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P Ravasse

Publications and source records attributed to P Ravasse.

At least 19 recordsLinked to original sources
PubMed2006

[Acquired non hypertrophic pyloric stenosis in children].

UNLABELLED: Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated. MATERIAL AND METHOD: Retrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984-2002. RESULTS: Six children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed. DISCUSSION: We discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective. CONCLUSION: The diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative.

Adolescent↗
PubMed2006

[Is there any interest to perform ultrasonography in boys with undescended testis?].

OBJECTIVE: To evaluate the accuracy of ultrasonographic examination in boys with an undescended testis. MATERIAL AND METHODS: All patients who were referred to the paediatric surgeon after detection of an undescended testis were evaluated prospectively between November 2001 and November 2004. Among these 377 patients, 87 were referred with an ultrasonogram previously prescribed by the referring primary physician. The results of the ultrasonogram were compared to the results of the clinical examination of the paediatric surgeon and, in cases of no palpable testis, to the surgical findings. RESULTS: Ultrasonography did not detect the retractile testes. Ultrasonography detected 67% of the palpable undescended testes. In cases of no palpable testis, the ultrasonographic examination missed the abdominal testes and sometimes other structures were falsely interpreted as a testis. CONCLUSION: Sonography has no place in the diagnosis of undescended testis.

Child↗
PubMed2002

Retroperineoscopic excision of a single blind ectopic ureter in childhood.

Retroperitoneoscopy is gradually gaining in importance in pediatric urology, especially for renal and adrenal diseases. Direct retroperitoneal pelvic access seems interesting in children when low urinary tract malformations are concerned. We report a case of a 12-year-old boy with a blind ectopic ureter managed by pelvic retroperitoneoscopy. We describe the surgical technique, focusing on the difficulty in the pediatric population. Nevertheless, retroperitoneoscopy is an excellent alternate way to manage such ureteral malformations.

Child↗
PubMed2002

[Congenital rectovestibular fistula. An unusual diagnosis that should not be ignored].

UNLABELLED: Rectovestibular fistula without anorectal malformation is a rare anomaly. OBSERVATION: A six-week-old baby was hospitalized for a greater labium abscess. Stools leakage was secondary noted in the vagina and in abscess area. Clinical examination under anesthesia concluded to a congenital rectovestibular fistula with secondary drainage in the greater labium. Surgical treatment without colostomy led to recovery. COMMENTS: Congenital recto-vestibular fistula is a difficult diagnosis. It should be evoked when vaginal fecal leakage occurs in the absence of anorectal malformation or perineal injury. Fistula location is often confirmed by clinical examination under anesthesia. Treatment is surgical and allowed recovery without any functional damage.

Abscess↗
PubMed2002

[A rare retroperitoneal tumor: abdomino-scrotal hydrocele. Two case reports].

UNLABELLED: Abdominoscrotal hydrocele is a very rare condition, different from the majority of cases of hydroceles related to the persistence of the processus vaginalis. The anomaly consists of a large scrotal hydrocele which communicates in an hour-glass fashion with a large abdominal component through the inguinal canal. We report two cases observed in infants. CASE REPORTS: 1. A nine-month-old infant was referred because of a large bilateral hydrocele. On clinical examination on the right side in the lower quadrant of the abdomen was found a mass which communicated with the right scrotal pouch. Diagnosis of abdominoscrotal hydrocele was established by ultrasonography. During the surgical exploration the right testis was found to be dysmorphic, fusiform and ectopic in the inguinal canal. Surgical treatment comprised hydrocelectomy and right orchidectomy. 2. A six-month-old infant presented with a large right hydrocele in communication with an abdominal pouch located in the right lower quadrant, in association with a lymphoedema of the right limb. Diagnosis of abdominoscrotal hydrocele was confirmed by ultrasonography. During the surgical procedure the pouch was opened and everted. The testis was dysmorphic as in the first case, in normal scrotal position and was preserved. COMMENTS: Abdominoscrotal hydrocele is a rare condition reported in adult population and also in the infant. The exact mechanism by which it develops is unknown. The diagnosis can be suspected on clinical examination if an abdominal mass in a lower quadrant is palpable just above the inguinoscrotal pouch. The diagnosis relies on ultrasonography. Complications sometimes occur due to the pressure on adjacent structures (ureters, iliac vessels). Testicular dysmorphism has been reported in some patients. In any case, as spontaneous resolution of abdominoscrotal hydrocele has never been reported, surgical treatment is indicated.

Abdomen↗
PubMed2001

[Laparoscopic excision of an unusual appendiceal duplication].

Duplications of the alimentary tract are rare congenital anomalies and vermiform appendix duplication is exceptional. The aim of this study was to report a case of cystic appendiceal duplication in a 4 years old child, unusual in its anatomic type, its clinical presentation and its way of management.

