thoracic injury. In 53 patients (62%) the auscultation was found abnormal either with absent or diminished breath sounds or other pathological findings. 10 out of 26 cases of pneumothorax could be suspected by percussion dullness. Chest X-rays showed a lesion in 76% of cases. Only 30% of the pneumothorax were associated with visible rib fractures. 10 children suffered from 4 to 12 fractures of the ribs (mean 6.6). None of these patients presented a flail chest as in adults, even when multiple rib fractures existed. 31 thoracic drainages were performed, during a mean period of 3.3 days. 30 patients were intubated and ventilated, 22 of these due to a neurosurgical condition. All patients had physiotherapy starting on day 2, under analgesia if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Follow-up of renal morphology and growth of 141 children operated for vesicoureteral reflux: a retrospective computerized study.

This study relates the postoperative evolution after ureterovesical reimplantation for vesicoureteral reflux (VUR) in 141 children who were ten years old or younger at the time of surgery. Renal growth and morphology were evaluated 2 and 5 years after surgery. We estimated renal growth by measuring the ratio of the bipolar parenchymal thickness to the total length of the kidney. We noticed that whatever the degree of reflux might have been, most of the kidneys partially or totally compensated for their growth failure. This growth resumption required many years to be completed. Surgical correction of VUR had favorable consequences on the radiologic aspect of pyelonephritic scars only on some of the kidneys: in these cases, the child's age appeared to be the only factor that had a statistical importance affecting the postoperative evolution of pyelonephritic scarring: the younger the children were at the time of surgery, the better the results obtained.

Age Factors↗
PubMed1985

Renal growth retardation in children: sign suggestive of vesicoureteral reflux?

Of 141 children undergoing surgery for vesicoureteral reflux detected by voiding cystourethrography, preoperative excretory urography demonstrated signs suggestive of vesicoureteral reflux in 154 (67.5%) of 228 refluxing ureter. In 48 refluxing ureters (21%) renal growth retardation was the only sign; the latter was appreciated by applying the index described by Hodson, that is, the ratio of bipolar parenchymal thickness to total renal length. It was concluded that it is important to systematically calculate this simple index from every child's excretory urogram.

Child↗
PubMed1984

[Computerized retrospective study of 141 children operated on for vesico-ureteral reflux].

Follow-up study of 141 cases of vesico-ureteric reflux (less than 10 years old) treated by Cohen's method. Computerized study, 5 years after treatment, with analysis of the influence of different parameters (type of VUR, age, sex, urinary infection or not, space of time between diagnosis and treatment) on the renal parenchymal radiographic measurements ( Hodson 's method). The youngest is the child when he is treated, the best is the functional result.

Age Factors↗
PubMed1984

[Familial study of vesico-ureteral reflux].

We report our results of a retrospective study of vesico-ureteral reflux based on the families of 66 index patients. The recurrence risk for sibs is 9,3%. With a prospective approach (ultrasound and uroradiology), the proportion of affected sibs is 26,6%. Our results are discussed with reference to the data of the literature.

Adolescent↗
PubMed1983

[Therapeutic alternative in the treatment of portal hypertension in children. Vossschulte's esophageal dissection-ligation modified by Rehbein].

The dissection and Vossschulte ligature of the esophagus, modified by Rehbein, is precisely directed on the oesophageal varices, responsible for the most dangerous symptom of portal hypertension in childhood. This technic was employed six times between 1974 and 1977 in the prehepatic portacaval obstructions. The postoperative follow-up actually carries over a period from 5 to 8 years without any hemorrhage recurrency. The long term clinic, radiology, endoscopy and manometric analysis, allows to precise even better the advantages and inconveniences of this palliative method which was found to be curative in most cases.

Age Factors↗