Appendectomy↗
PubMed2001

Prenatal sonographic diagnosis of a twinning epigastric heteropagus.

Epigastric heteropagus is a rare type of conjoined twinning which results from an ischemic atrophy of one fetus at an early stage of gestation. We present what we believe to be the first case diagnosed antenatally at 22 weeks' gestation. The pelvis and lower limbs of the ischemic fetus (the parasite) were attached to the epigastrium of the well-developed fetus (the autosite), which had a small omphalocele. Antenatal sonography provided an accurate diagnosis, enabling unnecessary abortion to be avoided.

Abnormalities, Multiple↗
PubMed2001

[A rare case of epigastric heteropagus twinning].

Epigastric heteropagus is a very rare form of conjoined twins. It results from an ischemic atrophy of the body structure of the monozygotic conjoined twins at an early gestational age. Diagnosis is made by prenatal echography which must look for congenital heart disease associated in 28% of epigastric heteropagus. Cesarean section is indicated to prevent for mechanical dystocia. The autosite component of epigastric heteropagus can successfully be treated with early minor surgery. Autosite twin survival is good. Discussion with the family is important to avoid needless terminations. We report a rare prenatal diagnosis of epigastric parasitic twinning in which the parasite had pelvis with lower limbs. At birth, the autosite had omphalocele containing only bowel loops from the parasite.

Abnormalities, Multiple↗
PubMed2000

[Late revealing of congenital diaphragmatic hernia: diagnostic difficulties].

Two patients, aged four and six months, with congenital diaphragmatic hernias, and who presented outside of the neonatal period, are reported. Clinical presentation was a progressive respiratory failure, and radiographic findings showed a consolidation of the left lung, associated with a pneumothorax in one and an ascites in the other. One had previous normal chest X-rays. All cases with herniated bowel showed connecting bowel segments passing through the diaphragmatic defect. All were repaired via an abdominal approach. Delay in presentation of congenital diaphragmatic hernias is not uncommon. Long-term prognosis is favourable and postoperative morbidity is minimal, despite late presentation and undesirable time delay between first sign and surgery.

Age Factors↗
PubMed2000

[Mathieu's urethroplasty in surgery for hypospadia postoperative complications].

UNLABELLED: The aim of the study was to report the results of meatal based flap urethroplasty called Mathieu urethroplasty, in failed preliminary surgery for hypospadias. PATIENTS AND METHODS: Fourteen boys aged three to 14 years underwent surgery using a meatal-based flap urethroplasty for the correction of prior hypospadia repair complications. The secondary procedure was performed for glandular or coronal urethrocutaneous fistula in ten cases, completely failed urethroplasty in three cases, and for severe meatal retraction in one case. The surgical technique was the same as that used for the primary Mathieu procedures. RESULTS: Only one meatal retraction occurred; the other 13 cases had satisfactory procedure of hypospadias repair failures. Despite the scar skin used for secondary meatal based flap, good results can be achieved specially in two favorite indications: juxta coronal urethrocutaneous fistula and meatal retraction.

Adolescent↗
PubMed2000

[Anterior hypospadias: Duplay or Mathieu?].

OBJECTIVE: The Mathieu urethroplasty is considered to be the reference operation for the treatment of anterior hypospadias. The vertical incision of the urethral groove, described by Snodgrass, has extended the field of indications for urethroplasty by tubularisation of the urethral plate (Duplay principle), by allowing it to be applied in almost every case of anterior hypospadias, The objective of this study was to compare results of Mathieu urethroplasty and Duplay urethroplasty for the treatment of anterior hypospadias. MATERIALS AND METHODS: 50 Mathieu urethroplasties and 50 Duplay urethroplasties were performed by the same operator over the same period (1996 to 1999). All urethral sutures were performed by inverted running sutures. Urine drainage was ensured by Foley catheter for 48 hours. For Duplay operations, the urethral plate was incised longitudinally in 17 out of 50 cases. Foreskin reconstruction was performed 41 out of 100 cases. RESULTS: The follow-up is 6 months to 4 years. Three children (6%) in each group had to be reoperated because of urethral complications (fistula, meatal stricture, urethroplasty dehiscence). CONCLUSION: Our results confirm those published in the literature. Duplay and Mathieu urethroplasties provide equivalent results in terms of the urethra. The appearance of the urinary meatus appears to be more satisfactory after Duplay urethroplasty. The Snodgrass modification allows tubularisation of the urethral plate to be performed even when it is narrow. Cover of the urethroplasty by a foreskin subcutaneous connective tissue pedicled flap reduces the fistula rate of Duplay urethroplasty to the same value as that observed after Mathieu urethroplasty, although it classically used to be higher.

Child↗
PubMed1999

Does the endoscopic incision of ureteroceles reduce the indications for partial nephrectomy?

OBJECTIVE: To determine whether the endoscopic incision of ureteroceles reduces the indications for partial nephrectomy. PATIENTS AND METHODS: Between 1987 and 1996, endoscopic incision was used as the first-line treatment of 18 children (13 boys, five girls, aged 8 days to 6 months) with a duplex-system ureterocele diagnosed antenatally (15) or in the first weeks of life during the course of a urinary infection (three). Of the 19 ureteroceles (one bilateral), four were intravesical and 15 ectopic, according to the American Academy of Paediatrics classification. Vesico-ureteric reflux into the inferior pole of the kidney was present in 10 children, seven of whom had an ectopic ureterocele. A functioning upper pole was detected by intravenous pyelography (IVP) in half the intravesical and in a third of the ectopic ureteroceles. RESULTS: Endoscopic incision resulted in decompression and reduction of dilatation in 16 cases; three with inferior pole reflux resolved on control cystography, whilst in seven with an ectopic ureterocele, reflux into the upper urinary tract was induced by endoscopic incision. In three children with an ectopic ureterocele, renal function had improved at 3 months, as assessed by IVP. Endoscopic incision was the only treatment for half the intravesical and six of 15 ectopic ureteroceles. Overall, nephrectomy was required in four of 18 patients (three partial nephrectomies for persistent dilatation and one total nephrectomy). Five nonfunctioning, undilated upper poles with no reflux were left in place. Nine vesico-ureteric reimplantations for persistent or induced reflux were carried out using the Cohen technique. CONCLUSION: Endoscopic incision can allow the deferral of nephrectomy, facilitate lower urinary tract reconstruction and reduce the indications for partial nephrectomy, if it is accepted that a nonfunctioning, undilated renal pole with no reflux can safely be left in place.

Electrocoagulation↗
PubMed1998

The value of endoscopic treatment for ureteroceles during the neonatal period.

PURPOSE: We report a series of 35 neonates presenting with ureterocele diagnosed during the antenatal period or during the first weeks of life. The first line treatment was an endoscopic incision. MATERIALS AND METHODS: Immediate postnatal evaluations detected 37 ureteroceles (bilateral in 2 cases), including 16 of the intravesical type and 21 that were ectopic. Endoscopic incision permitted decompression of the majority of ureteroceles and improvement in renal function in most cases. Secondary low grade vesicoureteral reflux appeared in 9 neonates (ectopic in 8 cases) and had already been present in 14 patients. RESULTS: Endoscopic treatment alone proved effective in 14 of the intravesical ureteroceles, while the other 2 cases requiring upper pole nephrectomy (1) and ureterovesical reimplantation using the Cohen technique (1). In contrast, among patients with the ectopic form additional surgery was necessary in 18 cases. Treatment comprised resection of the ureterocele with bladder reconstruction and ureteral reimplantation without remodeling according to the Cohen technique in 15 cases, total ureteronephrectomy in 1 and pole nephrectomy in 2. CONCLUSIONS: We suggest that early endoscopic incision be used for first line treatment of ureteroceles. The aim of this procedure is to ensure better urine drainage, preserve function of the parenchyma and reduce the risk of severe infection in the neonate. The principal complication remains secondary vesicoureteral reflux onset, which can be controlled well by antibiotic prophylaxis but requires regular radiological monitoring.

Endoscopy↗
PubMed1996

Volvulus of the sigmoid colon as a complication of segmental dilatation of the colon. Report of 2 cases.

Sigmoid volvulus is an unusual cause of intestinal obstruction in children. We report two cases of sigmoid volvulus as a complication of segmental dilatation of the colon occurring in two girls (5 years old and 9 years old) previously treated for chronic constipation. In both cases the constipation had been recognised since the neonatal period mimicking a Hirschsprung's disease, a diagnosis which has been excluded after rectal biopsy. The delayed diagnosis of segmental dilatation of the sigmoid colon followed the volvulus. Segmental colonic resection resulted in both cases in the cure of the constipation.

Child↗
PubMed1996

[Value of endoscopic incisions in the treatment of ureteroceles in children].

Endoscopic incision is a simple method to provide decompression of the urinary tract above ureteroceles. This technique has been used in most cases of ureterocele seen since 1987. In 6 cases of ureterocele in a single system good results were achieved in all cases. In 13 cases of ureterocele in a duplex system, incision was the only procedure in 5 patients. Seven patients required further surgery : upper pole partial nephrectomy when dilatation persisted, ureteral reimplantation and ureterocele excision in cases of upper pole reflux, secondary to the endoscopic incision, or in cases of persistent reflux in the lower pole ureter. Endoscopic incision is a safe treatment in cases of intravesical ureterocele (single system or duplex system) but in the cases of ectopic ureteroceles, it generally provides only temporary benefit. In these cases, it facilitates delayed lower urinary tract surgery.

Age Factors↗